Its presence may cause malposition of adjacent teeth or prevent their eruption. Year introduced: Subheadings: anatomy and histology chemically induced . Malposition of teeth refers to improper positioning of teeth in the alveolar process of the maxilla or the mandible, with respect to other teeth as well as the overall. aAssistant Professor, Harvard School of Dental Medicine, Developmental Biology (Orthodontics), Boston, Mass. bAssociate Professor, Harvard School of Dental.

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Association between malpositioned teeth and periodontal disease. To identify malpositioned teeth in patients referred to periodontal treatment in the Brazilian Association of Dentistry, Pernambuco Division and evaluate the association of these irregularities with periodontal health. The sample comprised 90 individuals aged 15 to 69 years. First, each participant was examined to identify the types of abnormal tooth positions by means of visual inspection.

After that, their periodontal health was assessed according to the following clinical parameters: Gingival bleeding on probing, periodontal attachment loss, and probing depth. In bivariate analysis, a chi-square test was used to calculate significance of the associations.

Several types of changes in tooth position were detected in the participants, and the most significant were: All participants had periodontal changes associated dengal these abnormalities: The need of multidisciplinary treatment was clear in all the cases. Malpositioned teeth negatively affected the health of periodontal tissues, which draws attention to the importance of a multidisciplinary approach that includes, primarily, periodontal and orthodontic care to improve the oral health of patients.

The diagnostic combination of periodontics and orthodontics should be a usual practice in dental clinics, dengal among specialists. Early diagnoses of any type of abnormal tooth position provide information to direct treatment and, therefore, prevent periodontal diseases. Orthodontic treatments, as part of periodontal rehabilitation programs, may bring benefits, such as the improvement of access for dental denta, reestablishment of occlusal balance, and even adequate lip sealing.

Orthodontics acts in the tooth repositioning and presents a close relationship with the periodontal tissues, both because its execution manner as for the results achieved, reducing the possibility of tooth loss and gingival infections caused by tooth malpositioning. Of the several pathologies that affect the oral cavity, malocclusion is the third most important problem in the world population. Abnormal tooth positions may already be present in the deciduous ddental.

Therefore, dental care professionals, such as pediatric dentists and orthodontists, should act preventively to ensure correct tooth positioning detal to avoid or reduce malocclusion that may perpetuate in the mixed and permanent dentitions. Malocclusion alone does not result in periodontal disease. Results showed that most individuals had deficient oral hygiene and consequent accumulation of bacterial plaque, which may cause, in some cases, gingival inflammation, the most common periodontal problem.

However, other individuals may malposicionn no periodontal changes Fig 2. Those dentla also revealed dengal importance of oral hygiene instructions and referral to orthodontic treatment as dentql measures.

When the periodontium has already been affected, its response is different and, in addition to the physiological response to the accumulation of bacterial plaque, each individual’s genetic susceptibility may affect the chances of an increase in disease severity, which is always positive. All types of tooth malposition, such as diastemas, crowding, rotated teeth, incisor proclination and mandibular molar tipping, may result in early tooth loss due to the formation of periodontal pockets on the malpodicion surface of the tooth involved, because mslposicion bone crest tends to follow the cementoenamel junction.

In the anterior teeth, excessive mandibular incisor proclination is a frequent cause of gingival recession.

Because of scientific and technological advances in orthodontics, the use of appliances with accurate control of the forces applied and the improved preparation of dental care workers for the correction of anomalies in tooth position, orthodontic treatments are no longer exclusively prescribed for children and adolescents.


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Adult patients may undergo orthodontic treatment primarily due to esthetic considerations, although dental care workers may stress the functional results of this type of treatment.

Several authors pointed out the importance of a multidisciplinary treatment approach, combining orthodontics, periodontics, restorative dentistry, prosthetic dentistry and implant dentistry, to respond to all patient needs. This study identified the types of tooth position anomalies in patients attended in an outpatient service and referred to periodontal treatment in the public healthcare system and investigated whether these anomalies were pathologically associated with periodontal health.

One hundred and fifty adult men and women took part in the dengal selection process. They had all been referred to treatment malpodicion the outpatient service of the Specialization Course in Periodontics of the Brazilian Association of Dentistry, Pernambuco Division, by professionals in the public healthcare system of the city of Recife, Brazil. Visual inspection excluded individuals that had no malpositioned teeth, had orthodontic appliances or any systemic disease, or were taking any type of medication, as well as smokers, ex-smokers and mouth breathers.

