DDS, Dr.med.dent, MAS Ortho UniBe, MSc LSHTM, PhD
Dimitris Kloukos graduated from the Dental School of the Aristotle University οf Thessaloniki, Greece and the Military Medical Academy for Officers in 2003. He specialized in Orthodontics at the University of Bern, Switzerland, receiving the title ‘Master of Science in Orthodontics’ (2009-2013). He has been awarded with the title of Doctorate at University of Bern, Switzerland (Dr. Med. Dent. in Dentistry in 2011). He has achieved a second Master title (Master of Science in Clinical Trials) at the University of London, United Kingdom (2011-2015). He received his Doctorate title (PhD) in Department of Periodontology, University of Malmö, Sweden in 2023.
He is currently Lieut. Colonel of Greek Air Force and Head of the Orthodontic Department of the 251 Hellenic Air Force General Hospital, Athens, Greece and holds two private practices in Athens. He is also Senior Lecturer and Research Associate at Department of Orthodontics and Dentofacial Orthopedics in University of Bern. He has published over 80 articles in international journals and book chapters in the fields of orthodontics, clinical trials and research methodology. His scientific interests mainly include the various aspects of orthodontic-periodontal inter-relationship.
Timing of soft tissue augmentation in orthodontic patients. Before or after treatment?
The issue of incisor proclination outside their dentoalveolar envelope as a source of gingival recession has been considered for years. Although it is broadly believed that mandibular incisor proclination leads to gingival recession, there are limited clinical studies that have actually investigated this. Some of them have shown gingival recession to be associated with proclination of the mandibular incisors whereas others have found no such correlation.
Periodontal prevention of gingival recessions in orthodontic patients remains, likewise, contradictory. Historically, periodontists have indicated pre-treatment gingival augmentation to recreate the zone of attached gingiva. The early concept for this approach was that attached gingiva is important to dissipate the force of muscle pull and unattached mucosa.
Opposite to this preventive concept, however, some clinicians consider this approach as over-treatment and prefer to wait until the potential gingival recession becomes a pathological and clinical entity. Subsequently, the developed recession may be treated during or after orthodontic therapy. Therefore, and despite the clinical experience that soft tissue augmentation of bucco-lingual gingival dimensions before orthodontic treatment may be a clinically viable treatment option in patients considered at risk, this treatment approach is not yet based on solid scientific evidence.
Aim/ Learning outcomes
The aim of this presentation is to provide insight in the available literature and illustrate if, first of all, soft tissue augmentation is indicated for prevention or treatment of gingival recession, and at which point of time related to orthodontic treatment, when a change in the inclination of the incisors is anticipated.