Department of Oral Surgery and Implantology, Carolinum, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany.
Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
J Periodontol. 2018 Jun;89 Suppl 1:S267-S290. doi: 10.1002/JPER.16-0350.
OBJECTIVES: This narrative review provides an evidence-based overview on peri-implantitis for the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. METHODS: A literature review was conducted addressing the following topics: 1) definition of peri-implantitis; 2) conversion from peri-implant mucositis to peri-implantitis, 3) onset and pattern of disease progression, 4) characteristics of peri-implantitis, 5) risk factors/indicators for peri-implantitis, and 6) progressive crestal bone loss in the absence of soft tissue inflammation. CONCLUSIONS: 1)Peri-implantitis is a pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant connective tissue and progressive loss of supporting bone. 2)The histopathologic and clinical conditions leading to the conversion from peri-implant mucositis to peri-implantitis are not completely understood. 3)The onset of peri-implantitis may occur early during follow-up and the disease progresses in a non-linear and accelerating pattern. 4a)Peri-implantitis sites exhibit clinical signs of inflammation and increased probing depths compared to baseline measurements. 4b)At the histologic level, compared to periodontitis sites, peri-implantitis sites often have larger inflammatory lesions. 4c)Surgical entry at peri-implantitis sites often reveals a circumferential pattern of bone loss. 5a)There is strong evidence that there is an increased risk of developing peri-implantitis in patients who have a history of chronic periodontitis, poor plaque control skills, and no regular maintenance care after implant therapy. Data identifying "smoking" and "diabetes" as potential risk factors/indicators for peri-implantitis are inconclusive. 5b)There is some limited evidence linking peri-implantitis to other factors such as: post-restorative presence of submucosal cement, lack of peri-implant keratinized mucosa and positioning of implants that make it difficult to perform oral hygiene and maintenance. 6)Evidence suggests that progressive crestal bone loss around implants in the absence of clinical signs of soft tissue inflammation is a rare event.
目的:本叙述性综述提供了 2017 年世界牙周病和种植体周围病与状况分类研讨会的循证概述。
方法:对以下主题进行文献回顾:1)种植体周围炎的定义;2)从种植体周围黏膜炎到种植体周围炎的转化;3)疾病进展的起始和模式;4)种植体周围炎的特征;5)种植体周围炎的危险因素/指标;以及 6)无软组织炎症的情况下进行性牙槽骨丧失。
结论:1)种植体周围炎是一种发生在牙种植体周围组织的病理性疾病,其特征为种植体周围结缔组织炎症和支持骨的进行性丧失。2)导致从种植体周围黏膜炎到种植体周围炎转化的组织病理学和临床条件尚不完全清楚。3)种植体周围炎的发病可能在随访早期发生,且疾病呈非线性和加速进展模式。4a)与基线测量相比,种植体周围炎部位表现出炎症的临床体征和增加的探诊深度。4b)在组织学水平上,与牙周炎部位相比,种植体周围炎部位通常具有更大的炎症病变。4c)种植体周围炎部位的手术入路常显示出环状骨丧失模式。5a)有强有力的证据表明,患有慢性牙周炎、菌斑控制技能差且种植治疗后无定期维护护理的患者发生种植体周围炎的风险增加。将“吸烟”和“糖尿病”鉴定为种植体周围炎潜在危险因素/指标的证据不足。5b)有一些有限的证据表明种植体周围炎与其他因素有关,例如:修复后黏膜下水泥的存在、缺乏种植体周围角化黏膜以及植入物的位置,这些因素使得难以进行口腔卫生和维护。6)有证据表明,在缺乏软组织炎症临床体征的情况下,种植体周围牙槽骨的进行性丧失是一种罕见事件。
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