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牙周骨内缺损再生后立即进行正畸治疗:一项长期回顾性研究。

Immediate orthodontic treatment after regeneration of periodontal intrabony defects: A long-term retrospective study.

作者信息

Dung Shing-Zeng, Tzeng I-Shiang, Li Cheng-Shan

机构信息

Department of Dentistry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.

Department of Surgery, College of Medicine, Tzu Chi University, Hualien, Taiwan.

出版信息

J Dent Sci. 2025 Jan;20(1):417-427. doi: 10.1016/j.jds.2024.06.003. Epub 2024 Jun 12.

Abstract

BACKGROUND/PURPOSE: Orthodontic movement is often necessary for periodontally compromised patients to enhance esthetics, function, and long-term occlusal stability. However, the impact of orthodontic treatment immediately following the regeneration of intrabony defects on periodontal healing remains a topic of debate. The objective of this long-term case series study was to test the hypothesis that orthodontic treatment performed immediately after regenerative procedures for periodontal intrabony defects did not adversely affect periodontal healing.

MATERIALS AND METHODS

This case series study involved nine periodontally compromised subjects with a total of 17 intra-bony defects. Orthodontic brackets were applied immediately before surgery. Flaps were raised, and diseased roots were debrided. All intra-bony defects were filled with alloplastic bone grafts and covered with resorbable membranes, except for one defect treated with Emdogain. All patients initiated orthodontic treatment immediately after periodontal regenerative surgery. Clinical parameters, including probing depth, attachment level, and bone fill, were assessed at baseline and during final maintenance therapy.

RESULTS

The mean follow-up duration was 12.8 years. None of the 17 surgically regenerated teeth were lost. The mean reduction in probing depth was 3.94 mm (95% confidence level, 3.19-4.68;  < 0.001), with a mean clinical attachment gain of 3.47 mm (95% confidence level, 2.90-4.03;  < 0.001). The mean radiographic bone fill was 4.89 mm ( < 0.001).

CONCLUSION

Based on the findings of this long-term case study, it can be concluded that immediate orthodontic treatment does not adversely affect the maturation process of periodontal regeneration outcomes and can be maintained for more than ten years.

摘要

背景/目的:对于牙周状况不佳的患者,正畸治疗通常是必要的,以改善美观、功能和长期咬合稳定性。然而,骨内缺损再生后立即进行正畸治疗对牙周愈合的影响仍是一个有争议的话题。本长期病例系列研究的目的是检验以下假设:牙周骨内缺损再生手术后立即进行正畸治疗不会对牙周愈合产生不利影响。

材料与方法

本病例系列研究涉及9名牙周状况不佳的受试者,共有17处骨内缺损。在手术前立即粘贴正畸托槽。翻开龈瓣,对病变牙根进行清创。除一处用Emdogain治疗的缺损外,所有骨内缺损均用异体骨移植物填充,并用可吸收膜覆盖。所有患者在牙周再生手术后立即开始正畸治疗。在基线和最终维持治疗期间评估临床参数,包括探诊深度、附着水平和骨填充情况。

结果

平均随访时间为12.8年。17颗接受手术再生的牙齿无一脱落。探诊深度平均减少3.94毫米(95%置信区间,3.19 - 4.68;<0.001),临床附着平均增加3.47毫米(95%置信区间,2.90 - 4.03;<0.001)。影像学检查显示骨填充平均为4.89毫米(<0.001)。

结论

基于本长期病例研究的结果,可以得出结论,立即进行正畸治疗不会对牙周再生结果的成熟过程产生不利影响,并且可以维持十多年。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f01/11762914/a4cae53e1748/gr1.jpg

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