种植体修复时间超过1年,碟形骨吸收至种植体平台下3 mm,不需要翻瓣植骨
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摘要
种植体周围骨吸收是种植修复后的常见现象。当种植体修复时间超过1年出现碟形骨吸收达到种植体平台下3mm时,是否需要进行翻瓣植骨是值得探讨的临床问题。本文根据最新种植修复生物学并发症临床治疗指南,从评估和诊断、排除和控制风险因素、非手术治疗清创、早期再评估、手术治疗、临床维护和支持等多方面对此进行论述,总结认为种植修复时间超过1年,碟形骨吸收至种植体肩台下3 mm时并不需要进行翻瓣植骨。
Peri-implant bone resorption is one of the common phenomena after crown delivery. It remains a clinical question worth discussing that whether or not open flap debridement is indicated when the"saucer-like"marginal bone loss accumulates to 3 mm below the implant shoulder after 1-year functional loading. According to the Consensus Statements for prevention and management of biological implant complications,this article will focus on the recommended clinical protocol of assessment,reduction and control of risk factors,nonsurgical debridement,early reassessment,operative treatment,and clinical maintenance and support,thus demonstrating that open flap debridement may not be necessary when the"saucer-like"marginal bone loss amounts to 3 mm.
Peri-implant bone resorption is one of the common phenomena after crown delivery. It remains a clinical question worth discussing that whether or not open flap debridement is indicated when the"saucer-like"marginal bone loss accumulates to 3 mm below the implant shoulder after 1-year functional loading. According to the Consensus Statements for prevention and management of biological implant complications,this article will focus on the recommended clinical protocol of assessment,reduction and control of risk factors,nonsurgical debridement,early reassessment,operative treatment,and clinical maintenance and support,thus demonstrating that open flap debridement may not be necessary when the"saucer-like"marginal bone loss amounts to 3 mm.
引文
[1]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(Suppl 1):S304-S312.
[2]Heitz-Mayfield LJ,Needleman I,Salvi GE,et al.Concensus statements and clinical recommendations for prevention and management of biologic and technical implant complications[J].Int JOral Maxillofac Implants,2014,29:346-350.
[3]Aljateeli M,Fu JH,Wang HL.Managing peri-implant bone loss:current understanding[J].Clin Implant Dent Relat Res,2012,14(1):109-118.
[4]Wilson TG Jr.The positive relationship between excess cement andperi-implant disease:a prospective clinical endoscopic study[J].J Periodontol,2009,80(9):1388-1392.
[5]De Martinis Terra E,Berardini M,Trisi P.Nonsurgical management of peri-implant bone loss induced by residual cement:retrospective analysis of six cases[J/OL].Int J Peridontontic Restorative Dent,2018[2018-11-06].doi:10.11607/prd.3075.
[6]Nibali L,Donos N.Radiographic bone fill of peri-implantitis defects following nonsurgical therapy:Report of three cases[J].Quintessence Int,2011,42(5):393-397.
[7]Renvert S,Samuelsson E,Lindahl C,et al.Mechanical non-surgical treatment of peri-implantitis:a double-blind randomized longitudinal clinical study.I:clinical results[J].J Clin Periodontol,2009,36(7):604-609.
[8]Karring ES,Stavropoulos A,Ellegaard B,et al.Treatment of peri-implantitis by the Vector system[J].Clin Oral Implants Res,2005,16(3):288-293.
[9]Schwarz F,Bieling K,Nuesry E,et al.Clinical and histological healing pattern of peri-implantitis lesions following non-surgical treatment with an Er:YAG laser[J].Lasers Surg Med,2006,38(7):663-671.
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[11]Roncati M,Lucchese A,Carinci F.Non-surgical treatment of peri-implantitis with the adjunctive use of an 810-nm diode laser[J].J Indian Soc Periodontol,2013,17(6):812-815.
[12]Mettraux GR,Sculean A,Burgin WB,et al.Two-year clinical outcomes following non-surgical mechanical therapy of peri-implantitis with adjunctive diode laser application[J].Clin Oral Implants Res,2016,27(7):845-849.
[13]Bassetti M,Schar D,Wicki B,et al.Anti-infective therapy of peri-implantitis with adjunctive local drug delivery or photodynamic therapy:12-month outcomes of a randomized controlled clinical trial[J].Clin Oral Implants Res,2014,25(3):279-287.
[14]Heitz-Mayfield LJ,Mombelli A.The therapy of peri-implantitis:a systematic review[J].Int J Oral Maxillofac Implants,2014,29(Suppl):325-245.
