牙周炎患者的修复前正畸治疗

目的：观察修复前正畸治疗牙周炎的疗效。方法：对42例伴错He、牙移位、牙缺失的牙周炎患,用Tip-Edge技术矫治,结合修复及牙周治疗手段,消除He创伤,建立正常咬合关系,随访1年观察其疗效。结果：有效率为90．48％,无效4例,占9．52％,均于治疗过程中出现牙松动加重或被拔除。结论：通过正畸、修复和牙周治疗的综合作用,能有效控制炎症、消除创伤,以利牙周组织恢复健康。     

牙周炎致错位前牙正畸治疗后牙根吸收的临床研究

目的：观察牙周炎导致的唇向散开前牙经正畸治疗后牙根吸收情况,并与牙周健康的正畸患者进行比较。方法：选择安氏Ⅰ或Ⅱ1前牙散在间隙的成人牙周炎患者和牙周健康的成人正畸患者各12例,均无需拔牙,采用MBT直丝弓固定矫治,应用Nemoceph头影测量软件测量矫治前后前牙的牙冠与牙根比值,并作配对t检验,判断其牙根吸收程度。结果：矫治后两组均有轻度牙根吸收（P〈0.05）,牙周炎组牙根吸收程度较牙周健康组大,但二组间差别无统计学意义。结论：牙周炎患者和牙周健康患者正畸治疗后牙根均有一定程度吸收,但是可接受的。牙周炎患者通过正畸关闭前牙散在间隙并不会加重牙根吸收。     

无托槽隐形矫治中牙周炎患者下切牙压低的三维有限元研究

研究不同硬度及矫治位移量隐形矫治器在牙周炎患者切牙压低时的生物力学机制。方法:建立轻、中度牙周炎患者的三维有限元模型,分析415.6 MPa、528.0 MPa、816.31 MPa硬度及0.15 mm、0.2 mm隐形矫治器在切牙压低时牙齿位移趋势及牙周膜应力分布情况。结果:8组工况切牙均表现为伴唇侧倾斜的压低,隐形矫治器硬度增加,垂直向位移趋势增加,唇侧倾斜趋势减小而随着矫治位移量增加,唇侧倾斜趋势增大。牙周膜最大应力分布于牙颈部和根尖区,最小应力分布于根中部。随着硬度增加,牙周膜整体应力值增大,牙颈部应力分布更均匀而随着矫治位移量增加牙颈部应力更集中。结论:隐形矫治器硬度增大,有利于提高矫治器效能和三维向控制,矫治位移量增加不利于三维向控制。临床上建议使用中等硬度矫治器,配合较小的步距可以实现牙齿压低,维护牙周组织健康。     

嵴上纤维环切辅助正畸压低牙周炎患牙的研究进展

随着人们对口腔健康及美观意识的提高,成年正畸患者逐渐增多,成年人的牙周状况较差,常有牙根暴露、附着丧失、松动度增加、前牙扇形移位等临床表现。近年来有研究报道,嵴上纤维环切术联合正畸治疗可以增加牙周炎患牙骨内根长、减少附着丧失、改善牙周炎患者的牙周状况和美观。本文就嵴上纤维环切术辅助牙周炎患牙正畸压低的背景、临床操作及效果作一综述。     

猴牙压低的实验研究

<正> 在正畸牙齿移动的诸类型中,垂直方向的移动方式比较独特,效果较难产生,产生后还易复发。此外,力值较难掌握,力量过大易使牙齿松动加剧,甚至造成根尖血循环障碍导致牙髓坏死;力量小时难以取得疗效,尤其是牙齿的压低移动。本文的目的是探索猴下切牙压低的实际效果,观察猴牙压低过程中的组织学特征,为临床提供理论根据。     

不同类型的辅弓在正畸前牙压低中的应用与研究进展

前牙深覆是临床中常见的疑难错畸形,常伴随有不同程度的关节、牙周及美观等问题。压低辅弓是目前临床中治疗前牙深覆的主要方式之一。压低辅弓种类繁多,不同辅弓在适应证、疗效、不良反应、弓丝弯制及生物力学等方面存在差异。在临床实践中,正畸医生应根据目标位及患者牙槽骨情况选择合适的辅弓类型,并适时调整压低力的大小和方向,以达到最佳的效果。本文就不同类型的压低辅弓的应用和研究进展作一综述,以期为临床研究的开展及临床实践提供一定的参考。     

