In what scenario should periodontal grafting be performed before orthodontic treatment?

Periodontal grafting should be performed before orthodontic treatment specifically when attachment needs are present. This scenario is critical because the health of the supporting structures around the teeth, particularly the periodontal ligaments and alveolar bone, can directly influence the success of orthodontic movements. If there is inadequate attachment due to periodontal disease, there's a high risk of adverse outcomes during and after orthodontic treatment, such as additional attachment loss or mobility of the teeth.

When periodontal grafting is done beforehand, it helps restore the needed gingival tissue and attachment levels, ensuring a more stable environment for orthodontic forces to act upon. Addressing the periodontal needs first lays a solid foundation for subsequently moving teeth into their desired positions without compromising periodontal health.

In contrast, considering the other scenarios: performing grafting solely for cosmetic reasons may not address the functional stability required for effective orthodontic treatment. If recession is not an issue, then the underlying attachment levels might still be deficient, meaning grafting could still be necessary. Lastly, while some cases may be straightforward and not require grafting, it is not universally applicable in all situations, highlighting the importance of assessing each patient’s periodontal condition individually.