基于病因分析的种植体周炎综合序列治疗1例

doi:10.12337/zgkqzzxzz.2025.04.010

摘要/Abstract

摘要： 种植体周炎是一种以菌斑生物膜为原发病因、多因素共同影响的种植体周软、硬组织的炎症性疾病。本文通过介绍1例种植体周炎患者的综合序列治疗过程和随访结果,以探讨种植体周炎的最佳治疗方案。该病例通过拆除种植修复体,进行非手术治疗初步控制感染,实施骨再生性手术治疗,重建种植体周骨组织,通过游离龈移植改善种植体周软组织条件,调整修复体形态后重新戴入,治疗及随访期间加强自我维护和专业维护。随访2年结果显示,种植体周牙龈红肿及溢脓消退,深牙周袋消失,牙槽骨再生并保持稳定,达到了满意的治疗效果。

关键词: 种植体周炎, 序列治疗, 再生性手术, 角化黏膜, 修复体

Abstract: Peri-implantitis is an inflammatory disease of the peri-implant soft and hard tissues, primarily caused by plaque biofilms and influenced by multiple factors. This article presents the comprehensive sequential treatment process and follow-up results of a patient with peri-implantitis and discusses the optimal treatment approach. In this case, the implant prosthesis was first removed for non-surgical treatment to preliminarily control the infection, followed by bone regenerative surgery to reconstruct peri-implant bone tissue. Subsequently, free gingival grafting was performed to improve peri-implant soft tissue conditions, and the prosthesis morphology was adjusted and reinserted. Throughout the treatment and follow-up periods, both self-maintenance and professional maintenance were emphasized. After a 2-year follow-up, the peri-implant gingival redness, swelling, and suppuration subsided, the deep periodontal pockets resolved, and alveolar bone regeneration was achieved and maintained, resulting in a satisfactory therapeutic outcome.

Key words: Peri-implantitis, Sequential treatment, Regenerative surgery, Keratinized gingiva, Prosthesis

杨蕊,许志杰. 基于病因分析的种植体周炎综合序列治疗1例[J]. 中国口腔种植学杂志, 2025, 30(2): 161-168. DOI: 10.12337/zgkqzzxzz.2025.04.010

Yang Rui, Xu Zhijie. Comprehensive sequential treatment of peri-implantitis based on etiological analysis: a case report[J].Chinese Journal of Oral Implantology, 2025, 30(2): 161-168.DOI: 10.12337/zgkqzzxzz.2025.04.010.

