种植体周围炎重复非手术治疗的短期疗效观察
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摘要
目的观察轻、中、重度种植体周围炎的重复非手术治疗效果。方法选择种植修复完成2年以上的种植体周围炎病例29例、植体31颗,按病情严重程度分为轻、中、重度三组,每组分别有种植体周围炎植体12、10、9颗,进行种植体周袋内超声清创+甘氨酸喷砂+盐酸米诺环素凝胶袋内注射+复方氯己定含漱联合治疗,共治疗两次。分别记录三组治疗前(T0)、治疗第1次后1个月(T1)、重复治疗第2次后1个月(T2)3个时间点的种植体周探诊深度(PD)、探诊出血(BOP)位点阳性率、探诊溢脓位点阳性率,比较各个时间点的临床参数变化。结果经过两次治疗,轻、中、重度组PD均值减少,轻度组T0 vs.T1,P>0.05,T0 vs.T2,P<0.05;中重度组T0 vs.T1,P<0.05,T0 vs.T2,P<0.01。三组在治疗两次后种植体周探诊出血率均不断降低,轻、中度组T0 vs.T1,P<0.05,T0 vs.T2,P<0.01,重度组治疗前后三个时间点没统计学差异。溢脓位点阳性率随炎症程度加重而升高,轻度组没有溢脓位点,中度和重度组治疗后溢脓位点阳性率不断下降(T0 vs.T1,P<0.05, T0 vs.T2,P<0.01)。经治疗,中、重度组T1、T2时仍有种植体周探诊深袋、探诊出血点和溢脓点。结论非手术方法治疗轻、中、重度种植体周围炎能显著改善其种植体周软组织炎症,重复进行非手术治疗是有必要的。轻度种植体周围炎经两次非手术治疗,能基本控制软组织炎症;中重度种植体周围炎经两次非手术治疗,不能完全控制软组织炎症。
Objective To observe the repeated non-surgical therapeutic effects on mild, moderate and severe peri-implantitis. Methods 29 patients with 31 peri-implantitis implants that were repaired for over 2 years were chosen. According to the severity, there were 12 peri-implantitis implants in mild group, 10 in moderate group and 9 in severe group. The 31 peri-implantitis implants were treated twice with non-surgical combination scheme, ultrasonic mechanical debridement + air-polishing with amino acid glycine powder + minocycline ointment injection + chlorhexidine rinse. One month later, the treatment was repeated again. The PD, BOP positive site numbers, suppuration positive site numbers at the three time points were recorded respectively(the time before therapy denoted as T0, 1 month after 1~(st) therapy as T1, 1 month after 2~(st) therapy as T2). The changes of clinical parameters were compared at different time points. Results After two treatments, in mild peri-implantitis group, although the mean PD had no statistical difference(P>0.05) between T0 and T1, the difference between T0 and T2 became more obvious(P<0.05), and BOP positive site numbers decreased(T0 vs.T1, P<0.05; T0 vs.T2, P<0.01), at T0 none suppuration site was detected. In moderate group, PD, BOP positive site numbers, suppuration positive site numbers decreased continuously through repeated non-surgical therapy(T0 vs.T1, P<0.05; T0 vs.T2, P<0.01). In sever group, there were obvious differences in PD, suppuration positive site numbers(T0 vs.T1, P<0.05; T0 vs.T2, P<0.01), while there were no statistical differences in BOP among the three time points. At the time of T2, there were still deep PD sites, BOP sites, suppuration sites in both moderate and sever groups. Conclusions The non-surgical therapy can improve the clinical parameters but cannot cure the peri-implantitis thoroughly. Repeated therapy procedure is needed. Mild peri-implantitis can be basically controlled after two repeated non-surgical therapies while moderate and severe peri-implantitis cannot be controlled thoroughly.
Objective To observe the repeated non-surgical therapeutic effects on mild, moderate and severe peri-implantitis. Methods 29 patients with 31 peri-implantitis implants that were repaired for over 2 years were chosen. According to the severity, there were 12 peri-implantitis implants in mild group, 10 in moderate group and 9 in severe group. The 31 peri-implantitis implants were treated twice with non-surgical combination scheme, ultrasonic mechanical debridement + air-polishing with amino acid glycine powder + minocycline ointment injection + chlorhexidine rinse. One month later, the treatment was repeated again. The PD, BOP positive site numbers, suppuration positive site numbers at the three time points were recorded respectively(the time before therapy denoted as T0, 1 month after 1~(st) therapy as T1, 1 month after 2~(st) therapy as T2). The changes of clinical parameters were compared at different time points. Results After two treatments, in mild peri-implantitis group, although the mean PD had no statistical difference(P>0.05) between T0 and T1, the difference between T0 and T2 became more obvious(P<0.05), and BOP positive site numbers decreased(T0 vs.T1, P<0.05; T0 vs.T2, P<0.01), at T0 none suppuration site was detected. In moderate group, PD, BOP positive site numbers, suppuration positive site numbers decreased continuously through repeated non-surgical therapy(T0 vs.T1, P<0.05; T0 vs.T2, P<0.01). In sever group, there were obvious differences in PD, suppuration positive site numbers(T0 vs.T1, P<0.05; T0 vs.T2, P<0.01), while there were no statistical differences in BOP among the three time points. At the time of T2, there were still deep PD sites, BOP sites, suppuration sites in both moderate and sever groups. Conclusions The non-surgical therapy can improve the clinical parameters but cannot cure the peri-implantitis thoroughly. Repeated therapy procedure is needed. Mild peri-implantitis can be basically controlled after two repeated non-surgical therapies while moderate and severe peri-implantitis cannot be controlled thoroughly.
