Periodontal Challenges in Orthodontics:
Bone Loss, Tooth Mobility, and Interdisciplinary Approaches.
DOI:
https://doi.org/10.36557/2009-3578.2025v11n2p2818-2830Keywords:
Orthodontics, Periodontal disease, Alveolar bone loss, Tooth mobility, OsteoimmunologyAbstract
Orthodontic treatment in adult patients has become increasingly common, but it remains a clinical challenge when associated with alveolar bone loss and tooth mobility, conditions frequently observed in individuals with a history of periodontitis or systemic impairment. Unlike younger patients, whose bone response is more predictable, adults with reduced periodontal support are at higher risk of resorption, dehiscence, and long-term instability. This review aimed to analyze biological, systemic, and clinical aspects related to orthodontic treatment in patients with alveolar bone loss and tooth mobility, highlighting recent evidence on osteoimmunology, systemic conditions, adjuvant therapies, and regenerative strategies. A narrative literature review was carried out, including experimental and clinical studies published in recent years that investigated periodontal response, systemic influences, biological mediators, and long-term outcomes in orthodontic patients with compromised alveolar bone. Evidence shows that alveolar bone remodeling during orthodontic tooth movement is strongly influenced by immune-mediated mechanisms. Osteoimmunology studies have demonstrated that cytokines, osteocyte necroptosis, and Th17/Treg modulation by periodontal ligament cells are central to bone resorption and formation. Systemic conditions such as aging and diabetes negatively affect periodontal homeostasis, while metabolic influences, such as thermogenic supplements, exacerbate bone loss through the RANK/RANKL/OPG pathway. Adjuvant therapies, including parathyroid hormone, recombinant Irisin, Semaphorin 3A, and natural compounds like Chroogomphus rutilus, have shown protective effects in experimental models. Clinically, regenerative strategies such as autologous dentin matrix grafts and long-term evidence in agenesis cases demonstrate that orthodontic tooth movement can promote stable bone formation, preserving alveolar ridge architecture.Orthodontic treatment in patients with alveolar bone loss and tooth mobility is feasible, provided it is performed under strict periodontal control, light and individualized forces, and interdisciplinary management. Advances in biological knowledge, pharmacological modulation, and regenerative approaches expand the possibilities for safe and predictable orthodontic care in compromised patients.
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Copyright (c) 2025 Ana Luísa de Castro e Silva, Jennifer Vera Santos Gumert, Klarice Rafaella Menezes de Oliveira, Dra. Ediliana Dias Chaves Campos de Amaral, Diego Barbosa da Silva, Jessica Castro Costa, Aléxia Caroline Leandro da Conceição , Antonio Maurício Cristal Pio , Nataly Nascimento Lemos Cavanha
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