[15]John G,Becker J,Schwarz F.Effectivity of air-abrasive powder based on glycine and tricalcium phosphate in removal of initial biofilm on titanium and zirconium oxide surfaces in an ex vivo model[J].Clin Oral Investig,2016,20(4):711-719.
[16]John G,Sahm N,Becker J,et al.Nonsurgical treatment of periimplantitis using an air-abrasive device or mechanical debridement and local application of chlorhexidine.Twelve-month follow-up of a prospective,randomized,controlled clinical study[J].Clin Oral Investig,2015,19(8):1807-1814.
[17]John G,Becker J,Schmucker A,et al.Non-surgical treatment of peri-implant mucositis and peri-implantitis at two-piece zirconium implants:A clinical follow-up observation after up to 3 years[J].JClin Periodontol,2017,44(7):756-761.
[18]Mettraux GR,Sculean A,Bürgin WB,et al.Two-year clinical outcomes following non-surgical mechanical therapy of peri-implantitis with adjunctive diode laser application[J].Clin Oral Implants Res,2016,27(7):845-849.
[19]Schwarz F,Herten M,Sager M,et al.Comparison of naturally occurring and ligature-induced peri-implantitis bone defects in humans and dogs[J].Clin Oral Implants Res,2007,18(2):161-170.
[20]Schwarz F,Sculean A,Bieling K,et al.Two-year clinical results following treatment of peri-implantitis lesions using a nanocrystalline hydroxyapatite or a natural bone mineral in combination with a collagen membrane[J].J Clin Periodontol,2008,35(1):80-87.
[21]Schwarz F,Sahm N,Schwarz K,et al.Impact of defect configuration on the clinical outcome following surgical regenerative therapy of peri-implantitis[J].J Clin Periodontol,2010,37(5):449-55.
[22]Roos-Jansaker AM,Persson GR,Lindahl C,et al.Surgical treatment of peri-implantitis using a bone substitute with or without a resorbable membrane:a 5-year follow-up[J].J Clin Periodontol,2014,41(11):1108-1114.
[23]Roccuzzo M,Gaudioso L,Lungo M,et al.Surgical therapy of single peri-implantitis intrabony defects,by means of deproteinized bovine bone mineral with 10%collagen[J].J Clin Periodontol,2016,43(3):311-318.
[24]Roccuzzo M,Pittoni D,Roccuzzo A,et al.Surgical treatment of peri-implantitis intrabony lesions by means of deproteinized bovine bone mineral with 10%collagen:7-year-results[J].Clin Oral Implants Res,2017,28(12):1577-1583.
[25]Ramanauskaite A,Daugela P,Faria de Almeida R,et al.Surgical non-regenerative treatments for peri-implantitis:a systematic revie[J].J Oral Maxillofac Res,2016,7(3):e14.
[26]Renvert S,Polyzois I,Claffey N.Surgical therapy for the control of peri-implantitis[J].Clin Oral Implants Res,2012,23(Suppl 6):84-94.
[27]Nociti FH Jr,Caffesse RG,Sallum EA,et al.Evaluation of guided bone regeneration and/or bone grafts in the treatment of ligatureinduced peri-implantitis defects:a morphometric study in dogs[J].J Oral Implantol,2000,26(4):244-249.
[2]Heitz-Mayfield LJ,Needleman I,Salvi GE,et al.Concensus statements and clinical recommendations for prevention and management of biologic and technical implant complications[J].Int JOral Maxillofac Implants,2014,29:346-350.
[3]Aljateeli M,Fu JH,Wang HL.Managing peri-implant bone loss:current understanding[J].Clin Implant Dent Relat Res,2012,14(1):109-118.
[4]Wilson TG Jr.The positive relationship between excess cement andperi-implant disease:a prospective clinical endoscopic study[J].J Periodontol,2009,80(9):1388-1392.
[5]De Martinis Terra E,Berardini M,Trisi P.Nonsurgical management of peri-implant bone loss induced by residual cement:retrospective analysis of six cases[J/OL].Int J Peridontontic Restorative Dent,2018[2018-11-06].doi:10.11607/prd.3075.
[6]Nibali L,Donos N.Radiographic bone fill of peri-implantitis defects following nonsurgical therapy:Report of three cases[J].Quintessence Int,2011,42(5):393-397.
[7]Renvert S,Samuelsson E,Lindahl C,et al.Mechanical non-surgical treatment of peri-implantitis:a double-blind randomized longitudinal clinical study.I:clinical results[J].J Clin Periodontol,2009,36(7):604-609.
[8]Karring ES,Stavropoulos A,Ellegaard B,et al.Treatment of peri-implantitis by the Vector system[J].Clin Oral Implants Res,2005,16(3):288-293.
