种植体折裂的临床分型与临床治疗方案

Clinical classification and treatment decision of implant fracture

目的:基于对32枚折裂种植体的再治疗随访观察,拟提出一套基于种植体折裂位置与骨吸收形态的种植体折裂二元临床分型法,并依据此分型归纳总结种植体折裂的治疗决策,为临床工作提供指导。方法:选择1994年4月至2019年8月在北京大学口腔医院种植科及第四门诊部就诊且由作者团队种植治疗后出现种植体折裂并接受再治疗的病例进行回顾分析和长期随访,提出基于种植体折裂形态与骨吸收的二元临床分型法,并探讨基于种植体折裂新分型的治疗方案。结果:回顾了5481例患者(10642枚种植体),共发现27例患者(32枚种植体)折裂。在新分型体系下,种植体颈部垂直型折裂(F1,50.0%)与种植体颈部水平型折裂(F2,40.6%)多见,深部水平型折裂(F3,9.4%)少见,植体周围骨缺损的3种类型(D1:无骨吸收或窄骨内袋;D2:四壁杯状骨缺损;D3:杯状骨缺损伴颊侧和/或舌侧骨缺损)则分布均匀。在种植体折裂二元分型体系中,出现频率最高的是F1D1型(31.3%)和F2D2型(25.0%),其中F1与D1成显著正相关(r=0.592,P<0.001);F2与D2成显著正相关(r=0.352,P=0.048);F1与D2成显著负相关(r=-0.465,P=0.007)。种植体折裂最常采用的治疗手段为植体取出+引导骨再生术+延期种植(65.6%);其次为植体取出+同期种植(18.8%)。F1D1分型与植体取出+同期种植的治疗策略显著相关(r=0.367,P=0.039)。结论:种植体折裂二元新分型法可以较好适应临床应用,并能为种植体折裂的临床治疗提供参考和指导。

Objective:To propose a set of two-dimensional clinical classification of fractured implants based on the follow-up of fracturing pattern of implant body and peri-implant bone defect morphology of 32 fractrued implants,and summarize the treatment decisions of fractured implants according to this new set of classification,so as to provide guidance for clinical practice.Methods:During 25 years of clinical practice,clinical records of 27 patients of 32 fractured implants in 5481 patients with 10642 implants were made.The fracturing pattern of implant body,implant design,peri-implant bone defect morphology and treatment options were analyzed.A set of two-dimensional clinical classification based on the morphology and bone absorption of implant fracture was proposed.The treatment decision-making scheme based on the new classification of implant fracture was discussed.Results:In the new classification system,vertical fracture of implant neck(Type 1 of implant fracture morphology,F1)and horizontal fracture of implant neck(Type 2 of implant fracture morphology,F2)were common,accounting for 50%and 40.6%respectively,while deep horizontal fracture of implant body(Type 3 of implant fracture morphology,F3)(9.4%)were rare,while the three types of bone defects(D1,no bone defect or narrow infrabony defects;D2,wide 4-wall bone defects or cup-like defects,D3,wide 3-wall or 2-wall defects)around implants were evenly distributed.In the two-dimensional classification system of implant fracture,F1D1(31.3%)and F2D2(25%)were the most frequent.There was a significant positive correlation between F1 and D1(r=0.592,P<0.001),a significant positive correlation between F2 and D2(r=0.352,P=0.048),and a significant negative correlation between F1 and D2(r=-0.465,P=0.007).The most common treatment for implant fracture was implant removal+guided bone regeneration(GBR)+delayed implant(65.6%),followed by implant removal+simultaneous implant(18.8%).F1D1 type was significantly related to the treatment strategy of implant removal+simultaneous implantation(r=0.367,P=0.039).On this basis,the decision tree of implant fracture treatment was summarized.Conclusion:The new two-dimensional classification of implant fracture is suitable for clinical application,and can provide guidance and reference for clinical treatment of implant fracture.