成人牙周炎患者正畸后四种保持器的临床应用

目的：研究成人牙周炎患者正畸后保持牙台稳定的有效方法，提高正畸治疗成功率。方法：40例成人牙周炎病例正畸完成后随机分成A、B、C、D四组，分别用四种保持器来维护疗效，A组应用钢丝联合光敏树脂固定保持器；B组应用Hawley活动保持器；C组应用夹板式可摘铸造保持器；D组应用固定桥保持器。比较治疗后3、6、12个月后牙周临床症状及X线片的改变。结果：D组菌斑指数、牙龈指数、龈沟出血指数、牙周指数及牙槽骨吸收程度明显低于其他三组。结论：成人牙周炎患者正畸完成后使用固定桥形式的保持器效果好。     

牙周组织再生术-正畸联合治疗牙周炎患者的初步研究

目的 通过比较治疗前后牙周组织健康指数的变化,探讨牙周组织再生术联合正畸治疗牙周炎患者的疗效,为成人牙周病患者的治疗提供临床参考.方法 选择成人患者11例,包含17颗具有角形牙槽骨吸收的患牙,患牙同时存在不同程度的咬合创伤.对其进行牙周组织再生术联合正畸治疗,分别记录再生性手术前后以及联合治疗后的牙周袋探诊深度与临床附着丧失,应用SPSS 13.0统计软件对治疗前后的牙周指数进行配对t检验.结果 患牙完成再生性手术后,垂直骨缺损侧探诊深度由（5.91±1.05）mm减小为（3.02±1.09）mm,临床附着丧失则从（7.02±1.81） mm减小到（3.83±1.55）mm,患牙6位点平均PPD以及CAL也都明显减小,改变均具有统计学意义;随后的正畸治疗,解除了患牙的咬合创伤,并使得临床附着丧失减小到（3.37±1.22）mm,差异有统计学意义.结论 牙周组织再生术与正畸联合治疗,对于具有角形牙槽骨吸收且伴有（殆）创伤的患牙,不但能够解决创伤问题,且改善了牙周组织健康,使得患者功能和美观均得到了显著提高,是一种安全有效的治疗方法.     

牙周炎致错位前牙的正畸牙周联合治疗

目的　对牙周炎致唇向散开的前牙经环切离断牙槽嵴顶纤维后进行正畸治疗 ,观察其疗效。方法　正畸牙周联合治疗 16例患者唇向散开的上前牙 ,使用临床牙周健康指数分析、根尖片观察牙槽骨高度变化及模型分析的方法比较治疗前后的变化。结果　离断牙槽嵴顶纤维后正畸压入使牙槽骨高度平均增加 1 2mm ,前牙覆盖由 7 0mm减至 2 0mm ,覆由 4 0mm减至 2 0mm;牙周组织健康指数无明显变化。结论　经环切离断牙槽嵴顶纤维后 ,正畸压入治疗在矫正患牙咬合关系的同时可改善牙周组织状况 ,增加牙槽骨高度     

错畸形患者牙周炎症消除后的正畸治疗

对于经牙周治疗消除炎症后的牙周病患者,临床医师应注意正畸力对其牙周组织所产生的效应,并根据此设计牙移动方式。近年来,国内外的相关研究多围绕不同牙移动方式对不同牙周损害类型的作用展开,并对传统观念提供了补充和革新,本文从不同类型牙周损害中的牙移动、不同牙移动方式对剩余牙周组织的影响以及其他需特殊考虑的问题3个方面作一综述。     

Reduction of gingival recession following orthodontic intrusion in periodontally compromised patients

Authors – Re S, Cardaropoli D, Abundo R, Corrente G Objectives – To evaluate the role of orthodontic intrusion and alignment in the reduction of gingival recession (REC) around maxillary incisors of adult periodontal patients. Design – Prospective clinical study. Setting and Sample Population – Twenty‐eight consecutively treated adult patients, suffering from severe chronic periodontitis and with one upper central incisor extruded and infrabony defect on its mesial site. All patients were seen in a private practice in Turin, Italy. At baseline, all patients presented with REC on the buccal and mesial aspects of the treated teeth. Measurements and Results – For each patient probing pocket depth (PPD) and REC were assessed at baseline, at the end of treatment and 1‐year after the end of treatment. REC was also evaluated independently in patients with narrow (NPB) or wide periodontal biotype (WPB). All parameters showed improvement between initial and final measurements statistically, and showed no changes between final and follow‐up measurements. Mean mesial PPD decrease was 4.29 mm, with a residual PPD of 2.50 mm. Mean REC reduction was 0.96 mm on the buccal sites and 1.71 mm on the mesial. No statistical difference was recorded on REC values between groups NPB and WPB. Conclusion – The presented clinical protocol resulted in improvement of all parameters examined. At the end of orthodontic treatment a predictable reduction of REC was reported, both in patients with thin or wide gingiva.     

