国际口腔医学杂志

国际口腔医学杂志 ›› 2025, Vol. 52 ›› Issue (6): 823-831.doi: 10.7518/gjkq.2025071

• 综述 • 上一篇    下一篇

牙周炎患者缺失牙修复的临床考量及预后评估

陈禹黄(),梁星(),李然   

  1. 口腔疾病防治全国重点实验室 国家口腔医学中心 国家口腔疾病临床医学研究中心四川大学华西口腔医院修复科 成都 610041
  • 收稿日期:2024-12-11 修回日期:2025-04-15 出版日期:2025-11-01 发布日期:2025-10-23
  • 通讯作者: 梁星
  • 作者简介:陈禹黄，住院医师，硕士，Email：cyhcyh0313@163.com
  • 基金资助:
    四川省科技计划项目(2021YJ0146);成都市技术创新研发项目(2022-YF05-01768-SN)

Comparison of common restoration methods for missing teeth in patients with periodontitis

Yuhuang Chen(),Xing Liang(),Ran Li   

  1. State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2024-12-11 Revised:2025-04-15 Online:2025-11-01 Published:2025-10-23
  • Contact: Xing Liang
  • Supported by:
    Sichuan Province Science and Technology Plan Project(2021YJ0146);Chengdu Technology Innovation Research and Development Project(2022-YF05-01768-SN)

RichHTML

2

PDF (PC)

16

摘要：

牙周炎患者因牙周受损且牙周状态相对不稳定，导致其缺失牙的修复常是修复工作中的难点。不同严重程度的牙周炎对修复工作带来的风险与挑战不同，因此有必要明确牙周炎的不同分期在修复工作中所存在的问题和风险。此外，在修复治疗前进行充分的牙周诊治准备、掌握好修复时机、评估患牙的保留价值等，也是影响修复成功的关键因素。牙周炎患者在缺失牙后常选用可摘局部义齿、固定局部义齿、种植义齿3种修复方式。本文就对牙周炎患者缺失牙修复的临床考量及预后评估作一综述，为临床应用提供一定的理论依据。

关键词: 牙周炎, 牙列缺损, 修复治疗

Abstract:

Patients with periodontitis have damaged periodontium and a relatively unstable periodontal state, making the restoration of their missing teeth a difficult task. The risks and challenges brought by periodontitis of different stages to restorative work vary and thus must be clarified. Sufficient periodontal treatment preparation, grasping the restoration opportunity, and evaluating the retention value of the teeth before restorative treatment are also key factors affecting restoration success. Removable partial denture, fixed partial denture, and implant supported denture are often used to restore missing teeth in patients with periodontitis. This study reviews the clinical considerations and prognosis evaluation of prosthetic therapy in patients with periodontitis to provide theoretical basis for its clinical application.

Key words: periodontitis, dentition defect, prosthetic therapy

中图分类号: 

