*2.1.1.2.3 Gingival curettage*

Gingival curettage is a surgical procedure designed to remove the infected/ affected soft tissue lining of the periodontal pocket with a curet, leaving only a gingival connective tissue lining (**Figures 5** and **6**). The purpose of curettage is to eliminate or reduce the depth of the periodontal pocket by promoting the shrinkage of gingiva and enhancing new connective tissue attachment [11].


*Orthodontic-Periodontics: An Interdisciplinary Approach DOI: http://dx.doi.org/10.5772/intechopen.98627*

**Figure 5.** *Pre-operative picture, presence of deep pockets.*

**Figure 6.** *Post-operative–full mouth curettage done.*

In many cases, it may be possible to correct bony pockets by correcting the tooth position and allowing reestablishment of the periodontal apparatus with the help of orthodontics [12]. A combination of orthodontics and periodontal therapy may help to improve the periodontal status and maintenance of oral health for a patient [13].

### *2.1.1.2.4 Crown lengthening*

Crown lengthening is usually done to correct a gummy smile or fix a clinically short crown height for a tooth that requires bonding or banding.

When malalignment is responsible for a gummy smile, a gingival surgery is not the first treatment of choice, the teeth, then must be moved to a more esthetic and functional position, and the smile is corrected by an orthodontic leveling of the gingival margins.

It's important for the periodontist and orthodontist to identify the cases in which the teeth can be treated by gingival surgery and the ones in which orthodontics can benefit [12–14].

A gummy smile, may occur due to 3 reasons, the first being a maxillary excess, which is usually treated with a combination of orthodontics and surgery [14], secondly, a short anatomic lip and thirdly, the excessive eruption of maxillary teeth with delayed apical migration over the maxillary anterior can cause a gummy smile.

For gingivectomy or crown lengthening the sulcular depth is 3-4 mm when it should be only 1 mm, it may not migrate easily towards the CEJ, hence it has to be corrected [15].

Gingival margin discrepancy can be assessed by 4 parameters

1.Relation between the gingival margin of the maxillary central incisor and the patients lip line


In some cases, the molars may have a short crown height and the placement of an orthodontic band can lead to attachment loss due to the encroachment of the biologic width. To prevent these problems, a crown lengthening procedure should be considered prior to the placement of orthodontic bands used for anchorage.

To achieve the appropriate crown to root ratio for orthodontic bonding, one may need to do a crown lengthening procedure [16] as this is a crucial step and can aid in a more specific outcome in treatment planning.

### *2.1.1.2.5 Gingival recession and root coverage*

Gingival recession is not due to Orthodontics, it may be a multifactorial issue (**Figures 7** and **8**) [17]. There are many ways to cover a recession, and various grafting techniques are available [18]. Conventionally, gingival and pedicle grafts were used for root coverage previously, but presently connective tissue grafts are the treatment of choice to cover root exposures [19]. The advantages are, greater root coverage, superior esthetics and the ease and patient comfort.

Usually, the grafting is conducted after the completion of orthodontic treatment, however in many circumstances, due to inadequate gingiva and detrimental recession, the procedure may be done before or during Orthodontic treatment. This is usually case specific.

The factors to be considered before deciding for intervention.


4.Patients concerns regarding the treatment.

5.Any gingival restorations.

**Figure 7.** *Pre–operative: gingival recession in relation to 31.* *Orthodontic-Periodontics: An Interdisciplinary Approach DOI: http://dx.doi.org/10.5772/intechopen.98627*

**Figure 8.** *Post-operative: root coverage done in relation to 31.*
