Professor, Department of Prosthodontics, University of Heidelberg, Heidelberg, Germany.
Associate Professor, Department of Prosthodontics, University of Heidelberg, Heidelberg, Germany.
J Prosthet Dent. 2021 Aug;126(2):196-203. doi: 10.1016/j.prosdent.2020.05.020. Epub 2020 Aug 14.
Combined tooth-implant-supported fixed dental prostheses have been associated with an increased risk of long-term failure. Furthermore, high chipping rates have been reported for ceramic fixed dental prostheses. However, clinical data are sparse.
The purpose of this observational cohort study was to evaluate the chipping and failure rates of metal-ceramic and ceramic implant-supported and combined tooth-implant-supported fixed dental prostheses.
Four hundred thirty-four fixed dental prostheses placed in 324 patients (mean age: 60.8 years) were selected from a prospective clinical long-term study comprising 213 implant-supported fixed dental prostheses, 66 implant-supported cantilever fixed dental prostheses, and 155 tooth-implant-supported fixed dental prostheses. Metal-ceramic fixed dental prostheses (n=260) were fabricated with a high noble metal alloy (n=225) or Co-Cr base metal alloy (n=35) frameworks. Ceramic fixed dental prostheses (n=174) were all zirconia based and had monolithic (n=68), completely veneered (n=43), or partially veneered frameworks (n=63). Kaplan-Meier curves were used to estimate the survival probability and the chipping-free survival rate of the fixed dental prostheses.
During the observation period of 0.5 to 12.6 years (mean: 4.26 years), 17 fixed dental prostheses failed because of implant failure (n=6), tooth loss (n=5), major chipping (n=5), or abutment screw loosening (n=1). Survival probability was 96% after 5 years and 91% after 10 years. Cox regression analysis showed that age, sex, fixed dental prosthesis location, type of fixed dental prosthesis support, and fixed dental prosthesis material had no significant effect on fixed dental prosthesis failure. Chipping (n=61) was significantly affected by the framework material and type of veneer (P=.001). After 5 years, the greatest incidence of chipping (39%) was observed for zirconia fixed dental prostheses with a complete veneer compared with an 18% incidence of chipping for metal-ceramic fixed dental prostheses with a high noble metal framework. A lower incidence of chipping was observed for zirconia fixed dental prostheses with a partial veneer or monolithic design.
Implant-implant-supported and combined tooth-implant-supported fixed dental prostheses have promising long-term survival rates. Chipping seems to occur less frequently in monolithic or partially veneered fixed dental prostheses than in fixed dental prostheses with complete veneers.
组合牙-种植体支持的固定义齿与长期失败风险增加有关。此外，陶瓷固定义齿的崩瓷率报告较高。然而，临床数据较为缺乏。
本观察性队列研究的目的是评估金属陶瓷和陶瓷种植体支持以及组合牙-种植体支持的固定义齿的崩瓷和失败率。
从一项包含 213 例种植体支持的固定义齿、66 例种植体支持的悬臂固定义齿和 155 例牙-种植体支持的固定义齿的前瞻性临床长期研究中选择了 434 个固定义齿，这些固定义齿放置在 324 名患者（平均年龄：60.8 岁）中。金属陶瓷固定义齿（n=260）采用高贵金属合金（n=225）或 Co-Cr 基底金属合金（n=35）制成。陶瓷固定义齿（n=174）均为氧化锆基，具有整体式（n=68）、完全贴面式（n=43）或部分贴面式（n=63）。Kaplan-Meier 曲线用于估计固定义齿的生存概率和无崩瓷生存概率。
在 0.5 至 12.6 年（平均：4.26 年）的观察期内，有 17 个固定义齿因种植体失败（n=6）、牙齿脱落（n=5）、严重崩瓷（n=5）或基台螺丝松动（n=1）而失败。5 年后的生存率为 96%，10 年后的生存率为 91%。Cox 回归分析显示，年龄、性别、固定义齿位置、固定义齿支持类型和固定义齿材料对固定义齿失败没有显著影响。崩瓷（n=61）明显受基台材料和贴面类型的影响（P=.001）。5 年后，全瓷贴面氧化锆固定义齿的崩瓷发生率最高（39%），而高贵金属基台金属陶瓷固定义齿的崩瓷发生率为 18%。部分贴面或整体式设计的氧化锆固定义齿崩瓷发生率较低。
种植体-种植体支持和组合牙-种植体支持的固定义齿具有良好的长期生存率。崩瓷似乎较少发生在全瓷贴面或部分贴面的固定义齿中，而不是全瓷贴面的固定义齿中。
