锥形锁柱种植体用于因牙周炎缺牙患者修复的临床观察

Clinical study of locking-taper implants in patients treated for periodontitis

目的:比较因非牙周炎(non-periodontitis,NP)、慢性牙周炎(chronic periodontitis,CP)、侵袭性牙周炎(aggressive periodontitis,Ag P)失牙患者行Bicon种植修复后1~5年种植体存留率及种植体周围组织探诊指标变化。方法:基于前瞻性队列研究,纳入2008年9月至2012年9月于北京大学口腔医院牙周科就诊的缺牙患者145名,共植入种植体315枚。其中CP失牙患者70例,Ag P失牙患者31例,NP失牙患者44例,分别植入132、83、100枚种植体。对研究对象进行问卷调查和随访,检查并记录患者刮治前(T0)、种植前(T1)、复查时(T2)的牙周临床指标,记录种植修复完成时及T2时的种植体周围组织牙周指标并拍摄X线根尖片,T2时记录种植体存留情况。采用t检验比较不同分组的种植体存留率、种植体探诊深度(probing depth,PD)变化。结果:经系统牙周基础治疗后,T1时期CP组和Ag P组PD≥6 mm位点百分比(%)较T0时显著降低(P<0.001),且T2与T1相比,PD≥6 mm位点百分比差异无统计学意义(P>0.05)。NP组、CP组和Ag P组种植体1~5年存留率分别为100%、97.6%和100%,三组间差异无统计学意义(P>0.05)。T2时,CP组与AgP组种植体平均PD分别为2.96 mm、2.97 mm,显著高于NP组(2.78 mm)(P=0.006,P=0.010);CP组与AgP组种植体平均PD≥6 mm位点百分比分别为3.7%、4.8%,显著高于NP组(1.2%)(P=0.003,P<0.001);CP组种植体PD较修复完成时增加2 mm以上的位点百分比为8.4%,显著高于NP组(4.3%,P=0.003),但AgP组与NP组间差异无统计学意义(P>0.05)。结论:经积极牙周基础治疗,CP和AgP患者牙周状况在种植前得到显著改善,并在种植修复完成1~5年后基本稳定;CP和Ag P患者植入锥形锁柱种植体的短期累积存留率与NP患者相近,但CP和Ag P患者种植体周围组织PD随时间增加的趋势更为明显。

Objective:To evaluate the survival rate and peri-implant clinical parameters of Locking-Taper implants in patients having lost their teeth due to non-periodontitis(NP)reasons,chronic periodontitis(CP)and aggressive periodontitis(AgP).Methods:In the study,145 subjects were installed with 315 Bicon Locking-Taper implants and followed up for 1-5 years.The subjects and implants were classified into three groups,tooth loss by NP,CP and AgP.NP included 44 subjects with 100 implants,CP 70 subjects with 132 implants and AgP 31 subjects with 83 implants.Periodontal parameters before subgingival scaling and root planning(T0),at the end of active periodontal therapy(T1)and at the time of last recall(T2)were recorded.Right after the installation of final restoration and at the time of last recall(T2),peri-implant probing parameters were recorded.Results:After active periodontal therapy,mean probing depth(PD)in CP and AgP were reduced from 4.05 mm,5.20 mm at T0 to 3.07 mm,2.96 mm at T1(P<0.001,P<0.001),(PD≥6 mm)%were reduced from 33.2%,58.5%at T0 to 14.4%,10.5%at T1(P<0.001,P<0.001).The periodontal parameters remained stable at T2 compared with T1(P>0.05).Cumulative survival rates of implants in NP,CP and AgP were 100%,97.6%and 100%for 1-5 years’follow-ups with no statistical significance found.At T2,mean implant PD was 2.78 mm,2.96 mm and 2.97 mm in NP,CP and AgP,with NP significantly lower than the other two groups(P=0.006,P=0.01).The percentage of implant sites with PD≥6 mm was 3.7%in CP and 4.8%in AgP,both significantly higher than NP(P=0.003,P<0.001).8.4%implant sites showed at least 2 mm deeper than those at prosthesis installation were found in CP group,significantly higher than NP(4.3%,P=0.003).Conclusion:Periodontal conditions of patients having lost their teeth for chronic and aggressive periodontitis were significantly improved after active periodontal therapy and remained stable during 1-5 years.Short-term survival rates of Locking-Taper implants in patients treated for CP and AgP was no less than those who lost their teeth for non-periodontitis reasons.More sites with increasing peri-implant probing depth were found in CP and AgP patients,compared with NP.