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

Good judgement comes from experience...

…experience comesfrom bad judgement.

-Mark Twain

“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

VISTA

VestibularIncisionSubperiostealTunnelingApproach

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

Classes of Orthodontic Anchorage

Minimal Anchorage Posterior Protraction

Classes of Orthodontic Anchorage

Moderate Anchorage Equal Space Closure

Classes of Orthodontic Anchorage

• Maximum Anchorage• Anterior Retraction

“…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

OnPlantOnPlant

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

OrthoSystem

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…”

www.frankcelenza.com

www.frankcelenza.com

www.frankcelenza.com

Dr. Vincent Kokich Sr.

web: www.frankcelenza.com

e-mail: fcelenza@orthoperio.com

Thank You!