Combined bone grafting and orthodontic treatment of an iatrogenic periodontal defect: a case report with clinical reentry.
BACKGROUND
This case report discusses the treatment of an iatrogenic periodontal defect caused by an inadequate orthodontic appliance in a 9-year-old girl.


METHODS
The multidisciplinary approach to this case consisted of periodontal treatment using a bone grafting technique to restore the 10 mm bone dehiscence. Three months later orthodontic treatment was initiated to straighten and level the central incisors. Six months later mucogingival surgery was performed to cover 2 to 3 mm gingival recession.


RESULTS
The bony defects were completely filled and the 10 mm dehiscence was reduced to 4 mm. The connective tissue graft resulted in a complete coverage of the recessions and a thickening of the keratinized gingiva. The patient is still undergoing orthodontic treatment. So far, straightening of the upper central incisors and closure of the diastema are satisfactory.


CONCLUSIONS
Inadequate orthodontic appliances can cause iatrogenic periodontal defects. A multidisciplinary approach in a well-defined sequence can restore lost periodontal tissue, thus achieving comfort, function, and esthetics.
Naaman
Nada Bou-Abboud
NB
Department of Periodontology, Laboratory of Calcified Tissue, School of Medical Dentistry, Saint-Joseph University, Beirut, Lebanon. nada.naaman@usj.edu.lb
Chaptini
Edmond
E
Taha
Hala
H
Mokbel
Nadim
N
D016025:Bone Transplantation; D002648:Child; D003238:Connective Tissue / Q000637:transplantation; D003970:Diastema / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005889:Gingival Recession / Q000209:etiology / Q000601:surgery; D006801:Humans; D007049:Iatrogenic Disease; D009967:Orthodontic Appliances / Q000009:adverse effects*; D010510:Periodontal Diseases / Q000209:etiology* / Q000601:surgery; D014087:Tooth Movement Techniques