Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt, Germany.
Department of Periodontology, Cariology and Endodontology, University of Basel, Basel, Switzerland.
J Clin Periodontol. 2023 Jun;50 Suppl 26:317-335. doi: 10.1111/jcpe.13783. Epub 2023 Feb 26.
AIM: To evaluate the efficacy of adjunctive/alternative photo/mechanical and physical implant-surface decontamination approaches compared to standard instrumentation in conjunction with surgical peri-implantitis treatment. MATERIALS AND METHODS: Randomized controlled clinical trials (RCTs) and controlled clinical trials investigating the efficacy of adjunctive or alternative photo/mechanical/physical measures for implant surface decontamination in conjunction with surgical peri-implantitis treatment without (PICOS 1) or with (PICOS 2) additional decontamination methods performed in test and control groups with changing inflammation parameters were covered. Changes in bleeding scores (i.e., bleeding index, or bleeding on probing [BOP]), suppuration, and probing depth (PD) were considered the primary outcomes. RESULTS: Six articles describing five original RCTs were eligible for analysis. Based on two RCTs, the adjunctive/alternative use of air polishing with glycine or erythritol powder did not improve BOP reduction compared to standard instrumentation (PICOS 1). Based on one RCT, alternative use of titanium brushes resulted in significantly higher BOP reduction compared to either air polishing or standard instrumentation (PICOS 1). During reconstructive therapy and as an adjunct to implantoplasty, use of a titanium brush did not have any benefit on the BOP and mean PD reductions compared to the control group (i.e., implantoplasty + mechanical and chemical implant surface decontamination; one RCT; PICOS 2). Use of the Er:YAG laser resulted in significantly higher PD reduction after 6 months (one RCT), whereas no difference between the test and respective controls could be detected after 1 and 2 years (one RCT). Additionally, the use of the Er:YAG laser was not associated with improved BOP reductions over respective controls (two RCTs; PICOS 2). CONCLUSIONS: Owing to the limited available data, clinical efficacy of photo/mechanical and physical implant surface decontamination in conjunction with surgical peri-implantitis therapy is inconclusive. However, titanium brushes may be beneficial in reducing signs of inflammation.
目的：评估辅助/替代光/机械和物理植入物表面去污方法与标准器械联合使用在治疗种植体周围炎方面的疗效。
材料和方法：纳入了评估辅助或替代光/机械/物理措施对种植体表面去污的随机对照临床试验（RCT）和对照临床试验，这些措施与手术治疗种植体周围炎联合使用，不（PICOS1）或同时（PICOS2）使用其他去污方法，试验组和对照组的炎症参数发生变化。将出血评分（即出血指数或探诊出血[BOP]）、溢脓和探诊深度（PD）的变化作为主要结局。
结果：有 6 篇描述 5 项原始 RCT 的文章符合分析标准。基于两项 RCT，与标准器械相比，辅助/替代使用空气抛光与甘氨酸或赤藓糖醇粉末并不能改善 BOP 的减少（PICOS1）。基于一项 RCT，与空气抛光或标准器械相比，替代使用钛刷可显著提高 BOP 的减少（PICOS1）。在重建治疗期间，作为植入物成形术的辅助手段，与对照组（即植入物成形术+机械和化学植入物表面去污；一项 RCT；PICOS2）相比，钛刷在 BOP 和平均 PD 减少方面没有任何益处。与对照组相比，使用 Er:YAG 激光治疗可显著降低 6 个月后的 PD（一项 RCT），但在 1 年和 2 年后未检测到试验组和相应对照组之间的差异（一项 RCT）。此外，与相应对照组相比，Er:YAG 激光的使用并未改善 BOP 的减少（两项 RCT；PICOS2）。
结论：由于现有数据有限，手术治疗种植体周围炎时联合使用光/机械和物理植入物表面去污的临床疗效尚不确定。然而，钛刷可能有助于减轻炎症迹象。
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