慢性牙周炎患者龈下菌斑对种植体周骨吸收影响的临床研究

Clinical study on the effect of subgingival plaque on peri-implant bone resorption in patients with chronic periodontitis

目的探讨慢性牙周炎患者种植体手术治疗中龈下菌斑与种植体周围骨吸收的关系。方法采用前瞻性对照研究的方法,选取2016年4月至2018年8月秦皇岛市第二医院收治的选择种植体修复治疗的牙缺失患者84例,根据是否存在慢性牙周炎将患者分为两组,观察组(存在慢性牙周炎) 44例种植49颗牙,对照组(不存在慢性牙周炎) 40例种植53颗牙,比较两组患者的种植体改良菌斑指数(m PLI)、改良龈沟出血指数(m SBI)与种植体周围的骨吸收量。结果两组患者手术结束后种植体稳定性较强,未出现脱落情况,影像学检查显示种植体附近牙槽骨没有低密度阴影。观察组49颗牙术前m PLI为(2. 51±0. 19)分,相比对照组的(1. 34±0. 15)分明显升高(P <0. 05);术后m PLI为(0. 82±0. 12)分,明显低于术前(P <0. 05),与对照组的(0. 83±0. 11)分相比差异无统计学意义(P> 0. 05)。观察组术前mSBI为(2. 05±0. 24)分,术后为(1. 71±0. 23)分;对照组术前mSBI为(2. 01±0. 21)分,术后mSBI为(1. 24±0. 22)分。两组患者术前m SBI差异无统计学意义(P> 0. 05),术后两组患者m SBI均明显降低(P <0. 05),观察组患者术后m SBI明显高于对照组(P <0. 05)。观察组术前种植体远中边缘骨吸收量为(2. 76±0. 22) mm,术后为(1. 42±0. 25) mm,近中边缘骨吸收量为(2. 78±0. 29) mm,术后为(1. 23±0. 14) mm;对照组术前种植体远中边缘骨吸收量为(2. 81±0. 26) mm,术后为(1. 25±0. 21) mm,近中边缘骨吸收量为(2. 76±0. 24) mm,术后为(1. 38±0. 19) mm。两组患者术前远中与近中边缘骨吸收量比较差异无统计学意义(P> 0. 05),术后两组患者远中与近中边缘骨吸收量均明显降低(P <0. 05);观察组患者术后远中边缘骨吸收量明显高于对照组(P <0. 05),近中边缘骨吸收量明显低于对照组(P <0. 05)。结论慢性牙周炎患者龈下菌斑相比无牙周炎患者明显增多,对种植体附近边缘骨吸收存在明显的影响,在常规牙周治疗后能够提高种植体边缘骨稳定性。

Objective To investigate the relationship between subgingival plaque and bone resorption around implants in the surgical treatment of patients with chronic periodontitis.Methods A prospective controlled study was conducted to select 84 patients with tooth loss who underwent selective implant restoration treatment from April 2016 to August 2018 in Qinhuangdao Second Hospital.Patients were divided into two groups according to the presence or absence of chronic periodontitis.In the observation group(the presence of chronic periodontitis),44 cases were implanted with 49 teeth,and in the control group(no chronic periodontitis),40 cases were implanted with 53 teeth.The implant modified plaque index(m PLI)and improvement were compared between the two groups.The sulcus bleeding index(m SBI)and the amount of bone resorption around the implant.Results The implants were stable after surgery and there was no shedding.Imaging studies showed no low-density shadows in the alveolar bone near the implant.The preoperative m PLI of the 49 teeth in the observation group was(2.51±0.19),which was significantly higher than that of the control group(1.34±0.15)(P<0.05).The postoperative m PLI was(0.82±0.12),which was significantly lower than that.There was no significant difference between the preoperative(P<0.05)and the control group(0.83±0.11)(P>0.05).The mSBI of the observation group was(2.05±0.24)points and(1.71±0.23)points after operation.The preoperative m SBI was(2.01±0.21)points and the postoperative m SBI was(1.24±0.22)points.There was no significant difference in preoperative m SBI between the two groups(P>0.05).The m SBI of the two groups were significantly lower(P<0.05).The postoperative m SBI of the observation group was significantly higher than that of the control group(P<0.05).In the observation group,the bone resorption of the distal margin of the implant was(2.76±0.22)mm,the postoperative was(1.42±0.25)mm,the proximal margin bone resorption was(2.78±0.29)mm,and the postoperative was(1.23±0.14)mm;the bone absorptivity of the distal margin of the control group was(2.81±0.26)mm,the postoperative period was(1.25±0.21)mm,and the proximal marginal bone resorption was(2.76±0.24)mm.Is(1.38±0.19)mm.There was no significant difference in the bone resorption between the two groups before and after the operation(P>0.05).The bone resorption of the distal and proximal margins of the two groups was significantly lower(P<0.05).The bone resorption of the distal margin was significantly higher in the group than in the control group(P<0.05),and the bone resorption in the proximal margin was significantly lower than that in the control group(P<0.05).Conclusion The number of subgingival plaque in patients with chronic periodontitis is significantly higher than that in patients without periodontitis,which has a significant impact on marginal bone resorption near the implant and can improve the stability of marginal bone of the implant after conventional periodontal treatment.