Aktuelle Konzepte der nicht chirurgischen Parodontitistherapie

Peter Cichon; Stefan Klar

doi:10.1055/a-1331-4949

ZWR - Das Deutsche Zahnärzteblatt, Table of Contents

ZWR - Das Deutsche Zahnärzteblatt 2021; 130(01/02): 32-46
DOI: 10.1055/a-1331-4949

Fortbildung

Parodontologie

Aktuelle Konzepte der nicht chirurgischen Parodontitistherapie

Peter Cichon

,

Stefan Klar

Abstract

Trotz eines hohen Erkrankungsbefalls werden Patienten mit entzündlichen Parodontalerkrankungen nur unzureichend versorgt. Die meisten Parodontitiden können durch den Allgemeinzahnarzt erfolgreich behandelt werden. Grundlage ist zunächst eine antiinfektiöse Therapie durch eine subgingivale Instrumentierung mit Entfernung des Biofilms und von Konkrementen. Eine adjuvante Verabreichung von systemischen oder lokal wirksamen antimikrobiellen Medikamenten kann dies in bestimmten Fällen unterstützen.

Full Text

References

Literatur
1 Eke PI, Dye BA, Wei L. et al. Prevalence of periodontitis in adults in the United States: 2009 and 2010. J Dent Res 2012; 91: 914-920
2 Jordan AR, Micheelis W. Fünfte Deutsche Mundgesundheitsstudie (DMS V), Materialienreihe Band 35. Köln: Deutscher Ärzteverlag; 2016
3 Glockmann E, Panzner K-D, Huhn P, Sigusch BW, Glockmann K. Ursachen des Zahnverlustes in Deutschland-Dokumentation einer bundesweiten Erhebung (2007). Köln: IDZ, Institut der Deutschen Zahnärzte; 2011
4 Kassenzahnärztliche Bundesvereinigung. KZBV Jahrbuch 2019. Statistische Basisdaten zur vertragszahnärztlichen Versorgung. Köln: Kassenzahnärztliche Bundesvereinigung; 2019
5 Kassenzahnärztliche Bundesvereinigung (KZBV), Bundeszahnärztekammer (BZÄK). Hrsg. PAR-Versorgungskonzept.Konzept für die Behandlung von Parodontalerkrankungen bei Versicherten der Gesetzlichen Krankenversicherung. Köln: KZBV; 2017
6 The American Academy of Periodontology. Consensus Report: Discussion Section I. In: Proceedings of the Workshop in Clinical Periodontics. Chicago: The American Academy of Periodontology; 1989: I-23-I-30
7 Offenbacher S. Periodontal diseases: Pathogenesis. Ann Periodontol 1996; 1: 821-878
8 The American Academy of Periodontology. Parameters on chronic periodontitis with slight to moderate loss of periodontal support. J Periodontol 2000; 71: 853-855
9 American Academy of Periodontology. Parameter on Chronic Periodontitis With Advanced Loss of Periodontal Support. J Periodontol 2000; 71: 856-858
10 Haffajee AD, Socransky SS. Microbial etiological agents of destructive periodontal diseases. Periodontol 2000 1994; 5: 78-111 doi:10.1111/j.1600-0757.1994.tb00020.x
11 Marsh PD, Zaura E. Dental plaque biofilm: ecological interactions in health and disease. J Clin Periodontol 2017; 44 (Suppl. 18) 12-22
12 Socransky SS, Haffajee AD, Cugini MA. et al. Microbialcomplexes in subgingival plaque. J Clin Periodontol 1998; 25: 134-144
13 Offenbacher S. Periodontal diseases: Pathogenesis. Ann Periodontol 1996; 1: 821-878
14 Page RC, Kornman KS. The pathogenesis of human periodontitis: an introduction. Periodontol 2000 1997; 14: 9-11
15 Kebschull M, Demmer RT, Papapanou PN. “Gum bug, leave my heart alone!” Epidemiologic and mechanistic evidence linking periodontal infections and atherosclerosis. J Dent Res 2010; 89: 879-902
