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Zahnmedizin up2date 2012; 6(1): 59-81
DOI: 10.1055/s-0031-1298274
Prothetik
Georg Thieme Verlag KG Stuttgart · New York

Parodontale Therapie und prothetische Versorgung im parodontal vorgeschädigten Gebiss

Nicola Ursula Zitzmann
,
Sabrina Lill Buset
,
Roland Weiger
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Publication History

Publication Date:
27 March 2012 (online)

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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

  • 1 Hamp SE, Nyman S, Lindhe J. Periodontal treatment of multirooted teeth. Results after 5 years. J Clin Periodontol 1975; 2: 126-135
    CrossrefGoogle Scholar
  • 2 Walter C, Kaner D, Berndt DC et al. Three-dimensional imaging as a pre-operative tool in decision making for furcation surgery. J Clin Periodontol 2009; 36: 250-257
    CrossrefGoogle Scholar
  • 3 Newell DH. The diagnosis and treatment of molar furcation invasions. Dent Clin North Am 1998; 42: 301-337
    Google Scholar
  • 4 Landt H, Hedegard B. Prosthetic oral rehabilitation after treatment of serious periodontal disease. Quintessence Int Dent Dig 1982; 13: 1087-1094
    Google Scholar
  • 5 Zitzmann NU, Berglundh T. Definition and prevalence of peri-implant diseases. J Clin Periodontol 2008; 35: 286-291
    CrossrefGoogle Scholar
  • 6 Zitzmann NU, Weiger R. Wurzelkanalbehandlung versus Implantation. Zahnmedizin up2date 2009; 4: 363-385
    Article in Thieme ConnectGoogle Scholar
  • 7 Matarazzo F, Figueiredo LC, Cruz SE et al. Clinical and microbiological benefits of systemic metronidazole and amoxicillin in the treatment of smokers with chronic periodontitis: a randomized placebo-controlled study. J Clin Periodontol 2008; 35: 885-896
    CrossrefGoogle Scholar
  • 8 Greenstein G, Greenstein B, Cavallaro J. Prerequisite for treatment planning implant dentistry: periodontal prognostication of compromised teeth. Compend Contin Educ Dent 2007; 28: 436-446 quiz: 447–470
    Google Scholar
  • 9 McGuire MK. Prognosis versus actual outcome: a long-term survey of 100 treated periodontal patients under maintenance care. J Periodontol 1991; 62: 51-58
    CrossrefGoogle Scholar
  • 10 Renvert S, Persson GR. A systematic review on the use of residual probing depth, bleeding on probing and furcation status following initial periodontal therapy to predict further attachment and tooth loss. J Clin Periodontol 2002; 29 (Suppl. 03) 82-89 discussion: 90–81
    CrossrefGoogle Scholar
  • 11 Socransky SS, Haffajee AD, Cugini MA et al. Microbial complexes in subgingival plaque. J Clin Periodontol 1998; 25: 134-144
    CrossrefGoogle Scholar
  • 12 Westfelt E, Rylander H et al. The effect of supragingival plaque control on the progression of advanced periodontal disease. J Clin Periodontol 1998; 25: 536-541
    CrossrefGoogle Scholar
  • 13 Badersten A, Nilveus R, Egelberg J. Effect of nonsurgical periodontal therapy. II. Severely advanced periodontitis. J Clin Periodontol 1984; 11: 63-76
    CrossrefGoogle Scholar
  • 14 Matuliene G, Pjetursson BE, Salvi GE et al. Influence of residual pockets on progression of periodontitis and tooth loss: results after 11 years of maintenance. J Clin Periodontol 2008; 35: 685-695
    CrossrefGoogle Scholar
  • 15 Faggion Jr CM, Petersilka G, Lange DE et al. Prognostic model for tooth survival in patients treated for periodontitis. J Clin Periodontol 2007; 34: 226-231
    CrossrefGoogle Scholar
  • 16 Tonetti MS, Steffen P, Muller-Campanile V et al. Initial extractions and tooth loss during supportive care in a periodontal population seeking comprehensive care. J Clin Periodontol 2000; 27: 824-831
    CrossrefGoogle Scholar
  • 17 Eickholz P, Kaltschmitt J, Berbig J et al. Tooth loss after active periodontal therapy. 1: patient-related factors for risk, prognosis, and quality of outcome. J Clin Periodontol 2008; 35: 165-174
    CrossrefGoogle Scholar
  • 18 Graetz C, Dorfer CE, Kahl M et al. Retention of questionable and hopeless teeth in compliant patients treated for aggressive periodontitis. J Clin Periodontol 2011; 38: 707-714
    CrossrefGoogle Scholar
  • 19 Zitzmann NU, Krastl G, Hecker H et al. Strategic considerations in treatment planning: Deciding when to treat, extract or replace a questionable tooth. J Prosthet Dent 2010; 104: 80-91
    CrossrefGoogle Scholar
  • 20 Carnevale G, Cairo F, Tonetti MS. Long-term effects of supportive therapy in periodontal patients treated with fibre retention osseous resective surgery. II: tooth extractions during active and supportive therapy. J Clin Periodontol 2007; 34: 342-348
