Shi D, Cao J, Dai S A, Meng H X
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.
Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Feb 18;52(1):58-63. doi: 10.19723/j.issn.1671-167X.2020.01.009.
To evaluate the short-term outcome of regenerative surgery for peri-implantitis therapy.
From March 2018 to January 2019, 9 patients with 10 implants who suffered from peri-implantitis were included in the present research. Vertical bone defect at least 3mm in depth with 2 or more residual bone walls was confirmed around each implant by radiographic examination. Restorations were replaced by healing abutments on 3 implants with the consent of the patients. Guided bone regeneration surgery was performed after a hygienic phase. During surgery, full thickness flaps were elevated on both buccal and lingual aspects. Titanium curette was used for inflammatory granulation tissue removal and implant surface cleaning. The implant surface was decontaminated by chemical rinsing with 3% hydrogen peroxide solution. After being thoroughly rinsed with saline, the bone substitutes were placed in bone defects which were covered by collagen membranes. 6 months after non-submerged healing, the clinical parameters including peri-implant probing depth (PD, distance between pocket bottom and peri-implant soft tissue margin) and radiographic bone level (BL, distance form implant shoulder to the first bone-to-implant contact) were used to evaluate the regenerative outcome. PD was measured at six sites (mesial, middle and distal sites at both buccal and lingual aspects) around each implant, and BL was measured at the mesial and distal surfaces of each implant on a periapical radiograph.
The deepest PD and largest BL of each implant ranged from 6-10 mm and 3.2-8.3 mm respectively. All the implants healed uneventfully after surgery. The mean peri-implant PD at baseline and 6 months after surgery were (6.2±1.4) mm and (3.1±0.6) mm respectively, and a mean (3.0±1.5) mm radiographic bone gain was observed, P<0.01. Treatment success was defined as: no sites with residual PD≥6 mm, no bleeding on probing, and BL elevation of at least 1 mm. Nine implants from 8 patients fulfilled the success criteria. Residual pockets with 6 mm in depth and bleeding on probing could be detected in only one implant.
Within the limitation of the present research, guided bone regeneration surgery can be used for the treatment of bone defect that resulted from peri-implantitis. Significant PD reduction and radiographic bone gain can be obtained after 6 months observation.
评估种植体周围炎治疗中再生手术的短期效果。
2018年3月至2019年1月，本研究纳入9例患有种植体周围炎的患者共10颗种植体。通过影像学检查确认每个种植体周围存在深度至少3mm且有2个或更多残留骨壁的垂直骨缺损。经患者同意，3颗种植体上的修复体被愈合基台取代。在进行清洁阶段后实施引导骨再生手术。手术过程中，在颊侧和舌侧均掀起全厚瓣。使用钛刮匙去除炎性肉芽组织并清洁种植体表面。用3%过氧化氢溶液化学冲洗对种植体表面进行去污处理。用生理盐水彻底冲洗后，将骨替代物置于骨缺损处，并用胶原膜覆盖。非潜入式愈合6个月后，使用包括种植体周围探诊深度（PD，袋底与种植体周围软组织边缘之间的距离）和影像学骨水平（BL，从种植体肩部到第一个骨与种植体接触点的距离）等临床参数来评估再生效果。在每个种植体周围的六个部位（颊侧和舌侧的近中、中间和远中部位）测量PD，在根尖片上每个种植体的近中和远中表面测量BL。
每个种植体最深的PD和最大的BL分别为6 - 10mm和3.2 - 8.3mm。所有种植体术后均顺利愈合。术后6个月时种植体周围平均PD由基线时的(6.2±1.4)mm降至(3.1±0.6)mm，平均影像学骨增量为(3.0±1.5)mm，P<0.01。治疗成功的定义为：无残留PD≥6mm的部位，探诊无出血，且BL升高至少1mm。8例患者的9颗种植体达到成功标准。仅1颗种植体可检测到深度为6mm的残留袋且探诊出血。
在本研究的局限性范围内，引导骨再生手术可用于治疗种植体周围炎导致的骨缺损。观察6个月后可获得显著的PD降低和影像学骨增量。
