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HERRERA ET AL .
FIGURE 1
Visual description of timing/sequence of implementation of the adjunctive orthodontic/restorative treatment and the periodontal
treatment (OH, oral hygiene)
mind patient wishes and aesthetic considerations. Ideally, interim tooth-retained restorations or dental implants should not be placed before completion of step 2 of treatment and, if possible, deferred until the periodontal treatment objectives have been achieved (after re-evaluation following steps 2 and 3 of periodontal treatment). Definitive restorative treatment or placement of dental implants must be performed after successful completion of periodontal therapy and any additional conservative treatment of the abutment teeth. • Case type4 : partially edentulous patients who need to be restored by means of full-arch rehabilitation, either tooth- or implant- retained, and either fixed or removable. The timing of treatment differs for cases with tooth-supported full-arch restorations and cases with implant-supported full-arch restorations. In tooth-supported cases, an intermediate restoration is frequently placed following successful completion of step 1 of periodontal treatment. Step 2 of periodontal treatment, including scaling and root surface instrumentation of the abutment teeth, is performed with the intermediate restoration in place. Insertion of a definitive restoration (or long-term intermediate restoration) follows success- ful completion of periodontal therapy and achievement of shallow maintainable pockets and control of periodontal inflammation. For implant-supported cases requiring extraction of the terminal dentition, in one or both arches, teeth are extracted, and implants placed after successful completion of step 1 of periodontal treat- ment if one arch still has natural teeth. The sequence of treatment and the insertion of intermediate fixed or removable prostheses aims to reconcile the biology of wound healing with the need to manage patient expectations and ensure an adequate level of com- fort during the transition.
rehabilitation phases (orthodontics and/or restorative dentistry, as appropriate). Furthermore, adequate self-performed oral hygiene, and risk factor control must be realized, alongside satisfactory initial treat- ment outcomes prior to progressing the case to subsequent periodon- tal/oral rehabilitation. • Case type 1 : the patient with tooth hypermobility due to secondary occlusal trauma that can be corrected without tooth replacement. Temporary tooth splinting and initial occlusal adjustment (mostly relief of fremitus in combination with splinting) can be implemented during step 1 of therapy to manage secondary occlusal trauma and the impact of tooth hypermobility on patient comfort. The need for and the implementation of longer-term splinting needs to be re- assessed following completion of steps 2 and 3 of periodontal therapy. • Case type 2 : the patient with pathological tooth migration, charac- terized by tooth elongation, drifting and flaring, which is amenable to orthodontic correction. Orthodontic therapy can be planned during step 2 of care (sub- gingival instrumentation with or without adjunctives) and, in some cases, step 3 (subgingival re-instrumentation and periodontal sur- gery) of treatment, but should not be implemented before achiev- ing the periodontal treatment objectives of shallow maintainable pockets and control of periodontal inflammation. Special consider- ations apply to the regenerative treatment of intra-bony defects (see Section 7). • Case type 3 : partially edentulous patients who can be prostheti- cally restored without full-arch rehabilitation. The timing of intermediate restorations, if required, should be care- fully evaluated based on the individuality of the case and keeping in
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