The Effect of Periodontally Accelerated Osteogenic Orthodontics on Periodontal Phenotypes in Adult Patients With Skeletal Class II Malocclusion: A Retrospective Cohort Study.

AIMS: To assess the impact of periodontally accelerated osteogenic orthodontics (PAOO) on periodontal phenotypes of mandibular anterior teeth in skeletal Class II malocclusion patients. METHODS: In this study, we enrolled 30 skeletal Class II malocclusion patients with 176 mandibular anterior teeth who were recommended for PAOO surgery due to insufficient labial alveolar bone in the anterior mandible. Participants were divided into two groups: the PAOO group (n = 15, receiving orthodontics with PAOO) and the control group (n = 15, receiving orthodontics alone), based on whether they had a history of PAOO or not. Data on patient characteristics, periodontal phenotypes, alveolar bone status, and dental parameters were collected from the medical record system and cone-beam CT scans at baseline (T0) and 1-year post-treatment (T1). RESULTS: At T1, the PAOO group demonstrated significant improvements in periodontal parameters compared to the control group. The keratinized gingival width (KGW) increased by 0.76 ± 1.03mm (-0.53 ± 0.97mm in controls, P < .001) and gingival thickness (GT) increased by 0.38 ± 0.82mm (-0.08 ± 0.60mm in controls, P < .001). Gingival recession (GR) showed a minor reduction of 0.06 ± 0.71mm in the PAOO group, contrasting with an increase of 0.18 ± 0.41mm in controls (P < .001). The PAOO group exhibited significantly greater buccal bone height (BBH) augmentation (2.90 ± 3.77mm vs. -3.56 ± 4.48mm in controls, P < .001). Furthermore, buccal bone thickness (BBT) at 4mm, 6mm, and 8mm from the cemento-enamel junction and apex level showed substantial increases in the PAOO group (0.59 ± 0.90mm, 1.09 ± 0.97mm, 1.08 ± 0.97mm, and 0.61 ± 1.17mm, respectively) compared to the control group (-0.39 ± 0.51mm, -0.11 ± 0.51mm, 0.11 ± 1.01mm, and 0.05 ± 1.55mm, P < .01). Univariate regression analysis revealed an inverse correlation between KGW increment and preoperative KGW and GT values. CONCLUSIONS: PAOO may have the effect of improving periodontal phenotypes in skeletal Class II malocclusion patients compared to conventional orthodontics, as evidenced by improvements in KGW, GT, BBT, BBH, and GR. The treatment appears particularly beneficial for patients with thin gingival biotype or more pronounced bone deficiencies. CLINICAL RELEVANCE: Traditional orthodontics presents substantial periodontal risks in the mandibular anterior region for patients with skeletal Class II malocclusion. Our study found that PAOO attenuates the detrimental periodontal consequences associated with conventional orthodontics, including keratinized tissue thinning, width reduction, and alveolar bone loss in the mandibular anterior region. Notably, the therapeutic superiority of PAOO was particularly evident in patients presenting with thin gingiva biotype or severe bone defects. These findings provide valuable evidence for developing interdisciplinary periodontal-orthodontic treatment strategies in skeletal Class II malocclusion cases.