Parmar Nidhi
MClinDent Prosthodontics Specialty Trainee, Eastman Dental Institute, London, United Kingdom.
Evid Based Dent. 2024 Dec;25(4):182-183. doi: 10.1038/s41432-024-01071-x. Epub 2024 Oct 9.
A retrospective cohort design was used to assess the long-term clinical effectiveness of systemic amoxicillin and metronidazole, used adjunctively with non-surgical peri-implantitis treatment (NST) and whether it prevents the need for further surgical interventions.
Of the 57 peri-implantitis patients examined, 45 patients were included in this study. The participants were divided into two subgroups in accordance to who had received NST with or without systemic antibiotics. Selection was based on prior participation in a three-month randomised control trial, ensuring comparability of data regarding peri-implantitis severity and treatment history.
Data were extracted pre-treatment, 3-months post-treatment and at a long-term follow-up interval of 36 months. The primary outcome was the need for additional surgical intervention and was analysed via Kaplan-Meier analysis and Cox regression. A multitude of secondary clinical outcomes were evaluated using parametric and non-parametric tests, including peri- implant probing depth, bleeding scores and treatment success.
Overall, 62.2% of the 45 NST patients did not need surgical peri-implantitis treatment: 73.9% of the subgroup with antibiotics and 50% of the subgroup without antibiotics respectively. However, the difference between the two groups was not statistically significant (log-rank test, p = 0.110). The Cox regression analysis also displayed no significance over the first three years post-treatment (p = 0.115). Additionally, the study found that deeper peri- implant pockets at baseline significantly predicted the need for future surgical treatment (p = 0.031), highlighting the importance of initial disease severity in treatment outcomes.
The study concludes that the adjunctive use of systemic amoxicillin and metronidazole with NST may delay but not statistically reduce or prevent a future surgical need. Although a short-term reduction in clinical inflammatory parameters was evident, the long-term effectiveness in altering the progression of peri-implantitis remains limited.
采用回顾性队列设计，以评估全身性阿莫西林和甲硝唑辅助非手术性种植体周围炎治疗（NST）的长期临床疗效，以及其是否能避免进一步手术干预的必要性。
在检查的57例种植体周围炎患者中，45例纳入本研究。参与者根据是否接受了全身性抗生素的NST分为两个亚组。选择基于先前参与的一项为期三个月的随机对照试验，以确保种植体周围炎严重程度和治疗史的数据具有可比性。
在治疗前、治疗后3个月和36个月的长期随访期提取数据。主要结局是是否需要额外的手术干预，并通过Kaplan-Meier分析和Cox回归进行分析。使用参数和非参数检验评估了多种次要临床结局，包括种植体周围探诊深度、出血评分和治疗成功率。
总体而言，45例接受NST的患者中，62.2%不需要手术治疗种植体周围炎：使用抗生素亚组的比例为73.9%，未使用抗生素亚组的比例为50%。然而，两组之间的差异无统计学意义（对数秩检验，p = 0.110）。Cox回归分析在治疗后的前三年也无显著性差异（p = 0.115）。此外，研究发现基线时较深的种植体周围袋显著预示了未来手术治疗的必要性（p = 0.031），突出了初始疾病严重程度对治疗结局的重要性。
该研究得出结论，全身性阿莫西林和甲硝唑与NST联合使用可能会延迟但不能在统计学上减少或预防未来的手术需求。虽然临床炎症参数在短期内有明显降低，但改变种植体周围炎进展的长期疗效仍然有限。
