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Informationen aus Orthodontie & Kieferorthopädie 2017; 49(01): 11-17
DOI: 10.1055/s-0043-101389
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© Georg Thieme Verlag KG Stuttgart · New York

Kieferorthopädie bei Parodontitispatienten – Worauf sollte man Acht geben?

Orthodontic Therapy in Periodontitis Patients – What Should be Taken Care of?
Kristina Bertl
1   Abteilung für Parodontologie, Universität Malmö, Schweden
2   Fachbereich für Orale Chirurgie, Universitätszahnklinik Wien, Österreich
,
Birte Melsen
3   Abteilung für Kieferorthopädie, Universität Aarhus, Dänemark
,
Andreas Stavropoulos
1   Abteilung für Parodontologie, Universität Malmö, Schweden
› Author Affiliations
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Publication History

Publication Date:
25 April 2017 (online)

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Zusammenfassung

Zielsetzung Ein Überblick zu der Thematik ,,Kieferorthopädie bei Parodontitispatienten“ anhand folgender 3 Fragestellungen: (1) Wann kann man mit der kieferorthopädischen Therapie starten? (2) Worauf muss man während der kieferorthopädischen Therapie achten? (3) Kann das Ergebnis nach abgeschlossener Kieferorthopädie aufrechterhalten werden?

Ergebnis Generell basiert die wissenschaftliche Evidenz zu dieser Thematik hauptsächlich auf präklinischen und retrospektiven Studien sowie Fallberichtserien; kontrollierte Studien liegen kaum vor. Jedoch unumstritten ist, dass Zahnbewegungen nur im entzündungsfreien Zustand erfolgen sollten, da es ansonsten zu vermehrtem Attachmentverlust kommen kann. Vorab sollte stets eine ursachenbezogene Parodontaltherapie erfolgen sowie in weiterer Folge eine regelmäßige Erhaltungstherapie. In Bezug auf Zeitpunkt und Art einer allfälligen chirurgischen Therapie vor Beginn der Kieferorthopädie lässt sich anhand der Literatur keine klare Therapieempfehlung geben. Bei vertikalen Knochendefekten scheint diese vorteilhaft; ob aber eine offene Kürettage ausreichend ist oder zusätzlich regenerative Materialien verwendet werden sollten, ist nach wie vor unklar. Nach Abschluss der kieferorthopädischen Therapie kann mit entsprechender Stabilisierung auch in einem reduzierten Parodont ein ansprechendes Langzeitoutcome erzielt werden.

Schlussfolgerung Kieferorthopädische Zahnbewegungen führen in einem reduzierten aber entzündungsfreien Parodont zu keinem Attachmentverlust und ein ansprechendes Langzeitoutcome ist möglich. Daher sollte vor Beginn der Kieferorthopädie stets eine ursachenbezogene Parodontaltherapie erfolgen, um entzündungsfreie Verhältnisse zu etablieren. Jedoch kann in Bezug auf Zeitpunkt und Art allfälliger parodontal-chirurgischer Eingriffe bislang keine eindeutige Therapieempfehlung gegeben werden.

Abstract

Objective To provide an overview on “orthodontic therapy in periodontitis patients” by addressing the following 3 questions: (1) At which point of time can orthodontic treatment start in periodontitis patients? (2) What should be considered during orthodontic treatment? (3) Can teeth with a reduced periodontium be maintained after orthodontic treatment?

Results In general, scientific evidence on this topic is mainly based on preclinical, retrospective studies, and case series; controlled clinical trials are scarce. Nevertheless, it is obvious, that orthodontic tooth movement should be performed only in periodontally healthy (i. e. non-inflamed) tissues, otherwise further attachment loss might occur. Therefore, cause-related periodontal therapy should always precede orthodontic treatment and supportive periodontal treatment should be continuously provided during orthodontic therapy. Yet, up-to-now, there is no clear treatment recommendation regarding the point of time and type of any surgical intervention before orthodontic treatment. In relation to the treatment of patients with vertical defects it is, however, not clear whether an open flap debridement is sufficient or if the application of any additional regenerative material will improve the prognosis. The results of orthodontic treatment can be successfully preserved in the long-term – also on a reduced periodontium – if sufficient stabilization and periodontal maintenance is provided.

