植体周炎再生治疗短期疗效观察

doi:10.19723/j.issn.1671-167X.2020.01.009

摘要/Abstract

摘要：

目的:评价植体周炎相关骨缺损进行再生性手术的短期疗效。方法:纳入2018年3月至2019年1月就诊的植体周炎患者9例,受累植体共计10枚,所有纳入植体经影像学检查均有3 mm以上垂直骨缺损,存留2个或以上骨壁,其中3枚植体因修复体存在缺陷,治疗前拆除修复体,更换为愈合基台。常规牙周及植体周非手术治疗后,进行植体周引导性骨再生手术,植体周翻瓣后进行机械清创,彻底清除炎症肉芽组织,用3%过氧化氢溶液充分擦洗植体表面,生理盐水冲洗后,骨缺损内植入骨替代材料,覆盖胶原屏障膜,采用非埋入愈合方式,术后追踪观察6个月,分别比较治疗前和术后6个月的植体周探诊深度(probing depth,PD,植体周袋底与黏膜边缘之间的距离)和骨水平(bone level, BL,植体周骨缺损最根方与植体颈部平台之间的距离)。结果:所有受累植体基线时最深PD范围6~10 mm,最大BL范围3.2~8.3 mm。相比基线水平, 术后6个月植体周平均PD从(6.2±1.4) mm降低为(3.1±0.6) mm, BL平均改善为(3.0±1.5) mm,治疗前后PD和BL的差异均有统计学意义,P<0.01。如果将术后6个月无PD≥6 mm位点及探诊出血,且实现1 mm以上骨高度增加作为再生治疗成功的标准,8例患者的9枚植体治疗成功,另有一枚植体因术后6个月PD仍达6 mm,且有明显探诊出血,未达到治疗成功标准。结论:引导性骨再生技术应用于植体周炎骨缺损的再生治疗,可获得较好的短期疗效,长期疗效有待继续观察。

关键词: 牙种植体, 植体周炎, 引导性骨再生

Abstract:

Objective: To evaluate the short-term outcome of regenerative surgery for peri-implantitis therapy. Methods: From March 2018 to January 2019, 9 patients with 10 implants who suffered from peri-implantitis were included in the present research. Vertical bone defect at least 3mm in depth with 2 or more residual bone walls was confirmed around each implant by radiographic examination. Restorations were replaced by healing abutments on 3 implants with the consent of the patients. Guided bone regeneration surgery was performed after a hygienic phase. During surgery, full thickness flaps were elevated on both buccal and lingual aspects. Titanium curette was used for inflammatory granulation tissue removal and implant surface cleaning. The implant surface was decontaminated by chemical rinsing with 3% hydrogen peroxide solution. After being thoroughly rinsed with saline,the bone substitutes were placed in bone defects which were covered by collagen membranes. 6 months after non-submerged healing, the clinical parameters including peri-implant probing depth (PD, distance between pocket bottom and peri-implant soft tissue margin) and radiographic bone level (BL, distance form implant shoulder to the first bone-to-implant contact) were used to evaluate the regenerative outcome. PD was measured at six sites (mesial, middle and distal sites at both buccal and lingual aspects) around each implant, and BL was measured at the mesial and distal surfaces of each implant on a periapical radiograph. Results: The deepest PD and largest BL of each implant ranged from 6-10 mm and 3.2-8.3 mm respectively. All the implants healed uneventfully after surgery. The mean peri-implant PD at baseline and 6 months after surgery were (6.2±1.4) mm and (3.1±0.6) mm respectively, and a mean (3.0±1.5) mm radiographic bone gain was observed, P<0.01. Treatment success was defined as: no sites with residual PD≥6 mm, no bleeding on probing, and BL elevation of at least 1 mm. Nine implants from 8 patients fulfilled the success criteria. Residual pockets with 6 mm in depth and bleeding on probing could be detected in only one implant. Conclusion: Within the limitation of the present research, guided bone regeneration surgery can be used for the treatment of bone defect that resulted from peri-implantitis. Significant PD reduction and radiographic bone gain can be obtained after 6 months observation.

Key words: Dental implant, Peri-implantitis, Guided bone regeneration

中图分类号:

R781.4

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.

Dong SHI,Jie CAO,Shi-ai DAI,Huan-xin MENG. Short-term outcome of regenerative surgery treating peri-implantitis[J]. Journal of Peking University(Health Sciences), 2020, 52(1): 58-63.

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参考文献 16

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Code	Implant length/mm	Site	Maximum PD/mm	Maximum BL/mm	Defect classification
1	10	Lower left second molar	9	5.6	Ⅰe
2	10	Lower right lateral incisor	9	8.0	Ⅰe
3	10	Upper right central incisor	10	6.2	Ⅰd
4	10	Upper left first molar	8	8.0	Ⅰd
5	15	Lower right first premolar	10	5.4	Ⅰd
6	10	Upper right central incisor	8	3.2	Ⅰd
7	10	Lower right first molar	6	4.1	Ⅰd
8	10	Lower left first molar	10	5.4	Ⅰc
9	10	Lower right first molar	7	6.9	Ⅰe
10	10	Upper right central incisor	9	8.3	Ⅰd