摘要
目的:对比戴用与未戴用压膜保持器患者的种植单冠邻接触丧失率,探讨压膜保持器对预防或减缓种植修复体邻接触丧失的作用,以期为临床诊疗提供参考。方法:从临床收集46例(共92个邻接触位点)下颌后牙种植单冠修复患者,男性19例,女性27例,年龄25~66岁(平均49.0岁),分别在种植单冠戴用即刻和1、3、6、12个月时进行复查。将以上病例随机分为两组,试验组(22例)自种植单冠戴入当日起,每天夜间佩戴压膜保持器;对照组(24例)仅定期复查,不佩戴压膜保持器。每次复查时均检测种植单冠与邻牙的接触松紧度。以金属咬合膜和测力计作为邻接触检查工具,分别在种植单冠近远中面与天然邻牙之间向插入金属咬合膜,用测力计沿颊舌向缓慢水平拉出金属咬合膜,逐张增加金属咬合膜,直到拉力值F>0,并记录此时金属膜的张数(N)。复查时,若插入与戴牙即刻检测时同样张数的金属膜,而拉力值F降为0,则表示该位点的邻接触丧失。比较不同时间点,两组病例近远中的邻接触丧失率,采用卡方检验,对数据进行统计学分析,同时记录患者每次复查时的种植体与天然牙牙周探诊深度(probing depth,PD)、牙龈出血指数(bleeding index,BI)、松动度(mobility,M)及有无食物嵌塞主诉等。结果:种植单冠戴用1、3、6个月时,试验组近中邻接触丧失率分别为18.2%、22.7%和27.3%,对照组近中邻接触丧失率分别为20.8%、37.5%和45.8%,两组间差异无统计学意义(1个月:χ2=0.000,P=1.000;3个月:χ2=1.183,P=0.277;6个月:χ2=1.697,P=0.193)。在种植单冠戴用12个月时,试验组的近中邻接触丧失率为31.8%,显著低于对照组近中邻接触丧失率(62.5%,χ2=4.330,P=0.037)。在种植单冠的远中邻面,整个随访周期内(1、3、6、12个月)两组间均未观察到差异有统计学意义(χ2=0.000,P=1.000)。结论:对于下颌后牙种植单冠修复的病例,佩戴压膜保持器1年时,可以观察到近中邻接触丧失率明显降低,研究未观察到佩戴压膜保持器对种植单冠远中邻接触丧失率的影响。
Objective： To evaluate the effect of the vacuum-formed retainer on preventing the proximal contact loss between the implant supported crown and its adjacent natural teeth. Methods： Forty-six posterior implant crowns in the mandible including 92 interproximal contacts in 46 patients（ 19 men,27 women） aged from 25 to 66 years were included. The participants in experimental group（ 22 cases） were vacuum-formed retainers at night,while participants in control group（ 24 cases） only received routine examination. The two groups were not different in age,gender,the time interval of the tooth loss and tooth position at baseline. Mesial and distal proximal contact tightness was measured using the orthodontic dynamometer and metallic articulating film immediately after crown delivery,and 1-month,3-month,6-month,and 1-year follow-up respectively. The articulating film was inserted interdentally from the occlusal direction,and then it was slowly removed in the buccal-lingual direction by the dynamometer. Increasing the number of films（ N） piece by piece until the frictional force（ F） was great than 0,and the number of films（ N） was recorded. At each follow-up,proximal contact between implant crown and its adjacent teeth was considered to be loss if the number of films（ N） used at immediate crown delivery passed without frictional force（ F = 0）. Besides,the periodontal conditions [scored according to the probing depth（ PD）,bleeding index（ BI）,mobility（ M） ]and complaint of food impaction were recorded. The mesial and distal proximal contact loss rates were compared between the two groups at different times.Chi-square test or Fisher＇s exact test was used for statistical analysis. Results： The proximal contact loss rate on the mesial surface of the implant supported crown continuously increased over the follow-up periods. At the end of the 1-,3-,and 6-month follow ups,18. 2%,22. 7% and 27. 3% were identified for the contact loss rates on the mesial surface of the implant supported crown in the experimental group,respectively. Meanwhile in control group,the rates were 20. 8%,37. 5% and 45. 8%. No significant differences were observed at the end of the 1-,3-,and 6-month follow ups（ 1-month： χ2= 0. 000,P =1. 000; 3-month： χ2= 1. 183,P = 0. 277; 6-month： χ2= 1. 697,P = 0. 193）. The proximal contact loss rate on the mesial surface in control group（ 62. 5%） was significantly higher than that in the experimental group（ 31. 8%,χ2= 4. 330,P = 0. 037） at the end of the 1-year follow-up. However,no statistical difference was found on the distal surfaces between the two groups during the whole follow-up periods.The first open contact was noted 1 month after crown insertion. Conclusion： By wearing vacuum-formed retainer for one year,the incidence of open contacts between the posterior implant prostheses and mesial adjacent teeth in the mandible has been reduced.
作者
曾百进
果莹
余日月
ZENG Bai-jin1, GUO Ying2, YU Ri-yue2(1. Department of Prosthodontics, Beijing Stomatologieal Hospital ＆ School of Stomatology, Capital Medical University, Beijing 100050, China; 2. Department of Stomatology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, Chin)
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2018年第3期553-559,共7页
Journal of Peking University:Health Sciences
关键词
种植修复体
压膜保持器
种植修复体邻接触丧失
Dental implant restorations
Vacuum-fomled retainer
Proximal contact loss adjacent to implant prostheses