参考文献

[1] Berglundh T, Armitage G, Araujo MG, et al.Peri-implant diseases and conditions: consensus report of Workgroup 4 of the 2017 World Workshop on the classification of periodontal and peri-implant diseases and conditions[J]. J Clin Periodontol, 2018,45(Suppl 20):S286-S291. DOI: 10.1111/jcpe.12957.
[2] Schwarz F, Derks J, Monje A, et al, Peri-implantitis[J]. J Clin Periodontol, 2018, 45(Suppl 20): S246-S266.
[3] Mombelli A, Lang NP.The diagnosis and treatment of peri-implantitis[J]. Periodontol 2000, 1998,17:63-76. DOI: 10.1111/j.1600-0757.1998.tb00124.x.
[4] Gamborena I, Avila-Ortiz G.Peri-implant marginal mucosa defects: classification and clinical management[J]. J Periodontol, 2021,92(7):947-957. DOI: 10.1002/JPER.20-0519.
[5] Ramanauskaite A, Schwarz F, Sader R.Influence of width of keratinized tissue on the prevalence of peri-implant diseases: a systematic review and meta-analysis[J]. Clin Oral Implants Res, 2022,33(Suppl 23):8-31. DOI: 10.1111/clr.13766.
[6] Katafuchi M, Weinstein BF, Leroux BG, et al.Restoration contour is a risk indicator for peri-implantitis: a cross-sectional radiographic analysis[J]. J Clin Periodontol, 2018,45(2):225-232. DOI: 10.1111/jcpe.12829.
[7] Valente NA, Wu M, Toti P, et al.Impact of concave/convergent vs parallel/ divergent implant transmucosal profiles on hard and soft Peri-implant tissues: a systematic review with Meta-analyses[J]. Int J Prosthodont, 2020,33(5):553-564. DOI: 10.11607/ijp.6726.
[8] 黄枚钰, 沈玉凤, 姜丹丹, 等. 穿龈轮廓与骨水平种植体周围炎的相关性研究[J].口腔医学研究, 2022, 38(11):1042-1046. DOI: 10.13701/j.cnki.kqyxyj. 2022.11.009.
Huang MY,Sheng YF,Jiang DD, et al.Correlation between emergence profile and peri-implantitis of bone level implants[J].J Oral Sci Res,2022,38(11):1042-1046. DOI: 10.13701/j.cnki.kqyxyj.2022.11.009.
[9] Schwarz F, Herten M, Sager M, et al.Comparison of naturally occurring and ligature-induced peri-implantitis bone defects in humans and dogs[J]. Clin Oral Implants Res, 2007,18(2):161-170. DOI: 10.1111/j.1600-0501.2006.01320.x.
[10] Belibasakis GN.Microbiological and immuno-pathological aspects of peri-implant diseases[J]. Arch Oral Biol, 2014,59(1):66-72. DOI: 10.1016/j.archoralbio.2013.09.013.
[11] Lin GH, Curtis DA, Kapila Y, et al.The significance of surgically modifying soft tissue phenotype around fixed dental prostheses: an American Academy of Periodontology best evidence review[J]. J Periodontol, 2020,91(3):339-351. DOI: 10.1002/JPER.19-0310.
[12] 王鹃, 尉华杰, 邱立新. 前牙种植修复体穿龈形态设计的研究进展[J].中华口腔医学杂志,2020,55(6):417-420. DOI: 10.3760/cma.j.cn112144-20190729-00292.
Wang J,Yu HJ,Qiu LX.Progress in emergence profile design for implant restorations in the esthetic area[J].Chin J Stomatol,2020,55(6):417-420. DOI: 10.3760/cma.j.cn112144-20190729-00292.
[13] Chaves ES, Lovell JS, Tahmasebi S.Implant‐supported crown design and the risk for peri‐implantitis[J]. Clin Adv Periodontics, 2014, 4(2):118-126.DOI:10.1902/cap.2013.120117.
[14] Serino G, Hultin K.Periimplant disease and prosthetic risk indicators: a literature review[J]. Implant Dent, 2019,28(2):125-137. DOI: 10.1097/ID.0000000000000841.
[15] Derks J, Schaller D, Håkansson J, et al.Effectiveness of implant therapy analyzed in a swedish population: prevalence of peri-implantitis[J]. J Dent Res, 2016,95(1):43-49. DOI: 10.1177/0022034515608832.
[16] 宫苹. 牙缺失种植修复并发症与咬合[J].中华口腔医学杂志, 2018,53(12):800-804. DOI: 10.3760/cma.j.issn. 1002-0098.2018.12.002.
Gong P.Role of occlusion in complications of implant rehabilitation[J].Chin J Stomatol,2018,53(12):800-804. DOI: 10.3760/cma.j.issn.1002-0098.2018.12.002.
[17] Pellegrini G, Canullo L, Dellavia C.Histological features of peri-implant bone subjected to overload[J]. Ann Anat, 2016,206:57-63. DOI: 10.1016/j.aanat.2015.02.011.
[18] Brägger U, Heitz-Mayfield LJA.Biological and Hardware complications in implant dentistry. The ITI treatment guide volume 8[M]. Berlin: Quintessence Publishing, 2015.
[19] Herrera D, Berglundh T, Schwarz F, et al.Prevention and treatment of peri-implant diseases-The EFP S3 level clinical practice guideline[J]. J Clin Periodontol, 2023,50(Suppl 26):4-76. DOI: 10.1111/jcpe.13823.
[20] Cosgarea R, Roccuzzo A, Jepsen K, et al.Efficacy of mechanical/physical approaches for implant surface decontamination in nonsurgical sub-marginal instrumentation of periimplantitis. A systematic review[J]. J Clin Periodontol, 2023, 50(Suppl 26):188-211. DOI: 10.1111/jcpe.13762.
[21] de Waal YCM, Winning L, Stavropoulos A, et al. Efficacy of chemical approaches for implant surface decontamination in conjunction with sub-marginal instrumentation, in the non-surgical treatment of peri-implantitis: a systematic review[J]. J Clin Periodontol, 2023, 50(Suppl 26):212-223. DOI: 10.1111/jcpe.13749.
