Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.
Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
Clin Implant Dent Relat Res. 2024 Jun;26(3):554-563. doi: 10.1111/cid.13314. Epub 2024 Feb 28.
To investigate whether the lack of keratinized mucosa (KM) affects peri-implant health after 10 years of loading.
Data from 74 patients with 148 implants from two randomized controlled studies comparing different implant systems were included and analyzed. Clinical parameters including bleeding on probing (BOP), probing depth (PD), plaque index, marginal bone loss (MBL), and KM width (KMW) at buccal sites were collected at baseline (time of the final prosthesis insertion), 5-year and 10 years postloading. Multivariable logistic and linear regression models by means of a generalized estimated equation (GEE) were used to evaluate the influence of buccal KM on peri-implant clinical parameters; BOP, MBL, PD, and adjusted for implant type (one-piece or two-piece) and compliance.
A total of 35 (24.8%) implants were healthy, 67 (47.5%) had mucositis and 39 (27.6%) were affected by peri-implantitis. In absence of buccal KM (KM = 0 mm), 75% of the implants exhibited mucositis, while in the presence of KM (KMW >0 mm) 41.2% exhibited mucositis. Regarding peri-implantitis, the corresponding percentages were 20% (KM = 0 mm) and 26.7% (KM >0 mm). Unadjusted logistic regression showed that the presence of buccal KM tended to reduce the odds of showing BOP at buccal sites (OR: 0.28 [95% CI, 0.07 to 1.09], p = 0.06). The adjusted logistic regression model revealed that having buccal KM (OR: 0.21 [95% CI, 0.05 to 0.85], p = 0.02) and using two-piece implants (OR: 0.34 [95% CI, 0.15 to 0.75], p = 0.008) significantly reduced the odds of showing BOP. Adjusted linear regression by means of GEE showed that KM and two-piece implants were associated with reduced MBL and MBL changes (p < 0.05).
The lack of buccal KM appears to be linked with peri-implant parameters such as BOP and MBL, but the association is weak. The design of one-piece implants may account for their increased odds of exhibiting BOP.
探究在负载 10 年后，角化黏膜（KM）缺失是否会影响种植体周围的健康。
本研究纳入了两项比较不同种植体系统的随机对照研究的 74 名患者的 148 个种植体的数据，并进行了分析。临床参数包括探诊出血（BOP）、探诊深度（PD）、菌斑指数、边缘骨丧失（MBL）和颊侧位点的角化黏膜宽度（KMW），在基线（最终修复体插入时）、5 年和 10 年后进行收集。采用广义估计方程（GEE）的多变量逻辑和线性回归模型来评估颊侧 KM 对种植体周围临床参数的影响；BOP、MBL、PD，并针对种植体类型（一体式或分体式）和依从性进行调整。
共有 35 个（24.8%）种植体为健康状态，67 个（47.5%）为黏膜炎状态，39 个（27.6%）为种植体周围炎状态。在颊侧无 KM（KM=0mm）的情况下，75%的种植体表现为黏膜炎，而在有 KM（KMW>0mm）的情况下，41.2%的种植体表现为黏膜炎。关于种植体周围炎，相应的百分比为 20%（KM=0mm）和 26.7%（KM>0mm）。未调整的逻辑回归显示，颊侧 KM 的存在倾向于降低颊侧探诊出血的可能性（OR：0.28[95%CI，0.07 至 1.09]，p=0.06）。调整后的逻辑回归模型显示，颊侧 KM（OR：0.21[95%CI，0.05 至 0.85]，p=0.02）和使用分体式种植体（OR：0.34[95%CI，0.15 至 0.75]，p=0.008）显著降低了探诊出血的可能性。通过 GEE 进行的调整后的线性回归显示，KM 和分体式种植体与减少 MBL 和 MBL 变化相关（p<0.05）。
颊侧 KM 的缺失似乎与 BOP 和 MBL 等种植体周围参数有关，但关联较弱。一体式种植体的设计可能导致其出现 BOP 的可能性增加。
