The effect of orthodontic intrusion on periodontally-compromised teeth: a systematic review and meta-analysis

This study systematically reviewed and meta-analysed the impact of orthodontic intrusion on teeth compromised by periodontal disease with pathological tooth migration (PTM). A comprehensive search was conducted across 6 databases (PubMed, Scopus, Web of Sciences, Scopus, Wiley, Cochrane and Google Scholar). Utilizing the PICO (Patient, Intervention, Comparator, Outcome) frameworks to guide search strategy development by identifying key terms for databases. Two independent reviewers screened studies, extracted data, and assessed quality using predefined criteria. The primary outcome of interest includes changes in probing pocket depth (PPD) and clinical attachment level (CAL). Meta-analysis was performed to pool the data. Subgroup analyses were conducted to explore the effect of the treatment timing and biomechanical approach. Most included studies with moderate to high quality, demonstrated significant improvement of PPD and CAL following orthodontic intrusion. The meta-analysis of two studies found no significant additional reduction in PPD among patients undergoing combined orthodontic-periodontal treatments compared to those receiving periodontal treatment alone. Single-arm meta-analyses showed statistically significant improvement in CAL and PPD with high heterogeneity noted among studies. Subgroup analyses indicated that optimal clinical outcomes may be achieved though immediate/ simultaneous timing and segmental/ partial/ sectional approaches. These findings suggested the timing and biomechanic approach of orthodontic intrusion may enhance therapeutic efficacy. There were high heterogeneity noted across studies, moderate to high precision and potential publication bias. This review concluded that the orthodontic intrusion may help in improving periodontal health with optimal results can be achieved via early intervention and segmental approach. However, these finding should be interpreted with cautions and more comprehensive research is needed to draw a definitive conclusion about the safety of the intervention. This insight gained may guide treatment protocols, improve patients’ outcomes, and influence the best practices in clinical orthodontics and periodontology.