Longitudinal analysis of peri-implant keratinized mucosa using computer imaging

Unrestricted Background: Peri-implant keratinized mucosa contributes to long-term health and success of implant-supported restorations. It is more easily maintained and less vulnerable to inflammation than non-keratinized alveolar mucosa. Understanding changes that occur in peri-implant mucosa may influence treatment planning, post- operative procedures and maintenance. Digital photography and computer imaging may enable us to gain a more precise assessment of peri-implant tissue than past methodologies.; Purpose: Monitor changes in peri-implant tissues using ImageJ computer analysis. To identify if changes vary by mesial, mid, distal and surface area of peri-implant keratinized mucosa. In addition, the relationship between tissue thickness, proximity to adjacent dentition, mucosal health and mucosal marginal stability will be investigated.; Methods: Seventeen systemically healthy, non-smokers, receiving one-stage Straumann implants with an adjacent control tooth were enrolled. Digital photographs were taken at baseline, 3 and 6 months after implant placement and analyzed with ImageJ software. Plaque and gingival indices, pocket probing depths, bleeding on probing and tissue thickness were examined at 3 and 6 months. Inter-rater agreement was evaluated by intraclass coefficient.; Results: Twenty-one implants were placed in the mandibular posterior, five 4.8mm regular neck (RN) and sixteen 6.5mm wide neck (WN). Loss of mean width peri-implant keratinized mucosa was significantly greater on the lingual surface than buccal, .7 vs. .1mm respectively (p.05). Inter-rater agreement intraclass coefficient was .99.; Conclusion: Imaging analysis software, ImageJ, yields a more precise assessment and quantification of peri-implant soft tissues than current chair-side techniques and may facilitate a database for future studies. Lingual peri-implant tissue and wide-neck implants were significantly correlated to a loss of keratinized mucosa. This may be due to tension or "stretching" of mucosa, causing it to thin, making it more susceptible to recession as a manifestation of inflammation. Thinning of mucosa may be a consequence of clinicians positioning and inclination of the implant within the alveolar housing, which is influenced by anatomical limitations, bone resorption patterns and biomechanic requirements.研究背景：种植体周围角化黏膜（peri-implant keratinized mucosa）对于种植修复体的长期健康与成功至关重要。相较于非角化牙槽黏膜，其更易于维护，且不易发生炎症。明晰种植体周围黏膜的变化规律，可为治疗方案制定、术后操作及日常维护提供参考。相较于传统方法，数码摄影与计算机成像技术可实现对种植体周围软组织更精准的评估。 研究目的：采用ImageJ计算机分析技术监测种植体周围组织的变化，明确种植体周围角化黏膜在近中、正中、远中区域及不同表面积下的变化差异。此外，本研究还将探讨组织厚度、与邻牙的距离、黏膜健康状况与黏膜边缘稳定性之间的关联。 研究方法：本研究纳入17名全身健康、无吸烟史的受试者，均接受同期植入士卓曼（Straumann）种植体，并以邻牙作为对照。分别于种植体植入基线期、术后3个月及6个月拍摄数码照片，采用ImageJ软件进行分析。于术后3个月及6个月记录菌斑指数、牙龈指数、牙周探诊深度、探诊出血情况及组织厚度。采用组内相关系数（intraclass coefficient）评估评分者间一致性。 研究结果：本研究共在下颌后牙区植入21枚种植体，其中5枚为4.8mm常规颈圈（regular neck, RN）种植体，16枚为6.5mm宽颈圈（wide neck, WN）种植体。舌侧区域种植体周围角化黏膜的平均宽度丢失量显著高于颊侧区域，分别为0.7mm与0.1mm（p<0.05）。评分者间一致性的组内相关系数为0.99。 研究结论：相较于当前临床椅旁技术，ImageJ成像分析软件可对种植体周围软组织实现更精准的评估与量化，可为后续研究构建标准化数据库提供支撑。舌侧种植体周围组织与宽颈圈种植体与角化黏膜丢失显著相关，这可能源于黏膜张力或“拉伸”导致的组织变薄，使其更易因炎症表现发生退缩。黏膜变薄可能与临床医师在牙槽窝内的种植体植入位置与倾斜角度有关，而该操作受解剖限制、骨吸收模式及生物力学需求的影响。