国产ZDI种植体的长期临床效果分析

目的观察和评价国产ZDI种植系统的长期临床效果。方法通过观察随访35例种植病例,共计46枚ZDI种植体在修复完成后6年内生物和机械并发症的发生率、种植体周围骨吸收的程度以及患者对修复效果的满意度来评估ZDI种植系统的临床效果。结果修复6年后,仅有两枚种植体发生种植体周围炎,一例牙冠脱落,无其他种植体及上部结构相关的机械并发症,累计成功率为95.7%、存留率为100%;患者总体满意度达(9.79±0.29)分。结论只要规范种植操作,精确制作修复体,维持良好的口腔卫生,ZDI种植系统能获得良好的长期临床效果。     

种植体支持切削杆固位无牙颌种植修复体的临床应用和加工技术研究

目的：探讨种植体支持切削杆固位覆盖义齿的临床效果及工艺特点.方法：28例无牙颌患者（男12例,女16例,年龄22-71岁）,共31个修复体,植入种植体168枚.所有病例在种植体植入4-6个月后开始种植修复,均采用切削杆固位的覆盖义齿修复.修复后追踪最长39个月,最短12个月.观察方法为临床检查和x线片检查.结果：31个修复体固位力好、稳定.23例患者对修复效果非常满意,5例满意.5例患者由于口腔卫生差导致种植体周围软组织炎,4例经过局部冲洗上药,炎症消退,1例在修复后五年发展为种植体周围炎,最终修改修复设计,改用磁性基台固位.X线片示27例患者的160枚种植体周围骨组织稳定,无骨吸收,1例8颗种植体周围骨吸收2-4 mm.28例患者中2例在修复后一年发生修复体树脂基托断裂,2例在修复后四年发生修复体树脂基托断裂,修补后重新使用,无需重做修复体.所有病例在修复后至最后一次复查未见种植体脱落.结论：应用种植体支持切削杆固位修复无牙颌的修复效果满意,种植体受力均匀,但加工工艺及设备要求较高,材料成本高,是该技术推广应用不足之处.     

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。     

种植体周围炎龈下优势厌氧菌群的研究

目的：为了探讨种植体周围炎的病因及发病机制，明确其龈下优势厌氧菌群。方法：运用厌氧培养技术，对３９例种值体周围炎的龈下标本进行厌氧菌的分离与鉴定，另外还选取了２２例健康种植体及３０例牙周炎作对照。结果：种植体周围炎组厌氧菌检出率（８９．７％）显著高于健康对照组（６３．６％）（Ｐ＜０．０５），而与牙周炎组（９０％）则无显著性差异（Ｐ＞０．０５），并发现不同临床症状的种植体周围炎病例其龈下的所得厌氧菌株的构成比有显著性差异。结论：本文认为种植体周围炎是种植后细菌再定植过程中的一种菌群失调症，Ｇ－厌氧菌为其龈下优势厌氧菌群。     

种植体周围炎的风险因素研究现状

种植体周围炎是种植术后的常见并发症，患者的口腔卫生状况，吸烟，牙周炎，糖尿病，角化龈过窄、过薄或缺失，基因多态性，牙科粘接剂的残留，咬合超载，牙种植体的复查维护，种植体行使功能的时间长短，种植体的表面特性及修复设计等都可以影响种植体周围炎的发生、发展以及预后。本文将对种植体周围炎的相关风险因素进行综述，以利于更客观地认识种植体周围炎。     

