A Multidisciplinary Approach for the Management of a Pathological Tooth Migration

Objectives: The physiological tooth position is determined by interactions between periodontal tissue and lip, tongue and masticatory forces. Disturbance of those balances might lead to pathological tooth migration which often requires multidisciplinary treatment approaches. This case demonstrates a single visit restorative-periodontal treatment of a pathological migration due to chronic periodontitis and a prominent labial frenum.
Methods: 46-year-old male patient was initially subjected to phase-I periodontal treatment. A fiber reinforced bridge with direct composite build-up were applied to the mandibular midline diastema comprising an extra incisor. Following the restorative procedure, frenectomy was performed with simple excision technique. Sutures were removed 1 week postoperatively and patient was recalled 6 months later.
Results: The restoration was still satisfying the patient with its good function, esthetics and durability after six months. Patient’s oral hygiene level was improved. Frenum attachment did not extent over the alveolar crest and free gingival margin was not mobile.
Conclusions: This report describes a rapid, conservative, cost effective and reliable treatment option of pathological migration. As well as the adhesive technique, adaptation and retention of fiber net, it’s important to eliminate the etiologic factors such as prominent frenum and chronic periodontitis.