Department of Periodontology, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, Sant Cugat del Vallés, 08195, Barcelona, Spain.
Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, MI, USA.
Clin Oral Investig. 2023 Jun;27(6):3125-3138. doi: 10.1007/s00784-023-04918-2. Epub 2023 Feb 14.
This study aims to identify patient and implant indicators influencing the non-surgical therapeutic outcomes of peri-implantitis at 6 months of follow-up.
This case series involved patients with at least one implant diagnosed with peri-implantitis according to the 2017 World Workshop criteria. Non-surgical therapy consisted of mechanical debridement of the peri-implant pockets combined with metronidazole 500 mg 3 times a day for 7 days. At baseline and at 6 months, clinical and radiographic variables were collected to calculate treatment success (probing pocket depth reduction to 5 mm without bleeding on probing or < 5 mm irrespective of bleeding on probing at all implant sites, and lack of bone loss progression). The primary outcome was treatment success (%) at 6 months. The influence of the patient and implant/prosthetic variables upon disease resolution was assessed through simple and multiple logistic regression analyses at patient and implant level, using generalized estimation equations models.
A total of 74 patients and 107 implants were analyzed at 6 months. Disease resolution was established in 25.7% of the patients and 24.1% of the implants. Patients with stage IV and grade C periodontitis, inadequate oral hygiene at baseline, and wide diameter (≥ 4.5 mm) presented significantly greater treatment failure, whereas smokers and former smokers demonstrated a tendency toward failure. At 6 months, there was a significant decrease in probing pocket depth and bleeding on probing of 1.08 ± 1.06 mm and 14%, respectively. Radiographically, a significant gain in marginal bone level of 0.43 ± 0.56 mm was observed.
Disease resolution after non-surgical treatment of peri-implantitis is negatively influenced by the loss of support of the adjacent periodontium, poor baseline oral hygiene, and wide diameter implants (≥ 4.5 mm).
This study helps to discriminate the clinical situations in which non-surgical treatment is less likely to achieve treatment success at short term.
本研究旨在确定影响种植体周围炎患者在 6 个月随访时非手术治疗效果的患者和种植体相关指标。
本病例系列研究纳入了至少有一颗种植体被诊断为种植体周围炎的患者，这些患者符合 2017 年世界工作坊标准。非手术治疗包括机械清创结合甲硝唑 500mg，每天 3 次，共 7 天。在基线和 6 个月时，收集临床和影像学变量，以计算治疗成功率（探诊深度减少至 5mm 且无探诊出血或所有种植体部位无论探诊是否出血均≤5mm，且无骨吸收进展）。主要结局是 6 个月时的治疗成功率（%）。通过简单和多逻辑回归分析，在患者和种植体水平上，使用广义估计方程模型，评估患者和种植体/修复体变量对疾病缓解的影响。
共有 74 名患者和 107 颗种植体在 6 个月时被分析。患者的疾病缓解率为 25.7%，种植体的疾病缓解率为 24.1%。患有牙周炎 IV 期和 C 级、基线时口腔卫生状况不佳和种植体直径较宽（≥4.5mm）的患者治疗失败的风险显著增加，而吸烟者和曾经吸烟者的治疗失败风险则呈现出增加的趋势。在 6 个月时，探诊深度和探诊出血分别显著减少了 1.08±1.06mm 和 14%。影像学上，边缘骨水平显著增加了 0.43±0.56mm。
非手术治疗种植体周围炎后，牙周组织支持丧失、基线口腔卫生状况差和直径较宽的种植体（≥4.5mm）会对疾病缓解产生负面影响。
本研究有助于区分在短期内非手术治疗不太可能获得治疗成功的临床情况。
