ベースラインデータがない場合のインプラント周囲炎の診断：診断精度調査

Diagnosis of peri-implantitis in the absence of baseline data: a diagnostic accuracy study.

• Mario Romandini
• Jessica Berglundh
• Jan Derks
• Mariano Sanz
• Tord Berglundh

抄録

目的:

本研究の目的は、フォローアップ期間中の1回の時点で、(i)インプラント周囲骨喪失の既往歴と(ii)インプラント周囲炎の有無を特定するために行われた臨床検査とX線検査の診断精度を評価することであった。

OBJECTIVES: The aim of the present study was to evaluate the diagnostic accuracy of clinical and radiographic evaluations made at a single time point during follow-up in identifying (i) a history of peri-implant bone loss and (ii) the presence of peri-implantitis.

MATERIAL & METHODS: 427 patients provided with implant-supported reconstructions 9 years earlier were evaluated clinically by Probing Pocket Depth, Bleeding or Suppuration on Probing (PPD, BoP & SoP) and radiographically. Bone levels were assessed relative to the most coronal point of the intra-osseous part of the implant. A history of bone loss and diagnosis of peri-implantitis was confirmed through baseline documentation (direct evidence). Diagnostic accuracy of radiographic bone levels at 9 years and clinical findings (indirect evidence/secondary case definition) in identifying a history of bone loss and peri-implantitis were evaluated through correlation and multi-level regression analyses as well as Receiver Operating Characteristic curves. Results were expressed as sensitivity/specificity and area under the curve (AUC).

結果:

9年後に観察された骨レベルは、顕著な骨量減少（2mm以上；AUC=0.96；95%CI 0.95-0.98）を識別する上で非常に正確であった。ベースラインの記録がない場合には、BoP/SoPの存在と骨量1mm以上の骨量（間接的証拠）に基づく二次的な症例定義が、インプラント周囲炎症例（直接証拠：BoP/SoPと骨量0.5mm以上の骨量）の同定において、全体的に最高の診断精度（AUC=0.80; 95%CI 0.77-0.82）を提供していた。中等度/重度のインプラント周囲炎（BoP/SoPと骨量2mm以上）は、BoP/SoPと骨量2mm以上の組み合わせで最も正確に識別された（AUC=0.93）。

RESULTS: Bone levels observed at 9 years were highly accurate in identifying pronounced bone loss (>2 mm; AUC=0.96; 95%CI 0.95-0.98). In the absence of baseline documentation, a secondary case definition based on the presence of BoP/SoP & bone level ≥1 mm (indirect evidence) provided the overall best diagnostic accuracy (AUC=0.80; 95%CI 0.77-0.82) in identifying peri-implantitis cases (direct evidence: BoP/SoP & bone loss >0.5 mm). Moderate/severe peri-implantitis (BoP/SoP & bone loss >2 mm) was most accurately identified by the combination of BoP/SoP & bone level ≥2 mm (AUC=0.93; 95%CI 0.91-0.96). Sensitivity of the secondary case definition suggested by the 2017 World Workshop of Periodontology (WWP) (BoP/SoP ≥1 site & bone level ≥3 mm & PPD ≥6 mm) was low.

結論:

CONCLUSIONS: The present results underline the importance of baseline documentation for the correct diagnosis of peri-implantitis, especially in its early/incipient forms. The secondary case definition of peri-implantitis suggested at the 2017 WWP demonstrated a high level of specificity but low sensitivity. Moderate/severe peri-implantitis was most accurately identified by the combination of BoP/SoP & bone level ≥2 mm.

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