16 Buhlin K, Mantyla P, Paju S. et al. Periodontitis is associated with angiographically verified coronary artery disease. J Clin Periodontol 2011; 38: 1007-1014
17 Ide M, Papapanou PN. Epidemiology of association between maternal periodontal disease and adverse pregnancy outcomes-systematic review. J Clin Periodontol 2013; 40 (Suppl. 14) 181-194
18 Preshaw PM, Alba AL, Herrera D. et al. Periodontitis and diabetes: a two-way relationship. Diabetologia 2012; 55: 21-31
19 Michalowicz BS, Diehl SR, Gunsolley JC. et al. Evidence of a substantial genetic basis for risk of adult periodontitis. J Clin Periodontol 2000; 71: 1699-1707
20 Ronderos M, Ryder MI. Risk assessment in clinical practice. Periodontol 2000 2004; 34: 120-135
21 Schäfer AS, Van der Velden U, Laine ML. et al. Genetic susceptibility to periodontal disease: new insights and challenges. In: Lindhe J, Lang NP. eds. Clinical Periodontology and Implant Dentistry. 6th ed. Chichester, UK: Wiley Blackwell; 2015: 290-310
22 Van Dyke TE, Levine MJ, Tabak LA. et al. Reduced chemotactic peptid binding in juvenile periodontitis: a model for neutrophil function. Biochem Biophys Res Commun 1981; 100: 1278-1284
23 Gorlin RJ, Sedano H, Anderson VE. The syndrome of palmar-plantar hyperkeratosis and premature periodontal destruction of the teeth. A clinical and genetic analysis of the Papillon-Lefèvre syndrome. J Pediatr 1964; 65: 895-908
24 Hart TC, Hart PS, Michalec MD. et al. Localisation of a gene for prepubertal periodontitis to chromosome 11q14 and identification of a cathepsin C gene mutation. J Med Genet 2000; 37: 95-101
25 Kinane DF, Hart TC. Genes and gene polymorphisms associated with periodontal disease. Crit Rev Oral Biol Med 2003; 14: 430-449
26 Kornman KS, Crane A, Wang HY. et al. The interleukin-1 genotype as a severity factor in adult periodontal disease. J Clin Periodontol 1997; 24: 72-77
27 Rawlinson A, Dalati MHN, Rahman S. et al. Interleukin-1 and IL-1 receptor antagonist in gingival crevicular fluid. J Clin Periodontol 2000; 27: 738-743
28 Genco RJ. Current view of risk factors for periodontal diseases. J Periodontol 1996; 67: 1041-1049
29 Grossi SG, Zambon JJ, Ho AW. et al. Assessment of risk for periodontal disease. I. Risk indicators, for attachment loss. J Periodontol 1994; 65: 260-267
30 Grossi SG, Genco RJ, Machtei EE. et al. Assessment of risk for periodontal disease. II. Risk indicators for alveolar bone loss. J Periodontol 1995; 66: 23-29
31 American Diabetes Association. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 2005; 28 (Suppl. 01) S37-S42
32 Fletcher B, Gulanick M, Lamendola C. Risk Factors for Type 2 Diabetes Mellitus. J Cardiovasc Nurs 2002; 16: 17-23
33 Icks A, Rathmann W, Rosenbauer J, Giani G. Gesundheitsberichterstattung des Bundes – Heft 24. Diabetes mellitus. Berlin: Robert Koch-Institut; 2005. Im Internet (Stand: 14.03.2005): http://edoc.rki.de/documents/rki_fv/ren4T3cctjHcA/PDF/%2020Vo4CXYDBpeQ_47.pdf
34 Mealey BL, Oates TW. Diabetes Mellitus and Periodontal Diseases. J Periodontol 2006; 77: 1289-1303
35 Kaur G, Holtfreter B, Rathmann W. et al. Association between type 1 and type 2 diabetes with periodontal disease and tooth loss. J Clin Periodontol 2009; 36: 765-774
