2015年 · 第50卷第03期

Prosthodontics is inseparable from periodontology. Prostheticians usually encounter the following problems related to periodontal disease in clinical practice: what they deal with before restoration: periodontal tissue inflammation, periodontal soft and hard tissue defects; Faced with restoration: Designing restorations that are beneficial to periodontal health; Encountered after restoration: Invasion of periodontal tissue by restoration, lack of periodontal maintenance. To solve these problems, prosthodontists should have good background knowledge of periodontology and work closely with periodontists, so as to ensure the harmonious coexistence of restoration and periodontal tissue. Starting from the basic concepts of periodontology, the author will elaborate the most common periodontal problems in prosthetic treatment and their solutions.

The primary purpose of periodontal treatment is to restore and maintain the health and integrity of periodontal support tissues. During periodontitis, the periodontal supporting tissue is destroyed, resulting in pathological displacement of teeth susceptible to various forces, including tilt, torsion, gap widening, fan-shaped displacement and elongation, etc., causing secondary occlusal trauma and aggravating the loss of periodontal supporting tissue. To solve these problems, it is necessary to align the misaligned teeth through orthodontic and restorative treatment, establish a good occlusal relationship, restore the occlusal balance between teeth, and promote the recovery of periodontal tissue on the premise of completing the basic periodontal treatment and controlling the periodontal inflammation^[1,2]。 For patients with moderate to severe periodontitis accompanied by tooth misalignment or secondary occlusal trauma, orthodontic adjuvant treatment is an important means to achieve the goal of periodontal treatment, which is to establish a dentition that can perform well in a healthy periodontal state. However, orthodontic treatment must be performed when periodontal inflammation is controlled or periodontitis is in a quiescent phase^[3]。

Orthodontic treatment is attracting more and more attention. Besides adolescent orthodontic treatment, adult orthodontic treatment is gradually increasing. Periodontitis often leads to tooth displacement, and after controlling infection and inflammation, orthodontic treatment can help to improve the occlusal relationship, which is beneficial to the stability of periodontal tissue. The basic principle of orthodontic treatment is to change the position of the tooth in the jaw by applying an orthodontic force to the tooth, which guides the periodontal tissue remodeling. Therefore, orthodontic treatment is closely related to periodontal tissue^[1]。 Before orthodontic treatment, attention should be paid to check the periodontal condition and diagnose and treat periodontal diseases. During the design and treatment of orthodontic treatment, attention should be paid to avoid damage to periodontal tissue, and attention should be paid to control plaque and maintain the health of periodontal tissue, so as to avoid medical risks and disputes. The author will discuss how to recognize these risks and preventive measures from the perspective of the risk of periodontal tissue damage caused by orthodontics.

There is a special interdisciplinary interrelationship between orthodontics and periodontology. Any orthodontic treatment that applies biomechanical principles will affect periodontal conditions such as root length and morphology, alveolar ridge width and height, and gingival structure, among others. Successful orthodontic treatment can maintain the level of gingival attachment and the integrity of tooth root, thus forming a long-term periodontal stable state, and achieving good aesthetic and functional results. On the contrary, imperfect orthodontic and periodontal comprehensive treatment will increase the risk of periodontal disease and aggravate the destruction of periodontal soft and hard tissues caused by inflammation. Therefore, in order to reduce the treatment risk and improve the clinical treatment effect, it is very important for orthodontists and periodontists to grasp the relationship between orthodontics and periodontal treatment in adult periodontal-orthodontic comprehensive treatment.

Aggressive periodontitis is characterized by early onset and rapid progression, which can lead to loosening or even loss of teeth in young people, and clinical treatment is difficult. Because patients are relatively young and have high requirements for aesthetics and function, they often require multidisciplinary comprehensive treatment. Comprehensive treatment design is the key to successful treatment, while basic periodontal treatment to control inflammation provides a basic guarantee for long-term stable curative effect. A patient with aggressive periodontitis was admitted to the Stomatological Hospital of Peking University School of Stomatology. The patient was treated with multidisciplinary comprehensive treatment such as basic periodontal treatment, orthodontic treatment and oral implant treatment. The longitudinal observation for 7 years is now reported as follows.

Beautiful smile is an important symbol of beauty and health. Many factors together determine the overall beauty of smile. Among them, "red and white aesthetics" related to gingival-tooth complex is one of the most important factors affecting smile^[1]。 However, within the aesthetic category it determines, there is a group of patients presenting with short crowns and gingival smiles, which have varying degrees of influence on the aesthetics of the smile. Crown extension is mainly used to solve aesthetic problems involving the anterior tooth region, such as short clinical crowns and exposed gingival smiles caused by delayed passive eruption, gingival inflammation caused by destroying the biological width of the prosthesis edge, etc. In order to meet patients'precise requirements for the aesthetic appearance of a smile, it is often necessary to predict and evaluate the effect of aesthetic crown extension, for example: preoperative analysis using diagnostic wax or digital imaging. However, in the course of surgical operation, there is often a lack of standard measurement tools to guide the operation, which affects the postoperative effect. Chu's Aesthetic Gauges (Hu-Friedy Inc, Chicago, IL), invented by Chu in 2007, provide a reference for accurately establishing aesthetically pleasing, stable and healthy gingival-dental complexes^[2]。 Chu aesthetic scales include: proportion gauge, sounding gauge, and crown lengthening gauge. The Periodontology Department of West China School of Stomatology of Sichuan University admitted a typical case requiring a solution to gingival smile, and the patient was treated with a crown extension operation using the Chu aesthetic scale, which is now reported as follows.

Bisphosphonates, a class of bone resorption inhibitors developed in the 1980s, have been widely used to prevent and treat osteoporosis caused by enhanced osteoclast activity, metabolic bone disease, multiple myeloma, hypercalcemia, and bone diseases associated with tumor bone metastasis. In recent years, there have been more and more reports on bisphosphonate-related osteonecrosis of the jaw (BRONJ) abroad, and BRONJ has attracted more and more attention internationally^[1]。 The main clinical manifestation of BRONJ was necrosis and exposure of the jaw. In addition to jaw necrosis, a BRONJ patient admitted to the periodontal department of the School of Stomatology of Shandong University also showed repeated multiple periodontal abscesses in the lower anterior teeth area, which is easily confused with periodontal abscesses caused by periodontitis. However, the treatment principles of the two are significantly different and should be differentiated clinically, which is reported as follows.

From July 15th to 17th, 2014, the "2014 10th National Periodontology Academic Conference" sponsored by the Periodontology Professional Committee of Chinese Stomatological Association and undertaken by Jilin University Stomatological Hospital was held in Changchun, Jilin Province. The opening ceremony was presided over by Professor Zhang Jincai, Vice President of Chinese Stomatological Association and President of Guangdong Stomatological Hospital. Professor Lu Zhenfu, Vice President of Chinese Stomatological Association, expressed warm congratulations on the convening of this periodontal conference on behalf of Chinese Stomatological Association and President Wang Xing. Professor Hou Mingshan, Deputy Director of Jilin Provincial Health and Family Planning Commission, Professor Li Fan, Vice President of Jilin University, and Professor Zhou Yanmin, Dean of Jilin University Stomatological Hospital, delivered speeches respectively.

Dental hard tissues include enamel, dentin and cementum, and all genetic disorders involving these tissues can be generally classified as genetic dental hard tissue disorders. These genetic diseases can occur in the hard tissue of the tooth alone or appear locally in the tissue of the tooth as syndromes or systemic diseases, but eventually can cause many changes in the shape, hardness and relationship with adjacent tissues of the tooth.