The influence of the orthodontic tooth extrusion on the alveolar bone and the width of the attached gingiva

[I. Arsić]

83 str.

Ortopedija vilica, parodontologija i radiologija - Ortopedija vilica / Orthodontics, Periodontology and Radiology - Orthodontics

Metod ortodontske ekstruzije zuba predstavlja pomeranje zuba u vertikalnom pravcu, u smeru nicanja zuba, pomoću ortodontskih aparata. Može se postići različitim mehanizmima, a najefikasnija je primena fiksnih ortodontskih aparata. Ekstruzivno pomeranje zuba je nezaobilazni deo terapije fiksnim ortodontskim aparatima. Primenom tehnike pravog luka u fiksnoj ortodonciji, u početnim fazama, gde se vrši nivelacija tankim nitinolskim lukovima, uvek je prisutna i vertikalna komponenta ortodontske sile. Terapija gubitka zuba i mekih tkiva, kao i resorpcija alveolarnog grebena, u savremenoj stomatologiji, zahteva multidisciplinarni pristup. Primena ortodontskih sila na zub, u zavisnosti od pravca delovanja, može stimulisati augmentaciju koštanog tegmenta i okolnih mekih tkiva. Reakcija parodontalnih tkiva, udružena sa promenama na gingivi, u sklopu ortodontskog pomeranja zuba, sve više je predmet istraživanja. Ključni faktor, koji omogućava osteoblastnu aktivnost i stvaranje nove kosti, kao i gingive, tokom ortodontske ekstruzije zuba, je periodontalni ligament koji obuhvata koren zuba. Objavljene su studije koje pokazuju da dolazi do pomeranja gingive u pravcu dejstva ortodontske sile tokom ekstruzije, intruzije i rotacije. Johal i sar. navode kontroverzu u literaturi o ulozi ortodontskog tretmana na nastanak gingivalnih recesija ukoliko se zub pomera van alveolarne kosti. Lin i sar. opisuju formiranje izgubljene interdentalne papile multidisciplinarnim pristupom uz ortodontsku ekstruziju. Kajiyama i sar. su pokazali i pomak mukogingivalne linije, ivice slobodne gingive i dna gingivalnog sulkusa u koronarnom pravcu prilikom ekstruzije zuba ortodontskim aparatima. Dannan i sar. navode pomeranje granice pokretne i nepokretne sluzokože kao i ivice slobodne gingive u apikalnom smeru kod ortodontske intruzije zuba. Ortodontska ekstruzija zuba koji imaju lošu prognozu, koja za rezultat ima uvećanje koštanog tegmenta i visine alveolarnog grebena, se opisuje kao metoda koja prethodi ugradnji zubnog implanta. Oikarinen i sar. ukazuju na neophodnost augmentacije mekih i čvrstih tkiva pre terapije zubnim implantima. Ortodontskom ekstruzijom se rastežu vlakna periodontalnog ligamenta i očekuje stimulacija diferenciranja fibroblasta u osteoblaste, kao i osteoblastne aktivnosti i produkcije nove kosti. U skladu sa tim, opisana je i metoda razvoja regije za ugradnju implanta (eng, Implant Site Development - ISD). Bach i sar. navode mogućnost redukcije dubine izolovanih parodontalnih džepova ortodontskom ekstruzijom zuba. Zachrisson B. i Brindis i sar. navode da se, ortodontskom ekstruzijom zuba, i u frontalnoj i u bočnoj regiji, može značajno poboljšati stanje gingive i alveolarne kosti, estetika kao i oseointegracija pojedinačnih zubnih implanata...

The method of orthodontic tooth extrusion is the movement of the tooth in the vertical direction, in the direction of tooth eruption, using orthodontic appliances. It can be achieved by various mechanisms, and the most efficient is the use of fixed orthodontic appliances. Extrusion tooth movement is, most often, an unavoidable part of therapy with fixed appliances. By applying the straight archwire technique in fixed orthodontics, in the initial stages, where leveling with thin nitinol arches is performed, the vertical component of orthodontic force is always present. Tooth and soft tissue loss, as well as alveolar ridge resorption, in modern dentistry, requires a multidisciplinary approach. The application of orthodontic forces on the tooth, depending on the direction of action, can stimulate the augmentation of the bone tegment and the surrounding soft tissues. The reaction of periodontal tissues, associated with changes in the gingiva, as part of orthodontic tooth displacement, is increasingly the subject of research. The key factor, which enables osteoblastic activity and the formation of new bone, as well as gingiva, during orthodontic tooth extrusion, is the periodontal ligament that supports the root of the tooth. Studies have been published showing that gingiva movement is present, in the direction of orthodontic force during extrusion, intrusion, and rotation. Johal et al. cite controversy in the literature on the role of orthodontic treatment in the occurrence of gingival recessions if the tooth moves outside the alveolar bone. Lin et al. describe the formation of missing interdental papilla by a multidisciplinary approach with orthodontic extrusion. Kajiyama et al. also showed a shift of the mucogingival line, the margin of the free gingiva and the bottom of the gingival sulcus in the coronary direction during tooth extrusion with orthodontic appliances. Dannan et al. state that there is a movement of the mucogingival junction as well as the margins of the free gingiva in the apical direction during orthodontic tooth intrusion. Orthodontic extrusion of a tooth with a poor prognosis, which results in an increase in bone levels and alveolar ridge height, is described as a method that precedes dental implant placement. Oikarinen et al. indicate the need for augmentation of soft and hard tissues before dental implant therapy. Orthodontic extrusion stretches the periodontal ligament fibers and stimulates fibroblasts differentiation into osteoblasts, as well as osteoblast activity and new bone production. Accordingly, the method of development of the region for implant placement (Implant Site Development - ISD) is described. Bach et al. state the possibility of reducing the depth of isolated periodontal pockets by orthodontic tooth extrusion. Zachrisson B. and Brindis et al. state that orthodontic extrusion of teeth, both in the frontal and lateral regions, may significantly improve the condition of the gingiva and alveolar bone, aesthetics and osseointegration of individual dental implants...

ortodontska ekstruzija, forsirana erupcija, CBCT, alveolarna kost, pripojna gingiva

orthodontic extrusion, forced eruption, CBCT, alveolar bone, attached gingiva

616.314-089.23(043.3)

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