"All-on-4"种植即刻修复治疗的临床回顾性分析

目的 分析施行"All-on-4"种植即刻修复病例的种植体存留率及并发症发生情况,探讨"All-on-4"的技术要点及注意事项.方法 根据纳入及排除标准,纳入2007年1月~2015年12月完成的"All-on-4"种植即刻修复治疗的病例共23例108枚种植体,其中上颌牙列缺失5例,下颌牙列缺失14例,全口牙列缺失4例,均在术后当天或1~2d内取模,并于术后7~10d戴入临时固定修复体,采用螺丝固位,术后3~6个月取模并制作最终修复体,共完成27件临时修复体及27件最终修复体.完成最终修复后平均追踪3年(1~9年),对种植体留存率、修复并发症进行总结及分析.结果 108枚种植体及27件最终修复体至最后1次复查为止,种植体存留率100%.23位患者当中,3位患者发生并发症,并发症发生率13.0%.结论 "All-on-4"在牙列缺失病例治疗中疗效确切可靠,并发症的发生率较低,是一种切实可行的方法.     

口腔扁平苔藓患者口腔健康相关生活质量的初步研究

目的通过口腔健康影响程度量表（OHIP）-14中文版了解口腔扁平苔藓患者口腔健康相关生活质量情况,探讨其应用于口腔扁平苔藓临床诊疗的可靠性和准确性。方法采用OHIP-14中文版对51例口腔扁平苔藓患者进行问卷调查,同时采用视觉类比标尺（VAS）对疼痛程度进行评分,REU评分系统对病损情况进行评分。通过SPSS 16.0软件对量表的信度和效度进行统计分析。结果OHIP-14的得分为21.67±9.45,量表的内部一致性Cronbach’s α系数为0.901,因子分析提取的5个公因子与量表各领域有密切的逻辑关系,量表得分与REU分值和VAS分值间呈正相关关系（r=0.608,0.807;P<0.000）。结论OHIP-14中文版评测口腔扁平苔藓患者的口腔健康相关生活质量具有较好的信度和效度,可为病情评估提供参考。     

全牙弓种植即刻固定修复患者的口腔健康相关生活质量与义齿满意度评价研究

目的:追踪观察全牙弓种植即刻固定修复1至12年后患者的口腔健康相关生活质量（oral health-related quality of life,OHRQoL）以及义齿满意度。方法:选取2008年10月至2020年11月于北京大学口腔医学院·口腔医院种植中心就诊的73例行全牙弓种植即刻固定修复的无牙颌或潜在无牙颌患者...     

“All-on-4”种植即刻修复后三年临床观察

目的 无牙颌患者经“All-on-4”种植即刻修复经3年追踪观察,评价该技术的中短期临床效果.方法 选择2008年6月至2009年6月完成修复的牙列缺失患者10例共40枚种植体.分别于即刻修复后6、12个月及随后每年复诊,修复后1年及3年拍摄X线片测量种植体周围边缘骨吸收量,比较倾斜种植(20枚)与轴向种植(20枚)种植体边缘骨水平变化;观测种植体周围软组织状况.结果 1、3年种植体存留率分别为100％(40/40)和97％(37/38),修复体存留率均为100％(10/10);1年和3年种植体周围边缘平均骨吸收量分别为(0.96±0.25)和(1.48±0.20) mm;修复后1、3年,种植体周围边缘骨吸收量倾斜种植[(0.98±0.29)、(1.51±0.22) mm]与轴向种植[(0.95±0.23)、(1.47±0.21) mm]的差异均无统计学意义(P＞0.05).种植体周围软组织健康.结论 无牙颌患者“All-on-4”即刻修复中短期临床效果满意;倾斜种植体周围骨吸收水平与轴向种植体相比,差异无统计学意义.     

复发性阿弗他溃疡患者口腔健康相关生活质量的初步研究

目的:通过口腔健康影响程度量表了解复发性阿弗他溃疡患者口腔健康相关生活质量。方法:采用OHIP-14中文版对复发性阿弗他溃疡患者进行问卷调查,同时记录其总间歇时间和VAS分值,并与普通人群OHQOL进行比较。结果:RAU患者量表得分中位数为22.00,明显高于普通人群中位数7.50(P<0.01),经历负面影响比例占前3位的依次是生理性疼痛、生理障碍和心理不适3个领域,量表得分与总间歇时间呈负相关关系(P<0.01),量表得分与VAS分值间呈正相关关系(P<0.01)。结论:RAU患者OHQOL明显低于普通人群,可为RAU病情评估提供参考。     

