A conceptual review on reconstructive peri-implantitis therapy: Challenges and opportunities.
A conceptual review on reconstructive peri-implantitis therapy: Challenges and opportunities.
复制标题
DOI：
10.1002/cre2.788
复制
发表时间：
2023-10
影响因子：
1.8
通讯作者：
中科院分区：
文献类型：
--
作者：
目前重建因疾病而丢失的植入物组织的策略在很大程度上是不可预测的。本概念综述的目的是讨论应用重建方法治疗种植体炎的相关生物学和生物力学挑战。此外，提出了改善治疗可预测性的机会。为了达到目的，进行了叙述性综述。阻碍有效重建的四个相互关联的负面条件是：组织灌注不足、骨地形图不良、表面处理无效和伤口不稳定。首先，种植体组织类似于瘢痕，细胞结构和血管分布减少，加上缺乏牙周韧带丛和无血管种植体和生物材料，保持一期闭合是一项挑战，这对再生至关重要。其次，种植体周围的缺损形态和骨形貌决定了重建潜力。不幸的是，经常会遇到非包容性缺损，骨上（水平骨缺损）和骨下（垂直骨缺损，通常涉及周向骨缺损）缺损的组合。第三，目前植入物表面去污的尝试是不够的，因为在微观尺度上难以接近宏观结构和粗糙表面。组织学评价显示植入物周围有细菌聚集和钙化沉积物。最后，由于固有的软组织生物力学质量和数量缺陷以及移动的骨颗粒，难以实现伤口稳定性。解决上述挑战的机会包括使用新型成像技术，如高频牙科超声和激光散斑成像，以评估组织灌注、软组织质量/数量和术前骨地形图。使用手术显微镜可以更好地观察和去除病因。改善软组织质量的策略可能包括术前控制软组织炎症和生物制剂的潜在使用。诸如固定以稳定生物材料的方法可能是有益的。对当前挑战和机遇的更细致的理解可以导致更有效的术前和术后护理方案，最终提高重建手术的成功率。
The current strategies to reconstruct lost peri‐implant tissues due to the disease have been largely unpredictable. The aim of this conceptual review is to discuss relevant biological and biomechanical challenges of applying reconstructive means to treat peri‐implantitis. Additionally, opportunities to improve treatment predictability are presented. A narrative review was conducted to fulfill the aim. The four interrelated negative conditions hampering effective reconstruction are: inferior tissue perfusion, unfavorable bone topography, ineffective surface treatment, and unstable wound. First, peri‐implant tissues resemble scars with reduced cellularity and vascularity, coupled with the absence of the periodontal ligament plexuses and the avascular implant and biomaterials, maintaining primary closure is a challenge, which is critical for regeneration. Second, defect morphology and bone topography surrounding implants determine the reconstructive potential. Unfortunately, noncontained defects are frequently encountered, with a combination of suprabony (horizontal bone loss) and infrabony (vertical usually involving circumferential bone loss) defects. Third, current attempts for implant surface decontamination are insufficient due to inaccessible macrostructure and rough surfaces in the micro‐scale. Histologic evaluation has shown bacteria aggregation and calcified deposits around implants. Lastly, wound stability is difficult to achieve due to inherent soft tissue biomechanical quality and quantity deficiencies and mobile bone particulates. Opportunities to tackle the abovementioned challenges include the use of novel imaging technologies, such as high‐frequency dental ultrasound and laser speckle imaging to evaluate tissue perfusion, soft tissue quality/quantity, and bone topography pre‐surgically. The use of the operating microscope could allow better visualization and removal of etiologic factors. Strategies to improve soft tissue quality may include preoperative control of soft tissue inflammation and the potential use of biologics. Methods such as fixation to stabilize the biomaterials could be beneficial. A more nuanced understanding of the current challenges and opportunities can lead to more effective preoperative and postoperative care protocols, ultimately improving the success rate of reconstructive procedures.