Stellingsma Kees, Raghoebar Gerry M, Visser Anita, Vissink Arjan, Meijer Henny J A
Department of Oral and Maxillofacial Surgery and Maxillofacial Prosthetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Clin Oral Implants Res. 2014 Aug;25(8):926-32. doi: 10.1111/clr.12184. Epub 2013 May 3.
To prospectively compare the clinical and radiographic results of three modes of implant treatment for implant-retained mandibular overdentures in patients with extremely resorbed mandibles. The three treatment strategies used were (1) a transmandibular implant, (2) augmentation of the mandible with an autologous bone graft followed by placement of four endosseous implants, and (3) placement of four short endosseous implants.
Sixty edentulous patients met the inclusion criteria and were assigned according to a balanced allocation method to 1 of the 3 treatment strategies. Implant survival, surgical retreatment rates, and peri-implant bone loss were assessed according to a standardized protocol during a 10-year evaluation period.
During the evaluation period, significantly more implants were lost in the transmandibular implant (cumulative 10-year implant survival rate, 76.3%) and the augmentation groups (88%) compared to the group provided with short endosseous implants (98.8%). The 10-year retreatment rate was significantly more favorable in the endosseous implants only (0%) and augmentation groups (5%) compared to the transmandibular group (30%). In all three groups, there was minor peri-implant bone loss.
Although implant loss is a frequently used outcome measure for success, the necessity of surgical retreatment seems to be of more relevance for both the patient and the clinician.
Considering the favorable clinical and radiographic parameters and the fact that patients can be treated in outdoor clinic setting, the use of short endosseous implants in combination with an overdenture is the first choice of treatment in patients with extremely resorbed mandibles.
前瞻性比较三种种植治疗方式用于极度吸收下颌骨患者的种植体支持式下颌覆盖义齿的临床和影像学结果。所采用的三种治疗策略分别为：（1）经下颌种植体；（2）自体骨移植增加下颌骨量后植入4枚骨内种植体；（3）植入4枚短骨内种植体。
60例无牙颌患者符合纳入标准，采用均衡分配法分配至三种治疗策略中的一种。在10年的评估期内，按照标准化方案评估种植体存留率、手术再治疗率和种植体周围骨吸收情况。
在评估期内，与短骨内种植体组（98.8%）相比，经下颌种植体组（10年累计种植体存留率为76.3%）和骨增量组（88%）的种植体丢失明显更多。仅骨内种植体组（0%）和骨增量组（5%）的10年再治疗率明显优于经下颌种植体组（30%）。在所有三组中，种植体周围骨吸收均较少。
虽然种植体丢失是衡量成功的常用指标，但手术再治疗的必要性对患者和临床医生似乎更为重要。
考虑到良好的临床和影像学参数，以及患者可在门诊治疗的情况，短骨内种植体联合覆盖义齿是极度吸收下颌骨患者的首选治疗方法。
