Bone loss, often resulting from advanced periodontal disease, presents a unique challenge for individuals considering orthodontic treatment. Braces can still be an option, but only under highly specific and controlled circumstances. Receiving braces with compromised bone support requires a collaborative approach between the orthodontist and a periodontist, focusing first on achieving complete gum health. Adequate bone is necessary because it is the foundation that allows teeth to move safely, and its reduction complicates the mechanics of tooth repositioning. Therefore, treatment proceeds only after the active disease is halted and a specialized plan is created to protect the remaining tooth support.
The Relationship Between Bone Loss and Tooth Movement
Orthodontic tooth movement relies entirely on the biological process of bone remodeling within the alveolar bone that surrounds the tooth roots. When a gentle, continuous force is applied by braces, it creates areas of pressure and tension around the tooth’s periodontal ligament. On the compression side, specialized cells called osteoclasts break down the existing bone through resorption. Simultaneously, on the tension side, osteoblasts build new bone to fill the space. This coordinated destruction and creation allows the tooth to migrate through the jaw without becoming loose or unstable. Bone loss from periodontal disease reduces the amount of root surface area embedded in the jaw, which is responsible for this remodeling. With less supporting bone, the center of resistance for the tooth shifts further down the root, meaning the same orthodontic force can have a much greater, more destabilizing effect. If forces are not dramatically reduced, the tooth risks severe root resorption, increased mobility, or further damage to the compromised bone structure.
Achieving Periodontal Stability Before Treatment
The prerequisite for beginning any tooth movement is the complete resolution of active gum disease. An orthodontist will not proceed until a periodontist confirms the periodontal condition is stable, meaning the infection is under control. This stabilization phase involves comprehensive periodontal charting to measure pocket depths and attachment loss. Deep cleaning procedures, known as scaling and root planing, are performed to remove hardened plaque and bacteria below the gumline. In some instances, surgical intervention or bone grafting may be necessary to address specific defects. The goal is to eliminate the active infection that causes further loss, not necessarily to regrow all the lost bone. Once the tissues are confirmed as healthy, stable, and non-bleeding, the bone loss is considered “reduced but healthy,” providing a safe environment to introduce orthodontic forces. This commitment to hygiene and stability must be maintained throughout the treatment duration to prevent relapse of the disease.
Adapting Orthodontic Techniques for Reduced Bone Support
When treating teeth with reduced bone, the orthodontist must adjust the biomechanics of movement to minimize stress on the compromised foundation. The most significant adaptation is the use of significantly lighter, continuous forces than those used for patients with full bone support. Forces applied to teeth, such as for intrusion, may be reduced to a range of 5 to 10 grams per tooth, substantially less than typical orthodontic forces. This gentle approach slows the movement, preventing the excessive pressure that can cause tissue necrosis and unwanted root damage. Orthodontists prioritize controlled, bodily movement of the entire tooth root instead of simple tipping movements, which stress the bone crest. To achieve this control, specialized mechanics like segmental archwires are often employed, allowing the clinician to move smaller groups of teeth independently. Temporary Anchorage Devices (TADs), small, temporary implants placed in the bone, may be used to provide a stable, fixed point for applying precise forces. The overall treatment time is often longer, allowing the bone more time to remodel safely around the moving root.
Long-Term Monitoring and Retention
Monitoring continues throughout the active treatment phase after braces are bonded. Patients with a history of bone loss must see their periodontist or dental hygienist for professional cleanings and check-ups more frequently than average, often every one to three months. This frequent monitoring ensures that inflammation and periodontal pockets do not recur, which would immediately halt tooth movement. Once the teeth are positioned, the retention phase is crucial because teeth moved through reduced bone support have a higher tendency to relapse. For this reason, permanent, fixed retainers—thin wires bonded to the back surfaces of the teeth—are almost always recommended for long-term stability.