引文
[1] Atieh MA,Alsabeeha NH,Faggion CM Jr,et al.The frequency of peri-implant diseases:a systematic review and meta-analysis[J].J Periodontol,2013,84(11):1586-1598.
[2] Derks J,Tomasi C.Peri-implant health and disease.A systematic review of current epidemiology[J].J Clin Periodontol,2015,42(Suppl 16):S158-S171.
[3] Pimentel SP,Shiota R,Cirano FR,et al.Occurrence of peri-implant diseases and risk indicators at the patient and implant levels:A multilevel cross-sectional study[J].J Periodontol,2018,89(9):1091-1100.
[4] 李晓明,李惠山,崔晓慧,等.种植体周围炎发病率及相关因素的研究[J].大连医科大学学报,2017,39(4):334-338.
[5] 王丽娟,江少云,王莉华.口腔种植术后2年随访结果的回顾性研究[J].中国口腔种植学杂志,2017,22(2):84-86.
[6] Froum SJ,Rosen PS.A proposed classification for peri-implantitis[J].Int J Periodontics Restorative Dent,2012,32(5):533-540.
[7] Esposito M,Grusovin MG,Worthington HV.Interventions for replacing missing teeth:treatment of peri-implantitis[J].Cochrane Database Syst Rev,2012,1:CD004970.
[8] Karring ES,Stavropoulos A,Ellegaard B,et al.Treatment of peri-implantitis by the Vector system[J].Clin Oral Implants Res,2005,16(3):288-293.
[9] Persson GR,Samuelsson E,Lindahl C,et al.Mechanical non-surgical treatment of peri-implantitis:a single-blinded randomized longitudinal clinical study.II.Microbiological results[J].J Clin Periodontol,2010,37(6):563-573.
[10] Renvert S,Samuelsson E,Lindahl C,et al.Mechanical non-surgical treatment of peri-implantitis:a double-blind randomized longitudinal clinical study.I:clinical results[J].J Clin Periodontol,2009,36(7):604-609.
[11] Bassetti M,Sch?r D,Wicki B,et al.Anti-infective therapy of peri-implantitis with adjunctive local drug delivery or photodynamic therapy:12-month outcomes of a randomized controlled clinical trial[J].Clin Oral Implants Res,2014,25(3):279-287.
[12] Renvert S,Lessem J,Dahlén G,et al.Topical minocycline microspheres versus topical chlorhexidine gel as an adjunct to mechanical debridement of incipient peri-implant infections:a randomized clinical trial[J].J Clin Periodontol,2006,33(5):362-369.
[13] Renvert S,Lessem J,Dahlén G,et al.Mechanical and repeated antimicrobial therapy using a local drug delivery system in the treatment of peri-implantitis:a randomized clinical trial[J].J Periodontol,2008,79(5):836-844.
[14] Lang NP,Berglundh T,Heitz-Mayfield LJ,et al.Consensus statements and recommended clinical procedures regarding implant survival and complications[J].Int J Oral Maxillofac Implants,2004,19(Suppl):150-154.
[15] Suzuki H,Takahashi D,Matsuo K,et al.Clinical study of 19 cases resulting in dental implant removal[J].Kobe J Med Sci,2016,61(4):E102-E108.
[16] Wohlfahrt JC,Evensen BJ,Zeza B,et al.A novel non-surgical method for mild peri-implantitis- a multicenter consecutive case series[J].Int J Implant Dent,2017,3(1):38.
[17] Suárez-López Del Amo F,Yu SH,Wang HL.Non-surgical therapy for peri-implant diseases:a systematic review[J].J Oral Maxillofac Res,2016,7(3):e13.
[18] Jepsen K,Jepsen S,Laine ML,et al.Reconstruction of Peri-implant osseous defects:a multicenter randomized trial[J].J Dent Res,2016,95(1):58-66.
[19] Schwarz F,Schmucker A,Becker J.Efficacy of alternative or adjunctive measures to conventional treatment of peri-implant mucositis and peri-implantitis:a systematic review and meta-analysis[J].Int J Implant Dent,2015,1(1):22.
