Risk of Superinfection in Peri-implantitis After Systemic Broad Spectrum Antibiotics.
Risk of Superinfection in Peri-implantitis After Systemic Broad Spectrum Antibiotics.
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DOI：
10.11607/prd.2546
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发表时间：
2017-08
期刊：
影响因子：
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通讯作者：
F. Verdugo
中科院分区：
文献类型：
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作者：
F. Verdugo
种植体周围疾病在过去几年中发展为通常难以解决的并发症。该病的发病过程主要是由细菌感染引起的。拟议的联合疗法使用广谱抗生素来阻止其进展。一个主要的相关风险是难以根除的重复感染的未被发现的发展。一组患有晚期种植体周围炎（PI）的健康个体因严重、快速进行性骨丢失而接受评价。既往接受过非手术和经验性抗生素治疗。对PI病变、健康种植体和唾液进行培养和基于聚合酶链反应的鉴定。临床和影像学检查显示探查时种植体周围出血、深囊袋和严重的影像学骨丢失伴硬膜板缺失。确定了一些重复感染因子，如伴放线菌聚集杆菌、牙龈卟啉单胞菌、嗜酸坦纳菌、齿垢密螺旋体、白色念珠菌和EB病毒（EBV）。EBV在种植体周围炎部位比在健康种植体和唾液中显著更普遍。特定的全身抗菌治疗和非手术或手术清创可以根除一些机会性病原体，但应进行随访试验，以确定潜在的新兴致病菌群，如白色念珠菌和肠杆菌，在植入物周围部位。可能需要抗真菌和抗病毒治疗。由于组织缺损的程度和严重性，取出了一些植入物。在免疫功能正常的个体中，植入物周围重复感染是与广谱抗生素相关的主要风险。缺乏随访和抗生素敏感性测试以及不加选择的经验性治疗方案可能导致持续的微生物挑战，从而加剧并维持疾病进展。个性化牙周支持治疗可以通过维持健康的微生物生态平衡，减少特定病原体比例，保持最佳的菌斑控制，并检测炎症的早期迹象来预防风险。
Peri-implant disease has developed over the last few years as a complication that is often difficult to resolve. The disease process is mainly attributed to bacterial infection. Proposed combined therapies use broad-spectrum antibiotics to halt its progression. A major associated risk is the undetected development of superinfections that are difficult to eradicate. A group of healthy individuals with advanced peri-implantitis (PI) were referred for evaluation due to severe, rapidly progressive bone loss. Previous nonsurgical and empiric antibiotic therapy had been rendered. Culture and polymerase chain reaction-based identification were performed for PI lesions, healthy implants, and saliva. Clinical and radiographic examinations revealed peri-implant bleeding on probing, deep pockets, and severe radiographic bone loss with absence of lamina dura. A number of superinfecting agents were identified, such as Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Candida albicans, and Epstein-Barr virus (EBV). EBV is significantly more prevalent at peri-implantitis sites than at healthy implants and in saliva. Specific systemic antimicrobial therapy and nonsurgical or surgical debridement may eradicate some opportunistic pathogens, but follow-up tests should be performed to identify potential emerging pathogenic microbiota, such as C albicans and enteric rods, at peri-implant sites. Antifungal and antiviral therapy may be needed. Due to the extent and severity of tissue loss, some implants were removed. Peri-implant superinfections are a major risk associated with broad-spectrum antibiotics in immunocompetent individuals. Lack of follow-up and antibiotic susceptibility testing and indiscriminate empiric treatment regimens may lead to ongoing microbial challenge that exacerbates and maintains the disease progression. Personalized periodontal supportive therapy could prevent risks by sustaining a healthy microbial ecologic balance, reducing specific pathogen proportions, maintaining optimal plaque control, and detecting early signs of inflammation.