**2. Role of periodontics in orthodontic treatment**

When moving teeth orthodontically, the entire periodontal attachment apparatus, including the osseous structure, the PDL, and the soft tissue components, move with the tooth. Even though the connective tissue attachment level remains unchanged along the root surface there are considerable morphological alterations to crestal bone with tooth uprighting [3]. Hence we can say that orthodontic treatment is almost always an interdisciplinary approach, where the health of the periodontium plays a vital role throughout the treatment. Certain techniques can be adjunctive to the Orthodontic treatment which will be discussed further in this chapter.

#### **2.1 Soft tissue considerations**

#### *2.1.1 Adjunctive procedures*

They can majorly be classified, based on the extent and involvement, as, minimal, moderate and severe involvement. The procedures are discussed in the following.

#### *2.1.1.1 Minimal involvement*

#### *2.1.1.1.1 Fiberotomy*

Also known as circumferential supracrestal fiberotomy (CSF), it is one of the common procedures conducted to enhance retention after fixed orthodontic therapy. The procedure involves detachment of the supracrestal fibers to increase the retention of a re-established tooth position. Tooth repositioning (for e.g.: rotation) is tough in maintenance. To accommodate the new tooth position after orthodontic therapy, reorganization of the PDL fibers take place. This rearrangement of fibers, especially the Sharpe's fibers, take place even after 6 months, due to which the retention period is always advised for a minimum of 12 months [4].

Literature suggests that the maximum amount of relapse takes place during the first 5 hours post the removal of the appliance. Hence it is ideal for fiberotomy to be done at the end of the finishing phase of orthodontic therapy. This minimizes the relapse that usually occurs due to the elastic supracrestal gingival fibers [3].

#### *2.1.1.1.2 Frenectomy*

A frenectomy is a procedure that removes the frenum (a small muscular attachment that connects two pieces of oral tissue) (**Figures 1** and **2**). Labial frenum is present apical, between the two central incisors. Most commonly, the maxillary labial frenum tends to be more muscular causing midline diastema. In such cases apart from orthodontic therapy, adjuvant frenectomy procedure aids in space closure ensuring lesser chances of relapse. Usually the surgical removal of frenum is done after orthodontic treatment is complete or during the finishing phase of active orthodontic treatment [5].

#### *2.1.1.1.3 Gingivectomy and gingivoplasty*

Gingivectomy is a dental procedure, where a part of the gingiva is surgically removed (**Figures 3** and **4**). It is an essential and adjunctive procedure to orthodontic therapy. Gingivoplasty, on the other hand, is the reshaping of the gingiva *Orthodontic-Periodontics: An Interdisciplinary Approach DOI: http://dx.doi.org/10.5772/intechopen.98627*

**Figure 1.** *High labial frenum (pre-operative).*

**Figure 2.** *Post-operative picture of Frenectomy.*

**Figure 3.** *Uneven gingival margins (pre–operative).*

to re-create physiologic contours with the purpose of recontouring the gingiva in the absence of pockets. Gingivectomy and gingivoplasty procedures are commonly performed together [6]. They are usually done for improving esthetics and for enhancing the prognosis of the teeth. Gingivectomy is needed in areas of space closure, where the tissue bunching also called clefts are surgically removed. It has also been documented that, performing CSF during a forced eruption of a tooth prevents displacement of gingiva more coronally [7, 8]. This will reduce the requirement for gingival recontouring after the completion of tooth movement.

**Figure 4.** *Post-operative picture gingivectomy done to correct the uneven margins.*
