铒激光辅助治疗种植体周炎的疗效及机制初探

doi:10.13591/j.cnki.kqyx.2025.12.009

摘要/Abstract

摘要：

目的评估Er, Cr: YSGG激光辅助治疗种植体周炎(peri-implantitis,PI)的临床疗效,初步探索种植体周炎治疗前后炎症因子的水平差异。方法本研究选取种植体周炎患者19例,共22颗种植体,随机分为3组。SRP组采用钛刮治器进行机械清创;SRPL1组采用钛刮治器进行机械清创后,使用1.5 W Er, Cr: YSGG激光进行辅助治疗;SRPL2组采用钛刮治器进行机械清创后,使用2.0 W Er, Cr:YSGG激光进行辅助治疗。术前和术后1、3个月分别记录并比较3组种植体周临床指标,包括探诊深度(probing depth,PD)、改良龈沟出血指数(modified sulcus bleeding index,mSBI)、改良菌斑指数(modified plaque index,mPLI);同时收集种植体周围龈沟液,ELISA检测炎症因子白介素(interleukin,IL)-17、血管内皮生长因子(vascular endothelial growth factor,VEGF)、IL-1ra表达水平,并分析临床指标及炎症因子的相关性;术后2 h通过视觉模拟量表(visual analogue scale,VAS)记录受试者疼痛程度。结果 3组术后PD和mSBI均较术前明显改善(P<0.05),mPLI无明显改善,且组间差异无统计学意义(P>0.05);术后1个月,SRPL1组、SRPL2组PD、mSBI均明显低于SRP组(P<0.05),但SRPL1组、SRPL2组间差异无统计学意义(P>0.05);术后3个月,与SRP组相比,SRPL1组、SRPL2组仅PD明显降低(P<0.05),2组间差异无统计学意义(P>0.05)。术后1、3个月,3组IL-17和VEGF水平较术前明显下降(P<0.05),IL-1ra水平明显上升(P<0.05);术后1个月,与SRP组相比,SRPL1组、SRPL2组IL-17和VEGF水平明显下降(P<0.05),IL-1ra水平明显上升(P<0.05);术后3个月,3组间差异无统计学意义(P>0.05)。各组中IL-17、VEGF与PD均呈正相关(P<0.05),IL-1ra与PD、mSBI均呈负相关(P<0.05)。SRP组VAS评分明显高于SRPL1组、SRPL2组(P<0.05)。结论 Er, Cr: YSGG激光辅助SRP治疗种植体周炎在改善临床指标、调控炎症因子水平和减轻术后疼痛方面表现优异,种植体周围龈沟液中IL-17、VEGF和IL-1ra水平可为种植体周炎的疗效评价提供有效信息。

关键词: Er, Cr: YSGG激光, 种植体周炎, 临床疗效, 炎症因子

Abstract:

Objective To evaluate the clinical efficacy of Er, Cr: YSGG laser-assisted treatment for peri-implantitis (PI) and to preliminarily explore the differences in the levels of inflammatory factors before and after treatment. Methods This study included 19 patients with peri-implantitis, involving a total of 22 implants, which were randomly divided into three groups. The SRP group received subgingival debridement with a titanium scaler; the SRPL1 group underwent subgingival debridement followed by 1.5 W Er, Cr: YSGG laser-assisted treatment; and the SRPL2 group received subgingival debridement followed by 2.0 W Er, Cr: YSGG laser-assisted treatment. Clinical parameters, including probing depth (PD), modified sulcus bleeding index (mSBI), and modified plaque index (mPLI), were recorded and compared before treatment and 1 and 3 months post-treatment. Peri-implant sulcular fluid was collected for ELISA detection of inflammatory factors, including interleukin (IL)-17, vascular endothelial growth factor (VEGF), and IL-1ra, and the correlations between clinical parameters and inflammatory factors were analyzed. Pain levels were recorded using the visual analogue scale (VAS) at 2 h after treatment. Results All three groups showed significant improvement in PD and mSBI at post-treatment compared to pre-treatment values (P<0.05). However, there was no significant improvement in mPLI, and no differences were observed among the groups (P>0.05). At 1 month post-treatment, both the SRPL1 and SRPL2 groups had significantly lower PD and mSBI values than the SRP group (P<0.05), but no statistically significant difference was found between the SRPL1 and SRPL2 groups (P>0.05). At 3 months post-treatment, only PD was significantly lower in the SRPL1 and SRPL2 groups compared to the SRP group (P<0.05). No significant difference was observed between the two groups (P>0.05). One and three months post-treatment, IL-17 and VEGF levels were significantly reduced (P<0.05). At 1 month post-treatment, compared to the SRP group, the SRPL1 and SRPL2 groups showed a significant decrease in IL-17 and VEGF levels (P<0.05) and a significant increase in IL-1ra levels (P<0.05). At 3 months post-treatment, no significant differences were observed among the three groups (P>0.05). PD were positively correlated with IL-17 and VEGF (P<0.05), while IL-1ra was negatively correlated with PD and mSBI (P>0.05). The VAS scores were significantly higher in the SRP group compared to the SRPL1 and SRPL2 groups (P<0.05). Conclusion Er, Cr: YSGG laser-assisted SRP treatment for peri-implantitis demonstrates excellent clinical outcomes, including improvements in clinical parameters, regulation of inflammatory factor levels, and reduced postoperative pain. The levels of IL-17, VEGF, and IL-1ra in peri-implant sulcular fluid can provide valuable information for the diagnosis, treatment, and evaluation of peri-implantitis.

