Int J Stomatol

Int J Stomatol ›› 2025, Vol. 52 ›› Issue (2): 238-245.doi: 10.7518/gjkq.2025019

• Reviews • Previous Articles     Next Articles

Strategies for preventing periodontal diseases in the restoration of subgingival tooth defects

Meng Lu1(),Wenchuan Chen1,2(),Yi Gao2   

  1. 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
    2.Dept. of Jinjiang Clinic, West China Hospital of Stomatology, Sichuan University, Chengdu 610011, China
  • Received:2024-06-17 Revised:2024-09-30 Online:2025-03-01 Published:2025-03-01
  • Contact: Wenchuan Chen E-mail:lumeng940710@163.com;hxkqcwc@scu.edu.cn

RichHTML

40

PDF (PC)

234

Abstract:

When the tooth defect is under the gingiva, problems such as the edge of the restoration is not tight and the adhesive is retained cause serious periodontal diseases. Different clinical strategies can be employed to avoid these pro-blems according to the depth of the tooth defect to prevent periodontal diseases and maintain the periodontal health of restored teeth. Commonly used clinical treatment techniques include gingival retraction, deep margin elevation, crown lengthening, and orthodontic extrusion. In this paper, the indications, characteristics, operation methods, and means to avoid periodontal diseases in each method are described.

Key words: tooth defect, periodontal diseases, deep margin elevation, crown lengthening, orthodontic extrusion

CLC Number: 

  • R781.05

TrendMD: 

Tab 1

Classification of depth of subgingival tooth defect"

文献分类及其依据
Fichera等[1]B类：缺损位于龈下小于3 mm的位置（龈沟内）
C类：缺损位于牙槽嵴顶上方1.5 mm以上
D类：缺损位于牙槽嵴顶上方1.5 mm以内
R类：缺损位于牙槽嵴顶下方
Venuti[2]1类：软组织可以通过橡皮障、排龈线、特氟龙等材料隔开后暴露缺损
2类：软组织需要通过刀片、电刀、激光等去除一部分后才能暴露缺损
3类：通过牙冠延长术去除软组织和骨组织后暴露缺损
4类：需要通过正畸牵引、外科手术牵引等才能暴露缺损位置
Ghezzi等[3]1类：不需要进行外科手术的龈壁提升术
2a类：需要进行牙龈手术的龈壁提升术
2b类：需要进行骨组织切除的龈壁提升术
本文使用的分类第1类：缺损较浅，位于龈缘与龈沟底之间
第2类：缺损边缘侵犯了生物学宽度，位于结合上皮或上皮下结缔组织内
第3类：缺损较深，已到达或位于牙槽嵴顶下方

Fig 1

Schematic diagram of tooth defect classification summarized in this paper"

