种植体周围龈沟液细胞因子的研究进展

种植牙目前在国际上被认为是牙齿缺失的首选修复手段,种植体周围炎是种植体植入后的常见并发症之一,严重影响种植修复的远期成功率。探讨种植体周围炎的病因和发病机制,检测种植体周围龈沟液细胞因子作为早期诊断和监测疾病进展的指标具有重要的临床意义,本文对这方面的研究进展作一综述。     

盐酸米诺环素软膏与甲硝唑对种植体周围炎抑制作用的 临床研究

目的 对比局部运用盐酸米诺环素软膏和口服甲硝唑治疗种植体周围炎的临床效果。方法 选取2016年3月~2018年5月来我院口腔门诊就诊的种植体周围炎患者36例,在对种植体进行龈上洁治、龈下刮治后,随机分为盐酸米诺环素软膏组和口服甲硝唑组,每组18例。盐酸米诺环素软膏组局部运用盐酸米诺环素软膏治疗,口服甲硝唑组采用口服甲硝唑治疗。对比基线、治疗后4周和8周改良菌斑指数（mPLI）、改良龈沟出血指数（mSBI）和探诊深度（PD）参数。结果 治疗后4周及8周,两组患者mPLI、mSBI以及PD参数均低于基线,差异具有统计学意义（P＜0.05）;盐酸米诺环素软膏组治疗后4周及8周的mPLI、mSBI以及PD参数均低于口服甲硝唑组[4周:mPLI（0.69±0.47）vs （1.46±0.33）,mSBI（0.62±0.41） vs （1.16±0.38）,PD（2.47±0.37）mm vs （3.52±0.54）mm;8周:mPLI（0.98±0.39）vs（1.52±0.30）,mSBI（0.86±0.45）vs（1.26±0.43）,PD（2.93±0.50）mm vs （3.46±0.46）mm],差异具有统计学意义（P＜0.05）。结论 盐酸米诺环素软膏和甲硝唑治疗种植体周围炎有确切的疗效,应用盐酸米诺环素软膏效果明显优于口服甲硝唑,局部使用药物可以实现短期的大幅优化。     

Effect of 308-nm excimer laser light on peri-implantitis-associated bacteria—an in vitro investigation

Dental implants are becoming increasingly important in prosthodontic rehabilitation. Bacterial infections, however, can induce bone loss and jeopardize clinical success. Recent literature has demonstrated that infrared CO₂ laser light is suitable for the decontamination of exposed implant surfaces. The aim of the present study was to investigate the influence of 308-nm excimer laser irradiation on peri-implantitis-associated bacteria in vitro. In this study, a XeCl excimer laser (308 nm) was used (Summit Technology, Boston, USA). Both aerobe (Streptococcus mutans, S. sanguis, Actinomyces naeslundii) and anaerobe microorganisms (A. odontolyticus, Prevotella melaninogenica) were tested. According to previous studies, a constant energy of 0.8 J/cm² and a constant frequency of 20 Hz were used for all irradiations. Colony-forming units after laser irradiation were counted. Excimer laser irradiation showed significant influence on the growth of all microorganisms. As compared to S. mutans and S. sanguis, A. naeslundii demonstrated higher sensitivity to laser irradiation. Anaerobe microorganisms, in contrast, demonstrated that a total of 200 pulses were sufficient to reduce the replication of these germs for more than 99.9%. Excimer laser irradiation (λ = 308 nm) can significantly reduce both aerobe and anaerobe microorganisms. Depending on the parameters chosen, 200 pulses are sufficient for sterilization. New studies are necessary to evaluate if this wavelength is more of value in the treatment of peri-implantitis than other wavelengths or conventional therapies.     

Er:YAG laser therapy for peri-implant infection: a histological study

The purpose of this study was to evaluate the effects of Er:YAG laser on degranulation and implant surface debridement in peri-implant infection. The peri-implant infection was experimentally induced in dogs, and the treatment was performed using an Er:YAG laser or a plastic curet. Animals were sacrificed after 24 weeks, and undecalcified histological sections were prepared and analyzed. Degranulation and implant surface debridement were obtained effectively and safely by Er:YAG laser. Histologically, a favorable formation of new bone was observed on the laser-treated implant surface, and the laser group showed a tendency to produce greater bone-to-implant contact than the curet group. These results indicate that the Er:YAG laser therapy has promise in the treatment of peri-implantitis. Contract grant sponsor: 21^st Century Center of Excellence Program for Frontier Research on Molecular Destruction and Reconstruction of Tooth and Bone in Tokyo Medical and Dental University and a Grant-in-Aid for Scientific Research(c)(2) (No. 16592064) (A.A.), Ministry of Education, Culture, Sports, Science and Technology of Japan.     

