Can someone with periodontal disease get braces? In selected patients, orthodontic treatment is possible after periodontal disease has been appropriately treated and periodontal stability has been established.
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Modern evidence supports an interdisciplinary periodontal-orthodontic approach, particularly in adults with a history of periodontitis, reduced periodontal support, or pathological tooth migration. The primary objective is to establish periodontal health or stability before active orthodontic treatment begins.
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Yes, but the clinical decision depends primarily on whether the periodontal disease is active or successfully treated.
Patients with untreated or uncontrolled periodontitis should generally undergo periodontal therapy before orthodontic treatment. Once inflammation has been controlled and periodontal stability has been demonstrated, orthodontic tooth movement can be considered with modified biomechanics and close periodontal monitoring.
A systematic review and meta-analysis found that orthodontic treatment in patients with treated periodontitis and a healthy but reduced periodontium produced minimal changes in periodontal outcomes compared with patients without periodontitis, although the overall evidence base was limited and included studies with substantial risk of bias.
The European Federation of Periodontology (EFP) specifically recommends that orthodontic treatment in successfully treated stage IV periodontitis patients can be considered when indicated, provided that periodontal therapy has been completed and the patient remains under supportive periodontal care.
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Orthodontic tooth movement involves controlled remodeling of the periodontal ligament and alveolar bone. When periodontal tissues are already affected by active inflammation, this biological response may occur in an unfavorable environment.
The EFP clinical practice guideline reports that when periodontitis has not been adequately treated and inflammation remains active, orthodontic forces may contribute to renewed or accelerated periodontal destruction, including additional clinical attachment and alveolar bone loss.
Therefore, periodontal therapy should precede orthodontic treatment when active disease is present.
🔹 Clinical Factors to Evaluate Before Orthodontic Treatment
| Factor | Clinical Consideration |
|---|---|
| Periodontal inflammation | Active inflammation should be controlled before orthodontic tooth movement. |
| Probing depth | Residual periodontal pockets require assessment and appropriate management. |
| Clinical attachment | Existing attachment loss should be incorporated into orthodontic treatment planning. |
| Alveolar bone support | Reduced bone support requires individualized biomechanics and force control. |
| Tooth mobility | Mobility should be evaluated in relation to periodontal support and occlusal factors. |
| Oral hygiene | Effective plaque control is essential throughout orthodontic treatment. |
| Periodontal maintenance | Supportive periodontal care should continue during and after orthodontic treatment. |
The principal concern is not simply the presence of a previous diagnosis of periodontitis, but orthodontic treatment in a periodontium affected by uncontrolled inflammation.
Orthodontic appliances can also increase plaque-retention sites and make oral hygiene more difficult. Systematic reviews have reported increases in gingival inflammation and bleeding parameters during orthodontic treatment, particularly with fixed appliances.
Potential complications in susceptible patients include:
▪️ Increased gingival inflammation
▪️ Periodontal pocket deterioration
▪️ Additional clinical attachment loss if active disease is present
▪️ Gingival recession
▪️ Further alveolar bone loss in poorly controlled cases
▪️ Tooth mobility
▪️ Difficulty maintaining adequate plaque control
These risks do not mean that orthodontic treatment is automatically contraindicated in patients with a history of periodontitis. Rather, they emphasize the importance of periodontal stability, individualized biomechanics, and maintenance therapy.
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🔹 Orthodontic Treatment After Periodontal Therapy
In patients with treated periodontitis, orthodontics may have functional as well as aesthetic indications. Periodontally compromised patients may develop pathological tooth migration, including flaring, drifting, spacing, and elongation.
Correcting these changes may form part of comprehensive rehabilitation. In stage IV periodontitis, the EFP guideline recognizes orthodontic treatment as an adjunctive component of interdisciplinary rehabilitation after successful periodontal treatment.
Evidence from systematic reviews suggests that orthodontic treatment of pathologically migrated teeth after periodontal therapy may be associated with improvements in selected periodontal parameters, although the certainty of evidence remains limited.
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The type of orthodontic appliance should be selected according to the patient's periodontal condition, orthodontic requirements, oral hygiene ability, and treatment objectives.
