The intersection of orthodontics and periodontology has gained increasing attention as more adults with compromised periodontal support seek orthodontic treatment to address malocclusions and pathologic tooth migration resulting from periodontitis. This scoping review synthesizes contemporary evidence from peer-reviewed literature published on orthodontic interventions in patients with reduced periodontal attachment, focusing on treatment models, outcomes, and risks. A comprehensive search of databases such as PubMed was conducted to identify systematic reviews, randomized controlled trials, and clinical studies. Key themes include the necessity for prior periodontal stabilization, modified biomechanics to minimize forces, interdisciplinary collaboration, and long-term retention strategies. Evidence indicates that orthodontic treatment in periodontally compromised patients can improve esthetics, function, and periodontal parameters when preceded by effective periodontal therapy. Systematic reviews highlight small improvements in probing depths and attachment levels, with no significant adverse effects if inflammation is controlled. Randomized trials demonstrate comparable survival rates between regenerative periodontal approaches and extraction/implant replacement, with lower costs for regeneration. However, heterogeneity in study designs and low evidence quality underscore the need for high-quality researc. Retention protocols, including fixed or removable retainers, are crucial for stability, though evidence on optimal strategies remains limited.