Conclusion Orthodontic therapy has no negative influence on teeth with a reduced but healthy periodontium and the results can be maintained for a long period of time. Hence, cause-related periodontal therapy should always precede orthodontic treatment to establish inflammation-free conditions, but up-to-now there is no clear recommendation regarding the point of time and the type of periodontal surgical interventions.

Schlüsselwörter

Kieferorthopädie, Parodontitis - parodontale Defekte - regenerative Therapie - interdisziplinäre Behandlung

Key words

orthodontics, periodontics - periodontal defects - regenerative therapy - interdisciplinary treatment
 

  • Literatur

  • 1 Kassebaum NJ, Bernabé E, Dahiya M. et al. Global burden of severe periodontitis in 1990–2010: a systematic review and meta-regression. J Dent Res 2014; 93: 1045-1053
    CrossrefPubMedGoogle Scholar
  • 2 Brunsvold MA. Pathologic tooth migration. J Periodontol 2005; 76: 859-866
    CrossrefPubMedGoogle Scholar
  • 3 Martinez-Canut P, Carrasquer A, Magán R. et al. A study on factors associated with pathologic tooth migration. J Clin Periodontol 1997; 24: 492-497
    CrossrefPubMedGoogle Scholar
  • 4 Ericsson I, Thilander B, Lindhe J. et al. The effect of orthodontic tilting movements on the periodontal tissues of infected and non-infected dentitions in dogs. J Clin Periodontol 1977; 4: 278-293
    CrossrefPubMedGoogle Scholar
  • 5 Ericsson I, Thilander B, Lindhe J. Periodontal conditions after orthodontic tooth movements in the dog. Angle Orthod 1978; 48: 210-218
    PubMedGoogle Scholar
  • 6 Melsen B. Tissue reaction following application of extrusive and intrusive forces to teeth in adult monkeys. Am J Orthod 1986; 89: 469-475
    CrossrefPubMedGoogle Scholar
  • 7 Melsen B, Agerbaek N, Eriksen J. et al. New attachment through periodontal treatment and orthodontic intrusion. Am J Orthod Dentofacial Orthop 1988; 94: 104-116
    CrossrefPubMedGoogle Scholar
  • 8 Wennström JL, Lindhe J, Sinclair F. et al. Some periodontal tissue reactions to orthodontic tooth movement in monkeys. J Clin Periodontol 1987; 14: 121-129
    CrossrefPubMedGoogle Scholar
  • 9 Wennström JL, Stokland BL, Nyman S. et al. Periodontal tissue response to orthodontic movement of teeth with infrabony pockets. Am J Orthod Dentofacial Orthop 1993; 103: 313-319
    CrossrefPubMedGoogle Scholar
  • 10 Almeida RC, Capelli J, Teles RP. Levels of gingival crevicular fluid matrix metalloproteinases in periodontally compromised teeth under orthodontic forces. Angle Orthod 2015; 85: 1009-1014
    CrossrefPubMedGoogle Scholar
  • 11 Zasciurinskiene E, Lindsten R, Slotte C. et al. Orthodontic treatment in periodontitis-susceptible subjects: a systematic literature review. Clinical and Experimental Dental Research 2016; 1-12
    PubMedGoogle Scholar
  • 12 Artun J, Urbye KS. The effect of orthodontic treatment on periodontal bone support in patients with advanced loss of marginal periodontium. Am J Orthod Dentofacial Orthop 1988; 93: 143-148
    CrossrefPubMedGoogle Scholar
  • 13 Attia MS, Shoreibah EA, Ibrahim SA. et al. Regenerative therapy of osseous defects combined with orthodontic tooth movement. J Int Acad Periodontol 2012; 14: 17-25
    PubMedGoogle Scholar
  • 14 Boyd RL, Leggott PJ, Quinn RS. et al. Periodontal implications of orthodontic treatment in adults with reduced or normal periodontal tissues versus those of adolescents. Am J Orthod Dentofacial Orthop 1989; 96: 191-198
    CrossrefPubMedGoogle Scholar