牙周炎患者种植修复后可疑致病菌的变化研究

目的比较牙周炎种植患者和牙周健康种植患者修复后不同时段几种常见致病菌的变化情况,为牙周炎种植治疗的开展及维护提供微生物学帮助。方法临床选取44名种植患者的55枚种植体,并将其分成A、B两组,A组是有牙周炎病史的患者种植体26枚,为实验组。B组是牙周健康的患者种植体29枚,为对照组。记录了修复后1个月,6个月,12个月四个时段,入选种植牙的菌斑指数,牙龈指数,牙龈出血指数,探诊深度;采用牙龈卟啉单胞菌、中间普氏菌、具核梭杆菌及粘性放线菌的选择性培养基对龈下菌斑标本进行了分离培养、计数,统计分析各项临床和实验室数据。结果横向比较：A、B两组之间牙龈卟啉单胞菌、中间普氏菌、具核梭杆菌、牙龈指数、牙龈出血指数、探诊深度有统计学差异,其余各检测指标无统计学意义。修复后1月时,A、B两组之间牙龈卟啉单胞菌、中间普氏菌计数值已有统计学差异。纵向比较：有牙周炎病史的患者种植体周各指数三个时段纵向比较,牙龈卟啉单胞菌,中间普氏菌,具核梭杆菌,粘性放线菌随时间变化有统计学差异,其余指标随时间变化无统计学差异。结论有牙周炎病史的患者种植体周的微生物指标在种植早期即高于正常种植患者,应指导该类患者及早进行种植牙及天然牙的清洁和维护,预防种植体周围炎的发生,提高牙周炎种植的成功率。     

A comprehensive and critical review of dental implant prognosis in periodontally compromised partially edentulous patients

OBJECTIVES: The outcome of implant treatment in periodontally compromised partially edentulous patients has not been completely clarified. Therefore, the aim of the present study was to perform, applying a systematic methodology, a comprehensive and critical review of the prospective studies published in English up to and including August 2006, regarding the short-term (<5 years) and long-term (>or=5 years) prognosis of osseointegrated implants placed in periodontally compromised partially edentulous patients. MATERIAL AND METHODS: Using The National Library Of Medicine and Cochrane Oral Health Group databases, a literature search for articles published up to and including August 2006 was performed. At the first phase of selection the titles and abstracts and at the second phase full papers were screened independently and in duplicate by the three reviewers (I. K. K., S. K., I. F.). RESULTS: The search provided 2987 potentially relevant titles and abstracts. At the first phase of evaluation, 2956 publications were rejected based on title and abstract. At the second phase, the full text of the remaining 31 publications was retrieved for more detailed evaluation. Finally, 15 prospective studies were selected, including seven short-term and eight long-term studies. Because of considerable discrepancies among these studies, meta-analysis was not performed. CONCLUSIONS: No statistically significant differences in both short-term and long-term implant survival exist between patients with a history of chronic periodontitis and periodontally healthy individuals. Patients with a history of chronic periodontitis may exhibit significantly greater long-term probing pocket depth, peri-implant marginal bone loss and incidence of peri-implantitis compared with periodontally healthy subjects. Even though the short-term implant prognosis for patients treated for aggressive periodontitis is acceptable, on a long-term basis the matter is open to question. Alterations in clinical parameters around implants and teeth in aggressive periodontitis patients may not follow the same pattern, in contrast to what has been reported for chronic periodontitis patients. However, as only three studies comprising patients treated for aggressive periodontitis were selected, more studies, specially designed, are required to evaluate implant prognosis in this subtype of periodontitis. As the selected publications exhibited considerable discrepancies, more studies, uniformly designed, preferably longitudinal, prospective and controlled, would be important.     

