PERIODONTAL TREATMENTS AND PROCEDURES

牙周治疗及程序  

英文原文引自美国牙周病学院

   Periodontists are dentistry's experts in treating periodontal disease. They receive up to three additional years of specialized training in periodontal disease treatment in both non-surgical treatments and periodontal plastic surgery procedures. Periodontists are also experts in replacing missing teeth with dental implants.

   牙周医生是牙科治疗牙周病的专家。他们在牙周疾病的非手术治疗和牙周整形手术治疗方面接受超过三年的专门培训。牙周医生也是用种植体修复缺失牙齿的专家。

• Non-Surgical Treatments

• Gum Graft Surgery

• Laser Treatment

• Regenerative Procedures

• Dental Crown Lengthening

• Dental Implants

• Pocket Reduction Procedures

• Plastic Surgery Procedures

• 非手术治疗

• 牙龈移植手术

• 激光治疗

• 再生治疗

• 牙冠延长

• 牙科种植

• 根向复位

• 塑形手术

NON-SURGICAL PERIODONTAL TREATMENT

非手术治疗牙周

  AAP treatment guidelines stress that periodontal health should be achieved in the least invasive and most cost-effective manner. This is often accomplished through non-surgical periodontal treatment.

Non-surgical periodontal treatment does have its limitations. When it does not achieve periodontal health, surgery may be indicated to restore periodontal health.

   AAP治疗指南强调，牙周健康应以侵入性最小、成本效益最高的方式实现。这通常是通过非手术牙周治疗来完成的。

     非手术牙周治疗有其局限性。如未能达到牙周健康，可建议进行手术以恢复牙周健康。

SCALING AND ROOT PLANING

刮治与根面平整

   Scaling and root planing is a careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins. Scaling and root planing is sometimes followed by adjunctive therapy such as local delivery antimicrobials, systemic antibiotics, and host modulation, as needed on a case-by-case basis.

Most periodontists would agree that after scaling and root planing, many patients do not require any further active treatment. However, the majority of patients will require ongoing maintenance therapy to sustain health.

     刮治与根面平整是一种仔细清洁牙根表面的方法，可以清除牙周深层的牙菌斑和牙石，并使牙根光滑，清除细菌毒素。如果需要的话，有时还需要局部给药、全身抗生素和宿主调节等辅助治疗。

     大多数牙周医生会同意，在刮治与根面平整后，许多病人不需要任何进一步的积极治疗。然而，大多数患者需要持续的维持治疗来维持健康。

GUM GRAFT SURGERY

牙龈移植手术

   Exposed tooth roots are the result of gum recession. Gum graft surgery will repair the defect and help to prevent additional recession and bone loss.

    牙根外露是牙龈萎缩的结果。牙龈移植手术可以修复缺损，有助于防止额外的骨萎缩和骨质流失。

Before Gum Graft Surgery

After Gum Graft Surgery

    Gum grafts can be used to cover roots or develop gum tissue where absent due to excessive gingival recession. During gum graft surgery, your periodontist takes gum tissue from your palate or another donor source to cover the exposed root. This can be done for one tooth or several teeth to even your gum line and reduce sensitivity.

    牙龈移植可以用来覆盖牙根或在由于牙龈过度萎缩而缺失的地方形成牙龈组织。在牙龈移植手术中，你的牙周医生从你的上颚或其他供牙源取出牙龈组织覆盖暴露在外的牙根。这可以对一颗牙齿或几颗牙齿做，使你的牙龈线均匀，降低敏感度。

WHAT ARE THE BENEFITS OF GUM GRAFT SURGERY?

牙龈移植手术有什么好处?

    A gum graft can reduce further recession and bone loss. In some cases, it can cover exposed roots to protect them from decay. This may reduce tooth sensitivity and improve esthetics of your smile. Whether you have a gum graft to improve function or esthetics, patients often receive the benefits of both: a beautiful new smile and improved periodontal health – your keys to smiling, eating and speaking with comfort and confidence.

    牙龈移植可以减少进一步衰退和骨质流失。在某些情况下，它可以覆盖暴露的根系，以保护它们不腐烂。这可以降低牙齿的敏感度，改善你的笑容。不管你是用牙龈移植来改善功能还是美观，患者通常都能从这两方面受益:

      美丽的新笑容和改善牙周健康

    这是你微笑、进食和说话时感到舒适和自信的关键。

LASER TREATMENT FOR GUM DISEASE

激光治疗牙龈疾病

 Lasers can be used to treat periodontal disease. Current controlled studies have shown that similar results have been found with the laser compared to specific other treatment options, including scaling and root planing alone. Scaling and root planing is a traditional non-surgical therapy used to treat periodontal diseases.

