Ⅳ期牙周炎伴病理性牙移位患者的多学科联合治疗

doi:10.3877/cma.j.issn.1674-1366.2025.04.002

Ⅳ期牙周炎患者由于牙周支持组织严重受损，常伴有牙周脓肿、牙齿松动等并发症。其中，病理性牙移位（PTM）因影响患者美观与咀嚼，是导致患者就诊的常见原因。治疗此类疾病较为复杂，通常需要牙周、正畸和修复等多学科协同合作以制订全面且综合的诊疗方案。在诊疗过程中，通过系统的牙周治疗恢复牙周健康是重要基础，而健康牙周是确保正畸和修复治疗成功的关键基石，能保障多学科联合治疗计划的顺利实施。本文就Ⅳ期牙周炎伴PTM患者的多学科联合治疗进行系统综述，并展示1例牙周-正畸等多学科联合治疗的病例，为Ⅳ期牙周炎伴PTM患者的治疗提供一定的参考。

关键词: 牙周炎，Ⅳ期, 牙移位，病理性, 牙周基础治疗, 多学科联合治疗

Patients with stage Ⅳ periodontitis often suffer from severe damage to the periodontal supporting tissues, accompanied by complications such as periodontal abscesses and increased tooth mobility. Among these, pathologic tooth migration (PTM) is a common motivator for seeking treatment due to its impact on aesthetics and masticatory function. Managing PTM is complex and typically requires collaborative efforts from multiple disciplines involving periodontics, orthodontics, and prosthodontics to develop a comprehensive treatment plan. Restoring periodontal health through systematic periodontal therapy is a critical foundation in the treatment process. Healthy periodontal tissues serve as a key prerequisite for successful orthodontic and prosthetic interventions, ensuring the smooth implementation of multidisciplinary treatment strategies. This article systematically reviews the multidisciplinary treatment of stage Ⅳ periodontitis with pathological tooth displacement, supplemented by a clinical case involving combined periodontal-orthodontic therapy. The findings provide valuable insights for the management of such cases.

Key words: Periodontitis, stage Ⅳ, Tooth migration, pathologic, Periodontal initial therapy, Multidisciplinary treatment

图1 Ⅳ期牙周炎伴病理性牙移位（PTM）患者初诊口内照　A：右上后牙腭侧相；B：上前牙腭侧相；C：左上后牙腭侧相；D：右侧后牙颊侧相；E：前牙唇侧相；F：左侧后牙颊侧相；G：右下后牙舌侧相；H：下前牙舌侧相；I：左下后牙舌侧相。

图2 Ⅳ期牙周炎伴病理性牙移位（PTM）患者初诊牙周专科检查表

图3 Ⅳ期牙周炎伴病理性牙移位（PTM）患者初诊X线影像　A：11牙根尖X线片；B：口腔全景曲面体层片。

图4 Ⅳ期牙周炎伴病理性牙移位（PTM）患者牙周病风险评估

图5 Ⅳ期牙周炎伴病理性牙移位（PTM）患者全口牙齿预后分析

图6 Ⅳ期牙周炎伴病理性牙移位（PTM）患者牙周基础治疗后6周口内照　A：右侧后牙颊侧相；B：前牙唇侧相；C：左侧后牙颊侧相。

图7 Ⅳ期牙周炎伴病理性牙移位（PTM）患者牙周基础治疗后6周牙周专科检查表

图8 Ⅳ期牙周炎伴病理性牙移位（PTM）患者17-27牙周翻瓣术　A：翻瓣后右上后牙颊侧相；B：翻瓣后上前牙唇侧相；C：翻瓣后左上后牙颊侧相。

图9 Ⅳ期牙周炎伴病理性牙移位（PTM）患者牙周翻瓣术后4个月牙周专科检查表

图10 Ⅳ期牙周炎伴病理性牙移位（PTM）患者正畸治疗1年口内照　A：右侧后牙颊侧相；B：前牙唇侧相；C：左侧后牙颊侧相。

图11 Ⅳ期牙周炎伴病理性牙移位（PTM）患者牙周-正畸联合治疗后1.5年口内照　A：右上后牙腭侧相；B：上前牙腭侧相；C：左上后牙腭侧相；D：右侧后牙颊侧相；E：前牙唇侧相；F：左侧后牙颊侧相；G：右下后牙舌侧相；H：下前牙舌侧相；I：左下后牙舌侧相。

图12 Ⅳ期牙周炎伴病理性牙移位（PTM）患者牙周-正畸联合治疗后1.5年牙周专科检查表

图13 Ⅳ期牙周炎伴病理性牙移位（PTM）患者牙周-正畸联合治疗后1.5年X线影像　A：11牙根尖X线片；B：口腔全景曲面体层片。

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Multidisciplinary treatment of patients with stage Ⅳ periodontitis and pathologic tooth migration

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Multidisciplinary treatment of patients with stage Ⅳ periodontitis and pathologic tooth migration