实验性种植体周围炎各时期龈沟液量变化的研究

目的：研究实验性种植体周围炎龈沟液（PISF）和种植体周围组织健康状态的关系。方法：通过丝线结扎法建立犬的种植体周围炎模型，以基台连接术为基线（作自身对照）0，在结扎后3、6、9周时检测种植体36个位点的龈沟液量和种植体周围组织各项临床病理指标变化，并对检测结果进行分析。结果：①种植体周龈沟液量（PISF）、菌斑指数（PLI）、改良龈沟出血指数（mBI）及探诊深度（PPD）等临床指标在结扎后3、6、9周时，均大于自身对照组，有显著性差异（P〈0．05），第6周时单纯黏膜炎无骨吸收和伴骨吸收位点之间的PISF和各项临床指标无显著性差异（P〉0．05）；②种植体组龈沟液量同各项临床指标之间都有显著的正相关关系。结论：种植体周龈沟液量可以在一定程度上反映种植体周围软组织的健康状态，有可能作为评价种植体周围软组织炎症状况的一项参考指标，但并不一定能反映骨组织状况。     

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。     

慢性牙周炎与种植体周围炎相关性的临床研究

目的：通过临床观察慢性牙周炎患者进行牙种植修复的早期临床效果,初步探讨慢性牙周炎与种植体周围炎发生发展的相关性。方法：选择15例慢性牙周炎患者24颗种植牙作为实验组,选择10例牙周健康者20颗种植牙作为对照组,二期修复负载时（种植体植入后4～6个月）检测两组患者种植体周围龈沟液量（PISF）、改良菌斑指数（mPLI）、改良龈沟出血指数（mBI）、探诊深度（PD）及附着丧失（AL）等各项临床指标,并进行比较。结果：慢性牙周炎患者种植体周的龈沟液量明显多于牙周健康患者（P〈0.05）;两组种植体周的各项临床指标均值除mPLI外均有显著性差异（P〈0.05）。结论：慢性牙周炎与种植体周围炎的发生可能具有一定的相关性。     

种植体周围炎再生治疗临床效果观察（附1例33个月随访报告）

口腔种植治疗目前已成为缺失牙修复的首选方案之一，种植体周围炎则是种植治疗常见的并发症，可造成种植体周围骨吸收，并最终导致种植治疗失败。有证据表明，再生手术可应用于种植体周围炎的治疗，并获得一定程度的探诊深度降低和骨高度增加。文章完整展示了1例种植体周围炎患者经过再生手术后纵向观察33个月，结果显示探诊深度从9 mm降低为3 mm，探诊出血消失，X线片显示一定的骨密度增加，疗效稳定。同时，文章对种植体周围炎再生手术的疗效及影响因素进行综述，为临床治疗提供相应证据支持。     

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目的探讨龈沟液中白介素-18（IL-18）和基质金属蛋白酶-13（MMP-13）表达与种植体周围炎的关系,评价其作为种植体周围炎诊断客观指标的意义。方法选择2011年5月至2013年5月在佳木斯大学口腔医学院口腔种植科行ITI种植体种植的患者30例作为研究对象（种植体40颗）,根据种植体周围情况将其分为健康种植体组（28颗）和炎症种植体组（12颗）：将对侧同名健康天然牙作为对照（健康天然牙组,40颗）。分别检测各组的牙周探诊深度（PD）、出血指数（SBI）、龈沟液（GCF）量及GCF中的IL-18、MMP-13含量并进行分析。结果炎症种植体组的PD、SBI值显著高于健康种植体组和健康天然牙组,差异有统计学意义（P〈0．05）。炎症种植体组的GCF量以及GCF中IL-18和MMP-13含量均高于健康种植体组和健康天然牙组,差异有统计学意义（P〈0．05）。健康种植体组与健康天然牙组比较,两组的PD、SBI、GCF量以及GCF中IL—18和MMP-13含量的差异均无统计学意义（P〉0．05）。结论IL-18和MMP-13与种植体周围炎有密切关系,可作为种植体周围炎早期诊断的有效检测指标。     

