Management of peri-implant mucositis and peri-implantitis
Management of peri-implant mucositis and peri-implantitis
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DOI：
10.1111/prd.12049
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发表时间：
2014-10-01
影响因子：
18.6
通讯作者：
Sanz, Mariano
中科院分区：
文献类型：
--
作者：
Figuero, Elena;Graziani, Filippo;Sanz, Mariano
种植体周围疾病是指种植体周围组织的炎性病变，包括种植体周围粘膜炎(一种局限于种植体周围黏膜的炎性病变)和种植体周围的炎性病变(一种影响支撑骨的炎性病变，导致骨整合丧失)。本审查旨在描述管理这两个实体的不同方法，并对现有的关于其效力的证据进行关键评价。种植体周黏膜炎的治疗和种植体周围炎的非手术治疗通常包括使用刮刀、超声波装置、空气研磨器或激光对种植体表面进行机械清理，并辅以或不使用局部抗生素或防腐剂。这些疗法对粘膜炎的疗效已被证明：对照临床试验显示临床参数有改善，尤其是在探查出血方面。对于种植体周围炎，结果是有限的，特别是在探查口袋深度减少方面。种植体周围炎的手术治疗是指非手术治疗不能控制炎症变化。手术方式的选择应根据种植体周围病变的特点。在存在深层环周和骨内缺陷的情况下，手术干预的目的应该是提供彻底的清创、种植体表面去污和缺陷重建。如果存在无明显骨壁或有明显松质成分的缺陷，手术干预的目的应该是彻底清创和重新定位边缘粘膜，以使患者能够进行有效的口腔卫生实践，尽管这一目标可能会损害种植体支持的修复的美学效果。
Peri‐implant diseases are defined as inflammatory lesions of the surrounding peri‐implant tissues and include peri‐implant mucositis (an inflammatory lesion limited to the surrounding mucosa of an implant) and peri‐implantitis (an inflammatory lesion of the mucosa that affects the supporting bone with resulting loss of osseointegration). This review aims to describe the different approaches to manage both entities and to provide a critical evaluation of the evidence available on their efficacy. Therapy of peri‐implant mucositis and nonsurgical therapy of peri‐implantitis usually involve mechanical debridement of the implant surface using curettes, ultrasonic devices, air‐abrasive devices or lasers, with or without the adjunctive use of local antibiotics or antiseptics. The efficacy of these therapies has been demonstrated for mucositis: controlled clinical trials show an improvement in clinical parameters, especially in bleeding on probing. For peri‐implantitis, the results are limited, especially in terms of probing pocket‐depth reduction. Surgical therapy of peri‐implantitis is indicated when nonsurgical therapy fails to control the inflammatory changes. Selection of the surgical technique should be based on the characteristics of the peri‐implant lesion. In the presence of deep circumferential and intrabony defects, surgical interventions should aim to provide thorough debridement, implant‐surface decontamination and defect reconstruction. In the presence of defects without clear bony walls or with a predominant suprabony component, the aim of the surgical intervention should be the thorough debridement and the repositioning of the marginal mucosa to enable the patient to perform effective oral‐hygiene practices, although this aim may compromise the esthetic result of the implant‐supported restoration.