后牙种植冠桥修复邻接触丧失的临床回顾研究

The loss of interproximal contact between posterior fixed implant prostheses and adjacent teeth：a retrospective study

目的 探讨后牙种植冠桥修复的邻接触丧失率及其预后因素,以期为临床诊疗提供参考.方法 从临床收集78例（共97件修复体,165个邻接触位点）后牙种植冠桥修复患者,男性34例,女性44例,年龄23～ 76岁（平均44.4岁）,修复体戴用时间1～44个月.以牙线和30 μm邻接触检查片无阻力通过邻接触区定义为邻接触丧失,临床复查记录种植修复体邻接触情况、种植位点、修复形式、邻牙形式、缺牙时间等情况,采用Cox回归分析筛选种植冠桥修复后邻接触丧失的预后因素.结果 78例患者165个邻接触位点的邻接触丧失率为29％（48/165）.近中邻接触丧失构成比[75％（36/48）]显著多于远中[25％（12/48）] （x2=7.344,P=0.007）;上颌[46％（22/48）]与下颌[54％（26/48）]邻接触丧失构成比差异无统计学意义（x2=2.992,P=0.084）.Cox回归显示,修复前缺牙时间（风险比为0.919）、游离端修复（风险比为2.870）显著影响邻接触丧失的发生（P＜0.05）.结论 后牙种植冠桥修复后邻接触丧失是一类发生比例较高的并发症,修复前缺牙时间短、游离端修复是其发生的预后相关因素.

Objective To investigate the interproximal contact（IC） loss rate and the associated risk factors of IC loss between posterior fixed implant prostheses and the adjacent teeth.Methods Ninety-seven posterior fixed implant prostheses including 165 IC in 78 patients（34 men, 44 women） between 23 and 76 years of age were investigated.The period after restoration ranged from 1 to 44 months.The IC between implant prostheses and adjacent teeth was evaluated using a 30-μm-thick contact gauge and dental floss, and the IC was regarded as lost when the gauge or dental floss was inserted into an IC without any resistance at follow-up visits.The state of IC, region of implant prostheses, the condition of opposing dentition, the vitality of the adjacent teeth and the time interval of tooth loss were also confirmed for correlation analysis.Results All 78 patients finished follow-up examination.Forty-eight of 165 IC（29%）were regarded as lost.The IC loss rate at the mesial aspect[75%（36/48）] was significantly greater than that at the distal aspect[25%（12/48）]（x2=7.344, P=0.007）.The difference between IC loss rate in the maxilla[46% （22/48）] and that in the mandible[54%（26/48）] was not significant（x2=2.992, P=0.084）.Free-end[hazard ratio （HR）=2.870], and the time interval of tooth loss（HR=0.919） affected the loss of IC significantly（P〈0.05, Cox regression analysis）.Conclusions Loss of IC between posterior fixed implant prostheses and adjacent teeth was one of biological complications, which was observed frequently at follow-up visits.Patients who have the free-end fixed implant prostheses, or undergo short time interval of tooth loss before restoration may have high risk of the IC loss.