“All-on-4”无牙颌种植即刻修复技术的初步临床观察

摘要/Abstract

摘要： 目的：回顾性评估“All-on- 4”即刻修复技术的临床效果。方法：根据纳入及排除标准，本研究共纳入40例“All-on- 4”患者。所有患者均采用4枚种植体支持的螺丝固位的即刻修复方案，共植入196枚种植体，对该修复方案下的种植体留存率、修复体留存率、种植1年后种植体边缘骨吸收情况、患者修复并发症进行归纳及分析。结果：在40例患者中，共有13枚种植体失败，其上颌种植体失败11枚，上颌留存率为85.5%（65/76），下颌种植体失败2枚，下颌留存率为98.3%(118/120)。垂直植入种植体失败5枚，留存率为95.0%(93/98)；角度植入种植体失败8枚，留存率为91.8%(90/98)。修复体留存率为95.9%(47/49)。所有于下颌的角度植入种植体边缘骨吸收的中位数0.60 mm，垂直植入的种植体边缘骨吸收的中位数为0.60 mm,Wilcoxon检验结果显示其1年后的骨吸收量差异无统计学意义（P>0.05）。上颌骨倾斜植入的种植体1年后边缘骨吸收的中位数为0.60 mm，垂直植入种植体的1年后边缘骨吸收的中位数为0.55 mm, Wilcoxon检验结果显示二者差异并无统计学意义 (P>0.05）。通过患者的病例回顾发现有20个修复体出现过不同程度的机械并发症，包括人工牙脱落、基台螺丝松动、义齿基托折裂和基台螺丝折裂等。结论：“All-on- 4”无牙颌即刻修复近期临床效果可靠，该技术的远期效果和技术细节对效果的影响等还需更多大样本的临床随机对照研究和长期临床观察。

关键词: 颌, 无牙, 即刻牙种植体负重, 骨质吸收

Abstract: Objective： To evaluate the treatment outcome of the “All-on-4” immediate loading protocol via survival rate of the implants，survival rate of the prosthesis，marginal bone, postoperative complications and patient satisfaction.Methods: In our study, 40 patients with 49 edentulous jaws (31 mandibles and 18 maxillae) were enrolled. Each jaw was restored by the shortened dental arch prosthesis supported by only 4 implants according to the All-on-4 protocol (All-on-4, Nobel Biocare AB, G-teborg, Sweden). For all the patients enrolled in the study,the loading was applied within 12 hours of surgery. The provisional prosthesis could be replaced by the final restorations within 6 to 12 months. In the present study, the survival rate of the both implants and restorations were calculated and analyzed. The radiographic evaluation of marginal bone level changes was measured. The values of the marginal bone level changes of the angled and axial implants were analyzed by the statistic software.Results: In the present study, totally 196 implants were inserted, of which 13 implants failed during the whole following up periods, with 11 implants of the maxillae and 2 of the mandibles. The survival rate of the prosthesis was 95.9% (47/49). The implant survival rate of the maxillae was 85.5%（65/76）while that for the mandibles was 98.3%(118/120). The implant survival rate of the angled implants was 91.8% (90/98), while that for the straight implants was 95.0% (93/98). No significant difference in marginal bone loss was found between angled and axial implants in the 12-month evaluation according to the Wilcoxon rank sum test (P>0.05). During the follow-up period，mechanical complications as fracture of the provisional prostheses, loose of the retain screw, or crack of the artificial teeth were found in 20 prostheses.Conclusion: The present preliminary data of the short term observation suggest that the “All-on-4” immediate loading protocol is a viable treatment modality for the edentulous jaws. However, long term clinical random controlled trials with large samples are still needed to confirm the validity of the technique.

Key words: Jaw, edentulous, Immediate dental implant loading, Bone resorption

赵旭, 邸萍, 林野, 李健慧, 邱立新, 罗佳, 崔宏燕. “All-on-4”无牙颌种植即刻修复技术的初步临床观察[J]. 北京大学学报（医学版）, 2014, 46(5): 720-726.

ZHAO Xu, DI Ping, Lin-Ye, Li-Jian-Hui, Qiu-Li-Xin, LUO Jia, Cui-Hong-Yan. Implanting the edentulous jaws with “All-on- 4” immediate reconstruction: a preliminary clinical observation[J]. Journal of Peking University(Health Sciences), 2014, 46(5): 720-726.

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