无牙颌患者locator附着体种植覆盖义齿修复后口腔卫生维护的纵向研究
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摘要
目的:调查无牙颌患者locator附着体种植覆盖义齿修复后口腔卫生维护状况,分析其口腔卫生维护行为、卫生状况与种植体周围软硬组织健康的相关性。方法:纳入2012年1月至2016年5月于北京大学口腔医院修复科接受locator附着体种植覆盖义齿修复的无牙颌患者,复查时记录种植体周围病的发生情况、改良菌斑指数(modified plaque index,m PLI)、探诊出血指数(sulcus bleeding index,SBI)、牙龈指数(gingival index,GI)、探诊深度(probing depth,PD)等,并利用X线平行投照法观察边缘骨吸收,同时调查患者对附着体的日常清洁行为。分析患者的口腔卫生维护行为、卫生状况与种植体周围病发生率的关系。结果:共纳入50名患者(125枚种植体),平均随访了22个月(6～54个月),平均m PLI、SBI、GI分别为1. 4±1. 2、0. 8±0. 7、0. 7±0. 6,PD为(2. 2±0. 7) mm,近远中边缘骨吸收分别为(1. 1±1. 1) mm、(0. 9±0. 9) mm。种植体周围黏膜炎的发生率为49. 6%,种植体周围炎的发生率为0。口腔卫生差(m PLI≥2)的患者种植体周围黏膜炎的发生率是口腔卫生良好者(m PLI <1)的11. 9倍,每日清洁附着体两次及以上的患者m PLI得分显著低于清洁次数不足两次的患者(P <0. 05)。结论:无牙颌患者种植locator附着体种植覆盖义齿修复后的口腔卫生维护不足,口腔卫生维护不良与无牙颌患者种植体周围黏膜炎的发生相关,口腔卫生差的患者种植体发生黏膜炎的风险是口腔卫生良好者的11. 9倍,附着体的清洁是患者应关注的重点内容。
Objective: To investigate the oral hygiene status of edentulous patients with locator attachments implant overdentures(IOD) and to analyze the relationship among daily hygiene behavior,oral hygiene status and peri-implant diseases. Methods: Edentulous patients who received IOD treatment with locator attachments from January 2012 to May 2016 were recruited. Clinical and radiographic examinations were conducted to assess the peri-implant tissue status. Modified plaque index(m PLI),sulcus bleeding index(SBI),gingival index(GI),and probing depth(PD) were recorded and peri-implant marginal bone loss(MBL) was measured using paralleling projection technique. Patients' peri-implant oral hygiene maintainence habits were investigated. The correlation between peri-implant diseases and oral hygiene status and behaviors was analyzed. Results: Fifty patients(125 implants) with an average follow-up time of 22 months(6-54 months) were enrolled. The mean values of m PLI,SBI,and GI were 1. 4 ± 1. 2,0. 8 ± 0. 7,and 0. 7 ± 0. 6,respectively. Average PD was(2. 2 ± 0. 7) mm. Mesial and distal maginal bone resorptions were(1. 1 ± 1. 1) mm and(0. 9 ± 0. 9) mm,respectively. The prevalance of mucositis and peri-implantitis of the implants were 49. 6% and 0. The prevelance of mucositis in the patients with poor oral hygiene(m PLI≥2) was 11. 9 times as much as that of those with adequate oral hygiene(m PLI < 1). The patients who performed oral hygiene procedure on attachments at least twice a day achieved much lower m PLI scores than those who cleaned less than twice a day. Conclusion: Oral hygiene condition in the group of patients with implant overdentures was poor,and it contributed to increased risk of peri-implant mucositis. The prevelance of musositis of the paitients with poor oral hygiene was 11. 9 times as much as that of those with proper oral hygiene. Patients wearing IOD should pay more attention to the hygiene of the attachments.
