Tooth movement into a suspected area of periodontosis is possible if sufficient time is allowed for fillin g of the socket. This report describes a 19-year-old woman with periodontosis who had orthodontic therapy and periodontal surgery five years after the initial examination. The disease was arrested and occlusion established through the com bined approach of orthodontic and periodontic treatment.
Treatment of periodontosis by combined orthodontic and periodontal approach: report of case
Marvin C. Goldstein, DOS Michael E. Fritz, DDS, PhD, MS, Atlanta ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ I Periodontosis has been reported in the dental literature1 for w ell over a quarter o f a century, and a technique for treatment is still obscure. G ottlieb2 w rote that periodontosis w as a disease o f eruption in which the tooth migrated out o f alignment; he suggested that a cem entopathia was present in the disease process. O ther3-6 re ports in the literature have attem pted to link the disease to various system ic conditions or m eta bolic im balances. Although there have been re ports associating periodontosis with a hyperkeratotic syndrom e,4,5 blood dyscrasia,6 and release o f macrophage migration inhibition fac tor in the d ise a se ,7 no definite causation has been established. For treatm ent o f periodontosis, a report by N ahoum and Tennenbaum 8 on a series o f pa tients show ed that splinting o f teeth for a period o f 17 to 20 years seem ed to have a beneficial long-range effect. Other authors9 have used bone fill procedures. T his report describes a case o f periodontosis in a patient w ho was given conser vative periodontal and orthodontic treatment for
several years. When the d isease appeared to be arrested, periodontal surgery and restorative work w ere performed.
Report of case When this patient, a 19-year-old black w om an, appeared for exam ination, her mandibular left first molar had been extracted because o f bone loss, and there w ere deep vertical bony defects around the maxillary first molars bilaterally, and evidence o f bone loss in the region o f the man dibular right first molar. In addition, there was vertical bone loss around the maxillary right and left lateral incisors, and evid en ce o f a vertical lesion betw een the maxillary right bicuspids (F ig 1). Pocket depths ranged from 2 mm around healthy teeth to 10 mm around the maxillary first molars and the maxillary right lateral incisor. T he patient’s medical history was normal. T he patient had a severe C lass II, division 1 JADA, V ol. 93, N ovem ber 1976 ■ 985
Fig 1 ■ Preoperative radiographs. Note spacing of teeth and evidence of per iodontic breakdown throughout arch.
m alocclusion with the maxillary anterior teeth protruding and spaced (F ig 2). The mandibular anterior teeth occluded in the soft tissue behind the cingulum o f the maxillary anterior teeth, and the gingival tissues were inflamed. M obility o f 1 mm or more was recorded for the maxillary and mandibular incisors, and the maxillary first mo lars. A lthough the result o f occlusal trauma and open contacts in the molar and incisor area were evident, a presum ptive diagnosis o f periodonto sis associated with periodontitis w as m ade. At the initial exam ination, it could not be deter mined whether the open contacts in the posterior region w ere the result— or the cause— o f the deep vertical defects and migration o f teeth. A fter deliberation, w e concluded that the prog nosis o f the tw o maxillary first molars w as hope less, and these w ere scheduled for extraction. Since the third molars w ere erupting, it w as de cided that the second and third molars could be m oved anteriorly to assum e the position o f the first and second molars respectively. T he same approach was to be used on the mandibular left segm ent, where there had been evidence o f pos terior bite collapse and tipping o f the second molar into the first molar space. T he teeth were to be uprighted and then m oved in an anterior direction, so that the second molar would be po sitioned in the first molar region and the third molar would be positioned in the second molar region. During orthodontic treatment, the pa tient w as scheduled for periodic exercises in oral 986 ■ JADA, Vol. 93, November 1976
Fig 2 ■ Preoperative photographs of patient. Top, right lateral view; center, frontal view; and bottom, left lateral view.
