正畸治疗中牙周硬组织相关并发症的处理

doi:10.13591/j.cnki.kqyx.2025.01.006

口腔医学 ›› 2025, Vol. 45 ›› Issue (1): 37-44.doi: 10.13591/j.cnki.kqyx.2025.01.006

正畸治疗中牙周硬组织相关并发症的处理

包佳琦¹, 王中秀¹, 冯贻苗², 雷利红¹(), 陈莉丽¹()

1 浙江大学医学院附属第二医院牙周病专科,浙江杭州(310009)
2 浙江大学医学院附属第二医院正畸科,浙江杭州(310009)

收稿日期:2024-10-29 出版日期:2025-01-28 发布日期:2025-01-16
通讯作者: 陈莉丽 E-mail:chenlili_1030@zju.edu.cn；雷利红 E-mail:kqllh@zju.edu.cn
作者简介:雷利红,副主任医师、硕士研究生导师。现任中华口腔医学会牙周病学专委会委员、浙江省医师协会口腔医师分会青年委员会副主任委员、浙江省口腔医学会牙周病学专委会委员。主持、主参国家及省部级课题8项,发表国内外高质量论文20余篇。擅长各类牙周疾病个性化综合治疗,尤其擅长重度牙周炎患牙保存治疗、三维牙槽骨缺损多技术联合修复、牙龈退缩手术修复、牙种植及种植体周软硬组织增量手术。
陈莉丽,教授、主任医师、博士研究生导师,现任中华口腔医学会牙周病学专业委员会顾问、浙江省口腔医学会副会长、浙江省口腔医学会牙周病学专委会主任委员、《中华口腔医学杂志》《口腔医学》《中国实用口腔科杂志》编委。曾任中华口腔医学会牙周病学专委会副主任委员、中华口腔医学会第五届及第六届理事、浙江省医师协会口腔分会副会长、浙大二院口腔内科主任、浙江大学口腔医学院牙周病学教研室主任、浙江大学医学院临床二系口腔全科住培基地主任。从事牙周病临床诊治、科研及教学工作40年。主要研究方向为牙周病牙槽骨吸收分子机制研究,作为第一负责人主持国家自然科学基金6项、浙江省科技厅重点研发项目、浙江省自然科学基金、高等学校博士学科点专项科研基金等省部级项目10项;作为第一完成者,相关研究结果《牙龈卟啉单胞菌分子毒力结构和牙周组织发病机理的研究》获得浙江省科技进步二等奖、《可疑牙周病原体及其基因型与牙周炎的发生发展》获得浙江省科技进步三等奖、《牙周炎性环境中牙槽骨再生调控的分子机制》获得浙江省科技进步三等奖;主编《牙周病与口腔厌氧菌》由人民卫生出版社出版。1998年获中华人民共和国国务院政府特殊津贴专家、全国先进女职工称号,2005年获浙江省“151”人才证书,2019年获国际牙医师学院院士(ICD)。
基金资助:
国家自然科学基金(82170954)

Management of periodontal hard tissue related complications in orthodontic treatment

BAO Jiaqi¹, WANG Zhongxiu¹, FENG Yimiao², LEI Lihong¹(), CHEN Lili¹()

Department of Periodontology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China

Received:2024-10-29 Online:2025-01-28 Published:2025-01-16

摘要/Abstract

摘要：

随着正畸治疗能改善错牙合畸形、提高口腔健康质量,正畸患者日趋增多。然而,正畸治疗中因缺乏对牙周炎症及牙周支持组织健康的认识,引发牙槽骨的破坏吸收,导致骨开窗、骨开裂、根间距异常、牙齿松动脱落等牙周硬组织相关并发症。目前,上述并发症已成为正畸治疗中的棘手问题。本文详细介绍正畸治疗中常见的牙周硬组织相关并发症,以及临床防治策略与方法,同时附1例采用牙周多学科治疗因正畸治疗不当引起的上前牙牙槽骨吸收、牙齿松动移位的典型病例,以期为临床医生提供参考。

关键词: 正畸治疗, 牙周硬组织, 并发症, 牙周炎

Abstract:

