半程数字化导板引导口腔种植修复治疗无牙颌患者的3年存留率分析

Short-term effects and long-term prognosis of digitally designed guided implant therapy in edentulous patients

目的:探讨数字化导板引导无牙颌患者种植修复效果和术后3年存留率分析。方法:回顾性选取2015年3月~2019年3月期间惠州口腔医院种植科收治的无牙颌种植患者32例,其中18例(82枚种植体)采用数字化导板(导板组),另14例(70枚种植体)采用自由手种植(常规组)。分析两组种植精确度,近期效果(满意度、种植体周临床指标)及远期预后(种植体存留率及成功率),影响远期预后的关键因素。结果:导板组植体颈部、根部及角度偏差均小于常规组(P<0.05),深度偏差两组无统计学差异(P>0.05)。修复6个月后,导板组发音、美观、舒适度均优于常规组(P<0.05),两组菌斑指数(plaque index,PLI)、出血指数(bleeding index,BI)、牙龈指数(gingival index,GI)、探诊深度(probing depth,PD)均无明显差异(P>0.05)。随访3年,两组种植体存留率无明显差异(P>0.05),导板组种植体成功率明显高于常规组(P<0.05);经分析,吸烟、牙周病史、低密度骨、种植体直径<4.0 mm、长度<10 mm种植体失败率明显较高(P<0.05);吸烟、牙周病史、骨密度、种植体直径、长度是种植修复的独立危险因素(P<0.05),数字化导板引导是种植修复的独立保护因素(P<0.05)。结论:无牙颌患者使用数字化导板引导种植精确度高,近期效果及远期预后好,无牙颌种植修复远期预后受吸烟、牙周病史、骨密度、种植体直径、长度及数字化导板等因素影响。

Objective:To explore the effect of implant repair and 3-year survival rate of digitally designed guided implant therapy in edentulous patients.Methods:A total of 32 patients were enrolled in the retrospective study,who received therapy in the Department of Oral Implantology of Huizhou Stomatological Hospital from March 2015 to March 2019,82 implants of 18 patients were placed based on the assistance of surgical templates(group A),and 70 implants of 14 patients were inserted based on the preoperative planning with free-hand operation(group B).The accuracy was measured in both groups,and the short-term effects of treatment(degree of satisfaction,periimplant clinical indicators)and long-term prognosis(survival rate and success rate)were assessed,including the key factors affecting the long-term prognosis.Results:The shoulder deviation,root deviation,and angle deviation of group A were significantly smaller than those of group B(P<0.05).There were no significant differences in depth deviation between two groups(P>0.05).After 6 months of follow-up,group A received higher degree of satisfaction than group B(P<0.05),including pronunciation,aesthetic and comfort.There were no significant differences in plaque index(PLI),bleeding index(BI),gingival index(GI),probing depth(PD)between two groups(P>0.05).After 3 years of follow-up,there was no significant difference in the implant suivival rate between two groups(P>0.05),and the success rate of the implants in group A was significantly higher than that in group B(P<0.05).The failure rate was significantly higher in patients with smoking,history of periodontal disease,low-density bone,implant diameter<4.0 mm,and implant length<10 mm(P<0.05).Smoking,periodontal history,bone density,implant diameter,and length were independent risks factor for implant restoration(P<0.05).Digital guided treatment was an independent protective factor for implant restoration(P<0.05).Conclusion:Digitally designed guided implant therapy in edentulous patients has high implant accuracy,good short-term effect and long-term prognosis,the long-term prognosis is influenced by smoking,periodontal history,bone density,implant diameter,implant length and digital guidance.