     激光可以用来治疗牙周病。目前的对照研究表明，激光治疗与其他治疗方法(包括刮治与根面平整)相比，有类似的结果。牙周刮治是一种传统的非手术治疗牙周疾病的方法。

CAN THE USE OF LASERS IN PERIODONTAL THERAPY HARM PATIENTS?

在牙周治疗中使用激光会对病人造成伤害吗?

   Yes and no. Each laser has different wavelengths and power levels that can be used safely during different periodontal procedures. However, damage to periodontal tissues can result if a laser with an inappropriate wavelength and/or power level is used during a periodontal procedure.

    是的,没有。每种激光都有不同的波长和功率级别，可以在不同的牙周手术中安全使用。然而，如果在牙周手术中使用了波长和/或功率不适当的激光，可能会对牙周组织造成损伤。

DOES THE RESEARCH ON LASERS SUPPORT THEIR USE IN PERIODONTICS AT THIS TIME?

目前对激光的研究是否支持其在牙周医学中的应用?

   At this time, there is insufficient evidence to suggest that any specific laser wavelength is superior to the traditional treatment methods of the common periodontal diseases, such as periodontitis.

    目前还没有足够的证据表明，任何特定的激光波长都优于常见牙周病的传统治疗方法。

CAN I TRUST THE CLAIMS IN AN AD FOR PERIODONTAL THERAPY PERFORMED WITH A LASER?

我可以相信广告上所说的用激光进行牙周治疗吗?

    It is important to beware of advertising that sounds too good to be true because it very well may be. A dental professional can help you separate fact from hype.

     很重要的一点是要小心那些听起来好得令人难以置信的广告，因为它很可能是真的。牙医可以帮你区分事实和炒作。

REGENERATIVE PROCEDURES

再生手术

    Procedures that regenerate lost bone and tissue supporting your teeth can reverse some of the damage caused by periodontal disease.

    修复支撑牙齿的骨质和组织的过程可以逆转牙周病造成的一些损害。

   Your periodontist may recommend a regenerative procedure when the bone supporting your teeth has been destroyed due to periodontal disease. These procedures can reverse some of the damage by regenerating lost bone and tissue.

    During this procedure, your periodontist folds back the gum tissue and removes the disease-causing bacteria. Membranes (filters), bone grafts or tissue-stimulating proteins can be used to encourage your body's natural ability to regenerate bone and tissue.

Eliminating existing bacteria and regenerating bone and tissue helps to reduce pocket depth and repair damage caused by the progression of periodontal disease. With a combination of daily oral hygiene and professional maintenance care, you'll increase the chances of keeping your natural teeth – and decrease the chances of other health problems associated with periodontal disease.

     当支撑牙齿的骨骼因牙周病而损坏时，你的牙周医生可能会建议你进行再生手术。这些手术可以通过再生失去的骨骼和组织来逆转部分损伤。

     在这个过程中，你的牙周医生会将牙龈组织翻瓣切开，清除致病细菌。膜(过滤器)，骨移植或组织刺激蛋白可以用来刺激你的身体的自然能力再生骨骼和组织。

     清除现有细菌和再生骨骼和组织有助于减少袋深度和修复牙周病进展所造成的损害。结合日常口腔卫生和专业的维护保养，你会增加保持天然牙齿的机会，并减少与牙周病有关的其他健康问题的机会。

DENTAL CROWN LENGTHENING PROCEDURE

冠延长手术

   You may have asked your periodontist about procedures to improve a "gummy" smile because your teeth appear short. Your teeth may actually be the proper lengths, but they're covered with too much gum tissue. To correct this, your periodontist performs a dental crown lengthening procedure.

    你可能已经问过你的牙周医生如何改善你的笑容，因为你的牙齿看起来很短。你的牙齿可能是合适的长度，但是它们被太多的牙龈组织覆盖。为了纠正这个问题，你的牙周医生做了一个牙冠延长手术。

Before Dental Crown Lengthening Procedure

After Dental Crown Lengthening Procedure

   During the dental crown lengthening procedure, excess gum and bone tissue is reshaped to expose more of the natural tooth. This can be done to one tooth, to even your gum line, or to several teeth to expose a natural, broad smile.

