Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Prosthodontics, University of Malmö, Scania, Sweden.
Clin Implant Dent Relat Res. 2019 Feb;21(1):183-189. doi: 10.1111/cid.12711. Epub 2018 Dec 28.
Oral implants have displayed clinical survival results at the 95%-99% level for over 10 years of follow up. Nevertheless, some clinical researchers see implant disease as a most common phenomenon. Oral implants are regarded to display disease in the form of mucositis or peri-implantitis. One purpose of the present article is to investigate whether a state of disease is necessarily occurring when implants display soft tissue inflammation or partially lose their bony attachment. Another purpose of this article is to analyze the mode of defense for implants that are placed in a bacteria rich environment and to analyze when an obtained steady state between tissue and the foreign materials is disturbed.
The present article is authored as a narrative review contribution.
Evidence is presented that further documents the fact that implants are but foreign bodies that elicit a foreign body response when placed in bone tissue. The foreign body response is characterized by a bony demarcation of implants in combination with a chronic inflammation in soft tissues. Oral implants survive in the bacteria-rich environments where they are placed due to a dual defense system in form of chronic inflammation coupled to immunological cellular actions. Clear evidence is presented that questions the automatic diagnostics of an oral implant disease based on the finding of so called mucositis that in many instances represents but a normal tissue response to foreign body implants instead of disease. Furthermore, neither is marginal bone loss around implants necessarily indicative of a disease; the challenge to the implant represented by bone resorption may be successfully counteracted by local defense mechanisms and a new tissue-implant steady state may evolve. Similar reactions including chronic inflammation occur in the interface of orthopedic implants that display similarly good long-term results as do oral implants, if mainly evaluated based on revision surgery in orthopedic cases. The most common mode of failure of orthopedic implants is aseptic loosening which has been found coupled to a reactivation of the inflammatory- immune system.
Implants survive in the body due to balanced defense reactions in form of chronic inflammation and activation of the innate immune system. Ten year results of oral and hip /knee implants are hence in the 90+ percentage region. Clinical problems may occur with bone resorption that in most cases is successfully counterbalanced by the defense/healing systems. However, in certain instances implant failure will ensue characterized by bacterial attacks and/or by reactivation of the immune system that now will act to remove the foreign bodies from the tissues.
口腔种植体在经过 10 年以上的随访后，临床存活率达到了 95%-99%。然而，一些临床研究人员认为种植体疾病是一种常见现象。口腔种植体被认为以黏膜炎或种植体周围炎的形式发生疾病。本文的目的之一是研究当种植体显示软组织炎症或部分丧失其骨附着时，是否必然会出现疾病状态。本文的另一个目的是分析在富含细菌的环境中植入物的防御模式，并分析组织与异物之间的稳定状态何时被破坏。
本文是一篇叙述性综述。
本文提供了进一步的证据，证明了植入物是异物的事实，当它们被植入骨组织时，会引起异物反应。异物反应的特征是植入物在骨组织中有一个骨性界限，同时伴有软组织的慢性炎症。口腔种植体在其所处的富含细菌的环境中得以存活，是因为它具有一种双重防御系统，即慢性炎症与免疫细胞作用相结合。有明确的证据表明，基于所谓的黏膜炎对口腔种植体疾病的自动诊断值得商榷，因为在许多情况下，黏膜炎只是对外来植入物的正常组织反应，而不是疾病。此外，边缘骨丧失并不一定表明种植体疾病；骨质吸收对种植体的挑战可能会被局部防御机制成功抵消，新的组织-种植体稳定状态可能会形成。类似的炎症反应发生在骨科植入物的界面中，这些植入物与口腔种植体一样，具有类似的良好长期效果，如果主要基于骨科病例的翻修手术进行评估。骨科植入物最常见的失效模式是无菌性松动，这种松动与炎症-免疫系统的重新激活有关。
植入物通过慢性炎症和先天免疫系统激活的平衡防御反应在体内存活。口腔种植体和髋关节/膝关节植入物的 10 年结果因此处于 90%以上的区域。在大多数情况下，骨质吸收引起的临床问题可以被防御/愈合系统成功地抵消。然而，在某些情况下，植入物的失败将随之而来，其特征是细菌攻击和/或免疫系统的重新激活，现在免疫系统将作用于从组织中清除异物。
