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一项为期三年的研究,针对牙周炎病史患者的短锁扣锥形种植体及其邻牙的牙周微生物。

A three-year study on periodontal microorganisms of short locking-taper implants and adjacent teeth in patients with history of periodontitis.

机构信息

Department of Periodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, China.

Department of Periodontology, Stomatology Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, China.

出版信息

J Dent. 2020 Apr;95:103299. doi: 10.1016/j.jdent.2020.103299. Epub 2020 Feb 15.

Abstract

OBJECTIVE

To analyze the change of six periodontal pathogens around short locking-taper implants and adjacent teeth in patients with different periodontal conditions for three years.

METHODS

Sixty implants and 62 adjacent teeth from 24 patients with different periodontal conditions were included: 5 patients with history of aggressive periodontitis (AgP group), 14 patients with history of chronic periodontitis (CP group), and 5 patients with healthy condition or slight gingivitis (H group). Subgingival samples were collected at five timepoints: before implant placement (T1); before second stage operation (T2); one month after restoration (T3); one year after functional loading (T4) and two years after functional loading (T5). Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, Fusobacterium nucleatum, Prevotella intermedia, and Aggregatibacter actinomycetemcomitans were detected by polymerase chain reaction (PCR).

RESULTS

Pathogens were hardly found around implants or adjacent teeth until T4. The detection rates of five pathogens other than A. actinomycetemcomitans raised up from T3 to T5. F. nucleatum and P. gingivalis were mostly detected followed by P. intermedia, T. forsythia, and T. denticola. The detection rate of P. gingivalis in implants were higher than natural teeth. There was significant correlation between pathogenic bacteria from implants and adjacent teeth. A. actinomycetemcomitans were only detected positively in peri-implant sites of AgP group. Peri-implantitis sites showed significantly higher detection rates of T. denticola, F. nucleatum at T4, and P. gingivalis, F. nucleatum at T5 than peri-implant mucositis and healthy groups.

CONCLUSION

This three-year longitudinal study demonstrated that periodontal pathogens accumulate over time around short locking-taper implants and adjacent natural teeth after restoration. Adjacent teeth may become the microbial reservoir for peri-implant bacteria. Therefore, periodontally compromised patients may face higher risk for peri-implant disease.

CLINICAL SIGNIFICANCE

Plaque control of implant should be intensified with time instead of diminished. Patients with history of periodontitis need more frequent and individualized implant maintenance. Treatment and maintenance for adjacent teeth is as important as for implants..

摘要

目的

分析三年间不同牙周状况患者的短锁锥形种植体及其邻牙周围六种牙周病原体的变化。

方法

共纳入 24 名患者的 60 个种植体和 62 颗邻牙,包括 5 名侵袭性牙周炎(AgP 组)、14 名慢性牙周炎(CP 组)和 5 名健康或轻度牙龈炎患者(H 组)。在五个时间点采集龈下样本:植入前(T1);二期手术前(T2);修复后一个月(T3);功能负荷一年后(T4)和功能负荷两年后(T5)。采用聚合酶链反应(PCR)检测牙龈卟啉单胞菌、齿密螺旋体、福赛斯坦纳菌、核梭杆菌、中间普氏菌和伴放线放线杆菌。

结果

在 T4 之前,种植体或邻牙周围几乎检测不到病原体。除 A. actinomycetemcomitans 外,五种病原体的检出率从 T3 上升至 T5。核梭杆菌和牙龈卟啉单胞菌检出最多,其次是中间普氏菌、福赛斯坦纳菌和齿密螺旋体。种植体上的牙龈卟啉单胞菌检出率高于天然牙。种植体和邻牙的病原菌之间存在显著相关性。仅在 AgP 组的种植体周围部位检测到 A. actinomycetemcomitans 呈阳性。与健康组和牙周炎黏膜组相比,T4 时种植体周围炎部位的齿密螺旋体、核梭杆菌检出率和 T5 时的牙龈卟啉单胞菌、核梭杆菌检出率显著升高。

结论

这项为期三年的纵向研究表明,修复后,短锁锥形种植体及其邻接天然牙周围的牙周病原体随时间推移而逐渐累积。邻牙可能成为种植体周围细菌的微生物储存库。因此,牙周状况不佳的患者可能面临更高的种植体周围疾病风险。

临床意义

随着时间的推移,应加强对种植体菌斑的控制,而不是减少。有牙周炎病史的患者需要更频繁和个体化的种植体维护。对邻牙的治疗和维护与对种植体的维护同样重要。

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