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Frank Celenza DDS
Periodontist and Orthodontist Past President, Northeastern Society of Periodontists Associate Clinical Professor, New York University Member, ITI (International Team of Implantologists)• Recipient, Leonard Hirschfeld Memorial Award• Recipient, New York City Commendation• Private Practice, 880 Fifth Avenue, New York, NY, • Scarsdale, NY, and Fair Lawn, NJ
Ortho/Perio Perio/Ortho
• Uprighting• Movement Relative to
Defects• Forced Eruption• Alteration of the
Gingival Embrasure• Interactions with
Implants
• Basic Therapy• Open Flap Curettage• Grafting• Exposures• Gingivectomy• Fiberotomy• Frenectomy
“The Effect of Orthodontic Therapy on Certain Types of
Periodontal Defects”
I.S. Brown, J Perio 44:742-756, 1973I.S. Brown, J Perio 44:742-756, 1973
Predetermination of Osseous Changes Associated with Uprighting Tipped
Molars by Probing Wise and Kramer
Int’l J Perio and Rest Dent1/1983
Ritchey and OrbanJ. Perio; 24:75, 1953
“In the absence of periodontal disease, the position of the crest is dictated by the relative positions of the cemento-
enamel junctions”
Treatment Options for Extruded Molars
• Orthodontic Intrusion• Subapical Osteotomy/Segmental Impaction• Occlusal Reduction/Crown
Lengthening/Elective Devitalization• Extraction/Implant Replacement
Periodontal Response After Tooth Movement Into
Intrabony DefectsPolson, Nyman, et alJ. Perio; 55(1):1984
Orthodontic Extrusionof Single-Rooted Teeth
Affected with AdvancedPeriodontal Disease
J. van Venrooy, R. YuknaAJO, Jan., ’85, p. 67
• “…orthodontic extrusion of teeth with advanced periodontal disease can have positive clinical and histologic results.”
Uses of Forced Eruption:• Soft Tissue Modification• Hard Tissue Modification
•Implant Site Development–“The Development of Forced Eruption as a Modality for Implant Site Enhancement”
•F. Celenza, Alpha Omegan, 90(2):Summer, 1997
•F. Celenza, Practical Perio & Rest Dent March, 2001
Extraction Site ClassificationSalama, Salama: IJPRD:13, 1993
Type I Incipient Site: -Three or Four Walls
-Good Labial Plate
Type II Moderate Site:
-Three Wall Defect
-Compromised Labial Plate
Type III Severe Defect:
-Less Than Three Walls
-Poor Labial Plate
“The Development of Forced Eruption as a Modality for
Implant Site Enhancement”
F. Celenza, Alpha Omegan, F. Celenza, Alpha Omegan, 90(2):Summer, 199790(2):Summer, 1997
F. Celenza, Practical Perio & Rest Dent F. Celenza, Practical Perio & Rest Dent March, 2001March, 2001
Miller, PD Jr.Root Coverage with the Free Gingival Graft. Factors Associated
with Incomplete CoverageJ.Perio 87:58:674-681
The single most important factor for survival of the grafted tissue over the avascular root surface
is adequate blood supply from the tissues adjacent to the graft bed
Gingival MarginCoordination
By Semi-Lunar IncisionTarnow, JCP
By Connective Tissue GraftLanger, Calagna JP
By Forced EruptionIngber IJPRD
By VISTA
Spontaneous improvement of gingival recession after correction
of tooth positioning
• Machado, MacGinnis, Damis, Moon, AJO-DO, 145(6): 828-835, June, 2014
Tarnow, Magner, FletcherJ. Perio, 1992
“…when the measurement from the contact point to the crest of
bone was 5mm or less, the papilla was present almost 100% of the
time.”
Tarnow, Magner, FletcherJ. Perio, 1992
-At 5mm the papilla was present 98% of the time
-At 6mm the papilla was present 56% of the time
-At 7mm the papilla was present 27% of the time
Interactions with Implants
• Preparatory to Implant Placement–Tissue Modification–Spacial Relations
• Utilizing Implants as Anchorage–Direct Anchorage–Indirect Anchorage
“The Development of Forced Eruption as a Modality for
Implant Site Enhancement”
F. Celenza, Alpha Omegan, F. Celenza, Alpha Omegan, 90(2):Summer, 199790(2):Summer, 1997
F. Celenza, Practical Perio & Rest Dent F. Celenza, Practical Perio & Rest Dent March, 2001March, 2001
Implant Site Development by Orthodontic Forced Extraction:
A Prelim Study-Amato, Tarnow et al
JOMI 27(2):2012, 411-420
-OISD is a viable treatment for hopeless teeth to regenerate hard and soft tissue
-70% efficacy for hard tissue-60% efficacy for gingival augmentation-Residual attachment level on the tooth is not a limitation
“…within physiologic limits, rigid endosseous implants provide excellent
orthodontic and orthopedic anchorage.”
Roberts et al, 1988,90
“…static load applied laterally to implants resulted in a structural adaptation of the peri-implant bone”
Gotfredsen, Berglundh, LindheClin.Oral Imp..Res. 12,2001; 1-8
Direct Anchorage:
Enhanced anchorage utilizing forces that originate
from the actual implant
Indirect Anchorage:Indirect Anchorage:
Enhanced anchorage utilizing an implant Enhanced anchorage utilizing an implant to stabilize dental units to stabilize dental units
which in turn serve as the anchor unitswhich in turn serve as the anchor units
“Implants for Tooth Movement:Determining Implant Location and
Orientation”-Smalley
• J Esthetic and Rest Dent: 7(2); 62-72, March, 1995
Forces Acting upon Dental Versus Orthodontic
Implants
• Magnitude: Much higher on dental implants
• Duration: Dental implants receive intermittent force, Ortho is continuous
• Directionality: Ortho implants receive unidirectional force
Periodontal and Restorative Considerations in Molar
UprightingCelenza Mantzikos and Shamus
Compendium of Continuing EducationMarch,1996; p294
A New Device for Absolute Anchorage for Orthodontics
(“OnPlant”)
Block, HoffmanAm J Orthod Dent Orthopedics
1995: 107:251-8
The Use of Palatal Implants for Orthodontic Anchorage
Design and Clinical Application of the Orthosystem
Wehrbein, Merz, Diedrich, GlatzmaierClin. Oral Impl. Res. 7:410-416, 1996
Aspects of the Use of Endosseous Palatal Implants
in Orthodontic Therapy
Wehrbein, MerzJ. Esthetic Dent. 10(6):315-324, 1998
“Game Changers in Orthodontics”
“Invisalign and TADs were clearly the major game changers in orthodontics over the past decade and a half”
-Editor’s Corner, JCO, May, 2012
Maxillary Lateral Incisor Agenesisand its Relationship to
Overall Tooth SizeWright, Bosio et al
J Prosthet Dent., Feb, 2016; 115(2):209-214
“Orthodontic patients with unilateral or bilateral agenesis of the maxillary lateral incisor have
smaller than average teeth…”
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