无牙颌种植支持式固定义齿粘接与螺丝固位的临床疗效观察

Clinical observation of cement-retained and screw-retained implant-supported denture in edentulous patients

目的评估无牙颌种植支持式固定义齿粘接固位及螺丝固位两种固位方式的临床疗效。方法对2013年6月至2018年6月在本院以Straumann骨水平种植体、钴铬支架及钴铬烤瓷修复体行种植支持式固定义齿粘接或螺丝固位修复的25例全口或半口无牙颌患者随访1年、3年、5年,评估粘接和螺丝固位两种固位方式的累计种植体存留率和累计修复体存留率、机械并发症、生物并发症。结果25例患者共植入165颗植体,28副半颌修复体。其中粘接固位组11副,69颗植体;螺丝固位组17副,96颗植体。粘接组累计种植体存留率留率为100%,螺丝组为96.9%;两组累计修复体存留率均为100%;粘接组、螺丝组累计种植体周黏膜炎发生率为23.2%、29.2%,累计种植体周炎发生率分别为6.8%、7.3%;粘接组出现1例崩瓷(n=1/11)、未出现基台螺丝松动,螺丝组发生4例崩瓷(n=4/17)、1例螺丝松动,两组均未出现修复基台折断;两组边缘骨吸收量第1年差异无显著性(P>0.05),第3年、第5年螺丝组均高于粘接组,差异有显著性(P<0.05);两组改良出血指数(modified sulcus bleeding index,mSBI)第1年、第3年差异无显著性(P>0.05),第5年粘接组mSBI高于螺丝组,差异有显著性(P<0.05)。结论在合理选择适应证时,全口或半口种植支持式固定义齿粘接固位修复和螺丝固位修复均可获得较高的种植体存留率、修复体存留率,但传统钴铬合金支架螺丝固位方式的机械、生物学并发症较高。

Objective To evaluate the clinical effects of full-arch cement-retained implant-supported combined crowns and screw-retained implant-supported bridge dentures in complete or half edentulous patients.Methods A to-tal of 25 patients with complete or partial edentulous dentures followed up for 1,3,and 5 years in our hospital from June 2013 to June 2018 and were treated with Straumann bone horizontal implantation,cobalt-chromium stenting and cobalt-chromium porcelain restoration with cement-retained and screw-retained implant-supported fixed dental prosthe-ses to evaluate the accumulative implant survival rate,accumulative prosthesis survival rate,mechanical complications,and biological complications in both groups.Results There were 25 complete or half edentulous patients who received 165 Straumann implants and 28 implant-supported fixed dental prostheses in this study.There were 11 cases with 69 implants in the cement group and 17 cases with 96 implants in the screw group.The accumulative implant survival rate was 100%in the cement group and 96.9%in the screw group.The accumulative prosthesis survival rate was 100%in both groups.The cumulative peri-implant mucositis rate was 23.2%in the cement group and 29.2%in the screw group,and the peri-implantitis rate was 6.8%in the cement group and 7.3%in the screw group.There was 1 case of porcelain collapse(n=1/11)and no screw of abutment loosening in the cement group and 4 cases of porcelain collapse(n=4/17)and 1 case of screw loosening in the screw group.No fracture of abutment was observed in either group.There was no difference in bone loss between the two groups in the first year(P>0.05),and a higher rate of bone loss was found in the screw group in the third and fifth years(P<0.05).There was no difference in the sulcus bleeding index(mSBI)be-tween the two groups in the first year and the third year(P>0.05)and a higher modified mSBI value in the cement group in the fifth year(P<0.05).Conclusion The survival rates of the implant and prosthesis for cement-retained or screw-retained implant-supported fixed dental prostheses were both high,but there were more mechanical and biological complications in the traditional cobalt-chromium alloy screw-retainer group.The removal of residual adhesives must be reasonably considered when choosing the cement retention method.