Periodontics and Orthodontics Integration to Enhance the Prognosis of Compromised Anterior Teeth: A Report of Two Cases

Introduction. Modifying the prognosis of a periodontally compromised tooth from “questionable” to “fair” or “favorable” is a challenging clinical task. However, it has the potential to significantly impact the preservation of natural dentition over time and achieve satisfying results for both patients and clinicians. The aim of this case series is to report on the multidisciplinary management of two periodontally compromised anterior teeth with “questionable” prognosis. Case Presentation. Two adult patients were diagnosed with severe periodontal disease. Each patient exhibited a maxillary central incisor with deep periodontal pocket, mobility, pathological migration, radiological evidence of severe bone loss, and infrabony defect resulting in a “questionable” prognosis for the affected teeth. Function and esthetic were compromised in both teeth. The periodontal diagnosis was Stage III and Stage IV Grade C periodontitis. To save the teeth, a multidisciplinary management plan was implemented, including both surgical and non-surgical periodontal therapy followed by orthodontic tooth movement with light forces to eliminate the occlusal trauma and improve esthetics. Follow-ups were conducted for one year. Treatment Outcomes. The periodontal condition improved significantly, with reductions in the periodontal pocket depth up to 9 mm, clinical attachment level gain up to 4 mm, and radiographic bone fill of up to 90%. The tooth prognosis improved from “questionable” to “fair”. All patients were enrolled in a strict maintenance program to prevent disease recurrence and maintain long-term stability. Conclusions. In this case series, we demonstrated that a multidisciplinary treatment approach involving non-surgical periodontal therapy, regenerative periodontal therapy, and orthodontic treatment, can preserve periodontally compromised teeth, maintain long-term periodontal health, improve tooth prognosis, and achieve satisfying functional and esthetic outcomes.