48例Locator种植覆盖全口义齿5年临床修复效果评价

doi:10.19439/j.sjos.2024.01.016

摘要/Abstract

摘要： 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。

关键词: 种植牙, 无牙颌, 覆盖全口义齿, 出血指数, 牙槽骨吸收

Abstract: 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.

Key words: Implant teeth, Edentulous jaw, Complete overdenture, Bleeding index, Alveolar bone resorption

中图分类号:

R783.6

周团锋, 杨雪, 张华, 张智勇, 陈全. 48例Locator种植覆盖全口义齿5年临床修复效果评价[J]. 上海口腔医学, 2024, 33(1): 90-96.

ZHOU Tuan-feng, YANG Xue, ZHANG Hua, ZHANG Zhi-yong, CHEN Quan. Evaluation of the 5-year clinical restoration effect of implants retained complete overdentures with Locator attachments in 48 patients[J]. Shanghai Journal of Stomatology, 2024, 33(1): 90-96.

参考文献

[1] Kapur KK, Soman SD.Masticatory performance and efficiency in denture wearers. 1964[J]. J Prosthet Dent, 2006, 95(6):407-411.
[2] Bilhan H.An alternative method to treat a case with severe maxillary atrophy by the use of angled implants instead of complicated augmentation procedures: a case report[J]. J Oral Implantol, 2008, 34(1): 47-51.
[3] Kleis WK, Kämmerer PW, Hartmann S, et al.A comparison of three different attachment systems for mandibular two-implant overdentures: one-year report[J]. Clin Implant Dent Relat Res, 2010, 12(3): 209-218.
[4] Cordaro L, di Torresanto VM, Petricevic N, et al. Single unit attachments improve peri-implant soft tissue conditions in mandibular overdentures supported by four implants[J]. Clin Oral Implants Res, 2013, 24(5): 536-542.
[5] Abbasi MRA, Vinnakota DN, Sankar V, et al.Comparison of stress induced in mandible around an implant-supported overdenture with Locator attachment and telescopic crowns-a finite element analysis[J]. Med Pharm Rep, 2020, 93(2):181-189.
[6] Mombelli A, van Oosten MA, Schurch E Jr, et al. The microbiota associated with successful or failing osseointegrated titanium implants[J]. Oral Microbiol Immun, 1987, 2(4): 145-151.
[7] Papaspyridakos P, Barizan Bordin T, Kim YJ, et al.Implant survival rates and biologic complications with implant-supported fixed complete dental prostheses: a retrospective study with up to 12-year follow-up[J]. Clin Oral Implants Res, 2018, 29(8): 881-893.
[8] Ayub KV, Ayub EA, Lins do Valle A, et al. Seven-year follow-up of full-arch prostheses supported by four implants: a prospective study[J]. Int J Oral Maxillofac Implants, 2017, 32(6):1351-1358.
[9] Pieralli S, Kohal RJ, Rabel K, et al.Clinical outcomes of partial and full-arch all-ceramic implant-supported fixed dental prostheses. a systematic review and meta-analysis[J]. Clin Oral Implants Res, 2018, 29(Suppl 18): 224-236.
[10] 姜梦洋, 文静, 徐珊珊, 等. 下颌四枚种植体支持的两种附着体覆盖义齿的三维有限元分析[J]. 中华口腔医学杂志, 2019, 54(1): 41-45.
[11] 胡秀莲, 罗佳, 李健慧, 等. 无牙颌种植修复患者127例临床回顾研究[J]. 中华口腔医学杂志, 2014, 49(6): 333-338
[12] Menini M, Pesce P, Bevilacqua M, et al.Effect of framework in an implant-supported full-arch fixed prosthesis: 3D finite element analysis[J]. Int J Prosthodont, 2015, 28(6): 627-630.
[13] Alvarez-Arenal A, Gonzalez-Gonzalez I, deLlanos-Lanchares H, et al. Effect of implant- and occlusal load location on stress distribution in Locator attachments of mandibular overdenture: a finite element study[J]. J Adv Prosthodont, 2017, 9(5): 371-380.
[14] Onclin P, Slot W, Vissink A, et al.Incidence of peri-implant mucositis and peri-implantitis in patients with a maxillary overdenture: a sub-analysis of two prospective studies with a 10-year follow-up period[J]. Clin Implant Dent Relat Res, 2022, 24(2): 188-195.
[15] 郭淑娟, 刘倩, 丁一. 牙周病和植体周病国际新分类简介[J]. 国际口腔医学杂志, 2019, 46(2): 125-134.
[16] Schwarz F, Derks J, Monje A, et al.Peri-implantitis[J]. J Clin Periodontol, 2018, 45(Suppl 20):S246-S266.
[17] 刘潇倩, 陈秋雯, 冯海兰, 等. 无牙颌患者Locator附着体种植覆盖义齿修复后口腔卫生维护的纵向研究[J].北京大学学报(医学版), 2019, 51(1): 136-144.
[18] Yildirim RS, Buyukerkmen EB.Finite element analysis of stress distribution in mandibles with different bone types loaded by implant-supported overdentures with different localizations of locator attachments[J]. Int J Oral Maxillofac Implants, 2021, 36(5): 851-862.
[19] Alvarez-Arenal A, Gonzalez-Gonzalez I, Dellanos-Lanchares H, et al.Influence of implant positions and occlusal forces on peri-implant bone stress in mandibular two-implant overdentures: a 3d finite element analysis[J]. J Oral Implantol, 2017, 43(6): 419-428.
[20] Pisani MX, Presotto AGC, Mesquita MF, et al.Biomechanical behavior of 2-implant and single-implant-retained mandibular overdentures with conventional or mini implants[J]. J Prosthet Dent, 2018, 120(3): 421-430.
[21] Berger G, Pereira LFO, Souza EM, et al. A 3D finite element analysis of glass fiber reinforcement designs on the stress of an implant-supported overdenture[J]. J Prosthet Dent, 2019, 121(5):865.e1-865.e7