全牙弓种植修复体[牙合]面重度磨耗的随访研究

A follow-up study of the severe occlusal surface wear of implant-supported full-arch prostheses

目的回顾全牙弓种植修复体[牙合]面重度磨耗情况,探究影响全牙弓种植修复体[牙合]面重度磨耗的危险因素。方法纳入1994年10月至2021年10月于北京大学口腔医学院·口腔医院种植科完成全牙弓种植修复的无牙颌或潜在无牙颌患者。收集纳入患者的人口统计学、种植修复及面重度磨耗资料,采用Cox比例风险回归模型分析影响全牙弓种植修复体[牙合]面重度磨耗的危险因素。分别将可能影响全牙弓种植修复体[牙合]面重度磨耗的因素进行单因素分析,将单因素分析中P<0.10的参数纳入多因素分析,探究影响全牙弓种植修复体[牙合]面重度磨耗的危险因素。结果共纳入535例患者(699件全牙弓种植修复体),随访44.8(19.8,81.4)个月,共计114件修复体的面发生重度磨耗,面发生重度磨耗的时间为正式修复后61.4(33.3,89.4)个月。13件修复体[牙合]面重度磨耗发生于正式修复后≤2年,44件发生于正式修复后>2年且≤5年,44件发生于正式修复后>5年且≤10年,13件发生于正式修复后>10年。上颌固定义齿和覆盖义齿发生面重度磨耗的时间差异无统计学意义(Z=-1.03,P=0.303);下颌覆盖义齿发生面重度磨耗的时间[79.2(51.3,119.1)个月]显著晚于固定义齿[48.2(31.2,80.2)个月](Z=-2.93,P=0.003)。Cox比例风险回归模型显示,对颌牙列为固定牙列、有夜磨牙症、正式修复体后牙面为树脂材料,是影响全牙弓种植修复体[牙合]面重度磨耗的危险因素(P<0.05)。结论全牙弓种植修复体[牙合]面重度磨耗现象临床常见,对颌牙列为固定牙列、夜磨牙症患者、后牙面为树脂材料的全牙弓种植修复体,面重度磨耗现象发生更早、风险更大。定期复诊、给予患者行为指导和适当的干预是必要的。

Objective To evaluate the severe occlusal surface wear of implant-supported full-arch prostheses,and to explore the risk factors affecting the severe occlusal surface wear of implant-supported full-arch prostheses.Methods Five hundred and thirty-five patients who received implant-supported fixed complete dental prostheses or implant-overdentures and completed at least one follow-up 3 months after the delivery of definitive prostheses were enrolled from October 1994 to October 2021 in this retrospective cohort study.The information on demographics,implants,definitive prostheses,and related outcomes was collected.Cox proportional hazard regression model was adopted to analyze the risk factors of the severe wear of occlusal surfaces in implant-supported full-arch prostheses.Univariate analysis was performed on the factors that may affect the severe wear of occlusal surfaces,and the parameters of P<0.10 in univariate analysis were included in multivariate analysis to explore the risk factors affecting the severe wear of occlusal surfaces in implant-supported full-arch prostheses.Results Severe wear of the posterior occlusal surfaces was detected in 114 prostheses with a duration of 61.4(33.3,89.4)months.13 cases occurred≤2 years after the delivery of definitive prostheses,44 cases>2 years and≤5 years,44 cases>5 years and≤10 years,and the other 13 cases>10 years.There was no significant difference in the average time of severe occlusal surface wear between implant-supported fixed complete dental prostheses and implant-overdentures in the maxilla(Z=-1.03,P=0.303).However,in the mandible,it was 48.2(31.2,80.2)and 79.2(51.3,119.1)months respectively,which was statistically significant(Z=-2.93,P=0.003).Cox proportional hazard regression model showed opposed fixed dentition,bruxism,and posterior resin occlusal surfaces were risk factors(P<0.05)affecting the severe wear of the occlusal surfaces.Conclusions Severe occlusal surface wear was clinically common with the prolonged application of implant-supported full-arch prostheses.Prostheses opposed to fixed dentition,in patients with bruxism,and made of posterior resin materials were at higher risk of severe occlusal surface wear on the posterior artificial teeth.Regular follow-up,patients′behavior guidance,and clinicians′appropriate intervention were necessary to manage this complication.