不同类型粘接固定义齿修复前牙缺失的长期临床观察

Long-term clinical evaluation of different types of resin-bonded fixed partial denture to replace lost anterior teeth

目的评价粘接固定义齿(RBFPD)修复前牙缺失的长期临床应用效果并分析其影响因素。方法对2006年1月至2021年12月于北京大学口腔医学院·口腔医院修复科就诊的1或2颗前牙缺失患者[92例,男性43例,女性49例,年龄(46.1±12.8)岁]的RBFPD(93件)进行回顾性分析,包括玻璃纤维增强树脂RBFPD(32件)、玻璃陶瓷RBFPD(39件)以及镍铬合金烤瓷RBFPD(22件)。统计修复后RBFPD的完全存活率和功能存活率,利用Kaplan-Meier生存曲线法进行生存分析,Log-rank检验比较缺牙数、修复位置(上颌或下颌)、单端或双端修复以及性别因素对修复体生存率的影响。结果93件RBFPD的总体生存时间为13.7年(95%CI:12.3~15.1年)。3种材料RBFPD的完全存活率及功能存活率呈逐年下降趋势,但修复后5年完全存活率和功能存活率均超过90%,修复后10年完全存活率和功能存活率均超过80%。随访期间玻璃陶瓷RBFPD的完全存活率均高于其他两种RBFPD,修复后15年完全存活率为90%(35/39)。修复后1~8年镍铬合金烤瓷RBFPD功能存活率较高,但修复后9年镍铬合金烤瓷RBFPD完全存活率和功能存活率出现大幅度降低。单因素分析显示,镍铬合金烤瓷RBFPD的生存率显著大于玻璃纤维增强树脂RBFPD(χ2=7.33,P=0.007),修复1颗缺失牙的RBFPD生存率显著大于修复2颗缺失牙的RBFPD(χ2=3.23,P=0.072);而修复位置(上颌或下颌)、单端或双端修复以及性别因素对生存率的影响差异无统计学意义(χ2=2.26,P=0.133;χ2=0.68,P=0.411;χ2=1.07,P=0.300)。结论对于个别前牙缺失,镍铬合金烤瓷RBFPD和玻璃陶瓷RBFPD均可取得较长期的临床成功率,玻璃陶瓷RBFPD能保证长期修复效果。

Objective To evaluate the clinical survival rates and influence factors of different types of resin-bonded fixed partial dentures(RBFPD)used in anterior missing teeth restoration.Methods Ninety-three RBFPD were delivered to 92 patients[92 patients,43 males and 49 females,average age(46.1±12.8)years]who visited Peking University School and Hospital of Stomatology from January 2006 to December 2021 for restoration of 1 or 2 anterior missing teeth.Altogether 32 cases of glass fiber reinforced RBFPD,39 cases of glass-based ceramic RBFPD and 22 cases of porcelain-fused-to-metal RBFPD were retrospectively analyzed.The complete survival rate,functional survival rate,patients′satisfaction and color matching of the restorations were recorded and evaluated every year since the replacement with RBFPD.The Kaplan-Meier survival curve method was used for survival analysis,and the Log-rank analysis was used to compare the effect of the number of missing teeth,position(maxillary or mandibular),cantilever or non-cantilever and gender on the survival rate of the restorations.Results The overall survival time for the 93 RBFPD was 13.7 years(95%CI:12.3-15.1 years).There was a decreasing trend in complete survival and functional survival for all three material RBFPD from year to year,but complete and functional survival rates exceeded 90%at year 5 and exceeded 80%at year 10.The complete survival rate of the glass-ceramic RBFPD was higher than the other two during the follow-up period,with a complete survival rate of 90%(35/39)at year 15.The porcelain-fused-to-metal RBFPD had a higher functional survival rate in years 1-8,but the complete and functional survival rates showed a substantial decrease after year 9.The single-factor Log-rank analysis showed that the success rate of porcelain-fused-to-metal RBFPD was significantly higher than that of glass fiber reinforced RBFPD(χ²=7.33,P=0.007),and the success rate of RBFPD with 1 missing tooth restored was significantly higher than that of RBFPD with 2 missing teeth restored(χ²=3.23,P=0.072).The differences in success rates between different restoration positions(maxillary and mandibular),cantilever or non-cantilever,and gender factors were not statistically significant(χ²=2.26,P=0.133;χ²=0.68,P=0.411;χ²=1.07,P=0.300).Conclusions For the restoration of individual missing anterior teeth,both porcelain-fused-to-metal RBFPD and glass-based ceramic RBFPD achieve a high long-term clinical success rate,with glass-based ceramic RBFPD being more able to ensure long-term restorative result.