Email Alert | RSS

北京大学学报（医学版） ›› 2020, Vol. 52 ›› Issue (2): 332-338. doi: 10.19723/j.issn.1671-167X.2020.02.022

• 论著 • 上一篇    下一篇

软组织垂直厚度对牙周炎患者种植修复临床效果的影响

张众,孟焕新(),韩劼(),张立,释栋   

  1. 北京大学口腔医学院·口腔医院,牙周科 国家口腔疾病临床医学研究中心 口腔数字化医疗技术和材料国家工程实验室 口腔数字医学北京市重点实验室,北京 100081
  • 收稿日期:2019-10-07 出版日期:2020-04-18 发布日期:2020-04-18
  • 通讯作者: 孟焕新,韩劼 E-mail:kqhxmeng@bjmu.edu.cn;han_jie17@sina.com

Effect of vertical soft tissue thickness on clinical manifestation of peri-implant tissue in patients with periodontitis

Zhong ZHANG,Huan-xin MENG(),Jie HAN(),Li ZHANG,Dong SHI   

  1. Department of Periodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2019-10-07 Online:2020-04-18 Published:2020-04-18
  • Contact: Huan-xin MENG,Jie HAN E-mail:kqhxmeng@bjmu.edu.cn;han_jie17@sina.com

RICH HTML

 16   

PDF (PC)

225

摘要：

目的 观察牙周炎病史患者种植后的中,长期临床效果,探讨软组织垂直厚度对植体周组织健康及植体周病发生的影响.方法: 根据种植术中测量的植入位点软组织垂直厚度,将66名患者的66颗植体分为正常组(normal,软组织垂直厚度 ≤4.5 mm)及过厚组(thick,软组织垂直厚度 >4.5 mm)两组.随访至少2年后进行复查,记录植体留存情况,植体周探诊深度,出血指数,菌斑指数,植体周边缘骨吸收量及植体周病发生情况,并进行统计分析,比较两组之间的差异.结果: 植体留存率为100%.复查时过厚组植体的植体周探诊深度最大值(max PDi),植体周探诊深度平均值(mean PDi),植体周出血指数最大值(max BIi),植体周出血指数平均值(mean BIi),植体近中边缘骨吸收量平均值,植体远中边缘骨吸收量平均值,植体周边缘骨吸收量平均值,植体周菌斑指数平均值(mean PLIi)均显著高于正常组(P＜0.05).此外,正常组复查时植体周炎发病率2.3%,过厚组复查时植体周炎发病率34.8%,两组植体周炎发病率的差异有统计学意义(P＜0.05).结论: 牙周炎患者种植位点的软组织垂直厚度对植体周软硬组织健康存在显著影响;过厚的软组织垂直厚度与植体周探诊深度及植体周边缘骨吸收量增多有关,最终可能增加植体周病的发病风险.

关键词: 牙科种植体, 软组织垂直厚度, 植体边缘骨吸收, 植体周病, 植体周炎

Abstract:

Objective: To observe and investigate the effect of vertical soft tissue thickness on the peri-implant tissue condition and the prevalence of peri-implant disease in patients with history of periodontitis. Methods: Among 210 patients who showed initial interest of implant therapy, 92 patients were included in this study and received implant surgery during 2010 and 2015. Sixty-six patients with 66 implants finally came back for T2 evaluation. Prior to the implant therapy, all the patients had received periodontal treatment. During the implant placement surgery, the distance from palatal soft tissue edge to the alveolar crest, which was defined as vertical soft tissue thickness (VT), was measured after the buccal full thickness flap was elevated. According to the cut off point which was adopted from the operating characteristic curve, 66 implants within 66 patients were divided into two groups, which were called normal group (VT≤4.5 mm) and thick group (VT>4.5 mm), respectively. Information of the patient's general status, periodontal situation and implant information were recorded. After a follow-up period of 42.9 months, the parameters of peri-implant tissue and condition of peri-implant disease were recorded. Mann-Whitney U test as well as Chi-square test were used to compare the parameters between two groups. Moreover, Kaplan-Meier method was chosen to draw the event(peri-implantitis)-free survival curve. Results: The survival rate of the implants was 100%. At the end of the follow-up examination(T2), the parameters including max PDi, mean PDi, max BIi, mean BIi, mean MBL, MBL at distal side, MBL at mesial side, mean PLIi presented significantly higher values in thick group than in normal group (P ＜ 0.05). Moreover, the prevalence of peri-implantitis and peri-implant disease(peri-implant mucositis & peri-implantitis) in thick group was respectively 34.8% and 73.9%, which was significantly higher than 2.3% and 48.8% respectively in normal group (P＜0.05). The prevalence of peri-implant mucositis did not show significant difference in the two groups. In addition, Kaplan-Meier analysis showed that there was significant difference between the event-free survivals of the two groups. Conclusion: The vertical soft tissue thickness around implants in patients with periodontitis has a significant effect on the health of the peri-implant tissue. Excessive vertical soft tissue thickness may result in deeper peri-implant probing depth as well as more peri-implant marginal bone loss, and eventually increase the risk of peri-implant disease. The vertical remodeling of soft tissue may be a new direction to indicate the role of periodontitis in peri-implant tissue condition. Moreover, the biological mechanism of the association between soft tissue thickness and peri-implantitis risk as well as effective approaches to prevent the adverse effect of excessive soft tissue thickness on peri-implant tissue is necessary to be investigated.

Key words: Dental implants, Vertical soft tissue thickness, Peri-implant marginal bone loss, Peri-implant disease, Peri-implantitis

中图分类号: 

  • R783.3

图1

决定垂直软组织厚度分界点的ROC曲线"

表1

患者基本信息"

Soft tissue
thickness		Number of
patients		Mean age/
years		Gender,
male/female		Periodontitis,
chronic/aggressive		Periodontitis,
grade Ⅰ-Ⅱ/Ⅲ-Ⅳ		Smoking,
yes/no		Follow-up
period/months		Maintenance
frequency,M1/M0
Normal4351.4±10.116/2739/45/387/3637(26-55)29/14
Thick2351.0±11.911/1218/51/224/1945(32-53)11/12

表2

植体信息"

Soft tissue
thickness		Number of
implants		Anterior
region		Posterior
region		MaxillaMandibleType of implantsBone grafting,
yes/no
Subcrestal implantsBone levelTissue level
Normal439(20.9%)34(70.1%)16(37.2%)27(62.8)12(27.9%)10(23.3%)21(48.8%)25/18
Thick2310(43.5%)13(56.5%)16(69.6%)*7(30.4%)*13(56.5%)*6(26.1%)4(17.4%)*14/9

表3

随访时植体周相关指标"

Soft tissue
thickness		Max PDi/
mm		Mean PDi/
mm		Max BIiMean BIiMean MBL/mmMean PLIi
Mesial sideDistal sideMean
Normal4(3-5)3(2.3-3.5)2(1-3)2(1-2.5)0.39(0.00-0.67)0.40(0.03-0.67)0.38(0.16-0.64)2(1-2)
Thick5(4-7)*4.8(3-5)*3(2-4)*2.5(2-4)*0.74(0.52-1.07)*0.81(0.45-1.06)*0.69(0.44-1.07)*2(2-3)*

表4

随访时植体周黏膜炎,植体周炎及植体周病发病情况"

Soft tissue thicknessNumber of implantsPeri-implant mucositisPeri-implantitisPeri-implant disease
(Peri-implant mucositis & Peri-implantitis)
Normal4330(69.8%)1(2.3%)31(72.1%)
Thick2313(56.5%)8(34.8%)*21(91.3%)

表5

患植体周炎植体的相关信息"

Soft tissue thicknessNumber of implantsPosition of implantsType of implantsBone grafting, yes/no
Normal126Subcrestal implantYes
Thick143Subcrestal implantNo
246Tissue levelYes
316Tissue levelYes
425Subcrestal implantYes
512Bone levelYes
611Subcrestal implantYes
711Subcrestal implantYes
815Bone levelYes

图2

植体无植体周炎发生的生存曲线图"

