Fig. 1.

a, b, c, d, e, f, g) Proclination of the maxillary left central incisor due to a combination of reduced alveolar bone support and lip incompetence. Other orthodontic hallmarks of periodontal disease including extrusion of the upper left central incisor, local rotations and over-eruption was also present. Irregular spacing in the upper midline and distal to the upper left canine was also present. h, i, j, k) Following open flap debridement and periodontal regeneration in the upper right canine-first premolar region, fixed appliances were placed. It was hoped that the infra-boney defect in the maxillary incisor region would respond to simple debridement allied to orthodontic intrusion. l, m, n, o, p) She was treated with fixed appliances over a 6.5-month period with local interproximal reduction to reduce the dimensions of the open gingival embraces, particularly in the upper anterior region. q, r, s, t, u, v, w) A well-interdigitated Class I occlusion was obtained with the outcome retained using a combination of fixed and removable retainers. Reattachment occurred in the upper anterior region with local intrusion being favoured in order to maximise this beneficial effect of appliance therapy