药物涂层预防种植体周围炎的研究与进展

Research advances in drug coatings for prevention of peri-implantitis

背景:种植体/基台表面药物涂层可实现局部抗菌、促骨结合和促软组织封闭形成,预防种植体周围炎的发生,从而提高种植成功率。目的:归纳总结不同药物涂层预防种植体周围炎发生的研究现状和进展。方法:应用计算机检索中国知网、万方数据、PubMed及维普数据库,以“种植体周围炎、载药材料、涂层、抗菌、骨结合、软组织封闭”为中文检索词,以“peri-implantitis,drug loading materials,coating,antibacterial,osseointegration,soft-tissue integration/soft tissue sealing”为英文检索词,按照纳入和排除标准对文献进行筛选,最终纳入79篇文献进行综述分析。结果与结论:①目前的药物载体具有良好的机械、热化学和生物性能,能够通过加载和释放药物来改善种植体/基台表面抗菌、促骨结合及软组织封闭形成等功能,实现种植体周围炎的直接和/或间接预防,为种植体周围炎的预防提供了新的研究方向;例如基台表面载抗菌肽涂层既可抑制细菌的聚集和黏附,又可促进种植体软组织封闭的形成,阻止细菌侵犯下方的牙槽骨、避免骨组织的炎性吸收,从而预防种植体周围炎。②单一药物涂层可能存在药物突释、功能简单、难以持续给药和药物补充的问题,未来研究者们可通过复合不同的载体及药物、改善载药方式及改进涂层技术,开发既能“智能”控释药物,又具备多功能及“再生性”的药物涂层。③尽管目前大多数体外研究都证明了药物涂层具有预防种植体周围炎的潜力,但相关动物体内研究及临床研究较少,未来需进行更多的相关研究以进一步探究种植窝内其他细胞或物质是否影响药物的释放,探索种植体负载状态下药物涂层的作用效果,从而促进药物涂层的临床推广。

BACKGROUND:Pharmaceutical coating applied to the surface of an implant or an abutment can produce localized antibacterial,pro-osseointegration,and softtissue integration effects,reducing the risk of developing peri-implantitis and increasing implant success rates.OBJECTIVE:To review the current state and achievements in the application of various drug coatings for the management of peri-implantitis.METHODS:A computer was used to search the relevant articles in the CNKI,WanFang,PubMed,and VIP databases using the Chinese and English search terms“peri-implantitis,drug loading materials,coating,antibacterial,osseointegration,soft-tissue integration/soft tissue sealing”.The literature was screened using the inclusion and exclusion criteria.Finally,79 papers were considered for evaluation and analysis.RESULTS AND CONCLUSION:(1)Current drug carriers have good mechanical,thermochemical,and biological properties,which can improve the antibacterial functions of the implant/abutment surface,promote the formation of osseointegration and soft tissue sealing by loading and releasing drugs to achieve direct and/or indirect prevention of peri-implantitis,and provide a new research direction for the prevention of peri-implantitis.For example,an antimicrobial peptide coating on the abutment surface can inhibit microorganisms’aggregation and adhesion,promote implant soft tissue sealing,prevent bacteria from invading the alveolar bone below,avoid inflammatory absorption of bone tissue,and thus prevent peri-implantitis.(2)Specific drug coatings,on the other hand,may have issues such as sudden drug release,simple function,and difficulty in continuous drug delivery and drug supplementation.In the future,by combining different carriers and drugs,improving drug loading methods,and improving coating technology,a drug coating that can“smart”control drug release and has multifunctional and“regenerative”properties will be developed by researchers.(3)While most current in vitro studies have demonstrated that drug coatings have the potential to prevent peri-implantitis,there are few in vivo animal studies and clinical studies,and more relevant studies are needed in the future to investigate whether other cells or substances in the implant nest affect drug release,as well as the effect of drug coatings under implant loading to promote the clinical promotion of drug coating.