Grötz K A, Wahlmann U W, Krummenauer F, Wegener J, al-Nawas B, Kuffner H D, Wagner W
Universitäts-Klinik für Mund-, Kiefer- und Gesichtschirurgie, Johannes-Gutenberg-Universität, Mainz.
Mund Kiefer Gesichtschir. 1999 May;3 Suppl 1:S117-24. doi: 10.1007/PL00014497.
In comparison to tumor patients not receiving radiotherapy, the rehabilitation of masticatory function after head and neck irradiation is limited due to radiation-induced caries, radioxerostomia, and the risk of osteoradionecrosis. This study focused on implants in the irradiated jaw and on the evaluation of the prognosis and the effect of potential factors on the prognosis. The retrospective study covered 197 implants (47 patients) from 1988 to 1997. The implant prognosis was determined by implant survival statistics (Kaplan-Meier). Losses not related to the implants were censored. In addition, groups were formed according to factors potentially affecting the prognosis. The significance of differences in the groups relative to survival were tested using the log-rank test. Twelve (6.1%) implants from a total of 197 were lost due to peri-implantitis, and eight (4.1%) due to possible biomechanical stress. A total of 52 losses (26.4%) due to death of patients and two (1.0%) due to resection of the jaw were censored; 111 (56.3%) implants remained at recall and the average interval was 33 months. The rates of implant survival (Kaplan-Meier) after 1 and 2 years were 95%, after 3 and 4 years 92%, and after 5 and 6 years 72%. The univariate analysis of group comparisons showed a significantly lower rate of loss after perimplant flap reconstruction (p = 0.036). There was no effect due to the doses of irradiation (p = 0.16), chemotherapy (p = 0.90), or peri-implant osteoplasty (p = 0.84). Although none of the implants inserted before radiotherapy had to be explanted, the implant survival difference in the very heterogeneous groups was not significant (preirradiation, n = 29; postirradiation: n = 156; p = 0.13). According to the literature, the rate of survival of teeth which were sound before radiotherapy (1 year, 75%; 5 years, 45%) was distinctly lower than the survival of enossal implants (1 year, 95%; 5 years, 72%). The high-quality rehabilitation of masticatory function with implant-based protheses is the preferred method of treatment for irradiated tumor patients. In addition, contraindications for enossal implants were ruled out for all studied factors affecting prognosis.
与未接受放疗的肿瘤患者相比，头颈部放疗后咀嚼功能的康复受到限制，原因包括放射性龋齿、放射性口干症以及骨放射性坏死的风险。本研究聚焦于受照射颌骨中的种植体，并评估其预后以及潜在因素对预后的影响。这项回顾性研究涵盖了1988年至1997年的197枚种植体（47例患者）。通过种植体存活统计（Kaplan-Meier法）确定种植体预后。与种植体无关的失访情况进行截尾处理。此外，根据可能影响预后的因素进行分组。使用对数秩检验来检验各组在存活方面差异的显著性。197枚种植体中，有12枚（6.1%）因种植体周围炎而丢失，8枚（4.1%）因可能的生物力学应力而丢失。因患者死亡导致的52例失访（26.4%）以及因颌骨切除导致的2例失访（1.0%）进行截尾处理；111枚（56.3%）种植体在随访时仍留存，平均随访间隔为33个月。种植体1年和2年后的存活概率（Kaplan-Meier法）为95%，3年和4年后为92%，5年和6年后为72%。组间比较的单因素分析显示，种植体周围瓣重建后丢失率显著更低（p = 0.036）。照射剂量（p = 0.16）、化疗（p = 0.90）或种植体周围骨成形术（p = 0.84）均无影响。尽管放疗前植入的种植体无一需要取出，但在非常异质性的组中种植体存活差异并不显著（放疗前，n = 29；放疗后：n = 156；p = 0.13）。根据文献，放疗前完好牙齿的存活率（1年，75%；5年，45%）明显低于牙内种植体的存活率（1年，95%；5年，72%）。使用基于种植体的修复体对咀嚼功能进行高质量康复是受照射肿瘤患者的首选治疗方法。此外，对于所有研究的影响预后的因素，均排除了牙内种植体的禁忌证。
