一階式植體之臨床應用表現及成功率研究分析

以傳統植牙方式來進行缺牙區重建是為一種可預期的成功治療方式。但傳統二階式植體往往伴隨著不少的併發症，例如植體零件鬆脫斷裂、製作假牙療程次數頻繁並冗長。現代的病人期待更舒適更簡化的治療療程。新起的一階式植體系統有著二階式的植體沒有的優勢。整體來說，一階式植體的設計穩定口腔裡的軟硬組織、立即承載功能以及美觀需求。在本篇研究中，探討研究一階式植體臨床上的應用表現結果。107 位病人中植牙總數為1906 顆，共用了四種不同的一階式植體系統。研究中並探討不同因素對植體成功率所造成的影響，例如：骨頭位置、植體設計、承載的時間點以及骨頭的質量。在研究中，整體累積平均存活率為94.39%. 下顎前牙區成功率為98.66%，在所有口腔區域中成功率為最高的。經卡方檢定可知，植牙成敗與觀察期間有顯著相關(Pearson 卡方值=8.168，P＜ 0.05) ，其中觀察期小於一年的植牙成功率相對較其他觀察期高。在即拔即植的案例分析中，植牙成敗與是否即拔即植有顯著相關(P=8.541，P＜0.01) ，其中非即拔即植的植牙成功率相對較即拔即植高。依據此篇研究分析，下顎的植牙成敗與負載時間有顯著相關(P=19.804，P＜0.001) ，其中early loading 的植牙成功率顯著高於conventional loading。骨量不足與骨質鬆軟顯著影響植體的存活率。然而一階式植體有其操作以及功能上的限制，例如：不可改變的支柱台角度、植體植入的角度位置很重要，因而醫生的手術操作能力及經驗是成功的關鍵。整體而言，在缺牙重建的治療中，一階式植體是可行並成功的治療方式。但是由於此臨床研究結果僅限來自於一個診所，建議將來可在多個醫學中心進行更為縝密的大規模研究以達到更紮實的論證。

關鍵字

人工牙根，一階式植體，植體存活率

並列摘要

Conventional implant therapy used for oral rehabilitation has proven to have predictable results. Yet there are many complications associated with conventional two piece implant system such as connection loosening and fractures and several visits for prosthodontic treatments. People nowadays seek for less discomfort and shorter treatment time. A novel concept of one piece implant has many advantages in comparison with two piece implant. In general, one piece implant is designed to provide a stable maintenance of soft and hard tissue, immediate function and esthetic need. In this present study, clinical outcome of one piece implant was evaluated. A total amount of 1906 implants were placed in 107 patients. Four types of one piece implant system were used in the study. Various factors associated with survival rates were evaluated such as anatomical positions, implant design features, different loading times, and bone qualities. The overall cumulative survival rate of one piece implants was 94.39%. Within the study group, mandibular anterior region has the highest survival rate of 98.66%. There was a significant difference with implant survival rate and observation period (P value=8.168，P＜0.05), and there was a higher survival rate with observation period less than a year as compared with other observation periods. There was a significant difference between survival rate and immediate loading, with higher success in implants that not immediately installed post extraction (P=8.541 ， P ＜ 0.01). According to statistical analysis, there was a significant difference between mandibular implant survival rate and loading time, with higher success rate in early loading as compared with conventional loading (P=19.804，P＜0.001). Insufficient bone quantity and poor bone quality may significantly compromise the survival rate. One piece implant has some limitations such as no angled abutment options and path of implant insertion is critical, for this reason clinician’s skill and experience is crucial. In conclusion, one piece implant is a IV successful alternative treatment option for oral rehabilitation. However, limitation of the study include the result are reported from one practice only. It is advised that well-designed studies on larger sample sizes in multicenter settings can be done in the future to reach a much solid conclusion.