   Your dentist or periodontist may also recommend dental crown lengthening to make a restorative or cosmetic dental procedure possible. Perhaps your tooth is decayed, broken below the gum line, or has insufficient tooth structure for a restoration, such as a crown or bridge. Crown lengthening adjusts the gum and bone level to expose more of the tooth so it can be restored.

     在牙冠延长过程中，多余的牙龈和骨组织被重塑，露出更多的天然牙齿。这可以对一颗牙齿，甚至你的牙龈线，或对几颗牙齿露出一个自然的，广泛的微笑。

     你的牙医或牙周医生可能也会建议延长牙冠，使修复或牙齿美容手术成为可能。也许你的牙齿已经蛀坏了，牙龈线以下断裂了，或者没有足够的牙齿结构可以修复，比如牙冠或牙桥。牙冠延长可以调整牙龈和骨骼的水平，让牙齿露出更多的地方，这样牙齿就可以修复了。

DENTAL IMPLANTS

牙科种植修复

   A dental implant is an artificial tooth root that is placed into your jaw to hold a replacement tooth or bridge. Dental implants may be an option for people who have lost a tooth or teeth due to periodontal disease, an injury, or some other reason.

     种植牙是一种人工牙根，它被植入你的骨下，用来固定替换的牙齿或牙桥。对于因牙周病、受伤或其他原因而失去牙齿的人来说，种植牙可能是一种选择。

TYPES OF DENTAL IMPLANTS

种植牙的种类

• Endosteal (in the bone): This is the most commonly used type of implant. The various types include screws, cylinders or blades surgically placed into the jawbone. Each implant holds one or more prosthetic teeth. This type of implant is generally used as an alternative for patients with bridges or removable dentures.

• Subperiosteal (on the bone): These are placed on top of the jaw with the metal framework's posts protruding through the gum to hold the prosthesis. These types of implants are used for patients who are unable to wear conventional dentures and who have minimal bone height.

• 内骨(骨内):这是最常用的种植体类型。各种类型包括螺钉状、圆筒状或片状通过手术置入颌骨。每个种植体都有一个或多个假牙。这种类型的种植体通常被用作桥梁或可摘假牙患者的替代。

• 骨膜下(在骨头上):这些被放置在颚的顶部，金属框架的柱子通过牙龈突出来支撑假体。这些类型的种植体用于那些不能戴传统假牙和骨高度最小的患者。

Before dental implant

After dental implant

ARE YOU A CANDIDATE FOR DENTAL IMPLANTS?

你是植牙的候选人吗?

   The ideal candidate for a dental implant is in good general and oral health. Adequate bone in your jaw is needed to support the implant, and the best candidates have healthy gum tissues that are free of periodontal disease.

    Dental implants are intimately connected with the gum tissues and underlying bone in the mouth. Since periodontists are the dental experts who specialize in precisely these areas, they are ideal members of your dental implant team. Not only do periodontists have experience working with other dental professionals, they also have the special knowledge, training and facilities that you need to have teeth that look and feel just like your own. Your dentist and periodontist will work together to make your dreams come true.

       理想的种植需要良好口腔卫生及健康。你的下颌需要足够的骨头来支撑种植体，最好的候选人有健康的牙龈组织，没有牙周病。

      种植体与口腔中的牙龈组织和下面的骨骼有着密切的联系。由于牙周医生是专门从事这些领域的牙科专家，他们是您的种植团队的理想成员。牙周医生不仅有与其他牙科专业人员合作的经验，他们还拥有特殊的知识、培训和设备，使你的牙齿看起来和感觉都像你自己的一样。你的牙医和牙周医生会一起努力让你的梦想成真。

WHAT IS A DENTAL IMPLANT PROCEDURE LIKE?

植牙手术是什么样的?

     This procedure is a team effort between you, your dentist and your periodontist. Your periodontist and dentist will consult with you to determine where and how your implant should be placed. Depending on your specific condition and the type of implant chosen, your periodontist will create a treatment plan tailored to meet your needs.

     这个过程是你、你的牙医和你的牙周医生共同努力的结果。你的牙周医生和牙医会与你协商，以确定你的种植体应该放在哪里和如何放置。根据你的具体情况和选择的种植体类型，你的牙周医生会根据你的需要制定一个治疗计划。

• Replacing a Single Tooth   If you are missing a single tooth, one implant and a crown can replace it.

