无牙颌种植修复长期成功的因素分析

传统的全口义齿因稳定性不佳、支持力不足,常常难以达到理想的修复效果。长期研究表明,无牙颌种植修复可明显提高修复体的稳定性及患者的舒适度,同时可有效减少牙槽骨的吸收,是一种理想的修复方法。本文通过回顾近年发表的文献,同时结合作者的临床心得,探讨并分析影响无牙颌种植修复长期成功的主要因素。     

牙列缺失患者种植体支持的固定和可摘义齿的回顾性研究

目的:研究十年观察期内种植体支持的固定和可摘义齿修复牙列缺失患者种植体的生存率和影响因素。方法:1995-2006年,227例患者(92例男性,135例女性)平均年龄63.7岁,在Charite’大学口腔颌面外科门诊接受种植和修复治疗。共1652颗种植体种植在牙列缺失上颌骨、下颌骨或双侧颌骨,支持76例(24.68%)固定义齿,232例(75.32%)可摘义齿。观察性别,种植体部位、修复方法对种植体生存率的影响。结果:其中有50例患者73颗种植体丧失,累计种植体生存率94.76%,本研究显示种植体生存率女性(93.93%)略低于男性(95.93%),但没有显著性差异。在上颌骨种植的种植体生存率(95.87%)略高于在下颌骨种植(94.53%),但统计学没有显著性意义。10年累计固定和可摘义齿的种植体生存率分别是98.02%和93.55%,两种修复方法差异有显著性。结论:确认了种植体支持牙列缺失患者修复中长期的成功率,并得出结论种植体生存率与性别,种植部位关系不大,与修复方法有关。种植体支持的固定义齿预后比可摘义齿好。     

Implant-supported fixed prostheses in the edentulous maxilla: 8-year prospective results

Objective: The purpose of this prospective study was to evaluate the long‐term survival and success rates of implants and screw‐retained, full‐arch prostheses placed in edentulous maxillae over 8 years of function. Materials and methods: A total of 106 Astra Tech implants were placed in the maxillae of 17 edentulous patients in a one‐stage surgical approach. After a healing period of 6 months, the patients received fixed screw‐retained bridges. Follow‐up visits, including clinical and radiographic examinations, were performed after 6 months and at yearly intervals. Implant survival, implant success, and marginal bone‐level changes were defined as the primary outcome variables. The secondary aims were to report periodontal pathogens at 5 years' follow‐up and patients' satisfaction at the 8‐year follow‐up. Results: The overall observation time was 8 years. One patient died during the study and one implant failed during the healing period, yielding an 8‐year cumulative implant survival rate of 99%. The prosthetic survival rate was 100%. The mean crestal bone loss amounted to 0.3 ± 0.72 mm. Patients' subjective evaluations demonstrated an overall high level of satisfaction. In all cases, except for one, microbiologic probing of the peri‐implant sulcus after 5 years showed no higher incidence of periodontal pathogens. Conclusions: Screw‐retained, full‐arch restorations on six implants in an edentulous maxilla are a predictable and highly successful treatment concept as observed throughout this study with an observation period of 8 years of function, in particular with respect to low crestal bone loss and high patient satisfaction. To cite this article:
Mertens C, Steveling HG. Implant‐supported fixed prostheses in the edentulous maxilla: 8‐year prospective results.
Clin. Oral Impl. Res. 22 , 2011; 464–472
doi: 10.1111/j.1600‐0501.2010.02028.x     

Immediate rehabilitation of the edentulous jaws with full fixed prostheses supported by four implants: interim results of a single cohort prospective study

Objectives: The purpose of this study was to prospectively evaluate the clinical and radiographic outcomes of immediately loaded full‐arch fixed prostheses supported by a combination of axially and non‐axially positioned implants in a large cohort of patients with completely edentulous jaws, up to 5 years of function. Materials and methods: One hundred and seventy‐three edentulous patients (80 males and 93 females) were enrolled according to specific selection criteria. Each patient received a full‐arch fixed prosthesis supported by two distal tilted implants and two anterior axially placed implants. The provisional functional acrylic prosthesis was delivered the same day as surgery in all cases. All cases were finalized 4–6 months later. The patients were scheduled for follow‐up at 6 and 12 months of function, and annually up to 5 years. At each follow‐up plaque and bleeding score was assessed and radiographic evaluation of marginal bone level was performed. Results: The overall follow‐up range was 4–59 months. A total of 154 immediately loaded prostheses (61 in the maxilla and 93 in the mandible) were in function for at least 1 year and were considered for the analysis. Four axially placed implants failed in the maxilla and one tilted implant in the mandible, all within 6 months of loading. No further implant failure occurred to date. Implant survival at 1 year was 98.36% and 99.73% for the maxilla and the mandible, respectively. Marginal bone loss at 1 year averaged 0.9±0.7 mm in the maxilla (204 implants) and 1.2±0.9 mm in the mandible (292 implants). No difference was found in marginal bone loss between axial and tilted implants. Plaque and bleeding scores progressively improved from 6 to 12 months. Fracture of the acrylic prosthesis occurred in 14% of total cases. Conclusions: The present preliminary results from a relatively large sample size suggest that the present technique can be considered a viable treatment option for the immediate rehabilitation of both mandible and maxilla. To cite this article:
Agliardi E, Panigatti S, Clericò M, Villa C, Malò P. Immediate rehabilitation of the edentulous jaws with full fixed prostheses supported by four implants: interim results of a single cohort prospective study.
Clin. Oral Impl. Res. 21 , 2010; 459–465.
doi: 10.1111/j.1600‐0501.2009.01852.x     