1 Fichera G, Mazzitelli C, Picciariello V, et al. Structurally compromised teeth. Part Ⅰ: clinical considera-tions and novel classification proposal[J]. J Esthet Restor Dent, 2024, 36(1): 7-19.
2 Venuti P. Rethinking deep marginal extension (DME)[J]. Int J Cosmet Dent, 2018, 7: 26-32.
3 Ghezzi C, Brambilla G, Conti A, et al. Cervical margin relocation: case series and new classification system[J]. Int J Esthet Dent, 2019, 14(3): 272-284.
4 Kazakova R, Vlahova A, Tomov G, et al. A compa-rative analysis of post-retraction changes in gingival height after conventional and surgical gingival displacement: rotary curettage, diode and Er: YAG laser troughing[J]. Healthcare (Basel), 2023, 11(16): 2262.
5 李蓉, 左恩俊. 排龈技术的应用方案及热点聚焦[J]. 中国组织工程研究, 2021, 25(2): 322-328.
Li R, Zuo EJ. Gingival retraction: application profiles and hot spotlights[J]. Chin J Tissue Eng Res, 2021, 25(2): 322-328.
6 闫雪冰, 彭红, 刘利, 等. 不同排龈方法修复龈下楔状缺损临床疗效观察[J]. 实用口腔医学杂志, 2012, 28(1): 70-73.
Yan XB, Peng H, Liu L, et al. The clinical effect of different gingival retraction methods in subgingival non-carious cervical lesions[J]. J Pract Stomatol, 2012, 28(1): 70-73.
7 Lawson NC, Litaker MS, Sowell E, et al. Clinical acceptance of single-unit crowns and its association with impression and tissue displacement techniques: findings from the National Dental Practice-Based Research Network[J]. J Prosthet Dent, 2020, 123(5): 701-709.
8 顾敏, 顾卫平. 排龈术的临床应用[J]. 国际口腔医学杂志, 2010, 37(3): 344-347.
Gu M, Gu WP. Clinical application of gingival retraction technology[J]. Int J Stomatol, 2010, 37(3): 344-347.
9 Safari S, Ma VS, Mi VS, et al. Gingival retraction methods for fabrication of fixed partial denture: lite-rature review[J]. J Dent Biomater, 2016, 3(2): 205-213.
10 Giridhar Reddy SV, Bharathi M, Vinod B, et al. Gingival displacement methods used by dental professionals: a survey[J]. J Orofac Sci, 2016, 8(2): 120.
11 倪莹, 张晓明, 惠敏, 等. 三种排龈线对体外培养人牙龈成纤维细胞毒性的比较[J]. 中国组织工程研究, 2012, 16(29): 5396-5400.
Ni Y, Zhang XM, Hui M, et al. Comparison of cytotoxicity among three gingival retraction cords on human gingival fibroblasts in vitro [J]. Chin J Tissue Eng Res, 2012, 16(29): 5396-5400.
12 张锋, 王建军, 朱凯, 等. 排龈膏排龈在前牙固定修复中的应用研究[J]. 福建医科大学学报, 2013, 47(6): 386-388.
Zhang F, Wang JJ, Zhu K, et al. The application of gingival retraction paste in anterior fixed proshesis[J]. J Fujian Med Univ, 2013, 47(6): 386-388.
13 曾静, 黄文博, 曾庆. 单线排龈联合排龈膏在老年前牙龈下根面龋填充治疗中的应用效果分析[J]. 哈尔滨医药, 2021, 41(2): 38-40.
Zeng J, Huang WB, Zeng Q. Analysis of the effect of single-line gingival removal combined with expasyl in the treatment of caries in the subgingival root surface of the elderly[J]. Harbin Med J, 2021, 41(2): 38-40.
14 杨贝贝, 郜珍燕, 安虹, 等. 两种排龈方法排龈效果的数字化分析[J]. 口腔医学, 2021, 41(7): 618-622.
Yang BB, Gao ZY, An H, et al. Digital analysis of gingival retraction effects following two methods[J]. Stomatology, 2021, 41(7): 618-622.
15 Qureshi SM, Anasane NS, Kakade D. Comparative evaluation of the amount of gingival displacement using three recent gingival retraction systems-in vivo study[J]. Contemp Clin Dent, 2020, 11(1): 28-33.
16 Kazakova R, Vlahova A, Tomov G, et al. A compara-tive analysis of post-retraction changes in gingival height after conventional and surgical gingival displacement: rotary curettage, diode and Er: YAG laser troughing[J]. Healthcare, 2023, 11(16): 2262.
17 佟英. 双线与单线排龈方法固定修复的效果评价[J]. 辽宁医学院学报, 2008, 29(3): 269-270.
Tong Y. Evaluation of the effect of fixed restoration with double-line and single-line gingival drainage [J]. J Liaoning Med Coll, 2008, 29(3): 269-270.