牙种植体即刻负重临床疗效观察

目的：种植体即刻负重技术有益于缩短种植手术与修复的“等待期”，及时满足美观和咀嚼要求，进一步扩大种植义齿临床适应证。本文旨在探讨该技术的适应证、操作技巧，评价其临床疗效。方法：CDIC种植体植入23例牙缺失患者，共植入49枚种植体，术后1周内完成上部结构修复，经检测种植体动度、GI及有无种植体周围炎、口腔全景片等指标，评价临床成功率。结果：随访1-6年，23例患者中，仅1例患者的1枚种植体松动、脱落，其余种植体均获临床成功，临床成功率为98％。结论：即刻负重修复患者应为牙槽嵴丰满之中青年患者．种植体周围应有足够的骨壁包绕，以增加初期稳定性。从黏骨膜瓣环切至种植体窝洞预备，都应贯彻“宁小勿大”原则，增加种植体的嵌合能力。一期法、非翻瓣式手术有利于软组织愈合，减少种植体周围炎发生几率：前牙即刻负重修复时，多枚种植体的连冠（T-T）修复优于单枚种植体修复，后牙即刻负重适用于2颗以上的种植体支持式固定修复，以分散[牙合]力，增加稳定性。     

种植体周围炎发病影响因素的病例对照研究

目的 探讨种植体周围炎发生的相关影响因素,为临床预防和控制提供依据。方法 采用病例对照研究收集相关资料,病例为2010年1月—2013年6月期间完成的种植修复后确诊种植体周围炎新发病例（A组）52例,对照为同期完成种植修复种植体周围健康者（B组）95例。采用SPSS16.0软件包中的非条件logistic回归分析,明确种植体周围炎发生密切相关的患者自身和手术修复相关因素。结果 单因素分析结果中,有意义的变量包括年龄、文化程度、牙周病、吸烟、糖尿病、定期洁牙并使用种植专门护理产品、上部结构修复方式(P<0.05)。多因素回归分析表明,吸烟、糖尿病、牙周疾病、种植部位是种植体周围炎的危险因素;定期洁牙是种植体周围炎的保护因素。结论 影响种植体周围炎发生的危险因素多为患者自身因素,建议严格掌握种植手术适应证,对高风险患者加强卫生宣教,术后注意随访,尽早发现、治疗种植体周围炎。     

窄种植体微创术式近期临床效果研究

目的：研究Axiom覫2．8 mm窄种植体用于小缺牙间隙微创种植修复的临床效果。方法：10例患者的10个＜5 mm缺牙间隙以微创术式植入10枚Axiom覫2．8 mm窄种植体，6个月后进行固定义齿修复。随访所有病例的临床效果和全景X线曲面断层影像学检查。结果：10枚窄种植体植入6个月时，经影像学检查显示种植体牙槽骨嵴平均吸收量0．20 mm，无种植体周围炎及种植体周围黏膜炎，修复义齿与邻牙间龈乳头充盈，所有患者感觉咀嚼有力，对其修复效果满意。无种植体松动、脱落病例。结论：小于5mm缺牙间隙采用Axiom覫2．8 mm窄种植体微创种植修复后可以取得良好的近期临床效果与美学效果。     

上颌窦底植骨种植效果的回顾性研究

目的 评价上颌窦底植骨种植术的远期临床应用效果及其相关影响因素。方法74例患者接受100侧上颌窦底植骨，共植人种植体206颗。采用单纯自体骨、骨代用品或混合骨作为植骨材料。术后随访1-9年，平均3．5年。结果种植体5年存活198颗，累积存活率为92．28％，共8颗种植体脱落。未发生上颌窦炎，植骨材料稳定。13例颏部取骨术后曾出现下唇暂时性感觉迟钝或麻木，后均恢复，全部患者对种植修复效果满意。结论上颌窦底植骨种植术是上颌骨后牙区骨量不足时，临床效果可靠的重建方法，修复远期效果好；影响远期效果的因素为过度负荷、种植方式及患者的口腔卫生状况。     

种植体颈部的优化设计在预防种植体周围炎中的应用

种植体周围炎是种植修复失败的一个重要因素,种植体 基台连接方式及种植体颈部表面的宏观形状、微观形貌及化学组成在种植体周围炎的发生、发展中的作用已经得到证实。该文就种植体周围炎的病因及治疗手段,特别是通过种植体颈部的优化设计预防种植体周围炎的研究现状进行综述。     