  • 15 Burch JG, Bagci B, Sabulski D. et al. Periodontal changes in furcations resulting from orthodontic uprighting of mandibular molars. Quintessence Int 1992; 23: 509-513
    PubMedGoogle Scholar
  • 16 Cardaropoli D, Re S, Corrente G. et al. Intrusion of migrated incisors with infrabony defects in adult periodontal patients. Am J Orthod Dentofacial Orthop 2001; 120: 671-675 quiz 677
    CrossrefPubMedGoogle Scholar
  • 17 Cardaropoli D, Re S, Corrente G. et al. Reconstruction of the maxillary midline papilla following a combined orthodontic-periodontic treatment in adult periodontal patients. J Clin Periodontol 2004; 31: 79-84
    CrossrefPubMedGoogle Scholar
  • 18 Corrente G, Abundo R, Re S. et al. Orthodontic movement into infrabony defects in patients with advanced periodontal disease: a clinical and radiological study. J Periodontol 2003; 74: 1104-1109
    CrossrefPubMedGoogle Scholar
  • 19 Eliasson LA, Hugoson A, Kurol J. et al. The effects of orthodontic treatment on periodontal tissues in patients with reduced periodontal support. Eur J Orthod 1982; 4: 1-9
    CrossrefPubMedGoogle Scholar
  • 20 Ghezzi C, Masiero S, Silvestri M. et al. Orthodontic treatment of periodontally involved teeth after tissue regeneration. Int J Periodontics Restorative Dent 2008; 28: 559-567
    PubMedGoogle Scholar
  • 21 Melsen B, Agerbaek N, Markenstam G. Intrusion of incisors in adult patients with marginal bone loss. Am J Orthod Dentofacial Orthop 1989; 96: 232-241
    CrossrefPubMedGoogle Scholar
  • 22 Melsen B. Tissue reaction to orthodontic tooth movement – a new paradigm. Eur J Orthod 2001; 23: 671-681
    CrossrefPubMedGoogle Scholar
  • 23 Ogihara S, Wang HL. Periodontal regeneration with or without limited orthodontics for the treatment of 2- or 3-wall infrabony defects. J Periodontol 2010; 81: 1734-1742
    CrossrefPubMedGoogle Scholar
  • 24 Re S, Corrente G, Abundo R. et al. Orthodontic treatment in periodontally compromised patients: 12-year report. Int J Periodontics Restorative Dent 2000; 20: 31-39
    PubMedGoogle Scholar
  • 25 Re S, Cardaropoli D, Abundo R. et al. Reduction of gingival recession following orthodontic intrusion in periodontally compromised patients. Orthod Craniofac Res 2004; 7: 35-39
    CrossrefPubMedGoogle Scholar
  • 26 Re S, Corrente G, Abundo R. et al. Orthodontic movement into bone defects augmented with bovine bone mineral and fibrin sealer: a reentry case report. Int J Periodontics Restorative Dent 2002; 22: 138-145
    PubMedGoogle Scholar
  • 27 Khorsand A, Paknejad M, Yaghobee S. et al. Periodontal parameters following orthodontic treatment in patients with aggressive periodontitis: A before-after clinical study. Dent Res J (Isfahan) 2013; 10: 744-751
    PubMedGoogle Scholar
  • 28 Nemcovsky CE, Sasson M, Beny L. et al. Periodontal healing following orthodontic movement of rat molars with intact versus damaged periodontia towards a bony defect. Eur J Orthod 2007; 29: 338-344
    CrossrefPubMedGoogle Scholar
  • 29 Polson A, Caton J, Polson AP. et al. Periodontal response after tooth movement into intrabony defects. J Periodontol 1984; 55: 197-202
    CrossrefPubMedGoogle Scholar
  • 30 Attia MS, Shoreibah EA, Ibrahim SA. et al. Histological evaluation of osseous defects combined with orthodontic tooth movement. J Int Acad Periodontol 2012; 14: 7-16
    PubMedGoogle Scholar
  • 31 Cao T, Xu L, Shi J. et al. Combined orthodontic-periodontal treatment in periodontal patients with anteriorly displaced incisors. Am J Orthod Dentofacial Orthop 2015; 148: 805-813
    CrossrefPubMedGoogle Scholar
