盐酸米诺环素软膏对种植体周围炎临床疗效的系统评价

发布时间：2018-04-03 14:14

本文选题：盐酸米诺环素　切入点：种植体周围炎　出处：《重庆医科大学》2017年硕士论文

【摘要】：背景:种植修复治疗现已成为临床修复缺失牙的一种重要手段,更是牙周炎(Periodontitis)患者失牙后进行修复的重要方法,其临床应用已经越来越广泛。但随着种植修复在临床治疗中的广泛应用,种植体周围炎(Periimplantitis)的发病呈一种明显上升的趋势,不得不引起口腔医师的重视。种植体周围炎是一种发生在种植体周围由龈下菌斑感染引起的炎症性疾病,病变不仅累及周围软组织,还会造成深层支持组织的病变,若不加以关注,将造成种植体(Inplant denture)周围黏膜的红肿溢脓,松动度的增加甚至脱落,远期修复治疗效果不理想,给患者造成较大的痛苦和经济负担。对于种植体周围炎的治疗,基础治疗(Initial therapy)后辅助药物治疗的综合疗法已成为多数国内外学者的共识。通过对种植体周围炎龈下菌斑微生物的研究,现有证据表明其主要致病菌与牙周炎的优势菌群比较相似,主要由革兰阴性菌组成。通过这些研究,我们推断目前临床用于治疗牙周炎的常用药物,在治疗种植体周围炎时也应有较好的治疗效果。目前临床常用的牙周辅助抗菌药物有甲硝唑凝胶(Metronidazole)、碘甘油(Glycerin Iodine)、盐酸米诺环素软膏(Minocy cline-hydrochloride)等药物。盐酸米诺环素软膏(商品名派丽奥)中含的有效抗菌成分主要为盐酸米诺环素,是一种新型可被牙周组织吸收的软膏装缓释剂,作为一种新型局部缓释抗菌剂型,目前已被广泛应用于牙周炎的治疗当中,其不仅具有耐药菌少、抗菌谱广的杀菌抑菌特点,还能延长药物作用时间,提高牙周袋内的药物浓度,并且还能减少毒副作用,患者的依从性较好。但在治疗种植体周围炎的临床效果上与其他临床常用抗菌药物的对比方面,目前还缺乏相关的报道,因此我们有必要对其进行更进一步的研究。目的:本研究拟采用Meta分析的方法对目前国内外已发表的有关盐酸米诺环素软膏与牙种植体周围炎相关的文献进行综合的分析和评价,更为明确地阐明在治疗种植体周围炎的临床效果上,与其他临床常用抗菌药物(甲硝唑凝胶和碘甘油)的治疗效果进行对比评价,为临床局部用药提供一定的参考。方法:计算机检索国内外的医学文献数据库Pub Med、Web of Science、Cochrane library、中国学术期刊全文数据库(CNKI)和万方数据库等,并翻阅口腔种植、口腔颌面外科、口腔修复以及牙周相关方面的国内外现刊,检索时间截止至2017年3月,获取有关国内外公开发表的研究盐酸米诺环素软膏临床疗效的相关文献。由两名评价者分别独立对相关资料进行严格筛选,并对文献质量进行详细评价的基础上,采用Rev Man5.3软件对纳入文献中提取的研究结果进行Meta分析,利用漏斗图分析发表性偏倚,最后进行敏感性分析。结果:初步筛选共检出相关文献86篇,其中9篇临床对照试验研究符合入选标准。Meta分析的结果显示:盐酸米诺环素软膏对于牙菌斑指数(Plaque index,PLI),龈沟出血指数(Sulcus bleeding index,SBI),牙周袋深度(Probing depth,PD)方面以及其它临床症状的治疗效果要优于对照组(碘甘油和甲硝唑组),且差异具有统计学意义。结论:本研究结果表明,患者在经过牙周的非手术性基础治疗后(龈上洁治、龈下刮治及根面平整等),配合使用牙周抑菌药物,可明显改善患者探诊深度、龈沟出血指数和菌斑指数等临床指标。相较于传统的碘甘油和甲硝唑等临床常用牙周抑菌药物,盐酸米诺环素软膏在治疗效果方面显得更具有优势。但为了更好的巩固治疗效果,至少应每隔3-4周后进行重复治疗。
[Abstract]:Background: implant treatment has become an important means of repairing missing teeth and periodontitis (Periodontitis) is an important method to repair the patients after tooth loss, its clinical application has been more and more widely. But with the wide application of implants in the clinical treatment of peri implantitis (Periimplantitis) is a disease a clear upward trend, had caused the attention of oral physicians. Peri implantitis is a place in the peri implant inflammation caused by the infection of subgingival plaque, soft tissue around the lesions involved not only, still can cause deep support tissues, if unchecked, will cause the implant (Inplant denture the surrounding mucosa swelling pus overflow), increase mobility and fell off, the long-term repair effect is not ideal, resulting in greater pain and economic burden to patients. For peri implantitis. The treatment, basic treatment (Initial therapy) comprehensive therapy drug for treatment of the majority of scholars at home and abroad has become a consensus. Through the research on the pathogenic bacteria of peri implantitis subgingival evidence showed that the main pathogenic bacteria and periodontitis are similar, mainly by Gram negative bacteria. Through these study, we conclude that the clinical commonly used drugs for the treatment of periodontitis, planting in the treatment of inflammation around the body should also have a better therapeutic effect. The current clinical periodontal auxiliary antibacterial drugs have Metronidazole Gel (Metronidazole), Iodine Glycerol (Glycerin Iodine), Minocycline Hydrochloride Ointment (Minocy cline-hydrochloride) and other drugs. Minocycline Hydrochloride Ointment (brand name