甘氨酸龈下喷砂联合引导组织再生术治疗种植体周围炎

doi:10.3877/cma.j.issn.1674-1366.2019.01.006

目的

探讨甘氨酸龈下喷砂联合引导组织再生术（GTR）治疗种植体周围炎的有效性。

方法

28例伴有牙槽骨吸收的种植体周围炎患者，按照随机、双盲、对照原则将种植体（共34枚）分成2组，分别行GTR，其中试验组（n= 18）在术中使用甘氨酸龈下喷砂系统对种植体表面进行清创；对照组（n= 16）采用塑料刮治器对种植体表面进行清创。在治疗前（基线）、治疗后3个月、治疗后6个月和治疗后12个月进行临床指标的检测，包括菌斑指数（PLI）、出血指数（BI）、探诊深度（PD）、临床附着水平（CAL）及影像学垂直骨增量。数据采用重复测量资料的方差分析，每个时间点采用独立样本t检验进行分析，试验组和对照组分别进行治疗前与治疗后的自身对比，并在基线、治疗后3个月、治疗后6个月和治疗后12个月进行临床指标的组间对比，以P<0.05为差异有统计学意义。

结果

在基线，试验组和对照组各临床指标差异无统计学意义（P>0.05）。各组术后PLI、BI、PD、CAL及影像学垂直骨增量均较治疗前（基线）有明显改善，差异有统计学意义（P<0.05）。患者治疗后3个月，试验组与对照组BI、PLI、PD、CAL差异均有统计学意义（t_BI= 5.103，P_BI= 0.031；t_PLI= 5.556，P_PLI= 0.025；t_PD= 4.440，P_PD= 0.043；t_CAL= 4.879，P_CAL= 0.034）。患者治疗后6个月，试验组和对照组的PD、CAL差异均有统计学意义（t_PD= 4.994，P_PD= 0.033；t_CAL= 4.831，P_CAL= 0.035）。患者治疗后12个月，试验组和对照组的PD、CAL差异均有统计学意义（t_PD= 4.302，P_PD= 0.046；t_CAL= 4.325，P_CAL= 0.048）。患者治疗后6及12个月，试验组与对照组种植体的PLI和BI均有改善，但差异无统计学意义（P>0.05）。患者影像学垂直骨增量在治疗后3、6、12个月试验组较对照组增加更明显，差异均有统计学意义（t₃=4.831，P₃= 0.035；t₆= 4.412，P₆= 0.044；t₁₂= 5.087，P₁₂= 0.031）。

结论

在改善种植体周围炎炎症水平及促进牙槽骨再生方面，甘氨酸龈下喷砂联合GTR较机械刮治联合GTR更具优势，可考虑在GTR中使用甘氨酸龈下喷砂来提高种植体周围炎的治疗效果。

关键词: 引导组织再生术, 牙龈下刮治术, 种植体周围炎, 甘氨酸龈下喷砂

Objective

To explore the effectiveness of glycine subgingival air polishing combined with guided tissue regeneration (GTR) in the treatment of peri-implantitis.

Methods

There were 28 peri-implantitis patients (34 implants) with alveolar bone resorption who were divided into 2 groups according to double blinded randomized controlled principles, and GTR was carried out respectively. In test group (n= 18) , the dental plaque on implant surface was cleaned by glycine subgingival air polishing. While in control group (n= 16) , plastic curettage instrument was used. The clinical parameters including plaque index, bleeding index, probing depth, clinical attachment level, and the vertical bone height were recorded and evaluated at baseline and 3, 6, and 12 months after treatment. All the clinical data was analyzed using the variance of repeated measurements, and independent samples t-test was applied at each time point. All the clinical parameters were compared with itself before and after treatment, and were compared between the two groups at baseline, 3 months, 6 months and 12 months after treatment. The difference was considered statistically significant by P<0.05.