种植体周围炎动物模型建立及意义

目的:为进一步研究种植体周围炎提供与临床实际近似的实验用动物模型。方法:在犬下颌第一、二、三前磨牙及第一磨牙区植入Branemark纯钛种植体30枚,运用丝线栓结法引入炎症致骨组织吸收,并通过临床数据测量、X线摄片、龈沟液IL8测定、手术直观评价和组织学评价相结合观察种植体周骨缺损程度。结果:丝线栓结后1个月临床指数明显上升,与栓结前存在着显著性差异(P<0.001)、X线片及手术直观评价显示种植体周围存在明显骨缺损。种植体周龈沟液IL8测定栓结前后存在着显著性差异(P<0.05)。组织学显示种植体周围牙槽骨吸收,破骨细胞增生活跃。结论:丝线栓结法可成功建立与临床实际近似的种植体周围炎模型,成功率高,容易控制,为临床研究提供了有效手段。     

Treatment of periodontal patients-current clinical concepts

The main goal of the treatment of patients with periodontitis is to establish adequate infection control. To satisfy demands for acceptable aesthetics and chewing function with good long-term prognosis in patients with periodontitis requires the establishment of adequate infection control. Pocket instrumentation (scaling and root planing with or without flap elevation), combined with effective self-performed supragingival plaque control measures, constitutes the basic treatment modalities.     

Longitudinal study on risk indicators for peri-implantitis using survival-time analysis

Purpose

The purpose of this study was to evaluate the incidence of peri-implantitis and to identify potential associated risk indicators.

种植体周病非手术治疗中联合应用甘氨酸粉喷砂的临床效果评价

目的: 比较单纯手工黏膜下刮治与联合应用甘氨酸粉喷砂在非手术治疗种植体周病中的临床疗效。方法: 本研究为随机临床对照研究,研究对象为2020年5月至2021年6月就诊于北京大学口腔医院牙周科的种植体周病患者。共纳入28例患者的62颗种植体,采用随机数字表法将患者随机分为试验组和对照组,其中试验组(13例/32颗种植体)采用钛刮治器行黏膜下刮治联合应用甘氨酸粉喷砂治疗,对照组(15例/30颗种植体)单纯使用钛刮治器行黏膜下刮治。分别记录基线期和治疗后8周种植体周探诊深度(peri-implant probing depth,PPD)、出血指数(bleeding index,BI)、菌斑指数(plaque index,PLI)和探诊溢脓种植体占该组总种植体数目的百分比(suppuration on probing %,SoP%),比较治疗前后种植体周临床指标的变化及治疗后组间差异。结果: 治疗后8周两组种植体的平均PLI、PPD、BI均下降,差异具有统计学意义(P<0.05)。与对照组相比,治疗后试验组BI更低(2.7±0.8 vs. 2.2±0.7,P<0.05),BI改善值更大(0.6±0.7 vs. 1.1±0.6,P<0.01),SoP%降低更多(21.9% vs. 10.0%, P<0.05),差异均具有统计学意义。其中罹患种植体周黏膜炎的种植体,试验组BI及SoP%改善值大于对照组(1.0±0.7 vs. 0.4±0.7,P=0.02;6.3% vs. 0,P=0.012),差异具有统计学意义,而两组间PLI和PPD改善值差异均无统计学意义(P>0.05)。罹患种植体周炎的种植体,两组间PLI、PPD、BI及SoP%改善值差异均无统计学意义(P>0.05)。结论: 联合应用甘氨酸粉喷砂和单纯手工黏膜下刮治均可改善种植体周软组织炎症,而前者在改善种植体周软组织出血及探诊溢脓,特别是罹患种植体周黏膜炎的效果方面更佳。     

种植体周围疾病发病率及危险因素的研究

目的:明确国人种植体周围疾病发病率并探索种植体周围炎的风险因素。方法:收集北京大学口腔医院第二门诊部种植修复后的736例患者的1612枚种植体复查情况,平均负重时间(22.64±0.92)个月,记录种植体周围菌斑指数、探诊深度(probing depth,PD)、探诊出血指数(bleeding index, BI),角化龈宽度,粘接剂残留、骨吸收情况,记录口内天然牙PD、BI。分析不同种植系统及不同复查时间段种植体周围炎的发病率,Logistic回归分析种植体周围炎的相关风险因素。结果:在个体和植体水平,种植体周围黏膜炎发病率分别为81.90%、83.60%,种植体周围炎发病率分别为4.50%和3.70%。各系统间种植体周围炎发病率无显著差异,在修复后1~5年各时间段组种植体周围炎发病率无显著差异,修复后0.5~1年和5~7年发病率显著低于1~5年各时间段组(P<0.05)。Logistic回归分析显示,在调整性别、年龄、吸烟、粘接剂、角化龈宽度等变量后,口内缺牙数、种植体周围PD、BI是种植体周围炎的风险因素(P<0.01)。结论:种植体周围黏膜炎发病广泛,种植体周围炎的发病率并非随着修复时间的延长而增加,对种植体周围探诊深度和出血的控制是预防种植体周围炎发生的关键。