Objective: To investigate the oral hygiene status of edentulous patients with locator attachments implant overdentures(IOD) and to analyze the relationship among daily hygiene behavior,oral hygiene status and peri-implant diseases. Methods: Edentulous patients who received IOD treatment with locator attachments from January 2012 to May 2016 were recruited. Clinical and radiographic examinations were conducted to assess the peri-implant tissue status. Modified plaque index(m PLI),sulcus bleeding index(SBI),gingival index(GI),and probing depth(PD) were recorded and peri-implant marginal bone loss(MBL) was measured using paralleling projection technique. Patients' peri-implant oral hygiene maintainence habits were investigated. The correlation between peri-implant diseases and oral hygiene status and behaviors was analyzed. Results: Fifty patients(125 implants) with an average follow-up time of 22 months(6-54 months) were enrolled. The mean values of m PLI,SBI,and GI were 1. 4 ± 1. 2,0. 8 ± 0. 7,and 0. 7 ± 0. 6,respectively. Average PD was(2. 2 ± 0. 7) mm. Mesial and distal maginal bone resorptions were(1. 1 ± 1. 1) mm and(0. 9 ± 0. 9) mm,respectively. The prevalance of mucositis and peri-implantitis of the implants were 49. 6% and 0. The prevelance of mucositis in the patients with poor oral hygiene(m PLI≥2) was 11. 9 times as much as that of those with adequate oral hygiene(m PLI < 1). The patients who performed oral hygiene procedure on attachments at least twice a day achieved much lower m PLI scores than those who cleaned less than twice a day. Conclusion: Oral hygiene condition in the group of patients with implant overdentures was poor,and it contributed to increased risk of peri-implant mucositis. The prevelance of musositis of the paitients with poor oral hygiene was 11. 9 times as much as that of those with proper oral hygiene. Patients wearing IOD should pay more attention to the hygiene of the attachments.
引文
[1] Lindhe J,Meyle J. Peri-implant diseases:Consensus report of the sixth European Workshop on periodontology[J]. J Clin Periodontol,2008,35(8 Suppl):282-285.
[2] Heitz-Mayfield LJ. Peri-implant diseases:diagnosis and risk indicators[J]. J Clin Periodontol,2008,35(8 Suppl):292-304.
[3] Laine ML,Leonhardt A,Roos-Jansker AM,et al. IL-1RN gene polymorphism is associated with peri-implantitis[J]. Clin Oral Implants Res,2006,17(4):380-385.
[4] Heitz-Mayfield LJ. Disease progression:identification of high-risk groups and individuals for periodontitis[J]. J Clin Periodontol,2005,32(Suppl 6):196-209.
[5] Ericsson I, Berglundh T, Marinello C,et al. Long-standing plaque and gingivitis at implants and teeth in the dog[J]. Clin Oral Implants Res,1992,3(3):99-103.
[6] Pontoriero R,Tonelli MP,Carnevale G,et al. Experimentally induced peri-implant mucositis. A clinical study in humans[J].Clin Oral Implants Res,1994,5(4):254-259.
[7] Salvi GE,Aglietta M,Eick S,et al. Reversibility of experimental peri-implant mucositis compared with experimental gingivitis in humans[J]. Clin Oral Implants Res,2012,23(2):182-190.
[8] Salvi GE,Ramseier CA. Efficacy of patient-administered mechanical and/or chemical plaque control protocols in the management of peri-implant mucositis. A systematic review[J]. J Clin Periodontol,2015,42(Suppl 16):S187-S201.
[9] Todescan S,Lavigne S,Kelekis-Cholakis A. Guidance for the maintenance care of dental implants:clinical review[J]. J Can Dent Assoc,2012,78:c107.
[10] Tawse-Smith A,Duncan WJ,Payne AG,et al. Relative effectiveness of powered and manual toothbrushes in elderly patients with implant-supported mandibular overdentures[J]. J Clin Periodontol,2002,29(4):275-280.
[11] Budtz-Jorgensen E. Prosthodontics for the elderly:Diagnosis and treatment[M]. Chicago:Quintessence,1999.
[12] Mombelli A,van Oosten MA,Schurch EJ,et al. The microbiota associated with successful or failing osseointegrated titanium implants[J]. Oral Microbiol Immunol,1987,2(4):145-151.
[13] Loe H,Silness J. Periodontal disease in pregnancy. I. Prevalence and severity[J]. Acta Odontol Scand,1963,21:533-551.
