Clear orthodontic aligners in patients with a history of severe periodontitis: Two case reports with 12 months of follow‐up

BACKGROUND: The orthodontic treatment of patients with a history of severe periodontitis helps to improve periodontal health, functional occlusion, and esthetics. The use of aligners in patients with a history of severe periodontitis, with a single protocol of periodontal treatment, and the report of periodontal parameters throughout the orthodontic treatment has not yet been evidenced. Therefore, this manuscript aimed to describe the treatment with a clear orthodontic aligner system in two patients with reduced periodontium associated with a history of severe periodontitis. METHODS AND RESULTS: Two male participants (43-year-old and 62-year-old, respectively) were diagnosed with generalized, stage III, grade B periodontitis and treated with the same periodontal treatment protocol. After a 12-month follow-up of periodontal maintenance, the subjects were referred for tooth migration and Class II malocclusion orthodontic treatment. The subjects received orthodontic treatment with clear aligners. After starting orthodontic therapy, the patient received periodontal maintenance and clinical monitoring at 3, 6, 9, and 12 months. The periodontal parameters remained stable throughout the aligner treatment. At 12 months of orthodontic treatment, an improvement in angulations, inclinations, and dental positioning was observed, obtaining a stable occlusion, and reaching the proposed objectives for the treatment stage. CONCLUSIONS: A significant improvement in the occlusal relationship could be achieved with the clear orthodontic aligner system in adult patients with reduced periodontium by a history of severe periodontitis. Orthodontic therapy with clear aligners was shown to be safe in maintaining good periodontal health with the protocol of periodontal treatment used in the clinical cases presented. PLAIN LANGUAGE SUMMARY: This case presentation is a contemporary and innovative approach to orthodontic and periodontic treatment of patients with a history of severe periodontitis that in the recent past would not be referred to an interdisciplinary treatment because of the lengthy orthodontic treatment time and the difficulty of hygiene that fixed appliance brings, putting at risk the permanence of these teeth in the oral cavity even with adequate periodontal treatment. The keys to the success of this partnership intervention are a precise diagnosis and careful treatment planning of orthodontic treatment and a correct periodontal intervention to keep teeth and periodontium in good health. The primary limitation is without a doubt, the patient's collaboration both in the correct use of the aligners and in the adherence to periodontal treatment.