下顎無牙患者使用迷你人工牙根固持覆蓋式義齒之滿意度及生活品質改善調查

Satisfaction and Life Quality Improvement of mini-implant retained overdenture for mandibular edentulous patients

莊淑惠(Shuhui Chuang)

指導教授 ： 林立德

國立臺灣大學/牙醫專業學院/臨床牙醫學研究所/碩士(2011年)

https://doi.org/10.6342/NTU.2011.03209

摘要

臨床牙科重建治療中，全口無牙的患者對於配戴全口活動義齒時常有許多的不滿。其中又以下顎的全口活動義齒最容易產生疼痛的情形，引發的問題也比上顎全口活動義齒來得多。直至現今，大部分關於人工牙根治療的結果報告書主要都是以存活率和補綴物套件的耐久性的角度來看。迷你人工牙根(mini dental implant的優點在於手術步驟簡易、復原期短、且傷口很小；迷你人工牙根的設計不僅解決了骨頭寬度不足的問題，也因價格比傳統人工牙根便宜讓更多經濟能力不佳的患者也能接受人工牙根固持的覆蓋式全口活動義齒的治療方式。
本研究的目的是在利用義齒滿意度量表及缺牙版自覺口腔健康衝擊量表(Oral Health Impact Profile for edentulous,OHIP-edent)評估下顎無牙患者於下顎使用四根迷你人工牙根(MDIs，Sendax 3M)改善其穩定度的治療方式和一般傳統全口活動義齒的治療方式來做比較，對於咀嚼功能恢復程度與整體生活品質改善程度的影響。
研究中，包括兩組病人，5位控制組(CD組)病人只接受新義齒治療，6位實驗組(MDI組)病人在接受新義齒治療三個月後再接受迷你人工牙根治療並繼續使用新的義齒。研究先請患者在新義齒治療前與治療後一個月及三個月填寫義齒滿意度量表及缺牙版自覺口腔健康衝擊量表問卷，此外MDI組患者則繼續請患者在接受植體治療後一個月及三個月時填寫義齒滿意度及缺牙版自覺口腔健康衝擊量表問卷。問卷的結果，除了比較下顎無牙患者在接受新的下顎全口活動義齒和植牙後不同時間的感覺外，也比較兩組患者以新的傳統全口義齒治療後的感覺。將量表之編碼(code)記錄後之數值進行比較，組間的比較使用Mann-Whitney U test，組內的比較則是使用Wilcoxon 符號檢定(Wilcoxon signed rank test)。
實驗結果顯示在有了人工牙根的輔助後，在義齒滿意度方面:咀嚼功能、發音、下顎義齒的固持度與穩定度及整體滿意度等項目在人工牙根植入後的三個月與舊義齒相比時都有統計學上的差異(p<0.05)。而咀嚼功能、下顎義齒配戴的難易度、下顎義齒固持度與穩定度及整體滿意度等項目在人工牙根植入後的三個月與新義齒三個月相比時都有統計學上的差異(p<0.05)。
在缺牙版自覺口腔健康衝擊量表方面，OHIP總分、功能上的限制、生理上的疼痛、生理上的障礙、心理上的障礙及心理上的不舒服等項目，在人工牙根植入後的三個月與舊義齒相比時都有統計學上的差異(p<0.05)。
人工牙根植入後的三個月與新義齒製作後三個月相比在OHIP總分、功能上的限制、生理上的疼痛及生理上的障礙等項目都有統計學上的差異(p<0.05)。
單獨比較新義齒與舊義齒的話，則可以發現在新義齒製作之後的一個月與舊義齒相比在整體滿意度方面有統計學上的差異(p<0.05)。但是在新義齒製作之後的三個月與舊義齒相比時在整體滿意度方面則沒有統計學上的差異。

關鍵字

迷你人工牙根 ； 人工牙根支持覆蓋式義齒 ； 義齒滿意度 ； 口腔健康衝擊量表

並列摘要

Introduction: Dissatisfaction with complete denture treatment among edentulous patients has long been a frustrating problem, especially for mandibular edentulous patients. Implant overdentures have been proposed to be the first choice of treatment for these patients. To date, the outcomes of implant therapy have been reported mainly in terms of implant survival rates and durability of prosthetic components. Mini dental implants have the advantage of low cost and are suitable for edentulous patients with narrow alveolar ridges. However, the patient-based outcome was not well understood in patients receiving mini dental implant retained overdenture therapy.
Objectives: The aim of this study was to investigate patient-based outcomes of mini dental implant retained overdenture using Denture Satisfaction Scale(DS) and Oral Health Impact Profile for edentulous(OHIP-edent) in terms of phonetics, chewing function, denture retention, stability and oral health related quality of life.
Materials and methods: This study included patients who came to dental department of National Taiwan University Hospital(NTUH) searching for new lower complete denture. Two treatment options: complete mandibular denture, and implant supported overdenture were informed. Patients were assigned according to their preference.
The control group (CD group) includes patients receiving therapies including a conventional mandibular complete denture. For the experimental group (MDI group), a conventional mandibular complete denture was fabricated first and then 4 mini dental implants(MDIs, sendax 3M) were placed in the mandible to retain the denture. Two questionnaires were used in this study including patient satisfaction questionnaire (visual analogue scale) and oral health impact profile for edentulous (OHIP-edent,Likert scale) to assess effect of therapies on patient’s quality of life and health status.
All patients filled the questionnaires before the treatment about their old prosthesis (baseline) and then one month and three month after receiving a new mandibular denture. After the mandibular complete denture was delivered and followed up for 3 months, 4 mini dental implants were inserted between mental foramens. The patients were requested to fill questionnaires one month and three months after implant placement.
Results: The denture satisfaction in CD group three months after new denture delivery was not statistically significant different from the baseline, except for ease of removal and esthetic(p<0.05)。
The OHIP summary score and functional and physical and psychological subscale scores were statistically significantly different at three months after implant insertion versus baseline (p<0.05). The OHIP summary scores and functional and physical subscale scores were statistically significantly different at 3 month after implant insertion versus 3 months after new denture delivery (p<0.05). The data indicated an improvement both globally and for the functional subscales. Patients with high scores on the Denture satisfaction scale for their mandibular prosthesis reported better OHIP outcomes after treatment with implants. Postoperative functional satisfaction with the implant-retained prosthesis resulted improved quality of life.
Conclusions: Implant retained overdenture using mini dental implants improves denture satisfaction and oral health related quality of life when compared to a conventional denture.

並列關鍵字

Mini dental implant ； Implant overdenture ； Denture satisfaction scale ； Oral health impact profile ； OHIP

參考文獻

[1] Adell R, Lekholm U, Rockler B, et al.: A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg. 1981; 10: 387-416.

[2] Pietrokovski J, Harfin J, Mostavoy R, et al.: Oral findings in elderly nursing home residents in selected countries: quality of and satisfaction with complete dentures. J Prosthet Dent. 1995; 73: 132-135.

[3] Douglass CW, Shih A, Ostry L: Will there be a need for complete dentures in the United States in 2020? J Prosthet Dent. 2002; 87: 5-8.

[4] Feine JS, Carlsson GE, Awad MA, et al.: The McGill consensus statement on overdentures. Mandibular two-implant overdentures as first choice standard of care for edentulous patients. Montreal, Quebec, May 24-25, 2002. Int J Oral Maxillofac Implants. 2002; 17: 601-602.

[5] Feine JS, Dufresne E, Boudrias P, et al.: Outcome assessment of implant-supported prostheses. J Prosthet Dent. 1998; 79: 575-579.