Saving teeth: Revisited. Esthetic improvement and long-term periodontal stability of a pathologic tooth migration case: An 84-month follow-up

INTRODUCTION: Advances in implant dentistry, often influence our clinical treatment planning and steer us as periodontists from our fundamental values of preserving teeth. Pathologic tooth migration (PTM) of maxillary anterior teeth is a common sequela of periodontitis in patients and results in significant esthetic and functional problems. Patients' growing concern about the esthetics of their teeth and their fears of losing teeth are often reasons for them to seek treatment. We commonly assign a hopeless prognosis to these pathologically migrated teeth because of the significant loss of periodontal support and go with the "safer" choice of replacing them with implants. The purpose of this case report is to present the long-term (7-year) periodontal stability of compromised teeth and to emphasize the successful outcomes achieved when orthodontics, non-surgical periodontal, and restorative treatments are combined. METHODS AND RESULTS: A 38-year-old, otherwise healthy male with compromised function and esthetics, PTM, periodontal disease, and missing teeth presented to our clinic. Primary treatment objectives were to 1) eliminate the periodontal inflammation and 2) restore and stabilize the occlusion by employing non-surgical periodontal treatment, adult orthodontics, and prosthodontics. Following interdisciplinary treatment, clinical and radiographic re-evaluation revealed significant clinical attachment gain, reduction in tooth mobility, favorable esthetics, and better overall prognosis. At an 84-month follow-up, the patient was periodontally healthy and retained his natural dentition. CONCLUSIONS: Interdisciplinary collaboration along with patient compliance may increase the longevity of periodontally compromised teeth and improve esthetics for periodontitis patients who suffer from PTM. Such long-term favorable outcomes reaffirm the value of classic periodontal treatment and the success of multidisciplinary treatment to save teeth as a viable alternative to the extraction of teeth and the placement of implant retained restorations.