电子牙周探针在牙植体周围组织探诊检查中的应用

目的研究电子牙周探针在牙种植体和自然牙的探诊深度检查的可重复性,评价其在检查种植体周围组织健康状况中的应用价值。方法对48例患者54颗种植体的324个位点和54颗对照同名自然牙的324个位点用电子牙周探针分别间隔1小时检查探诊深度两次,将自然牙和种植体检查位点按探诊是否出血分为炎症组和健康组,比较两次探诊深度检查的可重复性。结果种植体炎症组两次探诊深度分别为2.97±1.24mm和3.25±1.35mm（X±S）,第二次检查的探诊深度大于第一次的探诊深度,差异有统计学意义（P〈0.05）。其它各组比较均未见差异的显著性。结论电子压力探针在自然牙和牙种植体健康位点的探诊检查中有较好的可重复性,但用于种植体周围组织炎症位点的探诊检查时,其可重复性有所下降,评价种植体周围组织的炎症发展情况时应同时参考其它检查指标。     

种植体周围炎病因、诊断、治疗与种植体周维护

种植体周围炎是指发生于种植体周围软硬组织的炎症性损害,并伴有支持骨的丧失。种植体周围炎的危险因素包括菌斑、牙周病史、吸烟、糖尿病等。临床诊断标准包括探诊出血、种植体周袋内有溢脓、探诊深度≥5 mm以及影像学显示边缘骨丧失≥2 mm。种植体周围炎的治疗包括机械清创联合药物治疗的非手术治疗,以及切除性和再生性手术等手术治疗。种植体周维护治疗可以保护种植体周围组织的健康和提高种植成功率。因此,要重视种植体周的维护,预防种植体周围炎的发生。     

种植体周围炎重复非手术治疗的短期疗效观察

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。     

35例种植体周围炎临床治疗效果观察

目的：针对种植体周围炎的致病相关因素采取系统治疗后,进行临床疗效评价。方法：35枚种植体根据临床检查指标确诊为种植体周围炎或种植体周围黏膜炎,采取对症治疗,局部以双氧水、生理盐水交替冲洗,龈袋内注入派力奥等方法,从病因上和症状上进行控制。记录用药前、用药后6周的菌斑指数,探诊出血指数,改良出血指数,探诊深度,牙龈乳头指数,并进行统计学分析。结果：探诊出血指数和改良出血指数有明显改变（P〈0.05）,菌斑指数,探诊深度,牙龈乳头指数,无明显统计学改变（P〉0.05）,种植体边缘骨吸收趋于稳定。结论：对症治疗对早期种植体周围炎有良好治疗效果。     

前列腺素E2在种植体周围龈沟液中的含量测定及其临床意义

目的：探讨前列腺素E2（Prstaglandin E2,PGE2）在种植体周龈沟液中的含量水平与种植牙牙周组织临床指数-菌斑指数（plaque index,PI）,牙龈指数（gingival index,GI）和牙周探诊深度（probing pocket depths,PPD）之间的关系.方法：检查实验组36颗和对照组36颗种植体牙周情况,实验组为有明显炎症的种植体,牙周探诊深度均超过3mm.同时试纸收集种植体周围龈沟液,ELISA法检测其龈沟液中的PGE2含量,所得数据用t检验和Pearson相关分析进行统计学处理.结果：PGE2表达和患种植体周围炎的种植体牙周指数呈显著相关（P＜0.05）,且实验组和对照组的PGE2表达统计学差异明显（P＜0.05）.结论：龈沟液中PGE2含量可为种植体周围炎病变的诊断提供客观参考.     

Spontaneous progression of ligature induced peri-implantitis at implants with different surface roughness: an experimental study in dogs

BACKGROUND: Peri-implantitis is associated with the presence of submarginal plaque, soft-tissue inflammation and advanced breakdown of the supporting bone. The progression of peri-implantitis following varying periods of continuing plaque accumulation has been studied in animal models. OBJECTIVE: The aim of the current experiment was to study the progression of peri-implantitis around implants with different surface roughness. MATERIAL AND METHODS: In five beagle dogs, three implants with either a sandblasted acid-etched surface (SLA) or a polished surface (P) were installed bilaterally in the edentulous premolar regions. After 3 months on a plaque control regimen, experimental peri-implantitis was induced by ligature placement and plaque accumulation was allowed to progress until about 40% of the height of the supporting bone had been lost. After this 4-month period, ligatures were removed and plaque accumulation was continued for an additional 5 months. Radiographs of all implant sites were obtained before and after 'active' experimental peri-implantitis as well as at the end of the experiment. Biopsies were harvested and the tissue samples were prepared for light microscopy. The sections were used for histometric and morphometric examinations. RESULTS: The radiographic examinations indicated that similar amounts of bone loss occurred at SLA and P sites during the active breakdown period, while the progression of bone loss was larger at SLA than at polished sites following ligature removal. The histological examination revealed that both bone loss and the size of the inflammatory lesion in the connective tissue were larger in SLA than in polished implant sites. The area of plaque was also larger at implants with an SLA surface than at implants with a polished surface. CONCLUSION: It is suggested that the progression of peri-implantitis, if left untreated, is more pronounced at implants with a moderately rough surface than at implants with a polished surface.     

