CAJ | 학술논문

目的通过对127例无牙颌种植修复患者10年临床资料回顾性总结,分析国人无牙颌种植修复的外科技术特点、修复方式及特点,评估长期效果.方法收集1994年8月至2009年11月北京大学口腔医学院·口腔医院口腔种植中心全口无牙颌及单颌无牙颌种植修复患者149例(184个单颌),平均年龄(56.0±10.9)岁.外科手术时视骨量行上颌窦底提升植骨、引导骨再生术(guide bone regeneration,GBR)植骨、外置法植骨术等,修复方式按设计分别为种植固定修复与种植覆盖义齿修复,后者固位方式有套筒冠、切削杆、杆卡式固位、磁性固位体和球帽固位修复.分别于术后即刻、3个月、义齿修复后即刻,以后每12个月拍摄X线片评估种植体颈部骨组织变化,临床检查种植体周围组织健康状态,修复体功能状态进行分析.结果 149例患者(860枚种植体)失访22例,随访127例(162个单颌、762枚牙种植体),平均追踪109.2个月(45 ～228个月),13枚种植体脱落,种植体10年累计存留率为97.8％,义齿存留率100.0％;种植体周围炎发生率3.8％(29/762).67.9％(110/162)的颌骨未植骨直接行种植体植入;上颌窦底提升术39例,占上颌无牙颌的84.8％(39/46),引导骨再生术10例(10/162,6.2％).71.0％(115/162)的义齿为种植覆盖义齿,其中覆盖义齿修复中套筒冠、切削杆和磁性附着体是本组病例最常用固位方式,分别占34.8％ (40/115)、27.0％(31/115)和20.0％(23/115).修复后10年修复体及上部结构并发症共68例(53.5％).结论无牙颌骨量不足最常用的骨增量技术长期效果可靠,植骨区域种植体存留率与常规种植体无明显差异.
목적 통과대127례무아합충식수복환자10년림상자료회고성총결,분석국인무아합충식수복적외과기술특점、수복방식급특점,평고장기효과.방법 수집1994년8월지2009년11월북경대학구강의학원·구강의원구강충식중심전구무아합급단합무아합충식수복환자149례(184개단합),평균년령(56.0±10.9)세.외과수술시시골량행상합두저제승식골、인도골재생술(guide bone regeneration,GBR)식골、외치법식골술등,수복방식안설계분별위충식고정수복여충식복개의치수복,후자고위방식유투통관、절삭간、간잡식고위、자성고위체화구모고위수복.분별우술후즉각、3개월、의치수복후즉각,이후매12개월박섭X선편평고충식체경부골조직변화,림상검사충식체주위조직건강상태,수복체공능상태진행분석.결과 149례환자(860매충식체)실방22례,수방127례(162개단합、762매아충식체),평균추종109.2개월(45 ～228개월),13매충식체탈락,충식체10년루계존류솔위97.8％,의치존류솔100.0％;충식체주위염발생솔3.8％(29/762).67.9％(110/162)적합골미식골직접행충식체식입;상합두저제승술39례,점상합무아합적84.8％(39/46),인도골재생술10례(10/162,6.2％).71.0％(115/162)적의치위충식복개의치,기중복개의치수복중투통관、절삭간화자성부착체시본조병례최상용고위방식,분별점34.8％ (40/115)、27.0％(31/115)화20.0％(23/115).수복후10년수복체급상부결구병발증공68례(53.5％).결론 무아합골량불족최상용적골증량기술장기효과가고,식골구역충식체존류솔여상규충식체무명현차이.
Objective To evaluate the 10-year clinical results of implant prostheses in edentulous patients.Methods Between August 1994 and November 2009,762 implants were placed in 127 patients (162 jaws) with the mean age of (56.0 ± 10.9) years in Peking University,School and Hospital of Stomatology.Sinus lift,guide bone regeneration (GBR) and onlay graft were used according to the indications of bone defect types.Overdentures and fixed bridges were delivered.Overdentures were retained/supported by ball,magnet,telescopic crown or milled bar.Clinical evaluation included peri-implant soft tissue health status,prostheses functional status and complications.Radiographic evaluations were conducted at operation day,3 months post-operatively,right after prostheses delivery,and annually afterwards.Clinical data were collected and analyzed.Results Of the 127 patients,116 were edentulous mandible and 46 edentulous maxilla,with a mean follow-up period 109.2 months (45-228 months).Thirteen implants were lost and the 10-year implant cumulative survival rate was 97.8％ and the prostheses success rate was 100.0％.The prevalence of peri-implantitis was 3.8％ (29/762).Sixty-seven point nine percent of the patients underwent implant placement without bone graft.Sinus lift technique and guided bone regeneration technique were the most often used with 84.8％(39/46) in the upper jaws and 6.2％(10/162) in the total jaws respectively.Seventy-one percent of the cases(115/162) was overdentures.Telescopic,milled-bar,and magnetic retained/supported overdentures were the most commonly used with 34.8％(40/115),27.0％ (31/115),and 20.0％ (23/115) respectively.The implant-supported fixed prostheses included adhesive retained fixed bridges and screw retained fixed bridges with the ratio of 19.1％ and 80.9％ respectively.The prevalence of 10-year post-prosthodontic complications was 53.5％(68 cases).The most common complications were prosthetic and uperstructure complications.Conclusions The 10-year implant-retained/supported prostheses was a successful modality in edentulous cases.Sinus lift technique and guided bone regeneration technique are the most commonly used techniques with predictable clinical results.Telescopic crowns milled bar and magnet with 4-6 implants retained/supported overdenture were the most often used retention systems and telescopic crown overdenture had more advantages in terms of long-term maintenance and satisfaction.