Case Study:
When tooth alignment goals meet gum disease
From gum therapy to aligners, one step at a time.
Patient concerns
Mr D first visited Dr Jen at Simply Teeth with two main concerns: persistent gum bleeding with bad breath, and crowded lower front teeth. The overlapping teeth made daily cleaning more difficult and were contributing to his gum problems.
His priority was clear—address his gum health first, then proceed with clear aligners to improve alignment and make cleaning more effective.
Examination and findings
After a comprehensive check-up and periodontal assessment, we noted the following:
Gum health: The gums appeared inflamed with bleeding on probing. There was visible plaque and tartar along the gumline, as well as early periodontal pocketing, consistent with mild to moderate periodontitis.
Tooth position: Noticeable crowding was present in the lower front teeth, with overlapping incisors creating areas where plaque and tartar were more likely to accumulate.
Oral hygiene function: The overlapping teeth made flossing and thorough cleaning more difficult.
General health: No underlying medical conditions contributing to gum disease were identified. The patient is a non-smoker.
- Generalised mild-to-moderate periodontitis
- Lower anterior crowding
Mr D’s treatment plan was set out in two steps: first improving his gum health, then beginning orthodontic correction.
Phase 1: Gum disease treatment and stabilisation
Oral hygiene instruction: Dr Jen provided tailored education on effective brushing techniques and introduced interdental brushes to help Mr D clean the crowded areas more effectively.
Professional cleaning: We performed comprehensive scaling and root surface debridement (deep cleaning below the gumline) over multiple appointments, with local anaesthesia provided for comfort.
Supportive care: Polishing was carried out and desensitising agents were applied where needed.
Adjunctive therapy: Dr Jen prescribed a short course of antimicrobial mouthrinse and delivered localised treatment in deeper sites.
Re-evaluation: A follow-up appointment was scheduled to assess healing, measure improvements in gum health, and confirm stability before moving to the next stage.
Phase 2: Orthodontic correction with clear aligners
Commencement only after stability: Clear aligner treatment was scheduled to begin only once gums were healthy and inflammation was under control.
Treatment planning: The aligners were designed to gradually create space and correct the crowding in his lower front teeth. Where needed, minor reshaping between teeth (interproximal reduction) would be carried out to support long-term stability.
Ongoing hygiene support: Throughout treatment, Dr Jen reinforced oral hygiene techniques at every stage to help prevent gum relapse during tooth movement.
Retention phase: Once alignment is complete, retainers will be prescribed to maintain the new positions and support long-term gum and oral health.
Treatment progress
Following periodontal therapy and tailored hygiene instruction, Mr D showed significant improvement:
Gum health: Bleeding and inflammation were reduced, with healthier gum tone observed.
Oral hygiene: Daily plaque control improved, including in previously hard-to-reach areas around the crowded lower front teeth.
Breath: Oral freshness was noticeably improved.
Clinical findings: At re-examination, periodontal pocket depths had decreased, confirming that gum stability had been achieved.
With this healthier foundation, Mr D could safely continue to the next phase of treatment with clear aligners. Orthodontic correction will help address the lower anterior crowding, reduce areas where plaque can accumulate, and support long-term gum and oral health.
Healthy gums before straightening teeth
Mr D’s case highlights the importance of establishing healthy gums before moving on to more advanced treatments like orthodontics. By addressing gum disease first, we created a stable foundation for clear aligner therapy. Correcting the crowding with aligners will not only improve tooth alignment but also make daily cleaning more effective, supporting long-term gum and oral health.
