【摘要】 目的应用循证医学方法为吸烟者患种植体周围炎提供最佳治疗方案。方法针对1例吸烟者患种植体周围炎的临床问题,以吸烟、种植体周围炎、种植体周骨丧失等为主题词,检索Cochrane图书馆(2009年第2期)、ACP Journal Club(1991～2009.7)、MEDLINE(1950～2009.7)、EMbase(1980～2009.7)及中国期刊全文数据库(1994～2009.7),收集相关指南、系统评价、Meta分析及随机对照试验,并评价证据的质量和适用性。结果共纳入4篇系统评价、8个随机对照试验。其中推荐级别为A级的证据有:①洁治配合局部应用抗菌药物;②引导骨再生治疗;③钛刮匙机械清洁或超声波清洁。针对本病案,结合医院现有条件、患者及家属意愿,采取以下治疗方案:第一阶段:全口超声洁治,龈下刮治行种植体表面的机械清创,并局部辅以盐酸米诺环素缓释软膏;口腔卫生宣教及戒烟教育。第二阶段:引导骨再生治疗。第三阶段:口腔卫生及种植义齿的长期维护。随访6个月,患者未述不适,种植体周软组织无肿胀,探诊出血为阴性,种植体周探诊深度4mm,X线片示,种植体周无透射影。结论采用循证治疗方法为种植体周围炎患者制定了合理的治疗方案,保证了良好的治疗效果。更多还原

【Abstract】 Objective To make an evidence-based treatment plan for a smoker with periimplantitis.Methods Based on the clinical problems raised from the case,we searched The Cochrane Library(Issue 2,2009),ACP Journal Club(1991 to July 2009),MEDLINE(1950 to July 2009),EMbase(1980 to July 2009) and Chinese Journal Fulltext Database(1994 to July 2009) for guidelines,systematic reviews,meta-analyses and randomized controlled trials(RCTs).The quality of the included studies was assessed.Results A total of 4 systematic reviews,8 RCTs were included.The following methods were supported by Level A evidence:(1) Scaling combined with local antibiotics;(2) Guided bone regeneration;(3) Non-surgical debridement with titanium hand-instruments or with an ultrasonic device.Based on the available evidence,we proposed a three-stage therapy plan for the patient:In the first stage,full mouth ultrasonic scaling was performed.The peri-implant pocket was debrided with plastic curettes,and then minocycline gel was applied once a week for four times.The patient was persuaded to maintain oral hygiene and quit smoking.In the second stage,four weeks later,open flap debridement and guided bone regeneration were conducted.In the third stage,long-term care of oral hygiene and dental implants were performed.After 6 months of follow-up,the peri-implant tissues were healthy with no evidence of inflammation,bleeding or suppuration.Conclusion Based on the approach of evidence-based medicine,we accomplished the treatment of the case with reliable outcomes.更多还原