[14] Renvert S,Persson GR,Pirih FQ,et al. Peri-implant health,peri-implant mucositis,and peri-implantitis:Case definitions and diagnostic considerations[J]. J Periodontol,2018,89(Suppl1):S304-S312.
[15] Meijer HJA,Raghoebar GM,Batenburg RHK,et al. Mandibular overdentures supported by two Brnemark,IMZ or ITI implants:a ten-year prospective randomized study[J]. J Clin Periodontol,2009,36(9):799-806.
[16] Elsyad MA,Elsaih EA,Khairallah AS. Marginal bone resorption around immediate and delayed loaded implants supporting a locator-retained mandibular overdenture. A 1-year randomised controlled trial[J]. J Oral Rehabil,2014,41(8):608-618.
[17] di Torresanto VM,Milinkovic I,Torsello F,et al. Computer-assisted flapless implant surgery in edentulous elderly patients:a 2-year follow up[J]. Quintessence Int,2014,45(5):419-429.
[18]胡秀莲,罗佳,李健慧,等.无牙颌种植修复患者127例临床回顾研究[J].中华口腔医学杂志,2014,49(6):333-338.
[19] Meijer HJ,Raghoebar GM,de Waal YC,et al. Incidence of periimplant mucositis and peri-implantitis in edentulous patients with an implant-retained mandibular overdenture during a 10-year follow-up period[J]. J Clin Periodontol,2014,41(12):1178-1183.
[20] Roos-Jansaker AM,Renvert H,Lindahl C,et al. Nine-to fourteen-year follow-up of implant treatment. PartⅢ:factors associated with peri-implant lesions[J]. J Clin Periodontol,2006,33(4):296-301.
[21] Ferreira SD,Silva GL,Cortelli JR,et al. Prevalence and risk variables for peri-implant disease in Brazilian subjects[J]. J Clin Periodontol,2006,33(12):929-935.
[22] Zitzmann NU,Berglundh T,Marinello CP,et al. Experimental peri-implant mucositis in man[J]. J Clin Periodontol,2001,28(6):517-523.
[23] Costa FO,Takenaka-Martinez S,Cota LO,et al. Peri-implant disease in subjects with and without preventive maintenance:a 5-year follow-up[J]. J Clin Periodontol,2012,39(2):173-181.
[24] Ogata Y,Nakayama Y,Tatsumi J,et al. Prevalence and risk factors for peri-implant diseases in Japanese adult dental patients[J]. J Oral Sci,2016,59(1):1-11.
[25] D’Hoedt B,Schulte W. A comparative study of results with various endosseous implant systems[J]. Int J Oral Maxillofac Implants,1989,4(2):95-105.
[26] Versteegh PA,van Beek GJ,Slagter AP,et al. Clinical evaluation of mandibular overdentures supported by multiple-bar fabrication:a follow-up study of two implant systems[J]. Int J Oral Maxillofac Implants,1995,10(5):595-603.
[27] Kirsch A,Mentag PJ. The IMZ endosseous two phase implant system:a complete oral rehabilitation treatment concept[J]. J Oral Implantol,1986,12(4):576-589.
[28] Smith DE,Zarb GA. Criteria for success of osseointegrated endosseous implants[J]. J Prosthet Dent,1989,62(5):567-572.
[29] Esposito M,Hirsch JM,Lekholm U,et al. Biological factors contributing to failures of osseointegrated oral implants.(II). Etiopathogenesis[J]. Eur J Oral Sci,1998,106(3):721-764.
[30] Pjetursson BE,Helbling C,Weber HP,et al. Peri-implantitis susceptibility as it relates to periodontal therapy and supportive care[J]. Clin Oral Implants Res,2012,23(7):888-894.
[31] Cho-Yan LJ,Mattheos N,Nixon KC,et al. Residual periodontal pockets are a risk indicator for peri-implantitis in patients treated for periodontitis[J]. Clin Oral Implants Res,2012,23(3):325-333.
[32] Karoussis IK,Salvi GE,Heitz-Mayfield LJ,et al. Long-term implant prognosis in patients with and without a history of chronic periodontitis:a 10-year prospective cohort study of the ITI Dental Implant System[J]. Clin Oral Implants Res,2003,14(3):329-339.
