Abstract

Synergistic Management of Intrabony Defects: Periodontal Regeneration and Orthodontic Movement

by Cardaropoli Daniele

The interdisciplinary integration of periodontology and orthodontics has become a cornerstone in the management of patients with periodontitis presenting with intrabony defects and pathologic tooth migration. While periodontal regenerative therapy aims to reconstruct the lost periodontal supporting tissues, orthodontic treatment plays a fundamental role in restoring function, aesthetics, and occlusal stability. However, one of the most debated clinical questions remains the optimal timing for initiating orthodontic tooth movement following regenerative periodontal surgery. For decades, the conventional approach has recommended delaying orthodontic treatment for several months after surgery, despite the limited scientific evidence supporting this practice. More recently, advances in the understanding of periodontal wound healing and tissue regeneration, together with emerging clinical evidence, have challenged this traditional concept. This lecture will primarily focus on the biological rationale and the current scientific evidence regarding the timing of orthodontic tooth movement after regenerative treatment of intrabony periodontal defects. Particular emphasis will be placed on the healing dynamics of regenerated periodontal tissues and on how these biological events may influence clinical decision-making. Special attention will be devoted to the results of the first randomized clinical trial comparing early orthodontic tooth movement initiated four weeks after regenerative periodontal surgery with the conventional delayed approach at six months. Clinical and radiographic outcomes, together with long-term clinical cases, will be presented to illustrate the advantages, limitations, and clinical indications of the different treatment protocols. The aim of this lecture is to provide clinicians with an evidence-based framework for planning the sequence of regenerative periodontal therapy and orthodontic treatment, moving beyond empirical concepts toward a biologically driven interdisciplinary approach that optimizes both periodontal regeneration and orthodontic outcomes in patients with periodontitis.