  • R783.4
[1] Peres MA, MacPherson LMD, Weyant RJ, et al. Oral diseases: a global public health challenge[J]. Lancet, 2019, 394(10194): 249-260.
[2] Bertolini M, Clark D. Periodontal disease as a mo-del to study chronic inflammation in aging[J]. Geroscience, 2024, 46(4): 3695-3709.
[3] Trindade D, Carvalho R, Machado V, et al. Prevalence of periodontitis in dentate people between 2011 and 2020: a systematic review and meta-analysis of epidemiological studies[J]. J Clin Periodontol, 2023, 50(5): 604-626.
[4] Li Y, Huang CL, Lu XZ, et al. Longitudinal association of edentulism with cognitive impairment, sarcopenia and all-cause mortality among older Chinese adults[J]. BMC Oral Health, 2023, 23(1): 333.
[5] Rădulescu V, Boariu M, Rusu D, et al. Is the diagnosis of generalized stage Ⅳ (severe) periodontitis compatible with the survival of extended stabilizing prosthetic restorations? A medium-term retrospective study[J]. Diagnostics (Basel), 2022, 12(12): 3053.
[6] Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: framework and propo-sal of a new classification and case definition[J]. J Periodontol, 2018, 89(): S159-S172.
[7] Papapanou PN, Sanz M, Buduneli N, et al. Perio-dontitis: consensus report of workgroup 2 of the 2017 world workshop on the classification of pe-riodontal and peri-implant diseases and conditions[J]. J Periodontol, 2018, 89(): S173-S182.
[8] 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(): 4-71.
[9] Kwon T, Lamster IB, Levin L. Current concepts in the management of periodontitis[J]. Int Dent J, 2021, 71(6): 462-476.
[10] Sanz M, Herrera D, Kebschull M, et al. Treatment of stage Ⅰ-Ⅲ periodontitis-the EFP S3 level clinical practice guideline[J]. J Clin Periodontol, 2020, 47(): 4-60.
[11] Chapple ILC, Mealey BL, Van Dyke TE, et al. Pe-riodontal health and gingival diseases and conditions on an intact and a reduced periodontium: consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions[J]. J Clin Periodontol, 2018, 45(): S68-S77.
[12] Schulz S, Stein JM, Schumacher A, et al. Nonsurgical periodontal treatment options and their impact on subgingival microbiota[J]. J Clin Med, 2022, 11(5): 1187.
[13] Sarafidou K, Lazaridi I, Gotsis S, et al. Tooth preservation vs. extraction and implant placement in pe-riodontally compromised patients: a systematic review and analysis of studies[J]. J Prosthodont, 2022, 31(8): e87-e99.
[14] Cortellini P, Stalpers G, Mollo A, et al. Periodontal regeneration versus extraction and dental implant or prosthetic replacement of teeth severely compromised by attachment loss to the apex: a randomized controlled clinical trial reporting 10-year outcomes, survival analysis and mean cumulative cost of recurrence[J]. J Clin Periodontol, 2020, 47(6): 768-776.
[15] Afrashtehfar KI, Hicklin SP, Schmidlin PR. Long-term outcomes of implant placement versus tooth preservation in periodontally compromised teeth may be comparable[J]. J Evid Based Dent Pract, 2024, 24(1): 101931.
[16] Ming PY, Liu YF, Yu PY, et al. A biomimetic Se-nHA/PC composite microsphere with synergistic immunomodulatory and osteogenic ability to activate bone regeneration in periodontitis[J]. Small, 2024, 20(9): e2305490.
[17] Peng SM, Fu HJ, Li R, et al. A new direction in pe-riodontitis treatment: biomaterial-mediated macrophage immunotherapy[J]. J Nanobiotechnology, 2024, 22(1): 359.
[18] Zeng WY, Ning Y, Huang X. Advanced technologies in periodontal tissue regeneration based on stem cells: current status and future perspectives[J]. J Dent Sci, 2021, 16(1): 501-507.
[19] 王勤涛, 马志伟, 王津津. 重度牙周炎患牙拔除或挽救之思考[J]. 华西口腔医学杂志, 2023, 41(6): 635-640.