Treatment of peri-implantitis defects with autogenous bone grafts: six-month to 3-year results of a prospective study in 17 patients

As part of an ongoing prospective study, the treatment of peri-implantitis defects using autogenous bone grafts was evaluated. This present report is based on data from 25 ITI screw implants in 17 patients with progressive peri-implant tissue destruction during the maintenance phase. Treatment of these lesions included raising flaps, removal of the surrounding granulation tissue, and air-polishing of the implant surface. Subsequently, corticocancellous bone grafts or particulate bone were placed into the peri-implant osseous defects, and the flaps were sutured around the cervical segment of the implants, allowing for transmucosal healing. Two of the 25 cases resulted in a negative outcome of the procedure. One of the transplants had to be removed 40 days after augmentation because of flap dehiscence and graft mobility. In another patient, the healing period was uneventful until the re-entry surgery, but when the site was reopened, the total graft volume was resorbed. The primary therapeutic success at re-entry surgery evaluated by intraoperative measurements resulted in a median defect depth reduction of 6.9 to 0.7 mm (P = .001), corresponding to a bone repair of 90%. The change in defect width was 1.9 mm (P = .002, repair 100%). A positive result of the reconstructive therapy has been observed during a re-evaluation time of up to 3 years. Median marginal bone loss was reduced from 6.2 to 2.3 mm after 2 and 3 years, respectively. The median vertical bone resorption of 4.5 mm was completely repaired. The crevicular fluid volume, a parameter of the level of marginal inflammation, along with probing depths and attachment levels, were reduced to a physiologic rate. The implant observation period until the first appearance of the lesion seems to be crucial to the effectiveness of the therapy. Early failures appearing within the first 2 years after implant placement showed a more stable therapeutic result over time.     

Re-osseointegration after treatment of peri-implantitis at different implant surfaces

Peri-implantitis is a condition that includes soft tissue inflammation and rapid loss of bone. Treatment of peri-implantitis includes both antimicrobial and bone augmenting methods. The question of whether true re-osseointegration may occur following treatment of peri-implantitis is controversial. The aim of this study was to investigate whether the character of the implant surface was of importance for the occurrence of re-osseointegration following treatment of peri-implantitis. Four beagle dogs were used. The mandibular premolars were extracted. After 12 months, 3 ITI(R) solid screw dental implants were placed in each side of the mandible. In the left side, implants with a turned surface (Turned sites) were used, while in the right side implants with a SLA surface (SLA sites) were placed. After 3 months of healing, peri-implantitis was induced by ligature placement and plaque accumulation. When about 50% of the initial bone support was lost, the ligatures were removed. Five weeks later, treatment was initiated. Each animal received tablets of Amoxicillin and Metronidazole for a period of 17 days. Three days after the start of the antibiotic regimen, one implant site (experimental site) in each quadrant was exposed to local therapy. Following flap elevation, the exposed titanium surface was cleaned with the use of cotton pellets soaked in saline. The implants were submerged. Six months later, biopsies were obtained. Treatment resulted in a 72% bone fill of the bone defects at Turned sites and 76% at SLA sites. The amount of re-osseointegration was 22% at Turned sites and 84% at SLA sites. A treatment regimen that included (i) systemic administration of antibiotics combined with (ii) granulation tissue removal and implant surface cleaning resulted in resolution of peri-implantitis and bone fill in adjacent bone defects. Further, while substantial "re-osseointegration" occurred to an implant with a rough surface (SLA), bone growth on a previously exposed smooth surface (Turned) was minimal.     

