Interdisciplinary therapy for severe periodontitis with Angle Class II Division 1 malocclusion : A case report with 7-year follow-up

Background: Previous studies have suggested that occlusal discrepancy is a risk factor contributing to periodontal disease. 1-3 Occlusal discrepancy could increase the risk of infrabony defects. This is a case of a patient with severe periodontitis who exhibited many infrabony defects in the molar region due to malocclusion-induced trauma. Here, we report the 7-year prognosis of the patient after periodontal regenerative and comprehensive orthodontic therapies for functional recovery with implant prosthodontics.
Case Description: A 54-year-old female presented with the chief complaint of masticatory disturbance. In the molar region, significant tooth mobility, deep periodontal pockets, and infrabony defects were observed. She had excessive overjet, resulting in collapse of anterior guidance. Malocclusion was considered to be an exacerbating factor of the infrabony defects. After initial periodontal therapy, we performed periodontal regenerative therapy in the mandibular molar regions. We carefully placed implants in a position in the maxillary molar region that would ensure an appropriate anterior dental relationship after orthodontic treatment. Comprehensive orthodontic treatment was subsequently performed using implants as anchoring units. Then, definitive surgery was performed on the mandibular molars before placing the final prosthesis. A favorable periodontal condition and a stable occlusion have been maintained for the 7-year post-treatment period.
Practical Implications: Comprehensive and interdisciplinary treatment enables stable occlusion and establishment of periodontal tissue and peri-implant tissues with high cleansability, even in patients with severe periodontitis and malocclusion. In the present case, a favorable long-term treatment outcome can be expected.

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