18 张婧秋, 何舒奇. 龈壁提升术对牙周组织影响的研究进展[J]. 口腔医学研究, 2023, 39(4): 295-299.
Zhang JQ, He SQ. Advance in effects of deep margin elevation on periodontal tissue[J]. J Oral Sci Res, 2023, 39(4): 295-299.
19 Dablanca-Blanco AB, Blanco-Carrión J, Martín-Biedma B, et al. Management of large class Ⅱ lesions in molars: how to restore and when to perform surgical crown lengthening[J]. Restor Dent Endod, 2017, 42(3): 240-252.
20 Abdulsattar YH, Kadhim AJ. Effect of immediate dentin sealing on the fracture strength of indirect overlay restorations using different types of luting agents (a comparative in vitro study) [J]. J Conserv Dent Endod, 2023, 26(4): 434-440.
21 Gresnigt MMM. Is immediate dentin sealing of ad-ded value in partial indirect restoration[J]. Ned Tijdschr Tandheelkd, 2023, 130(2): 81-84.
22 Samartzi TK, Papalexopoulos D, Sarafianou A, et al. Immediate dentin sealing: a literature review[J]. Clin Cosmet Investig Dent, 2021, 13: 233-256.
23 Juloski J, KÖken S, Ferrari M. No correlation between two methodological approaches applied to evaluate cervical margin relocation[J]. Dent Mater J, 2020, 39(4): 624-632.
24 Da Silva D, Ceballos L, Fuentes MV. Influence of the adhesive strategy in the sealing ability of resin composite inlays after deep margin elevation[J]. J Clin Exp Dent, 2021, 13(9): e886-e893.
25 Geo TD, Gupta S, Gupta SG, et al. Is deep margin elevation a reliable tool for cervical margin relocation-a comparative review[J]. J Oral Biol Craniofac Res, 2024, 14(1): 33-38.
26 Juloski J, Köken S, Ferrari M. Cervical margin relocation in indirect adhesive restorations: a literature review[J]. J Prosthodont Res, 2018, 62(3): 273-280.
27 Alahmari NM, Adawi HA, Moaleem MMA, et al. Effects of the cervical marginal relocation technique on the marginal adaptation of lithium disilicate CAD/CAM ceramic crowns on premolars[J]. J Contemp Dent Pract, 2021, 22(8): 900-906.
28 Ilgenstein I, Zitzmann NU, Bühler J, et al. Influence of proximal box elevation on the marginal quality and fracture behavior of root-filled molars restored with CAD/CAM ceramic or composite onlays[J]. Clin Oral Investig, 2015, 19(5): 1021-1028.
29 韩雨亭, 吴燕茹. 应用龈壁提升术修复牙体缺损的研究进展[J]. 国际口腔医学杂志, 2019, 46(3): 349-355.
Han YT, Wu YR. Research progress on deep margin elevation in tooth defect restorations[J]. Int J Stomatol, 2019, 46(3): 349-355.
30 Aldakheel M, Aldosary K, Alnafissah S, et al. Deep margin elevation: current concepts and clinical considerations: a review[J]. Medicina, 2022, 58(10): 1482.
31 赵川江. 牙冠延长术的临床应用[J]. 中华口腔医学研究杂志(电子版), 2015, 9(4): 329.
Zhao CJ. Clinical application of crown lengthening[J]. Chin J Stomatol Res (Electron Ed), 2015, 9(4): 329.
32 Wang C, Jia XT, Zhen M, et al. Success rate of fractured teeth receiving modified crown lengthening surgery and restorations[J]. BMC Oral Health, 2022, 22(1): 99.
33 贾彦, 于寰, 张研, 等. 下颌第二磨牙牙冠延长术后疗效观察及其风险因素分析[J]. 口腔医学研究, 2024, 40(2): 130-135.
Jia Y, Yu H, Zhang Y, et al. Clinical observation and risk factors analysis of crown lengthening of mandibular second molar[J]. J Oral Sci Res, 2024, 40(2): 130-135.
34 金园园, 汪涌. 牙冠延长术的临床应用现状[J]. 临床口腔医学杂志, 2017, 33(8): 492-495.
Jin YY, Wang Y. Clinical application of crown lengthening[J]. J Clin Stomatol, 2017, 33(8): 492-495.
35 赵孟臻, 张子怡, 国晓曼, 等. 双波长激光微创美学冠延长术1例[J]. 现代口腔医学杂志, 2022, 36(5): 346-348.
Zhao MZ, Zhang ZY, Guo XM, et al. A case of minimally invasive aesthetic crown lengthening with dual-wavelength laser[J]. J Mod Stomatol, 2022, 36(5): 346-348.
