Orthodontic Tooth Movement in Periodontally Compromised Patients: Biological Basis and Clinical Complications

Orthodontic treatment in patients with periodontitis, particularly stages III and IV, presents significant clinical challenges owing to compromised periodontal support, alveolar bone loss, and elevated inflammatory response. This narrative review explores the biological interactions between orthodontic forces and periodontal tissues in periodontitis patients, aiming to clarify mechanisms of inflammation, bone remodelling, and implications for clinical decision-making. A comprehensive literature search was conducted using PubMed, Scopus, ScienceDirect, and Google Scholar, limited to English-language articles published between January 2015 and January 2025. Relevant studies were retrieved using keywords such as “biology” OR “periodontium” OR “tooth supporting structures” OR “inflammation” OR “cell and tissue-based therapy” AND “orthodontic” AND “tooth movement” AND “periodontitis,” focusing on biological responses of periodontal tissues during orthodontic therapy in periodontally compromised individuals. Current evidence demonstrates a complex interplay of periodontal ligament adaptation, alveolar bone turnover, and inflammatory mediators, including cytokines and prostaglandins, in response to orthodontic forces. Alterations in the subgingival microbiota and systemic host responses further influence treatment stability. Regenerative periodontal interventions, including guided tissue regeneration and bone grafting, appear promising in enhancing periodontal support during orthodontic tooth movement. Successful management of orthodontic treatment in periodontitis patients demands a multidisciplinary approach, precise control of mechanical forces, and modulation of inflammation. Integrating regenerative therapies and host-modulatory strategies holds potential to improve long-term periodontal stability and treatment outcomes.