[Behavior of the periodontium during leveling of the mandibular incisors: what precautions are needed?].

Since the position of the mandibular incisors is one of the keys to successful treatment, most orthodontic treatments focus on control but take no special precautions regarding the periodontal environment. Can we trust the lateral headfilm alone when evaluating such slender quantities of bone surrounding the mandibular incisors? What is the true bone situation prior to treatment and above all, following alignment, leveling and uprighting of the incisors? We performed a prospective 3-year study on 50 patients to assess the periodontal behavior of the mandibular incisors following a leveling phase by means of a clinical approach using periodontal and radiologic probing based on measurements of bone thickness obtained by cone beam. The bone loss observed was not inconsiderable given the thinness of the initial bone. In the face of this clinical situation, we need to adapt our treatment by performing a pre-orthodontic periodontal check-up and by supplementing the diagnosis with 3D examinations for at-risk patients and by checking the incisal axes during the leveling phase. The advent of cone beam has provided us with a valuable tool making it possible to individualize orthodontic treatment and view the posttreatment bone environment and root positions.