    CrossrefGoogle Scholar
  • 21 König J, Plagmann HC et al. Tooth loss and pocket probing depths in compliant periodontally treated patients: a retrospective analysis. J Clin Periodontol 2002; 29: 1092-1100
    CrossrefGoogle Scholar
  • 22 Al-Shammari KF, Kazor CE, Wang HL. Molar root anatomy and management of furcation defects. J Clin Periodontol 2001; 28: 730-740
    CrossrefGoogle Scholar
  • 23 Hirschfeld L, Wasserman B. A long-term survey of tooth loss in 600 treated periodontal patients. J Periodontol 1978; 49: 225-237
    CrossrefGoogle Scholar
  • 24 McFall jr. WT. Tooth loss in 100 treated patients with periodontal disease. A long-term study. J Periodontol 1982; 53: 539-549
    CrossrefGoogle Scholar
  • 25 Greenstein G, Caton J, Polson A. Trisection of maxillary molars: a clinical technique. Compend Contin Educ Dent 1984; 5: 624-626 und 631–632
    Google Scholar
  • 26 Huynh-Ba G, Kuonen P, Hofer D et al. The effect of periodontal therapy on the survival rate and incidence of complications of multirooted teeth with furcation involvement after an observation period of at least 5 years: a systematic review. J Clin Periodontol 2009; 36: 164-176
    CrossrefGoogle Scholar
  • 27 Feres M, Araujo MW et al. Clinical evaluation of tunneled molars: a retrospective study. J Int Acad Periodontol 2006; 8: 96-103
    Google Scholar
  • 28 Park SY, Shin SY et al. Factors influencing the outcome of root-resection therapy in molars: a 10-year retrospective study. J Periodontol 2009; 80: 32-40
    CrossrefGoogle Scholar
  • 29 Bühler H. Evaluation of root-resected teeth. Results after 10 years. J Periodontol 1988; 59: 805-810
    CrossrefGoogle Scholar
  • 30 Ducar JP, Tsutsui F, Merin RL. Therapeutic choices in the molar region. J Calif Dent Assoc 2002; 30: 355-361
    Google Scholar
  • 31 Kinsel RP, Lamb RE, Ho D. The treatment dilemma of the furcated molar: root resection versus single-tooth implant restoration. A literature review. Int J Oral Maxillofac Implants 1998; 13: 322-332
    Google Scholar
  • 32 Minsk L, Polson AM. The role of root resection in the age of dental implants. Compend Contin Educ Dent 2006; 27: 384-388
    Google Scholar
  • 33 OʼNeal RB, Butler BL. Restoration or implant placement: a growing treatment planning quandary. Periodontol 2000 2002; 30: 111-122
    CrossrefGoogle Scholar
  • 34 Fugazzotto PA. A comparison of the success of root resected molars and molar position implants in function in a private practice: results of up to 15-plus years. J Periodontol 2001; 72: 1113-1123
    CrossrefGoogle Scholar
  • 35 Käyser AF. Shortened dental arches and oral function. J Oral Rehabil 1981; 8: 457-462
    CrossrefGoogle Scholar
  • 36 Aukes JN, Käyser AF, Felling AJ. The subjective experience of mastication in subjects with shortened dental arches. J Oral Rehabil 1988; 15: 321-324
    CrossrefGoogle Scholar
  • 37 Walter MH, Weber A, Marre B et al. The randomized shortened dental arch study: tooth loss. J Dent Res 2010; 89: 818-822
    CrossrefGoogle Scholar
  • 38 Ross IF. Problems connected with combined periodontal therapy and fixed restorative care. Dent Clin North Am 1972; 16: 47-57
    Google Scholar
  • 39 Reynolds JM. Abutment selection for fixed prosthodontics. J Prosthet Dent 1968; 19: 483-488
    CrossrefPubMedGoogle Scholar
  • 40 Ante ICH. The fundamental principles of abutments. Michigan State Dental Society Bulletin 1926; 8: 14-23
    Google Scholar
  • 41 Zitzmann NU, Margolin MD, Filippi A et al. Patient assessment and diagnosis in implant treatment. Aust Dent J 2008; 53 (Suppl. 01) S3-10
    CrossrefGoogle Scholar
  • 42 Martinez-Canut P, Carrasquer A et al. A study on factors associated with pathologic tooth migration. J Clin Periodontol 1997; 24: 492-497
    CrossrefGoogle Scholar
  • 43 Mathews DP, Kokich VG. Managing treatment for the orthodontic patient with periodontal problems. Semin Orthod 1997; 3: 21-38
    CrossrefGoogle Scholar
  • 44 Karlsson S. A clinical evaluation of fixed bridges, 10 years following insertion. J Oral Rehabil 1986; 13: 423-432
    CrossrefGoogle Scholar
  • 45 Schwartz NL, Whitsett LD et al. Unserviceable crowns and fixed partial dentures: life-span and causes for loss of serviceability. J Am Dent Assoc 1970; 81: 1395-1401
    Google Scholar