Key words: Er, Cr:YSGG, peri-implantitis, clinical efficacy, inflammatory factors

中图分类号:

R781.4

程昶, 陈武. 铒激光辅助治疗种植体周炎的疗效及机制初探[J]. 口腔医学, 2025, 45(12): 927-931.

CHENG Chang, CHEN Wu. Efficacy and preliminary mechanisms of Er,Cr:YSGG laser-assisted therapy for peri-implantitis[J]. Stomatology, 2025, 45(12): 927-931.

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参考文献 20

[1]	Salvi GE, Cosgarea R, Sculean A. Prevalence of periimplant diseases[J]. Implant Dent, 2019, 28(2): 100-102. doi: 10.1097/ID.0000000000000872 pmid: 30762625
[2]	刘宇涵, 孟维艳. 生物膜在种植体表面的形成及其对种植稳态的影响[J]. 口腔医学, 2025, 45(8): 637-640.
[3]	Aoki A, Mizutani K, Schwarz F, et al. Periodontal and peri-implant wound healing following laser therapy[J]. Periodontol 2000, 2015, 68(1): 217-269. doi: 10.1111/prd.12080 pmid: 25867988
[4]	Lin GH, Suárez López Del Amo F, Wang HL. Laser therapy for treatment of peri-implant mucositis and peri-implantitis: An American Academy of Periodontology best evidence review[J]. J Periodontol, 2018, 89(7): 766-782.
[5]	Takagi T, Aoki A, Ichinose S, et al. Effective removal of calcified deposits on microstructured titanium fixture surfaces of dental implants with erbium lasers[J]. J Periodontol, 2018, 89(6): 680-690. doi: 10.1002/JPER.17-0389 pmid: 29536538
[6]	Schwarz F, Alcoforado G, Guerrero A, et al. Peri-implantitis: Summary and consensus statements of group 3. The 6th EAO Consensus Conference 2021[J]. Clin Oral Implants Res, 2021, 32(S21): 245-253. doi: 10.1111/clr.v32.s21
[7]	Schwarz F, Derks J, Monje A, et al. Peri-implantitis[J]. J Clin Periodontol, 2018, 45(S20): S246-S266.
[8]	Smeets R, Henningsen A, Jung O, et al. Definition, etiology, prevention and treatment of peri-implantitis: A review[J]. Head Face Med, 2014, 10: 34. doi: 10.1186/1746-160X-10-34 pmid: 25185675
[9]	Shiba T, Ho K, Ma XH, et al. Effect of Er, Cr: YSGG laser irradiation on the surface modification and cell adhesion on titanium discs: An in vitro study[J]. Materials, 2024, 17(19): 4899. doi: 10.3390/ma17194899
[10]	Srinivasan M, Kamnoedboon P, Papi P, et al. Efficacy of non-surgical laser therapy for the management of peri-implantitis: A systematic review and meta-analysis[J]. J Dent, 2025, 154: 105562. doi: 10.1016/j.jdent.2025.105562
[11]	Alpaslan Yayli NZ, Talmac AC, Keskin Tunc S, et al. Erbium, chromium-doped: Yttrium, scandium, gallium, garnet and diode lasers in the treatment of peri-implantitis: Clinical and biochemical outcomes in a randomized-controlled clinical trial[J]. Lasers Med Sci, 2022, 37(1): 665-674. doi: 10.1007/s10103-021-03436-5
[12]	Yao WL, Lin JCY, Salamanca E, et al. Er, Cr: YSGG laser performance improves biological response on titanium surfaces[J]. Materials, 2020, 13(3): 756. doi: 10.3390/ma13030756
[13]	Moaven H, Giacaman A, Beltrán V, et al. Biomarker expression of peri-implantitis lesions before and after treatment: A systematic review[J]. Int J Environ Res Public Health, 2022, 19(21): 14085. doi: 10.3390/ijerph192114085
[14]	Darabi E, Kadkhoda Z, Amirzargar A. Comparison of the levels of tumor necrosis factor-α and interleukin-17 in gingival crevicular fluid of patients with peri-implantitis and a control group with healthy implants[J]. Iran J Allergy Asthma Immunol, 2013, 12(1): 75-80.
[15]	de Araújo MF, Filho AFL, da Silva GP, et al. Evaluation of peri-implant mucosa: Clinical, histopathological and immunological aspects[J]. Arch Oral Biol, 2014, 59(5): 470-478. doi: 10.1016/j.archoralbio.2014.01.011 pmid: 24631629
[16]	Farhad SZ, Rezazadeh F, Mohammadi M. Interleukin-17 and interleukin-10 as inflammatory and prevention biomarkers in periimplant diseases[J]. Int J Prev Med, 2019, 10(1): 137.
[17]	Niklander S, Bordagaray MJ, Fernández A, et al. Vascular endothelial growth factor: A translational view in oral non-communicable diseases[J]. Biomolecules, 2021, 11(1): 85. doi: 10.3390/biom11010085
[18]	Steemers E, Talbi WMI, Hogervorst JMA, et al. IL-1 receptor antagonist anakinra inhibits the effect of IL-1β mediated osteoclast formation by periodontal ligament fibroblasts[J]. Biology, 2025, 14(3): 250. doi: 10.3390/biology14030250
[19]	Alagl AS, Madi M, Bedi S, et al. The effect of Er, Cr: YSGG and diode laser applications on dental implant surfaces contaminated with Acinetobacter baumannii and Pseudomonas aeruginosa[J]. Materials, 2019, 12(13): 2073. doi: 10.3390/ma12132073
[20]	Mikami R, Mizutani K, Sasaki Y, et al. Patient-reported outcomes of laser-assisted pain control following non-surgical and surgical periodontal therapy: A systematic review and meta-analysis[J]. PLoS One, 2020, 15(9): e0238659. doi: 10.1371/journal.pone.0238659