Implant therapy in periodontally compromised patients

The present study evaluates the outcome of implant therapy in periodontally compromised patients in need of additional functional tooth support. A total of 3 1 Astra® implants and 93 ITI Dental Implant System implants were inserted in 19 and 56 patients, respectively. The length of the implants varied between 8 and 14 mm. with 45% being 8 mm and 21% being 11 mm or more. Most implants were placed in the maxilla, predominantly in the premolar region, while less than 25% were placed in the mandible. The obser vation period ranged between 12 and 40 months for Astra® implants and between 3 and 84 months for ITI implants. At annual recall visits, 4 sites on all implants were assessed for presence of plaque, bleeding on probing, probing depth, and radiographic assessment of bone loss was performed. A total of 3 implants, all ITI implants, failed, yielding a 3‐year survival rate of 95–lOO%, depending on type of implant. After 3 years, 76–86% of all implants remained free from radiographic bone loss 2 1.5 mm. After 5 years, 55% of the ITI implants remained free from such bone loss. These results indicate that periodontally compromised patients, who have experienced a considerable loss of alveolar bony support, can be successfully treated with implants.     

Effect of orthodontic treatment on periodontal health of periodontally compromised patients:: A randomized controlled clinical trial

ObjectivesTo evaluate the effect of fixed orthodontic treatment on periodontal parameters in periodontally compromised adult orthodontic patients.Materials and MethodsThis was a prospective, randomized, controlled clinical trial. Thirty-six periodontally compromised adult patients (mean age: 29.67 ± 4.8 years) were randomly allocated to either test (perio-ortho) or control group (perio). After periodontal stabilization in both groups, orthodontic treatment was started in the test group, whereas the control group remained on periodontal maintenance only. Evaluation and comparison of clinical parameters (plaque index [PI]; gingival index [GI]; bleeding on probing [BOP]; probing depth [PD]; clinical attachment level [CAL]) of both groups was assessed at three time intervals: T0 (base line), T1 (at start of orthodontic treatment), and T2 (1 year after start of orthodontic treatment). Radiological parameters (alveolar bone levels [ABL]) were recorded using CBCT at T1 and T2.ResultsIntragroup analysis showed statistically significant improvement in all clinical and radiological periodontal parameters in both groups (P ≤ .05). Intergroup comparison revealed improvement in the periodontal parameters was not statistically significant between the groups (P ≥ .05). Subgroup analysis showed reduction in the number of moderate and severe periodontitis sites in both groups with significant more gains in ABL in the test group compared to the control group.ConclusionsOrthodontic treatment after periodontal stabilization does not have any detrimental effect on periodontal health in adult periodontally compromised orthodontic patients and may add to the benefits achieved by periodontal treatment alone.     

The use of implant‐supported titanium prostheses for treatment of periodontally compromised patients including functional and orthodontic therapy. Report of 2 cases.

Due to its corrosion resistance and biocompatibility, titanium appears to be an alternative material for implant-supported restorations. However, due to technological difficulties, the clinical application of titanium in implant restorations has been limited. Only after recent progress in technology could the clinical use of ceramo‐metal titanium restorations be recommended. The therapeutic repertoire for treating patients with missing teeth has been significantly expanded by modem implant methods. Osseointegrated prostheses have become an integral part of restorative therapy also for periodontally compromised dentitions. This article presents 2 case reports for the use of ceramo‐metal implant‐supported titanium cast prostheses for restorative treatment of periodontally compromised patients requiring comprehensive treatment involving periodontal, functional, orthodontic and prosthodontic therapy. Favourable clinical results have been obtained and a complication‐free service of these reconstructions has been documented throughout a 12‐ to 24‐month observation period. These observations suggest that implant‐supported ceramo‐metal titanium prostheses may be a valuable part of restorative therapy for periodontally compromised dentitions in that they facilitate restorations with optimal biocompatibility. However, controlled clinical studies are needed to establish the long‐term serviceability of these titanium restorations.     

口腔正畸患者治疗前丙型肝炎病毒感染状况的调查分析

目的了解口腔正畸科就诊患者治疗前丙型肝炎病毒感染情况,控制口腔途径的医源性交叉感染。方法用酶联免疫吸附试验法(ELISA)检测2000年6月至2001年7月期间在正畸科就诊的2529名患者治疗前血清中丙型肝炎抗体(抗-HCV)。结果抗-HCV阳性率为0.63％(16/2529),抗-HCV阳性者中87.5％(14/16)有输血(或血制品)史;抗-HCV阳性伴谷丙转氨酶(ALT)异常的亚临床型感染者占37.5％(6/16),病毒携带状态者占62.5％。结论输血(或血制品)为本研究患者HCV感染的主要途径;血清抗-HCV阳性患者有可能成为HCV传播者。为有效地控制传染源,防止医院内交叉感染,有必要加强正畸患者矫治前各型肝炎标志物及肝脏功能生化指标的检测。     

