Self-Ligation and the Periodontally Compromised Patient: A Different Perspective

Orthodontic therapy is not contraindicated for patients with advanced periodontal destruction, provided that factors such as inflammation, plaque, subgingival calculus, and occlusal trauma are well controlled both before and during the orthodontic treatment. The application of extremely light continuous forces might have a better effect on the cell biology of tooth movements. By minimizing necrosis, and the subsequent hyalinization and indirect resorption, it might be possible to achieve continuous progress in tooth movement, avoiding the repeated interruptions occurring when the blood vessels are occluded, and reducing the great risk for further bone loss when treatment is rendered for individuals with decreased osseous support. A new generation of low friction, passive self-ligating brackets, in combination with newer wire and coil materials and longer activation spans, seems to be capable of exerting lower force levels providing more favorable periodontal reactions in patients with previous bone loss. A patient treated following these principles and using these newer technologies is presented.