Ercoli Carlo, Tarnow Dennis, Poggio Carlo E, Tsigarida Alexandra, Ferrari Marco, Caton Jack G, Chochlidakis Konstantinos
Departments of Prosthodontics and Periodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY.
Department of Periodontics, Columbia University College of Dentistry, New York, NY.
J Prosthodont. 2021 Apr;30(4):305-317. doi: 10.1111/jopr.13292. Epub 2020 Dec 10.
To search the literature and to critically evaluate the findings on the periodontal outcomes of restorations and tooth-supported fixed prostheses.
PubMed was searched according to a systematic methodology, previously reported, but updated to include a larger database. Filters applied were: Case reports, clinical trial, review, guideline, randomized controlled trial, meta-analysis, systematic reviews, and English. A narrative review was then synthesized to discuss periodontal outcomes related to restorations and tooth-supported fixed prostheses. Relevant data was organized into four sections: Direct restorations, indirect restorations, biologic width or supracrestal tissue attachment and tooth preparation/finish line design.
While increased gingival index, bleeding on probing, probing depth and clinical attachment loss have been associated with subgingival restorations, intracrevicular margins do not cause periodontal diseases. Inflammation and bone loss occur, for both direct and indirect restorations, only with large overhangs. Different restorative materials are associated with different clinical responses when placed in the gingival sulcus or within the epithelial and connective tissue attachments. When the connective tissue attachment is removed, histological changes occur causing its apical shift and subsequent re-establishment. Gingival displacement during impression procedures can cause gingival recession. Emergence profile can have a range of values, not associated with periodontal diseases. Periodontal response appears to be clinically not different when compared among different finish line designs.
Contemporary procedures and materials used for the placement and fabrication of tooth-supported restorations and fixed prostheses are compatible with periodontal health when adequate patient education and motivation in self-performed oral hygiene are present. Periodontal diagnostic criteria should be thoroughly reviewed before fixed restorative treatments are planned and executed.
检索文献并严格评估关于修复体和牙支持固定义齿牙周治疗效果的研究结果。
按照先前报道的系统方法检索PubMed，但更新为纳入更大的数据库。应用的筛选条件为：病例报告、临床试验、综述、指南、随机对照试验、荟萃分析、系统评价以及英文文献。随后综合叙述性综述，讨论与修复体和牙支持固定义齿相关的牙周治疗效果。相关数据分为四个部分进行整理：直接修复体、间接修复体、生物学宽度或龈上组织附着以及牙体预备/边缘线设计。
虽然牙龈指数增加、探诊出血、探诊深度和临床附着丧失与龈下修复体有关，但龈沟内边缘不会引发牙周疾病。直接和间接修复体仅在存在大的悬突时才会发生炎症和骨质丧失。当置于龈沟或上皮及结缔组织附着内时，不同的修复材料会产生不同的临床反应。当结缔组织附着被破坏时，会发生组织学改变，导致其向根尖移位并随后重新建立。印模过程中的牙龈移位可导致牙龈退缩。外形高点可以有一系列值，与牙周疾病无关。不同边缘线设计之间的牙周反应在临床上似乎没有差异。
当患者接受充分的口腔卫生教育并具备自我口腔卫生维护的积极性时，用于牙支持修复体和固定义齿放置及制作的现代方法和材料与牙周健康是相容的。在计划和实施固定修复治疗之前，应全面审查牙周诊断标准。
