Page 15 - Academy of Osseointegration (AO) Academy News Vol 36, No 1 2025

Interdisciplinary treatment planning
in the modern era and the move
to phenotype
By George A. Mandelaris, DDS, MS; Academy News Editorial Consultant
Over the last five years, the American Academy of Periodontology (AAP) has published Best-Evidence Consensus (BEC) reports highlighting the limitation of “normal” human buccal bone thickness in the anterior periodontium and the need to consider phenotype modification therapies, especially when interdisciplinary dentofacial therapy (IDT) involving tooth movement
is planned.
Periodontal and peri-implant phenotype consists of two components: the gingival phenotype (specifically, the thickness of the marginal tissue and width of keratinized gingiva) and the bone morphotype (thickness of buccal bone, with 1mm being normal on average). This call for progress on how we diagnose and treatment plan perio- ortho patients when evaluating regional anatomy (beyond the standard focus of attachment levels and width of keratinized tissue), is transforming what we can do for patient wellness and sustainability on a global scale.,
Recently, the ethics of dentistry have come under scrutiny by the national media.3, 4 The first topic that garnered attention was as a result of disfiguring outcomes that occurred in adults who had orthodontic therapy and where the limits of tooth movement were overlooked, marginalized, or misguided (CBS News).3 As a result
of this negative press, dentists and their credentialing were put under a magnifying glass as well as the labs who manufactured the devices that aided such therapy. In addition, the institutes and continuing education bodies have not been held harmless in the damages to unsuspecting patients.
The profession of dentistry is highly regarded worldwide and our role in the overall healthcare sector has never been more important to patient well-being as it is today. The respect and public perception inherent in being a dentist is something that has been bestowed through generations and by innovations in the delivery of care. It has been earned from developing public trust through transparency, due diligence, honesty, healing, and prudent service to our patients by generalists, specialists, auxiliary team members, and scientists working together to advance oral healthcare.
Therefore, questioning our purpose and commitment to a moral code of ethics is something I find unconscionable. So, how should I, we and you respond to the undertone of suspicion that has now been created which threatens
our integrity?
The primary goals of
orthodontic therapy can no
longer be the achievement of
a class I canine relationship and
the outcome of the suprabony
environment showing no
attachment loss. In the modern era where sophisticated CBCT imaging and simulation software programs are readily available that allow for accurate risk assessment before adult orthodontic treatment begins, using gingival recession as the barometer for when to halt expansion of the dental arches can no longer be justified.
If we consider the origins of IDT, Morton Amsterdam,
DDS can largely be credited with ushering in the need for interdisciplinary collaboration in his periodontal-prosthesis concepts that were centered on saving teeth. He is quoted as saying: “There may be many ways to treat a disease, but there can only be but one correct diagnosis.” In a similar context, would we accept a diagnosis of hypertension from a physician and the subsequent prescription of anti- hypertension medications if only the systolic pressure was considered? If not, my question is: Are we as a profession, fundamentally treatment planning our patients with a biologic compass and a periodontal conscience or has the glamour of digital dentistry usurped our critical thinking skills and marginalized the value of collaboration?
Periodontal phenotype must be carefully evaluated, diagnosed and considered when we are planning implant surgery or orthodontic therapy in adults. The availability of CBCT imaging technology and the use of advanced simulation software that allows us to accurately predict the impact of tooth movement on the dentoalveolar complex should be an emerging standard of care.
When one considers periodontal phenotype, it is
the orthodontist that is the earliest caretaker of the periodontium and is, perhaps, the specialty that has the greatest potential to impact human growth and direct (or re-direct) systemic health care conditions by optimizing airway structure, function and behavior at an early age.
For those whose craniofacial phenotype has not been optimized and are more skeletally mature, the advent
of non-surgical skeletal expansion therapies to help decompensate the transverse maxillary deficiency and improve nasal breathing/resistance for patients suffering from upper airway resistance syndrome and associated sleep disordered breathing conditions has opened entirely new opportunities.
Continues on page 17
Dr. George A. Mandelaris
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