25例种植体周围黏膜炎治疗的临床研究

目的：观察口腔卫生指导配合碳纤维工作头洁治治疗种植体周围黏膜炎的临床疗效。方法：25例种植体周围黏膜炎患者，用碳纤维工作头对种植体周围进行洁治，同时对患者进行口腔卫生指导以控制菌斑。记录前后种植体周围改良菌斑指数（mPLI）、改良龈沟出血指数（mSBI）、探诊深度（PD）等相关指标。结果：用碳纤维工作头洁治种植体周围和口腔卫生指导可使mPLI、mSBI、PD等指标明显改善。结论：口腔卫生指导和碳纤维工作头洁治术对种植体周围黏膜炎的临床治疗是有效的。     

种植体周围炎的病因分析和治疗

目的：探讨种植体周围炎的病因和临床治疗。材料与方法：对７８例ＢＬＢＣ种植体中１０例种植体的周围炎患者进行病因分析，临床及Ｘ线诊断局部超声洁治、甲硝唑缓释和全身药物治疗并随访２年。结果：１０例患者病因主要是种植体周围卫生差，口腔卫生差及种植体材料等原因。通过系统的治疗后，９例在短期内痊愈，随访２年，未见复发。纣：种植体周围炎发病与种植材料、种植前口腔卫生、种植术后患者口腔卫生习惯密切相关。其治疗方法     

甘氨酸喷砂技术治疗轻中度种植体周围炎的疗效观察

目的:评价甘氨酸喷砂粉龈下喷砂治疗（GPAP）对轻中度种植体周围炎的临床疗效。方法:收集25例种植体周围炎患者作为研究对象,其中,每例至少有1颗种植体患有早期轻度种植体周围炎,且符合纳入标准和排除标准。采用简单随机抽样方法分为2组,试验组采用GPAP方法治疗,对照组采用碳纤维刮治器和0.2%氯己定治疗。在基线和治疗后6个月进行种植体周围临床指标检查,包括菌斑指数(mPLI)、探诊后出血指数(BOP)、龈沟出血指数(mSBI)、探诊深度(PPD)、临床附着水平(AL)。采用SPSS 21.0软件包对数据进行统计学分析。结果:基线时试验组和对照组间各项临床指标的差异无统计学意义（P>0.05）。治疗后6个月,2组临床指标与基线相比均有所降低,GPAP组的降低程度显著大于对照组,差异有统计学意义（P<0.05）。结论:GPAP治疗可在一定程度上增强治疗轻中度种植体周围炎的效果,长期疗效需要大样本长时间的随访观察。     

透明质酸钠治疗种植体周粘膜炎的临床研究

目的：评价透明质酸钠治疗种植体周粘膜炎的临床效果。方法：对28例种植体周粘膜炎患牙，分别行碳纤维头超声洁治及局部应用透明质酸钠治疗，定期复查，观察牙周各项指标变化。结果：应用碳纤维头超声洁治及透明质酸钠治疗后，种植体周牙龈出血指数及菌斑指数均有显著降低，牙周探诊深度呈下降趋势。结论：透明质酸钠对种植体周粘膜炎有良好的治疗作用。     

白介素-1β与种植体周围炎的相关性实验研究

目的:研究种植体周围龈沟液(PICF)中的IL-1β(白介素-1β)与种植体周围炎的相关性。方法:将受试种植体大致分为三组:A组轻度种植体周围炎25枚、B组重度种植体周围炎5枚、C健康组(对照组)16枚,用ELISA法检测各PICF中IL-1β的含量。结果:C组的PICF中未检测到IL-1β,而A、B组的PICF中可检测出IL-1β,且检出率与炎症程度成正相关。结论:IL-1β与种植体周围炎的发生具有相关性,可作为评价种植体周围炎程度的指标。     