As orthodontic treatment improves malocclusion and enhances oral health quality, the number of orthodontic patients is steadily increasing. However, a lack of understanding of periodontal inflammation and the health of periodontal supporting tissues during orthodontic treatment can lead to alveolar bone destruction and resorption. This, in turn, results in periodontal hard tissue-related complications such as bone fenestration, bone dehiscence, abnormal interradicular distance, and tooth mobility or loss. Currently, these complications present a significant challenge in orthodontic practice. This paper provides a comprehensive overview of common periodontal hard tissue-related complications during orthodontic treatment, along with clinical prevention and management strategies. A typical case of multidisciplinary periodontal treatment is also presented, addressing alveolar bone resorption and tooth mobility in the upper anterior teeth caused by improper orthodontic treatment. This report aims to offer valuable reference for clinicians.

Key words: orthodontic treatment, periodontal hard tissue, complications, periodontitis

中图分类号:

包佳琦, 王中秀, 冯贻苗, 雷利红, 陈莉丽. 正畸治疗中牙周硬组织相关并发症的处理[J]. 口腔医学, 2025, 45(1): 37-44.

BAO Jiaqi, WANG Zhongxiu, FENG Yimiao, LEI Lihong, CHEN Lili. Management of periodontal hard tissue related complications in orthodontic treatment[J]. Stomatology, 2025, 45(1): 37-44.