physiotherapy; during the appointment she would be given a local anesthetic, so that deep scaling and curettage procedures could be per form ed. It was decided that the teeth could be m oved and retained in proper position, and the oral cavity evaluated for future periodontal sur gery. In May 1969, after the treatment plan was de termined, the patient was referred to an oral sur geon for extraction o f the maxillary right and left first molars. Orthodontic treatment was delayed for three months because w e have found when teeth are orthodontically m oved into a suspected
area o f periodontosis, they often becom e afflict ed. W e also have observed that if bone healing was adequate before tooth m ovem ent was ini tiated, typical orthodontic procedures could be used. In Septem ber 1969, all teeth w ere banded. The second molars were given 0 .0 2 2 x 0 .0 1 8 buccal tube attachm ents; and the premolar, canine, and incisor bands, 0.018 edgew ise bracket attach m ents. A fter initial bracket alignment with light
round arches, 0 .0 1 6 x 0 .2 2 rectangular arches w ere placed so the posterior teeth would remain upright while space closure was progressing. C lass II elastics w ere used to retract the m axil lary anterior teeth, and medium and heavy elastic thread ligature was used to close the spaces caused by loss o f the first molars. T he orthodon tic procedure was com pleted with auxiliaries to upright the maxillary and mandibular anterior teeth by exerting lingual root torquing. Orthodontic treatment lasted 24 m onths, and rem ovable maxillary and mandibular retainers w ere placed in January 1972. During orthodon tic treatment, the teeth were scaled and curetted at regular intervals, and hom e care was em pha sized. A dvanced periodontal disease was evident in the regions o f other teeth, especially the m axil lary lateral incisors, but it was decided to per form orthodontic therapy first, and determine later if these teeth could be retained. This would alleviate the need for temporary prostheses dur ing orthodontic treatment. Figures 3 and 4 show the status o f the patient on removal o f orthodon tic appliances in January 1972, before occlusal adjustment and retention were initiated. Since tooth mobility still w as evident after orthodontic treatment and retention, it was de cided that periodontal surgery w ould not be done at that tim e, and an attempt would be made to obtain further stability o f the teeth. Radiographs (Fig 4) show lamina dura around m ost teeth, but a deep vertical defect appears to be present be tw een the maxillary right cuspid and lateral inciFig 4 ■ Full-mouth radiographic series immediately after orthodontic therapy. Radiographs correspond to clinical photographs shown in Figure 3.
Fig 3 ■ Photographs of patient immediately after orthodontic treatment and before retention and occlusal adjustment. Top, right lateral view; center, frontal view; and bottom, left lateral view. G oldstein— Fritz: ORTHODONTIC AND PERIODONTIC APPROACH TO PERIODONTOSIS ■ 987
Fig 5 ■ Probe measurement of periodontic defect on distal as
Fig 7 ■ Same area depicted in Figure 6, after osteoectomy-
pect of maxillary right lateral incisor. Probe passes about 9 mm
osteoplasty procedures and before closure of mucoperiosteal
into underlying tissue.
flaps.
Fig 6 ■ View of maxillary left quadrant at time of periodontal surgery. Full-thickness mucoperiosteal flap has been reflected.
Fig 8 ■ Full-thickness mucoperiosteal flap has been reflected around region of maxillary left anterior and posterior segments.
Notice height of alveolar crest, and rolled contours of bone that
Notice vertical periodontal defect on distal aspect of maxillary
would be reduced by osteoectomy-osteoplasty procedures.
left lateral incisor.
