种植体周围炎的治疗：系统文献综述结果的荟萃分析及新方案建议

Treatment of peri-implantitis: Meta-analysis of findings in a systematic literature review and novel protocol proposal.

作者信息

Ramanauskaite Ausra, Daugela Povilas, Juodzbalys Gintaras

出版信息

Quintessence Int. 2016;47(5):379-93. doi: 10.3290/j.qi.a35131.

DOI:10.3290/j.qi.a35131

PMID:26574611

Abstract

OBJECTIVE

To test the effectiveness of nonsurgical and surgical treatment methods for clinical and radiographic peri-implantitis symptoms resolution with respect to pocket probing depth (PD), bleeding on probing (BOP), and marginal bone-loss reduction (RBL); to propose guidelines for managing peri-implantitis.

METHOD AND MATERIALS

An electronic literature search was conducted of the MEDLINE and EMBASE databases for articles published between 2002 and 2015. Sequential screening at the title/abstract and full-text levels was performed. Clinical human studies in the English language that had reported changes in PD and/or BOP and/or radiologic marginal bone level (RBL) changes after peri-implantitis treatment at 6-month follow-up or longer were included. A meta-analysis was performed using the random-effects model on the selected qualifying articles.

RESULTS

The search resulted in 29 articles meeting the inclusion criteria. The meta-analysis demonstrated improved BOP values (P = .001; OR = 1.567; 95% CI, 1.405 to 1.748) after the nonsurgical treatment but did not reveal a statistically significant difference in the PD changes (P = .8093; standardized mean difference [SMD] = 0.346 mm; 95% CI, 0.181 to 0.512). There was a significant improvement in PD (P < .001; SMD = 1.647 mm; 95% CI, 1.414 to 1.880) and BOP values (P < .001; OR = 4.044; 95% CI, 3.571 to 4.381) after surgical treatment and an intrabony defect fill was found to be 1.66 mm (1.0) using a regenerative treatment modality. Our meta-analysis confirms there is a significant reduction in RBL after nonsurgical (P = 0.037; SMD = 0.157 mm; 95% CI, -0.183 to 0.496), resective (P = .0212; SMD = -0.116 mm; 95% CI, -0.433 to 0.201), and regenerative (P = .0305; SMD = 1.703 mm; 95% CI, 1.266 to 2.139) surgical treatment. A novel complex management and maintenance (CMM) six-step protocol is thus suggested for treatment of peri-implantitis.

CONCLUSION

Regenerative surgical treatment of peri-implantitis was found to be most effective. A novel six-step protocol aimed at managing patients with peri-implantitis can be a useful tool in peri-implantitis treatment.

摘要

目的

测试非手术和手术治疗方法在解决临床和影像学种植体周围炎症状方面的有效性，包括牙周袋探诊深度（PD）、探诊出血（BOP）和边缘骨吸收减少（RBL）；提出种植体周围炎的管理指南。

方法和材料

对MEDLINE和EMBASE数据库进行电子文献检索，查找2002年至2015年发表的文章。在标题/摘要和全文层面进行序贯筛选。纳入英文的临床人体研究，这些研究报告了种植体周围炎治疗6个月或更长时间随访后PD和/或BOP以及放射学边缘骨水平（RBL）的变化。对选定的符合标准的文章使用随机效应模型进行荟萃分析。

结果

检索结果为29篇符合纳入标准的文章。荟萃分析表明，非手术治疗后BOP值有所改善（P = 0.001；OR = 1.567；95% CI，1.405至1.748），但PD变化无统计学显著差异（P = 0.8093；标准化均数差[SMD] = 0.346 mm；95% CI，0.181至0.512）。手术治疗后PD（P < 0.001；SMD = 1.647 mm；95% CI，1.414至1.880）和BOP值（P < 0.001；OR = 4.044；95% CI，3.571至4.381）有显著改善，并且发现使用再生治疗方式时骨内缺损填充为1.66 mm（1.0）。我们的荟萃分析证实，非手术（P = 0.037；SMD = 0.157 mm；95% CI，-0.183至0.496）、切除性（P = 0.0212；SMD = -0.116 mm；95% CI，-0.433至0.201）和再生性（P = 0.0305；SMD = 1.703 mm；95% CI,；术治疗后RBL有显著降低。因此，建议采用一种新颖的综合管理与维护（CMM）六步方案来治疗种植体周围炎。