[22] Liñares A, Sanz-Sánchez I, Dopico J, et al.Efficacy of adjunctive measures in the non-surgical treatment of peri-implantitis: a systematic review[J]. J Clin Periodontol, 2023, 50(Suppl 26):224-243. DOI: 10.1111/jcpe.13821.
[23] Lang NP, Wilson TG, Corbet EF.Biological complications with dental implants: their prevention, diagnosis and treatment[J]. Clin Oral Implants Res, 2000,11(Suppl 1): 146-155. DOI: 10.1034/j.1600-0501.2000.011s1146.x.
[24] 宿玉成. 口腔种植学[M]. 北京:人民卫生出版社, 2014.
Su YC.Implant dentistry[M].Beijing:People's Medical Publishing House,2014.
[25] Monje A, Pons R, Roccuzzo A, et al.Reconstructive therapy for the management of peri-implantitis via submerged guided bone regeneration: a prospective case series[J]. Clin Implant Dent Relat Res, 2020,22(3):342-350. DOI: 10.1111/cid.12913.
[26] 夏春雨, 王宏远. Er:YAG激光在治疗种植体周围炎中的研究进展[J].口腔颌面修复学杂志,2023,24(2):154-160. DOI: 10.19748/j.cn.kqxf.1009-3761.2023.2.012.
Xia CY,Wang HY.Research progress of Er:YAG laser in the treatment of peri-implantitis[J].Chin J Prosthodont,2023,24(2):154-160. DOI: 10.19748/j.cn.kqxf.1009-3761.2023.2.012.
[27] Tournadre C, Gritsch K, Takagi T, et al.Cleaning potential of five different methods for peri-implantitis treatment: an in-vitro study[J]. Clin Oral Impl Res, 2019, 30(S19):322-322.DOI:10.1111/clr.278_13509.
[28] Takagi T, Aoki A, Ichinose S, et al.Effective removal of calcified deposits on microstructured titanium fixture surfaces of dental implants with erbium lasers[J]. J Periodontol, 2018,89(6):680-690. DOI: 10.1002/JPER.17-0389.
[29] Nejem Wakim R, Namour M, Nguyen HV, et al. Decontamination of dental implant surfaces by the Er:YAG laser beam: a comparative in vitro study of various protocols[J]. Dent J (Basel), 2018,6(4)66.DOI: 10.3390/dj6040066.
[30] Teughels W, Seyssens L, Christiaens V, et al.Adjunctive locally and systemically delivered antimicrobials during surgical treatment of peri-implantitis: a systematic review[J]. J Clin Periodontol, 2023,50(Suppl 26):359-372. DOI: 10.1111/jcpe.13773.
[31] Serino G, Ström C.Peri-implantitis in partially edentulous patients: association with inadequate plaque control[J]. Clin Oral Implants Res, 2009,20(2):169-174. DOI: 10.1111/j.1600-0501.2008.01627.x.
[32] 刘倩, 皮雪敏, 陆扬宁, 等. 种植体周围炎治疗与维护策略[J].中国实用口腔科杂志,2016,9(5):257-260,264. DOI: 10.7504/kq.2016.05.001.
Liu Q,Pi XM, Lu YN, et al.Protocols of treatment and maintenance of peri-implantitis[J].Chin J Prac Stomatol,2016,9(5):257-260,264. DOI: 10.7504/kq.2016.05.001.
[33] Roccuzzo M, Sculean A.The ITI treatment guide.volume 12:peri-implant soft-tissue integration and management [M]. Berlin: Quintessence Publishing, 2021.
[34] Basegmez C, Karabuda ZC, Demirel K, et al.The comparison of acellular dermal matrix allografts with free gingival grafts in the augmentation of peri-implant attached mucosa: a randomised controlled trial[J]. Eur J Oral Implantol, 2013,6(2):145-152.
[35] Cairo F, Barbato L, Tonelli P, et al.Xenogeneic collagen matrix versus connective tissue graft for buccal soft tissue augmentation at implant site. A randomized, controlled clinical trial[J]. J Clin Periodontol, 2017,44(7):769-776. DOI: 10.1111/jcpe.12750.
[36] Thoma DS, Lim HC, Paeng KW, et al.Augmentation of keratinized tissue at tooth and implant sites by using autogenous grafts and collagen-based soft-tissue substitutes[J]. J Clin Periodontol, 2020,47(1):64-71. DOI: 10.1111/jcpe.13194.
[37] De Ry SP, Roccuzzo A, Lang NP, et al.Evaluation of the implant disease risk assessment (IDRA) tool: a retrospective study in patients with treated periodontitis and implant-supported fixed dental prostheses (FDPs)[J]. Clin Oral Implants Res, 2021,32(11):1299-1307. DOI: 10.1111/clr.13828.
[38] Serino G, Ström C.Peri-implantitis in partially edentulous patients: association with inadequate plaque control[J]. Clin Oral Implants Res, 2009,20(2):169-174. DOI: 10.1111/j.1600-0501.2008.01627.x.
[39] Tormena M, Matarazzo F, de Oliveira BM, et al. The effect of inadequate access to peri-implant hygiene on marginal bone level. A 4-year cohort prospective study[J]. Clin Oral Implants Res, 2020,31(9):836-845. DOI: 10.1111/clr.13629.
[40] Serino G, Hultin K.Peri-implant disease and prosthetic risk indicators:a literature review[J]. Implant Dentistry, 2019, 28(2): 125-137.DOI:10.1097/ID.0000000000000841.
[41] Heitz-Mayfield LJA, Needleman L, Salvi GE, et al.Consensus statements and clinical recommendations for prevention and management of biologic and technical implant complications[J]. Int J Oral Maxillofac Implants, 2014,29(Suppl):346-350.DOI:10.11607/jomi.2013.g5.