[9]Schwarz F,Bieling K,Nuesry E,et al.Clinical and histological healing pattern of peri-implantitis lesions following non-surgical treatment with an Er:YAG laser[J].Lasers Surg Med,2006,38(7):663-671.
[10]Renvert S,Lindahl C,Roos Jansaker AM,et al.Treatment of peri-implantitis using an Er:YAG laser or an air-abrasive device:a randomized clinical trial[J].J Clin Periodontol,2011,38(1):65-73.
[11]Roncati M,Lucchese A,Carinci F.Non-surgical treatment of peri-implantitis with the adjunctive use of an 810-nm diode laser[J].J Indian Soc Periodontol,2013,17(6):812-815.
[12]Mettraux GR,Sculean A,Burgin WB,et al.Two-year clinical outcomes following non-surgical mechanical therapy of peri-implantitis with adjunctive diode laser application[J].Clin Oral Implants Res,2016,27(7):845-849.
[13]Bassetti M,Schar D,Wicki B,et al.Anti-infective therapy of peri-implantitis with adjunctive local drug delivery or photodynamic therapy:12-month outcomes of a randomized controlled clinical trial[J].Clin Oral Implants Res,2014,25(3):279-287.
[14]Heitz-Mayfield LJ,Mombelli A.The therapy of peri-implantitis:a systematic review[J].Int J Oral Maxillofac Implants,2014,29(Suppl):325-245.
[15]John G,Becker J,Schwarz F.Effectivity of air-abrasive powder based on glycine and tricalcium phosphate in removal of initial biofilm on titanium and zirconium oxide surfaces in an ex vivo model[J].Clin Oral Investig,2016,20(4):711-719.
[16]John G,Sahm N,Becker J,et al.Nonsurgical treatment of periimplantitis using an air-abrasive device or mechanical debridement and local application of chlorhexidine.Twelve-month follow-up of a prospective,randomized,controlled clinical study[J].Clin Oral Investig,2015,19(8):1807-1814.
[17]John G,Becker J,Schmucker A,et al.Non-surgical treatment of peri-implant mucositis and peri-implantitis at two-piece zirconium implants:A clinical follow-up observation after up to 3 years[J].JClin Periodontol,2017,44(7):756-761.
[18]Mettraux GR,Sculean A,Bürgin WB,et al.Two-year clinical outcomes following non-surgical mechanical therapy of peri-implantitis with adjunctive diode laser application[J].Clin Oral Implants Res,2016,27(7):845-849.
[19]Schwarz F,Herten M,Sager M,et al.Comparison of naturally occurring and ligature-induced peri-implantitis bone defects in humans and dogs[J].Clin Oral Implants Res,2007,18(2):161-170.
[20]Schwarz F,Sculean A,Bieling K,et al.Two-year clinical results following treatment of peri-implantitis lesions using a nanocrystalline hydroxyapatite or a natural bone mineral in combination with a collagen membrane[J].J Clin Periodontol,2008,35(1):80-87.
[21]Schwarz F,Sahm N,Schwarz K,et al.Impact of defect configuration on the clinical outcome following surgical regenerative therapy of peri-implantitis[J].J Clin Periodontol,2010,37(5):449-55.
[22]Roos-Jansaker AM,Persson GR,Lindahl C,et al.Surgical treatment of peri-implantitis using a bone substitute with or without a resorbable membrane:a 5-year follow-up[J].J Clin Periodontol,2014,41(11):1108-1114.
[23]Roccuzzo M,Gaudioso L,Lungo M,et al.Surgical therapy of single peri-implantitis intrabony defects,by means of deproteinized bovine bone mineral with 10%collagen[J].J Clin Periodontol,2016,43(3):311-318.
[24]Roccuzzo M,Pittoni D,Roccuzzo A,et al.Surgical treatment of peri-implantitis intrabony lesions by means of deproteinized bovine bone mineral with 10%collagen:7-year-results[J].Clin Oral Implants Res,2017,28(12):1577-1583.
[25]Ramanauskaite A,Daugela P,Faria de Almeida R,et al.Surgical non-regenerative treatments for peri-implantitis:a systematic revie[J].J Oral Maxillofac Res,2016,7(3):e14.
[26]Renvert S,Polyzois I,Claffey N.Surgical therapy for the control of peri-implantitis[J].Clin Oral Implants Res,2012,23(Suppl 6):84-94.
[27]Nociti FH Jr,Caffesse RG,Sallum EA,et al.Evaluation of guided bone regeneration and/or bone grafts in the treatment of ligatureinduced peri-implantitis defects:a morphometric study in dogs[J].J Oral Implantol,2000,26(4):244-249.