Results

There was no significant difference of the clinical parameters between the two groups at baseline (P>0.05) . After treatment, all subjects showed significant improvement in plaque index, bleeding index, probing depth, and clinical attachment level (P<0.05) . At 3 months, bleeding index was 1.61 ± 0.50 versus 2.13 ± 0.81 (t= 5.103, P= 0.031) , plaque index was 1.89 ± 0.58 versus 2.38 ± 0.62 (t= 5.556, P= 0.025) , probing depth was 4.06 ± 0.80 versus 4.69±0.95 (t= 4.440, P= 0.043) , and clinical attachment level was 3.72±1.07 versus 4.50 ± 0.97 (t= 4.879, P= 0.034) , respectively for test and control group. The difference between the two groups was statistically significant (P<0.05) . At 6 months, probing depth for test and control group was 3.28 ± 0.67 versus 3.88±0.8 (t= 4.994, P= 0.033) , and clinical attachment level was 3.28 ± 0.96 versus 4.06 ± 1.12 (t= 4.831, P= 0.035) . The difference between the two groups was statistically significant (P<0.05) . At 12 months, probing depth for test and control group was 3.00 ± 0.69 versus 3.56 ± 0.89 (t= 4.302, P= 0.046) , and clinical attachment level was 3.00 ± 0.77 versus 3.50 ± 0.63 (t= 4.325, P= 0.048) . The difference between the two groups was statistically significant (P<0.05) . While at 6 and 12 months, both groups presented improvement in plaque index and bleeding index, however, inter-group difference was not significant (P>0.05) . The vertical bone height for test and control group was 3.44±0.70 versus 2.88±0.81 (t= 4.831, P= 0.035) at 3 months, 3.50 ± 0.79 versus 2.94 ± 0.77 (t= 4.412, P= 0.044) at 6 months, and 3.56 ± 0.78 versus 3.00 ± 0.63 (t= 5.087, P= 0.031) at 12 months, and the increment in test group was more remarkable (P<0.05) .

Conclusions

Glycine subgingival air polishing combined with GTR is more effective than mechanical curettage combined with GTR in controlling the clinical symptoms and improving bone regeneration in patients with peri-implantitis. Therefore, glycine subgingival air polishing is a better additional method when treating peri-implantitis with GTR.

Key words: Guided tissue regeneration, Subgingival curettage, Peri-implantitis, Glycine subgingival air polishing

图2 术后牙槽骨最低点与标志点的垂直距离b

图4 术中使用手工刮治对种植体清创操作示意图

表1 本研究伴有牙槽骨吸收的种植体周围炎患者种植体植入不同时期的牙周临床指标结果（ ± s）

临床指标	试验组（n = 18）				对照组（n = 16）
临床指标	基线	3个月	6个月	12个月	基线	3个月	6个月	12个月
出血指数	2.56 ± 0.51	1.61 ± 0.51^a	1.50 ± 0.51^a	1.50 ± 0.62^a	2.63 ± 0.62	2.13 ± 0.81^a	1.56 ± 0.51^ab	1.50 ± 0.63^ab
菌斑指数	2.72 ± 0.46	1.89 ± 0.58^a	1.50 ± 0.51^ab	1.33 ± 0.49^a	2.81 ± 0.40	2.38 ± 0.62^a	1.75 ± 0.58^ab	1.44 ± 0.51^ab
探诊深度（mm）	6.44 ± 0.86	4.06 ± 0.80^a	3.28 ± 0.67^ab	3.00 ± 0.69^ab	6.50 ± 0.63	4.69 ± 0.95^a	3.88 ± 0.89^ab	3.56 ± 0.89^ab
临床附着水平（mm）	5.06 ± 1.00	3.72 ± 1.07^a	3.28 ± 0.96^a	3.00 ± 0.77^ab	5.25 ± 0.68	4.50 ± 0.97^a	4.06 ± 1.12^a	3.50 ± 0.63^ab
垂直骨增量（mm）	0	3.44 ± 0.70^a	3.50 ± 0.79^a	3.56 ± 0.78^a	0	2.88 ± 0.81^a	2.94 ± 0.77^a	3.00 ± 0.63^a