Implant therapy involving maxillary sinus lift in periodontally compromised patients

This study reports the results of implant therapy involving a sinus membrane lift as well as conventional implant therapy in 24 periodontally compromised patients who were treated during the period between June 1990 and May 1995. Patients were included on the basis of being in need of at least 2 implants, 1 of which was to be placed in the maxillary sinus region, and at least 3 mm bone height was required in the sinus region. Following fenestration of the lateral sinus wall and lifting of the sinus membrane sinus implants were inserted as described for conventional implants. Annual follow‐up visits included recording of plaque, probing pocket depth and bleeding on probing, and recording of the radiographic distance from the implant shoulder to the alveolar crest in mm. The Astra®, Astra® sinus, ITI®, and ITI® sinus were observed for an average of 30.8, 29.9,29.4 and 25.3 months, respectively. Of the 80 implants inserted 1 Astram and 2 ITI® hadfailed at 11–12 months and 1 ITI® had failed at 42 months. The Kaplan‐Meier estimate of the proportion of non‐failed implants at 36 months were lOO%, 95%, 9l%, and 86% for the Astra®, Astra® sinus, ITI®, and ITI® sinus implants, respectively. Of the Astra®, Astra® sinus, and ITI® implants, 71–82% remained free from bone‐loss ≥ 1.5 mm at 36 months. whereas this was the case for only 29% of the ITI® sinus implants. About 80–90% of the implants remained free from plaque; 65–86% remained free from bleeding; and 44–80% remained free from pockets ≥ 4 mm. These results indicate that the sinus lift technique can be used successfully in periodontally compromised patients.     

骨增量技术在正畸治疗中的应用

报告1例后牙缺失且牙槽骨量不足的患者,进行上颌窦提升、下颌骨骨劈开植骨后,完成正畸治疗的临床病例.正畸治疗前采用骨增量技术可以有效增加牙齿移动路径的骨量,从而促进牙齿移动,减少并发症的发生.     

Ten‐year results of a three‐arm prospective cohort study on implants in periodontally compromised patients. Part 1: implant loss and radiographic bone loss

Objectives: The aim of this study was to compare the long‐term outcomes of implants placed in patients treated for periodontitis periodontally compromised patients (PCP) and in periodontally healthy patients (PHP) in relation to adhesion to supportive periodontal therapy (SPT). Material and methods: One hundred and twelve partially edentulous patients were consecutively enrolled in private specialist practice and divided into three groups according to their initial periodontal condition: PHP, moderate PCP and severe PCP. Perio and implant treatment was carried out as needed. Solid screws (S), hollow screws (HS) and hollow cylinders (HC) were installed to support fixed prostheses, after successful completion of initial periodontal therapy (full‐mouth plaque score <25% and full‐mouth bleeding score <25%). At the end of treatment, patients were asked to follow an individualized SPT program. At 10 years, clinical measures and radiographic bone changes were recorded by two calibrated operators, blinded to the initial patient classification. Results: Eleven patients were lost to follow‐up. During the period of observation, 18 implants were removed because of biological complications. The implant survival rate was 96.6%, 92.8% and 90% for all implants and 98%, 94.2% and 90% for S‐implants only, respectively, for PHP, moderate PCP and severe PCP. The mean bone loss was 0.75 (± 0.88) mm in PHP, 1.14 (± 1.11) mm in moderate PCP and 0.98 (± 1.22) mm in severe PCP, without any statistically significant difference. The percentage of sites, with bone loss ≥3 mm, was, respectively, 4.7% for PHP, 11.2% for moderate PCP and 15.1% for severe PCP, with a statistically significant difference between PHP and severe PCP (P<0.05). Lack of adhesion to SPT was correlated with a higher incidence of bone loss and implant loss. Conclusion: Patients with a history of periodontitis presented a lower survival rate and a statistically significantly higher number of sites with peri‐implant bone loss. Furtheremore, PCP, who did not completely adhere to the SPT, were found to present a higher implant failure rate. This underlines the value of the SPT in enhancing the long‐term outcomes of implant therapy, particularly in subjects affected by periodontitis, in order to control reinfection and limit biological complications. To cite this article:
Roccuzzo M, De Angelis N, Bonino L, Aglietta M. Ten‐year results of a three arms prospective cohort study on implants in periodontally compromised patients. Part 1: implant loss and radiographic bone loss.
Clin. Oral Impl. Res. 21 , 2010; 490–496.
doi: 10.1111/j.1600‐0501.2009.01886.x