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种植体支持的氧化锆全牙弓修复体与不同对颌牙列的并发症及临床考量

Complications and Clinical Considerations of the Implant-Retained Zirconia Complete-Arch Prosthesis with Various Opposing Dentitions.

作者信息

Gonzalez Jorge, Triplett Robert G

出版信息

Int J Oral Maxillofac Implants. 2017 Jul/Aug;32(4):864-869. doi: 10.11607/jomi.5369.

Abstract

PURPOSE

To evaluate the performance of the implant-retained zirconia complete-arch prosthesis with various opposing dentitions.

MATERIALS AND METHODS

The 40 patients included in this retrospective case series study were treated with one or two implant-retained zirconia complete-arch prostheses (ZIRCAP) using the Zirkonzahn protocol. Prettau zirconia frames were created with strategic cutbacks in the structure to extend zirconia incisal coverage of the esthetic anterior sextants and complete monolithic zirconia in the molar areas; subsequent layers of porcelain were applied to nonfunctional and esthetic areas. Patients had three possible occlusal scenarios: (1) maxillary ZIRCAP and mandibular ZIRCAP, (2) maxillary ZIRCAP and mandibular natural dentition, and (3) maxillary ZIRCAP and mandibular conventional hybrid prosthesis. Complications were recorded during follow-up appointments 3, 6, and 12 months after definitive prosthesis delivery. The mean treatment observation period was 33 months.

RESULTS

Eight prosthetic complications were noted for the 40 implant-retained zirconia complete-arch prostheses (18.18%), including six cases of minor porcelain chipping and two cases of debonding of the metal insert from the zirconia framework. Maxillary ZIRCAP opposing mandibular ZIRCAP and maxillary ZIRCAP opposing mandibular natural dentition occlusal scenarios presented the same complication ratio of 4. No complications were seen in the maxillary ZIRCAP opposing mandibular conventional hybrid prosthesis group, yet 16 complications were found as denture tooth fractures in 12 mandibular conventional hybrid prostheses (ratio of 0.75).

CONCLUSION

The results indicate that the implant-retained zirconia complete-arch prosthesis offers acceptable performance for use as an alternative to the conventional titanium framework acrylic veneer prosthesis for complete edentulism with a lower incidence of prosthetic complications and fewer maintenance appointments. Chipping of veneering porcelain was the most common complication, but a low incidence was observed in this study. Acrylic denture teeth may represent the weakest link when restoring complete edentulism with a maxillary ZIRCAP and mandibular conventional hybrid prosthesis.

摘要

目的

评估种植体支持的氧化锆全牙弓修复体在不同对颌牙列情况下的性能。

材料与方法

本回顾性病例系列研究纳入40例患者,采用Zirkonzahn方案,用一个或两个种植体支持的氧化锆全牙弓修复体(ZIRCAP)进行治疗。制作Prettau氧化锆框架时,在结构上进行策略性削减,以扩大氧化锆对美观前牙区的切端覆盖范围,并在磨牙区采用整体式氧化锆;随后在非功能区和美观区施加多层瓷。患者有三种可能的咬合情况:(1)上颌ZIRCAP和下颌ZIRCAP,(2)上颌ZIRCAP和下颌天然牙列,(3)上颌ZIRCAP和下颌传统混合修复体。在最终修复体交付后3、6和12个月的随访预约中记录并发症情况。平均治疗观察期为33个月。

结果

40个种植体支持的氧化锆全牙弓修复体出现8例修复并发症(18.18%),包括6例轻微瓷崩裂和2例金属嵌体与氧化锆框架脱粘。上颌ZIRCAP对下颌ZIRCAP和上颌ZIRCAP对下颌天然牙列的咬合情况并发症发生率相同,均为4。上颌ZIRCAP对下颌传统混合修复体组未出现并发症,但在12个下颌传统混合修复体中发现16例义齿牙折并发症(发生率为0.75)。

结论

结果表明,种植体支持的氧化锆全牙弓修复体作为传统钛框架丙烯酸树脂贴面修复体的替代方案,用于全口无牙颌时性能可接受,修复并发症发生率较低,维护预约较少。贴面瓷崩裂是最常见的并发症,但本研究中发生率较低。当上颌使用ZIRCAP而下颌使用传统混合修复体修复全口无牙颌时,丙烯酸树脂义齿牙可能是最薄弱的环节。

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