Patient compliance as a risk factor for the outcome of implant treatment

Peri‐implantitis can be explained using a multicausality model. Many factors are involved in the etiology of peri‐implantitis, but patient compliance also plays a key role. Oral hygiene, attending recall visits, smoking behavior, and therapy comprehension are relevant factors that contribute to peri‐implant health. The clinician should create the most optimal conditions for patients to facilitate adequate oral self‐care and to help patients improve their oral hygiene skills. Implementation of a supportive periodontal therapy program is mandatory to control inflammation and plaque accumulation, as well as to keep the incidence of peri‐implant diseases low. Patient compliance, including plaque control and dental follow‐up, must be optimal. Consequently, precautions must be taken with patients treated with dental implants.     

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.     

Clinical evaluation of an implant maintenance protocol for the prevention of peri-implant diseases in patients treated with immediately loaded full-arch rehabilitations

To cite this article:
Int J Dent Hygiene 9 , 2011; 216–222
DOI: 10.1111/j.1601‐5037.2010.00489.x
Corbella S, Del Fabbro M, Taschieri S, De Siena F, Francetti L. Clinical evaluation of an implant maintenance protocol for the prevention of peri‐implant diseases in patients treated with immediately loaded full‐arch rehabilitations. Abstract: Objective: The aim of this prospective study was to assess the outcomes of an implant maintenance protocol for implants supporting a full‐arch rehabilitation. Materials and methods: Sixty‐one patients (28 women and 33 men) treated with immediately loaded full‐arch rehabilitation, both mandibular and maxillary, supported by a combination of two tilted and two axial implants, were included in the study. Patients were scheduled for follow‐up visits every 6 months for +2 years, then yearly up to 4 years. Each patient received professional oral hygiene treatment and detailed oral hygiene instructions. During each visit, modified plaque index, bleeding index and probing depth were assessed. The presence of peri‐implant tissue inflammation was also evaluated. Results: Mean observation time, considering both mandible and maxilla, was 18.3 months ranging from 6 months to 5 years. Both plaque and bleeding indexes frequency decreased over time. Probing depth was stable (2.46 ± 0.5 mm at 4 years). Only three implants were lost due to peri‐implantitis (1.4% at 12 months), whereas the incidence of peri‐implant mucositis was less than 10% in each considered period. Conclusions: The adoption of a systematic hygienic protocol is effective in keeping low the incidence of peri‐implant mucositis as well as in controlling plaque accumulation and clinical attachment loss.     

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.     

P43 Effectiveness of a mechanic-chemical method in reducing malodor of dentures

The purpose of this study was to investigate subjective symptoms about oral malodor and the knowledge and attitude for bad breath on dental students. The subjects were 213 students from 1st to 6th year undergraduate course of one dental school in Thailand (male: 70, female: 143). Their mean (s.d.) age was 21.0 (1.9). Questionnaire survey was conducted in November 2003. Questionnaire items were subjective symptoms about oral malodor and dry mouth, the knowledge and attitude for bad breath, oral hygiene practice, smoking/drinking habits, and life stress. Five students (2.3%) answered that they concerned their oral malodor often and 87.8% reported sometimes. Of them, 72.9% wanted to receive treatment for their malodor and 70.8% said they suffer from bad breath in daily life. Two-thirds of students perceived strong oral malodor when waking up. There were no significant differences of the self-perceived malodor rates between gender or among year of study. More than half of the students did not know that oral diseases and poor oral hygiene are the major causes of bad breath. The students' attitudes for bad breath were different if the target was family members or friends. The majority of the students (88.7%) answered they perceived dry mouth. Perception of dry mouth was significantly related with self-reported oral malodor prevalence ( P  < 0.05). However other oral or behavioral factors did not relate to the self-reported malodor rates. In this study, dental students perceived bad breath in high prevalence. However the knowledge for bad breath was not enough even the students who already provided dental treatment to the patients. It would be necessary to give them adequate knowledge and methods in education program for managing not only patients' but also their own oral malodor problem.     