洁治与派丽奥局部应用对种植体周围炎治疗的疗效比较

目的:观察种植体周围洁治、派丽奥药物局部应用和二者联合治疗对种植体周围炎的临床治疗效果。方法:选择15个患种植体周围炎的病人,且每个病人至少有2个种植体,随机将这些病人分为洁治组、药物组、洁治 药物组,在基线期、治疗后4周、12周检查种植体周围组织的相关变化。结果:三种治疗方法均可使菌斑指数、龈沟出血指数和探诊深度等指标明显改善,但洁治 药物治疗的疗效持久。结论:种植体周围洁治与留置派丽奥药物治疗方法均具有明显的治疗作用,二者结合应用效果更好。     

半导体激光在种植体周围炎药物治疗中的促进作用

目的 :探讨半导体激光在种植体周围炎治疗中的作用,为临床应用提供实验依据。方法 :6只实验用比格犬共植入36枚种植体,建立种植体周围炎动物模型后测量种植体周临床指标作为基线数据。然后将36枚罹患种植体周围炎的种植体随机分为3组,A组采用常规刮治,B组采用常规刮治+盐酸米诺环素软膏(派丽奥),C组为常规刮治+盐酸米诺环素软膏(派丽奥)+半导体激光照射。治疗4周后通过大体观察、临床有效率和组织学切片进行组间比较。结果:建模时3组各项检查指标差异均无统计学意义(P>0.05)。治疗4周后C组的临床有效率最高,B组次之,A组最低(91.67%>75.00%>41.67%),其中C组PLI和SBI指标均优于B组[(0.25±0.45)vs(0.67±0.49),(0.33±0.49)vs(0.75±0.45),P<0.05]。组织学观察发现C组种植体颈部新生骨组织较多,垂直向骨缺损最小。结论 :半导体激光在种植体周围炎治疗中可有效减少牙龈出血和病原菌量并能促进新骨形成,可作为种植体周围炎治疗的辅助手段。     

种植体周围炎非手术治疗的临床疗效分析

目的：比较两种种植体周围炎非手术治疗的临床疗效。方法：选择44例种植体周围炎患者（44枚种植体），随机分组，分别进行树脂洁治和超声洁治，分别在基线、4周和8周时测龈沟出血指数、探诊深度和最深探诊深度，进行统计学分析。结果：两种治疗方法均可明显改善牙龈出血，但不能改善探诊深度和最深探珍深度。结论：树脂洁治和超声洁治对种植体周围炎的治疗仅为有限效果。     

个体化口腔卫生指导对种植体周围黏膜炎治疗效果的影响

目的:探讨个体化口腔卫生指导对种植体周围黏膜炎的临床疗效的影响。方法:将36名种植体周围黏膜炎患者随机分为实验组和对照组。对照组用碳纤维工作头对种植体周围进行刮治,不作口腔卫生指导;实验组用同样方法刮治后进行个体化口腔卫生指导。分别于术后第1,3,6周记录改良菌斑指数(mPLI)、改良龈沟出血指数(mSBI)、探诊深度(PD)以评价口腔卫生指导的效果。结果:在第1周,两组病例各指标差异无统计学意义(P>0.05)。到第3,6周,实验组与对照组相比mPLI及mSBI改善效果明显,两组PD稳定。结论:个体化口腔卫生指导可以有效提高种植体周围黏膜炎的治疗效果。     

Er：YAG激光应用于种植体周围炎治疗的临床效果评估

目的：探讨Er：YAG激光( erbium-doped： yttrium aluminium garnet)与机械刮治治疗种植体周围炎的有效性。方法22例种植体周围炎患者,按照单盲随机分组对照原则将种植体分成2组,试验组采用Er：YAG激光照射,激光能量设定为100 mJ/脉冲、频率10 Hz;对照组采用塑料刮治器和0.2%洗必泰抗菌治疗。在基线、3个月和6个月时进行临床牙周指标的检查测定,包括菌斑指数、出血指数、临床附着水平和探诊深度。结果基线时试验组和对照组间各项临床牙周指标的差异无统计学意义(P>0.05)。治疗后3个月(P<0.01)和6个月(P<0.05),试验组出血指数、菌斑指数和对照组比较差异具有统计学意义;2组探诊深度在治疗后3个月和6个月均有降低,且2组探诊深度的差异均有统计学意义(P<0.05);然而2组临床附着水平差异无统计学意义(P>0.05)。结论 Er：YAG激光治疗后能显著改善种植体周围炎炎症水平,控制种植体周围炎的有效性优于机械刮治治疗。     

