A 10-year retrospective analysis of clinical results of implant-retained/supported prostheses in full edentulous patients

目的 通过对127例无牙颌种植修复患者10年临床资料回顾性总结,分析国人无牙颌种植修复的外科技术特点、修复方式及特点,评估长期效果.方法 收集1994年8月至2009年11月北京大学口腔医学院·口腔医院口腔种植中心全口无牙颌及单颌无牙颌种植修复患者149例(184个单颌),平均年龄(56.0±10.9)岁.外科手术时视骨量行上颌窦底提升植骨、引导骨再生术(guide bone regeneration,GBR)植骨、外置法植骨术等,修复方式按设计分别为种植固定修复与种植覆盖义齿修复,后者固位方式有套筒冠、切削杆、杆卡式固位、磁性固位体和球帽固位修复.分别于术后即刻、3个月、义齿修复后即刻,以后每12个月拍摄X线片评估种植体颈部骨组织变化,临床检查种植体周围组织健康状态,修复体功能状态进行分析.结果 149例患者(860枚种植体)失访22例,随访127例(162个单颌、762枚牙种植体),平均追踪109.2个月(45 ～228个月),13枚种植体脱落,种植体10年累计存留率为97.8％,义齿存留率100.0％;种植体周围炎发生率3.8％(29/762).67.9％(110/162)的颌骨未植骨直接行种植体植入;上颌窦底提升术39例,占上颌无牙颌的84.8％(39/46),引导骨再生术10例(10/162,6.2％).71.0％(115/162)的义齿为种植覆盖义齿,其中覆盖义齿修复中套筒冠、切削杆和磁性附着体是本组病例最常用固位方式,分别占34.8％ (40/115)、27.0％(31/115)和20.0％(23/115).修复后10年修复体及上部结构并发症共68例(53.5％).结论 无牙颌骨量不足最常用的骨增量技术长期效果可靠,植骨区域种植体存留率与常规种植体无明显差异.To evaluate the 10-year clinical results of implant prostheses in edentulous patients.Between August 1994 and November 2009, 762 implants were placed in 127 patients (162 jaws) with the mean age of (56.0 ± 10.9) years in Peking University, School and Hospital of Stomatology. Sinus lift, guide bone regeneration (GBR) and onlay graft were used according to the indications of bone defect types. Overdentures and fixed bridges were delivered.Overdentures were retained/supported by ball, magnet, telescopic crown or milled bar. Clinical evaluation included peri-implant soft tissue health status, prostheses functional status and complications.Radiographic evaluations were conducted at operation day, 3 months post-operatively, right after prostheses delivery, and annually afterwards. Clinical data were collected and analyzed.Of the 127 patients, 116 were edentulous mandible and 46 edentulous maxilla, with a mean follow-up period 109.2 months(45-228 months). Thirteen implants were lost and the 10-year implant cumulative survival rate was 97.8% and the prostheses success rate was 100.0%. The prevalence of peri-implantitis was 3.8% (29/762). Sixty-seven point nine percent of the patients underwent implant placement without bone graft.Sinus lift technique and guided bone regeneration technique were the most often used with 84.8% (39/46) in the upper jaws and 6.2% (10/162) in the total jaws respectively. Seventy-one percent of the cases(115/162) was overdentures. Telescopic, milled-bar, and magnetic retained/supported overdentures were the most commonly used with 34.8% (40/115) , 27.0% (31/115) , and 20.0% (23/115) respectively. The implant-supported fixed prostheses included adhesive retained fixed bridges and screw retained fixed bridges with the ratio of 19.1% and 80.9% respectively. The prevalence of 10-year post-prosthodontic complications was 53.5% (68 cases). The most common complications were prosthetic and uperstructure complications.The 10-year implant-retained/supported prostheses was a successful modality in edentulous cases.Sinus lift technique and guided bone regeneration technique are the most commonly used techniques with predictable clinical results. Telescopic crowns milled bar and magnet with 4-6 implants retained/supported overdenture were the most often used retention systems and telescopic crown overdenture had more advantages in terms of long-term maintenance and satisfaction.PubMed中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)06333-3384