U.F.R. d'Odontologie, Université Paris Cité, Paris, France.
Service of Odontology, Periodontal and Oral Surgery Unit, Rothschild Hospital (AP-HP), Paris, France.
J Clin Periodontol. 2023 Jun;50 Suppl 26:77-112. doi: 10.1111/jcpe.13790. Epub 2023 Mar 6.
This systematic review and meta-analysis aims to assess the efficacy of risk factor control to prevent the occurrence of peri-implant diseases (PIDs) in adult patients awaiting dental implant rehabilitation (primordial prevention) or in patients with dental implants surrounded by healthy peri-implant tissues (primary prevention).
A literature search was performed without any time limit on different databases up to August 2022. Interventional and observational studies with at least 6 months of follow-up were considered. The occurrence of peri-implant mucositis and/or peri-implantitis was the primary outcome. Pooled data analyses were performed using random effect models according to the type of risk factor and outcome.
Overall, 48 studies were selected. None assessed the efficacy of primordial preventive interventions for PIDs. Indirect evidence on the primary prevention of PID indicated that diabetic patients with dental implants and good glycaemic control have a significantly lower risk of peri-implantitis (odds ratio [OR] = 0.16; 95% confidence interval [CI]: 0.03-0.96; I : 0%), and lower marginal bone level (MBL) changes (OR = -0.36 mm; 95% CI: -0.65 to -0.07; I : 95%) compared to diabetic patients with poor glycaemic control. Patients attending supportive periodontal/peri-implant care (SPC) regularly have a lower risk of overall PIDs (OR = 0.42; 95% CI: 0.24-0.75; I : 57%) and peri-implantitis compared to irregular attendees. The risk of dental implant failure (OR = 3.76; 95% CI: 1.50-9.45; I : 0%) appears to be greater under irregular or no SPC than regular SPC. Implants sites with augmented peri-implant keratinized mucosa (PIKM) show lower peri-implant inflammation (SMD = -1.18; 95% CI: -1.85 to -0.51; I : 69%) and lower MBL changes (MD = -0.25; 95% CI: -0.45 to -0.05; I : 62%) compared to dental implants with PIKM deficiency. Studies on smoking cessation and oral hygiene behaviors were inconclusive.
Within the limitations of available evidence, the present findings indicate that in patients with diabetes, glycaemic control should be promoted to avoid peri-implantitis development. The primary prevention of peri-implantitis should involve regular SPC. PIKM augmentation procedures, where a PIKM deficiency exists, may favour the control of peri-implant inflammation and the stability of MBL. Further studies are needed to assess the impact of smoking cessation and oral hygiene behaviours, as well as the implementation of standardized primordial and primary prevention protocols for PIDs.
本系统评价和荟萃分析旨在评估危险因素控制预防成年患者牙种植体修复（一级预防）或种植体周围健康的牙周组织（二级预防）中发生种植体周围疾病（PID）的疗效。
无时间限制地在不同数据库中进行了文献检索，直至 2022 年 8 月。纳入至少 6 个月随访的干预性和观察性研究。种植体周围黏膜炎和/或种植体周围炎的发生是主要结局。根据危险因素和结局的类型，采用随机效应模型进行汇总数据分析。
总体上，选择了 48 项研究。没有一项研究评估了 PID 一级预防的预防性干预措施的效果。PID 二级预防的间接证据表明，糖尿病患者如果血糖控制良好，种植体周围炎的风险显著降低（比值比 [OR] = 0.16；95%置信区间 [CI]：0.03-0.96；I²：0%），且边缘骨水平（MBL）变化较小（OR = -0.36 mm；95%CI：-0.65 至 -0.07；I²：95%）与血糖控制不佳的糖尿病患者相比。定期接受支持性牙周/种植体维护（SPC）的患者发生总体 PID（OR = 0.42；95%CI：0.24-0.75；I²：57%）和种植体周围炎的风险较低。与定期接受 SPC 相比，不规则或不接受 SPC 的患者种植体失败的风险（OR = 3.76；95%CI：1.50-9.45；I²：0%）似乎更大。有角化黏膜（PIKM）的种植体部位显示出较低的种植体周围炎症（SMD = -1.18；95%CI：-1.85 至 -0.51；I²：69%）和较低的 MBL 变化（MD = -0.25；95%CI：-0.45 至 -0.05；I²：62%）与 PIKM 不足的种植体相比。关于戒烟和口腔卫生行为的研究结果尚无定论。
在现有证据的限制范围内，本研究结果表明，对于糖尿病患者，应促进血糖控制以避免种植体周围炎的发生。种植体周围炎的一级预防应包括定期的 SPC。在存在 PIKM 不足的情况下，进行 PIKM 增强手术可能有利于控制种植体周围炎症和 MBL 的稳定性。需要进一步研究以评估戒烟和口腔卫生行为的影响，以及 PID 的标准化一级和二级预防方案的实施。
