Biomechanical Strategies and Compliance Monitoring for Orthodontic Treatment in Periodontally Compromised Adults

Abstract

Background: Orthodontic treatment in adults with reduced periodontal support requires interdisciplinary sequencing and strict plaque control; however, heterogeneity of periodontal phenotypes, biomechanics, and adjunctive therapies makes standardized clinical outcome evaluation challenging. This study therefore prioritised clinical compliance and cooperation as key modifiable determinants of safe treatment delivery. Objective: To assess patient cooperation during late active orthodontic therapy and clinical compliance during early retention in adults with stage I–II periodontitis. Materials and methods: A prospective clinical study was conducted in 25 adults (17 women, 8 men; 29–51 years) diagnosed with stage I–II periodontitis. Following periodontal stabilisation (non-surgical therapy in all cases; adjunctive periodontal surgery in 12%), orthodontic treatment was delivered using individualised, low-force biomechanics with periodic periodontal monitoring. Cooperation was assessed using the Orthodontic Patient Cooperation Scale (OPCS). Compliance during retention was assessed using a Clinical Compliance Evaluation (CCE) form at 6 months (T1) and 12 months (T2) after transition to retention. Non-parametric tests were used to compare timepoints and sex-based differences. Results: Women showed higher compliance scores for motivation/enthusiasm and fewer complaints about wearing appliances. CCE total scores improved significantly from T1 to T2 (86.20±14.73 vs 96.20±2.96; p=0.001), with a concurrent improvement in the oral hygiene subscore (23.12±1.64 vs 23.60±0.82; p=0.010). Conclusions: Structured compliance monitoring can support adherence during retention in periodontitis-susceptible adults undergoing orthodontic treatment. Larger controlled studies integrating standardised periodontal endpoints are required to clarify how compliance trajectories translate into long-term periodontal stability and orthodontic outcomes.