Evidence comparing clear aligners and fixed appliances suggests that aligners may produce slightly more favorable short-term periodontal parameters in some studies. However, systematic-review evidence indicates that these differences may be small and of limited clinical significance.
Therefore, appliance selection should not be based solely on periodontal considerations.
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The relationship between periodontal disease and orthodontic treatment is primarily determined by disease activity and periodontal support rather than by a previous diagnosis alone.
Current evidence supports orthodontic treatment in appropriately selected patients with successfully treated and stable periodontitis. The available studies generally indicate that orthodontic tooth movement does not significantly worsen periodontal outcomes in stable treated disease, although the evidence is heterogeneous and often limited by methodological quality.
The clinical situation is substantially different when periodontitis remains active. Inflammation should be controlled before orthodontic forces are applied because tooth movement through an inflamed periodontal environment may increase the risk of further periodontal destruction.
Consequently, orthodontic treatment in these patients is best considered as part of an interdisciplinary periodontal-orthodontic treatment plan, rather than as an isolated orthodontic procedure.
🎯 Clinical Recommendations
1. Complete a comprehensive periodontal examination before initiating orthodontic treatment in patients with a history or clinical signs of periodontitis.
2. Treat active periodontal inflammation before orthodontic tooth movement. Periodontal stability should be demonstrated through appropriate clinical reassessment.
3. Modify orthodontic biomechanics according to the patient's remaining periodontal support, particularly when significant attachment or alveolar bone loss is present.
4. Monitor periodontal parameters throughout orthodontic treatment. The EFP guideline recommends periodontal assessment at orthodontic visits in patients with advanced periodontal compromise.
5. Suspend active orthodontic movement if periodontal disease recurs. Orthodontic treatment can be resumed after periodontal health or stability has been re-established.
6. Maintain lifelong supportive periodontal care after orthodontic treatment in patients with a history of periodontitis, together with individualized orthodontic retention.
✍️ Conclusion
Patients with periodontal disease can receive braces when the disease has been adequately treated and periodontal stability has been established. Active periodontitis should be controlled before orthodontic tooth movement because inflammation combined with orthodontic forces may increase the risk of periodontal destruction.
For patients with a reduced periodontal support, orthodontic treatment requires careful diagnosis, controlled biomechanics, meticulous plaque control, regular periodontal monitoring, and interdisciplinary collaboration. When these principles are followed, orthodontic treatment can be incorporated into the rehabilitation of appropriately selected periodontally compromised patients.
📚 References
✔ Erbe, C., Heger, S., Kasaj, A., Berres, M., & Wehrbein, H. (2023). Orthodontic treatment in periodontally compromised patients: A systematic review. Clinical Oral Investigations, 27(1), 79–89. https://doi.org/10.1007/s00784-022-04822-1
✔ Herrera, D., Sanz, M., Kebschull, M., Jepsen, S., Sculean, A., Berglundh, T., Papapanou, P. N., Chapple, I., Tonetti, M. S., & EFP Workshop Participants and Methodological Consultant. (2022). Treatment of stage IV periodontitis: The EFP S3 level clinical practice guideline. Journal of Clinical Periodontology, 49(Suppl. 24), 4–71. https://doi.org/10.1111/jcpe.13639
✔ Martín, C., Celis, B., Ambrosio, N., Bollain, N., Antonoglou, G. N., & Figuero, E. (2022). Effect of orthodontic therapy in periodontitis and non-periodontitis patients: A systematic review with meta-analysis. Journal of Clinical Periodontology, 49(Suppl. 24), 72–101. https://doi.org/10.1111/jcpe.13487
✔ Zasciurinskiene, E., Lindsten, R., Slotte, C., & Bjerklin, K. (2016). Orthodontic treatment in periodontitis-susceptible subjects: A systematic literature review. Clinical and Experimental Dental Research, 2(2), 162–173. https://doi.org/10.1002/cre2.28
✔ Verrusio, C., Iorio-Siciliano, V., Blasi, A., Leuci, S., Adamo, D., & Nicolò, M. (2018). The effect of orthodontic treatment on periodontal tissue inflammation: A systematic review. Quintessence International, 49(1), 69–77. https://doi.org/10.3290/j.qi.a39225
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