图/表 6

图1

图2

图3

图4

图5

图6

参考文献 60

[1]	Jepsen K, Sculean A, Jepsen S. Complications and treatment errors involving periodontal tissues related to orthodontic therapy[J]. Periodontol 2000, 2023, 92(1): 135-158. doi: 10.1111/prd.12484 pmid: 36920050
[2]	Antonarakis GS, Zekeridou A, Kiliaridis S, et al. Periodontal considerations during orthodontic intrusion and extrusion in healthy and reduced periodontium[J/OL]. Periodontol 2000, 2024 [2024-10-29].doi:10.1111/prd.12578.
[3]	Antoun JS, Mei L, Gibbs K, et al. Effect of orthodontic treatment on the periodontal tissues[J]. Periodontol 2000, 2017, 74(1):140-157. doi: 10.1111/prd.12194 pmid: 28429487
[4]	Bister D, Meikle MC. Re-examination of ‘Einige Beitrage zur Theorie der Zahnregulierung’(Some contributions to the theory of the regulation of teeth)published in 1904—1905 by Carl Sandstedt[J]. Eur J Orthod, 2013, 35(2):160-168.
[5]	von Böhl M, Maltha JC, von Den Hoff JW, et al. Focal hyalinization during experimental tooth movement in beagle dogs[J]. Am J Orthod Dentofacial Orthop, 2004, 125(5):615-623.
[6]	Melsen B. Biological reaction of alveolar bone to orthodontic tooth movement[J]. Angle Orthod, 1999, 69(2):151-158. doi: 10.1043/0003-3219(1999)069<0151:BROABT>2.3.CO;2 pmid: 10227556
[7]	Li Y, Zhan Q, Bao M, et al. Biomechanical and biological responses of periodontium in orthodontic tooth movement:Up-date in a new decade[J]. Int J Oral Sci, 2021, 13(1):20.
[8]	Krishnan V, Davidovitch Z. Cellular, molecular, and tissue-level reactions to orthodontic force[J]. Am J Orthod Dentofacial Orthop, 2006, 129(4):469.
[9]	Alikhani M, Alyami B, Lee IS, et al. Saturation of the biological response to orthodontic forces and its effect on the rate of tooth movement[J]. Orthod Craniofac Res, 2015,18 Suppl 1:8-17.
[10]	He D, Kou X, Yang R, et al. M1-like macrophage polarization promotes orthodontic tooth movement[J]. J Dent Res, 2015, 94(9):1286-1294. doi: 10.1177/0022034515589714 pmid: 26124217
[11]	Alghamdi B, Jeon HH, Ni J, et al. Osteoimmunology in periodontitis and orthodontic tooth movement[J]. Curr Osteoporos Rep, 2023, 21(2):128-146. doi: 10.1007/s11914-023-00774-x pmid: 36862360
[12]	Rath-Deschner B, Nogueira A, Beisel-Memmert S, et al. Interaction of periodontitis and orthodontic tooth movement-An in vitro and in vivo study[J]. Clin Oral Investig, 2022, 26(1): 171-181.
[13]	Cǫskun I, Kaya B. Appraisal of the relationship between tooth inclination, dehiscence, fenestration, and sagittal skeletal pattern with cone beam computed tomography[J]. Angle Orthod, 2019, 89(4): 544-551. doi: 10.2319/050818-344.1 pmid: 30741575
[14]	Leung CC, Palomo L, Griffith R, et al. Accuracy and reliability of cone-beam computed tomography for measuring alveolar bone height and detecting bony dehiscences and fenestrations[J]. Am J Orthod Dentofacial Orthop, 2010, 137(4 Suppl):S109-119.
[15]	Jing WD, Xu L, Li XT, et al. Prevalence of and risk factors for alveolar fenestration and dehiscence in the anterior teeth of Chinese patients with skeletal Class Ⅲ malocclusion[J]. Am J Orthod Dentofacial Orthop, 2021, 159(3):312-320.
[16]	Sendyk M, Linhares DS, Pannuti CM, et al. Effect of orthodontic treatment on alveolar bone thickness in adults:A systematic review[J]. Dental Press J Orthod, 2019, 24(4):34-45.
[17]	Garlock DT, Buschang PH, Araujo EA, et al. Evaluation of marginal alveolar bone in the anterior mandible with pretreatment and posttreatment computed tomography in nonextraction patients[J]. Am J Orthod Dentofacial Orthop, 2016, 149(2):192-201.
[18]	Vermylen K, De Quincey GN, van 't Hof MA, et al. Classification, reproducibility and prevalence of root proximity in periodontal patients[J]. J Clin Periodontol, 2005, 32(3):254-259. pmid: 15766367
[19]	Ritchey B, Orban B. The crests of the interdental alveolar Septa[J]. J Periodontol, 1953, 24(2): 75-87.
[20]	Vermylen K, De Quincey GN, Wolffe GN, et al. Root proximity as a risk marker for periodontal disease:A case-control study[J]. J Clin Periodontol, 2005, 32(3):260-265. pmid: 15766368
