【作者】 李倩； 林野； 邱立新； 李健慧； 邸萍； 陈波； 胡秀莲； 张宇； 王莺； 崔宏燕； 王涛； 于海燕；

【Author】 LI Qian LIN Ye QIU Lixin LI Jianhui DI Ping CHEN Bo HU Xiulian ZHANG Yu WANG Ying GUI Hongyan WANG Tao YU Haiyan (Department of implant dentistry,Peking university school and hospital of Stomatology)

【机构】 北京大学口腔医院种植科；

【摘要】 目的:评估平台转换连接种植体和对接连接种植体种植修复的近期临床效果和种植体周围软硬组织的变化。材料和方法:2007年4月至2007年9月北京大学口腔医院种植中心就诊的双侧后牙区牙列缺损患者25例,患者双侧同名牙位上分别种植平台转换连接种植体(Ankylos种植体)和对接连接种植体(NobelSpeeoy种植体),共31对种植体作为研究对象进行配对比较研究。种植体负载3、6和12个月时复诊,临床检查包括有无并发症,mPI、mBI和PD。在种植体植入术后即刻、修复完成即刻、负载3、6和12个月时行X线检查,测量种植体边缘骨水平、计算边缘骨丧失量。比较同一患者口内平台转换连接种植体和对接连接种植体临床检查和X线检查结果。另以接受对接连接种植体植入的12例患者功能负重时间达2年的30枚种植体为对照组,与试验组中对接连接种植体负载1年时的X线检查结果进行比较。在SPSS14.0软件平台上应用配对t检验、方差分析、Wilcoxon符号秩检验、Mann-Whitney检验进行统计分析。结果:至功能负载12个月复查时,全部25例患者的31枚平台转换连接种植体和31枚对接连接种植体未发现严重并发症。应用平台转换技术和对接连接种植体功能负载12个月时种植体PD为2.2±0.4mm和2.6±0.4mm,P<0.05。两种种植体功能负载12个月内mPI和mBI无显著性差异。至功能负载12个月复查时,全部种植体骨结合良好,种植体周围未见透射影。平台转换连接种植体负载前、功能负载3、6个月和12个月时种植体边缘骨吸收分别为0.51±0.43mm,0.07±0.06mm,-0.03±0.29mm和-0.12±0.31mm,对接连接种植体边缘骨吸收为1.26±0.46mm,0.27±0.13mm,0.42±0.26mm和0.50±0.29mm,P<0.05。平台转换连接种植体功能负载12个月时边缘骨水平接近种植体平台(-0.15±0.58mm),对接连接种植体边缘骨水平低于种植体平台(1.89±0.32mm),P<0.01。两种种植体负载前边缘骨吸收量均显著大于负载后12个月内骨吸收量,P<0.01。对接连接种植体功能负重2年后边缘骨水平低于种植体平台1.83±0.35mm,边缘骨吸收量为0.58±0.34mm,与负载1年组对接连接种植体的结果比较无显著性差异。结论:本研究中平台转换连接种植体和对接连接种植体至功能负载1年临床效果满意。功能负载1年内平台转换连接种植体边缘骨吸收小于对接连接种植体,边缘骨水平稳定在接近种植体平台的水平。传统对接连接种植体负重1年内发生渐进性骨吸收,负重1年后种植体边缘骨水平趋于稳定。平台转换连接种植体和对接连接种植体的临床效果还需长期追踪观察,平台转换技术对种植体周围软硬组织影响的生物学机制有待进一步研究。更多还原

【Abstract】 Objective:To evaluate and compare the clinical and radiographic outcomes of dental implant restoration with platform - switched implants and butt - joint implants.Materials and Methods:The study included 25 patients with bilateral edentulous posterior ridges treated from April to September 2007(Department of implant dentistry,Peking university school and hospital of Stomatology).31 pairs of implants were placed in symmetric position.Each pair contains a platform -switched implant(Ankylos) on one site and a butt -joint implant (NobelSpeedy) on the opposite site.The clinical parameters including modified sulcus bleeding index(mBI),modified plaque index (mPI) and probing depth(PD) were measured after 3,6 and 12 months of functional loading.Standardized periapical radiograph or panoramic radiograph was taken at the following time:immediately after implant placement and restoration,3,6 and 12 months after functional loading.Marginal bone level and marginal bone loss was measured.30 butt -joint implants from 12 individuals served as control for 2 years functional loading.Marginal bone level and bone loss of control group were compared with results of butt -joint implants in testing group after 1 year of loading.The paired t test,Wilcoxon’s signed rank test and Mann - Whitney test were used to detect difference between the implants in each pair.Results:At the 12 -month examination,no implant loss or other severe complications occurred to platform -switched implant or butt-joint implant group,the mean value of PD of platform - switched implants was 2.2±0.4mm,and 2.6±0.4 mm for butt-joint implants.Significant difference was found for PD(P<0.05).No significant difference was found for mBI and mPI.All implants were successfully osseointegrated,and showed no peri -implant radiolucency.Marginal bone loss was assessed at the time of prosthesis delivery,3,6 and 12months after functional loading.The mean values of marginal bone loss of platform - switched implants (0.51±0.43mm,0.07±0.06mm,-0.03±0.29mm,and -0.12±0.31mm) were less than those of butt - joint implants (1.26±0.46mm,0.27±0.13mm,0.42±0.26mm,and 0.50±0.29mm),P<0.05.The mean marginal bone level was 0.15±0.58mm superior to the platform of platform -switched implants and 1.89±0.32mm below the platform of butt -joint implants,respectively. The difference was significant between the two types of implants(P<0.01).Both types of implants showed more marginal bone loss in the period before loading than that of the period of 12 months loading,P<0.01.The mean value of marginal bone loss for butt-joint implants after 2 years functional loading was 0.58±0.34mm,marginal bone level was below implant platform(1.83±0.35mm). There were no significant differences compared with those parameters of butt - joint implants after 1 year of functional loading.Conclusions:Based on the limited results ol this study,after the 12 months follow -up it showed predictable clinical outcomes for all platform - switched implants and butt -joint implants.Marginal bone loss around platform - switched implants was less than that of butt-joint implants,and marginal bone level around platform -switched implants was stable at the implant platform after one year of loading.Traditional butt -joint implants revealed continuous increase of marginal bone loss in the first year of functional loading,but the marginal bone level tended to be stable after 1 year of loading,no significant bone loss was detected from 1 year to 2 year after final restoration. Bone loss around implants occurred before functional loading.It seems to be important to apply platform switching from the first component placed on the implant.Long - term follow - up is needed.更多还原