Landes Constantin Alexander, Paffrath Christian, Koehler Christian, Thai Van Dung, Stübinger Stefan, Sader Robert, Lauer Hans-Christoph, Piwowarczyk Andree
Department of Oral Maxillofacial and Plastic Facial Surgery, J.-W. Goethe University Medical Centre, Frankfurt, Germany.
Int J Prosthodont. 2009 Jan-Feb;22(1):20-32.
This study presents successful maxillofacial prosthetic rehabilitation using telescopic and crowns on zygoma implants as abutments.
Fifteen patients received 36 zygomatic and 24 dental implants and were followed-up for an average of 65 months (range: 13 to 102 months). Machined zygoma implants were positioned classically in the maxillary molar region. In larger defects, premolar and canine implants were also used. Follow-up included implant and prosthetic success parameters as well as the completion of the Oral Health Impact Profile (OHIP14G).
Seventy-three percent of patients during the study period did not encounter notable complications after prosthetic rehabilitation. There was an 89% cumulative 8-year zygoma implant survival rate and a 100% survival rate for the dental implants. Three losses occurred due to overloading and persistent infection; each was immediately replaced. Five successfully osseointegrated implants had to be removed in two patients due to recurrences of disease; one patient died. Peri-implant bleeding and plaque index scores decreased. After prosthetic treatment with electroplated gold or galvanotelescopes, all patients who had participated in the follow-up declared function (i.e., retention, speech, and mastication) and esthetics as having improved. Other positive aspects mentioned were good hygiene, comfortable usage, and a decrease in sore spots. OHIP scores were 25 +/- 12 on a scale of 0 (no impairment) to 56 (maximum impairment).
Within the limitations of this study (a variable evaluation period), it was observed that zygomatic implants are reliable retention for maxillofacial prostheses. Losses were diagnosed as occuring primarily from chronic infection and overloading. A trapezoid prosthesis design support is recommended with a sufficient number of implants.
本研究展示了使用套筒冠和以颧骨种植体作为基牙的牙冠进行成功的颌面修复。
15名患者接受了36颗颧骨种植体和24颗牙种植体，并进行了平均65个月（范围：13至102个月）的随访。机械加工的颧骨种植体经典地放置在上颌磨牙区。在较大的缺损中，也使用了前磨牙和尖牙种植体。随访包括种植体和修复体的成功参数以及口腔健康影响量表（OHIP14G）的完成情况。
在研究期间，73%的患者在修复后未遇到明显并发症。颧骨种植体8年的累积生存率为89%，牙种植体的生存率为100%。3颗种植体因过载和持续感染而失败，均立即进行了更换。两名患者因疾病复发，不得不取出5颗成功骨结合的种植体；一名患者死亡。种植体周围出血和菌斑指数评分降低。在用电镀金或套筒冠进行修复治疗后，所有参与随访的患者均表示功能（即固位、语音和咀嚼）和美观得到改善。提到的其他积极方面包括良好的卫生状况、使用舒适以及痛点减少。OHIP评分在0（无损害）至56（最大损害）的量表上为25±12。
在本研究的局限性（可变的评估期）内，观察到颧骨种植体是颌面修复可靠的固位方式。种植体失败主要诊断为慢性感染和过载。建议采用梯形修复体设计支撑，并使用足够数量的种植体。
