The increasing prevalence of periodontal disease among adults seeking orthodontic treatment necessitates a robust interdisciplinary approach to optimize outcomes while minimizing risks. This narrative review synthesizes recent evidence on the management of adult patients with periodontal compromise undergoing orthodontic therapy, with a focus on timing, sequencing, and risk control. Drawing from peer-reviewed studies published between 2020 and 2025, the review highlights the importance of achieving periodontal stability prior to orthodontic intervention, typically through non-surgical and surgical therapies, followed by carefully timed tooth movement. Sequencing strategies emphasize phased integration of periodontal regeneration and orthodontic mechanics, such as early or delayed initiation post-surgery to leverage biological healing processes. Risk mitigation involves light forces, enhanced hygiene protocols, and ongoing monitoring to prevent exacerbation of bone loss, recession, or inflammation. The objectives are to provide clinicians with evidence-based guidelines for interdisciplinary collaboration, ensuring functional, aesthetic, and long-term periodontal health. Key findings underscore that, when inflammation is controlled, orthodontic treatment can enhance periodontal parameters without significant adverse effects, but requires individualized planning based on disease severity and patient compliance.
