Occlusal forces as a risk factor for periodontal disease
Occlusal forces as a risk factor for periodontal disease
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DOI：
10.1046/j.0906-6713.2002.03209.x
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发表时间：
2003-01-01
影响因子：
18.6
通讯作者：
Harrel, SK
中科院分区：
文献类型：
--
作者：
Harrel, SK
文献综述大多数关于咬合对牙周病进展影响的早期研究集中在因果关系上。Stillman清楚地感觉到过度的咬合力是牙周病的原因，而咬合治疗是有效的牙周治疗的主要方法。随着菌斑是牙周病过程中不可或缺的一部分这一事实变得越来越明显，咬合力的作用变得不那么清楚。最终，这导致了将咬合视为特定类型牙周破坏的原因。Glickman将其描述为咬合和菌斑在垂直骨缺损和分叉骨丢失形成中的共同破坏作用。Glickman的共同破坏理论继续坚持这一论点，即咬合与菌斑是牙周附着丧失和骨破坏的一个致病因素。Glickman描述了一种改变的破坏途径，试图阐明形成特定附着形态和骨丢失的功能机制，认为这是由咬合力和菌斑的共同破坏作用引起的。改变的破坏途径仍然坚持这样的概念，即咬合直接改变了疾病的过程，从而在存在菌斑的情况下，牙周破坏的病原体，对松鼠猴和比格犬的动物研究开始阐明咬合力在细胞水平上对牙周附着结构的影响。从这些研究中可以清楚地看出，在这些动物模型中，咬合以骨质疏松的形式对牙周组织产生影响，这导致了移动性的临床表现。然而，同样清楚的是，在动物模型中，仅在存在过度咬合力的情况下不会发生附着丧失和牙周破坏。附着丧失仅发生在比格犬模型中，然后仅在存在过度咬合力和菌斑的情况下发生。虽然这些动物研究使我们对过度咬合力对所研究动物牙周支持结构的影响有了详尽的了解，但必须记住，这些研究是使用在自然条件下几乎没有牙周破坏倾向的动物模型进行的。从这些动物模型中获得的信息应用于发生在人类的牙周破坏必须谨慎对待。这些动物研究很可能只给了我们牙周组织对过度咬合力（有或无菌斑）的生理反应。这些动物研究不太可能为我们提供关于当过度咬合力存在于人类中时可能发生的病理生理学的重要信息，人类可能在遗传上易于牙周破坏，并且除了咬合力和菌斑之外，还可能具有牙周病的其他风险因素。人类研究开始为我们提供过度咬合力对牙周病进展的影响的一些指示在那些表现出牙周破坏倾向的患者中。虽然有许多明显矛盾的结果，从人类的研究，似乎有一种趋势，证据表明，过度咬合力可能在牙周破坏和牙周组织的牙周治疗的反应中发挥作用。虽然现有的资料表明，过度咬合力和牙周病的进展之间的关系，1999年…
Summary of literature reviewMost early research on the effects of occlusion on the progression of periodontal disease focused on a cause and effect relationship. Stillman clearly felt that excessive occlusal forces were the cause of periodontal disease and that treatment of the occlusion was the primary method of effective periodontal treatment. As it became evident that bacterial plaque was an integral part of the periodontal disease process, the role of occlusal forces became less clear. Eventually this led to viewing occlusion as a cause of specific types of periodontal destruction. This was described by Glickman as the co‐destructive roles of occlusion and bacterial plaque in the formation of vertical osseous defects and furcation bone loss. Glickman's theory of Co‐Destruction continued to hold to the thesis that occlusion was, in concert with bacterial plaque, a causative factor in periodontal attachment loss and bony destruction. Glickman described an altered pathway of destruction in an attempt to articulate a functional mechanism for the formation of the specific morphology of attachment and bone loss thought to be caused by the co‐destructive action of occlusal forces and bacterial plaque. The altered pathway of destruction still held to the concept that occlusion directly changed the disease process and was thereby, in the presence of bacterial plaque, a causative agent for periodontal destruction.The animal studies on squirrel monkeys and beagle dogs began to shed light on the effect of occlusal forces on the periodontal attachment structures at a cellular level. From these studies it was clear that within these animal models, occlusion had an effect on the periodontium in the form of bone rarefaction, which resulted in the clinical manifestation of mobility. However, it was equally clear that, within the animal models, loss of attachment and thereby periodontal destruction did not occur in the presence of excessive occlusal forces only. Loss of attachment occurred only in the beagle dog model and then only in the presence of excessive occlusal forces and bacterial plaque. While these animal studies gave us an exhaustive insight into the effect of excessive occlusal forces on the periodontal supporting structures of the studied animals, it must be remembered that these studies were performed using animal models that show little or no tendency toward periodontal destruction under natural conditions. The application of the information obtained from these animal models to the periodontal destruction that occurs in humans must be approached with caution. It is probable that these animal studies give us a picture only of the physiologic response of the periodontium to excessive occlusal forces with and without bacterial plaque. It is unlikely that these animal studies give us significant information about the pathophysiology that may occur when excessive occlusal forces are present in humans who may be genetically prone to periodontal destruction and who may also have additional risk factors for periodontal disease beyond occlusal forces and bacterial plaque.Human studies begin to give us some indication of the effect of excessive occlusal forces on the progression of periodontal disease in those patients who show a tendency toward periodontal destruction. While there are many apparently contradictory findings from human studies, there appears to be a trend toward evidence that excessive occlusal forces may play a role in periodontal destruction and the response of the periodontium to periodontal treatment. While the available information suggests a relationship between excessive occlusal forces and progression of periodontal disease, the 1999 …