正畸治疗与牙周炎的关系:从临床研究到生物实验的分析

The relationship between orthodontic treatment and periodontitis: an analysis from clinical trials to biological experiments

在越来越多的要求正畸治疗的成人患者中,患有牙周炎的正畸患者比例增加。为了避免牙周炎引起的骨破坏进一步加重,正畸牙移动需要在牙周炎症彻底控制后才能进行。然而曾经患有牙周炎的牙齿,其牙周组织状态在炎症控制后能否完全恢复到健康状态且良好地耐受正畸力的加载,这仍然是一个具有争议的问题。本文从临床研究(宏观)到生物学检测(微观)的层面分析有牙周炎病史的牙齿的牙周组织及牙周膜细胞在承受正畸力加载后的生物特性,认为:受牙周炎影响的成人正畸治疗由于牙周状态的改变而具有特殊性;正畸力与未治疗的牙周炎症共同作用会加重病理性的牙槽骨吸收,因此正畸治疗前完善牙周治疗非常必要;牙周治疗后,牙周组织能够耐受适当的正畸力加载;正畸治疗作为辅助手段能改善牙周炎造成的牙周组织破坏及病理性牙齿移位。

Increasing numbers of adult patients are seeking orthodontic treatment, which increases the need for or- thodontists to treat malocclusion in periodontally compromised teeth affected by periodontitis. It is essential to controlaetlve irfflammatlon prior to iditlatlng an orthodontle protoeol to avoid further breakdown of alveolar bone eaused by pelfodontitis. However, whether the condition of periodontal ligaments can completely recover to a normal condition af- ter controlling irfflammation and tolerate orthodontic tooth movement remains controversial. The present review elabo- rates, from elidieal Ii-ials （macroscopic） to biological tests （microscopic）, the characteristics of periodontal tissue and pmfodontal ligament cells with a history of pmfodontitis that are submitted to orthodontic force loading. The following conclusions are made： 1. Orthodontic treatment in periodontally compromised patients is unusual because of changes in pm{odontal condition. 2. The combination of orthodontic force loading and uncontrolled pm{odontal irfflammation agan＇a- vates pathologleal bone resorption; therefore, it is crucial to perform pmfodontal therapy prior to orthodontic treatment. 3. The periodontal ligament can withstand proper meehadieal force loading after pmfodontal treatment. 4. （h-thodontie treatment, as an adjunctive therapy, can improve pelodontally compromised tissue and pathological tooth movement.