Outcome of implant therapy in patients with previous tooth loss due to periodontitis
Outcome of implant therapy in patients with previous tooth loss due to periodontitis
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DOI：
10.1111/j.1600-0501.2006.01347.x
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发表时间：
2006-10-01
影响因子：
4.3
通讯作者：
Esposito, Marco
中科院分区：
文献类型：
--
作者：
Schou, Soren;Holmstrup, Palle;Esposito, Marco
背景：对于因牙周炎导致牙齿脱落的患者进行种植治疗是否会增加种植体脱落和种植周炎的发生率，人们经常争论。目的：本系统综述的目的是评估由于牙周炎导致的既往牙齿脱落的个体与由于牙周炎以外的原因导致的既往牙齿脱落的个体相比，是否有更高的上结构丢失、种植体丢失、种植体周围炎和种植体周围边缘骨丢失的风险。检索策略：考虑纳入的研究在MEDLINE （PubMed）中检索，并手工检索相关期刊。此外，检索了用于全文筛选的文章的参考文献列表以及与本系统综述相关的先前发表的综述。检索由一名审稿人完成，限于1980年1月1日至2006年1月1日发表的人类研究。没有语言限制。选择标准：包括前瞻性和回顾性队列研究，随访至少5年，分别比较牙周炎相关和非牙周炎相关牙齿脱落患者种植体治疗的结果。结果测量是上结构的存活、种植体的存活、种植体周围炎的发生和种植体周围边缘骨丢失。评估5年和10年时间点。数据收集和分析：筛选符合条件的研究、方法学质量评估和数据提取由两名作者独立进行。我们联系了作者，以补充遗漏的信息。结果表示为随机效应模型，连续结果使用加权平均差异，二分类结果使用95%置信区间（ci）的相对风险。主要结果：两项研究分别进行了5年和10年的随访，包括33例因牙周炎导致的牙齿脱落患者和70例非牙周炎相关性牙齿脱落患者。5年后，两组间上层建筑的存活率无显著差异。此外，种植体在5年和10年后的存活率没有显著差异。然而，在10年随访期间，牙周炎相关牙齿脱落组发生种植周炎的患者明显多于牙周炎相关牙齿脱落组，风险比（RR）为9 （95% Cl 3.94-20.57）。此外，5年后牙周炎相关牙丢失患者种植体周围边缘骨丢失显著增加，平均差异0.5 mm （95% CI 0.06-0.94）。结论：牙周炎相关性和非牙周炎相关性牙齿脱落患者的上结构和种植体的存活率无显著差异。然而，在牙周炎相关牙齿脱落的个体中，种植体周围炎的发生率显著增加，种植体周围边缘骨丢失显著增加。这两项研究的小样本量和方法学质量评估表明，结果应谨慎解释。因此，在对有牙周炎病史的患者进行种植治疗的结果得出最终结论之前，需要进一步的长期研究，特别是针对侵袭性牙周炎的年轻成人种植治疗的结果。
Background: It is frequently debated whether implant treatment in individuals with previous tooth loss due to periodontitis is characterized by an increased incidence of implant loss and peri-implantitis.Objective: The objective of the present systematic review was to assess whether individuals with previous tooth loss due to periodontitis have an increased risk of loss of suprastructures, loss of implants, peri-implantitis, and peri-implant marginal bone loss as compared with individuals with previous tooth loss due to reasons other than periodontitis.Search strategy: Studies considered for inclusion were searched in MEDLINE (PubMed) and relevant journals were hand searched. Moreover, reference lists of articles selected for full-text screening as well as previously published reviews relevant for the present systematic review were searched. The search was performed by one reviewer and was restricted to human studies published from January 1, 1980 to January 1, 2006. No language restrictions were applied.Selection criteria: Prospective and retrospective cohort studies with at least a 5-year follow-up comparing the outcome of implant treatment in individuals with periodontitis-associated and non-periodontitis-associated tooth loss, respectively, were included. The outcome measures were survival of suprastructures, survival of implants, occurrence of peri-implantitis, and peri-implant marginal bone loss. The 5- and 10-year time points were evaluated.Data collection and analysis: Screening of eligible studies, methodological quality assessment, and data extraction were conducted in duplicate and independently by two of the authors. The authors were contacted for missing information.Results were expressed as random effect models using weighted mean differences for continuous outcomes and relative risk for dichotomous outcomes with 95% confidence intervals (CIs).Main results: Two studies with a 5- and 10-year follow-up, respectively, were identified including a total of 33 patients with tooth loss due to periodontitis and 70 patients with non-periodontitis-associated tooth loss. There was no significant difference in the survival of the suprastructures after 5 years. Furthermore, there were no significant differences in the survival of the implants after 5 and 10 years. However, there were significantly more patients affected by peri-implantitis in the group with periodontitis-associated tooth loss during the 10-year follow-up period, risk ratio (RR) 9 (95% Cl 3.94-20.57). Moreover, significantly increased peri-implant marginal bone loss was observed in patients with periodontitis-associated tooth loss after 5 years, mean difference 0.5 mm (95% CI 0.06-0.94).Conclusions: The survival of the suprastructures and the implants was not significantly different in individuals with periodontitis-associated and non-periodontitis-associated tooth loss. However, significantly increased incidence of peri-implantitis and significantly increased peri-implant marginal bone loss were revealed in individuals with periodontitis-associated tooth loss. The small sample size and the methodological quality assessment of the two studies suggest that the results should be interpreted with caution. Consequently, further long-term studies focusing particularly on the outcome of implant treatment in young adults with aggressive periodontitis are needed before final conclusions can be drawn about the outcome of implant treatment in patients with a history of periodontitis.