邢台地区某煤矿工人口腔健康相关生活质量水平及影响因素分析

目的了解邢台地区某煤矿工人的口腔健康相关生活质量水平并探索相关影响因素。方法抽样调查邢台地区某煤矿1116名煤矿工人,采用口腔健康影响程度量表(OHIP-14中文版)进行生活质量调查,分析煤矿工人口腔健康相关生活质量的影响因素并根据性别、年龄等因素进行分组比较。结果回收有效问卷1054份,平均得分为14.93±3.12分,单因素分析中差异有统计学意义的是年龄、文化程度、余留牙数、龋齿数、失牙数、CPI值、楔状缺损。在多元逐步回归分析模型中,龋齿数、CPI值以及失牙数被纳入到最终模型中。男性总得分为14.91±3.11,女性总得分为15.25±3.28,两组差别无统计学差异(t=-0.787,P=0.431)。根据年龄分组显示≤34岁组得分为14.29±2.91,35~44岁组的得分为15.05±2.88,≥45岁组的得分为15.42±3.46,方差分析显示各组差异有统计学差异。结论煤矿工人口腔健康相关生活质量相对较低,生活质量与龋病、牙周病的患病情况有紧密的联系。     

All-on-4种植固定修复的咬合设计

随着社会老龄化增长,无牙颌患者越来越多,无牙颌种植固定修复已广泛应用于临床。关于天然牙和传统义齿的咬合有比较多的研究,但是关于All-on-4种植固定修复的咬合方面的文献却比较有限。本文就All-on-4种植固定修复的咬合设计进行综述,以期为获得长期稳定的临床修复治疗提供参考。     

牙周炎致牙列缺失行All-on-4即刻种植修复的短期疗效观察

目的:评价重度牙周炎患者行All-on-4即刻负重种植义齿的临床效果。方法:对25例重度牙周炎致牙列缺失的患者行“All-on-4”即刻负重种植义齿修复。于永久修复3个月、6个月、12个月对种植体的菌斑指数、牙龈出血指数、探诊深度进行检查;并且对12个月时的种植体成功率、咀嚼效率、患者满意度进行评价。结果:永久修复1年后,种植体成功率为99%,咀嚼效率为(0.701±0.056)。永久修复3个月、6个月、12个月的菌斑指数无统计学差异;12个月时出血指数最高,差异有统计学意义(P＜0.05);探诊深度6个月时最高,3个月时最低,差异有统计学意义(P＜0.05)。患者对义齿的稳定性、发音满意度100%,美观性满意度92%,咀嚼功能满意度96%,舒适度满意度为88%。结论:“All-on-4”即刻负重种植义齿无论在牙周方面,还是在种植体成功率及咀嚼效率方面都有较理想的表现,患者满意度也较高,短期疗效可靠,长期疗效需进一步观察。     

前牙区牙种植即刻修复的临床评价

目的:评价前牙区牙种植即刻修复的临床效果,通过随访观察即刻修复技术的近期临床效果,以便对临床提供指导.方法:对33例病人植入48颗种植体(均为Xive及31种植系统)并于术后行即刻临时冠修复.种植体植入后安装临时基台,临时冠为树脂冠、患者原烤瓷牙或原自体牙,3-6个月后行最终烤瓷冠修复,并对其进行定期临床观察和放射学检查.结果:修复后经3-24个月观察,所有病例全部成功,美学效果好,患者均较满意.修复后至最近一次复查未见种植体异常,并且都取得良好的骨结合.结论:选择合适的病例,在前牙区行牙种植即刻修复可以取得良好的临床效果.前牙区即刻修复近期临床效果满意,是临床切实可行的方法.远期效果尚待进一步观察.     

Dental pain and oral health-related quality of life in individuals with severe dental anxiety

Objectives: To analyze the prevalence and level of dental pain among adult individuals with severe dental anxiety (DA), and the association between dental pain and oral health-related quality of life (OHRQoL).

Methods: The study was based on 170 adult individuals with DA referred to a specialized DA clinic. All patients answered a questionnaire including questions on DA (DAS, DFS), OHRQoL (OIDP) and dental pain. An adapted clinical examination and a panoramic radiograph revealed the present oral status.

Results: The prevalence of dental pain was high (77.6%) and among those reporting pain the intensity was high (49.0–61.0 on a VAS). One or more problems during the last 6 months with the mouth or teeth affecting the individual’s daily activities were reported in 85.3% of the participants. Individuals who reported dental pain had lower OHRQoL compared with those who did not report dental pain (p?p?p?=?.008).

Conclusion: This study revealed a high prevalence and a high level of dental pain among adult individuals with severe DA. Having dental pain was associated with poor OHRQoL.     

