植體周圍炎的診斷與治療

Treatment and Diagnosis of Peri-Implantitis

於現今的牙醫科學，植牙已非常廣泛運用在重建缺牙區，讓病患重拾咀嚼能力。Pjetursson在2004年針對長期追蹤研究的系統性文獻回顧亦指出，植牙的成功率10年內可達到9成以上。然而，植體周圍炎（peri-implantitis）仍是一個令植牙醫師頭痛的課題。在一些系統性回顧中指出，植體周圍炎的盛行率大約22%-56%，但不同研究間的結果差異甚大。植體周圍一旦開始發炎後，周圍組織破壞速度常比牙周病來得快速很多，且因植體螺紋周遭很難徹底清創，治療效果較難以預期。目前對於植體周圍炎的治療準則，仍無黃金標準，傳統的機械清創方式的效果仍有限制，各種植體表面去污方式優劣亦無定論。本篇文獻回顧主要聚焦於植體周圍炎的診斷及治療方式，並比較治療時各種去污方式的成效，整理植體周圍炎的治療準則，及探討如何評估植體周圍炎的風險。

Recently, replacing missing teeth with dental implant has become a routine procedure. Long-term follow-up studies have also pointed out that the survival rate of dental implants can reach more than 90% within ten years according to the systemic review done by Pjetursson in 2004. However, peri-implantitis remained a bothering issue. Prevalence of peri-implantitis has been reported around 22% to 56%, but the results of different studies vary greatly. Once inflammation around the peri-implant tissue initiates, the destruction rate is much faster than that of periodontal tissue. It is difficult to completely debride and decontaminate the contaminated implant threads. It is challenging to predict the treatment effects of different intervention as well. To date, there is still no gold standard for the treatment of peri-implantitis. Only limited benefit after traditional mechanical debridement was found. The pros and cons of the decontamination methods on the surface of implants remained inconclusive. This review of the literature focuses on the diagnosis and treatment of peri-implant inflammation, and compares the effectiveness of various decontamination methods during treatment for peri-implant diseases. Furthermore, it sorts out the treatment guidelines for peri-implant inflammation, and discusses how to assess the risk of peri-implant inflammation.