无牙颌种植固定修复的并发症及风险防控

随着医学技术和社会经济的发展,无牙颌种植即刻固定修复已在临床上广泛应用。这一技术尽管存在着许多优点,然而同样也存在着广泛的机械、生物、美学及外科并发症。文章就无牙颌种植固定修复的并发症及相关因素进行探讨,并提出有效的风险防控措施,为无牙颌患者种植即刻固定修复及最终永久修复的合理设计、安全实施提供参考。     

无牙颌固定种植修复设计的研究进展

长期以来,作为口腔修复领域的重点与难点,牙列缺失后的重建问题备受关注.随着社会生活水平的提高,人们对全口义齿提出了更高的要求,固定种植修复因其舒适、美观和极佳的性能,越来越受到临床医生与患者的青睐.固定修复体与种植体刚性连接并完全由其支持,患者无需取下,固位和稳定性能最好,咀嚼效能接近天然牙列.特别是即刻负载模式的推广...     

Implant treatment of patients with edentulous jaws: a 20-year follow-up

Background: Implant‐supported prostheses are today often used in rehabilitation of partially or totally edentulous patients. Both patients and the dental profession often regard implant treatment as successful in a life perspective. Therefore, studies with a long‐term follow‐up are important. Purpose: The aim was to investigate the outcome of implant treatment with fixed prostheses in edentulous jaws after 20 years, with special reference to survival rate of implants and prostheses and frequency of peri‐implantitis. Materials and Methods: The patient material was a group of patients treated in the early 1980s. The original patient group comprised the first 48 consecutive patients treated with implant‐supported prostheses at Umeå University. All patients were edentulous in one or two jaws. The patients had a mean age at the implant insertion of 54.3 years (range 40–74). At the planning of this study 20 years after treatment, 19 of the 48 patients were found to be deceased. Of the 29 patients still alive, 21 patients with altogether 23 implant‐supported prostheses could be examined clinically and radiographically. All patients were treated ad modum Brånemark® (Nobel Biocare AB, Göteborg, Sweden) with a two‐stage surgical procedure. The implants had a turned surface. Abutment connections were performed 3 to 4 months after fixture insertion in the mandible, and after a minimum of 6 months in the maxilla. The prostheses were fabricated with a framework of gold alloy and acrylic artificial teeth. Results: The 21 patients (with 23 implant prostheses) examined had at the time of treatment got 123 implants (27 in the upper jaw and 96 in the lower jaw) inserted. Only one of these implants had been lost (about 2 years after loading) giving a survival rate of 99.2%. Very small changes occurred in the marginal bone level. Between the 1 and 20‐year examinations, the mean bone loss was 0.53 mm and the mean bone level at the final examination was 2.33 mm below the reference point. Conclusions: This follow‐up over two decades of implant‐supported prostheses demonstrates a very good prognosis for the treatment performed. The frequencies of peri‐implantitis, implant failures, or other complications were very small, and the original treatment concept with a two‐stage surgery and a turned surface of the implants will obviously give very good results.     