盐酸米诺环素软膏治疗种植体周围炎的临床疗效观察

目的:探讨和评估盐酸米诺环素软膏在治疗种植体周围炎的临床疗效。方法:选择种植体周围炎患者20名(共23枚种植体),X线示种植体周围骨质吸收范围为种植体1/3～1/2。所有患者进行龈上洁治、龈下刮治,局部给予盐酸米诺环素软膏,一次/周。观察治疗前,治疗后第1～6周种植体周围的菌斑指数(PLI)、出血指数(SBI)和探诊深度(PD)等指标的变化。结果:除治疗后第2周,一枚种植体发生脱落外,6周后,其余种植体稳定性均良好,检测菌斑指数、探诊出血指数和探诊深度有明显改善,X线示未见明显继续骨质吸收。结论:局部应用盐酸米诺环素软膏对种植体周围炎有一定的治疗效果,远期效果应进一步观察。     

Efficacy of 0.12% Chlorhexidine Gluconate for Non‐Surgical Treatment of Peri‐Implant Mucositis

Background: Because peri‐implant mucositis may progress to peri‐implantitis, effective treatment resulting in resolution of inflammation could prevent peri‐implantitis. Current treatment protocols for this condition are still unpredictable. The purpose of this study is to analyze efficacy of non‐surgical treatment for patients with peri‐implant mucositis during a 6‐month follow‐up period. Methods: This controlled, randomized, double‐masked clinical trial included 37 patients diagnosed with peri‐implant mucositis, randomly assigned into test group (basic periodontal therapy + 0.12% chlorhexidine) with 61 implants; and control group (basic periodontal therapy + placebo) with 58 implants. Therapy consisted of adaptation of the full‐mouth scaling and root planing protocol. Clinical parameters of visible plaque index (VPI), gingival bleeding index (GBI), probing depth (PD), and bleeding on probing (BOP) were measured in implants and were evaluated at baseline and at 1, 3, and 6 months post‐therapy. Data were analyzed using the split‐plot analysis of variance and χ² tests with a significance level of 5%. Results: Intragroup analysis showed that VPI, GBI, PD, and BOP presented statistically significant improvements compared with baseline. No statistically significant differences were found between the test and control groups at any time. Conclusions: Both isolated mechanical therapy and its association with 0.12% chlorhexidine mouthwash reduced peri‐implant mucositis. Therefore, 0.12% of chlorhexidine was not more effective than placebo.     

3I和奥齿泰种植体系统周围组织稳定性差异的临床对比研究

目的：探讨3I种植体和奥齿泰种植体修复后对种植体周围软硬组织的影响，为临床种植系统的选择提供临床依据。方法随机选取单牙缺失需种植修复的患者42例，分别行3I种植体（23枚）和奥齿泰种植体（26枚）种植修复，于修复后3、6、9和12个月测量种植体周围骨吸收、龈沟出血指数（sulcus bleeding index， SBI）、菌斑指数（plaque index，PLI）、探诊深度（probing depth，PD）、种植体周围龈沟液（peri?implant crevicular fluid ，PICF）的天冬氨酸转氨酶（aspartate aminotransferase ，AST）水平，并选取对侧健康牙作为对照。结果种植体修复后1年，种植体颈部骨组织呈现不断吸收趋势，且奥齿泰种植体骨吸收量大于3I种植体（P <0.05）。在修复后6、9和12个月，3I种植体SBI、PLI均低于奥齿泰种植体（P<0.05），3I种植体AST水平与天然牙差异无统计学意义，而奥齿泰种植体AST水平高于天然牙（P<0.05）。修复后9、12个月，3I种植体PD明显低于奥齿泰种植体（P<0.05）。结论3I种植体对种植体周围骨组织及周围牙龈组织的影响较奥齿泰小，但两者在研究期内均表现出良好的临床效果。     

