Esposito M, Worthington H V, Coulthard P, Jokstad A
Department of Biomaterials, The Sahlgrenska Academy at Goteborg University, PO Box 412, Medicinaregatan 8B, Goteborg, Sweden, SE-40530.
Cochrane Database Syst Rev. 2002(3):CD003069. doi: 10.1002/14651858.CD003069.
To maintain healthy tissues around oral implants it is important to institute an effective preventive regimen (supportive therapy) and when a pathologic condition of the tissue around implants is diagnosed, an intervention should be initiated as soon as possible. Different maintenance regimens and treatment strategies for failing implants have been suggested, however it is unclear which are the most effective.
To test the null hypothesis of no difference between different interventions for maintaining or re-establishing healthy tissues around dental implants.
The Cochrane Oral Health Group Specialised Register, The Cochrane Controlled Trials Register, MEDLINE and EMBASE were searched. Hand searching included several dental journals. In addition, authors of all identified trials, fifty-five oral implant manufacturers and two extensive personal libraries (ME and AJ) were consulted.
All randomised controlled trials of oral implants comparing agents or interventions for maintaining or re-establishing healthy tissues around dental implants.
Data were independently extracted, in duplicate, by two reviewers (ME & HW). Authors were contacted for details of randomisation and withdrawals and a quality assessment was carried out. The Cochrane Oral Health Group's statistical guidelines were followed.
Nine RCTs were identified. Five of these trials, which reported results from a total of 127 patients, were suitable for inclusion in the review.
REVIEWER'S CONCLUSIONS: There is only a little reliable evidence for which are the most effective interventions for maintaining health around peri-implant tissues. There was no evidence that the use of powered or sonic toothbrushes was superior to manual toothbrushing. There is a weak evidence that Listerine mouthwash, used twice a day for 30 seconds, as adjunct to routine oral hygiene is effective in reducing plaque formation and marginal bleeding around implants. There was no evidence that phosphoric etching gel offered any clinical advantage over mechanical debridement. These findings are based on RCTs having short follow-up periods and few subjects. There is not any reliable evidence for the most effective regimens for long-term maintenance. For the treatment of failing implants (peri-implantitis) there is not any reliable evidence for preferring one therapeutic regimen over another. More RCTs should be conducted in this area. In particular, there is a definite need for trials investigating which is the most effective approach for the treatment of peri-implantitis and for trials with longer follow-up for maintenance. Such trials should be reported according the CONSORT guidelines (http://www.consort-statement.org/).
为维持口腔种植体周围组织的健康，制定有效的预防方案（支持性治疗）很重要；当诊断出种植体周围组织出现病理状况时，应尽快进行干预。对于失败种植体，已提出了不同的维护方案和治疗策略，但尚不清楚哪种最为有效。
检验不同干预措施在维持或重建牙种植体周围健康组织方面无差异的无效假设。
检索了Cochrane口腔健康小组专业注册库、Cochrane对照试验注册库、MEDLINE和EMBASE。手工检索包括几本牙科杂志。此外，还咨询了所有已识别试验的作者、55家口腔种植体制造商以及两个大型个人图书馆（ME和AJ）。
所有比较用于维持或重建牙种植体周围健康组织的药物或干预措施的口腔种植体随机对照试验。
数据由两名审阅者（ME和HW）独立提取，一式两份。联系作者获取随机分组和撤组的详细信息，并进行质量评估。遵循Cochrane口腔健康小组的统计指南。
识别出9项随机对照试验。其中5项试验报告了总共127名患者的结果，适合纳入本综述。
关于哪些是维持种植体周围组织健康的最有效干预措施，仅有少量可靠证据。没有证据表明电动牙刷或声波牙刷优于手动牙刷。有微弱证据表明，每天使用两次、每次30秒的李施德林漱口水作为常规口腔卫生的辅助手段，在减少种植体周围菌斑形成和边缘出血方面有效。没有证据表明磷酸蚀刻凝胶比机械清创有任何临床优势。这些发现基于随访期短且受试者少的随机对照试验。对于长期维护的最有效方案，没有任何可靠证据。对于失败种植体（种植体周围炎）的治疗，没有可靠证据表明一种治疗方案优于另一种。该领域应开展更多随机对照试验。特别是，明确需要进行试验来研究哪种是治疗种植体周围炎的最有效方法，以及进行随访时间更长的维护试验。此类试验应按照CONSORT指南（http://www.consort-statement.org/）报告。
