Balancing act: Orthodontic strategies in severe periodontitis – updating clinical practice with evidence-based insights

Periodontitis is a widespread disease affecting oral structures and requiring a multidisciplinary treatment approach once it reaches its advanced form. This paper aims to provide an evidence-based update on the management of orthodontic treatment in patients with aggressive periodontics, emphasizing the need for careful assessment, timely intervention, and ongoing collaboration between orthodontists and periodontists. This article was conducted as a narrative review aimed at providing a clinically oriented synthesis of current evidence regarding orthodontic treatment in patients with stage IV periodontitis. A targeted literature search with predefined relevant key terms was performed using electronic databases, including PubMed/MEDLINE, Scopus, and Google Scholar. The search focused on English-language publications over the last 15 years. The second is a review of evidence-based studies in the combined fields of orthodontics and periodontics, with a focus on orthodontic treatment possibilities, limitations, and risks inherent in patients with periodontal disorders, particularly active periodontal disease. The evidence presented highlights that while orthodontic treatment can be beneficial for patients with severe periodontitis, it must be preceded and accompanied by thorough periodontal therapy to mitigate potential risks such as increased plaque accumulation. Overall, while challenges exist in treating these complex cases, advancements in both periodontal and orthodontic techniques offer promising avenues for improving patient outcomes.