盐酸米诺环素软膏对微螺钉支抗种植体周围炎龈下牙龈卟啉单胞菌影响

目的:探讨盐酸米诺环素软膏对微螺钉支抗种植体周围炎龈下牙龈卟啉单胞菌(Porphyromonas gingivalis,Pg)影响。方法:选取我院2013年1月~2015年1月收治的15例微螺钉支抗治疗后种植体周围炎的患者,共20种植体,为观察组;选取同期于我院接受微螺钉支抗治疗的患者14例,共20种植体,经证实无种植体周围炎,为对照组。记录两组菌斑指数(PLI)、牙周袋探诊指数(PD)及龈沟出血指数(SBI )。采用实时荧光定量PCR检测Pg。结果:治疗前与治疗后,观察组PLI、PD和SBI均显著高于对照组(P<0.01或P<0.05),治疗1、3周后观察组PLI、PD和SBI显著降低,治疗6周后有上升趋势,但与治疗前相比差异仍有统计学意义(P<0.05);治疗前与治疗后6周,观察组Pg检出率显著高于对照组(P<0.05),治疗1、3周后观察组Pg检出率显著降低并与对照组接近,治疗6周后有上升趋势;Pg检出率与临床指标PLI、PD和SBI成正相关性(P<0.05)。结论:盐酸米诺环素软膏治疗微螺钉支抗种植体周围炎,可明显改善种植体周围炎临床症状,其对Pg具有较强的抗菌效果。     

Tenascin-C and matrix metalloproteinase-9 levels in crevicular fluid of teeth and implants

Background: The role of and interaction between bacterial infection and biomechanical impact in the development of peri‐implant inflammatory processes is not clear. Objective: To determine the amount and concentration of tenascin‐C (TNC) in gingival crevicular fluid (GCF) around teeth and in peri‐implant sulcus fluid from healthy implants and implants with peri‐implantitis, and to correlate it with matrix metalloproteinase‐9 (MMP‐9) levels. Materials and Methods: Seven control individuals and 18 patients with 41 implants with/without peri‐implantitis were included. GCF was collected with filter strips and volumes were measured with a Periotron device. The amount of serum albumin per sample was quantified by densitometric analysis of Coomassie‐stained sodium dodecyl sulfate–polyacrylamide gel electrophoresis. Relative activity of MMP‐9 was determined from the densitometry of zymograms. Amounts and concentrations of TNC were evaluated by ELISA. Results: Relative MMP‐9 activity was increased in peri‐implantitis. A tendency was observed to measure higher TNC concentrations at teeth than at implants. The amount of TNC in GCF collected from healthy implant sites and the peri‐implantitis sites was significantly different. Based on immunoblotting, TNC in GCF seemed degraded. In contrast to TNC, MMP‐9 was significantly related to the PD and the volume of GCF. Conclusion: TNC is known to be induced in inflammation. The increase found in peri‐implantitis was less than expected. In the context of peri‐implantitis, TNC might be a marker of bone remodelling rather than inflammation and infection. A possible proteolytic degradation of TNC during peri‐implantitis needs to be studied.     

Decontamination of Anodized Implant Surface With Different Modalities for Peri‐Implantitis Treatment: Lasers and Mechanical Debridement With Citric Acid

Background: Although oral rehabilitation with dental implants is a very promising and effective procedure, peri‐implantitis is an emerging concern. Surgical and non‐surgical methods have been applied to treat peri‐implantitis together with various implant surface decontamination methods. However, there is no consensus concerning the most effective treatment for peri‐implantitis. The aim of the present study is to evaluate the effects of erbium‐doped:yttrium, aluminum, and garnet (Er:YAG) laser, photodynamic therapy (PDT), and titanium bur with and without citric acid on ligature‐induced peri‐implantitis around an anodized implant surface. Methods: Thirty dental implants with anodized surface (3.3 × 10 mm) were installed in the mandibles of five beagle dogs. After 3 months, peri‐implantitis was induced by applying cotton ligatures subgingivally. After ligature removal (baseline), the implants were divided into the following treatment groups: 1) Er:YAG laser, 2) PDT, 3) titanium bur alone, and 4) titanium bur with citric acid. Animals were sacrificed after 3 months, and clinical, radiologic, histologic, and histomorphometric evaluations were conducted for all treatment modalities. The data were analyzed using one‐way analysis of variance and Tukey test. A value of P <0.05 was considered statistically significant. Results: The titanium bur with citric acid group exhibited statistically significantly greater improvement in vertical bone height than the Er:YAG laser group and significantly better bone‐to‐implant contact than the PDT group and the bur‐alone group. Conclusion: Within the limits of the study, the combination of mechanical and chemical treatment proved to be the most effective treatment for disinfection of the anodized implant surface.     

