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Informationen aus Orthodontie & Kieferorthopädie 2017; 49(01): 11-17
DOI: 10.1055/s-0043-101389
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© Georg Thieme Verlag KG Stuttgart · New York

Kieferorthopädie bei Parodontitispatienten – Worauf sollte man Acht geben?

Orthodontic Therapy in Periodontitis Patients – What Should be Taken Care of?
Kristina Bertl
1   Abteilung für Parodontologie, Universität Malmö, Schweden
2   Fachbereich für Orale Chirurgie, Universitätszahnklinik Wien, Österreich
,
Birte Melsen
3   Abteilung für Kieferorthopädie, Universität Aarhus, Dänemark
,
Andreas Stavropoulos
1   Abteilung für Parodontologie, Universität Malmö, Schweden
› Author Affiliations
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Publication History

Publication Date:
25 April 2017 (online)

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Zusammenfassung

Zielsetzung Ein Überblick zu der Thematik ,,Kieferorthopädie bei Parodontitispatienten“ anhand folgender 3 Fragestellungen: (1) Wann kann man mit der kieferorthopädischen Therapie starten? (2) Worauf muss man während der kieferorthopädischen Therapie achten? (3) Kann das Ergebnis nach abgeschlossener Kieferorthopädie aufrechterhalten werden?

Ergebnis Generell basiert die wissenschaftliche Evidenz zu dieser Thematik hauptsächlich auf präklinischen und retrospektiven Studien sowie Fallberichtserien; kontrollierte Studien liegen kaum vor. Jedoch unumstritten ist, dass Zahnbewegungen nur im entzündungsfreien Zustand erfolgen sollten, da es ansonsten zu vermehrtem Attachmentverlust kommen kann. Vorab sollte stets eine ursachenbezogene Parodontaltherapie erfolgen sowie in weiterer Folge eine regelmäßige Erhaltungstherapie. In Bezug auf Zeitpunkt und Art einer allfälligen chirurgischen Therapie vor Beginn der Kieferorthopädie lässt sich anhand der Literatur keine klare Therapieempfehlung geben. Bei vertikalen Knochendefekten scheint diese vorteilhaft; ob aber eine offene Kürettage ausreichend ist oder zusätzlich regenerative Materialien verwendet werden sollten, ist nach wie vor unklar. Nach Abschluss der kieferorthopädischen Therapie kann mit entsprechender Stabilisierung auch in einem reduzierten Parodont ein ansprechendes Langzeitoutcome erzielt werden.

Schlussfolgerung Kieferorthopädische Zahnbewegungen führen in einem reduzierten aber entzündungsfreien Parodont zu keinem Attachmentverlust und ein ansprechendes Langzeitoutcome ist möglich. Daher sollte vor Beginn der Kieferorthopädie stets eine ursachenbezogene Parodontaltherapie erfolgen, um entzündungsfreie Verhältnisse zu etablieren. Jedoch kann in Bezug auf Zeitpunkt und Art allfälliger parodontal-chirurgischer Eingriffe bislang keine eindeutige Therapieempfehlung gegeben werden.

Abstract

Objective To provide an overview on “orthodontic therapy in periodontitis patients” by addressing the following 3 questions: (1) At which point of time can orthodontic treatment start in periodontitis patients? (2) What should be considered during orthodontic treatment? (3) Can teeth with a reduced periodontium be maintained after orthodontic treatment?

Results In general, scientific evidence on this topic is mainly based on preclinical, retrospective studies, and case series; controlled clinical trials are scarce. Nevertheless, it is obvious, that orthodontic tooth movement should be performed only in periodontally healthy (i. e. non-inflamed) tissues, otherwise further attachment loss might occur. Therefore, cause-related periodontal therapy should always precede orthodontic treatment and supportive periodontal treatment should be continuously provided during orthodontic therapy. Yet, up-to-now, there is no clear treatment recommendation regarding the point of time and type of any surgical intervention before orthodontic treatment. In relation to the treatment of patients with vertical defects it is, however, not clear whether an open flap debridement is sufficient or if the application of any additional regenerative material will improve the prognosis. The results of orthodontic treatment can be successfully preserved in the long-term – also on a reduced periodontium – if sufficient stabilization and periodontal maintenance is provided.

Conclusion Orthodontic therapy has no negative influence on teeth with a reduced but healthy periodontium and the results can be maintained for a long period of time. Hence, cause-related periodontal therapy should always precede orthodontic treatment to establish inflammation-free conditions, but up-to-now there is no clear recommendation regarding the point of time and the type of periodontal surgical interventions.

Schlüsselwörter

Kieferorthopädie, Parodontitis - parodontale Defekte - regenerative Therapie - interdisziplinäre Behandlung

Key words

orthodontics, periodontics - periodontal defects - regenerative therapy - interdisciplinary treatment
 

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