[20] Farina R,Filippi M,Brazzioli J,et al.Bleeding on probing around dental implants:a retrospective study of associated factors[J].J Clin Periodontol,2017,44(1):115-122.
[21] Chang HY,Park SY,Kim JA,et al.Early radiographic diagnosis of peri-implantitis enhances the outcome of peri-implantitis treatment:a 5-year retrospective study after non-surgical treatment[J].J Periodont Implant Sci,2015,45(3):82.
[2] Derks J,Tomasi C.Peri-implant health and disease.A systematic review of current epidemiology[J].J Clin Periodontol,2015,42(Suppl 16):S158-S171.
[3] Pimentel SP,Shiota R,Cirano FR,et al.Occurrence of peri-implant diseases and risk indicators at the patient and implant levels:A multilevel cross-sectional study[J].J Periodontol,2018,89(9):1091-1100.
[4] 李晓明,李惠山,崔晓慧,等.种植体周围炎发病率及相关因素的研究[J].大连医科大学学报,2017,39(4):334-338.
[5] 王丽娟,江少云,王莉华.口腔种植术后2年随访结果的回顾性研究[J].中国口腔种植学杂志,2017,22(2):84-86.
[6] Froum SJ,Rosen PS.A proposed classification for peri-implantitis[J].Int J Periodontics Restorative Dent,2012,32(5):533-540.
[7] Esposito M,Grusovin MG,Worthington HV.Interventions for replacing missing teeth:treatment of peri-implantitis[J].Cochrane Database Syst Rev,2012,1:CD004970.
[8] Karring ES,Stavropoulos A,Ellegaard B,et al.Treatment of peri-implantitis by the Vector system[J].Clin Oral Implants Res,2005,16(3):288-293.
[9] Persson GR,Samuelsson E,Lindahl C,et al.Mechanical non-surgical treatment of peri-implantitis:a single-blinded randomized longitudinal clinical study.II.Microbiological results[J].J Clin Periodontol,2010,37(6):563-573.
[10] Renvert S,Samuelsson E,Lindahl C,et al.Mechanical non-surgical treatment of peri-implantitis:a double-blind randomized longitudinal clinical study.I:clinical results[J].J Clin Periodontol,2009,36(7):604-609.
[11] Bassetti M,Sch?r D,Wicki B,et al.Anti-infective therapy of peri-implantitis with adjunctive local drug delivery or photodynamic therapy:12-month outcomes of a randomized controlled clinical trial[J].Clin Oral Implants Res,2014,25(3):279-287.
[12] Renvert S,Lessem J,Dahlén G,et al.Topical minocycline microspheres versus topical chlorhexidine gel as an adjunct to mechanical debridement of incipient peri-implant infections:a randomized clinical trial[J].J Clin Periodontol,2006,33(5):362-369.
[13] Renvert S,Lessem J,Dahlén G,et al.Mechanical and repeated antimicrobial therapy using a local drug delivery system in the treatment of peri-implantitis:a randomized clinical trial[J].J Periodontol,2008,79(5):836-844.
[14] Lang NP,Berglundh T,Heitz-Mayfield LJ,et al.Consensus statements and recommended clinical procedures regarding implant survival and complications[J].Int J Oral Maxillofac Implants,2004,19(Suppl):150-154.
[15] Suzuki H,Takahashi D,Matsuo K,et al.Clinical study of 19 cases resulting in dental implant removal[J].Kobe J Med Sci,2016,61(4):E102-E108.
[16] Wohlfahrt JC,Evensen BJ,Zeza B,et al.A novel non-surgical method for mild peri-implantitis- a multicenter consecutive case series[J].Int J Implant Dent,2017,3(1):38.
[17] Suárez-López Del Amo F,Yu SH,Wang HL.Non-surgical therapy for peri-implant diseases:a systematic review[J].J Oral Maxillofac Res,2016,7(3):e13.
[18] Jepsen K,Jepsen S,Laine ML,et al.Reconstruction of Peri-implant osseous defects:a multicenter randomized trial[J].J Dent Res,2016,95(1):58-66.
[19] Schwarz F,Schmucker A,Becker J.Efficacy of alternative or adjunctive measures to conventional treatment of peri-implant mucositis and peri-implantitis:a systematic review and meta-analysis[J].Int J Implant Dent,2015,1(1):22.
[20] Farina R,Filippi M,Brazzioli J,et al.Bleeding on probing around dental implants:a retrospective study of associated factors[J].J Clin Periodontol,2017,44(1):115-122.
[21] Chang HY,Park SY,Kim JA,et al.Early radiographic diagnosis of peri-implantitis enhances the outcome of peri-implantitis treatment:a 5-year retrospective study after non-surgical treatment[J].J Periodont Implant Sci,2015,45(3):82.