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。     

Er:YAG激光联合引导骨再生治疗种植体周围炎伴骨缺损效果评价

目的: 探讨Er:YAG激光联合引导骨再生（guided bone regeneration,GBR）治疗种植体周围炎伴骨缺损的临床效果。方法: 选择2017—2019年在嘉定区牙病防治所行种植修复且诊断为种植体周围炎伴骨缺损的26例患者（共34颗种植体）作为研究对象,随机分为实验组和对照组。2组均接受翻瓣、清创和GBR治疗,实验组采用Er:YAG激光处理种植体表面及污染物,对照组采用传统机械法处理。记录和比较2组患者治疗前和治疗后6、12和24个月的探诊深度（probing depth,PD）、探诊出血指数（bleeding on probing,BOP）、菌斑指数（plaque index,PI）、种植体周围边缘骨缺损高度（reduce of marginal bone level,RBL）,采用SPSS 20.0软件包对数据进行统计学分析。结果: 2组患者经不同方法治疗后,PD、BOP、PI和RBL均显著改善;治疗后6、12和24个月后,PD、BOP和PI改善无统计学差异;治疗后12和24个月,实验组RBL改善显著优于对照组。结论: 在种植体周围炎伴骨缺损的GBR治疗中,Er:YAG激光疗法效果优于传统机械法,更有利于新骨再生。     

SLA表面种植体修复牙列缺损8年疗效观察

目的:评价SLA表面种植体固定修复牙列缺损的8年临床应用效果.方法:对130例在烟台市口腔医院种植科要求种植修复牙列缺损的患者,植入SLA表面处理种植体191颗,定期临床及放射学检查,记录种植体存留率、成功率、种植体周围软、硬组织状况及上部结构的稳定性.采用SPSS 17.0软件包对数据进行统计学分析.结果:24例患者的31颗种植体失访,1颗种植体在术后5个月时因松动取出,4颗种植体出现种植体周围炎,种植体失访率、存留率、成功率分别为18.46％、99.38％和96.88％.种植成功的155颗种植体,8年内未出现明显的生物学并发症,种植体边缘骨吸收平均为(1.34±0.52)mm.8年内共25颗种植体出现螺丝松动、冠脱落、崩瓷、种植体折断等机械性并发症,修复体成功率为83.87％.结论:SLA表面种植体不仅能够达到较好的骨结合,而且种植体周围软组织及上部结构能够长期保持健康稳定的状态,临床应用效果较好.     

Experimental peri-implant tissue breakdown around different dental implant surfaces: clinical and radiographic evaluation in dogs

PURPOSE: Tissue reactions to 4 different implant surfaces were evaluated in regard to the development and progression of ligature-induced peri-implantitis. MATERIALS AND METHODS: In 6 male mongrel dogs, a total of 36 dental implants with different surfaces (9 titanium plasma-sprayed, 9 hydroxyapatite-coated, 9 acid-etched, and 9 commercially pure titanium) were placed 3 months after mandibular premolar extraction. After 3 months with optimal plaque control, abutment connection was performed. Forty-five days later, cotton ligatures were placed around the implants to induce peri-implantitis. At baseline and 20, 40, and 60 days after placement, the presence of plaque, peri-implant mucosal redness, bleeding on probing, probing depth, clinical attachment loss, mobility, vertical bone loss, and horizontal bone loss were assessed. RESULTS: The results did not show significant differences among the surfaces for any parameter during the study (P > .05). All surfaces were equally susceptible to ligature-induced peri-implantitis over time (P < .001). Correlation analysis revealed a statistically significant relationship between width of keratinized tissue and vertical bone loss (r2 = 0.81; P = .014) and between mobility and vertical bone loss (r2 = 0.66; P = .04), both for the titanium plasma-sprayed surface. DISCUSSION AND CONCLUSIONS: The present data suggest that all surfaces were equally susceptible to experimental peri-implantitis after a 60-day period.     

The relationship of smoking on peri-implant tissue: A retrospective study

The term “peri-implantitis” is used to describe the formation of deep mucosal pockets around dental implants, inflammation of the peri-implant mucosa, and increased resorption of peri-implant bone. It has been speculated that when left untreated, peri-implantitis can result in implant failure. This retrospective study examines a possible correlation between smoking and the appearance of peri-implantitis. The clinical and radiographic observations of 366 implants in 107 patients who smoke were compared with those of a group of 1000 implants in 314 nonsmoking patients. Despite the retrospective nature of this study, a comparison between the two groups was possible. The mean follow-up period, mean patient age, implant locations, and percentages of fixed partial dentures and overdentures were consistent in both groups. There was no significant difference in the mean maxillary and mandibular hygienic indices between the group of smokers and that of nonsmokers. However, the group of smokers showed a higher score in the bleeding index, the mean peri-implant pocket depth, the degree of peri-implant mucosal inflammation, and radiographically discernible bone resorption mesial and distal to the implant. In the maxilla of the smoking group, these observations were significantly higher than both the mandibular observations for smokers and the maxillary observations of the group of nonsmokers (p < 0.01). No differences between the two groups were observed in the mandible. Aside from the systemic effects of tobacco smoking on the human organism, local cofactors seem to be responsible for the higher incidence of peri-implantitis in smokers and have a particularly negative effect on the maxilla. These findings confirm that smokers treated with dental implants have a greater risk of development of peri-implantitis.     