[33] Mombelli A,Marxer M,Gaberthuel T,et al. The microbiota of osseointegrated implants in patients with a history of periodontal disease[J]. J Clin Periodontol,1995,22(2):124-130.
[34]张海东,孟焕新.牙周状况及牙周治疗对口腔种植修复长期效果的影响[J].中华口腔医学杂志,2013,48(4):229-232.
[35] Quirynen M,van Assche N. Microbial changes after full-mouth tooth extraction,followed by 2-stage implant placement[J]. J Clin Periodontol,2011,38(6):581-589.
[36] Teughels W,van Eldere J,van Steenberghe D,et al. Influence of nicotine and cotinine on epithelial colonization by periodontopathogens[J]. J Periodontol,2005,76(8):1315-1322.
[37] Huang R,Li M,Gregory RL. Effect of nicotine on growth and metabolism of Streptococcus mutans[J]. Eur J Oral Sci,2012,120(4):319-325.
[38] Li M,Huang R,Zhou X,et al. Effect of nicotine on dual-species biofilms of Streptococcus mutans and Streptococcus sanguinis[J].FEMS Microbiol Lett,2014,350(2):125-132.
[39] Barao VA,Ricomini-Filho AP,Faverani LP,et al. The role of nicotine,cotinine and caffeine on the electrochemical behavior and bacterial colonization to cp-Ti[J]. Mater Sci Eng C Mater Biol Appl,2015,56:114-124.
[40] Mombelli A,Muller N,Cionca N. The epidemiology of peri-implantitis[J]. Clin Oral Implants Res,2012,23(Suppl 6):67-76.
[41] Vervaeke S,Collaert B,Cosyn J,et al. A multifactorial analysis to identify predictors of implant failure and peri-implant bone loss[J]. Clin Implant Dent Relat Res,2015,17(Suppl 1):e298-e307.
[42] Strietzel FP,Reichart PA,Kale A,et al. Smoking interferes with the prognosis of dental implant treatment:a systematic review and meta-analysis[J]. J Clin Periodontol,2007,34(6):523-544.
[43] Zimmermann H,Zimmermann N,Hagenfeld D,et al. Is frequency of tooth brushing a risk factor for periodontitis? A systematic review and meta-analysis[J]. Community Dentistry and Oral Epidemiology,2015,43(2):116-127.
[44] Elsyad MA. Patient satisfaction and prosthetic aspects with miniimplants retained mandibular overdentures. A 5-year prospective study[J]. Clin Oral Implants Res,2016,27(7):926-933.
[45] Cordaro L,di Torresanto VM,Petricevic N,et al. Single unit attachments improve peri-implant soft tissue conditions in mandibular overdentures supported by four implants[J]. Clin Oral Implants Res,2013,24(5):536-542.
[46] Walton JN,Mac Entee MI. Problems with prostheses on implants:a retrospective study[J]. J Prosthet Dent,1994,71(3):283-288.
[2] Heitz-Mayfield LJ. Peri-implant diseases:diagnosis and risk indicators[J]. J Clin Periodontol,2008,35(8 Suppl):292-304.
[3] Laine ML,Leonhardt A,Roos-Jansker AM,et al. IL-1RN gene polymorphism is associated with peri-implantitis[J]. Clin Oral Implants Res,2006,17(4):380-385.
[4] Heitz-Mayfield LJ. Disease progression:identification of high-risk groups and individuals for periodontitis[J]. J Clin Periodontol,2005,32(Suppl 6):196-209.
[5] Ericsson I, Berglundh T, Marinello C,et al. Long-standing plaque and gingivitis at implants and teeth in the dog[J]. Clin Oral Implants Res,1992,3(3):99-103.
[6] Pontoriero R,Tonelli MP,Carnevale G,et al. Experimentally induced peri-implant mucositis. A clinical study in humans[J].Clin Oral Implants Res,1994,5(4):254-259.
[7] Salvi GE,Aglietta M,Eick S,et al. Reversibility of experimental peri-implant mucositis compared with experimental gingivitis in humans[J]. Clin Oral Implants Res,2012,23(2):182-190.
