Zamparini Fausto, Spinelli Andrea, Buonavoglia Alessio, Gandolfi Maria Giovanna, Prati Carlo
Int J Oral Maxillofac Implants. 2023 Jul-Aug;38(4):697-708. doi: 10.11607/jomi.10055.
To evaluate the survival rate and marginal bone level (MBL) of calcium phosphate-blasted acid-etched titanium implants placed in a cohort of patients with different ridges after a follow-up period of at least 10 years. A total of 61 patients with a minimum implant follow-up of 10 years were selected for this historical prospective, best clinical practice cohort study. Between 2009 and 2012, 121 titanium implants were placed using a flap, flapless, or postextractive technique. The implant placement timing was performed according to pre-extractive diagnosis and divided into immediate (immediately after tooth extraction with an absence of infection), early (within 2 to 3 months with an acute periapical lesion), delayed (6 to 12 months from extraction with a large periapical infection), or late (> 12 months from extraction with healed edentulous ridges). All implants were loaded after 3 months with provisional and definitive cemented restorations. Periapical radiographs were taken before implant insertion and at 3, 6, 12, 24, 36, 48, 96, and 120 months (T3, T6, T12, T24, T36, T48, T96, and T120, respectively). The MBL was calculated in single blind by an additional examiner. Linear logistic regression was performed to analyze statistically significant differences in relation to different operative variables at all evaluation times. Multilevel mixed logistic regression was made to evaluate the factors associated to MBL at 10 years (T120). After 10 years, 47 patients and 92 implant restorations were analyzed, showing that 88 implants (95.6%) survived and 4 implants (4.4%) failed. The cumulative drop-out rate was 22.1%. Loosening and/or mobility was observed in a total of 9 abutments (9.7%) during the observational time. No other complications were reported. Implants placed with a flapless technique revealed a similar MBL to those placed with a flap technique. No significant differences were observed between the surgical techniques at T96 and T120. Immediate and early implants revealed a more stable MBL than both delayed and late implants up to T48. At longer evaluation times (T96 and T120), the MBL values were not statistically significant ( > .05). Narrower diameter implants (3.5 mm) revealed a higher bone loss when compared to the 4.1-mm- and 5.0-mm-diameters, especially in the first year from implant insertion (from T3 to T12) and at longer follow-up (T36 and T48). After that, the difference was reduced. Multilevel analysis showed that none of these variables appear to significantly influence MBL at 120 months. MBL was not influenced by surgical technique or implant placement timing after 10 years. Maintaining a strict occlusal and hygiene control created the conditions to preserve bone integrity and achieve a high implant survival rate.
为评估在至少10年的随访期后，植入不同牙槽嵴患者群体的经磷酸钙喷砂酸蚀处理的钛种植体的存活率和边缘骨水平（MBL）。本历史前瞻性、最佳临床实践队列研究共选取了61例种植体随访至少10年的患者。2009年至2012年期间，采用翻瓣、不翻瓣或拔牙后种植技术植入了121枚钛种植体。种植体植入时机根据拔牙前诊断进行，分为即刻（拔牙后无感染立即植入）、早期（急性根尖周病变在2至3个月内植入）、延期（拔牙后6至12个月，有较大根尖周感染）或晚期（拔牙后>12个月，无牙嵴已愈合）。所有种植体在3个月后加载临时和最终的粘结修复体。在种植体植入前以及3、6、12、24、36、48、96和120个月（分别为T3、T6、T12 T24、T36、T48、T96和T120）拍摄根尖片。MBL由另一名检查者单盲计算。进行线性逻辑回归分析所有评估时间与不同手术变量相关的统计学显著差异。进行多水平混合逻辑回归以评估10年时（T120）与MBL相关的因素。10年后，分析了47例患者和92个种植体修复体，结果显示88枚种植体（95.6%）存活，4枚种植体（4.4%）失败。累积失访率为22.1%。在观察期内共观察到9个基台（9.7%）出现松动和/或活动。未报告其他并发症。采用不翻瓣技术植入的种植体显示出与采用翻瓣技术植入的种植体相似的MBL。在T96和T120时，手术技术之间未观察到显著差异。即刻和早期种植体在T48之前显示出比延期和晚期种植体更稳定的MBL。在更长的评估时间（T96和T120），MBL值无统计学显著性（>.05）。与直径4.1毫米和5.0毫米相比直径较窄（3.5毫米）的种植体显示出更高的骨吸收，尤其是在种植体植入后的第一年（从T3到T12）以及更长的随访期（T36和T48）。此后，差异减小。多水平分析表明，这些变量在120个月时似乎均未对MBL产生显著影响。10年后，MBL不受手术技术或种植体植入时机的影响。保持严格的咬合和卫生控制为保持骨完整性和实现高种植体存活率创造了条件。
