齒槽骨質分佈與植體長期成功的研究

The Distribution of Bone Quality and Implant long-term Success

毛念平(Lian-Ping Mau) ； 曾春祺(Chuen-Chyi Tseng) ； 黃國精(Kuo-Ching Huang) ； 彭玉秋(Iok-Chao Pang) ； 陳俊榮(Chun-Jung Chen) ； 溫敏杰(Miin-Jye Wen)

《中華民國牙周病醫學會雜誌》 12卷3期 (2007/09) Pp. 261-271

https://doi.org/10.6121/CJP.200709_12(3).0009

摘要

背景：初期穩定是人工植體和齒槽骨進行骨整合的基本要求。LeKholm & Zarb將齒槽骨質分爲一、二、三、四級(type Ⅰ, Ⅱ, Ⅲ, Ⅳ)，對低密度的第四級齒槽骨質而言，要達到人工植體和齒槽骨之間的初期穩定是比較困難的而且文獻顯示人工植體種植在第一、二、三級齒槽骨的成功率明顯比種植在第四級齒槽骨要來得高。本研究目的爲探討一階段非埋入式人工植體治療的病人其齒槽骨質分布情形並探討齒槽骨質與植體長期成功的相關性。
材料與方法：以前瞻性的方法，收集奇美醫院自1997年8月起開始至2005年底止接受一階段非埋入式人工植體治療的病人，其植體贗復後至少六個月以上、七年間共316個病人、717根實心螺紋植體(solid screw implant)；其中男性145位(45.9%)、女性171位(54.1%)，平均年齡爲43.18±11.6歲。病人每年定期回診。齒槽骨質分類依據臨床操作者在手術中利用慢速機鑽骨的手感來辨別齒槽骨的密度予以記錄，並以齒槽骨質分類來分析植體存活的生命表(life table analysis)。
結果與結論：717根實心螺紋植體治療，手術中發現齒槽骨質屬於第一級的只l根(0.1%)、第二級齒槽骨質有186根(25.9%)、第三級齒槽骨質佔481根(67.1%)、第四級齒槽骨質則49根(6.8%)。上述的資料顯示我們的病人群中，齒槽骨質分佈最多爲第三級齒槽骨、其次爲第二級齒槽骨、接著爲第四級齒槽骨、最少的則是第一級齒槽骨。生命表的分析結果發現各級齒槽骨的植體存活率(survival rate)與成功率(success rate)分別都在97.7%與93.6%以上。從本研究的結果發現齒槽骨質與植體長期成功並無相關性。但術前的評估及診斷仍是影響術後結果的重要因素，希望藉由此研究可以提供臨床探作者對於齒槽骨質分部的情形作爲術前的參考。

並列摘要

Background and Aim: Primary stability is the most critical factor in the success of implant placement. There are four types of bone quality according to Lekholm and Zarb (1985). Literatures have demonstrated that low success rate in type Ⅳ bone. The purpose of this study was to investigate the relationship between bone quality and long-term success of ITI dental implant.
Material and Methods: The ITI dental implant system has been used in the Dental Department, Chi Mei Medical Center since August of 1997. Our treatment modality is trying to approach the patients with a team, which includes prosthodontist, periodontist, oral surgeon, and other dental specialties. All treatment procedures are followed to manufacturer's instruction. By the end of 2005, 717 solid-screw implants had been placed and loaded at least 6 months in 316 patients, included 145(45.9%) males and 171(54.1%) females, with mean of age of 43.18±11.60 years old. The follow-up interval is from 6 months after prosthesis completed up to 7 years. The success criteria of dental implant were based on Buser and coworkers (1990). Bone quality was assessed into four categories during the implant surgery according to Lekholm and Zarb (1985). Life table analysis and Chi-Square test for homogeneity were carried out.
Results and Conclusion: For all 717 solid screw implants, only one implant (0.1%) was placed in type Ⅰ bone, 186 implants (25.9%) were placed in type Ⅱ bone, 481 implants (67.1%) were placed in type Ⅲ bone, and 49 implants (6.8%) were placed in type Ⅳ bone. The data indicated that most of our patients have type Ⅱ and Ⅲ bone. Life table analysis demonstrated that the survival rates of implants in these four categories of bone quality are from 98.9% to 100%. The success rates are from 93.6% to 100%. The values of the Chi-Square test for the survival and success rates are 2.026 and 7.369, respectively. These values are less than the critical values of Chi-Square with 3 degree of freedom (7.815). There are no statistically significant differences in survival and success rates of ITI implants placed in different bone qualities.