[21]	Hixon EH, Aasen TO, Clark RA, et al. On force and tooth movement[J]. Am J Orthod, 1970, 57(5): 476-478. doi: 10.1016/0002-9416(70)90166-1 pmid: 5265830
[22]	Ericsson I, Thilander B, Lindhe J, et al. The effect of orthodontic tilting movements on the periodontal tissues of infected and non-infected dentitions in dogs[J]. J Clin Periodontol, 1977, 4(4):278-293. pmid: 271655
[23]	Herrera D, Sanz M, Kebschull M, et al. Treatment of stage Ⅳ periodontitis: The EFP S3 level clinical practice guideline[J]. J Clin Periodontol, 2022:49(Suppl 24):4-71.
[24]	Wennström JL, Stokland BL, Nyman S, et al. Periodontal tissue response to orthodontic movement of teeth with infrabony pockets[J]. Am J Orthod Dentofacial Orthop, 1993, 103(4):313-319.
[25]	Melsen B, Agerbaek N, Eriksen J, et al. New attachment through periodontal treatment and orthodontic intrusion[J]. Am J Orthod Dentofacial Orthop, 1988, 94(2):104-116.
[26]	Sondeijker CFW, Lamberts AA, Beckmann SH, et al. Development of a clinical practice guideline for orthodontically induced external apical root resorption[J]. Eur J Orthod, 2020, 42(2):115-124.
[27]	Bayir F, Bolat Gumus E. External apical root resorption after orthodontic treatment: Incidence, severity and risk factors[J]. J Dent Res Dent Clin Dent Prospects, 2021, 15(2):100-105.
[28]	Darendeliler MA, Kharbanda OP, Chan EK, et al. Root resorption and its association with alterations in physical properties, mineral contents and resorption craters in human premolars following application of light and heavy controlled orthodontic forces[J]. Orthod Craniofac Res, 2004, 7(2):79-97. doi: 10.1111/j.1601-6343.2004.00281.x pmid: 15180087
[29]	周鑫, 陈莉莉. 正畸治疗与牙根吸收的关系[J]. 中华口腔医学杂志, 2023, 58(9): 893-898.
[30]	Han G, Huang S, Von den Hoff JW, et al. Root resorption after orthodontic intrusion and extrusion:An intraindividual study[J]. Angle Orthod, 2005, 75(6):912-918.
[31]	Yassir YA, McIntyre GT, Bearn DR. Orthodontic treatment and root resorption:An overview of systematic reviews[J]. Eur J Orthod, 2021, 43(4):442-456.
[32]	Gupta M, Madhok K, Kulshrestha R, et al. Determination of stress distribution on periodontal ligament and alveolar bone by various tooth movements-A 3D FEM study[J]. J Oral Biol Craniofac Res, 2020, 10(4):758-763.
[33]	Kettenbeil A, Reimann S, Reichert C, et al. Numerical simulation and biomechanical analysis of an orthodontically treated periodontally damaged dentition[J]. J Orofac Orthop, 2013, 74(6): 480-493. doi: 10.1007/s00056-013-0182-8 pmid: 24173364
[34]	Kojima Y, Mizuno T, Fukui H. A numerical simulation of tooth movement produced by molar uprighting spring[J]. Am J Orthod Dentofacial Orthop, 2007, 132(5):630-638.
[35]	Campos MJDS, Silva KS, Lupatini PM, et al. Tooth root and alveolar bone grey values derived from cone-beam CT imaging in maxillary incisor teeth with and without apical root resorption[J]. J Orthod, 2018, 45(1):23-28. doi: 10.1080/14653125.2017.1417780 pmid: 29280412
[36]	Pini Prato GP, Chambrone L. Orthodontic treatment in periodontal patients: The use of periodontal gold standards to overcome the “grey zone”[J]. J Periodontol, 2020, 91(4):437-441.
[37]	Zasčiurinskienè E, Basevičienè N, Lindsten R, et al. Orthodontic treatment simultaneous to or after periodontal cause-related treatment in periodontitis susceptible patients. Part I: Clinical outcome. A randomized clinical trial[J]. J Clin Periodontol, 2018, 45(2):213-224. doi: 10.1111/jcpe.12835 pmid: 29106749
[38]	王中秀, 冯贻苗, 陈莉丽. 牙周联合正畸早期介入治疗重度牙周炎松动牙1例[J]. 中华口腔医学杂志, 2023, 58(9):953-957.
[39]	Gkantidis N, Christou P, Topouzelis N. The orthodontic-periodontic interrelationship in integrated treatment challenges:A systematic review[J]. J Oral Rehabil, 2010, 37(5):377-390. doi: 10.1111/j.1365-2842.2010.02068.x pmid: 20202098
[40]	Janiszewska-Olszowska J, Socha A, Bińczak P. The use of cortical screw anchorage for closing a space resulting from the loss of a lower molar: A case report[J]. Ann Acad Med Stetin, 2013, 59(2):90-93. pmid: 25026758
[41]	Cardaropoli D, Re S, Corrente G, et al. Intrusion of migrated incisors with infrabony defects in adult periodontal patients[J]. Am J Orthod Dentofacial Orthop, 2001, 120(6):671-675;quiz 677.