Wang QT, Ma ZW, Wang JJ. Personal understan-ding of the extraction or rescue on severe periodontitis teeth[J]. West China J Stomatol, 2023, 41(6): 635-640.
[20] Seo JG, Cho JH. Clinical outcomes of rigid and non-rigid telescopic double-crown-retained removable dental prostheses: an analytical review[J]. J Adv Prosthodont, 2020, 12(1): 38-48.
[21] da Fonte Porto Carreiro A, de Carvalho Dias K, Correia Lopes AL, et al. Periodontal conditions of abutments and non-abutments in removable partial dentures over 7 years of use[J]. J Prosthodont, 2017, 26(8): 644-649.
[22] Zlatarić DK, Celebić A, Valentić-Peruzović M. The effect of removable partial dentures on periodontal health of abutment and non-abutment teeth[J]. J Periodontol, 2002, 73(2): 137-144.
[23] Correia ARM, da Silva Lobo FD, Miranda MCP, et al. Evaluation of the periodontal status of abutment teeth in removable partial dentures[J]. Int J Perio-dontics Restorative Dent, 2018, 38(5): 755-760.
[24] Nisser J, Kisch J, Chrcanovic BR. Risk factor assessment for survival of removable partial dentures and their abutment teeth: a retrospective analysis[J]. Int J Prosthodont, 2022, 35(5): 598-608.
[25] Gotfredsen K, Rimborg S, Stavropoulos A. Efficacy and risks of removable partial prosthesis in perio-dontitis patients: a systematic review[J]. J Clin Pe-riodontol, 2022, 49(): 167-181.
[26] Gonda T, Togawa H, Ikebe K. Effects of denture use on occlusal force on abutment teeth in molar distal-extension edentulism[J]. J Prosthodont Res, 2025, 69(1): 91-96.
[27] Togawa H, Gonda T, Karino T, et al. Clinical measurements of force exerted on anterior teeth in partial edentulous distal extension[J]. Int J Prosthodont, 2024, 37(1): 27-33.
[28] Tada S, Allen PF, Ikebe K, et al. Impact of periodontal maintenance on tooth survival in patients with removable partial dentures[J]. J Clin Periodontol, 2015, 42(1): 46-53.
[29] Dommisch H, Walter C, Difloe-Geisert JC, et al. Efficacy of tooth splinting and occlusal adjustment in patients with periodontitis exhibiting masticatory dysfunction: a systematic review[J]. J Clin Perio-dontol, 2022, 49(): 149-166.
[30] 薛松霞. 可摘式钛合金牙周夹板应用于牙周病修复治疗中的临床有效性分析[J]. 中国医疗器械信息, 2022, 28(16): 47-49, 116.
Xue SX. Clinical effectiveness analysis of remo-vable titanium alloy periodontal splint in the treatment of periodontal disease[J]. China Med Dev Inform, 2022, 28(16): 47-49, 116.
[31] Merli M, Aquilanti L, Pagliaro U, et al. Masticatory function in stage Ⅳ periodontitis patients treated with fixed prosthetic rehabilitations: a case series[J]. Int J Periodontics Restorative Dent, 2024, 44(1): 103-113.
[32] Nyman S, Lindhe J. Prosthetic rehabilitation of patients with advanced periodontal disease[J]. J Clin Periodontol, 1976, 3(3): 135-147.
[33] Nyman SR, Lang NP. Tooth mobility and the biolo-gical rationale for splinting teeth[J]. Periodontol 2000, 1994, 4: 15-22.
[34] Fardal Ø, Linden GJ. Long-term outcomes for cross-arch stabilizing bridges in periodontal maintenance patients-a retrospective study[J]. J Clin Periodontol, 2010, 37: 299-304.
[35] Montero E, Molina A, Palombo D, et al. Efficacy and risks of tooth-supported prostheses in the treatment of partially edentulous patients with stage Ⅳ periodontitis. A systematic review and meta-analysis[J]. J Clin Periodontol, 2022, 49(): 182-207.
[36] Shi SW, Meng Y, Li WJ, et al. A nomogram prediction for mandibular molar survival in Chinese patients with periodontitis: a 10-year retrospective cohort study[J]. J Clin Periodontol, 2020, 47(9): 1121-1131.
[37] Tada S, Allen PF, Ikebe K, et al. The impact of the crown-root ratio on survival of abutment teeth for dentures[J]. J Dent Res, 2015, 94(9 ): 220S-225S.