种植体周围炎与牙周炎的类比探究

种植体周围炎症是种植失败的主要原因之一,包括种植体周围黏膜炎和种植体周围炎。种植体周围炎的发生、发展及治疗和预防与牙周炎存在一定的相似性,本文将种植体周围炎和牙周炎的流行病学、组织病理表现、始动因素、危险因素、治疗和预防等方面进行类比,探讨如何更好地预防和治疗种植体周围炎。     

Prevalence,Etiology and Treatment of Peri‐Implant Mucositis and Peri‐Implantitis: A Survey of Periodontists in the United States

Background: Currently, information available on the exact prevalence and standard therapeutic protocol of peri‐implant diseases is insufficient. The aim of this survey was to investigate the perceived prevalence, etiology, and management of peri‐implant mucositis and peri‐implantitis by periodontists in the United States. Methods: A twenty‐question survey was developed. Periodontists currently practicing in the United States were contacted by an e‐mail that contained a link to access the survey. Results: Two hundred eighty periodontists (79.3% males; 62.9% with >10 years in practice, 75.7% in private practice) completed the survey. Most (96.1%) of the participants were placing implants (58.3% for >10 years and 32.4% >150 implants/year). The majority reported that the prevalence of peri‐implant mucositis and peri‐implantitis in their practices is up to 25% but is higher in the general US population and that up to 10% of implants must be removed due to peri‐implantitis. There was agreement among contributing etiologic factors such as: 1) plaque; 2) smoking; 3) adverse loading; 4) oral hygiene; 5) use of antimicrobial gel/mouthrinse; 6) non‐surgical debridement; 7) use of systemic antibiotics; and 8) 3‐month supportive care for treatment of peri‐implantitis. Significant heterogeneity was recorded in relation to the instruments used for debridement, use and type of surgical treatment, and materials used for regeneration. Only 5.1% believed that treatment is very effective. Conclusions: This survey indicates that peri‐implant diseases are a frequently encountered problem in periodontal practices and that the absence of a standard therapeutic protocol results in significant empirical use of therapeutic modalities and a moderately effective treatment outcome.     

Treatment Outcome in Patients With Peri‐Implantitis in a Periodontal Clinic: A Retrospective Study

Background: The number of placed implants has grown during the past decade, and the prevalence of peri‐implantitis has increased. The purpose of the present study is to investigate the treatment outcome of peri‐implantitis and to identify factors influencing the treatment success rate. Methods: The study was conducted as a retrospective longitudinal study on a referral population. The material included 382 implants with peri‐implantitis in 150 patients. Peri‐implantitis was defined as presence of pocket depths ≥5 mm, bleeding at probing and/or suppuration, and the presence of implant radiographic bone loss ≥3 mm or bone loss comprising at least three threads of the implant. Variance analyses, χ² analyses, and logistic regression analysis were used for data analyses. Results: The mean age of the participants at baseline was found to be 64 years (range: 22 to 87 years). The mean ± SD follow‐up time was 26 ± 20 months, and the mean time between implant installation and baseline was 6.4 years (range: 1 to 20 years). Periodontal flap surgery with osteoplasty was the most common type of therapy (47%), and regenerative surgery procedures with bone substitute materials were chosen in 20% of the cases. The mean success rate at patient level was 69%. The results of the logistic regression analyses showed that the success rate was significantly lower for individuals with the diagnosis of severe periodontitis, severe marginal bone loss around the implants, poor oral hygiene, and low compliance. Conclusion: The effectiveness of the peri‐implantitis therapy was impaired by severe periodontitis, severe marginal bone loss around the implants, poor oral hygiene, and low compliance.