Optimizing orthodontic treatment protocol for patients with periodontitis or reduced periodontium: a systematic review and meta-analysis.

BACKGROUND: An increasing number of adults with periodontitis are pursuing orthodontic treatment to enhance their occlusion and aesthetics. To manage these patients effectively, it is essential to develop a tailored orthodontic treatment plan that addresses key factors such as anchorage, biomechanics, and interdisciplinary collaboration between orthodontists and periodontists. This comprehensive approach can significantly improve treatment outcomes. OBJECTIVES: This study aims to identify the most effective orthodontic protocols for treating patients with periodontitis or a reduced periodontium, paving a foundation for better clinical practices and improved patient satisfaction. SEARCH METHODS: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. Selection Criteria: It focused on patients aged 20-50 years, with no systemic disorders, and studies published since 2000. DATA COLLECTION AND ANALYSIS: Data was collected and the quality was assessed using the Critical Appraisal Skills Program (CASP) checklist. A meta-analysis was performed using the R program, with I2 used to quantify heterogeneity. Sensitivity analysis was performed on each subset of studies. RESULTS: The sensitivity analysis reveals that orthodontic therapy significantly resulted in improved clinical attachment level (CAL), with a pooled mean gain of 3.84-4.34 mm. Also, a significant reduction in probing depth (PD) with a pooled mean reduction of 4.32 mm was revealed after orthodontic treatment for periodontitis patients . CONCLUSION: This study suggested that individualized, interdisciplinary orthodontic and periodontic protocols are crucial for managing patients with periodontitis or reduced periodontium. Tailored approaches using conservative forces and regenerative strategies significantly improve clinical outcomes, making one-size-fits-all methods inadequate. REGISTRATION: PROSPERO: ID: CRD42024573973.