Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
Periodontology Unit, University College London, Eastman Dental Institute, London, UK.
Periodontol 2000. 2024 Jun;95(1):102-128. doi: 10.1111/prd.12597.
Following a comprehensive patient examination, including the assessment of periodontal and peri-implant diseases as well as considering the patient's needs, a pretherapeutic prognosis for each tooth and implant is given. Teeth and implants with a secure pretherapeutic prognosis require simple procedures and may be regarded as secure abutments for function and with a doubtful pretherapeutic prognosis usually need a comprehensive therapy. Such teeth and implants must be brought into the category with a secure prognosis by means of additional therapy such as endodontic, restorative, and surgical procedures. Teeth and implants with a hopeless pretherapeutic prognosis should be extracted/explanted during the initial phase of cause-related therapy (i.e., infection control). For example, teeth with vertical root fracture or unrestorable caries and implants with mobility or unrestorable malposition fall into the category of hopeless units. The primary goal of periodontal and peri-implant therapy should be to arrest disease progression. The latest consensus statement highlights that periodontitis can be successfully controlled and treated teeth can be retained for life. Nevertheless, for patients with uncontrolled contributing factors, the endpoints might not always be achievable, and low disease activity may be an acceptable therapeutic goal. Similarly, the management of peri-implantitis frequently requires surgical intervention following nonsurgical therapy due to incomplete treatment outcomes. Different surgical modalities can be effective and lead to significant improvement; however, achieving complete resolution of peri-implantitis is challenging, not always predictable, and can depend on multiple baseline factors. Therefore, this review aims at summarising available evidence on the rationale for incorporating systemic, lifestyle-related, clinical, and radiographic prognostic factors into treatment planning of patients diagnosed with periodontal and peri-implant diseases.
在全面的患者检查后，包括对牙周和种植体周围疾病的评估，并考虑患者的需求，对每个牙齿和种植体进行治疗前预后评估。具有可靠治疗前预后的牙齿和种植体需要简单的程序，可以被视为功能可靠的基台，而具有可疑治疗前预后的通常需要全面的治疗。通过额外的治疗，如牙髓、修复和手术程序，这些牙齿和种植体必须被归入具有可靠预后的类别。具有不可靠治疗前预后的牙齿和种植体应在病因相关治疗的初始阶段（即感染控制）中拔除/取出。例如，具有垂直根折或不可修复的龋齿的牙齿和具有活动性或不可修复的错位的种植体属于无望的单位。牙周和种植体治疗的主要目标应该是阻止疾病进展。最新的共识声明强调，牙周炎可以得到成功控制，治疗后的牙齿可以终生保留。然而，对于存在未控制的致病因素的患者，并非总是可以达到终点，低疾病活动度可能是可接受的治疗目标。同样，由于非手术治疗的结果不完全，种植体周围炎的管理通常需要在非手术治疗后进行手术干预。不同的手术方式可能有效，并导致显著改善；然而，实现种植体周围炎的完全缓解具有挑战性，并不总是可预测的，并且可能取决于多个基线因素。因此，本综述旨在总结有关将全身、与生活方式相关、临床和影像学预后因素纳入牙周和种植体疾病患者治疗计划的现有证据的原理。
