ABSTRACT
It is complicated to decide the treatment plan of hopeless anterior teeth in esthetic zone due to severe periodontitis, periodontal-endodontic combined lesion or teeth trauma.The optional treatment plan for this kind of teeth includes retention after periodontal treatment, extraction and implant treatment, extraction and prosthodontic treatment and so on.To make an appropriate treatment plan, patients'' periodontal conditions, periodontal biotype, local anatomy, esthetic demand, economic condition and social psychological status should be comprehensively considered.A combine of periodontal, endodontic and orthodontic therapy may achieve a good treatment effect in hopeless anterior teeth with severe periodontal destruction, tooth extrusion and occlusal trauma.In this case, a 20-year-old female who presented with symptoms of bleeding on brushing and upper incisors loosening for 1 month came to the Department of Periodontology, Peking University School and Hospital of Stomatology.The clinical examinations revealed that the patient''s right upper incisor had signs of mobility (Ⅲ°), intrusion of 1-2 mm, and probing depth (PD) of 9-10 mm.The periapical radiograph showed that the alveolar bone of right upper incisor absorbed horizontally to the apex.And the patients showed Angle Ⅱ° malocclusion with Ⅱ° overbite in anterior teeth and maxillary protrusion.A diagnosis of aggressive periodontitis and Angle Ⅱ° malocclusion was made.The treatment of this patient lasts for 5 years which include periodontal initial therapy, orthodontic therapy, guided tissue regeneration (GTR) of right upper incisor and supportive periodontal therapy and the clinical result is fine.A hopeless upper incisor was successfully retained and the longtime clinical condition was stable.The strategy of retention of hopeless upper anterior teeth, the relationship of periodontal treatment and orthodontic treatment, and the indications of periodontal and orthodontic combined therapy were also discussed on the basis of this case.Generally, the positive factors in retention of hopeless teeth includes young age, absence of systemic conditions, strong motivation for maintaining the tooth, single root anatomy, integrated dentition, good response to cause-related therapy, intrabony alveolar bone defect, thick periodontal biotype, and regular supportive periodontal therapy.And in the progress of orthodontic therapy, regular supportive periodontal therapy and good plaque control is extremely important.
ABSTRACT
The aim of the present study was to investigate the distribution of periodontally hopeless teeth in patients who had not been treated. Five hundred nineteen teeth of 163 patients who had visited at the Department of Periodontology, Chonbuk National University Hospital during the period from January 1999 to July 2001 were selected as a periodontally hopeless tooth. Selection criteria were as follows: 1) probing pocket depth more than 8mm, 2) tooth mobility of degree III, 3) radiographic bone loss more than 75%. The contralateral tooth to a hopeless tooth (experimental tooth) was designated as a control tooth. Between the experimental and control tooth, differences in probing pocket depth, tooth mobility and amount of radiographic bone loss were examined as well as correlation. The results showed that hopeless teeth were most frequently found in the maxillary first molar position and least frequently in the maxillary canine position. Differences between experimental and control teeth were 2mm in probing depth, 1 degree in tooth mobility, and 20% in amount of bone loss (p<0.01). The periodontal conditions between the experimental and control teeth showed correlation in general, however, statistical significances were found in posterior teeth positions. Within limitations of this study, it can be concluded that local factors may play a role in deterioration of periodontal disease along with symmetrical character of periodontal disease.