de Waal Yvonne C M, Raghoebar Gerry M, Meijer Henny J A, Winkel Edwin G, van Winkelhoff Arie Jan
Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Clin Oral Implants Res. 2016 Dec;27(12):1485-1491. doi: 10.1111/clr.12584. Epub 2015 Mar 29.
Objective of this study was to identify prognostic indicators for the outcome of resective peri-implantitis treatment, by an analysis of the pooled data of two previously conducted randomized controlled trials.
Data of 74 patients with peri-implantitis (187 implants) who had received resective surgical treatment were available. Primary outcome variable was failure of peri-implantitis treatment after 12 months. Multilevel univariable and multiple logistic regression analyses were performed to evaluate the effect of various potentially prognostic indicators on the primary outcome.
Peri-implantitis treatment was unsuccessful in 106 implants (57%) and 48 patients (67%) after 12 months. In the multiple regression analysis, the variables "order of inclusion" (P = 0.016) and mean bone loss at baseline (P = 0.030) were significant prognostic indicators for treatment failure. To eliminate the effect of "order of inclusion," post hoc analyses were carried out in a subgroup of patients. The univariable post hoc analysis showed a significant association for smoking (P = 0.015), maximum pocket depth at baseline (P = 0.073), mean bone loss at baseline (P = 0.003), and presence of plaque (P = 0.100). In the multiple regression post hoc analysis, only the variables smoking (P = 0.044) and mean bone loss (P = 0.043) remained statistically significant.
The outcome of surgical peri-implantitis treatment is influenced by the experience of the surgical team with the surgical procedure. The observed learning effect has consequences for clinical practice and for conducting and interpreting clinical trials on peri-implantitis treatment. Other prognostic indicators are amount of peri-implant bone loss at baseline and smoking, and to a lesser extent, probing pocket depth at baseline and presence of plaque during follow-up. Early diagnosis of peri-implantitis and control of behavioral factors are crucial in achieving peri-implantitis treatment success.
本研究的目的是通过对两项先前进行的随机对照试验的汇总数据进行分析，确定种植体周围炎切除治疗结果的预后指标。
有74例接受切除手术治疗的种植体周围炎患者（187颗种植体）的数据可供使用。主要结局变量是12个月后种植体周围炎治疗失败。进行多水平单变量和多因素逻辑回归分析，以评估各种潜在预后指标对主要结局的影响。
12个月后，106颗种植体（57%）和48例患者（67%）的种植体周围炎治疗未成功。在多因素回归分析中，“纳入顺序”变量（P = 0.016）和基线时的平均骨丢失（P = 0.030）是治疗失败的显著预后指标。为消除“纳入顺序”的影响，在一组患者中进行了事后分析。单变量事后分析显示吸烟（P = 0.015）、基线时的最大牙周袋深度（P = 0.073）、基线时的平均骨丢失（P = 0.003）和菌斑存在（P = 0.100）之间存在显著关联。在多因素回归事后分析中，只有吸烟（P = 0.044）和平均骨丢失（P = 0.043）变量仍具有统计学意义。
种植体周围炎手术治疗的结果受手术团队手术经验的影响。观察到的学习效应会对临床实践以及种植体周围炎治疗的临床试验开展和解释产生影响。其他预后指标是基线时种植体周围骨丢失量和吸烟情况，以及在较小程度上，基线时的探诊牙周袋深度和随访期间的菌斑存在情况。种植体周围炎的早期诊断和行为因素的控制对于实现种植体周围炎治疗成功至关重要。