sor; and there is som e evidence o f horizontal bone loss in other areas o f the mouth. T he pa tient was observed for about one m ore year, and no additional signs o f periodontal breakdown w ere seen. T he teeth had stabilized noticeably, and periodontal surgery could be initiated for elim ination o f periodontal pockets. W e considered periodontal surgery, with fullthickness m ucoperiosteal flaps and osteoectom yosteoplasty procedures on all quadrants. H ow ever, after evaluation before surgery, a 9-mm periodontal defect was found on the distal as pect o f the root o f the maxillary right lateral inci sor (F ig 5). It was decided that extraction o f this tooth should first be com pleted, and then a tem porary prosthesis built since this approach would im prove the prognosis for the maxillary right cuspid. T he tooth was extracted, and a tempor ary prosthesis constructed before periodontal surgery. Figures 6 and 7 depict osteoectom y-
osteoplasty procedures on the maxillary left quadrant and are included because they clearly show the level o f the coronal positioning o f the alveolar bone surrounding the teeth that had been orthodontically m oved. Figure 8 show s the maxillary left incisor, which also had a vertical defect, but this could be adequately treated by com bination o f osseou s recontouring and o sse ous fill procedures. Intraoral sources w ere used for the donor material. Figure 9 show s the patient one year after per iodontal surgery, and three years after orthodon tic treatm ent, with the permanent prosthesis cem ented in position. The tissue in m ost areas looks healthy, although there is slight inflam mation in the region o f the mandibular central incisors from lack o f home care by the patient. In addition, there is slight inflammation around the maxillary left cuspid, also from inadequate home care.
988 ■ JADA, Vol. 93, November 1976
Fig 10 ■ Radiographs corresponding to clinical slides in Figure 9.
Furthermore, the regions originally associated with large vertical osseou s defects no longer show the defects.
D iscu ssio n
Fig 9 ■ Patient one year after periodontal surgery and after in sertion of permanent prosthesis on maxillary anterior segment. Top, right lateral view; center, frontal view; and bottom, left lat eral view.
T he radiographs (Fig 10) show a four-unit prosthesis constructed from the maxillary left central incisor to the maxillary right cuspid. Spaces remain betw een som e teeth, such as in the maxillary left second and third molar region, and these will be observed in the future; if home care is inadequate, these regions will be evalu ated for possible restorative treatment. T he ra diographs (Fig 10) also show that, as the teeth have been m oved in an anterior direction, the crestal bone has maintained a high coronal level.
This report illustrates how a functionally ade quate occlusion was created in a patient with ob vious m alocclusion after periodontosis had been arrested; and orthodontic m ovem ent o f teeth into a suspected area o f periodontosis can be ac com plished if sufficient time is allowed for the socket to heal. T he final cephalic radiographs and tracings show that the mandibular incisors were retract ed 6° and that the mandibular facial angle in creased to 62°; this, according to the T w eed 10 concept, indicates an acceptable facial form (Fig 11). T he treatment result show s few indica tions o f pathosis. After com pletion o f periodon tal surgery and orthodontic m ovem ent o f teeth (five years after the initial exam ination) tooth mobility has noticeably diminished. There is no pathologic tooth m obility, except for the mandib ular incisors, which dem onstrate mobility o f approximately V2 mm. The clinical and radiological criteria for perio dontosis have been d efin ed .11,12 Baer11 reported that in a few patients, the loss o f alveolar bone progresses to a certain point; and in som e forms o f the disease, the rate o f destruction diminishes in early adulthood. This may have occurred in the patient.
G oldstein— Fritz: ORTHODONTIC AND PERIODONTIC APPROACH TO PERIODONTOSIS ■ 989
Fig 11 ■ Lateral cephalometric head film tracing. Left, before orthodontic treatment; right, after orthodontic treatment.
This report also shows that orthodontic m ove ment o f teeth into a suspected area o f periodon tosis is possible if sufficient time is allowed for filling o f the socket. Furthermore, in this patient, orthodontic tooth movement into a region asso ciated with periodontosis appeared to bring alve olar bone with it. This phenomenon in patients with periodontitis has recently been described in the periodontal literature.13
Summary and conclusion A 19-year-old patient with a presumed case of periodontosis was treated by orthodontics and periodontal surgery after the disease was thought to be arrested. F ive years after the initial exam ination, the periodontosis is arrested and occlu sion established.
