种植覆盖义齿修复牙列缺失的生活质量研究

Evaluation of quality of life on rehabilitation of implant-supported overdentures with edentulous dentition

目的研究下颌牙列缺失患者采用全口义齿(CD)和种植覆盖义齿(IOD)修复后的患者满意度以及口腔健康相关生活质量(OHRQoL),探讨种植覆盖全口义齿修复对老年下颌牙缺失患者的心理及社会行为是否存在积极的影响。方法收集2016至2018年在中山大学附属口腔医院门诊就诊,50~80岁下颌牙列缺失,曾采用传统全口义齿修复且因义齿稳定性差而自愿行种植覆盖全口义齿修复的受试者19例,其中男8例,平均69.25岁;女11例,平均72.45岁。通过自身对照研究,每位受试者均先后佩戴在相同标准下制作的新传统全口义齿(CD)以及种植覆盖义齿(IOD),并于戴用义齿3个月后完成口腔健康影响程度量表(OHIP-20)、老年口腔健康评价指数量表(GOHAI)和日常生活牙科影响量表(DIDL)调查,分析传统全口义齿和种植覆盖全口义齿修复对患者心理状态和生活质量的影响。数据采用Wilcoxon符号秩检验进行统计分析,P<0.05为差异有统计学意义,并计算CD组和IOD组OHRQoL得分的效应量(ES值)以评价其影响程度。结果OHIP-20、GOHAI、DIDL量表均显示,IOD组在量表的功能限制、疼痛、心理不适、生理能力受限、心理能力受限、社交能力丧失、身心缺陷、美观、口腔舒适的各领域得分及总体得分上均明显优于CD组,差异具有统计学意义(P<0.05)。此外,根据DIDL量表评价标准得知,IOD修复可有效提提升患者满意度,并减少不满意人数的比例。3个量表在各领域及总得分的ES值均大于0.8,代表每个领域均受到高度影响,并以咀嚼能力(ES=3.74)、生理能力受限(ES=3.12)和功能限制(ES=2.94)等生理功能改善最为显著。说明,IOD组比CD组对患者的生活质量改善较好,且对各方面的改善程度较高。结论OHIP-20、GOHAI、DIDL量表调查结果反映种植覆盖全口义齿修复对老年下颌牙缺失患者的心理及社会行为有积极的影响。

Objective The aim of this study was to evaluate the difference in patient satisfaction and oral health-related quality of life(OHRQoL)between complete dentures(CD)and two implants- supported overdentures(IOD).Methods From 2016 to 2018,19 subjects aged 50 - 80 years with edentulous mandible were selected and enrolled in this study(eight males,with an average age of 69.25 years;11 females,with an average age of 72.45 years).All these patients received treatment in Guanghua School of Stomatology,Hospital of Stomatology,Sun Yat-sen University,but were not satisfied with the complete denture and requested a stable denture.In this clinical trial,each subject received both a new complete denture(CD)and an implant-supported overdenture(IOD)made with the same standard.Using self-control method,patient satisfaction and OHRQoL were measured by Oral Health Impact Profile(OHIP- 20),geriatric oral health assessment index(GOHAI)and dental impact on daily living(DIDL)after 3- month adaptation to CD and IOD rehabilitation.Data were compared by Wilcoxon′s signed rank test at a significance level of 0.05,and the effect size(ES)of OHRQoL scores in the CD group and IOD group was calculated to evaluate the influence degree.Results All the results in OHIP-20,GOHAI,and DIDL scales showed that IOD group was better than CD group in terms of functional limitations,pain, psychological discomfort,physical disability,psychological disability,social disability,handicap, appearance,oral comfort,and global scores,with statistically significant differences (P<0.05).In addition,according to the evaluation criteria of DIDL scale,IOD was found to effectively improve patient satisfaction and reduce the proportion of dissatisfaction.The ES values in each field and the total score of the three scales were greater than 0.8,indicating that each field was highly affected,and physiological functions such as chewing ability(ES = 3.74),limited physiological ability(ES = 3.12)and limited functional ability(ES=2.94)were most improved.It can be concluded that IOD group had a better quality of life improvement than CD group,and had a higher degree of improvement in all aspects.Conclusion The OHIP-20,GOHAI and DIDL findings suggested that implant-supported overdenture had a positive impact on the psychological and social behavior of mandibular edentulism in elderly.