Parodontale Therapie und prothetische Versorgung im parodontal vorgeschädigten Gebiss

Einleitung

Grundsätzlich erfolgt die Planung und Durchführung der definitiven prothetischen Rekonstruktion erst nach Abschluss der aktiven parodontalen Behandlungsphase und einer Reevaluation der parodontalen Verhältnisse. Dieses schrittweise Vorgehen ist erforderlich, um die parodontale Heilung und den Behandlungserfolg insbesondere bei prognostisch fraglichen Zähnen abzuwarten und deren sinnvollen Einbezug in eine prothetische Versorgung abschätzen zu können. Patienten mit der Vorgeschichte einer Parodontitis tragen ein erhöhtes Risiko für eine Periimplantitis. Nicht zuletzt deshalb steht aus parodontaler Sicht der Zahnerhalt im Vordergrund, während aus prothetischer Sicht der Langzeiterfolg der Rekonstruktion sicherzustellen ist. Prothetischer Behandlungsbedarf kann jedoch auch bereits initial erforderlich werden, insbesondere, wenn nicht erhaltungsfähige Frontzähne primär zu extrahieren und temporär durch abnehmbare oder festsitzende Provisorien zu ersetzen sind. Neben dem anterioren Zahnverlust können auch Zahnwanderungen, Rezessionen und fortgeschrittene Alveolarkamm-Resorptionen eine prothetische Versorgung schon während oder unmittelbar nach der parodontalen Therapie erfordern und eine komplexe rekonstruktive Planung notwendig machen.

Das Ziel des vorliegenden Beitrags ist es, eine systematische Vorgehensweise für die parodontale Behandlung und prothetische Versorgung bei Dentitionen mit reduziertem Rest-Attachment vorzustellen. Dabei werden prognostische Faktoren, mögliche implantatbedingte Komplikationen und rekonstruktive Alternativen mit und ohne Implantate diskutiert. Anhand einer systematischen Literaturübersicht werden zudem die Langzeiterfolge prothetischer Rekonstruktionen bei parodontal vorgeschädigter Dentition analysiert.

• Literatur

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