Bone reactions at implants subjected to experimental peri-implantitis and static load. A study in the dog

AIM: The aim of the present experiment was to study peri-implant tissue reactions to lateral static load at implants subjected to experimental mucositis or peri-implantitis. MATERIAL AND METHODS: 5 beagle dogs were used. The mandibular premolars were extracted. After 12 weeks, 3 implants were installed in each quadrant of the mandible. In one side, the implants were designed with a SLA surface and in the contralateral side with a turned surface. A plaque control program was initiated. 12 weeks later, the central and posterior implants were connected with an appliance containing an expansion screw. Cotton ligatures were placed around the neck of the anterior and posterior implants in both sides, and the plaque control measures were terminated. Sixteen weeks later the ligatures were removed. After 8 weeks without ligatures, the expansion screws in both sides were activated. Once every 2 week during a 12-week interval, the screws were reactivated. Thus, the model included 3 different experimental sites of each surface group: group M+L (mucositis+load); group P (peri-implantitis); group P+L (peri-implantitis+load). Fluorochrome labels were injected and standardized radiographs obtained. The animals were sacrificed and block biopsies of all implant sites dissected and prepared for histological analysis. RESULTS: It was demonstrated that the lateral static load failed to induce peri-implant bone loss at implants with mucositis and failed to enhance the bone loss at implants with experimental peri-implantitis. The proportion of bone labels and the bone density in the interface zone were significantly higher in group P+L than in group P. CONCLUSION: It is suggested that a lateral static load with controlled forces may not be detrimental to implants exhibiting mucositis or peri-implantitis.     

Bone regeneration as treatment of peri-implant disease: A narrative review

Introduction

Analysis of the 3-dimensional implant position, the bone defect morphology, and the soft tissue situation guides the decision to preserve or to remove an implant with a severe peri-implantitis lesion. The aim of this narrative review was to analyze and to comprehensively illustrate the treatment options focusing on peri-implant bone regeneration in presence of severe peri-implant bone loss.

Methods

A database search was performed independently by the two reviewers to identify case reports, case series, cohort, retrospective, and prospective studies about peri-implant bone regeneration with a follow-up of at least 6 months. Of the 344 studies issued during the database analysis, 96 publications were selected by the authors for this review.

Results

Deproteinized bovine bone mineral remains the best documented material for defect regeneration in peri-implantitis in combination with or without a barrier membrane. While studies using autogenous bone in peri-implantitis therapy are rarely found, they do report favorable potential of vertical bone regeneration. Moreover, while membranes are an inherent part of the guided bone regeneration, a 5-year follow-up study demonstrated clinical and radiographic improvements with and without a membrane. The administration of systemic antibiotics is frequently performed in clinical studies observing regenerative surgical peri-implantitis therapy, but the analysis of the literature does not support a positive effect of this medication. Most studies for regenerative peri-implantitis surgery recommend the removal of the prosthetic rehabilitation and the use a marginal incision with a full-thickness access flap elevation. This allows for a good overview for regenerative procedures with a certain risk of wound dehiscences and incomplete regeneration. An alternative approach referring to the poncho technique may reduce the risk of dehiscence. The effectiveness of implant surface decontamination might have an impact on peri-implant bone regeneration without any clinical superiority of a certain technique.

Conclusion

The available literature reveals that the success of peri-implantitis therapy is limited to the reduction of bleeding on probing, the improvement of the peri-implant probing depth and a small amount of vertical defect fill. On this basis, no specific recommendations for bone regeneration in surgical peri-implantitis therapy can be made. Innovative approaches for flap design, surface decontamination, bone defect grafting material, and soft tissue augmentation should be followed closely to find advanced techniques for favorable peri-implant bone augmentation.