Technical complications of implant-supported fixed partial dentures in partially edentulous cases after an average observation period of 5 years

OBJECTIVES: The purpose of this prospective long-term study was to evaluate the incidence of the most common technical problems, namely screw loosening, screw fracture, fracturing of veneering porcelain and framework fracture in implant-supported fixed partial dentures (FPDs), and assess the survival and success rate (event-free survival) after 5 years of function. MATERIALS AND METHODS: In 76 partially edentulous patients, a total of 205 3i-implants (machined surface) were placed and restored with 112 implant-supported FPDs (46 single crowns, 81 splinted crowns, seven FPD bridges and 23 FPDs with cantilevers). The survival rate of FPDs supported by implants was 94.5% (CI-95: 90.1-98.8) after an average observation period of 5 years. The success rate (event-free survival) of the FPDs was 80% (CI-95: 87.3-72.7). After an observation period of 5 years the cumulative incidence of screw loosening was 6.7% (CI-95: 1.8-11.5), the cumulative incidence for screw fracture was 3.9% (CI-95: 0.1-7.7). Fracture of the veneering porcelain occurred in 5.7% (CI-95: 1.2-10.2) of all FPDs. Fracturing of the suprastructure framework was rare (1%; CI-95: 0-2.9). The overall complication incidence after 5 years was highest in the group of FPDs with cantilever, which showed the lowest success rate 68.6% (CI-95: 50-87.3), followed by single crowns (77.6%; CI-95: 53.3-100) and splinted crowns (86.1%; CI-95: 59.5-100). No complication occurred in FPD bridges. CONCLUSION: Fixed partial dentures supported by 3i-implants showed low technical complications rates, the most common being loosening of the abutment screw. Managing these complications can cause extra amount of chair-side time and patient dissatisfaction.     

Immediate occlusal loading and tilted implants for the rehabilitation of the atrophic edentulous maxilla: 1-year interim results of a multicenter prospective study

OBJECTIVES: The aims of this prospective study were to assess the treatment outcome of immediately loaded full-arch fixed bridges anchored to both tilted and axially placed implants for the rehabilitation of fully edentulous maxillae and to compare the outcome of axial vs. tilted implants. MATERIAL AND METHODS: Forty-one patients with edentulous maxillae were included in the study. Each patient received a full-arch fixed bridge supported by four axial implants and two distal tilted implants. Loading was applied within 48 h from surgery. Patients were scheduled for follow-up at 6 months, 1 year and annually up to 5 years. Radiographic evaluation of marginal bone-level change was performed at 1 year. RESULTS: One patient died 4 months after surgery. Thirty patients were followed for a minimum of 1 year (range 3-42 months, mean 22.1 months). Three failures were recorded at 1-year follow-up (two axial implants and one tilted). Two more implants (one tilted and one axially placed) were lost within 18 months of loading. The 1-year implant survival rate was 98.8% for both axial and tilted implants. Prosthesis success rate was 100% at 1 year. Marginal bone loss around axial and tilted implants at 12-month evaluation was similar, being, respectively, 0.9+/-0.4 (standard deviation) mm and 0.8+/-0.5 mm. CONCLUSIONS: The present preliminary data suggest that immediate loading associated with tilted implants could be considered to be a viable treatment modality for the atrophic maxilla and that there does not seem to be a different clinical outcome between tilted and axial implants.     

Early loading of implants with fixed dental prostheses in edentulous mandibles: 4.5‐year clinical results from a prospective study

Aim: The purpose of this study was to evaluate the survival and success of early‐loaded implants placed in the intraforaminal area of the edentulous mandible, and the survival of the implant‐supported fixed dental prostheses (FDP). Material and methods: Thirty‐seven patients (18.9% male, mean age 64.5 years) with edentulous lower jaws were treated with implant‐supported FDPs in the mandible. One hundred and eighty‐five screw‐type implants were placed in the intraforaminal area of the symphysis (five implants per patient). Immediately after implant placement, a framework was fabricated and the FDP was manufactured on the framework. Within 2 weeks, the implants were rigidly connected and loaded with the implant‐retained FDP. Results: During the 1–8‐year observation period (mean 4.5 years), a total of 32 implant‐retained complications occurred. Nineteen implants were lost in 10 patients, resulting in a cumulative survival of 89.7%. Nine implants in five patients did not osseointegrate. Although these implants were not removed, because stability within the connective tissue was acceptable and inflammation was absent, they were recorded as unsuccessful. Consequently, the cumulative success declined to 84.9%. Four implants in three patients had clinical signs of periimplantitis (2.2% of all implants). Denture‐related complications included one complete failure, when one FDP had to be removed after the last of five implants had been replaced. Furthermore, 10 fractures of the framework occurred in six patients, three FDPs had to be adapted or modified, and the facing of the FDP had to be repaired 16 times in 11 patients. Conclusion: Although one‐stage early‐loaded implants functioned well for most patients with edentulous mandibles, immediate loading is associated with a larger number of implant‐related complications than in other studies investigating delayed loading. Because of the substantial prosthetic complications and aftercare, this procedure cannot be generally recommended. To cite this article:
Schwarz S, Gabbert O, Hassel A J, Schmitter M, Séché C, Rammelsberg P. Early loading of implants with fixed dental prostheses in edentulous mandibles: 4.5‐year clinical results from a prospective study.
Clin. Oral Impl. Res. 21 , 2010; 284–289.
doi: 10.1111/j.1600‐0501.2009.01843.x     