[38] Shi SW, Meng Y, Jiao J, et al. Association of crown-root ratio and tooth survival in Chinese patients with advanced periodontitis: an 11-year retrospective cohort study[J]. J Dent, 2024, 150: 105360.
[39] Elsayed A, Meyer G, Wille S, et al. Influence of the yttrium content on the fracture strength of monoli-thic zirconia crowns after artificial aging[J]. Quintessence Int, 2019, 50(5): 344-348.
[40] De Backer H, Van Maele G, Decock V, et al. Long-term survival of complete crowns, fixed dental prostheses, and cantilever fixed dental prostheses with posts and cores on root canal-treated teeth[J]. Int J Prosthodont, 2007, 20(3): 229-234.
[41] Ercoli C, Caton JG. Dental prostheses and tooth-related factors[J]. J Clin Periodontol, 2018, 45(): S207-S218.
[42] Ma YH, Hsu HT, Chang PC. The influence of fixed prosthesis placement on the clinical effectiveness of non-surgical periodontal therapy[J]. J Dent Sci, 2023, 18(2): 674-680.
[43] Srimaneepong V, Heboyan A, Zafar MS, et al. Fixed prosthetic restorations and periodontal health: a narrative review[J]. J Funct Biomater, 2022, 13(1): 15.
[44] Zhu T, Chen JY, Xu YC, et al. Biomechanical beha-viour of tilted abutment after fixed partial denture restoration of CAD/CAM materials[J]. BMC Oral Health, 2024, 24(1): 1128.
[45] Hatta K, Takahashi T, Sato H, et al. Will implants with a fixed dental prosthesis in the molar region enhance the longevity of teeth adjacent to distal free-end edentulous spaces[J]. Clin Oral Implants Res, 2021, 32(2): 242-248.
[46] Sgolastra F, Petrucci A, Severino M, et al. Periodontitis, implant loss and peri-implantitis. A meta-analysis[J]. Clin Oral Implants Res, 2015, 26(4): e8-e16.
[47] Galindo-Moreno P, Ravidà A, Catena A, et al. Limi-ted marginal bone loss in implant-supported fixed full-arch rehabilitations after 5 years of follow-up[J]. Clin Oral Implants Res, 2022, 33(12): 1224-1232.
[48] Carra MC, Rangé H, Swerts PJ, et al. Effectiveness of implant-supported fixed partial denture in patients with history of periodontitis: a systematic review and meta-analysis[J]. J Clin Periodontol, 2022, 49(): 208-223.
[49] Pjetursson BE, Helbling C, Weber HP, et al. Peri-implantitis susceptibility as it relates to periodontal therapy and supportive care[J]. Clin Oral Implants Res, 2012, 23(7): 888-894.
[50] Tomina DC, Petruțiu ȘA, Crișan B, et al. Influence of periodontal status and prosthetic treatment on survival and success rates in implant therapy: a 5-year retrospective follow-up study[J]. J Clin Med, 2023, 12(13): 4275.
[51] Quirynen M, Papaioannou W, van Steenberghe D. Intraoral transmission and the colonization of oral hard surfaces[J]. J Periodontol, 1996, 67(10): 986-993.
[52] Aguirre-Zorzano LA, Estefanía-Fresco R, Telletxea O, et al. Prevalence of peri-implant inflammatory disease in patients with a history of periodontal di-sease who receive supportive periodontal therapy[J]. Clin Oral Implants Res, 2015, 26(11): 1338-1344.
[53] Yan X, Lu HY, Zhang L, et al. A three-year study on periodontal microorganisms of short locking-taper implants and adjacent teeth in patients with history of periodontitis[J]. J Dent, 2020, 95: 103299.
[54] Halperin-Sternfeld M, Zigdon-Giladi H, Machtei EE. The association between shallow vestibular depth and peri-implant parameters: a retrospective 6 years longitudinal study[J]. J Clin Periodontol, 2016, 43(3): 305-310.
[55] 曹正国. 修复治疗相关的牙周问题考量[J]. 国际口腔医学杂志, 2022, 49(1): 1-11.
Cao ZG. Periodontal considerations in prosthetic dentistry[J]. Int J Stomatol, 2022, 49(1): 1-11.
[56] 危伊萍, 徐涛, 胡文杰, 等. 重度牙周炎磨牙拔牙同期微翻瓣牙槽嵴保存术后种植修复效果的前瞻性队列研究[J]. 中华口腔医学杂志, 2024, 59(4): 318-325.
Wei YP, Xu T, Hu WJ, et al. A prospective cohort study on the effect of implant restoration following micro crestal flap‑alveolar ridge preservation at molar extraction sockets with severe periodontitis[J]. Chin J Stomatol, 2024, 59(4): 318-325.