[42]	Wennström JL, Lindhe J, Sinclair F, et al. Some periodontal tissue reactions to orthodontic tooth movement in monkeys[J]. J Clin Periodontol, 1987, 14(3):121-129. doi: 10.1111/j.1600-051x.1987.tb00954.x pmid: 3470318
[43]	Zhang Y, Cai P. Association between alveolar bone height changes in mandibular incisors and three-dimensional tooth movement in non-extraction orthodontic treatment with Invisalign[J]. Orthod Craniofac Res, 2023, 26(1):91-99.
[44]	Spray JR, Black CG, Morris HF, et al. The influence of bone thickness on facial marginal bone response:Stage 1 placement through stage 2 uncovering[J]. Ann Periodontol, 2000, 5(1):119-128. doi: 10.1902/annals.2000.5.1.119 pmid: 11885170
[45]	Wilcko WM, Wilcko T, Bouquot JE, et al. Rapid orthodontics with alveolar reshaping:Two case reports of decrowding[J]. Int J Periodontics Restorative Dent, 2001, 21(1):9-19.
[46]	Kamal AT, Malik DES, Fida M, et al. Does periodontally accelerated osteogenic orthodontics improve orthodontic treatment outcome?A systematic review and meta-analysis[J]. Int Orthod, 2019, 17(2):193-201.
[47]	Murphy KG, Wilcko MT, Wilcko WM, et al. Periodontal accelerated osteogenic orthodontics:A description of the surgical technique[J]. J Oral Maxillofac Surg, 2009, 67(10):2160-2166.
[48]	Frost HM. The regional acceleratory phenomenon:A review[J]. Henry Ford Hosp Med J, 1983, 31(1):3-9. pmid: 6345475
[49]	Xu M, Sun XY, Xu JG. Periodontally accelerated osteogenic orthodontics with platelet-rich fibrin in an adult patient with periodontal disease: A case report and review of literature[J]. World J Clin Cases, 2021, 9(6):1367-1378. doi: 10.12998/wjcc.v9.i6.1367 pmid: 33644204
[50]	Shafizadeh M, Tehranchi A, Shirvani A, et al. Alveolar bone thickness overlying healthy maxillary and mandibular teeth: A systematic review and meta-analysis[J]. Int Orthod, 2021, 19(3):389-405.
[51]	Garib DG, Henriques JF, Janson G, et al. Periodontal effects of rapid maxillary expansion with tooth-tissue-borne and tooth-borne expanders:A computed tomography evaluation[J]. Am J Orthod Dentofacial Orthop, 2006, 129(6):749-758.
[52]	Mostafavi AS, Yaghoobi N. Treatment planning challenges in cases with root proximity: An interdisciplinary approach[J]. Front Dent, 2022,19:9.
[53]	Aykol-Sahin G, Arsan B, Altan-Koran SM, et al. Association between root taper and root proximity of single-rooted teeth with periodontitis:A cone-beam computed tomography based study[J]. Odontology, 2022, 110(2):356-364.
[54]	Diedrich PR. Guided tissue regeneration associated with orthodontic therapy[J]. Semin Orthod, 1996, 2(1):39-45. pmid: 9161282
[55]	Ghouraba RF, Abotaha NF, Sagha SMA. Comparative evaluation of treatment of angular bone defect related to over-erupted tooth using guided tissue regeneration(GTR)followed by orthodontic intrusion(OI) versus OI followed by GTR:A controlled clinical trial[J]. BMC Oral Health, 2024, 24(1):273. doi: 10.1186/s12903-024-04036-9 pmid: 38402144
[56]	Jepsen K, Tietmann C, Martin C, et al. Synergy of regenerative periodontal surgery and orthodontics improves quality of life of patients with stage Ⅳ periodontitis: 24-month outcomes of a multicenter RCT[J]. Bioengineering(Basel, Switzerland), 2023, 10(6):695.
[57]	Deandra FA, Sulijaya B, Sudjatmika DA, et al. Selection of bone graft material and proper timing of periodontal surgery for orthodontic patients: A systematic review[J]. Heliyon, 2024, 10(1):e24201.
[58]	Abbas NH, Sabet NE, Hassan IT. Evaluation of corticotomy-facilitated orthodontics and piezocision in rapid canine retraction[J]. Am J Orthod Dentofacial Orthop, 2016, 149(4):473-480.
[59]	Hatrom AA, Zawawi KH, Al-Ali RM, et al. Effect of piezocision corticotomy on en-masse retraction[J]. Angle Orthod, 2020, 90(5):648-654.
[60]	Caton JG, Armitage G, Berglundh T, et al. A new classification scheme for periodontal and peri-implant diseases and conditions-Introduction and key changes from the 1999 classification[J]. J Clin Periodontol, 2018, 45(Suppl 20):S1-S8.

