不同方案设计种植覆盖义齿临床回顾性研究

Different design schemes of implant-supported overdentures:a clinical retrospective study

目的:根据X线片和临床软组织检测及修复后并发症情况,评价不同设计方案种植覆盖义齿长期临床效果。方法:搜集63名(平均年龄62.8岁)患者共74例无牙颌246个种植体,其中杆卡式44例;球帽式18例;套筒冠12例,平均随访42.6个月(14～82个月)。采用Buser存留标准评估种植体,纳入寿命表法进行生存分析,并对修复后边缘骨吸收(MBL)情况进行统计分析。结果:246个种植体累计存留率98.8%。种植体失访28个(9例患者),失败3个,8例修复体失败。边缘骨吸收为(0.79±0.15)mm,3种方式修复后MBL比较无统计学意义(P>0.05)。11个(5.1%)种植体发生种植体周围黏膜炎;5个(2.3%)发生种植体周围炎;27个(17.5%)种植杆卡式覆盖义齿出现牙龈黏膜增生。杆卡式修复后机械并发症主要为杆折断(34.9%)、基板折断(27.9%)、固位差(30.2%)、螺丝松动(30.2%),平均修理频次1.2;球帽式主要为固位差(16.7%)、弹簧圈破损(22.2%)、球基台折断(11.1%),平均修理频次0.5;套筒冠为基板折断(18.2%)、牙脱落(25.0%),平均修理频次0.4。结论:Straumann种植覆盖义齿长期效果可靠。杆卡式平均修理频次和机械并发症的发生率稍高于球帽式及套筒冠,且杆卡式修复发生黏膜增生情况较常见。

AIM： To evaluate the clinical results of different design schemes of implant-retained overden- tures. METHODS： A total of 246 implants in 63 patients （74 edentulous jaws）with the mean age of 62.8 years inclu- ding 44bar-clip attachments, 18 findings ball attachments and 12 findings telescopic crown attachments were retrospec- tively studied. The average follow-up time was 42.6 （ 14 - 82） months. The results were evaluated by Buser survival cri- teria and life table analysis, the marginal bone resorption behind of prostheses （MBL） was examined by X-ray film. Data were statisticaly analyzed. RFEULTS： The cumulative survival rate was 98.8%. 9 subjects（28implants） were loss of follow-up, 3 implants were failure, and 8 prostheses were loose. The mean MBL was（0.79 ±0.15 ）mm. No sta- tistical difference of MBL was found among the 3 design schemes. 11 implants （5.1% ） were with peri-implant mu- cositis, and 5 implants （2.3%） were with peri - implantitis. 27 implants （ 17.5% ） of bar-clip attachments were with mucosal hyperplasia. The major complications of bar-clip attachment were bar - clip fracture（ 34.9% ） prostheses frac- ture （27.9%）, poor retention （30.2%） and screw loosening （30.2%）. Those of ball attachment were poor retention （ 16.7% ）, replacement of matrix coils （ 22.2% ） and ball abutment frature （ 11.1% ）. Those of telescopic crown at- tachments were denture drop（25.0% ） and denture base fracture （ 18.2% ）. The repair frequency of 3 different pros- theses were 1.2,0.5 and 0.4 respectively. CONCLUSION ： The long term clinical effect of implant-retained overden-ture is reliable. Considering about mechanical complication and mean repair frequency, bar-clip attachment is slightly higher. Hyperplasia and mucositis are the most common soft tissue complications of bar-clip attachment.