  • 46 Bergenholtz G, Nyman S. Endodontic complications following periodontal and prosthetic treatment of patients with advanced periodontal disease. J Periodontol 1984; 55: 63-68
    CrossrefGoogle Scholar
  • 47 Randow K, Glantz P-O, Zoger B. Technical failures and some related clinical complications in extensive fixed prosthodontics. An epidemiological study of long-term clinical quality. Acta Odontol Scand 1986; 44: 241-255
    CrossrefGoogle Scholar
  • 48 Lundgren D, Nyman S et al. Functional analysis of fixed bridges on abutment teeth with reduced periodontal support. J Oral Rehabil 1975; 2: 105-116
    CrossrefGoogle Scholar
  • 49 Lulic M, Brägger U, Lang NP et al. Anteʼs (1926) law revisited: a systematic review on survival rates and complications of fixed dental prostheses (FDPs) on severely reduced periodontal tissue support. Clin Oral Implants Res 2007; 18 (Suppl. 03) 63-72
    CrossrefPubMedGoogle Scholar
  • 50 Nyman S, Ericsson I. The capacity of reduced periodontal tissues to support fixed bridgework. J Clin Periodontol 1982; 9: 409-414
    CrossrefGoogle Scholar
  • 51 Nyman S, Lindhe J. A longitudinal study of combined periodontal and prosthetic treatment of patients with advanced periodontal disease. J Periodontol 1979; 50: 163-169
    CrossrefGoogle Scholar
  • 52 Brägger U, Hirt-Steiner S, Schnell N et al. Complication and failure rates of fixed dental prostheses in patients treated for periodontal disease. Clin Oral Implants Res 2011; 22: 70-77
    CrossrefPubMedGoogle Scholar
  • 53 Fardal O, Linden GJ. Long-term outcomes for cross-arch stabilizing bridges in periodontal maintenance patients – a retrospective study. J Clin Periodontol 2010; 37: 299-304
    CrossrefGoogle Scholar
  • 54 Yi SW, Ericsson I et al. Long-term follow-up of cross-arch fixed partial dentures in patients with advanced periodontal destruction. Evaluation of the supporting tissues. Acta Odontol Scand 1995; 53: 242-248
    CrossrefGoogle Scholar
  • 55 Yi SW, Carlsson GE, Ericsson I. Prospective 3-year study of cross-arch fixed partial dentures in patients with advanced periodontal disease. J Prosthet Dent 2001; 86: 489-494
    CrossrefGoogle Scholar
  • 56 De Backer H, Van Maele G et al. Survival of complete crowns and periodontal health: 18-year retrospective study. Int J Prosthodont 2007; 20: 151-158
    Google Scholar
  • 57 Cabanilla LL, Neely AL, Hernandez F. The relationship between periodontal diagnosis and prognosis and the survival of prosthodontic abutments: a retrospective study. Quintessence Int 2009; 40: 821-831
    Google Scholar
  • 58 Zlataric DK, Celebic A, Valentic-Peruzovic M. The effect of removable partial dentures on periodontal health of abutment and non-abutment teeth. J Periodontol 2002; 73: 137-144
    CrossrefGoogle Scholar
  • 59 Bergman B, Hugoson A, Olsson CO. A 25 year longitudinal study of patients treated with removable partial dentures. J Oral Rehabil 1995; 22: 595-599
    CrossrefGoogle Scholar
  • 60 De Boever AL, Quirynen M, Coucke W et al. Clinical and radiographic study of implant treatment outcome in periodontally susceptible and non-susceptible patients: a prospective long-term study. Clin Oral Implants Res 2009; 20: 1341-1350
    CrossrefGoogle Scholar
  • 61 Walton TR. Changes in the outcome of metal-ceramic tooth-supported single crowns and FDPs following the introduction of osseointegrated implant dentistry into a prosthodontic practice. Int J Prosthodont 2009; 22: 260-267
    Google Scholar
  • 62 Walton TR. Changes in patient and FDP profiles following the introduction of osseointegrated implant dentistry in a prosthodontic practice. Int J Prosthodont 2009; 22: 127-135
    Google Scholar
  • 63 Lang NP, Pjetursson BE, Tan K et al. A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years. II. Combined tooth-implant-supported FPDs. Clin Oral Implants Res 2004; 15: 643-653
    CrossrefGoogle Scholar
  • 64 Zitzmann NU, Rohner U et al. When to choose which retention element to use for removable dental prostheses. Int J Prosthodont 2009; 22: 161-167
    Google Scholar
  • 65 Zitzmann NU, Rohner U et al. Kriterien zur Auswahl der Retentionselemente für herausnehmbaren Zahnersatz. Quintessenz Zahntech 2010; 36: 188-197
    Google Scholar
  • 66 Vallittu PK, Kokkonen M. Deflection fatigue of cobalt-chromium, titanium, and gold alloy cast denture clasp. J Prosthet Dent 1995; 74: 412-419
    CrossrefGoogle Scholar
  • 67 Ghani F, Mahood M. A laboratory examination of the behaviour of cast cobalt-chromium clasps. J Oral Rehabil 1990; 17: 229-237
    CrossrefGoogle Scholar