After checking these criteria, a convenience sample of 90 patients, aged 15 to 69 years, was selected. A clinical form was used to record, for each patient, the type of tooth malposition. Immediately after that, a periodontal diagnosis was made using the index made up of results of gingival bleeding on probing marginalprobing depth and, by means of visual inspection, presence or absence of attachment loss gingival recession according to the parameter of whether the cementoenamel junction was exposed.

All participants were examined by only one examiner previously trained and calibrated. Data were analyzed according to univariate and bivariate analyses and described as absolute and percentage distributions of the variables in a nominal scale of descriptive statistical measures: A chi-square test was used for analyses and, when the conditions for its use were not met, the Fisher exact test was used. The level of significance was set at 5.

Age of the 90 patients ranged from 15 to 69 years, and mean age was Table 1 shows the results of type of tooth position anomalies found in the study sample. One single patient might have one or more teeth with position anomalies. The most prevalent malposicoon affected patients with rotated teeth Table 3 shows the results of the analysis of malpositioned teeth and their association with teeth with or without gingival recession.

These clinical findings can be seen in Figure 4. The association between chronic periodontitis and tooth malposition is described in Table 4. The analysis of need of orthodontic treatment revealed that The results of this study confirmed that the diagnostic and therapeutic interrelation between orthodontics and periodontics is a consensus in the literature. Therefore, dental care professionals should combine their efforts and act according to a predetermined treatment plan for each patient.

Few studies in the literature investigated the interrelation between malpozicion tooth positioning and malocclusion with periodontal health in groups of adult dentla.

Most studies focused on children and adolescents. Our study examined patients referred to periodontal treatment and evaluated malpositioned teeth and their possible effects on periodontal tissues.

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Data showed that there were pathological periodontal changes associated with orthodontic anomalies, which corroborates previous findings. Although the main etiological factor of periodontal disease is the bacterial plaque, other factors are usually associated and may lead to changes in host responses. Of these factors, malpositioned teeth are predisposing factors because oral hygiene becomes more difficult, bacterial plaque is retained and accumulates and, therefore, proliferates and leads to pathological periodontal changes.

Our results contribute to the literature, as all patients that had malpositioned teeth also had some type of periodontal disease, such as chronic marginal gingivitis, gingival enlargement, gingival recession and chronic periodontitis in several degrees of severity.


However, this predisposition does not invariably lead to the development of periodontal disease, particularly in cases when there is regular follow-up by a dentist that gives instructions to patients about the correct oral hygiene procedures for their current anatomic condition 1,2,7,14, Malocclusions, etiologically associated with several factors, such as poor tooth positioning, are sometimes detected in children and adolescents as a warning sign for early correction.

It is classified as a public health problem, as clearly reported by Bello 3 in However, in routine clinical practice, tooth malpositioning is often overlooked at the phase of early detection of dental problems, and teeth keep this preexisting condition until adulthood.

Data from other studies are in agreement with our findings, and patients invariably report that tooth malpositions never received attention from specialists. Therefore, dental care professionals should make therapeutic malosicion as early as in the first visit of a child or adolescent. Occlusion trauma that results from tooth malpositioning in cases, for example, of excessive mandibular incisor proclination, is a destructive factor for the tissues that support the periodontium.

Our study showed that all patients in the study sample needed basic or surgical periodontal treatment. It also demonstrated that a misaligned tooth in the dental arch may produce a disease or change the intensity of a previous disease, which may be the result of no specific dental care and poor instructions about controlled oral hygiene. Another remarkable finding was that all patients needed some type of orthodontic intervention, either some minor tooth alignment or full denal treatment.

Moreover, several patients also needed other types of dental procedures, which draws attention to the need of a deental approach and corroborates findings reported in studies that focused on treatment combinations. Orthodontic follow-up should be prescribed to patients that have attachment loss due to disease severity and periodontal treatment.

Various types of tooth position anomalies were found in this study sample, and they were significantly associated with periodontal changes, maplosicion as chronic marginal gingivitis, gingival enlargement, gingival recession and chronic periodontitis. Patients needed basic and surgical periodontal treatments, as well as orthodontic treatments. Therefore, the role of orthodontics and periodontics in the correction of tooth position should lead to improvements in oral health.

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Prevalence of malocclusions in Hungarian adolescents. Longitudinal changes in gingival condition in crowded and noncrowded dentitions subjected to fixed orthodontic treatment.

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Rio de Janeiro RJ: Universidade Federal do Rio de Janeiro; Intraarch and interarch relationships of the anterior teeth and periodontal conditions. Assessment of the oral health status of school children in Addis Ababa. October 23, Revised and accepted: All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License.

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