with Periocline) the main component of effective antibiotic minocycline hydrochloride, is a new type of periodontal tissue can be absorbed with sustained-release ointment, as As a new local sustained-release dosage form, has been widely used in the treatment of periodontitis, which not only has less resistant bacteria, antibacterial antibacterial characteristics of broad spectrum, but also prolong the time of drug action, improve the drug concentration of the periodontal pocket, and can reduce side effects and compliance of patients with better clinical. But the effect of implant in the treatment with other antibiotics commonly used in clinic contrast drugs, there is a lack of relevant reports, so it is necessary for us to make further research. Objective: This study uses Meta analysis method to analysis and comprehensive evaluation of the current published at home and abroad with around the Minocycline Hydrochloride Ointment and implant related literature, more clearly clarify the clinical effect in the treatment of periarthritis of implant, and other antibiotics (Metronidazole Gel And Iodine Glycerol) to evaluate the therapeutic effect, to provide a reference for clinical medication. Methods: We searched the medical literature database Pub Med Web of Science at home and abroad, Cochrane, library, Chinese academic journal full text database (CNKI) and Wanfang database, and through oral implantology, oral and maxillofacial surgery, oral periodontal repair and related aspects of the domestic and foreign periodicals, the search ended in March 2017, Minocycline Hydrochloride Ointment acquisition of related literature about clinical outcomes published at home and abroad. By two reviewers independently performed a rigorous screening of the relevant information, and detailed evaluation on the quality of literature on the extraction results of included the literature analysis was conducted using Meta Rev Man5.3 software, using funnel plot analysis of publication bias, and the sensitivity analysis was performed. Results: preliminary screening of total Detection of 86 related articles, which were 9 clinical studies with analysis of selected standard.Meta results: Minocycline Hydrochloride Ointment for plaque index (Plaque index, PLI), sulcus bleeding index (Sulcus bleeding, index, SBI), periodontal pocket depth (Probing, depth, PD) and other clinical symptoms to treatment effect better than the control group (Iodine Glycerol and metronidazole group), and the difference was statistically significant. Conclusion: the results of this study showed that patients after non-surgical periodontal treatment after the foundation (Kami Geji, subgingival scaling and root planing, etc.) with the use of periodontal antimicrobial drugs, can significantly improve patients probing depth. Sulcus bleeding index and plaque index and other clinical parameters. Compared with the traditional Iodine Glycerol and metronidazole and other common clinical periodontal antimicrobial drugs, Minocycline Hydrochloride Ointment is more advantages in the treatment effect. However, in order to better consolidate the therapeutic effect, repeated treatment should be performed at least every 3-4 weeks.

【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R783.6

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