Dr. Goldstein is clinical professor of orthodontics in the School of Dentistry, Medical College of Georgia. Dr. Fritz is chairman and professor in the department of periodontology, Emory Univ
990 ■ JADA, Vol. 93, November 1976
ersity School of Dentistry. Address requests for reprints to Dr. Goldstein, West Paces Ferry Professional Park, Suite 100-103, 1218 W Paces Ferry Rd NW, Atlanta, 30327. 1. Orban, B., and Weinmann, J.P. Diffuse atrophy of the alveo lar bone (periodontosis). J Periodontol 13:31 Jan 1942. 2. Gottlieb, B. New concept of periodontoclasia. J Periodontol 17:7 Jan 1946. 3. Miller, S.C.; Wolf, W.A.; and Seidler, B.B. Generalized rapid alveolar atrophy. J Dent Res 19:306 June 1940. 4. Dekker, G.; and Jansen, L.H. Periodontosis in a child with hyperkeratosis palmo-plantaris. J Periodontol 29:266 Oct 1958. 5. Carvel, R.l. Palmar-plantar hyperkeratosis and premature periodontal destruction. (Papillon-Lefevre Syndrome in a 30-year study of two affected sisters.) J Oral Med 24:73 July-Oct 1969. 6. Cohen, D.W., and Morris, A.L. Periodontal manifestations of cyclic neutropenia. J Periodontol 32:159 April 1961. 7. Lehner, T., and others. Immunological aspects of juvenile periodontitis (periodontosis). J Periodont Res 9(5):261, 1974. 8. Nahoum, H.I., and Tennenbaum, B. Long term study of per iodontosis. J Periodontol 45:765 Oct 1974. 9. DeMarco, T.J., and Scaletta, L.J. The use of autogenous hip marrow in the treatment of juvenile periodontosis: a case report. J Periodontol 41:683 Dec 1970. 10. Tweed, C.H. Clinical orthodontics. St. Louis, C. V. Mosby Co., 1966, vol 1, p 33. 11. Baer, P.N. The case for periodontosis as a clinical entity. J Periodontol 42:516 Aug 1971. 12. Fourel, J. Periodontosis: a periodontal syndrome. J Per iodontol 43:240 ApriM 972. 13. Ingber, J.S. Forced eruption: a method of treating isolated one and two wall infrabony osseous defects—rationale and case report. J Periodontol 45:199 April 1974.
Treatment of periodontosis by combined orthodontic and periodontal approach: report of case
Marvin C. Goldstein, DOS Michael E. Fritz, DDS, PhD, MS, Atlanta ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ I Periodontosis has been reported in the dental literature1 for w ell over a quarter o f a century, and a technique for treatment is still obscure. G ottlieb2 w rote that periodontosis w as a disease o f eruption in which the tooth migrated out o f alignment; he suggested that a cem entopathia was present in the disease process. O ther3-6 re ports in the literature have attem pted to link the disease to various system ic conditions or m eta bolic im balances. Although there have been re ports associating periodontosis with a hyperkeratotic syndrom e,4,5 blood dyscrasia,6 and release o f macrophage migration inhibition fac tor in the d ise a se ,7 no definite causation has been established. For treatm ent o f periodontosis, a report by N ahoum and Tennenbaum 8 on a series o f pa tients show ed that splinting o f teeth for a period o f 17 to 20 years seem ed to have a beneficial long-range effect. Other authors9 have used bone fill procedures. T his report describes a case o f periodontosis in a patient w ho was given conser vative periodontal and orthodontic treatment for
several years. When the d isease appeared to be arrested, periodontal surgery and restorative work w ere performed.
Report of case When this patient, a 19-year-old black w om an, appeared for exam ination, her mandibular left first molar had been extracted because o f bone loss, and there w ere deep vertical bony defects around the maxillary first molars bilaterally, and evidence o f bone loss in the region o f the man dibular right first molar. In addition, there was vertical bone loss around the maxillary right and left lateral incisors, and evid en ce o f a vertical lesion betw een the maxillary right bicuspids (F ig 1). Pocket depths ranged from 2 mm around healthy teeth to 10 mm around the maxillary first molars and the maxillary right lateral incisor. T he patient’s medical history was normal. T he patient had a severe C lass II, division 1 JADA, V ol. 93, N ovem ber 1976 ■ 985
Fig 1 ■ Preoperative radiographs. Note spacing of teeth and evidence of per iodontic breakdown throughout arch.