36 栗洪师, 蔡成雄, 柯杰. 铒、钕双波长激光在前牙美学区冠延长术中疗效[J]. 中国激光医学杂志, 2021, 30(1): 21.
Li HS, Cai CX, Ke J. Effect of Er, Nd dual-wavelength laser on crown lengthening of anterior teeth[J]. Chin J Laser Med, 2021, 30(1): 21.
37 王雪纯, 汪涌, 许晓波, 等. 数字化冠延长导板在前牙美学修复中的应用效果评价[J]. 上海口腔医学, 2022, 31(3): 260-264.
Wang XC, Wang Y, Xu XB, et al. Evaluation of the effect of digital crown extension guide in aesthetic restoration of anterior teeth[J]. Shanghai J Stomatol, 2022, 31(3): 260-264.
38 熊萍, 刘彦, 王荃. 微创冠延长术保存冠根折裂磨牙和前磨牙1年后的牙周状态观察[J]. 实用口腔医学杂志, 2018, 34(4): 540-543.
Xiong P, Liu Y, Wang Q. Observation of periodontal status of molars and premolars with oblique crown-root fracture one year after minimally invasive crown lengthening[J]. J Pract Stomatol, 2018, 34(4): 540-543.
39 Altayeb W, Rossi R, Arnabat-Dominguez J. Positional stability of the periodontal tissues following crown lengthening surgery[J]. Dent Rev, 2022, 2(4): 100059.
40 杨娟霞, 王梦秀. 牙冠延长术临床效果及术后龈缘位置的观察[J]. 实用临床医学, 2019, 20(12): 44-46.
Yang JX, Wang MX. Clinical effect of crown leng-thening surgery and postoperative position of gingival margin[J]. Pract Clin Med, 2019, 20(12): 44-46.
41 Pontoriero R, Carnevale G. Surgical crown leng-thening: a 12-month clinical wound healing study[J]. J Periodontol, 2001, 72(7): 841-848.
42 石宇彤, 王翠, 江雨荷, 等. 改良牙冠延长术及桩核冠修复保留外伤上颌侧切牙的临床效果观察(附1例2年随访报告)[J]. 中国实用口腔科杂志, 2023, 16(3): 307-311.
Shi YT, Wang C, Jiang YH, et al. Efficacy of modified crown lengthening procedure and post-core crown restoration in maxillary lateral incisor with dental trauma: a case report of 2-year follow-up[J]. China J Pract Stomatol, 2023, 16(3): 307-311.
43 王翠, 阳婷, 胡文杰, 等. 美学区上颌前牙冠根折经改良牙冠延长术结合桩核冠修复长期疗效观察(附1例14年随访报告)[J]. 中国实用口腔科杂志, 2023, 16(3): 302-306.
Wang C, Yang T, Hu WJ, et al. Long-term effect of modified crown lengthening procedure combined with post-and-core restorations for a case of crown-root fracture of anterior teeth in the maxillary esthe-tic area: a case report of 14-year follow-up[J]. China J Pract Stomatol, 2023, 16(3): 302-306.
44 马春亮, 唐晓琳. 牙冠延长术与正畸牵引术在保留残根治疗方面研究进展[J]. 中国实用口腔科杂志, 2013, 6(3): 187-190.
Ma CL, Tang XL. Research progress of crown lengthening surgery and orthodontic traction in retaining residual roots[J]. Chin J Pract Stomatol, 2013, 6(3): 187-190.
45 Reichardt E, Krug R, Bornstein MM, et al. Ortho-dontic forced eruption of permanent anterior teeth with subgingival fractures: a systematic review[J]. Int J Environ Res Public Health, 2021, 18(23): 12580.
46 杨瑛, 张方明, 李景辉, 等. 口腔正畸牵引联合多学科综合治疗后牙残根的临床研究[J].临床和实验医学杂志, 2019, 18(13): 1451-1454.
Yang Y, Zhang FM, Li JH, et al. Study of orthodontic traction combined with multidisciplinary app-roach to treat posterior residual roots[J]. J Clin Exper Med, 2019,18(13): 1451-1454.
47 Bruhnke M, Beuer F, Böse MWH, et al. Forced ortho-dontic extrusion to restore extensively damaged anterior and premolar teeth as abutments for single-crown restorations: up to 5-year results from a pilot clinical study[J]. J Prosthet Dent, 2023, 129(1): 61-68.
48 Krug R, Connert T, Soliman S, et al. Surgical extrusion with an atraumatic extraction system: a clinical study[J]. J Prosthet Dent, 2018, 120(6): 879-885.
49 Plotino G, Abella Sans F, Duggal MS, et al. Clinical procedures and outcome of surgical extrusion, intentional replantation and tooth autotransplantation-a narrative review[J]. Int Endod J, 2020, 53(12): 1636-1652.