表1 本研究伴有牙槽骨吸收的种植体周围炎患者种植体植入不同时期的牙周临床指标结果（ ± s）

临床指标	试验组（n = 18）				对照组（n = 16）
临床指标	基线	3个月	6个月	12个月	基线	3个月	6个月	12个月
出血指数	2.56 ± 0.51	1.61 ± 0.51^a	1.50 ± 0.51^a	1.50 ± 0.62^a	2.63 ± 0.62	2.13 ± 0.81^a	1.56 ± 0.51^ab	1.50 ± 0.63^ab
菌斑指数	2.72 ± 0.46	1.89 ± 0.58^a	1.50 ± 0.51^ab	1.33 ± 0.49^a	2.81 ± 0.40	2.38 ± 0.62^a	1.75 ± 0.58^ab	1.44 ± 0.51^ab
探诊深度（mm）	6.44 ± 0.86	4.06 ± 0.80^a	3.28 ± 0.67^ab	3.00 ± 0.69^ab	6.50 ± 0.63	4.69 ± 0.95^a	3.88 ± 0.89^ab	3.56 ± 0.89^ab
临床附着水平（mm）	5.06 ± 1.00	3.72 ± 1.07^a	3.28 ± 0.96^a	3.00 ± 0.77^ab	5.25 ± 0.68	4.50 ± 0.97^a	4.06 ± 1.12^a	3.50 ± 0.63^ab
垂直骨增量（mm）	0	3.44 ± 0.70^a	3.50 ± 0.79^a	3.56 ± 0.78^a	0	2.88 ± 0.81^a	2.94 ± 0.77^a	3.00 ± 0.63^a

图5 试验组典型病例1治疗过程照片及X线片　A：术前探诊；B：引导组织再生术（GRT）术中甘氨酸龈下喷砂；C：种植体清创后；D：人工骨材料植入及生物膜覆盖；E：术后缝合；F：术后12个月探诊；G：术前X线片；H：术后12个月X线片；I ~ P：15个月种植体锥形束CT（CBCT）影像学图片（I：33冠状面，J：34冠状面，K：36冠状面，L：37冠状面，M：33矢状面，N：34矢状面，O：36矢状面，P：37矢状面）

图6 试验组典型病例2治疗过程照片及X线片　A：术前探诊；B：引导组织再生术（GRT）术中翻瓣；C：GRT术中甘氨酸龈下喷砂；D：人工骨材料植入；E：生物膜覆盖；F：术后缝合；G：术前X线片；H：术后12个月X线片；I：术后20个月口内照片；J ~ K：术后20个月种植体锥形束CT（CBCT）影像学图片（J：16矢状面，K：16冠状面）

图7 试验组典型病例3治疗过程照片及X线片　A：术前口内照；B：引导组织再生术（GRT）术中甘氨酸龈下喷砂；C：种植体清创后；D：人工骨材料植入；E：生物膜覆盖；F：术后缝合；G：术前X线片；H：术后12个月X线片；I：术后12个月口内照片

图8 对照组典型病例1治疗过程照片及X线片　A：术前口内照；B：翻瓣后；C：种植体手工刮治清创后；D：人工骨材料及生物膜植入；E：术后缝合；F：术后12个月口内照片；G：术前X线片；H：术后12个月X线片；I ~ L：术后20个月种植体锥形束CT（CBCT）影像学图片（I：11冠状面，J：11矢状面，K：12冠状面，L：12矢状面）

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Clinical study of glycine subgingival air polishing combined with guided tissue regeneration in the treatment of peri-implantitis

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Clinical study of glycine subgingival air polishing combined with guided tissue regeneration in the treatment of peri-implantitis