Peri-implantitis in partially edentulous patients: association with inadequate plaque control

Objective: The aim of the present study was to describe some clinical periodontal features of partially edentulous patients referred for the treatment of peri‐implantitis. Material and methods: The 23 subjects involved in this study were selected from consecutive patients referred to the department of Periodontology Södra Älvsborgs Hospital, Borås, Sweden, for treatment of peri‐implantitis during 2006. The patients had clinical signs of peri‐implantitis around one or more dental implants (i.e.≥6 mm pockets, bleeding on pockets and/or pus and radiographic images of bone loss to≥3 threads of the implants) and remaining teeth in the same and/or opposite jaw. The following clinical variables were recorded: Plaque Index (PI), Gingival Bleeding Index (GBI) Probing Pocket Depth (PPD), Access/capability to oral hygiene at implant site (yes/no), Function Time. The patients were categorized in the following sub‐groups: Periodontitis/No periodontitis, Bone loss/No bone loss at teeth, Smoker/Non‐smokers. Results: Out of the 23 patients, the majority (13) had minimal bone loss at teeth and no current periodontitis; 5 had bone loss at teeth exceeding 1/3 of the length of the root but not current periodontitis and only 5 had current periodontitis. Six patients were smokers (i.e. smoking more than 10 cig/day). The site level analysis showed that only 17 (6%) of the 281 teeth present had ≥1 pocket of ≥6mm, compared to 58 (53%) of the total 109 implants (28 ITI^® and 81 Brånemark^®); 74% of the implants had no accessibility to proper oral hygiene. High proportion of implants with diagnosis of peri‐implantitis were associated with no accessibility/capability for appropriate oral hygiene measures, while accessibility/capability was rarely associated with peri‐implantitis. Indeed 48% of the implants presenting peri‐implantitis were those with no accessibility/capability for proper oral hygiene (65% positive predict value) with respect to 4% of the implants with accessibility/capability (82% negative predict value). Conclusion: The results of the study indicate that local factors such as accessibility for oral hygiene at the implant sites seems to be related to the presence or absence of peri‐implantitis. Peri‐implantitis was a frequent finding in subjects having signs of minimal loss of supporting bone around the remaining natural dentition and no signs of presence of periodontitis (i.e. presence of periodontal pockets of ≥6 mm at natural teeth). Only 6 of the examinated subjects were smokers. In view of these results we should like to stress the importance of giving proper oral hygiene instructions to the patients who are rehabilitated with dental implant and of proper prosthetic constructions that allow accessibility for oral hygiene around implants.     

P42 Subjective symptoms and knowledge of oral malodor on dental students in Thailand

The purpose of this study was to investigate subjective symptoms about oral malodor and the knowledge and attitude for bad breath on dental students. The subjects were 213 students from 1st to 6th year undergraduate course of one dental school in Thailand (male: 70, female: 143). Their mean (s.d.) age was 21.0 (1.9). Questionnaire survey was conducted in November 2003. Questionnaire items were subjective symptoms about oral malodor and dry mouth, the knowledge and attitude for bad breath, oral hygiene practice, smoking/drinking habits, and life stress. Five students (2.3%) answered that they concerned their oral malodor often and 87.8% reported sometimes. Of them, 72.9% wanted to receive treatment for their malodor and 70.8% said they suffer from bad breath in daily life. Two‐thirds of students perceived strong oral malodor when waking up. There were no significant differences of the self‐perceived malodor rates between gender or among year of study. More than half of the students did not know that oral diseases and poor oral hygiene are the major causes of bad breath. The students’ attitudes for bad breath were different if the target was family members or friends. The majority of the students (88.7%) answered they perceived dry mouth. Perception of dry mouth was significantly related with self‐reported oral malodor prevalence (P < 0.05). However other oral or behavioral factors did not relate to the self‐reported malodor rates. In this study, dental students perceived bad breath in high prevalence. However the knowledge for bad breath was not enough even the students who already provided dental treatment to the patients. It would be necessary to give them adequate knowledge and methods in education program for managing not only patients’ but also their own oral malodor problem.     