• Replacing Several Teeth   If you are missing several teeth, implant-supported bridges can replace them.

• Replacing All of Your Teeth   If you are missing all of your teeth, an implant-supported full bridge or full denture can replace them.

• Sinus Augmentation   A key to implant success is the quantity and quality of the bone where the implant is to be placed. The upper back jaw has traditionally been one of the most difficult areas to successfully place dental implants due to insufficient bone quantity and quality and the close proximity to the sinus. Sinus augmentation can help correct this problem by raising the sinus floor and developing bone for the placement of dental implants.

• Ridge Modification   Deformities in the upper or lower jaw can leave you with inadequate bone in which to place dental implants. To correct the problem, the gum is lifted away from the ridge to expose the bony defect. The defect is then filled with bone or bone substitute to build up the ridge. Ridge modification has been shown to greatly improve appearance and increase your chances for successful implants that can last for years to come.

• 如果你缺了一颗牙齿，可以用一颗植体和一个牙冠来替换。

• 如果你缺了几颗牙齿，可以用植入式桥来代替。

• 如果你缺了所有的牙齿，可以用种植支架或全口义齿来替换。

• 上颌窦增高术种植体成功的关键是种植体要植入的骨头的数量和质量。上下颌由于骨量和质量的不足以及与上颌窦的距离较近，一直是最难以成功植入牙齿的部位之一。上颌窦增高术可以通过提高鼻窦底和发展种植体的骨来帮助矫正这一问题。

• 上颌或下颌的牙列畸形会使你没有足够的骨头来种植牙齿。为了纠正这一问题，将牙龈从牙列上切开，露出骨缺损。然后用骨或骨替代物填充缺损，恢复牙槽嵴。牙槽嵴骨增量已经被证明可以大大改善外观，增加你成功种植的机会，可以持续多年。

WHAT CAN I EXPECT AFTER RECEIVING A DENTAL IMPLANT?

接受植牙后，我可以期待什么?

   As you know, your own teeth require conscientious at-home oral care and regular dental visits. Dental implants are like your own teeth and will require the same care. In order to keep your implant clean and plaque-free, brushing and flossing still apply!

   After treatment, your periodontist will work closely with you and your dentist to develop the best care plan for you. Periodic follow-up visits will be scheduled to monitor your implant, teeth and gums to make sure they are healthy.

    如你所知，你自己的牙齿需要在家认真的口腔护理和定期的牙科检查。种植牙就像你自己的牙齿，需要同样的护理。为了保持您的种植体清洁和无菌斑，刷牙和牙线仍然适用!

    治疗后，你的牙周医生会与你和你的牙医紧密合作，为你制定最佳的护理计划。我们会定期跟进你的种植体、牙齿和牙龈，以确保它们健康。

PERIODONTAL POCKET REDUCTION PROCEDURES

根向复位程序

   Your bone and gum tissue should fit snugly around your teeth like a turtleneck around your neck. When you have periodontal disease, this supporting tissue and bone is destroyed, forming "pockets" around the teeth.

Over time, these pockets become deeper, providing a larger space for bacteria to live. As bacteria develop around the teeth, they can accumulate and advance under the gum tissue. These deep pockets collect even more bacteria, resulting in further bone and tissue loss. Eventually, if too much bone is lost, the teeth will need to be extracted.

    你的骨头和牙龈组织应该像高领毛衣一样紧贴着你的牙齿。当你患有牙周病时，这些支持组织和骨骼会被破坏，在牙齿周围形成“口袋”。

随着时间的推移，这些囊袋变得更深，为细菌提供了更大的生存空间。当细菌在牙齿周围生长时，它们会在牙龈组织下积聚和生长。这些深囊聚集更多的细菌，导致进一步的骨骼和组织损失。最终，如果骨质流失太多，就需要拔掉牙齿。    

  Your periodontist has measured the depth of your pocket(s). A periodontal pocket reduction procedure has been recommended because you have pockets that are too deep to clean with daily at-home oral hygiene and a professional care routine.

  During this procedure, your periodontist folds back the gum tissue and removes the disease-causing bacteria before securing the tissue into place. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. This allows the gum tissue to better reattach to healthy bone.