[8] Salvi GE,Ramseier CA. Efficacy of patient-administered mechanical and/or chemical plaque control protocols in the management of peri-implant mucositis. A systematic review[J]. J Clin Periodontol,2015,42(Suppl 16):S187-S201.
[9] Todescan S,Lavigne S,Kelekis-Cholakis A. Guidance for the maintenance care of dental implants:clinical review[J]. J Can Dent Assoc,2012,78:c107.
[10] Tawse-Smith A,Duncan WJ,Payne AG,et al. Relative effectiveness of powered and manual toothbrushes in elderly patients with implant-supported mandibular overdentures[J]. J Clin Periodontol,2002,29(4):275-280.
[11] Budtz-Jorgensen E. Prosthodontics for the elderly:Diagnosis and treatment[M]. Chicago:Quintessence,1999.
[12] Mombelli A,van Oosten MA,Schurch EJ,et al. The microbiota associated with successful or failing osseointegrated titanium implants[J]. Oral Microbiol Immunol,1987,2(4):145-151.
[13] Loe H,Silness J. Periodontal disease in pregnancy. I. Prevalence and severity[J]. Acta Odontol Scand,1963,21:533-551.
[14] Renvert S,Persson GR,Pirih FQ,et al. Peri-implant health,peri-implant mucositis,and peri-implantitis:Case definitions and diagnostic considerations[J]. J Periodontol,2018,89(Suppl1):S304-S312.
[15] Meijer HJA,Raghoebar GM,Batenburg RHK,et al. Mandibular overdentures supported by two Brnemark,IMZ or ITI implants:a ten-year prospective randomized study[J]. J Clin Periodontol,2009,36(9):799-806.
[16] Elsyad MA,Elsaih EA,Khairallah AS. Marginal bone resorption around immediate and delayed loaded implants supporting a locator-retained mandibular overdenture. A 1-year randomised controlled trial[J]. J Oral Rehabil,2014,41(8):608-618.
[17] di Torresanto VM,Milinkovic I,Torsello F,et al. Computer-assisted flapless implant surgery in edentulous elderly patients:a 2-year follow up[J]. Quintessence Int,2014,45(5):419-429.
[18]胡秀莲,罗佳,李健慧,等.无牙颌种植修复患者127例临床回顾研究[J].中华口腔医学杂志,2014,49(6):333-338.
[19] Meijer HJ,Raghoebar GM,de Waal YC,et al. Incidence of periimplant mucositis and peri-implantitis in edentulous patients with an implant-retained mandibular overdenture during a 10-year follow-up period[J]. J Clin Periodontol,2014,41(12):1178-1183.
[20] Roos-Jansaker AM,Renvert H,Lindahl C,et al. Nine-to fourteen-year follow-up of implant treatment. PartⅢ:factors associated with peri-implant lesions[J]. J Clin Periodontol,2006,33(4):296-301.
[21] Ferreira SD,Silva GL,Cortelli JR,et al. Prevalence and risk variables for peri-implant disease in Brazilian subjects[J]. J Clin Periodontol,2006,33(12):929-935.
[22] Zitzmann NU,Berglundh T,Marinello CP,et al. Experimental peri-implant mucositis in man[J]. J Clin Periodontol,2001,28(6):517-523.
[23] Costa FO,Takenaka-Martinez S,Cota LO,et al. Peri-implant disease in subjects with and without preventive maintenance:a 5-year follow-up[J]. J Clin Periodontol,2012,39(2):173-181.
[24] Ogata Y,Nakayama Y,Tatsumi J,et al. Prevalence and risk factors for peri-implant diseases in Japanese adult dental patients[J]. J Oral Sci,2016,59(1):1-11.
[25] D’Hoedt B,Schulte W. A comparative study of results with various endosseous implant systems[J]. Int J Oral Maxillofac Implants,1989,4(2):95-105.
[26] Versteegh PA,van Beek GJ,Slagter AP,et al. Clinical evaluation of mandibular overdentures supported by multiple-bar fabrication:a follow-up study of two implant systems[J]. Int J Oral Maxillofac Implants,1995,10(5):595-603.
