影響植體存活率和併發症之相關因素探討

Investigation of risk factors for the survival rate of dental implants and complications

林秋華(Chiu-Hua Lin)

指導教授 ： 林英助

高雄醫學大學/口腔醫學院/口腔衛生學系碩士在職專班/碩士(2015年)

摘要

研究背景
臨床上常應用牙科植體（implant）來取代缺牙位置，而植牙手術成功率高且可以被預測，有些許因素被認為會導致植牙手術失敗或造成術後併發症，可惜的是在台灣目前有那些影響因子並不是非常清楚，甚至在教學醫院系統牙科部和私人牙科診所間，導致植牙手術失敗或造成術後併發症是否有不同仍然未知。

研究目的
探討影響牙科植體存活率與發生第一次術後併發症與哪些因子最相關，並比較教學醫院牙科部和私人牙科診所間危險因子的異同。

材料方法
以回溯性研究設計於參與調查的私人牙科診所和教學醫院牙科部完成植牙的患者。最後我們收集2002年至2014年有植牙的患者，資料收集前先取得受試者同意書後，再由參與調查病患的病歷檔案收集臨床治療紀錄，以及讓病患自填一份結構式問卷（包含菸酒檳榔使用度以及口腔保健知識態度與行為的相關問題）。

結果
最後納入分析的患者有117位（男性54人以及女性63人）和429顆植體，第一顆植牙的平均年齡為44.58歲，其中失去4顆植體皆為在醫院植牙的男性患者，牙科植體累計存活率為98.85％；而與牙科植體失敗的單變項因子和植牙地點、性別、種植位置、植體廠牌、術後併發症以及嚼食檳榔習慣有顯著性差異（p < 0.05）。至於與牙科植體術後併發症發生之單變項因子則與植牙地點、性別、糖尿病、牙周病史、種植位置、廠牌、抽菸習慣和口腔保健知識態度與行為之總得>34分有相關（p < 0.05）；進一步以多變項Cox proportional hazard model分析來找出提早發生術後併發症的風險因子，發現有牙周病史相對於無牙周病病史者（adjusted hazard ratio，AHR = 2.63，95%CI = 1.22-5.66）有較高的機率提早發生術後併發症，植牙位置在上顎相對於下顎 （AHR =1.68，95%CI = 1.19-2.38）有較高的機率提早發生術後併發症。以私人牙科診所植牙患者來看，發現抽菸者相對於未抽菸者（AHR =3.42，95%CI = 1.95-6.01）有較高的機率提早發生術後併發症。

結論
本研究結果顯示牙科植體種植的成功率高且失敗率低，而植牙失敗植體數太少，無法有效評估其失敗的危險因子。而糖尿病、牙周病史、種植位置和植體廠牌會影響植體種植術後併發症發生。我們也發現在教學醫院牙科部和牙科診所間，發生植體種植術後併發症的危險因子有所不同。目前我們進行收案地點仍然太少，無法代表實際的狀況，相關的調查結果仍有待進一步的確認。

關鍵字

牙科植體 ； 存活率 ； 術後併發症 ； 牙科診所

並列摘要

Background
The application of dental implants in replacing missing teeth is highly predictable and successful. There were some risk factors are recognized to affect the dental implant survival rate or postoperative complications. However, the risk factors in Taiwan patients with implants are not clear. The differences in these risk factors are not available between private dental clinics and dental clinics under teaching hospital.

Objective
To investigate the risk factors to affect the overall survival rate of dental implants and complication-free survival rate of dental implants.

Materials and methods
A retrospective study is designed for present study. The inform consent is signed by the patients before data collection .The implants are completed in two cooperated hospitals and one private dental clinic between 2002 to 2014. The data are collected from patients’ medical files. A self-administered questionnaire is used to collect the histories of cigarette smoking, alcoholic drinking, betel quid chewing , and the knowledge, attitude and health behaviors of oral hygiene in patients. Finally, statistical analysis is applied to determine the association.

Results
The average age of 117 patients ,54 males and 63 females, is 44.58 years old. Total number of implants are 429 including 4 failed implants. The cumulative survival rate was 98.85%. The dental clinics, gender , implant position, brand of implant, postoperative complication and the habit of betel quid chewing were associated with an increased risk of implants failure (P < 0.05).The dental clinics, gender, diabetes, periodontal history, implant position, brand of implant, smoking habit and oral health total score were associated with an increased risk of complications (P < 0.05). Multivariate Cox propositional hazard model also revealed that histories of periodontitis could be a significant risk factor for implant with early complications (adjusted hazard ratio (AHR) = 2.63, 95% CI = 1.22-5.66). Located at maxillary implant has a higher probability of early postoperative complications than mandible (AHR = 1.68, 95% CI = 1.19-2.38). The smokers who implanted in dental clinics were associated with an increased risk of early complications (AHR = 3.42, 95% CI = 1.95-6.01).

Conclusion
Present study shows that the success rate of dental implants is high while the failure rate is low. Diabetes, histories of periodontitis, implant position, and brand of implant can affect the survival rate of the implant and the chance of occurring postoperative complications. We also found that there are different risk factors between private dental clinics and dental clinics under teaching hospital. Currently, the number of our data collection location were too few, may not represent the actual situation, relevant findings still need further confirmation.

並列關鍵字

Dental implant ； Survival rate ； Postoperative complications ； Dental clinic

參考文獻

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