36 Safkan-Seppälä B, Ainamo J. Periodontal conditionsin insulin-dependent diabetes mellitus. J Clin Periodontol 1992; 19: 24-29
37 Taylor GW, Burt BA, Becker MP. et al. Non-insulin dependent diabetes mellitus and alveolar bone loss progression over 2 years. J Periodontol 1998; 69: 76-83
38 NCHS, National Center for Health Statistics. Third National Health and Nutrition Examination Survey (NHANES III), 1988 – 1994. Centers for Disease Control, public use data file no. 7 – 0627. Hyattsville/Maryland: Centers for Disease Control; 1997
39 Tsai C, Hayes C, Taylor GW. Glycemic control of type 2 diabetes and severe periodontal disease in the US adult population. Community Dent Oral Epidemiol 2002; 30: 182-192
40 Bagdade JD, Stewart M, Walters E. Impaired granulocyte adherence. A reversible defect in host defense in patients with poorly controlled diabetes. Diabetes 1978; 27: 677-681
41 Mowat AG, Baum J. Chemotaxis of polymorphonuclear leukocytes from patients with diabetes mellitus. N Engl J Med 1971; 284: 621-627 doi:10.1056/NEJM197103252841201
42 Wilson RM, Reeves WG. Neutrophil phagocytosis and killing in insulin-dependent diabetes. Clin Exp Immunol 1986; 63: 478-484
43 Brownlee M, Cerami A, Vlassara H. Advanced products glycosylation and the pathogenesis of diabetic vascular disease. Diabetes Metab Rev 1988; 4: 437-451
44 Lien YH, Stern R, Fu JC. et al. Inhibition of collagen fibril formation in vitro and subsequent cross-linking by glucose. Science 1984; 28: 1489-1491
45 Seibold JR, Uitto J, Dorwart BB. et al. Collagen synthesis and collagenase activity in dermal fibroblasts from patients with diabetes mellitus and digital sclerosis. J Lab Clin Med 1985; 105: 664-667
46 Salvi GE, Collins JG, Yalda B. et al. Monocytic TNF-α secretion patterns in IDDM patients with periodontal diseases. J Clin Periodontol 1997; 24: 8-16 doi:10.1111/j.1600-051x.1997.tb01178.x
47 Salvi GE, Yalda B, Collins JG. et al. Inflammatory mediator response as a potential risk marker for periodontal diseases in insulin-dependent diabetes mellitus patients. J Periodontol 1997; 68: 127-135
48 Taylor JJ, Preshaw PM, Lalla E. A review of the evidence for pathogenic mechanisms that may link periodontitis and diabetes. J Clin Periodontol 2013; 40 (Suppl. 14) 113-134
49 Fahey TJ, Sadaty A, Jones WG. et al. Diabetes impairs the late inflammatory response to wound healing. J Surg Res 1991; 50: 308-313
50 Borgnakke WS, Ylöstalo PV, Taylor GW. et al. Effect of periodontal disease on diabetes: systematic review of epidemiologic observational evidence. J Periodontol 2013; 84 (4 Suppl.): S135-S152
51 Magnusson I, Walker CB. Refractory periodontitis or recurrence of disease. J Clin Periodontol 1996; 23 (3 Pt 2): 289-292
52 Albandar JM, Streckfus CF, Adesanya MR. et al. Cigar, pipe, and cigarette smoking as risk factors for periodontal disease and tooth loss. J Periodontol 2000; 71: 1874-1881
53 Nociti FH, Casati MZ, Duarte PM. Current perspective of the impact of smoking on the progression and treatment of periodontitis. Periodontol 2000 2015; 67: 187-191
54 Kenney EB, Kraal JH, Saxe SR. et al. The effect of cigarette smoke on human oral polymorphonuclear leukocytes. J Periodontal Res 1977; 12: 227-234
