İstanbul Provincial Private Administration Hospital for Oral and Dental Diseases, Istanbul, Turkey.
Clin Oral Implants Res. 2013 Aug;24(8):928-33. doi: 10.1111/j.1600-0501.2012.02475.x. Epub 2012 Apr 30.
The aim of this investigation was to evaluate the significance of keratinized mucosa (KM) around dental implants both clinically and biochemically for 12 months.
Fifteen edentulous patients treated with implant-retained overdentures in edentulous mandible (four implants per patient). Based on the presence of keratinized mucosa on the buccal surfaces, implants were divided into two groups: Implants having minimal 2 mm of KM on their buccal surfaces and implants having no KM on their buccal surfaces. Thirty-six implants were included in the evaluations; 19 implants in 15 patients had minimal 2 mm of KM on their buccal surfaces and 17 implants in 15 patients had no KM on their buccal surfaces. Clinical measurements of Plaque Index, Gingival Index, probing depths, and Bleeding on Probing were performed and peri-implant crevicular fluid (PICF) were collected immediately before loading (baseline) and at 6th, 12th months after loading. Interleukin-1 beta (IL-1 β) and tumor necrosis factor-alpha (TNF-α) have been assessed in the crevicular fluid. Results were analyzed by repeated-measures of variance (ANOVA) and Wilcoxon signed rank tests.
After 12 months of evaluation the results of ANOVA showed that implants with KM had lower levels of TNF-α total amounts than implants without KM (P < 0.05). Additionally, TNF-α total amounts were significantly higher at 12(th) month compared to baseline for implants without KM (P < 0.05). Plaque index and Gingival index values were also found significantly higher for implants without KM (P < 0.05). For IL-1 β and PICF volume levels the differences between the implant groups were non significant, whereas the differences between the periods were significant. (P < 0.05) Additionally, both of the groups had higher levels of PII and BoP scores when compared to baseline (P < 0.05).
The results of this study showed that an adequate band of keratinized mucosa was related with less plaque accumulation and mucosal inflammation as well as pro-inflammatuar mediators, suggesting that it may be critical especially for plaque control and plaque associated mucosal lesions around dental implants.
本研究旨在评估种植体周围角化黏膜（KM）在临床和生物化学方面的意义，为期 12 个月。
15 名下颌无牙颌患者，共植入 60 枚种植体，其中 4 枚/患者。根据颊侧 KM 的存在情况，将种植体分为两组：颊侧有 2mm 以上 KM 的种植体和颊侧无 KM 的种植体。共纳入 36 枚种植体，其中 19 枚种植体（15 名患者）颊侧有 2mm 以上 KM，17 枚种植体（15 名患者）颊侧无 KM。在负荷前（基线）和负荷后第 6、12 个月，对菌斑指数、牙龈指数、探诊深度和探诊出血进行临床测量，并采集种植体周围龈沟液（PICF）。采用重复测量方差分析（ANOVA）和 Wilcoxon 符号秩检验对白细胞介素-1β（IL-1β）和肿瘤坏死因子-α（TNF-α）进行评估。
经过 12 个月的评估，ANOVA 结果显示，有 KM 的种植体 TNF-α总量低于无 KM 的种植体（P<0.05）。此外，无 KM 的种植体在第 12 个月时 TNF-α总量明显高于基线时（P<0.05）。无 KM 的种植体菌斑指数和牙龈指数也明显较高（P<0.05）。对于 IL-1β和 PICF 体积水平，两组之间的差异无统计学意义，而各时期之间的差异有统计学意义（P<0.05）。此外，与基线相比，两组的 PII 和 BoP 评分均升高（P<0.05）。
本研究结果表明，充足的角化黏膜带与较少的菌斑堆积和黏膜炎症以及促炎介质有关，这表明其对于种植体周围菌斑控制和与菌斑相关的黏膜病变可能至关重要。