Implant-supported fixed prostheses in the edentulous maxilla. A 2-year clinical and radiological follow-up of treatment with non-submerged ITI implants

OBJECTIVES: To evaluate the survival rate of non-submerged solid-screw ITI dental implants with a rough (titanium plasma sprayed, TPS) surface in the edentulous maxilla after 1 and 2 years of loading. MATERIAL AND METHOD: Twenty-five patients (mean age 64 years) with edentulous upper jaws received five-seven implants and, after a mean healing time of 6.9 months, screw-retained implant-supported fixed prostheses. A total of 146 ITI solid screw TPS implants were inserted. The diameter of 56% of the implants was smaller (3.3 mm) than the standard (4.1 mm) and the diameter of the rest (44%) was standard. The bone quantity of the majority of the patients was low and the bone quality poor. Clinical parameters were registered at baseline and at two annual follow-ups. Radiological examinations and assessments were also made at these times. RESULTS: Mean marginal bone level at baseline was measured at a point 4.52 mm (range 1.45-7.70, SD 1.2) apical of the reference point. Mean bone loss from baseline to 1 year of loading was 0.24 mm (SD 0.9, P=0.002) and from 1 year to 2 years of loading 0.15 mm (SD 0.4, P<0.001). Five implants failed, four of which were early failures prior to loading. One implant failed shortly after bridge installation. The cumulative survival rate was 96.6% after 1 and 2 years. CONCLUSION: ITI TPS solid-screw implants in combination with fixed prostheses had successful survival rates and were found to be a viable treatment alternative in the edentulous maxilla.     

A prospective evaluation of Frialoc implants with ball-abutments in the edentulous mandible: 1-year results

Several surgical and prosthetic concepts for the treatment of patients with mandibular atrophy and related lower denture problems are proposed and described in the literature. The present study discusses and evaluates the use of a new single-stage implant and overdenture with ball-attachment for this purpose. This study evaluates the clinical performance of the implants and abutments and addresses surgical and prosthetic complications that were encountered. Eighteen fully edentulous patients received two, single-stage Frialoc implants (Friadent, Mannheim, Germany). The implants were left to osseointegrate for 3 months and were subsequently provided with ball-abutments and loaded through a mandibular overdenture. After 1-year of clinical service, two implants were lost, which accumulated to a 1-year survival rate of 93.9% (SE 4.2%). Patient satisfaction was high, and prosthetic complications and postinsertion maintenance were minimal. Three abutments loosened, one of which subsequently broke after 5 months of loading. Retightening of the attachment (gold matrix) was performed on seven occasions in four patients. Soft tissue response was excellent. Although minor hypertrophy of the peri-implant mucosa was observed, hardly any marginal bone loss between baseline and 1-year observations occurred. Short-term results indicate that mandibular implant overdenture treatment by means of two ball-abutments, using Frialoc implants and prosthetic components, leads to good clinical results, both from an objective and a subjective perspective.     

球帽附着体种植覆盖义齿在萎缩下颌无牙颌的应用

目的 探讨球帽附着体种植覆盖义齿在牙槽骨萎缩的下颌无牙颌病例中的应用。方法 用Endo—pore Dental Implant System种植体,球形基台和弹性橡皮帽,为15例牙槽嵴萎缩下颌无牙颌病人作球帽附着体种植覆盖义齿,观察义齿的固位力、稳定性和咀嚼功能,随访0．5—3年。结果 球帽附着体种植覆盖义齿能显著提高下颌全口义齿的固位力和稳定性,改善咀嚼功能,病人满意。结论 球帽附着体种植覆盖义齿修复能显著改善牙槽嵴萎缩的下颌全口义齿的功能。     

磁性附着体下颌种植覆盖义齿牙槽骨的三维光弹应力分析

目的：研究磁性附着体下颌种植覆盖义齿在各种咬合状态时下颌牙槽骨的应力分布。方法：选取标准无牙颌模型,在双侧尖牙区植入种植体,连接磁性附着体,翻制下颌环氧树脂模型,制作生物功能性全口义齿,分别在正中、前伸、侧向咬合时加载应力,冻结切片,观测各牙位应力条纹。结果：磁性附着体下颌种植覆盖义齿在正中、侧向、前伸咬合应力加载时种植体周围牙槽骨应力值最大,余留牙槽嵴后牙区所受应力大于前牙区。正中、前伸磨牙区最大应力值出现于颊侧,切牙区最大应力值出现于舌侧。侧向工作侧最大应力值出现于唇颊侧,平衡侧最大应力值出现于舌侧。结论：磁性附着体种植覆盖义齿各向咬合时,应力既分布到种植体,也分布到剩余牙槽嵴,可以明显降低种植体周围骨组织的受力,有利于种植体的健康。     