[1] Hämmerle CHF, Dennis T.The etiology of hard- and soft-tissue deficiencies at dental implants: a narrative review[J]. J Periodontol, 2018, 89(Suppl 1): S291-S303
[2] Karoussis I, Salvi G, Heitzmayfield L, et al.Long-term implant prognosis in patients with and without a history of chronic periodontitis: a 10-year prospective cohort study of the ITI® dental implant system[J]. Clin Oral Implants Res, 2003, 14(3): 329-339.
[3] Xie Y, Meng H, Han J, et al.A retrospective cohort study of peri-implant condition in Chinese patients with different periodontal condition and maintenance frequency[J]. Clin Oral Implants Res, 2018, 29(11): 1135-1142.
[4] Linkevicius T, Apse P, Grybauskas S, et al.The influence of soft tissue thickness on crestal bone changes around implants: a 1-year prospective controlled clinical trial[J]. Int J Oral Maxillofac Implants, 2009, 24(4): 712-719.
[5] Lee CT, Huang YW, Zhu L, et al.Prevalence of peri-implantitis and peri-implant mucositis: systematic review and meta-analysis[J]. J Dent, 2017, 62: 1-12.
[6] Berglundh T, Lindhe J.Dimension of the periimplant mucosa: biological width revisited[J]. J Clin Periodontol, 1996, 23(10): 971-973.
[7] Linkevicius T, Puisys A, Linkeviciene L, et al.Crestal bone stability around implants with horizontally matching connection after soft tissue thickening: a prospective clinical trial[J]. Clin Implant Dent Relat Res, 2015, 17(3): 497-508.
[8] Puisys A, Linkevicius T.The influence of mucosal tissue thickening on crestal bone stability around bone-level implants: a prospective controlled clinical trial[J]. Clin Oral Implants Res, 2015, 26(2): 123-129.
[9] Linkevicius T, Puisys A, Steigmann M, et al.Influence of vertical soft tissue thickness on crestal bone changes around implants with platform switching: a comparative clinical study[J]. Clin Implant Dent Relat Res, 2015, 17(6): 1228-1236.
[10] Suárez-López del Amo F, Lin GH, Monje A, et al. Influence of soft tissue thickness upon peri-implant marginal bone loss: a systematic review and meta-analysis[J]. J Periodontol, 2016, 87(6): 690-699.
[11] Berglundh T, Lindhe J, Ericsson I, et al.The soft tissue barrier at implants and teeth[J]. Clin Oral Implants Res, 1991, 2(2): 81-90.
[12] Cochran DL, Hermann JS, Schenk RK, et al.Biologic width around titanium implants. A histometric analysis of the implanto-gingival junction around unloaded and loaded nonsubmerged implants in the canine mandible[J]. J Periodontol, 1997, 68(2):186-197.
[13] Schwarz F, Derks J, Monje A, et al.Peri-implantitis[J]. J Periodontol, 2018, 89(6): S267-S290.
[14] Papaioannou W, Quirynen M, Steenberghe DV.The influence of periodontitis on the subgingival flora around implants in partially edentulous patients[J]. Clin Oral Implants Res, 1997, 7(4): 405-409.
[15] 闫夏. 牙周炎患者种植植骨的影像学分析和种植体及邻牙的微生物研究[D]. 北京: 北京大学医学部, 2016: 1-82.
[16] Kassebaum NJ, Bernabé E, Dahiya M, et al.Global burden of severe periodontitis in 1990-2010: a systematic review and meta-regression[J]. J Dent Res, 2014, 93(11): 1045-1053.
