外胚层发育不全缺牙患者种植修复临床效果

Clinical evaluation of implant-supported prostheses for edentulous patients with ectodermal dysplasia

目的探讨骨增量技术结合种植修复对外胚层发育不全缺牙患者进行口腔功能重建的临床效果。方法外胚层发育不全严重缺牙患者13例,行骨增量术后,植入常规种植体及颧种植体,固定义齿修复,并进行口腔健康宣教及心理辅导。治疗完成后,评估种植体生存率、患者满意度。结果 13例患者中2例患者选择髂骨移植,2例选择腓骨移植,1例选择下颌骨外斜线骨移植,1例下颌牙槽骨牵张成骨,其余7例应用引导骨再生。其中1例上颌移植骨出现明显的骨吸收;下颌骨增量效果良好,无明显骨吸收。13例患者共植入118枚种植体,其中22枚颧种植体,96枚常规种植体。5个常规种植体失败并拔除,随访3年常规种植体生存率94.79%,颧种植体生存率100%,患者满意度100%,50%以上的患者表示自信心得到了提升。结论骨增量技术结合种植体支持义齿修复可以有效对外胚层发育不全缺牙患者进行口腔功能重建,增强其自信心,但是上颌前牙区骨增量后可能存在术后骨吸收的问题。

Objective The aim of the present study was to evaluate the clinical outcomes of implant-supported prostheses for oral function rehabilitation in patients with ectodermal dysplasia. Methods Thirteen patients were included in the present study. After bone augmentation, zygomatic implants（ZIs） or regular implants（RIs） were placed, fabrication of dental prostheses were applied, and psychological and oral education was carried out. Implant survival rates, patient satisfaction and other related evaluation indicators were assessed. Results The ilium was chosen for autogenic bone grafts in two patients. The fibula was used in two other patients and the mandibular ramus in one other patient.One patient was treated through alveolar distraction osteogenesis of the mandible. Guided bone regeneration was applied in seven other patients. Bone graft resorption in the maxilla was observed in one patient; bone augmentation of the mandible was successful in all patients, and no obvious bone resorption was observed. One hundred and eighteen implants were placed, among which 22 were ZIs, and 96 were RIs. Five RIs failed and were removed. The survival rate for ZIs was 100%, and the survival rate for RIs was 94.79%, in a follow up after 3 years. All patients were satisfied with the restoration of their oral function. More than 50% of the patients exhibited self-confidence. Conclusion Oral function can be restored in edentulous ectodermal dysplasia patients using bone augmentation and implant-supported prostheses, and patient self-confidence can be enhanced. However, the resorption of grafted bone in the anterior region of the maxilla cannot be ignored.