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     

Bone level changes around axial and tilted implants in full-arch fixed immediate restorations. Interim results of a prospective study

Purpose: The aim of this prospective study was to assess clinical outcomes and peri‐implant bone level changes around tilted and axial implants supporting full‐arch fixed immediate rehabilitations up to 60 months of loading. Material and Methods: Forty‐seven patients (22 women and 25 men) were included in the study. Each patient received a full‐arch fixed bridge supported by two axial and two distal tilted implants. Loading was applied within 48 hours of surgery. Patients were scheduled for follow‐up at 6, 12, 18, 24 months, and annually up to 5 years. At each follow‐up, plaque level and bleeding scores were assessed and radiographic evaluation of marginal bone level change was performed. Periapical radiographs were taken using a paralleling technique, and subsequently scanned at 600 dpi. An image analysis software was used to assess bone level. Results: A total of 33 mandibles and 16 maxillae were rehabilitated (two patients received a fixed prosthesis in both arches). One hundred ninety‐six Nobel Biocare implants of 4 mm diameter were placed. The mean follow‐up duration was 52.8 months (range 30–66 months) in the mandible, and 33.8 months (range 22–40 months) in the maxilla. All subjects attended the scheduled follow‐up visits. No implant was lost. No significant difference in marginal bone loss was found between axial and tilted implants in both jaws, at each follow‐up. No significant difference in bone loss was found between mandible and maxilla, for both axial and tilted implants at each comparable time frame, although slightly higher mean values were always found for the mandible. Conclusion: The use of tilted implants in the immediate rehabilitation of fully edentulous jaws is safe and is not associated to a higher marginal bone loss as compared to axially placed implants.     

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.     

Self-perceived changes in oral health-related quality of life after receiving different types of conventional prosthetic treatments: A cohort follow-up study

Objectives

To evaluate the changes in oral health-related quality of life (OHRQoL) reported by subjects treated with conventional prostheses.

Methods

A consecutive sample of 153 patients seeking prosthodontic rehabilitation was recruited. Socio-demographic and prosthetic-related factors (Eichner Index; number of occlusal, aesthetic, and lost units) were registered. Baseline impacts on OHRQoL were collected using the OHIP-14 questionnaire. One month after treatment, the participants answered whether the prostheses had generated better, equal, or poorer effects within the 14 items of a retrospective scale (Post-OHIP). The study patients were compared with the reference population (P-population; n = 123) in terms of OHRQoL. Such P-population consisted of Spanish adults wearing conventional dental prostheses who were not seeking any dental treatment. The reliability and validity of the tests applied and the factor structure of the Post-OHIP were investigated. A Poisson regression model was calculated to predict what items would change favourably after treatment.

Results

Four prosthetic cohorts were established according to the types of rehabilitations performed: 1-FDPs: metal–ceramic fixed dental prostheses; 2-M-RPDs: metal-based removable partial dentures; 3-ADs: acrylic partial dentures and 4-CDs: complete dentures. Both tests confirmed adequate psychometric properties. Most items of the Post-OHIP consistently loaded on a single factor. Patients requiring ADs or CDs reported significantly lower baseline OHRQoL than those needing M-RPDs or FDPs. Pain/discomfort was the only hampering issue subsequent to removable rehabilitation. M-RPDs are expected to provide the significantly highest therapeutic improvements.

Conclusions

Patients perceived benefits in chewing ability, aesthetics and satisfaction with their mouth after receiving conventional dental prostheses.

Clinical significance

Conventional prosthetic therapy enhances patients’ overall well-being although it can cause discomfort and chewing dysfunction in more than 20% of subjects. Metal-based removable partial dentures are the most predictable in terms of patient satisfaction. The higher the clinical impairment felt by patients, the higher the increase in OHRQoL after rehabilitation.     

Response shift in oral health-related quality of life measurement in patients with partial edentulism

The purposes of this study were to determine whether a response shift was observable after partial denture treatment and to identify the predictors that influenced the response shift magnitude and direction. A total of 173 consecutive patients with no more than eight missing teeth who received implant-supported, fixed or removable partial dentures at Okayama University Dental Hospital were asked to complete a full-version Oral Health-Related Quality of Life (OHRQoL) questionnaire before (pre-test) and after treatment (post-test). Additionally, a short form (then-test) consisting of seven questions selected from the full version had its reliability verified and was utilised to retrospectively assess the pre-treatment OHRQoL status. The difference between the summary scores of the then-test and the pre-test determined the response shift magnitude and direction. The then-test mean score (22·9 ± 6·6) was significantly lower (worse OHRQoL) than that of the pre-test (26·4 ± 5·2). The response shift effect size was of moderate magnitude and negative direction (d = -0·78). A multiple regression analysis showed that age (younger patients) (P < 0·01), number of replaced teeth (fewer) (P < 0·01) and pre-test scores (lower) (P < 0·01) were the significant predictors for response shift. In conclusion, a response shift phenomenon with negative and moderate effect size was observed after partial denture treatment. The significant predictor variables were young age, fewer numbers of replaced teeth and lower pre-test scores.