Lopes Armando, Maló Paulo, de Araújo Nobre Miguel, Sánchez-Fernández Elena, Gravito Inês
Department of Oral Surgery, Maló Clinic, Private practice, Lisbon, Portugal.
Private practice, Research and Development, Maló Clinic, Lisbon, Portugal.
Clin Implant Dent Relat Res. 2017 Apr;19(2):233-244. doi: 10.1111/cid.12456. Epub 2016 Oct 18.
There is a necessity of studies documenting the long-term outcome of full-arch flapless rehabilitations.
To evaluate the 7 years implant and prosthesis survival rate and 5-years marginal bone loss of full-arch fixed prosthetic rehabilitations supported by implants in immediate function with the All-on-4 treatment concept using a computer guided surgical protocol (NobelGuide , Nobel Biocare).
This retrospective clinical study included 111 edentulous patients (n = 53 bruxers; n = 21 smokers; n = 59 systemically compromised), rehabilitated between February 2005 and November 2010 with 532 implants with the All-on-4 treatment concept using NobelGuide . Outcome measures were implant and prosthesis survival, marginal bone loss at 5-years and the incidence of mechanical and biological complications. Survival was calculated using life-table analysis. Inferential analysis was performed to compare the difference in marginal bone loss between axial and tilted implants.
Sixteen patients were lost to follow-up. The implant cumulative survival rate was 94.5% at 7 years. Prosthetic survival was 97.8% (n = 3 prosthetic failures). The average (standard deviation) marginal bone loss at 5 years was 1.3 mm (1.06 mm) overall, 1.27 mm (1.02 mm) for tilted implants and 1.34 mm (1.1 mm) for axial implants (p < .001). Ninety-one patients experienced complications in the provisional prostheses (n = 47 patients who were bruxers; n = 25 patients with implant-supported rehabilitation as opposing dentition) ranging from prosthetic fracture (n = 66 patients) to abutment or prosthetic screw loosening (n = 74 patients). Thirty-three patients experienced complications in the definitive prostheses (all exclusive to patients who were bruxers or had implant-supported rehabilitations as opposing dentition) ranging from acrylic-resin prosthetic/crown fracture (n = 23 patients) to abutment or prosthetic screw loosening (n = 10 patients). Twenty-five patients (22%) registered peri-implant pathology.
Within the limitations of this study, it is possible to conclude that this treatment modality for completely edentulous jaws is possible with high long-term survival outcomes. Bruxing and smoking habits had a negative impact on implant failure, mechanical, and biological complications.
有必要开展研究记录全牙弓无瓣修复的长期效果。
使用计算机引导手术方案（NobelGuide，诺贝尔生物公司），采用All-on-4治疗理念，评估即刻功能的种植体支持的全牙弓固定修复体7年的种植体和修复体生存率以及5年的边缘骨吸收情况。
这项回顾性临床研究纳入了111例无牙颌患者（53例磨牙症患者；21例吸烟者；59例全身状况不佳者），于2005年2月至2010年11月期间采用NobelGuide的All-on-4治疗理念用532颗种植体进行修复。观察指标为种植体和修复体生存率、5年时的边缘骨吸收以及机械和生物学并发症的发生率。使用寿命表分析法计算生存率。进行推断性分析以比较轴向种植体和倾斜种植体边缘骨吸收的差异。
16例患者失访。7年时种植体累积生存率为94.5%。修复体生存率为97.8%（3例修复体失败）。5年时总体平均（标准差）边缘骨吸收为1.3 mm（1.06 mm），倾斜种植体为1.27 mm（1.02 mm），轴向种植体为1.34 mm（1.1 mm）（p <.001）。91例患者在临时修复体上出现并发症（47例磨牙症患者；25例种植体支持修复作为对颌牙列的患者），范围从修复体骨折（66例患者）到基台或修复体螺钉松动（74例患者）。33例患者在最终修复体上出现并发症（均为磨牙症患者或种植体支持修复作为对颌牙列的患者所特有），范围从丙烯酸树脂修复体/牙冠骨折（23例患者）到基台或修复体螺钉松动（10例患者）。25例患者（22%）记录有种植体周围病变。
在本研究的局限性范围内，可以得出结论，这种针对完全无牙颌的治疗方式具有较高的长期生存效果是可行的。磨牙和吸烟习惯对种植体失败、机械和生物学并发症有负面影响。