55 Ryder MI, Fujitaki R, Lebus S. et al. Alterations of neutrophil L-selection and CD 18 expression by tobacco smoke: implications for periodontal diseases. J Periodontal Res 2006; 33: 359-368
56 Wendell KJ, Stein SH. Regulation of cytokine production in human gingival fibroblasts following treatment with nicotine and lipopolysaccharide. J Periodontol 2001; 72: 1038-1044
57 Mirbod SM, Abing SL, Pruthi VK. Immunohistochemical study of vestibular gingival blood vessel density and internal circumference in smokers and non-smokers. J Periodontol 2001; 72: 1318-1323
58 Caton JG, Armitage G, Berglundh T. et al. A new classification scheme for periodontal and peri-implant diseases and conditions – Introduction and key changes from the 1999 classification. J Clin Periodontol 2018; 45 (Suppl. 20) S1
59 Landi L, Amar S, Polins AS. et al. Host mechanisms in the pathogenesis of periodontal disease. Curr Opin Periodontol 1997; 4: 3-10
60 Slots J, Rams TE. New views on periodontal microbiota in special patient categories. J Clin Periodontol 1991; 18: 411-420
61 Schenkein HA, Van Dyke TE. Early-onset periodontitis: systemic aspects of etiology and pathogenesis. Periodontol 2000 1994; 6: 7-25
62 Renvert S, Wikström M, Dahlén G. et al. On the inability of root debridement and periodontal surgery to eliminate Actinobacillus actinomycetemcomitans from periodontal pockets. J Clin Periodontol 1990; 17: 351-355
63 The American Academy of Periodontology. Position Paper: Systemic Antibiotics in Periodontics. J Periodontol 2004; 75: 1553-1565
64 Eickholz P. Parodontale Therapie mit lokalen Antibiotika. Das Dental Vademekum. ZM online 2010. Im Internet (Stand: 16.06.2010): https://www.zm-online.de/archiv/2010/12/zahnmedizin/parodontale-therapie-mit-lokalen-antibiotika/
65 Schlagenhauf U. Adjuvante systemische Antibiotikagabe bei subgingivaler Instrumentierung im Rahmen der systematischen Parodontitistherapie. Die neuen S3 Leitlinien Parodontitistherapie. Deutsche Gesellschaft für Parodontologie. Frankfurt 2018. Im Internet (Stand: 12.11.2018): https://www.awmf.org/leitlinien/detail/ll/083-029.html
66 Lang NP, Tonetti MS. Periodontal Risk Assessment (PRA) for Patients in Supportive Periodontal Therapy (SPT). Oral Health Prev Dent 2003; 1: 7-16
67 Bürgerliches Gesetzbuch § 630e. Februar 2013.
68 Bharathi DM, Cobb CM. 7 Steps to the Nonsurgical Treatment of Periodontitis. Dimens Dent Hyg 2018; 16: 39-42
69 Sanz M, Herrera D, Kebschull M. et al. Treatment of stage I–III periodontitis – The EFP S3 level clinical practice guideline. Clin Periodontol 2020; 47 (Suppl. 22) 4-60 doi:10.1111/jcpe.13290
70 Lertpimonchai A, Rattanasiri S, Arj-Ong Vallibhakara S. et al. The association between oral hygiene and periodontitis: a systematic review and meta-analysis. Int Dent J 2017; 67: 332-343
71 Haffajee AD, Socransky SS. JC Gunsolley. Anti-infective periodontal therapy. A systematic review. Ann Periodontol 2003; 8: 115-181
72 van Winkelhoff AJ, Winkel EG. Antibiotics in Periodontics: Right or Wrong?. J Periodontol 2009; 80: 1555-1558
