Soft-Tissue-Focused Orthodontics in Patients With Stage IV Periodontitis: Segmented Arch Technique and Skeletal...

Orthodontic treatment in patients with advanced periodontitis is often considered high-risk due to impaired periodontal anchorage and increased susceptibility to treatment-related damage. This report presents a 60-year-old woman with stage IV periodontitis, upper anterior protrusion (overjet 7.5 mm), crowding, and advanced vertical bone loss. Treatment with a maxillary fixed appliance and skeletal anchorage over 9 months enabled intrusion and retraction of the anterior teeth, closure of a lateral diastema, and reduction of overjet, achieving functional and aesthetic improvement without compromising periodontal support. Orthodontic treatment is achievable and effective in patients in later adulthood with advanced periodontitis. Using only small, segmented appliances with a controlled force vector guided by skeletal anchorage allows controlled and secure anterior tooth movement. Considering the incisor/lip interaction according to the FAOP enables reliable tooth movements, improving function, aesthetics, and long-term tooth preservation.