m alocclusion with the maxillary anterior teeth protruding and spaced (F ig 2). The mandibular anterior teeth occluded in the soft tissue behind the cingulum o f the maxillary anterior teeth, and the gingival tissues were inflamed. M obility o f 1 mm or more was recorded for the maxillary and mandibular incisors, and the maxillary first mo lars. A lthough the result o f occlusal trauma and open contacts in the molar and incisor area were evident, a presum ptive diagnosis o f periodonto sis associated with periodontitis w as m ade. At the initial exam ination, it could not be deter mined whether the open contacts in the posterior region w ere the result— or the cause— o f the deep vertical defects and migration o f teeth. A fter deliberation, w e concluded that the prog nosis o f the tw o maxillary first molars w as hope less, and these w ere scheduled for extraction. Since the third molars w ere erupting, it w as de cided that the second and third molars could be m oved anteriorly to assum e the position o f the first and second molars respectively. T he same approach was to be used on the mandibular left segm ent, where there had been evidence o f pos terior bite collapse and tipping o f the second molar into the first molar space. T he teeth were to be uprighted and then m oved in an anterior direction, so that the second molar would be po sitioned in the first molar region and the third molar would be positioned in the second molar region. During orthodontic treatment, the pa tient w as scheduled for periodic exercises in oral 986 ■ JADA, Vol. 93, November 1976
Fig 2 ■ Preoperative photographs of patient. Top, right lateral view; center, frontal view; and bottom, left lateral view.
physiotherapy; during the appointment she would be given a local anesthetic, so that deep scaling and curettage procedures could be per form ed. It was decided that the teeth could be m oved and retained in proper position, and the oral cavity evaluated for future periodontal sur gery. In May 1969, after the treatment plan was de termined, the patient was referred to an oral sur geon for extraction o f the maxillary right and left first molars. Orthodontic treatment was delayed for three months because w e have found when teeth are orthodontically m oved into a suspected
area o f periodontosis, they often becom e afflict ed. W e also have observed that if bone healing was adequate before tooth m ovem ent was ini tiated, typical orthodontic procedures could be used. In Septem ber 1969, all teeth w ere banded. The second molars were given 0 .0 2 2 x 0 .0 1 8 buccal tube attachm ents; and the premolar, canine, and incisor bands, 0.018 edgew ise bracket attach m ents. A fter initial bracket alignment with light
round arches, 0 .0 1 6 x 0 .2 2 rectangular arches w ere placed so the posterior teeth would remain upright while space closure was progressing. C lass II elastics w ere used to retract the m axil lary anterior teeth, and medium and heavy elastic thread ligature was used to close the spaces caused by loss o f the first molars. T he orthodon tic procedure was com pleted with auxiliaries to upright the maxillary and mandibular anterior teeth by exerting lingual root torquing. Orthodontic treatment lasted 24 m onths, and rem ovable maxillary and mandibular retainers w ere placed in January 1972. During orthodon tic treatment, the teeth were scaled and curetted at regular intervals, and hom e care was em pha sized. A dvanced periodontal disease was evident in the regions o f other teeth, especially the m axil lary lateral incisors, but it was decided to per form orthodontic therapy first, and determine later if these teeth could be retained. This would alleviate the need for temporary prostheses dur ing orthodontic treatment. Figures 3 and 4 show the status o f the patient on removal o f orthodon tic appliances in January 1972, before occlusal adjustment and retention were initiated. Since tooth mobility still w as evident after orthodontic treatment and retention, it was de cided that periodontal surgery w ould not be done at that tim e, and an attempt would be made to obtain further stability o f the teeth. Radiographs (Fig 4) show lamina dura around m ost teeth, but a deep vertical defect appears to be present be tw een the maxillary right cuspid and lateral inciFig 4 ■ Full-mouth radiographic series immediately after orthodontic therapy. Radiographs correspond to clinical photographs shown in Figure 3.
