Tu Kang-Wei, Kuo Chia-Hwei, Hung Chun-Cheng, Yan Da-You, Mau Jimmy Lian Ping
Department of Periodontics, Chi Mei Medical Center, Tainan, Taiwan.
Department of Orthodontics, Chi Mei Medical Center, Tainan, Taiwan.
J Dent Sci. 2025 Jul;20(3):1391-1397. doi: 10.1016/j.jds.2025.03.010. Epub 2025 Mar 20.
The interrelationship between orthodontic treatment and periodontal health is critical in managing patients with complex dental and periodontal needs. Orthodontic treatment offers functional and esthetic improvements but may also pose risks to periodontal health. For patients with periodontal disease requiring orthodontic intervention, thorough assessment and meticulous treatment planning are essential. Periodontal phase I therapy must precede orthodontic treatment to ensure periodontal stability. Once periodontal health is achieved, the sequence of orthodontic treatment and periodontal regenerative surgery becomes a pivotal decision. Performing regenerative surgery prior to orthodontic treatment can address bony defects that might otherwise hinder orthodontic progress and exacerbate bone loss under orthodontic forces. Alternatively, initiating orthodontic treatment before surgery can optimize defect morphology, reduce defect size, and enhance the outcomes of regenerative therapies. This literature review evaluates the impact of orthodontic treatment on periodontal bone defects and explores treatment sequencing principles. Key areas of discussion include the timing and prioritization of orthodontic alignment versus periodontal surgery and the effects of specific orthodontic movements-such as extrusion, intrusion, bodily movement, and uprighting-on periodontal defects. The choice of sequencing depends on factors such as defect type, disease severity, and individual patient considerations. This review underscores the importance of an interdisciplinary approach that integrates biomechanical principles and periodontal health to minimize risks and maximize regenerative potential. By strategically combining orthodontic and periodontal therapies, clinicians can achieve superior functional and esthetic outcomes in patients with challenging periodontal conditions.
在管理有复杂牙齿和牙周需求的患者时，正畸治疗与牙周健康之间的相互关系至关重要。正畸治疗可改善功能和美观，但也可能对牙周健康构成风险。对于需要正畸干预的牙周病患者，全面评估和精心的治疗计划至关重要。正畸治疗前必须先进行牙周一期治疗，以确保牙周稳定性。一旦实现牙周健康，正畸治疗和牙周再生手术的顺序就成为一个关键决策。在正畸治疗前进行再生手术可以解决可能阻碍正畸进展并在正畸力作用下加剧骨质流失的骨缺损问题。或者，在手术前开始正畸治疗可以优化缺损形态、减小缺损大小并提高再生治疗的效果。这篇文献综述评估了正畸治疗对牙周骨缺损的影响，并探讨了治疗顺序原则。讨论的关键领域包括正畸排齐与牙周手术的时机和优先级，以及特定正畸移动（如伸长、压低、整体移动和直立）对牙周缺损的影响。顺序的选择取决于缺损类型、疾病严重程度和个体患者因素等。这篇综述强调了整合生物力学原理和牙周健康的多学科方法的重要性，以将风险降至最低并最大化再生潜力。通过策略性地结合正畸和牙周治疗，临床医生可以在具有挑战性的牙周状况患者中实现卓越的功能和美观效果。
