Management of peri-implantitis – A contemporary synopsis

Prevalence of peri-implant complication is expected to be on the rise with the increased number of implants being placed. Depending on the degree of osseous involvement, the clinician needs to decide if the treatment goal is to arrest the disease progression, regeneration or explantation and replacement. Host's medical status, defect configuration, aesthetic outcome, ability to access for plaque control post-treatment, and the patient's wishes are key factors to consider. The purpose of this review is to provide a contemporary synopsis on the management of peri-implantitis with emphasis on explantation. Guidance on the identification of factors/situations where salvaging an implant may be less favourable is discussed and the various techniques to remove a fractured, or peri-implantitis-affected non-mobile implant are described.     

盐酸米诺环素软膏辅助治疗种植体周围炎12例

目的 评估盐酸米诺环素软膏治疗种植体周围炎的效果. 方法 12例种植体周围炎患者(12枚种植体),彻底洁治,0.2%氯己定(洗必泰)冲洗,盐酸米诺环素软膏置入种植体周围袋袋底,分别在基线和治疗后4周测菌斑指数、龈沟出血指数和探诊深度,进行统计学分析. 结果菌斑指数、龈沟出血指数和探诊深度分别由治疗前(2.42±0.79)分,(3.08±0.67)分,(5.44±0.64) mm,治疗4周后显著下降至(0.91±0.67)分,(1.33±0.88)分,(3.98±0.78) mm,差异均有统计学意义(P<0.05). 结论 盐酸米诺环素软膏对种植体周围炎有较好辅助治疗作用.     

SLA种植体表面喷涂钽形成纳米复合表面预防种植术后早期感染的动物体内实验研究

目的　探讨大颗粒酸蚀喷砂（Sandblasted/Large-grit/Acide -tched,SLA）表面处理的种植体与SLA表面喷涂钽（Ta）形成纳米复合表面的种植体对种植体周围炎发生发展的影响。 方法　6只Beagle犬双侧前磨牙延期植入2种不同表面种植体。从左侧远中到右侧远中依次将植体记为1~6号,3、4号种植体设置非绑线的基线组,其余于基台颈部丝线结扎的方法建立犬种植体周围炎模型。分别在建模后四次对植体进行菌斑指数（plaque index, PI）、改良出血指数（modified Sulcus Bleeding Index, mSBI）、种植体周探诊深度（probing depth, PD）等临床指标测量,通过手术直观评价、显微CT扫描、组织学评价相结合观察种植体周骨缺损程度,对实验结果采用重复测量方差分析。 结果　绑线的SLA组PI、mSBI、PD、垂直缺损与水平缺损深度等指标均显著高于绑线的SLA+Ta组（P<0.05）;显微CT扫描和组织学评价相结合观察可见绑线的SLA组较绑线的SLA+Ta组种植体周骨缺损明显。 结论　SLA表面喷涂钽形成纳米复合表面的种植体较SLA表面处理的种植体延缓种植体周围炎的发生发展并减轻其症状。     

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。     

三种袋内冲洗制剂在早期种植体周围炎治疗中的疗效评价

目的对3种袋内冲洗液在早期种植体周围炎治疗中的临床疗效进行比较和评价。方法32例早期种植体周围炎患者龈下刮治术后,实验组分别用0．1％碘氧液、3％双氧水、0．2％洗必泰进行牙周袋内冲洗,术后每周冲洗1次,连续4周;对照组不进行牙周袋内冲洗。术前和术后4周分别检测MPI、GBI和PD。结果术后4周,碘氧液、双氧水、洗必泰及对照组MPI分别降低0．76,0．80,0．73和0．81,降低幅度各组无显著性差异（P〉0．05）;GBI分别降低0．62,0．62,0．67和0．43。IO、HP和CHX组降低幅度大于对照组．差异有显著性（P〈0．05）,其中CHX组与对照组比较（P〈0．01）,但碘氧液、双氧水、洗必泰组间无显著性差异（P〉0．05）。PD分别降低2．09mm,2．02mm,2．12mm和1．98mm,各组间差异均无显著性（P〉0．05）。结论含抗茵成分的袋内冲洗液有助于改善牙周组织的炎症状态,可提高龈下刮治在口腔种植体周围炎中的疗效。     

Oral microbial biofilms and plaque-related diseases: microbial communities and their role in the shift from oral health to disease

