Introduction
Severe periodontitis is a highly prevalent chronic inflammatory disease and a major global health burden. It is associated with dysbiotic plaque biofilms and progressive destruction of the tooth-supporting tissues, leading to periodontal pocketing, gingival bleeding, alveolar bone loss, and clinical attachment loss.
Orthodontic tooth movement relies on a controlled, sterile inflammatory response generated by mechanical force. This response stimulates bone remodelling, with osteoclastic bone resorption occurring at compression sites and osteoblastic bone formation occurring at tension sites.
Evidence on orthodontic tooth movement in clients with periodontitis remains limited. Orthodontic appliances can make plaque biofilm control more difficult and may promote plaque biofilm accumulation at the gingival margin and microbial dysbiosis. However, current evidence suggests that orthodontic therapy can be performed safely when periodontitis has been successfully treated and is closely monitored.
Objectives
This paper reviews how orthodontic therapy can be planned and delivered safely for clients with periodontitis. It focuses on diagnosis, treatment sequencing, periodontal risk control, and maintenance strategies for adolescents and adults, whose periodontal risk profiles and behavioural needs differ before and during orthodontic care.
By separating adolescents and adults into distinct clinical groups, the paper clarifies how risk factors, diagnostic considerations, and periodontal management strategies should be adapted throughout orthodontic therapy.
Conclusion
Orthodontic therapy can produce stable outcomes in clients with successfully treated periodontal disease when care is planned through a systematic interdisciplinary approach. Success depends on comprehensive diagnosis, individualized risk assessment, coordinated orthodontic and periodontal planning, and initiating tooth movement only when the dentition is periodontally healthy.
Throughout active treatment, close periodontal monitoring and timely intervention are essential to prevent deterioration, preserve periodontal stability, and minimize side effects. With structured maintenance and collaboration between periodontology and orthodontics, orthodontic therapy can support functional, stable, and health-focused outcomes for clients with periodontal disease.
