上颌后牙区不同术式种植修复10年累计存留率及患者相关因素对其成功率的影响分析

Assessment of the 10-year cumulative survival rates and the effect of patient-related factors on the success rate of implant-supported prosthesis in the posterior maxilla

目的分析不同术式上颌后牙区种植修复的10年累计存留率及患者相关因素对上颌后牙区不同术式种植修复成功率的影响。方法选择2005年1月至2012年12月在中国医科大学附属口腔医院种植中心行上颌后牙区种植修复的患者256例(共561颗种植体)。根据上颌后牙区剩余骨高度(residual bone height,RBH)的不同,分别采用常规种植术(native bone implant,NB)、经牙槽嵴顶上颌窦底提升术(internal sinus floor elevation,ISFE)及经上颌窦外侧壁开窗术(lateral sinus floor elevation,LSFE),术后随访3~10年,比较3组的累计存留率。并分析患者相关因素(年龄、性别、糖尿病、吸烟习惯、缺牙原因、种植部位、骨密度)对3组种植体成功率的影响。结果上颌后牙区种植时,采用NB、ISFE、LSFE的种植体累计存留率分别为94.38%、90.13%、95.25%,差异无统计学意义(P>0.05)。糖尿病作为3组的共同影响因素(P<0.05),降低3组种植体的成功率。骨密度是NB成功率的影响因素(P=0.038),种植体的成功率随骨密度的降低而降低。年龄是ISFE成功率的影响因素(P=0.047),高龄者的种植体成功率较低。结论上颌后牙区种植时,采用不同术式(NB、ISFE及LSFE)的种植体累计存留率无明显差异。糖尿病作为影响上颌后牙区种植的重要预后因素,在术前、术后均应严格控制以提高种植体的长期存留率。在常规种植术和经牙槽嵴顶上颌窦底提升术中,高龄者和骨密度低者的种植体成功率相对较低。

Objective To assess the 10-year cumulative survival rates （CSRs）and the effect of patient-related factors on the success rate of implant-supported prosthesis in the posterior maxilla. Methods A total of 561 implants were in- serted in the posterior maxilla between Jan. 2005 and Dec. 2012 in 265 patients with a follow-up of 3-10 years. The pa- tients were treated with native bone implant （NB）, internal sinus floor elevation （ISFE）and lateral sinus floor elevation （LSFE） according to residual bone height of posterior maxilla. Compare CSRs and access the effect of patient-related fac- tors, such as patients age, gender, diabetes mellitus, smoking habits, cause for tooth loss, region of implant and bone qual- ity, on the success rate. Results The CSRs of NB, ISFE and LSFE in the posterior maxilla were 94.38%, 90.13% and 95.25% respectively, but the differences of which were insignificant. The common significant factor of three groups was diabetes mellitus （P 〈 0.05）, which decreased the success rate of implant. The bone quality ＇was the predictors of NB （P = 0.038 ）and the success rate decreased with the decreased of bone density. The age was the predictors of ISFE（P = 0.047）and the eider had a lower success rate than the younger. Conclusion No significant statistical differences of CSRs are found among three groups when there is implant in the posterior maxilla. Diabetes mellitus, as an impor- tant prognostic factor, should be controlled preoperativelyand postoperatively to improve the long-term survival of implants in posterior maxilla. The elder in NB and low bone den- sity＇ s in ISFE exhibit lower implants success rates.