73 Eickholz P, Koch R, Kocher T. et al. Clinical benefits of systemic amoxicillin/metronidazole may depend on periodontitis severity and patientsʼ age: An exploratory sub-analysis of the ABPARO trial. J Clin Periodontol 2019; 46: 491-501
74 Sanz M, Teughels W. Innovations in non-surgical periodontal therapy: Consensus Report of the Sixth European Workshop on Periodontology. J Clin Periodontol 2008; 35 (8 Suppl.): 3-7
75 Lang NP, Suvan JE, Tonetti MS. Risk factor assessment tools for the prevention of periodontitis progression a systematic review. J Clin Periodontol 2015; 42 (Suppl. 16) S59-S70
76 Rentiert S, Badegästen A, Niles R. Healing after treatment of periodontal intraosseous defects I. Comparative study of clinical methods. J Clin Periodontol 1981; 8: 387-399
77 Badersten A, Nilvéus R, Egelberg J. Effect of non-surgical periodontal therapy. J Clin Periodontol 1985; 12: 190-200
78 Badersten A, Nilvéus R, Egelberg J. Effect of nonsurgical periodontal therapy. V. Patterns of probing attachment loss in non-responding sites. J Clin Periodontol 1985; 12: 270-282 doi:10.1111/j.1600-051x.1985.tb02293.x
79 Badersten A, Nilvéus R, Egelberg J. Effect of non-surgical periodontal therapy. J Clin Periodontol 1985; 12: 351-359
80 Newman MG. Proceedings of the 1966 World Workshop in Periodontics. American Academy of Periodontology. Ann Periodontol 1996; 1: 1-947
81 Schroeder HE. Pathobiologie oraler Strukturen: Zähne, Pulpa, Parodont. Freiburg i. B.: Karger; 1996
82 Garrett S. Periodontal regeneration around natural teeth. Ann Periodontol 1996; 1: 621-666
83 Stahl SS, Slavkin HC, Yamada L. et al. Speculations about gingival repair. J Periodontol 1972; 43: 395-402
84 Cole RT, Crigger M, Bogle G. et al. Connective tissue regeneration to periodontally diseased teeth. A histological study. J Periodontal Res 1980; 15: 1-9
85 Narayanan AS, Page RC. Connective tissues of the periodontium: a summary of current work. Coll Relat Res 1983; 3: 33-64
86 Cichon P. Alveoläre Knochenneubildung nach geschlossener Taschentherapie. ZWP spezial 2015; 10: 4-8
87 Rabbani GM, Ash MM, Caffesse RG. The effectiveness of subgingival scaling and root planing in calculus removal. J Periodontol 1981; 52: 119-123
88 Eickholz P. Glossar der Grundbegriffe für die Praxis: Unterstützende Parodontitistherapie (UPT). Teil 1: Ziele und Inhalte. Parodontologie 2007; 18: 165-170
89 Betsy J, Prasanth CS, Baiju KV. et al. Efficacy of antimicrobial photodynamic therapy in the management of chronic periodontitis: a randomized controlled clinical trial. J Clin Periodontol 2014; 41: 573-581
90 Dragoo MR. A clinical evaluation of hand and ultrasonic instruments on subgingival debridement. 1. With unmodified and modified ultrasonic inserts. Int J Periodontics Restorative Dent 1992; 12: 310-323
91 Takacs VJ, Lie T, Perala DG. et al. Efficacy of 5 machining instruments in scaling of molar furcations. J Periodontol 1993; 64: 228-236
92 Greenstein G. Periodontal Diseases are Curable. J Periodontol 2002; 73: 950-953
93 Schenkein HA. Finding genetic risk factors for periodontal diseases: is the climb worth the view?. Periodontol 2000 2002; 30: 79-90
94 Suvan J, Leira Y, Sancho FMM. et al. Subgingival instrumentation for treatment of periodontitis. A systematic review. J Clin Periodontol 2020; 47: 155-175