Fig 3 ■ Photographs of patient immediately after orthodontic treatment and before retention and occlusal adjustment. Top, right lateral view; center, frontal view; and bottom, left lateral view. G oldstein— Fritz: ORTHODONTIC AND PERIODONTIC APPROACH TO PERIODONTOSIS ■ 987
Fig 5 ■ Probe measurement of periodontic defect on distal as
Fig 7 ■ Same area depicted in Figure 6, after osteoectomy-
pect of maxillary right lateral incisor. Probe passes about 9 mm
osteoplasty procedures and before closure of mucoperiosteal
into underlying tissue.
flaps.
Fig 6 ■ View of maxillary left quadrant at time of periodontal surgery. Full-thickness mucoperiosteal flap has been reflected.
Fig 8 ■ Full-thickness mucoperiosteal flap has been reflected around region of maxillary left anterior and posterior segments.
Notice height of alveolar crest, and rolled contours of bone that
Notice vertical periodontal defect on distal aspect of maxillary
would be reduced by osteoectomy-osteoplasty procedures.
left lateral incisor.
sor; and there is som e evidence o f horizontal bone loss in other areas o f the mouth. T he pa tient was observed for about one m ore year, and no additional signs o f periodontal breakdown w ere seen. T he teeth had stabilized noticeably, and periodontal surgery could be initiated for elim ination o f periodontal pockets. W e considered periodontal surgery, with fullthickness m ucoperiosteal flaps and osteoectom yosteoplasty procedures on all quadrants. H ow ever, after evaluation before surgery, a 9-mm periodontal defect was found on the distal as pect o f the root o f the maxillary right lateral inci sor (F ig 5). It was decided that extraction o f this tooth should first be com pleted, and then a tem porary prosthesis built since this approach would im prove the prognosis for the maxillary right cuspid. T he tooth was extracted, and a tempor ary prosthesis constructed before periodontal surgery. Figures 6 and 7 depict osteoectom y-
osteoplasty procedures on the maxillary left quadrant and are included because they clearly show the level o f the coronal positioning o f the alveolar bone surrounding the teeth that had been orthodontically m oved. Figure 8 show s the maxillary left incisor, which also had a vertical defect, but this could be adequately treated by com bination o f osseou s recontouring and o sse ous fill procedures. Intraoral sources w ere used for the donor material. Figure 9 show s the patient one year after per iodontal surgery, and three years after orthodon tic treatm ent, with the permanent prosthesis cem ented in position. The tissue in m ost areas looks healthy, although there is slight inflam mation in the region o f the mandibular central incisors from lack o f home care by the patient. In addition, there is slight inflammation around the maxillary left cuspid, also from inadequate home care.
988 ■ JADA, Vol. 93, November 1976
Fig 10 ■ Radiographs corresponding to clinical slides in Figure 9.
Furthermore, the regions originally associated with large vertical osseou s defects no longer show the defects.
D iscu ssio n
Fig 9 ■ Patient one year after periodontal surgery and after in sertion of permanent prosthesis on maxillary anterior segment. Top, right lateral view; center, frontal view; and bottom, left lat eral view.
T he radiographs (Fig 10) show a four-unit prosthesis constructed from the maxillary left central incisor to the maxillary right cuspid. Spaces remain betw een som e teeth, such as in the maxillary left second and third molar region, and these will be observed in the future; if home care is inadequate, these regions will be evalu ated for possible restorative treatment. T he ra diographs (Fig 10) also show that, as the teeth have been m oved in an anterior direction, the crestal bone has maintained a high coronal level.