  • 32 Diedrich P, Fritz U, Kinzinger G. et al. Movement of periodontally affected teeth after guided tissue regeneration (GTR) – an experimental pilot study in animals. J Orofac Orthop 2003; 64: 214-227
    CrossrefPubMedGoogle Scholar
  • 33 Nemcovsky CE, Beny L, Shanberger S. et al. Bone apposition in surgical bony defects following orthodontic movement: a comparative histomorphometric study between root- and periodontal ligament-damaged and periodontally intact rat molars. J Periodontol 2004; 75: 1013-1019
    CrossrefPubMedGoogle Scholar
  • 34 van Venrooy JR, Yukna RA. Orthodontic extrusion of single-rooted teeth affected with advanced periodontal disease. Am J Orthod 1985; 87: 67-74
    CrossrefPubMedGoogle Scholar
  • 35 Vardimon AD, Nemcovsky CE, Dre E. Orthodontic tooth movement enhances bone healing of surgical bony defects in rats. J Periodontol 2001; 72: 858-864
    CrossrefPubMedGoogle Scholar
  • 36 Alexander SA. Effects of orthodontic attachments on the gingival health of permanent second molars. Am J Orthod Dentofacial Orthop 1991; 100: 337-340
    CrossrefPubMedGoogle Scholar
  • 37 Corbacho de Melo MM, Cardoso MG, Faber J. et al. Risk factors for periodontal changes in adult patients with banded second molars during orthodontic treatment. Angle Orthod 2012; 82: 224-228
    CrossrefPubMedGoogle Scholar
  • 38 Ristic M, Vlahovic Svabic M, Sasic M. et al. Effects of fixed orthodontic appliances on subgingival microflora. Int J Dent Hyg 2008; 6: 129-136
    CrossrefPubMedGoogle Scholar
  • 39 van Gastel J, Quirynen M, Teughels W. et al. Longitudinal changes in microbiology and clinical periodontal variables after placement of fixed orthodontic appliances. J Periodontol 2008; 79: 2078-2086
    CrossrefPubMedGoogle Scholar
  • 40 Lundström F, Hamp SE, Nyman S. Systematic plaque control in children undergoing long-term orthodontic treatment. Eur J Orthod 1980; 2: 27-39
    CrossrefPubMedGoogle Scholar
  • 41 Sinclair PM, Berry CW, Bennett CL. et al. Changes in gingiva and gingival flora with bonding and banding. Angle Orthod 1987; 57: 271-278
    PubMedGoogle Scholar
  • 42 Gkantidis N, Christou P, Topouzelis N. The orthodontic-periodontic interrelationship in integrated treatment challenges: a systematic review. J Oral Rehabil 2010; 37: 377-390
    CrossrefPubMedGoogle Scholar
  • 43 Lang NP, Tonetti MS. Periodontal risk assessment (PRA) for patients in supportive periodontal therapy (SPT). Oral Health Prev Dent 2003; 1: 7-16
    PubMedGoogle Scholar
  • 44 Matuliene G, Pjetursson BE, Salvi GE. et al. Influence of residual pockets on progression of periodontitis and tooth loss: results after 11 years of maintenance. J Clin Periodontol 2008; 35: 685-695
    CrossrefPubMedGoogle Scholar
  • 45 Boyer S, Fontanel F, Danan M. et al. Severe periodontitis and orthodontics: evaluation of long-term results. Int Orthod 2011; 9: 259-273
    PubMedGoogle Scholar
  • 46 Closs LQ, Gomes SC, Oppermann RV. et al. Combined periodontal and orthodontic treatment in a patient with aggressive periodontitis: a 9-year follow-up report. World J Orthod 2010; 11: 291-297
    PubMedGoogle Scholar
  • 47 Nakamura Y, Gomi K, Oikawa T. et al. Reconstruction of a collapsed dental arch in a patient with severe periodontitis. Am J Orthod Dentofacial Orthop 2013; 143: 704-712
    CrossrefPubMedGoogle Scholar
  • 48 Zafiropoulos GG, di Prisco MO, Deli G. et al. Maintenance after a complex orthoperio treatment in a case of generalized aggressive periodontitis: 7-year result. J Int Acad Periodontol 2010; 12: 112-122
    PubMedGoogle Scholar