编辑推荐 0

Metrics

阅读次数

全文

171

HTML			PDF

最新录用	在线预览	正式出版	最新录用	在线预览	正式出版
0	0	11	0	0	160

来源	本网站	其他网站

次数	39	132
比例	23%	77%

摘要

177

最新录用	在线预览	正式出版

0	0	177

来源	本网站	其他网站

次数	59	118
比例	33%	67%

正畸治疗中牙周硬组织相关并发症的处理

Management of periodontal hard tissue related complications in orthodontic treatment

RichHTML

PDF

可视化

摘要/Abstract

引用本文

使用本文

图/表 6

参考文献 60

相关文章 15

编辑推荐 0

Metrics

本文评价

[1]	陈旭, 李璐, 王晓茜, 王天尧, 徐艳. Ⅲ/Ⅳ期牙周炎的临床诊治决策进展[J]. 口腔医学, 2025, 45(1): 13-17.
[2]	彭焱, 张驰, 高雳, 李希庭, 赵川江. Ⅳ期牙周炎患者的正畸考量和时机选择[J]. 口腔医学, 2025, 45(1): 25-36.
[3]	周悦, 唐振兴, 李宇. 拔除前磨牙正畸病例的磨牙支抗丧失及其影响因素[J]. 口腔医学, 2025, 45(1): 64-68.
[4]	杨泽, 潘亚萍. 牙周炎患者的种植考量因素[J]. 口腔医学, 2025, 45(1): 8-12.
[5]	朱莎莎, 田卫东, 郭淑娟. 不同类型程序性细胞死亡在牙周炎中的研究进展[J]. 口腔医学, 2024, 44(8): 624-629.
[6]	徐华兴, 韦晓玲. 多不饱和脂肪酸代谢产物在口腔疾病中的作用及应用研究进展[J]. 口腔医学, 2024, 44(7): 545-550.
[7]	黄蔼岚, 郭培培, 陆晓庆, 吴锦涛, 李泽汉, 徐秀清, 王娟, 周莉丽. 牙髓干细胞治疗糖尿病的研究进展[J]. 口腔医学, 2024, 44(6): 452-457.
[8]	林仁杰, 戴安娜, 汪淑华, 丁佩惠. 糖尿病影响牙周炎患者口腔龈下菌群和唾液菌群组成的研究进展[J]. 口腔医学, 2024, 44(6): 458-461.
[9]	王雪奎, 孙瑶. 中性粒细胞与牙周炎关系的研究进展[J]. 口腔医学, 2024, 44(4): 292-296.
[10]	肖诗梦, 刘翼, 李茂雪, 丁一. 激光辅助伴2型糖尿病牙周炎非手术治疗的疗效评价[J]. 口腔医学, 2024, 44(3): 161-167.
[11]	张志豪, 杨益, 王月秋, 孙思怡, 陈虹, 舒菲, 刘梅. 克罗恩病和牙周炎的共有免疫相关基因及其作为诊断生物标志物的潜力[J]. 口腔医学, 2024, 44(3): 184-191.
[12]	张家铭, 段燕, 武云霞. 活性氧与线粒体自噬在牙周炎中的作用[J]. 口腔医学, 2024, 44(3): 237-240.
[13]	孙苏, 冷迪雅, 王晶艳, 顾培玉, 杨连丰, 吴大明, 孙超, 张娟. 上颌前牙区多生牙的锥形束CT影像学特征研究[J]. 口腔医学, 2024, 44(2): 115-120.
[14]	赵溟昱, 时彬冕, 谢旭东, 许春梅, 王骏. 木犀草素在牙周炎防治中的研究进展[J]. 口腔医学, 2024, 44(2): 126-129.
[15]	任佳宇, 任秀云. 氧化应激及抗氧化剂辅助治疗牙周炎的研究进展[J]. 口腔医学, 2024, 44(2): 148-151.