本文選題：鹽酸米諾環(huán)素　切入點(diǎn)：種植體周圍炎　出處：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景:種植修復(fù)治療現(xiàn)已成為臨床修復(fù)缺失牙的一種重要手段,更是牙周炎(Periodontitis)患者失牙后進(jìn)行修復(fù)的重要方法,其臨床應(yīng)用已經(jīng)越來(lái)越廣泛。但隨著種植修復(fù)在臨床治療中的廣泛應(yīng)用,種植體周圍炎(Periimplantitis)的發(fā)病呈一種明顯上升的趨勢(shì),不得不引起口腔醫(yī)師的重視。種植體周圍炎是一種發(fā)生在種植體周圍由齦下菌斑感染引起的炎癥性疾病,病變不僅累及周圍軟組織,還會(huì)造成深層支持組織的病變,若不加以關(guān)注,將造成種植體(Inplant denture)周圍黏膜的紅腫溢膿,松動(dòng)度的增加甚至脫落,遠(yuǎn)期修復(fù)治療效果不理想,給患者造成較大的痛苦和經(jīng)濟(jì)負(fù)擔(dān)。對(duì)于種植體周圍炎的治療,基礎(chǔ)治療(Initial therapy)后輔助藥物治療的綜合療法已成為多數(shù)國(guó)內(nèi)外學(xué)者的共識(shí)。通過(guò)對(duì)種植體周圍炎齦下菌斑微生物的研究,現(xiàn)有證據(jù)表明其主要致病菌與牙周炎的優(yōu)勢(shì)菌群比較相似,主要由革蘭陰性菌組成。通過(guò)這些研究,我們推斷目前臨床用于治療牙周炎的常用藥物,在治療種植體周圍炎時(shí)也應(yīng)有較好的治療效果。目前臨床常用的牙周輔助抗菌藥物有甲硝唑凝膠(Metronidazole)、碘甘油(Glycerin Iodine)、鹽酸米諾環(huán)素軟膏(Minocy cline-hydrochloride)等藥物。鹽酸米諾環(huán)素軟膏(商品名派麗奧)中含的有效抗菌成分主要為鹽酸米諾環(huán)素,是一種新型可被牙周組織吸收的軟膏裝緩釋劑,作為一種新型局部緩釋抗菌劑型,目前已被廣泛應(yīng)用于牙周炎的治療當(dāng)中,其不僅具有耐藥菌少、抗菌譜廣的殺菌抑菌特點(diǎn),還能延長(zhǎng)藥物作用時(shí)間,提高牙周袋內(nèi)的藥物濃度,并且還能減少毒副作用,患者的依從性較好。但在治療種植體周圍炎的臨床效果上與其他臨床常用抗菌藥物的對(duì)比方面,目前還缺乏相關(guān)的報(bào)道,因此我們有必要對(duì)其進(jìn)行更進(jìn)一步的研究。目的:本研究擬采用Meta分析的方法對(duì)目前國(guó)內(nèi)外已發(fā)表的有關(guān)鹽酸米諾環(huán)素軟膏與牙種植體周圍炎相關(guān)的文獻(xiàn)進(jìn)行綜合的分析和評(píng)價(jià),更為明確地闡明在治療種植體周圍炎的臨床效果上,與其他臨床常用抗菌藥物(甲硝唑凝膠和碘甘油)的治療效果進(jìn)行對(duì)比評(píng)價(jià),為臨床局部用藥提供一定的參考。方法:計(jì)算機(jī)檢索國(guó)內(nèi)外的醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)Pub Med、Web of Science、Cochrane library、中國(guó)學(xué)術(shù)期刊全文數(shù)據(jù)庫(kù)(CNKI)和萬(wàn)方數(shù)據(jù)庫(kù)等,并翻閱口腔種植、口腔頜面外科、口腔修復(fù)以及牙周相關(guān)方面的國(guó)內(nèi)外現(xiàn)刊,檢索時(shí)間截止至2017年3月,獲取有關(guān)國(guó)內(nèi)外公開(kāi)發(fā)表的研究鹽酸米諾環(huán)素軟膏臨床療效的相關(guān)文獻(xiàn)。由兩名評(píng)價(jià)者分別獨(dú)立對(duì)相關(guān)資料進(jìn)行嚴(yán)格篩選,并對(duì)文獻(xiàn)質(zhì)量進(jìn)行詳細(xì)評(píng)價(jià)的基礎(chǔ)上,采用Rev Man5.3軟件對(duì)納入文獻(xiàn)中提取的研究結(jié)果進(jìn)行Meta分析,利用漏斗圖分析發(fā)表性偏倚,最后進(jìn)行敏感性分析。結(jié)果:初步篩選共檢出相關(guān)文獻(xiàn)86篇,其中9篇臨床對(duì)照試驗(yàn)研究符合入選標(biāo)準(zhǔn)。Meta分析的結(jié)果顯示:鹽酸米諾環(huán)素軟膏對(duì)于牙菌斑指數(shù)(Plaque index,PLI),齦溝出血指數(shù)(Sulcus bleeding index,SBI),牙周袋深度(Probing depth,PD)方面以及其它臨床癥狀的治療效果要優(yōu)于對(duì)照組(碘甘油和甲硝唑組),且差異具有統(tǒng)計(jì)學(xué)意義。結(jié)論:本研究結(jié)果表明,患者在經(jīng)過(guò)牙周的非手術(shù)性基礎(chǔ)治療后(齦上潔治、齦下刮治及根面平整等),配合使用牙周抑菌藥物,可明顯改善患者探診深度、齦溝出血指數(shù)和菌斑指數(shù)等臨床指標(biāo)。相較于傳統(tǒng)的碘甘油和甲硝唑等臨床常用牙周抑菌藥物,鹽酸米諾環(huán)素軟膏在治療效果方面顯得更具有優(yōu)勢(shì)。但為了更好的鞏固治療效果,至少應(yīng)每隔3-4周后進(jìn)行重復(fù)治療。
[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.

【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R783.6

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