48例Locator种植覆盖全口义齿5年临床修复效果评价

Evaluation of the 5-year clinical restoration effect of implants retained complete overdentures with Locator attachments in 48 patients

目的:观察Locator按扣式种植覆盖全口义齿的长期临床修复效果。方法:选择2016—2017年北京大学口腔医院门诊部采用Locator按扣式种植覆盖全口义齿修复的无牙颌患者48例,其中双颌全口义齿修复21例,单颌27例,共植入种植体230颗。观察种植体的留存率、种植体周黏膜探诊出血(BOP)、种植体周牙槽骨垂直吸收高度变化、义齿基托折裂和人工牙脱落折断等并发症,以及义齿固位力变化等。采用SPSS 13.0软件包对数据进行统计学分析。结果:在5年观察期间,5颗种植体脱落,1颗前牙区窄颈种植体颈部折断,12颗失访,种植体存留率为97.25%。种植修复后1年,48颗种植体周黏膜探诊出血(BOP+)(21.4%),平均出血指数(BI)为0.21±0.42,前牙区高于后牙区。种植体周牙槽骨垂直吸收高度为(0.21±0.35) mm,义齿基托折断2例。修复后5年,163颗种植体周黏膜探诊出血(BOP+)(76.89%),BI为1.00±0.70,种植体周牙槽骨垂直吸收高度为(0.58±0.85) mm;种植体周黏膜探诊出血指数与牙槽骨垂直吸收高度在男女之间、前牙区与后牙区之间均无统计学差异(P>0.05)。1年观察期和5年观察期间,种植体周黏膜平均出血指数、种植体周牙槽骨垂直吸收高度前后比较有显著差异(P<0.01)。义齿折裂17例,折裂率为26.15%,人工牙脱落折断率为16.92%,多发于前牙中线区及Locator基台附着体安放位置,因固位力下降首次更换Locator基台固位垫圈平均(34.2±10.3)个月。结论:Locator按扣式种植覆盖全口义齿有良好的临床修复效果。并发症多见于种植体周黏膜探诊出血和垂直向骨吸收,随着戴用时间延长有逐渐加重的趋势。其次是义齿基托折裂及人工牙脱落与折断,种植体脱落及折断。提示义齿制作时应加强金属支架在Locator基台位置和前牙中线区的强度,前牙区尽量避免使用窄径种植体。

PURPOSE:To observe the long-term clinical effect of implants retained complete overdentures with Locator attachments.METHODS:A total of 48 patients with edentulous jaws treated with implants retained complete overdentures with Locator attachments were selected from the Outpatient Department of Peking University School and Hospital of Stomatology from 2016 to 2017.Among them,21 patients underwent double-maxillary complete overdentures restoration and 27 patients underwent single-maxillary restoration.A total of 230 implants were implanted.The clinical observation indicators included the implant survival rate,peri-implant mucosal bleeding on probing(BOP),the change in the vertical height of alveolar bone absorption around the implants,overdenture base fracture rate,artificial tooth fall off and fracture rate and other complications.The change of the locator attachment retention force of the implant-supported overdentures was evaluated.SPSS 13.0 software package was used for data analysis.RESULTS:During the five-years clinical observation period,5 implants fell off,1 narrow dimeter implant in the anterior zone was broken,and 12 implants were lost to follow-up.The implant survival rate was 97.25%.One year after the restoration therapy finished,peri-implant mucosal bleeding on probing(BOP+)was detected in 48(21.4%)implants.The average BI was 0.21±0.42,which was higher in the anterior zone than that in the posterior zone.The vertical alveolar bone absorption height around the implants was(0.21±0.35)mm,2 implants-supported complete overdenture bases were broken.After 5 years of restoration,163(76.89%)implants had peri-implant mucosal bleeding on probing(BOP+).The average BI was 1.00±0.70,and the vertical alveolar bone absorption height around the implants was(0.58±0.85)mm.There was no significant difference between males and females.There was no significant difference in the peri-implant mucosal bleeding index and the alveolar bone vertical absorption height between the anterior zone and the posterior zone(P>0.05).The mean BI of peri-implant mucosa and the vertical absorption height of peri-implant alveolar bone were significantly different between the 1-year observation period and the 5-year observation period respectively(P<0.01).There were 17(26.15%)cases with overdenture bases fracture,and the fracture rate of artificial teeth was 16.92%.Most of them occurred in the midline area of the anterior zone and the location of the overdenture base on the locator attachments.The average first replacement time of the locator attachment nylon retainer washer was 34.2±10.3 months.CONCLUSIONS:Implants retained complete overdentures with Locator attachments are effective in long term clinical observation.Complications are mainly found in peri-implant mucosal bleeding on probing and vertical alveolar bone absorption,and tended to increase gradually over time.The fracture of the implant retains complete overdenture bases and the fall off or fracture of the artificial teeth are the second serious complications.Overdenture base with metal frame at the location of the Locator abutment and the midline of the anterior area should be strengthened,and narrow diameter implants should be avoided as far as possible in the anterior zone.