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Before full-mouth rehabilitation, should periodontal, root canal or orthodontic treatment come first? The sequence is about dependencies, not preference｜證據鏈
When the same mouth has periodontal problems, teeth requiring root canal treatment and teeth that have moved out of position, it is natural to ask: which should come first? This may sound like a scheduling question, but it is not. In the literature, some sequences are preferences that can be adjusted to the circumstances, whereas others are conditions that must be met for the next step to proceed—if the preceding step has not been completed, the next one should not begin. The clearest dependency is that periodontal treatment precedes orthodontic treatment. A systematic review searched the literature from January 1990 to July 2022. From 1,067 electronic search results and a further 1,591 records identified by hand searching, it ultimately included 5 studies with a total of 366 participants. The review recorded one consistent fact: all participants had undergone scaling and root planing, as well as periodontal surgery, before orthodontic treatment began. Another set of recommendations on orthodontic treatment for patients with compromised periodontal conditions states directly that existing periodontal disease should be treated before orthodontic treatment.
Before full-mouth rehabilitation, should periodontal, root canal or orthodontic treatment come first? The sequence is about dependencies, not preference｜證據鏈
本頁逐條列出本卡每一個 [Fn] 標記對應的文獻出處。
- F1｜Orthodontic treatment in periodontally compromised patients: a systematic review. [PMID:36502508]（https://pubmed.ncbi.nlm.nih.gov/36502508/）
- F2｜Precautions and possibilities in orthodontic treatment of periodontally compromised patients: Current recommendations. [PMID:37994693]（https://pubmed.ncbi.nlm.nih.gov/37994693/）
- F3｜Factors affecting long-term success and survival in non-surgical root canal retreatment; a retrospective cohort study. [PMID:41062676]（https://pubmed.ncbi.nlm.nih.gov/41062676/）
- F4｜Long-term outcomes of regenerative periodontal therapy and orthodontic treatment: 20-year results from a prospective study. [PMID:42214655]（https://pubmed.ncbi.nlm.nih.gov/42214655/）
- F5｜Supportive periodontal care during active orthodontic therapy in patients with history of stage IV periodontitis: A narrative review. [PMID:40256787]（https://pubmed.ncbi.nlm.nih.gov/40256787/）
- F6｜Prosthetic Outcomes in Stage III/IV Periodontitis Patients With 20-29 Years of Supportive Periodontal Care. [PMID:40954447]（https://pubmed.ncbi.nlm.nih.gov/40954447/）
FAQ
- Can orthodontic treatment begin before periodontal disease has stabilised?
- The sequence indicated by current literature is to treat the periodontal condition first. Recommendations for patients with compromised periodontal conditions state that **existing periodontal disease should be treated before orthodontic treatment** [F2]. A systematic review also recorded that, in the 5 included studies (366 participants), **all participants had completed scaling, root planing and periodontal surgery before orthodontic treatment began** [F1]. A narrative review further states that **patients with stage IV periodontal disease can safely undergo orthodontic treatment after completing active periodontal therapy** [F5]—note the condition ‘after completing active therapy’.
- 歯周病がまだ安定していなくても、先に矯正治療を始められますか？ — 現在の文献が示す順序は、歯周治療が先です。歯周組織の状態が良好でない患者さんへの提言には、**矯正治療の前に、既存の歯周疾患を先に治療すべきである**と明記されています [F2]。システマティックレビューでも、採用された 5 件の研究（対象者 366 人）において、**すべての対象者が矯正治療の開始前に、スケーリング、ルートプレーニング、歯周外科治療を完了していた**と記録されています [F1]。別のナラティブレビューは、**ステージ IV の歯周疾患患者は、積極的な歯周治療を完了した後であれば、安全に矯正治療を受けられる**と述べています [F5]。ここでの前提が「積極的な治療を完了した後」であることに注意が必要です。
- Can orthodontic treatment begin before periodontal disease has stabilised? — The sequence indicated by current literature is to treat the periodontal condition first. Recommendations for patients with compromised periodontal conditions state that **existing periodontal disease should be treated before orthodontic treatment** [F2]. A systematic review also recorded that, in the 5 included studies (366 participants), **all participants had completed scaling, root planing and periodontal surgery before orthodontic treatment began** [F1]. A narrative review further states that **patients with stage IV periodontal disease can safely undergo orthodontic treatment after completing active periodontal therapy** [F5]—note the condition ‘after completing active therapy’.
Source anchors
- Orthodontic treatment in periodontally compromised patients: a systematic review. [PMID:36502508] · https://pubmed.ncbi.nlm.nih.gov/36502508/ · 在 IDAEO 的其他引用
- Precautions and possibilities in orthodontic treatment of periodontally compromised patients: Current recommendations. [PMID:37994693] · https://pubmed.ncbi.nlm.nih.gov/37994693/ · 在 IDAEO 的其他引用
- Factors affecting long-term success and survival in non-surgical root canal retreatment; a retrospective cohort study. [PMID:41062676] · https://pubmed.ncbi.nlm.nih.gov/41062676/ · 在 IDAEO 的其他引用
- Long-term outcomes of regenerative periodontal therapy and orthodontic treatment: 20-year results from a prospective study. [PMID:42214655] · https://pubmed.ncbi.nlm.nih.gov/42214655/ · 在 IDAEO 的其他引用
- Supportive periodontal care during active orthodontic therapy in patients with history of stage IV periodontitis: A narrative review. [PMID:40256787] · https://pubmed.ncbi.nlm.nih.gov/40256787/ · 在 IDAEO 的其他引用
- Prosthetic Outcomes in Stage III/IV Periodontitis Patients With 20-29 Years of Supportive Periodontal Care. [PMID:40954447] · https://pubmed.ncbi.nlm.nih.gov/40954447/ · 在 IDAEO 的其他引用
Cite this article
Lucy・《Before full-mouth rehabilitation, should periodontal, root canal or orthodontic treatment come first? The sequence is about dependencies, not preference｜證據鏈》・IDAEO 知識庫・2026-08-16・https://km.idaeo.ai/post/reports/dental-full-mouth-rehab-perio-endo-ortho-order-evidenceUpdated 2026-08-19