     你的牙周医生测量了你牙周袋的深度。牙周袋缩小程序（根向复位）已经被推荐，因为你的牙周袋太深，无法用日常家庭口腔卫生和专业护理常规清洁。

     在这个过程中，你的牙周医生切开牙龈组织，并在将组织固定到位之前清除致病细菌。在某些情况下，受损骨的不规则表面会被修平，以减少致病细菌可能藏身的区域。这使得牙龈组织能够更好地附着在健康的骨骼上。

  Reducing pocket depth and eliminating existing bacteria are important to prevent damage caused by the progression of periodontal disease and to help you maintain a healthy smile. Eliminating bacteria alone may not be sufficient to prevent disease recurrence. Deeper pockets are more difficult for you and your dental care professional to clean, so it's important for you to reduce them. Reduced pockets and a combination of daily oral hygiene and professional maintenance care increase your chances of keeping your natural teeth – and decrease the chance of serious health problems associated with periodontal disease.

     减少牙周袋深度和清除现有细菌对于预防牙周病进展所造成的损害和帮助你保持健康的微笑是很重要的。仅仅清除细菌可能不足以防止疾病复发。对于你和你的牙齿护理专业人员来说，牙周袋越深越难清洁，所以减少它们对你来说很重要。减少牙周袋，结合日常口腔卫生和专业的维护保养，可以增加你保持天然牙齿的机会，并减少与牙周病有关的严重健康问题的机会。

PERIODONTAL PLASTIC SURGERY PROCEDURES

牙周塑形手术程序

    Periodontists are often considered the plastic surgeons of dentistry. If you are looking to improve your smile, a periodontist may be able to help.

   牙周医生通常被认为是牙科整形外科医生。如果你想改善你的笑容，牙周医生也许能帮上忙。

    GUMMY SMILE OR UNEVEN GUM LINE

笑容不佳或牙龈线条不均匀

   Do you feel your teeth look too short and your smile is too gummy or your gums cover too much of some teeth while leaving the others the right length? If so, dental crown lengthening might be the solution for you. During this procedure, excess gum tissue is removed to expose more of the crown of the tooth. Then your gumline is sculpted to give your new smile just the right look.

    你是否觉得你的牙齿看起来太短了，你的笑容太黏人了，或者你的牙龈覆盖了太多的牙齿，而其他牙齿却保持了合适的长度?如果是这样，牙冠延长可能是你的解决方案。在这个过程中，多余的牙龈组织被移除，露出更多的牙冠。然后你的牙龈线被雕刻，给你的新微笑只是正确的外观。

LONG TEETH/EXPOSED ROOTS

长牙齿暴露/根

   Sometimes gum recession causes the tooth root to become exposed, which makes your teeth look long and can make you look older than you are. This recession can happen as a result of a variety of causes, including periodontal diseases.

Gum graft surgery and other root coverage procedures are designed to cover exposed roots, to reduce further gum recession and to protect vulnerable roots from decay.

     有时牙龈萎缩会导致牙根外露，这会让你的牙齿看起来很长，让你看起来比实际年龄老。这种衰退可能是多种原因造成的，包括牙周疾病。

牙龈移植手术和其他根系覆盖程序旨在覆盖暴露的根系，以减少进一步的牙龈衰退和保护脆弱的根系免受腐烂。

INDENTATIONS IN THE GUMS AND JAWBONE

牙床和颌骨上的凹痕

    Tooth loss can cause an indentation in the gums and jawbone where the tooth used to be. This happens because the jawbone recedes when it no longer is holding a tooth in place. Not only is this indention unnatural looking, it also causes the replacement tooth to look too long compared to the adjacent teeth.

    Ridge augmentation can fill in this defect recapturing the natural contour of the gums and jaw. A new tooth can then be created that is natural looking, easy to clean and beautiful.

     牙齿脱落会在牙齿原来所在的牙龈和颚骨上留下凹痕。这是因为下颌骨在不再固定牙齿的情况下会收缩。这种缩进不仅看起来不自然，而且会导致替换的牙齿看起来比相邻的牙齿要长。

     牙槽嵴骨增量可以填补这一缺陷，恢复牙龈和下巴的自然轮廓。这样就可以造出一颗外观自然、易于清洁、美观的新牙齿。

文章中部分配图来自：

道志斌医师（上海）、王雅琳医师（福建）、贺永信医师（上海）病例。