The PIANO-technique: A splint-assisted protocol for pathologic tooth migration in stage IV periodontitis

Pathologic tooth migration (PTM), tooth flaring, and severe mobility are frequent clinical problems in stage IV periodontitis and can cause major aesthetic and functional impairment. Conventional correction often requires prolonged interdisciplinary periodontal-orthodontic treatment. This case series introduces the PIANO protocol (Periodontal Immediate Adhesive Nonsurgical Orthorepositioning), a splint-assisted approach combining orthorepositioning with immediate stabilization during step 2 periodontal therapy. Three patients with generalized stage IV, grade C periodontitis, anterior PTM, and grade III mobility were treated. Before local anaesthesia, the affected teeth were moved with gentle digital pressure towards the closest passively achievable functional and aesthetic position. Movement was discontinued if resistance or discomfort occurred. The teeth were then adhesively splinted, premature occlusal contacts were adjusted, and nonsurgical periodontal therapy was performed. At 6 months, all treated teeth remained clinically stable and responded positively to pulp sensibility testing. Periodontal inflammation had resolved, no residual pathological probing depths were detected, and radiographs showed defect fill compatible with osseous repair. Patient-reported outcomes were favourable, particularly for aesthetics, function, and willingness to undergo the procedure again. No pulpal complications or splint failures occurred. Within the limitations of this three-patient case series, the PIANO protocol provided rapid aesthetic and functional improvement while facilitating periodontal treatment of grade III mobile teeth. It may represent a minimally invasive adjunct for selected patients seeking rapid aesthetic improvement and a time- and cost-efficient treatment option.