Keller W, Brägger U, Mombelli A
University of Bern, School of Dental Medicine, Bern, Switzerland.
Clin Oral Implants Res. 1998 Aug;9(4):209-17. doi: 10.1034/j.1600-0501.1998.090401.x.
The aims of this study were to compare clinical and microbiological features in the peri-implant area of implants carrying either screw retained or cemented suprastructures, and to investigate the relationship between the peri-implant microflora, the microbiota on the inner surface of removable suprastructures, and the periodontal microflora within the same subject. In 15 partially edentulous patients with ITI implants used as abutments for crown and bridge reconstructions, microbial samples were taken i) from the deepest periodontal pocket of each quadrant, ii) from the sulcus of the implants and iii) from the internal surface of the screw retained suprastructures. The samples were cultured using continuous anaerobic techniques. Five patients were found with both screw retained (S) and cemented (C) suprastructures. In these subjects the mean total cultivable counts were significantly higher in peri-implant samples from group C than in samples from group S. Furthermore, peri-implant samples of group S yielded a higher proportion of coccoid cells in the darkfield microscope and demonstrated absence of large spirochetes. From the 15 patients, Porphyromas gingivalis was detected in 10% of the periodontal samples and in only one peri-implant sample. Prevotella intermedia was detected in 33% of the periodontal and in 30% of the peri-implant samples. Fusobacterium spp. had a prevalence of 58% in the periodontal samples and was recovered from 50% of the peri-implant samples. Actinobacillus actinomycetemcomitans was not detected in any dental or peri-implant sample. In 1 case, however, the organism was recovered from the internal surface of the suprastructure. Linear regression analysis showed a significant relationship between the frequency of micro-organisms in peri-implant samples of group S and in samples from the inner surface of the suprastructure. Furthermore, there was a significant correlation between the incidence of micro-organisms in dental samples and i) in peri-implant samples of group S and ii) in samples from the internal suprastructure surface. These findings indicate, that the microbial leakage through the gap between the suprastructure and the abutment plays an important role in the bacterial colonization of the internal part of screw retained crowns and bridges. The study furthermore confirms the impact of the dental microflora on the microbial colonization of implants. This factor appears to be more important than the mode of fixation of the suprastructure.
本研究的目的是比较采用螺丝固位或粘结式上部结构的种植体周围区域的临床和微生物学特征，并调查同一受试者种植体周围微生物群、可摘上部结构内表面微生物群与牙周微生物群之间的关系。在15例部分牙列缺损患者中，使用ITI种植体作为冠桥修复的基牙，分别从以下部位采集微生物样本：i）每个象限最深的牙周袋；ii）种植体龈沟；iii）螺丝固位上部结构的内表面。采用连续厌氧技术对样本进行培养。发现5例患者同时存在螺丝固位（S）和粘结（C）上部结构。在这些受试者中，C组种植体周围样本的平均总可培养菌数显著高于S组样本。此外，S组种植体周围样本在暗视野显微镜下产生的球菌细胞比例更高，且未发现大型螺旋体。在15例患者中，牙龈卟啉单胞菌在10%的牙周样本中被检测到，仅在1例种植体周围样本中被检测到。中间普氏菌在33%的牙周样本和30%的种植体周围样本中被检测到。梭杆菌属在58%的牙周样本中存在，在50%的种植体周围样本中被检出。在任何牙齿或种植体周围样本中均未检测到伴放线放线杆菌。然而，在1例患者中，该菌从上部结构的内表面被检出。线性回归分析显示，S组种植体周围样本与上部结构内表面样本中的微生物频率之间存在显著关系。此外，牙齿样本中的微生物发生率与i）S组种植体周围样本和ii）上部结构内表面样本中的微生物发生率之间存在显著相关性。这些发现表明，通过上部结构与基牙之间的间隙发生的微生物渗漏在螺丝固位冠桥内部的细菌定植中起重要作用。该研究还证实了牙齿微生物群对种植体微生物定植的影响。这一因素似乎比上部结构的固定方式更为重要。
