Can Orthodontic Treatment Be Done in Your 40s? Can You Get Orthodontic Treatment Even with Periodontitis? Straightening Teeth Without Implants

Hello, this is Apgujeong Orthodontic Clinic.

Orthodontic treatment is often done for aesthetic reasons, but there are also cases where treatment is unavoidable for medical reasons.

�a0

Among the patients who come for consultations, some ask, “Can orthodontic treatment be done in your 40s?”

Yes, of course it can.

�a0

Today, I’d especially like to say that when severe cavities or periodontal disease make tooth extraction unavoidable, it is wiser to visit an orthodontic clinic first rather than immediately getting an implant.

�a0

If orthodontic treatment moves the surrounding teeth to close the extracted space, an implant may not be needed.

In particular, if there is protrusion or severe crowding, extraction as part of orthodontic treatment is sometimes done intentionally.

It is as if the tooth was extracted anyway, and the crowding or protrusion can be resolved through orthodontics, so there is no need to place an implant. From the patient’s perspective, there are many benefits at once.

�a0

Today, I’ll show you how treatment was completed without implants in a case where two front teeth were extracted because of severe periodontitis.

This is a Clippy-C case.

2022.11

In November of the year before last, the patient visited the orthodontic clinic because the lower front teeth were very loose.

In the end, they got a good result because they were wise enough to visit the orthodontic clinic first rather than an implant clinic.

�a0

The area marked with the blue arrow is where the periodontitis was severe.

Three of the four front teeth were all loose, and the periodontal condition was deep, so extraction was unavoidable.

Two of the three were extracted, and for the remaining one, we decided to use it until it could no longer be used, and then restore it later if it fell out. Orthodontic treatment was started with that plan.

2022.11

At the time of an earlier consultation for protrusion and crooked teeth, they had been told that four premolars would need to be extracted.

It is easy to think that if two lower front teeth are removed, two upper teeth must also be removed, but through a detailed diagnosis, we decided to treat the upper teeth by moving them backward using the space from the wisdom teeth, without extraction.

�a0

The reason is the patient’s philtrum length.

2022.11

From the pre-treatment facial appearance, you can see lip incompetence caused by the protruding front teeth, along with a philtrum that is relatively long compared with the lower face.

If upper teeth were also extracted, there is a possibility that the mouth would be retracted too much.

After orthodontic treatment, there could be a side effect that makes the philtrum look even longer.

So the final treatment plan was to resolve the protrusion without upper extractions by using the wisdom tooth space, and for the lower teeth, after extracting the two front teeth that could not be preserved, we planned to bring the canine teeth forward into the front tooth positions and use them like front teeth.

However, if the lower front teeth have severe periodontitis like in this case, extracting them and waiting for the swollen gums to subside can lead to a large black triangle.

We always explain this in advance.

23.03

We first extracted the lower front tooth in the worst condition and aligned the remaining teeth with the Clippy-C appliance.

The reason for extracting sequentially is that removing both at once from the beginning would create too large a space.

23.10

In the upper arch, orthodontic miniscrews were placed from the early stage, and the entire teeth were pushed backward into the wisdom tooth space to resolve the protrusion.

23.10

After the alignment had been improved to some extent, the remaining front tooth was also extracted.

23.10

A temporary tooth was attached in the extracted space to preserve the patient’s dignity, and after several more months of treatment,

24.05

Treatment was completed this month, 1 year and 6 months after starting treatment.

The blue arrow points to the canine tooth, which moved well into the front tooth position.

The bite is good as well.

2022.11~24.05

The canine tooth is now in the position of the front tooth, as indicated by the blue arrow.

2022.11~24.05

The periodontitis around the front teeth was well managed with consistent care, and the protrusion of the front teeth was improved.

2022.11~24.05

If treatment is completed with only two front teeth in the space where four front teeth should be, black triangles are bound to appear.

In particular, as the swollen gums caused by periodontitis subside, the black triangles can look even larger.

�a0

For this part, we advised the patient to keep cleaning well with interdental brushes after orthodontic treatment so that tartar would not build up there.

Sometimes patients want this area filled in, but since this was an area with very severe periodontitis, we do not recommend it.

�a0

The fortunate thing is that

depending on each person’s lip shape and the way their speaking muscles are used, the degree to which the upper and lower teeth show is different for everyone.

In this patient’s case, the black triangle at the lower front teeth was not visible externally during everyday conversation or when smiling.

2022.11~24.05

The smile line formed by the edges of the upper teeth and the lower lip is important.

2022.11~24.05

As the protruding mouth was improved, the overall impression became cleaner.

2022.11~24.05

As the lower front teeth that had been pushed up due to periodontitis were aligned and moved backward, the upper front teeth also moved back by about 5 mm.

22.11

24.05

This is the post-orthodontic X-ray.

The tooth root axes are in good condition, and the very loose front teeth were bonded with a fixed retainer wire.

If managed well, they can be used without major discomfort.

�a0

�a0

Can orthodontic treatment be done in your 40s? Can it be done even if you have periodontitis?

Yes, it can. However,

orthodontic treatment for patients with periodontitis usually takes longer than conventional orthodontic treatment.

That is because the teeth are moved slowly so as not to strain the gums.

This patient’s teeth moved relatively quickly, so the treatment period did not become especially longer, and the orthodontic treatment was completed successfully.

�a0

As shown today, when an extraction diagnosis is made, there are many cases where orthodontics can produce great results without implants.

Please visit an orthodontic clinic first.

�a0

�a0