[27] Kirsch A,Mentag PJ. The IMZ endosseous two phase implant system:a complete oral rehabilitation treatment concept[J]. J Oral Implantol,1986,12(4):576-589.
[28] Smith DE,Zarb GA. Criteria for success of osseointegrated endosseous implants[J]. J Prosthet Dent,1989,62(5):567-572.
[29] Esposito M,Hirsch JM,Lekholm U,et al. Biological factors contributing to failures of osseointegrated oral implants.(II). Etiopathogenesis[J]. Eur J Oral Sci,1998,106(3):721-764.
[30] Pjetursson BE,Helbling C,Weber HP,et al. Peri-implantitis susceptibility as it relates to periodontal therapy and supportive care[J]. Clin Oral Implants Res,2012,23(7):888-894.
[31] Cho-Yan LJ,Mattheos N,Nixon KC,et al. Residual periodontal pockets are a risk indicator for peri-implantitis in patients treated for periodontitis[J]. Clin Oral Implants Res,2012,23(3):325-333.
[32] Karoussis IK,Salvi GE,Heitz-Mayfield LJ,et al. Long-term implant prognosis in patients with and without a history of chronic periodontitis:a 10-year prospective cohort study of the ITI Dental Implant System[J]. Clin Oral Implants Res,2003,14(3):329-339.
[33] Mombelli A,Marxer M,Gaberthuel T,et al. The microbiota of osseointegrated implants in patients with a history of periodontal disease[J]. J Clin Periodontol,1995,22(2):124-130.
[34]张海东,孟焕新.牙周状况及牙周治疗对口腔种植修复长期效果的影响[J].中华口腔医学杂志,2013,48(4):229-232.
[35] Quirynen M,van Assche N. Microbial changes after full-mouth tooth extraction,followed by 2-stage implant placement[J]. J Clin Periodontol,2011,38(6):581-589.
[36] Teughels W,van Eldere J,van Steenberghe D,et al. Influence of nicotine and cotinine on epithelial colonization by periodontopathogens[J]. J Periodontol,2005,76(8):1315-1322.
[37] Huang R,Li M,Gregory RL. Effect of nicotine on growth and metabolism of Streptococcus mutans[J]. Eur J Oral Sci,2012,120(4):319-325.
[38] Li M,Huang R,Zhou X,et al. Effect of nicotine on dual-species biofilms of Streptococcus mutans and Streptococcus sanguinis[J].FEMS Microbiol Lett,2014,350(2):125-132.
[39] Barao VA,Ricomini-Filho AP,Faverani LP,et al. The role of nicotine,cotinine and caffeine on the electrochemical behavior and bacterial colonization to cp-Ti[J]. Mater Sci Eng C Mater Biol Appl,2015,56:114-124.
[40] Mombelli A,Muller N,Cionca N. The epidemiology of peri-implantitis[J]. Clin Oral Implants Res,2012,23(Suppl 6):67-76.
[41] Vervaeke S,Collaert B,Cosyn J,et al. A multifactorial analysis to identify predictors of implant failure and peri-implant bone loss[J]. Clin Implant Dent Relat Res,2015,17(Suppl 1):e298-e307.
[42] Strietzel FP,Reichart PA,Kale A,et al. Smoking interferes with the prognosis of dental implant treatment:a systematic review and meta-analysis[J]. J Clin Periodontol,2007,34(6):523-544.
[43] Zimmermann H,Zimmermann N,Hagenfeld D,et al. Is frequency of tooth brushing a risk factor for periodontitis? A systematic review and meta-analysis[J]. Community Dentistry and Oral Epidemiology,2015,43(2):116-127.
[44] Elsyad MA. Patient satisfaction and prosthetic aspects with miniimplants retained mandibular overdentures. A 5-year prospective study[J]. Clin Oral Implants Res,2016,27(7):926-933.
[45] Cordaro L,di Torresanto VM,Petricevic N,et al. Single unit attachments improve peri-implant soft tissue conditions in mandibular overdentures supported by four implants[J]. Clin Oral Implants Res,2013,24(5):536-542.
[46] Walton JN,Mac Entee MI. Problems with prostheses on implants:a retrospective study[J]. J Prosthet Dent,1994,71(3):283-288.