50 Scholtes E, Suttorp CM, Loomans BA, et al. Combined orthodontic, surgical, and restorative app-roach to treat a complicated crown-root fracture in a maxillary central incisor[J]. Am J Orthod Dentofacial Orthop, 2018, 154(4): 570-582.
51 de Araujo CM, Trannin PD, Schroder AGD, et al. Surgical-Periodontal aspects in orthodontic traction of palatally displaced canines: a meta-analysis[J]. Jpn Dent Sci Rev, 2020, 56(1): 164-176.
52 Naumann M, Adali U, Rosentritt M, et al. Effect of apical root resection, orthodontic extrusion, and surgical crown lengthening on load capability[J]. Clin Oral Investig, 2023, 27(8): 4379-4387.
[1] Cheng Yifan,Qin Xu,Jiang Ming,Zhu Guang-xun.. Research progress on innate lymphoid cells in periodontal diseases [J]. Int J Stomatol, 2023, 50(1): 32-36.
[2] Cao Zhengguo. Periodontal considerations in prosthetic dentistry [J]. Int J Stomatol, 2022, 49(1): 1-11.
[3] Wang Jian. Research progress and clinical application of inlays and onlays [J]. Int J Stomatol, 2021, 48(5): 497-505.
[4] Chen Liang,Ding Yi,Meng Shu. Research progress of host modulation therapy in the treatment of periodontal diseases [J]. Int J Stomatol, 2020, 47(6): 706-710.
[5] Jia Leming,Jia Xiaoyue,Yang Ran,Zhou Xuedong,Xu Xin. Progress on the application of probiotics in the management of periodontal diseases [J]. Int J Stomatol, 2020, 47(5): 515-521.
[6] Liu Lin,Zhou Jieyu,Wu Yafei,Zhao Lei. Application of probiotic ecological regulation in prevention and treatment of periodontal diseases [J]. Int J Stomatol, 2020, 47(2): 131-137.
[7] Chen Yanyan,Peng Xian,Zhou Xuedong,Cheng Lei. Application of quantitative light-induced fluorescence in the clinical treatment of caries and periodontal diseases [J]. Int J Stomatol, 2019, 46(6): 699-704.
[8] Yuting Han,Yanru Wu. Research progress on deep margin elevation in tooth defect restorations [J]. Int J Stomatol, 2019, 46(3): 349-355.
[9] Zheng Wei, Li Yu. New development in the comprehensive multidisciplinary treatment of gummy smile [J]. Inter J Stomatol, 2017, 44(5): 509-513.
[10] Zhao Yujun, Yuan Hongmei, Chen Wen, Lin Hongli. Nursing experience on crown lengthening surgery with piezosurgery [J]. Inter J Stomatol, 2016, 43(2): 143-145.
[11] Wen Xingtao1, Ren Bolin1, Bao Lina2, Li Dongjian1. Clinical study of traction preservation of maxillary anterior teeth residual root with microscrew anchorage [J]. Inter J Stomatol, 2015, 42(4): 426-429.
[12] Liu Man1, Meng Yao2, Wu Min1, Ye Lirong1, Zhang Qiang1, Wang Jindong1.. Relationship between periodontal disease and gestational diabetes mellitus [J]. Inter J Stomatol, 2015, 42(1): 19-21.
[13] Li Qian1, Pan Yaping1,2.. Relationship between survivin and oral diseases [J]. Inter J Stomatol, 2013, 40(5): 674-677.
[14] Huang Jing, Liang Jingping.. Research progress on gingival crevicular fluid in patients with diabetes mellitus and periodontal diseases [J]. Inter J Stomatol, 2013, 40(4): 519-522.
[15] Zhang Gang, Tan Yinghui.. Series study of periodontal diseases under highland environment [J]. Inter J Stomatol, 2013, 40(2): 141-143.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[2] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[3] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[4] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[5] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[6] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[7] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[8] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[9] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[10] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .