Meyle Joerg
Department of Periodontology, Centre for Dental, Oral and Maxillofacial Surgery, Justus Liebig University Giessen, Schlangenzahl 14, D-35392 Giessen, Germany.
Eur J Oral Implantol. 2012;5 Suppl:S71-81.
The objective of this review was to summarise current evidence with regard to the decontamination of implant surfaces by mechanical, chemical and physical methods in the presence of marginal bone loss arising from peri-implant infections.
A PubMed search identified studies and publications dealing with 'peri-implantitis', 'treatment', 'surface decontamination', 'laser application' 'air-abrasive treatment' and 'photodynamic therapy'. Only studies in international peer-reviewed journals were selected for further evaluation; case reports were not included.
Several therapeutic approaches were identified such as mechanical treatment, antiseptics and air-abrasive treatment, photodynamic treatment, and laser applications. Since treatment of infected surfaces with air-powder +/- citric acid, gauze soaked with saline + citric acid or gauze soaked with chlorhexidine led to similar results in experimental studies, cotton pellets with saline may be adequate for cleaning micro-rough surfaces. Antimicrobial photodynamic therapy can effectively reduce the prevalence of pathogens on implant surfaces, but the clinical benefits remain unknown. The increase in temperature of the implant surface caused by the CO2 laser poses a risk. The Er:YAG laser is considered to possess the best properties for implant surface decontamination. In vivo, no single method of surface decontamination (chemical agents, air abrasives or lasers) was found to be superior. In several animal experiments, thorough cleaning of the infected implant surfaces and implantation of these previously infected devices into freshly prepared sites resulted in re-osseointegration, while currently there are no controlled clinical trials where re-osseointegration has been demonstrated in patients.
For decontamination of the infected implant surfaces, rinsing with saline (or cleaning with cotton pellets soaked with sterile saline) and air-abrasive treatment seem to work. Laser decontamination of the surface does not improve healing results. Non-surgical therapy of implants with peri-implantitis does not lead to successful treatment outcomes.
本综述的目的是总结当前关于在种植体周围感染导致边缘骨丢失的情况下，通过机械、化学和物理方法对种植体表面进行去污的证据。
通过PubMed搜索，确定了涉及“种植体周围炎”“治疗”“表面去污”“激光应用”“空气喷砂治疗”和“光动力疗法”的研究和出版物。仅选择国际同行评审期刊上的研究进行进一步评估；不包括病例报告。
确定了几种治疗方法，如机械治疗、防腐剂和空气喷砂治疗、光动力治疗以及激光应用。由于在实验研究中，用空气粉末+/-柠檬酸、浸有盐水+柠檬酸的纱布或浸有氯己定的纱布处理感染表面会产生相似的结果，因此用生理盐水浸湿的棉球可能足以清洁微粗糙表面。抗菌光动力疗法可有效降低种植体表面病原体的流行率，但临床益处尚不清楚。二氧化碳激光引起的种植体表面温度升高存在风险。铒钇铝石榴石激光被认为具有用于种植体表面去污的最佳特性。在体内，未发现单一的表面去污方法（化学剂、空气喷砂或激光）具有优越性。在一些动物实验中，对感染的种植体表面进行彻底清洁，并将这些先前感染的装置植入新准备的部位，结果实现了再骨整合，而目前尚无对照临床试验证明患者实现了再骨整合。
对于感染的种植体表面去污，用生理盐水冲洗（或用浸有无菌生理盐水的棉球清洁）和空气喷砂治疗似乎有效。表面激光去污并不能改善愈合结果。对种植体周围炎的种植体进行非手术治疗不会带来成功的治疗结果。
