後牙區寬直徑與標準直徑OSSEOTITE植體之十年回溯性臨床研究

A 10-Year Retrospective Clinical Study of Wide- & Standard-diameter OSSEOTITE implants in Posterior Zone

林元婷(Yuan-Ting Lin)

指導教授 ： 王震乾

高雄醫學大學/口腔醫學院/牙醫學研究所/碩士(2008年)

摘要

研究背景：寬直徑牙科植體的使用，自1993年由Langer等學者提出，至今僅有少數長期臨床追蹤，並同時探討其與標準直徑植體之間存活率差異之報告。
研究目的：探討OSSEOTITE外六角混合表面寬直徑植體與標準直徑植體應用於後牙區之長期存活率差異、贋復體成果、影響植體失敗相關因子及植體邊緣骨吸收情況。
研究方法：記錄高雄醫學大學附設中和紀念醫院植牙門診自西元1996至2007年間，同時於後牙區接受至少一顆寬直徑(≧5mm)與標準直徑OSSEOTITE植體置入之92位患者。並於2006年3月至2008年3月間，選取定期回診且符合本實驗標準之61位患者，拍攝其環口X光片、牙科根尖片，記錄植體邊緣骨吸收狀況、有無放射線透射病灶；合併術式、時機、移植骨種類；贋復體設計、材質種類、對咬形式及贋復體併發症。統計分析以Kaplan-Meier estimates計算植體及贋復體存活率，使用Log-rank test比較植體與贋復體失敗之相關因子，並以Cox regression分析其於臨床之相對風險(relative risk)；影響贋復體併發症的相關因子則使用卡方檢定及Log-rank test分析。
結果：61位患者， 258顆植體(寬直徑113顆，標準直徑145顆)。植體置入平均年齡52.3±11.6歲(21到79歲)，平均追蹤期為57.2±33.6個月(0.9到131.3個月)。共7顆植體失敗，寬直徑與標準直徑植體之十年存活率分別為95.6%及97.9%，不具統計顯著差異；植體失敗與短長度植體(≦10mm)呈統計顯著相關。134座贋復體(含253顆植體)，僅1座受植體移除影響而失敗，十年贋復體存活率為98.8%。贋復體併發症以瓷-金屬界面之破折發生率最高，且以螺旋式固位與水晶瓷牙面之設計有顯著較高的併發率。寬直徑植體十年邊緣骨吸收為1.02±0.63公釐，與標準直徑植體(0.85±0.55公釐)之間不具統計顯著差別。
結論：本研究結果顯示，OSSEOTITE寬直徑與標準直徑植體於後牙區應用之臨床表現並無顯著差異，且與已發表文獻比較，皆有可接受的長期植體存活率、贋復體存活率及邊緣骨吸收。短長度植體為本實驗中影響植體存活率之危險因素之ㄧ。贋復體併發症以瓷-金屬界面之破折最常見，且以螺旋式固位與水晶瓷牙面之設計較易發生。

關鍵字

牙科植體 ； 邊緣骨吸收 ； 回溯性研究 ； 存活分析 ； 寬直徑

並列摘要

Objective: The purpose of this study was to examine the long-term implant and prosthesis outcome of OSSEOTITE wide-diameter dental implants (WDIs) used in the posterior jaws in comparison with standard-diameter implants (SDIs). Risk factors associated with implant failure, prosthetic complications and implant marginal bone loss (MBL) were also reported.
Materials & Methods: Between 1996 and 2007, patients at Kaohsiung Medical University Hospital who received at least one OSSEOTITE WDIs and SDIs in the posterior zones were selected. Among 92 patients who met the criteria, 61 patients were clinically recalled from 2006 to 2008 and were included in the study. At the examination, information regarding medical history, implant-specific, prosthetic, and surgical parameters were collected. MBL were measured from periapical radiographs taken with long-cone paralleling technique. Kaplan-Meier analyses with Log-rank test were applied to examine the difference in cumulative survival rates (CSR) between groups. Cox-regressions were conducted to assess the relative risks of potential factors for implant failure. Risk factors associated with prosthetic complications were analyzed through Chi-square and Log-rank test.
Results: Thirty-five men and 26 women with a mean age of 52 years (21 to 79 years) participated. The mean follow-up time for 113 WDIs and 145 SDIs was 57.2±33.6 months. Four WDIs and 3 SDIs failed during the period. The 10-year CSR for WDIs and SDIs were 93.98% and 97.25%, respectively. Implant diameter was not statistically correlated with implant survival whereas implant length was (p<.05). A total of 134 prostheses supported by 253 implants were fabricated. Only 1 set of prosthesis failed due to implant loss, resulting in a 98.81% prosthesis survival rate. Veneer fracture was the most frequent prosthetic complication in this study, with fiber-reinforced composite (FRC) veneer and screw-retained designs having a significant higher incidence. The mean MBL for the WDIs was 1.02±0.63 mm after 10 years of function, and had no statistical difference with the SDIs (0.85±0.55 mm).
Conclusions: The present clinical study showed comparable survival rates and marginal bone loss between wide- and standard-diameter external hexed OSSEOTITE implants. Implants with short length (≦10mm) were found to have higher failure rates. The majority of prosthetic complications were veneer fractures, with screw-retained and FRC-veneered designs showing higher incidences.

並列關鍵字

Dental implants ； marginal bone loss ； retrospective study ； survival analysis ； wide-diameter

參考文獻

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