Departments of Periodontics and Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA.
Department of Periodontics, Eastman Institute for Oral Health, University of Rochester.
J Clin Periodontol. 2018 Jun;45 Suppl 20:S207-S218. doi: 10.1111/jcpe.12950.
This narrative review summarizes the current evidence about the role that the fabrication and presence of dental prostheses and tooth-related factors have on the initiation and progression of gingivitis and periodontitis.
Placement of restoration margins within the junctional epithelium and supracrestal connective tissue attachment can be associated with gingival inflammation and, potentially, recession. The presence of fixed prostheses finish lines within the gingival sulcus or the wearing of partial, removable dental prostheses does not cause gingivitis if patients are compliant with self-performed plaque control and periodic maintenance. However, hypersensitivity reactions to the prosthesis dental material can be present. Procedures adopted for the fabrication of dental restorations and fixed prostheses have the potential to cause traumatic loss of periodontal supporting tissues. Tooth anatomic factors, root abnormalities, and fractures can act as plaque-retentive factors and increase the likelihood of gingivitis and periodontitis.
Tooth anatomic factors, such as root abnormalities and fractures, and tooth relationships in the dental arch and with the opposing dentition can enhance plaque retention. Restoration margins located within the gingival sulcus do not cause gingivitis if patients are compliant with self-performed plaque control and periodic maintenance. Tooth-supported and/or tooth-retained restorations and their design, fabrication, delivery, and materials have often been associated with plaque retention and loss of attachment. Hypersensitivity reactions can occur to dental materials. Restoration margins placed within the junctional epithelium and supracrestal connective tissue attachment can be associated with inflammation and, potentially, recession. However, the evidence in several of the reviewed areas, especially related to the biologic mechanisms by which these factors affect the periodontium, is not conclusive. This highlights the need for additional well-controlled animal studies to elucidate biologic mechanisms, as well as longitudinal prospective human trials. Adequate periodontal assessment and treatment, appropriate instructions, and motivation in self-performed plaque control and compliance to maintenance protocols appear to be the most important factors to limit or avoid potential negative effects on the periodontium caused by fixed and removable prostheses.
本叙述性综述总结了目前关于义齿和牙相关因素的制作和存在对龈炎和牙周炎的发生和进展所起作用的证据。
修复体边缘位于结合上皮和龈上结缔组织附着处可能与牙龈炎症有关，并可能导致退缩。如果患者能够遵守自我进行的菌斑控制和定期维护，固定义齿修复体边缘位于龈沟内或佩戴部分可摘义齿并不会引起龈炎。然而，可能存在对义齿材料的过敏反应。为制作牙修复体和固定义齿而采用的程序可能会导致牙周支持组织的创伤性丧失。牙齿解剖因素、牙根异常和骨折可作为菌斑滞留因素，增加龈炎和牙周炎的可能性。
牙齿解剖因素，如牙根异常和骨折，以及牙齿在牙弓中的位置和与对颌牙的关系，都可以增强菌斑的滞留。如果患者能够遵守自我进行的菌斑控制和定期维护，修复体边缘位于龈沟内不会引起龈炎。牙支持和/或牙保留的修复体及其设计、制作、交付和材料常常与菌斑滞留和附着丧失有关。可能会发生对牙科材料的过敏反应。如果患者能够遵守自我进行的菌斑控制和定期维护，修复体边缘位于结合上皮和龈上结缔组织附着处可能与炎症有关，并可能导致退缩。然而，在几个被审查的领域，尤其是与这些因素影响牙周组织的生物学机制相关的证据并不具有结论性。这凸显了需要进行更多的、有良好对照的动物研究，以阐明生物学机制，以及进行纵向前瞻性人类试验。充分的牙周评估和治疗、适当的指导、自我进行的菌斑控制以及对维护方案的遵守，似乎是限制或避免固定和可摘义齿对牙周组织可能产生的负面影响的最重要因素。
