后牙种植冠桥修复后局部咬合变化的定量分析

Quantitative analysis of occlusal changes in posterior partial fixed implant supported prostheses

目的:定量分析后牙种植冠桥修复后局部咬合力与咬合接触的变化规律,为种植修复体的精确咬合设计、调整和维护提供参考。方法:按照一定的纳入和排除标准收集后牙区缺牙并行种植单冠或固定桥修复的患者,分别于修复后2周、3个月、6个月、12个月复查,采用咬合纸和T-ScanⅢ(Tekscan,South Boston,USA)电子咬合分析系统检查全牙列咬合接触情况,分别记录每个时间点对照牙、近中邻牙和种植修复体的咬合接触时间和咬合力百分比,分析局部咬合接触和咬合力随时间的变化。结果:共收集33例患者(男性16人,女性17人,年龄24~72岁)、37颗种植修复体,修复体戴用3~12个月(平均8.3个月)。2周到3个月,种植修复体达到咬合接触的时间显著缩短(P<0.05,Wilcoxon检验),种植修复体的咬合力百分比显著增大(P<0.05,Wilcoxon检验);3~6个月、6~12个月期间,咬合力百分比和咬合接触时间变化均不明显。2周时,种植修复体咬合力显著低于对照牙(P<0.01),而戴用3个月后种植修复体咬合力与对照牙差异已无统计学意义,6个月、12个月时差异均无统计学意义。结论:轻咬合接触和咬合接触时间延迟的后牙种植修复体,在修复后3个月咬合接触强度会明显增加,临床上种植修复后3个月复查时应重点关注咬合情况。

Objective: To analyze changes in occlusal force distribution and occlusal contact in posterior partial fixed implant-supported prostheses over time,and to provide reference for the precise occlusion design,adjustment and maintenance of implant prostheses. Methods: According to certain inclusion and exclusion criteria,patients were recruited from partially edentulous patients who had received implant-supported single crown or fixed bridge in the posterior region. The patients were collected since the implant prostheses settling and scheduled for the routine examination of implant prostheses and the occlusal examinations of complete dentition after 2 weeks,3,6,and 12 months. Occlusal examinations were taken with the articulating papers and T-Scan Ⅲ ( Tekscan,South Boston,USA),which could check and measure the occlusal contact condition of complete dentition. The occlusion time and relative occlusal forces of implant prostheses,mesial adjacent teeth and control teeth were recorded at the same time. Results: Thirty-seven posterior partial fixed implant prostheses in 33 patients( 17 women and 16 men,aged24-70 years) were followed up for 3-12 months( average 8. 3 months). At baseline,the relative occlusal forces of implant prostheses were significantly lower than those of the corresponding control teeth( P < 0. 001). However,after 3 months,the relative occlusal forces of implant prostheses had significantly increased( P < 0. 05),while control teeth decreased significantly( P < 0. 05),resulting in no statistical significance between them. The implant prostheses occlusion time ratio also increased significantly from 2 weeks to 3 months( P < 0. 05). There was no significant difference from the third month to the sixth month,or from the sixth month to the twelfth month( P > 0. 05). Conclusion: Light contact and time-delayed occlusion of posterior implant prostheses changes significantly in the first three months after settling implant prostheses. These changes mainly include the advance of the time point of the implant prosthesis to start the occlusion contact,and the increase of the occlusal force of the implant prosthesis.The occlusion of posterior implant prostheses should be carefully monitored at end of the third month follow-up clinically.