Many oral pathologies, such as dental caries, periodontal disease and peri-implantitis are plaque-related. Dental plaque is a microbial biofilm formed by organisms tightly bound to a solid substrate and each other by means of an exopolymer matrix. Bacteria exhibit different properties when contained within a biofilm. Knowing the mechanisms controlling the formation and development of biofilms can help to understand the emergence and progression of such pathologies and to plan effective treatment. Most periodontal pathogens are common saprophytes of the oral cavity, expressing their virulence only in a susceptible host or when some changes come about in the oral environment. Physical, metabolic and physiological interactions may cause positive or negative effects among the various microbiota present. Such mechanisms of antagonism/synergy select the bacterial population and alterations of its composition affect the balance with the host and may lead to pathology. The effectiveness of antimicrobial agents, as measured through in vitro tests, is dramatically reduced in vivo due to the properties of the microbial community: mature, intact biofilms are less sensitive to such agents, as the exopolymer matrix, bacterial enzymes and slow growth rate hinder the action of chemotherapeutic agents. The present literature review aims to examine the most representative studies, focusing on the characteristics of bacterial communities and the crucial shift from oral health to plaque-related diseases.This material was partially presented at the symposium Oral biofilms and future orientation of antimicrobial therapy during the 37th annual meeting of the Continental European Division of the International Association for Dental Research in Rome, Italy, 5–8 September 2001. The symposium was graciously sponsored by Procter & Gamble, Geneva, Switzerland.     

Altered immunolocalization of heat-shock proteins in human peri-implant gingiva

It has been suggested that heat-shock proteins (HSPs) might be involved in autoimmune disease mechanisms in humans, considering the high degree of sequence homology between bacterial and human HSPs. Several authors have postulated that HSPs might be involved in periodontal disease processes, but not specifically in peri-implantitis. Consequently, using immunohistochemical techniques, we studied the distribution of HSP25, HSP32, HSP60 and HSP72 in three groups of patients: (1) subjects with natural teeth (healthy periodontal tissue), (2) subjects with normal peri-implant mucosa and (3) subjects with clinically evident peri-implantitis. The immunolabelling for HSP25 and HSP60 was increased in the peri-implantitis group HSP32 immunolabelling slightly decreased in peri-implant and peri-implantitis gingiva. Labelling for HSP72 was undetectable in all three groups. In conclusion, we observed in peri-implantitis a clearly enhanced immunolabelling of two specific HSPs, HSP25 and HSP60, restricted to gingival epithelium and this could indicate a signal of local altered homeostasis.     

牙周内窥镜治疗早期口腔种植体周围炎研究

目的:评估牙周内窥镜在早期种植体周围炎治疗中的疗效.方法:选取医院收治的60例种植体周围炎患者,按照随机数表法将其分为内窥镜辅助组和传统方法组,每组30例,内窥镜辅助组使用牙周内窥镜进行超声及手工器械龈下刮治,传统方法组采用常规方法进行超声及手工器械龈下刮治,分析比较两组治疗前和治疗后3个月的菌斑指数(PLI)、牙龈指...     

口腔种植患者种植体周围炎预防护理研究进展

口腔种植通过种植人工制作的种植体使患者恢复牙齿功能,并且带有口腔美学修复的作用,是多 种口腔疾病的常用治疗措施。但在种植后,患者存在种植体周围炎的发生风险,而这可导致种植的失败,不 仅影响患者的种植效果,还可增加患者的医疗开支。因此,及时采取有效预防护理措施十分必要。本文对 种植体周围炎进行概述,并对其致病危险因素、预防护理措施进行综述,以期为临床护理提供参考依据。     

氯己定联合机械清创对种植体周围炎的治疗效果及对患者SF-36评分的影响

目的：研究氯己定联合机械清创对种植体周围炎的治疗效果及对患者SF-36评分的影响。方法：选取2015年1月—2019年1月浙江省人民医院收治的种植体周围炎患者100例,按照随机数字表法随机分为对照组和联合组各50例。2组患者均采用机械清创术进行治疗,联合组在机械清创术后使用氯己定漱口液含漱。对2组患者治疗前、后菌斑生物膜不同层面平均活性、改良菌斑指数（modified plaque index,mPLI）、探诊后出血指数（bleeding on probing,BOP）、改良龈沟出血指数（modification sulcus bleeding index,mSBI）、探诊深度（probing depth,PPD）、临床附着水平（clinical attachment level,AL）进行评价,并使用SF-36评分量表、VAS视觉疼痛评分法对2组患者生活质量、疼痛程度进行评价,评定治疗效果及统计并发症发生情况。采用SPSS 20.0软件包对数据进行统计学分析。结果：治疗前2组患者菌斑生物膜不同层面平均活性、mPLI、mSBI、AL、PPD、BOP、VAS、SF-36评分比较,无显著差异（P>0.05）;治疗后联合组患者菌斑生物膜不同层面平均活性、mPLI、mSBI、AL、PPD、BOP、VAS评分均低于对照组,SF-36评分高于对照组,治疗总有效率显著高于对照组（P<0.05）。联合组患者治疗过程中并发症发生率显著低于对照组（P<0.05）。结论：氯己定联合机械清创对种植体周围炎患者进行治疗,效果显著,可有效抑制菌斑生物膜活性,抑制菌斑形成,减轻患者疼痛,提高生活质量。