This report illustrates how a functionally ade quate occlusion was created in a patient with ob vious m alocclusion after periodontosis had been arrested; and orthodontic m ovem ent o f teeth into a suspected area o f periodontosis can be ac com plished if sufficient time is allowed for the socket to heal. T he final cephalic radiographs and tracings show that the mandibular incisors were retract ed 6° and that the mandibular facial angle in creased to 62°; this, according to the T w eed 10 concept, indicates an acceptable facial form (Fig 11). T he treatment result show s few indica tions o f pathosis. After com pletion o f periodon tal surgery and orthodontic m ovem ent o f teeth (five years after the initial exam ination) tooth mobility has noticeably diminished. There is no pathologic tooth m obility, except for the mandib ular incisors, which dem onstrate mobility o f approximately V2 mm. The clinical and radiological criteria for perio dontosis have been d efin ed .11,12 Baer11 reported that in a few patients, the loss o f alveolar bone progresses to a certain point; and in som e forms o f the disease, the rate o f destruction diminishes in early adulthood. This may have occurred in the patient.
G oldstein— Fritz: ORTHODONTIC AND PERIODONTIC APPROACH TO PERIODONTOSIS ■ 989
Fig 11 ■ Lateral cephalometric head film tracing. Left, before orthodontic treatment; right, after orthodontic treatment.
This report also shows that orthodontic m ove ment o f teeth into a suspected area o f periodon tosis is possible if sufficient time is allowed for filling o f the socket. Furthermore, in this patient, orthodontic tooth movement into a region asso ciated with periodontosis appeared to bring alve olar bone with it. This phenomenon in patients with periodontitis has recently been described in the periodontal literature.13
Summary and conclusion A 19-year-old patient with a presumed case of periodontosis was treated by orthodontics and periodontal surgery after the disease was thought to be arrested. F ive years after the initial exam ination, the periodontosis is arrested and occlu sion established.
Dr. Goldstein is clinical professor of orthodontics in the School of Dentistry, Medical College of Georgia. Dr. Fritz is chairman and professor in the department of periodontology, Emory Univ
990 ■ JADA, Vol. 93, November 1976
ersity School of Dentistry. Address requests for reprints to Dr. Goldstein, West Paces Ferry Professional Park, Suite 100-103, 1218 W Paces Ferry Rd NW, Atlanta, 30327. 1. Orban, B., and Weinmann, J.P. Diffuse atrophy of the alveo lar bone (periodontosis). J Periodontol 13:31 Jan 1942. 2. Gottlieb, B. New concept of periodontoclasia. J Periodontol 17:7 Jan 1946. 3. Miller, S.C.; Wolf, W.A.; and Seidler, B.B. Generalized rapid alveolar atrophy. J Dent Res 19:306 June 1940. 4. Dekker, G.; and Jansen, L.H. Periodontosis in a child with hyperkeratosis palmo-plantaris. J Periodontol 29:266 Oct 1958. 5. Carvel, R.l. Palmar-plantar hyperkeratosis and premature periodontal destruction. (Papillon-Lefevre Syndrome in a 30-year study of two affected sisters.) J Oral Med 24:73 July-Oct 1969. 6. Cohen, D.W., and Morris, A.L. Periodontal manifestations of cyclic neutropenia. J Periodontol 32:159 April 1961. 7. Lehner, T., and others. Immunological aspects of juvenile periodontitis (periodontosis). J Periodont Res 9(5):261, 1974. 8. Nahoum, H.I., and Tennenbaum, B. Long term study of per iodontosis. J Periodontol 45:765 Oct 1974. 9. DeMarco, T.J., and Scaletta, L.J. The use of autogenous hip marrow in the treatment of juvenile periodontosis: a case report. J Periodontol 41:683 Dec 1970. 10. Tweed, C.H. Clinical orthodontics. St. Louis, C. V. Mosby Co., 1966, vol 1, p 33. 11. Baer, P.N. The case for periodontosis as a clinical entity. J Periodontol 42:516 Aug 1971. 12. Fourel, J. Periodontosis: a periodontal syndrome. J Per iodontol 43:240 ApriM 972. 13. Ingber, J.S. Forced eruption: a method of treating isolated one and two wall infrabony osseous defects—rationale and case report. J Periodontol 45:199 April 1974.