[57] Ramanauskaite A, Becker K, Wolfart S, et al. Efficacy of rehabilitation with different approaches of implant-supported full-arch prosthetic designs: a systematic review[J]. J Clin Periodontol, 2022, 49(): 272-290.
[58] Busscher HJ, Rinastiti M, Siswomihardjo W, et al. Biofilm formation on dental restorative and implant materials[J]. J Dent Res, 2010, 89(7): 657-665.
[59] Grischke J, Szafrański SP, Muthukumarasamy U, et al. Removable denture is a risk indicator for peri-implantitis and facilitates expansion of specific pe-riodontopathogens: a cross-sectional study[J]. BMC Oral Health, 2021, 21(1): 173.
[60] Dreyer H, Grischke J, Tiede C, et al. Epidemiology and risk factors of peri-implantitis: a systematic review[J]. J Periodontal Res, 2018, 53(5): 657-681.
[61] Park WB, Kwon KH, Hwang KG, et al. Risk indicators affecting the survival of the mandibular first molar adjacent to an implant at the mandibular se-cond molar site: a retrospective study[J]. J Clin Med, 2021, 10(12): 2543.
[62] Hirotomi T, Yoshihara A, Ogawa H, et al. Tooth-related risk factors for periodontal disease in community-dwelling elderly people[J]. J Clin Periodontol, 2010, 37(6): 494-500.
[63] Tomasi C, Albouy JP, Schaller D, et al. Efficacy of rehabilitation of stage Ⅳ periodontitis patients with full-arch fixed prostheses: tooth-supported versus implant-supported-a systematic review[J]. J Clin Periodontol, 2022, 49(): 248-271.
[64] Bischof FM, Mathey AA, Stähli A, et al. Survival and complication rates of tooth- and implant-supported restorations after an observation period up to 36 years[J]. Clin Oral Implants Res, 2024, 35(12): 1640-1654.
[65] Soheili F, Delfan N, Masoudifar N, et al. Toward digital periodontal health: recent advances and future perspectives[J]. Bioengineering (Basel), 2024, 11(9): 937.
[66] Li JL, Ji ZH, Zhao Z, et al. Prosthesis choice in the adult USA population with partial edentulism[J]. Clin Oral Investig, 2024, 28(10): 554.
[67] Øzhayat EB, Gotfredsen K. Patient-reported effect of oral rehabilitation[J]. J Oral Rehabil, 2019, 46(4): 369-376.
[68] Techapiroontong S, Limpuangthip N. Oral health-related quality of life and reasons for discontinuing partial removable dental prosthesis usage: a cross-sectional study with one to seven years of follow-up[J]. BMC Oral Health, 2024, 24(1): 355.
[1] 王诗雅,袁国华,邹静. 异位釉质的形成机制及临床诊疗策略[J]. 国际口腔医学杂志, 2025, 52(6): 713-721.
[2] 朱然,严静,孙卫斌,吴文蕾,刘玉. 服用抗血栓药物患者牙周基础治疗期间的出血风险管理[J]. 国际口腔医学杂志, 2025, 52(5): 670-676.
[3] 李欢,原韶钟. 牙周炎与非酒精性脂肪性肝病相关性的研究进展[J]. 国际口腔医学杂志, 2025, 52(5): 677-683.
[4] 祝舒钰,周静,谢志刚. 辅助性T细胞17与调节性T细胞之间的制衡效应调控口腔颌面部骨损伤修复的研究进展[J]. 国际口腔医学杂志, 2025, 52(4): 514-525.
[5] 于寰,康健. 牙周内镜在口腔临床诊疗中的应用进展[J]. 国际口腔医学杂志, 2025, 52(4): 544-551.
[6] 李天元, 朱彤欣, 柳庆, 董迎春, 陈斌. 间充质干细胞用于牙周再生临床疗效的系统评价与Meta分析[J]. 国际口腔医学杂志, 2025, 52(3): 296-307.
[7] 别梦瑶,周婕妤,吴亚菲,赵蕾. 牙龈卟啉单胞菌影响血管平滑肌细胞调节性细胞死亡及表型转换的研究进展[J]. 国际口腔医学杂志, 2025, 52(3): 308-316.
[8] 范兴丽,潘乐,赵家园,项秋猛,陈启林. 竞争性内源性RNA在牙周炎中的作用及机制的研究进展[J]. 国际口腔医学杂志, 2025, 52(3): 317-322.
[9] 周婕妤,赵蕾,吴亚菲,李勇,赵寰. 腭侧带蒂结缔组织转瓣移植联合冠修复重建美学区龈乳头1例[J]. 国际口腔医学杂志, 2025, 52(3): 323-332.
[10] 赵美林,赵依琼,黄姣. Ⅲ期C级牙周炎正畸患者上前牙龈乳头缺陷伴牙龈退缩1例[J]. 国际口腔医学杂志, 2025, 52(3): 333-340.
[11] 李晶,康健. 牙周微创手术中再生材料选择及疗效的研究进展[J]. 国际口腔医学杂志, 2025, 52(2): 161-168.
[12] 张潇月,陈舒泽,周婕妤,程磊,赵蕾. 具核梭杆菌经铁死亡途径破坏体外肠道上皮屏障模型的研究[J]. 国际口腔医学杂志, 2025, 52(2): 183-194.
[13] 钟良军. 数字化技术在重度牙周炎治疗中的应用[J]. 国际口腔医学杂志, 2025, 52(1): 1-10.
[14] 程守正,李太文,赵蕾. 血清淀粉样蛋白A与牙周炎相关性的研究进展[J]. 国际口腔医学杂志, 2025, 52(1): 117-122.
[15] 陈梦洁,徐文华,刘青青,康毓聃,刘蓉,朱丽雷. 全身免疫炎症指数与牙周炎患者分级诊断的相关性研究[J]. 国际口腔医学杂志, 2024, 51(6): 706-712.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!