Prevalence and Predictive Factors for Peri‐Implant Disease and Implant Failure: A Cross‐Sectional Analysis

Background: Long‐term studies worldwide indicate that peri‐implant inflammation is a frequent finding and that the prevalence of peri‐implantitis correlates with loading time. Implant loss, although less frequent, has serious oral health and economic consequences. An understanding of predictive factors for peri‐implant disease and implant loss would help providers and patients make informed decisions. Methods: A cross‐sectional study was performed on 96 patients with 225 implants that were placed between 1998 and 2003. Implant placement data were collected from patient records, and patients presented for a clinical and radiographic follow‐up examination. Implant status and periodontal status were determined, the data were analyzed to determine the prevalence of peri‐implant disease or implant loss, and a predictive model was tested. Results: The mean follow‐up time for the patients was 10.9 years. The implant survival rate was 91.6%. Peri‐implant mucositis was found in 33% of the implants and 48% of the patients, and peri‐implantitis occurred in 16% of the implants and 26% of the patients. Individuals with peri‐implantitis were twice as likely to report a problem with an implant as individuals with healthy implants. Peri‐implantitis is associated with younger ages and diabetes at the time of placement and with periodontal status at the time of follow‐up. Implant loss is associated with diabetes, immediate placement, and larger‐diameter implants. Conclusions: One in four patients and one in six implants have peri‐implantitis after 11 years. The data suggest that periodontal and diabetes status of the patient may be useful for predicting implant outcomes.     

An inventory of patients' response to treatment at a multidisciplinary breath odor clinic.

OBJECTIVE: This study was undertaken to assess patients' response to their treatment at a multidisciplinary oral malodor clinic. METHOD AND MATERIALS: In 4 years, a multidisciplinary breath odor clinic in Belgium examined 406 patients. The team consisted of an ear, nose, and throat specialist, a periodontologist, occasionally a specialist in internal medicine, and, more recently, a psychiatrist. After the initial visit, each patient was scheduled for a follow-up appointment 2 to 6 months later; however, only 143 patients (35%) showed up for this control visit. The remaining 65% of the patients answered a mailed questionnaire. RESULTS: About half of the patients who returned no longer had complaints, while 17% reported no improvement. This group was characterized by imaginary bad breath and manifest psychologic problems. There was also disbelief of their cure, although clinical examination (organoleptic evaluation and volatile sulfide measurement by means of a portable monitor) did not reveal any oral malodor. Some also insufficiently performed the recommended oral hygiene measures (tongue brushing and interdental cleaning). Most of the patients who returned the questionnaire were disappointed by the suggestion that their halitosis was the result of insufficient oral hygiene. CONCLUSION: Better education of both the public and dental professionals as to the most frequent cause of halitosis, insufficient oral hygiene, might elevate the level of compliance by patients.     

Effectiveness of oral hygiene protocol in patients with post-traumatic splinting.

AIM: In dental trauma with severe periodontal tissue involvement, as dental avulsion and severe luxation, the splinting procedure requires the patient to maintain a scrupulous hygiene of the affected zone, so to allow an effective tissue healing. The aim of this study was to assess the effectiveness of a specific oral hygiene protocol in the treatment of patients with post-traumatic splinting, comparing the plaque indexes of dental hygienist-helped patients versus not helped. MATERIALS AND METHODS: This study was carried out on 82 selected patients with post-traumatic splinting due to traumatic avulsion and severe luxation. They were divided into 2 groups, comparable for age, sex, type of trauma and splinting. The group A patients underwent an oral hygiene protocol, managed by a dental hygienist, while the group B patients were followed without the help of the hygienist. Plaque indexes were observed and compared in all cases during 6 weeks-follow up. RESULTS: Our results showed that at the 6th week follow up the plaque indexes of dental hygienist-assisted traumatized patients were significantly (p=0.001) lower than those of not assisted patients. CONCLUSION: Therefore, the role of dental hygienists is essential in the management of dental trauma with periodontal damage, which needs specific oral hygiene protocols.