دانلود رایگان ترجمه مقاله خطرات عفونی برای ایمپلنت های دهانی (نشریه وایلی 2002)

خطرات عفونی برای ایمپلنت های دهانی: مروری بر ادبیات

Infectious risks for oral implants: a review of the literature

Abstract

The use of oral implants in the rehabilitation of partially and fully edentulous patients is widely accepted even though failures do occur. The chance for implants to integrate can for example be jeopardised by the intra-oral presence of bacteria and concomitant inflammatory reactions. The longevity of osseointegrated implants can be compromised by occlusal overload and/or plaque-induced peri-implantitis, depending on the implant geometry and surface characteristics. Animal studies, cross-sectional and longitudinal observations in man, as well as association studies indicate that periimplantitis is characterised by a microbiota comparable to that of periodontitis (high proportion of anaerobic Gram-negative rods, motile organisms and spirochetes), but this does not necessarily prove a causal relationship. However, in order to prevent such a bacterial shift, the following measures can be considered: periodontal health in the remaining dentition (to prevent bacterial translocation), the avoidance of deepened peri-implant pockets, and the use of a relatively smooth abutment and implant surface. Finally, periodontitis enhancing factors such as smoking and poor oral hygiene also increase the risk for peri-implantitis. Whether the susceptibility for periodontitis is related to that for peri-implantitis may vary according to the implant type and especially its surface topography.

1 Introduction

The high clinical success rate of some implant designs in (partially) edentulous patients, as demonstrated in well-designed long-term prospective studies, has led to the widespread acceptance and use of oral implants (for review see van Steenberghe et al. 1999). Besides a number of patient-related factors such as smoking (Bain & Moy 1993), bone quality (Jaffin & Berman 1991; Hutton et al. 1995), systemic diseases or chemotherapy, surgical trauma or bacterial contamination during implant surgery are factors associated with early failures (impaired healing, i.e. during the healing phase and thus before loading). Overload (defined as a situation in which the functional load applied to the implants exceeds the capacity of the bone-implant interface to withstand it) is another important cause of early implant failure, once the prosthesis is installed. Factors associated with late failures of implants are less well understood and seem to be related to both the peri-implant environment and host parameters. Lesions similar to those associated with teeth, such as peri-implantitis, gingival hyperplasia, fistulae and bone loss, are related to microbial plaque accumulation. The pres- ent review will focus on peri-implantitis and the microbial factors associated with its prevalence.

Epidemiological studies from the late eighties indicated that there was no universal susceptibility to periodontitis. Only 5 to 20% of the population suffers from severe forms of periodontitis (Hugoson & Jordan 1982; Brown & Löe 1993). Late implant failures also cluster in a small subset of individuals (Tonetti 1998; Esposito et al. 1998). Weyant & Burt (1993) examined the survival rate of oral implants in a group of 598 consecutive patients from the U.S. Veterans Administration registry. Over a period of 5.5 years, a total of 81 implants out of 2098 were removed in 45 out of 598 subjects. The probability for the removal of a second implant increased by 30% in patients who had already lost one implant.