Steri-Oss种植体支持固定和可摘义齿修复牙列缺失患者的临床回顾研究

目的：研究十年观察期内用Steri-Oss种植体修复牙列缺失患者种植体生存率和影响因素。方法：自1995-2006年,共有57例无牙颌患者接受种植与修复治疗,共353颗Steri-Oss种植体。其中81颗种植体（22.95%）做固定修复,272颗种植体（77.05%）做可摘义齿修复,观察性别、种植体部位和修复类型对种植体成功率的影响。结果：其中有9例病人24颗种植体脱落,种植体成功率93.20%,女性病人的种植体生存率略低,但性别没有显著的差异（P〉0.05）。累计的种植体生存率上颌骨92.64%,略低于下颌骨93.68%,但统计学上的没有显著差异（P〉0.05）。种植体支持的固定修复的十年成功率是97.5%,种植体固位的可摘义齿成功率99.02%,累计的种植体生存率在可摘与固定义齿修复之间没有显著性差异（P〉0.05）。结论：确认了种植体支持无牙颌病人修复学中长期成功率。种植体固位的可摘全口义齿治疗方式在种植体生存率上和种植体支持的固定义齿的结果是相同的。     

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近年来无牙颌种植支持式固定义齿的应用得到了极大的普及。但是由于受到上颌骨的解剖形态、上颌骨吸收形式、种植区牙槽骨的质量、上颌骨在发音中的重要作用、上前牙在面部美学中的重要作用等因素的影响。因此,医生在进行上颌无牙颌种植支持式固定义齿的诊断和设计时需要非常谨慎。本文回顾了近年来关于上颌无牙颌种植支持式固定义齿牙颌面部美学诊断、设计的文章,通过对牙颌面部进行垂直向美学分析,为需要进行上颌无牙颌种植支持式固定义齿修复的患者提供美学设计基础。     

无牙颌种植义齿修复方式探讨

种植体在无牙颌修复中的应用可显著改善义齿的修复效果,提高患者的满意度。为促进无牙颌种植修复技术的推广与合理应用,本文基于现有临床报道与基础研究结果,针对下颌无牙颌种植修复和上颌无牙颌种植修复两部分内容,就无牙颌种植修复中种植体数量与位置的选择、种植体上部结构的设计等问题进行探讨,目的在于为临床医生选择修复方案提供引导。     

Rehabilitation of the edentulous mandible with a fixed implant-supported prosthesis.

Implant rehabilitation of an edentulous mandible presents significant improvements over conventional complete denture therapy with regard to patient satisfaction, and it can improve a patient's quality of life. Several implant prosthetic designs have been developed and successfully utilized in clinical practices. The goal of this article is to describe the prosthetic design and technical steps in the fabrication of a fixed implant-supported mandibular prosthesis. A technique is described in which the positioning of appropriately selected abutments is completed in a predictable manner. LEARNING OBJECTIVES: This article discusses the prosthetic designs and technical steps in fabricating a fixed implant-supported mandibular prosthesis. Upon reading this article, the reader should: Understand the prosthetic design for the treatment of an edentulous mandible. Recognize the significance of the technical steps in this rehabilitation process.     

In vivo measurements of some functional aspects with mandibular fixed prostheses supported by implants

Maximal occlusal force and oral tactile sensibility were recorded in 21 edentulous patients wearing maxillary complete dentures and mandibular fixed prostheses supported 1 by Brånemark implants. Bite force was measured with a miniature force transducer between antagonistic molars and premolars, and the passive tactile sensibility of the fixtures was recorded in the horizontal and vertical directions with spring balances. The active tactile sensibility was tested using steel foils 100 to 10 . The range of maximal occlusal force recorded was from 35 to 330N with highest values observed on the second premolars (mean 143N). Significantly lower forces were found on molars and first premolars ( p <0.01). The detection threshold of minimal pressure was about 330g in the horizontal, and 388g in the vertical direction. This difference was not statistically significant. The average number of incorrect assessments when testing steel foils was 16.6 errors, out of 100 recordings. Similar results when using these 3 test modalities had been found on overdentures supported by two mandibular implants and occluding with maxillary complete dentures. The results of this study suggest that mandibular implants supporting fixed prostheses are not likely to improve oral tactile sensibility and maximal occlusal force in the presence of maxillary complete dentures.