甲硝唑治疗牙种植体周围炎患者的临床研究

Clinical trial of metronidazole in the treatmen of patients with peri-implantitis

目的探究甲硝唑治疗牙种植体周围炎患者的临床疗效及安全性。方法将接受全口龈上洁治术、龈下刮治术治疗的牙种植体周围炎患者根据治疗方案分为对照组(予以双氧水及0.9%NaCl交替冲洗牙种植体周围)和试验组(在对照组治疗的基础上,口服甲硝唑片0.2g,bid)。比较2组患者临床疗效、牙周指数、龈沟液(PICF)中Ⅱ型胶原酶(COL-Ⅱ)、白细胞介素(IL)-17、细胞间黏附分子-1(ICAM-1)水平,并进行安全性评价。结果对照组纳入32例,试验组纳入42例。治疗后,试验组和对照组的总有效率分别为95.24%(40例/42例)和90.63%(29例/32例),在统计学上差异有统计学意义(P<0.05)。治疗后,试验组和对照组牙周探诊深度分别为(3.18±0.55)和(4.49±0.62)mm,龈沟出血指数分别为(1.21±0.21)和(2.48±0.27)分,附着水平分别为(0.87±0.22)和(2.09±0.60)mm,牙菌斑指数分别为(0.91±0.17)和(1.16±0.14)分,在统计学上差异均有统计学意义(均P<0.05)。治疗后,试验组和对照组PICF中COL-Ⅱ分别为(112.51±33.27)和(154.85±25.35)μg·L^(-1),IL-17分别为(14.51±2.62)和(17.64±3.07)ng·L^(-1),ICAM-1分别为(92.21±8.37)和(106.58±11.22)μg·L^(-1),在统计学上差异均有统计学意义(均P<0.05)。试验组和对照组药物不良反应发生率分别为23.81%(10例/42例)和12.50%(4例/32例),在统计学上差异无统计学意义(P>0.05)。结论甲硝唑用于牙种植体周围炎患者中疗效显著,可提高抗菌效果,减轻牙种植体周围炎症程度,改善牙周指数,且安全性高。

Objective To observe the clinical efficacy and safety of metronidazole on patients with peri-implantitis.Methods Patients with peri-implantitis who received complete supragingival scaling and subgingival scaling were divided into control group(hydrogen peroxide and 0.9%NaCl alternately washing around the implant)and treatment group(metronidazole orally 0.2 g every time for 3 times a day on the basis of control group)according to the treatment regimens.The efficacy,periodontal indexes,peri-implant crevicular fluid(PICF)typeⅡcollagenase(COL-Ⅱ),interleukin(IL)-17 and intercellular adhesion molecule-1(ICAM-1)levels were compared between groups,and the safety evaluation was performed.Results 32 cases in control group and 42 cases in treatment group.After treatment,the total effective rates in treatment group and control group were 95.24%(40 cases/42 cases)and 90.26%(29 cases/32 cases)(P<0.05).After treatment,the periodontal probing depths in treatment group and control group were(3.18±0.55)and(4.49±0.62)mm,gingival sulcus bleeding indexes were(1.21±0.21)and(2.48±0.27)points,attachment levels(0.87±0.22)and(2.09±0.60)mm,plaque indexes were(0.91±0.17)and(1.16±0.14)points(all P<0.05).After treatment,the levels of COL-Ⅱin PICF in treatment group and control group were(112.51±33.27)and(154.85±25.35)μg·L^(-1),IL-17 levels were(14.51±2.62)and(17.64±3.07)ng·L^(-1),ICAM-1 levels were(92.21±8.37)and(106.58±11.22)μg·L^(-1),respectively(all P<0.05).The incidence rates of adverse reactions in treatment group and control group were 23.81%(10 cases/42 cases)and 12.50%(4 cases/32 cases),respectively(P>0.05).Conclusion Metronidazole has significant efficacy on patients with peri-implantitis,and can enhance the antibacterial effect,relieve the degree of inflammation around the implant,and improve the periodontal indexes,and it has high safety.