[17] Roccuzzo M, De AN, Bonino L, et al.Ten-year results of a three-arm prospective cohort study on implants in periodontally compromised patients. Part 1: implant loss and radiographic bone loss[J]. Clin Oral Implants Res, 2010, 21(5): 490-496.
[18] Roccuzzo M, Bonino F, Aglietta M, et al.Ten-year results of a three arms prospective cohort study on implants in periodontally compromised patients. Part 2: clinical results[J]. Clin Oral Implants Res, 2012, 23(4): 389-395.
[19] Koldsland OC, Scheie AA, Aass AM.Prevalence of peri-implantitis related to severity of the disease with different degrees of bone loss[J]. J Periodontol, 2010, 81(2): 231-238.
[20] Ladeira CP, Constante PM, Leite DME, et al.History of chronic periodontitis is a high risk indicator for peri-implant disease[J]. Braz Dent J, 2013, 24(2): 136-141.
[21] Han J, Zhang X, Tang Z, et al.A prospective, multicenter study assessing the DENTSPLY Implants, OsseoSpeedTM TX, length 6 mm in the posterior maxilla and mandible: a 1-year follow-up study[J]. Clin Oral Implants Res, 2016, 27(4): 452-457.
[22] Fuchigami K, Munakata M, Kitazume T, et al.A diversity of peri-implant mucosal thickness by site[J]. Clin Oral Implants Res, 2017, 28(2): 171-176.
[23] Zhang H, Li W, Zhang L, et al.A nomogram prediction of peri-implantitis in treated severe periodontitis patients: a 1-5-year prospective cohort study[J]. Clin Implant Dent Relat Res, 2018, 20(6): 962-968.
[1] 孙菲,李思琪,危伊萍,钟金晟,王翠,胡文杰. 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[J]. 北京大学学报（医学版）, 2022, 54(1): 119-125.
[2] 释栋,曹婕,戴世爱,孟焕新. 植体周炎再生治疗短期疗效观察[J]. 北京大学学报（医学版）, 2020, 52(1): 58-63.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 田增民, 陈涛, Nanbert ZHONG, 李志超, 尹丰, 刘爽. 神经干细胞移植治疗遗传性小脑萎缩的临床研究（英文稿）[J]. 北京大学学报（医学版）, 2009, 41(4): 456 -458 .
[2] 郭岩, 谢铮. 用一代人时间弥合差距——健康社会决定因素理论及其国际经验[J]. 北京大学学报（医学版）, 2009, 41(2): 125 -128 .
[3] 成刚, 钱振华, 胡军. 艾滋病项目自愿咨询检测的技术效率分析[J]. 北京大学学报（医学版）, 2009, 41(2): 135 -140 .
[4] 卢恬, 朱晓辉, 柳世庆, 郑杰, 邱晓彦. 白细胞介素2促进宫颈癌细胞系HeLaS3免疫球蛋白G的表达[J]. 北京大学学报（医学版）, 2009, 41(2): 158 -161 .
[5] 袁惠燕, 张苑, 范田园. 离子交换型栓塞微球及其载平阳霉素的制备与性质研究[J]. 北京大学学报（医学版）, 2009, 41(2): 217 -220 .
[6] 徐莉, 孟焕新, 张立, 陈智滨, 冯向辉, 释栋. 侵袭性牙周炎患者血清中抗牙龈卟啉单胞菌的IgG抗体水平的研究[J]. 北京大学学报（医学版）, 2009, 41(1): 52 -55 .
[7] 董稳, 刘瑞昌, 刘克英, 关明, 杨旭东. 氯诺昔康和舒芬太尼用于颌面外科术后自控静脉镇痛的比较[J]. 北京大学学报（医学版）, 2009, 41(1): 109 -111 .
[8] 祁琨, 邓芙蓉, 郭新彪. 纳米二氧化钛颗粒对人肺成纤维细胞缝隙连接通讯的影响[J]. 北京大学学报（医学版）, 2009, 41(3): 297 -301 .
[9] Jian-wei GU, Emily YOUNG, Zhi-jun PAN, Kevan B. TUCKER, Megan SHPARAGO, Min HUANG, Amelia Purser BAILEY. SD大鼠长期高盐饮食可导致其高血压并改变肾细胞因子基因表达谱[J]. 北京大学学报（医学版）, 2009, 41(5): 505 -515 .
[10] 李宏亮*, 安卫红*, 赵扬玉, 朱曦. 妊娠合并高脂血症性胰腺炎行血液净化治疗1例[J]. 北京大学学报（医学版）, 2009, 41(5): 599 -601 .
ISSN 1671-167X
CN 11-4691/R
主管单位：中华人民共和国教育部
主办单位：北京大学
地址： 北京市海淀区学院路38号 北京大学医学部 《北京大学学报（医学版）》
邮编：100191
电话：010-82801551
Email： xbbjb2@bjmu.edu.cn

《北京大学学报（医学版）》
微信公众号
版权所有 © 2018 《北京大学学报（医学版）》编辑部