Brånemark P I, Engstrand P, Ohrnell L O, Gröndahl K, Nilsson P, Hagberg K, Darle C, Lekholm U
Brånemark Osseointegration Center, Box 5411, SE-402 29 Göteborg, Sweden.
Clin Implant Dent Relat Res. 1999;1(1):2-16. doi: 10.1111/j.1708-8208.1999.tb00086.x.
Brånemark fixtures were originally prescribed to be placed in two surgical stages. During the past years, reports on the placement of machined titanium implants in a one-stage procedure have been published, and the results have been encouraging. Recently there has been considerable interest in early or immediate loading.
The purpose of this article is to report the preliminary clinical results of a new method for implant treatment of the edentulous mandible. The new protocol involves prefabricated components and surgical guides, elimination of the prosthetic impression procedure and attachment of the permanent fixed bridge on the day of implant placement.
Fifty patients (26 males, 24 females) received 150 Brånemark Novum implants and were followed from 6 months to 3 years after implant placement. Bone width and height were determined preoperatively with the use of radiographs. The jaw was reduced in height to accommodate three special 5-mm wide implants. Precise implant positioning was accomplished with special drilling templates. Drill guides were placed over the drilling templates during site preparation using a series of specially designed drills. After the mucosa had been sutured back into position, a prefabricated titanium lower bar was connected with titanium screws to the transmucosal fixture. Another titanium bar was then attached by the prosthodontist, and a bite registration was performed. The bridge was attached to the upper bar. The permanent reconstruction was provided to the patient later the same day.
Three implants were lost to follow-up and three failed, resulting in an overall survival rate of 98%. One prosthesis failed, leaving a prosthetic survival rate of 98%. The average treatment time was approximately 7 hours. At the baseline examination, the marginal bone level was 0.72 mm below the reference point. The average marginal bone loss was 0.2 mm per year and 0.26 mm between the 3-month and 1-year control visits. The accumulated mean bone loss, including baseline, was -1.25 mm. A patient questionnaire demonstrated that 94% of the patients did not experience any discomfort during treatment and all patients would recommend the procedure to others.
The results of this study indicate that the precise surgical and prosthetic protocol allows successful prosthetic rehabilitation of mandibular edentulism and that the permanent reconstruction can be provided to the patient on the day of fixture surgery.
布兰emark种植体最初规定分两个手术阶段植入。在过去几年中，有关在一期手术中植入加工钛种植体的报道已发表，且结果令人鼓舞。最近，人们对早期或即刻负重产生了浓厚兴趣。
本文旨在报告一种用于无牙下颌种植治疗的新方法的初步临床结果。新方案涉及预制组件和手术导板，省去了修复取模程序，并在种植体植入当天安装永久性固定桥。
50例患者（26例男性，24例女性）接受了150枚布兰emark Novum种植体，并在种植体植入后6个月至3年进行随访。术前通过X光片确定骨宽度和高度。为容纳3枚特殊的5毫米宽种植体，对颌骨高度进行了降低。使用特殊的钻孔模板实现种植体的精确定位。在备洞过程中，使用一系列专门设计的钻头，将钻导板放置在钻孔模板上。黏膜缝合复位后，用钛螺钉将预制的钛下颌杆与穿黏膜种植体相连。然后由修复医生连接另一根钛杆，并进行咬合记录。将桥体连接到上杆上。同一天晚些时候为患者提供永久性修复体。
3枚种植体失访，3枚失败，总体生存率为98%。1个修复体失败，修复体生存率为98%。平均治疗时间约为7小时。在基线检查时，边缘骨水平比参考点低0.72毫米。平均边缘骨丢失为每年0.2毫米，在3个月和1年的对照访视之间为0.26毫米。包括基线在内的累积平均骨丢失为-1.25毫米。一份患者问卷显示，94%的患者在治疗期间未感到任何不适，所有患者都会向他人推荐该手术。
本研究结果表明，精确的手术和修复方案能够成功地对下颌无牙症进行修复重建，并且可以在种植体手术当天为患者提供永久性修复体。
