重度牙周炎患者种植体与天然牙相互影响的回顾性研究

Interaction between implants and natural teeth in patients with severe periodontitis:a retrospective study

目的从改善天然牙牙周健康的角度,评价规律复查的重度牙周炎患者后牙区种植修复治疗对天然牙的影响,以及天然牙牙周状态对种植体的影响,为临床提供参考。方法收集2014年6月至2023年6月于中国医科大学口腔医学院·附属口腔医院牙周病科就诊,并完成后牙单冠种植修复治疗的重度牙周炎者53例,其中男性16例,女性37例,年龄(52.2±8.0)岁,种植体共136枚,缺牙区相邻天然牙135颗。回顾性比较种植前后口内余留天然牙的探诊深度(PD)、探诊出血(BOP)和松动度变化,并通过单因素和多因素分析探讨天然牙对种植体PD、BOP和末次复查时边缘骨丧失(MBL)的可能影响因素。结果53例患者的随访时间为(44.5±14.1)个月,最长复查间隔为(8.3±2.7)个月。缺牙区相邻天然牙PD由种植前的4.3(3.6,4.6)mm显著改善至末次复查时的3.6(3.2,4.0)mm(P<0.01),BOP(+)%由种植前的69.6%(94/135)显著改善至末次复查时的46.7%(63/135)(P<0.01),松动度≥Ⅱ度的牙齿占比由15.6%(21/135)显著降至5.9%(8/135)(P<0.01);同区段天然牙的PD≥4 mm%由种植前的21.0%(13.3%,26.0%)显著改善至末次复查时的18.0%(12.0%,25.0%)(P<0.05),BOP(+)%由种植前的29.0%(24.0%,35.0%)显著改善至末次复查的23.0%(18.0%,31.0%)(P<0.05),松动度≥Ⅱ度的牙齿数量由0.0(0.0,1.0)颗显著下降至0.0(0.0,0.8)颗(P<0.05);全口天然牙的功能牙齿单位(FTU)分值由种植前的8.0(6.0,10.0)分显著提升至末次复查时的12.0(12.0,12.0)分(P<0.01),PD≥4 mm%由种植前的11.0%(6.0%,25.0%)显著提升至末次复查时的13.0%(3.0%,21.0%)(P<0.05),种植前BOP(+)%[(17.0±9.7)%]与末次复查时[(14.6±7.2)%]相比差异无统计学意义(P>0.05),松动度≥Ⅱ度的牙齿数量由1.0(0.0,1.8)颗显著降为1.0(0.0,1.0)颗(P<0.05)。结论规律复查的前提下,重度牙周炎患者后牙区种植修复治疗有助于改善余留天然牙的PD、BOP和松动度,同时初诊牙周炎分期分级可影响种植体的PD和BOP。

ObjectiveTo evaluate the clinical outcomes after implant restoration in the posterior region of severe periodontitis patients and to investigate the factors of natural tooth affecting the implant from the perspective of improving natural periodontal health,which may provide a reference for clinical practice.MethodsFifty-three patients with severe periodontitis who visited the Department of Periodontology at the Affiliated Stomatological Hospital of China Medical University from June 2014 to June 2023 and completed posterior implant treatment with single crown were included,among which were 16 males and 37 females,aged(52.2±8.0)years old,with a total of 136 implants,135 adjacent natural teeth in the edentulous area.We retrospectively compared the changes of probing depth(PD),bleeding on probing(BOP)and tooth mobility(TM)before and after implant placement.Besides,we explored the effects of the natural periodontal status on PD,BOP and marginal bone loss(MBL)of the implant at the last follow-up examination by univariate analysis and multivariate analysis.ResultsFifty-three patients were followed up for(44.5±14.1)months in average,with longest interval of(8.3±2.7)months.The PD of adjacent natural teeth in the edentulous area improved from 4.3(3.6,4.6)mm before implantation to 3.6(3.2,4.0)mm in the last review(P<0.01),while the proportion of BOP(+)improved from 69.6%(94/135)before implantation to 46.7%(63/135)in the last review(P<0.01).The proportion of teeth with mobility≥Ⅱdecreased from 15.6%(21/135)to 5.9%(8/135)(P<0.01).The percentage of natural teeth with PD≥4 mm in the same segment improved from 21.0%(13.3%,26.0%)before implantation to 18.0%(12.0%,25.0%)in the last review(P<0.05).The BOP(+)%improved from 29.0%(24.0%,35.0%)before implantation to 23.0%(18.0%,31.0%)in the last review(P<0.05),and the number of teeth with mobility≥Ⅱdecreased from 0.0(0.0,1.0)to 0.0(0.0,0.8)(P<0.05).The functional tooth unit score of full natural teeth increased from 8.0(6.0,10.0)points before implantation to 12.0(12.0,12.0)points in the last review(P<0.01).PD≥4 mm%increased from 11.0%(6.0%,25.0%)before implantation to 13.0%(3.0%,21.0%)in the last review(P<0.05)and there was no significant differences in BOP(+)%[(17.0±9.7)%vs(14.6±7.2)%,P>0.05].The number of teeth with mobility≥Ⅱdecreased from 1.0(0.0,1.8)to 0.0(0.0,0.8)(P<0.05).ConclusionsUnder the premise of regular supportive care,implant restorative treatment in the posterior region of severe periodontitis patients is helpful to improve the PD,BOP and TM of remaining natural teeth.Besides,the stages and grades of periodontitis at initial diagnosis can affect the PD and BOP of implants.