组别	术前	术后1个月	术后3个月	F	P
SRP组	6.63±1.51	4.88±0.99^a	4.63±0.52^a	11.043	0.004
SRPL1组	6.13±0.99	3.75±0.71^ab	3.25±0.71^ab	14.889	0.001
SRPL2组	5.83±0.75	3.17±0.75^ab	2.50±1.05^ab	11.273	0.004
F	1.978	9.110	13.445
P	0.372	0.011	0.001

组别	术前	术后1个月	术后3个月	χ²	P
SRP组	2.00(2.00,2.75)	1.00(1.00,1.75)^a	1.00(1.00,1.00)^a	12.091	0.002
SRPL1组	2.00(2.00,2.75)	1.00(0,1.00)^ab	0(0,1.00)^a	14.000	0.001
SRPL2组	2.00(1.75,3.00)	0.50(0,1.00)^ab	0(0,1.00)^a	9.500	0.009
H	0.547	6.776	5.926
P	0.761	0.034	0.052

组别	术前	术后1个月	术后3个月	χ²	P
SRP组	1.00(0.25,1.00)	1.00(0,1.00)	0.50(0,1.00)	1.500	0.472
SRPL1组	1.00(0,1.00)	0.50(0,1.00)	0(0,1.00)	1.500	0.472
SRPL2组	1.00(0.75,1.00)	0(0,1.00)	0(0,1.00)	6.000	0.050
H	0.747	1.114	0.434
P	0.688	0.573	0.805

组别	术前	术后1个月	术后3个月	F	P
SRP组	36.80±4.62	29.20±3.94^a	25.36±4.69^ab	21.851	<0.001
SRPL1组	34.34±6.59	23.26±3.60^ac	21.30±3.00^a	28.017	<0.001
SRPL2组	33.11±2.66	22.49±4.08^ac	20.34±4.66^a	20.097	<0.001
F	0.981	6.794	3.065
P	0.393	0.006	0.070

组别	术前	术后1个月	术后3个月	F	P
SRP组	55.37±3.19	43.40±9.88^a	37.32±4.65^a	18.865	<0.001
SRPL1组	56.20±5.56	33.92±5.07^ab	33.05±5.00^a	31.971	<0.001
SRPL2组	53.81±5.70	32.81±3.10^ab	31.71±7.31^a	21.716	<0.001
F	0.418	5.307	2.009
P	0.664	0.015	0.162