Knobloch Lisa A, Larsen Peter, Gohel Anita, McGlumphy Edwin, Messner Robin, Johnston William, Saponaro Paola
Professor, Division of Restorative and Prosthetic Dentistry, The Ohio State University College of Dentistry, Columbus, OH.
Retired Professor, Division of Oral and Maxillofacial Surgery, The Ohio State University College of Dentistry, Columbus, OH.
J Prosthet Dent. 2024 Sep 21. doi: 10.1016/j.prosdent.2024.07.048.
The maxillary lateral incisor is often congenitally missing in patients with a cleft palate. The congenital cleft presents the practitioner with challenges including quantity and quality of bone, a surgically managed cleft correction, and limited clinical space.
The purpose of this investigation was to calculate the 5-year success and survival rate of narrow-diameter implants used to restore a missing lateral incisor in patients with a cleft palate.
Fourteen study participants with a cleft palate and a missing maxillary lateral incisor were enrolled based on established criteria. Seventeen narrow-diameter implants (AstraTech OsseoSpeed 3.0S and OsseoSpeed TX 3.5 mm) were placed using a 2-stage protocol and restored with a custom titanium abutment and a cement-retained crown. Clinical and radiographic examinations were performed annually for 5 years. Four probe depth measurements were measured and evaluated using an analysis of covariance (ANCOVA) with Tukey-Kramer multiple comparisons tests. Radiographic marginal bone loss was measured annually using a digital subtraction technique and evaluated with ANCOVA, and the least square mean was derived. The restoration was evaluated using Pink (PES) and White (WES) Esthetic scores.
Regarding probing depth measurements, a significant variance was found between the 4 locations (P<.001), and a linear effect of year was also found (P=.005). The multiple comparisons tests showed the mean buccal probe depth was lower compared with the mean at each of the other 3 locations (P≤.039) from baseline to 5-year follow-up. The least square mean ±standard deviation of the marginal bone loss over the 5-year entire study was 0.55 ±0.088 mm. Regarding prosthesis evaluation, the mean score for PES was 6.15 and 6.63 for the WES with a maximum score of 10. The level for clinical acceptance was set at a total score of 6. To meet the criteria for success over the 5-year period, no more than 2.3 mm of total bone loss was acceptable. The number of implants that met the criteria for success at 5 years was 92%. Regarding survival, the number of implants still in place, functional, and asymptomatic at 5 years was 100%.
Based on the findings, the peri-implant soft tissue probe depths exhibited significant change during the 5-year investigation. Regarding esthetic outcomes, single tooth NDI for replacing a lateral incisor in the cleft patient is a clinically acceptable treatment. Narrow-diameter implants may be a reliable treatment for replacing a missing lateral incisor in patients with a cleft at 5-year follow-up with an implant survival rate of 100% and a success rate of 92%.
腭裂患者的上颌侧切牙常先天性缺失。先天性腭裂给医生带来了诸多挑战，包括骨量和骨质量、手术修复腭裂以及有限的临床空间。
本研究旨在计算用于修复腭裂患者缺失侧切牙的窄直径种植体的5年成功率和存留率。
根据既定标准招募了14名患有腭裂且上颌侧切牙缺失的研究参与者。使用两阶段方案植入17枚窄直径种植体（AstraTech OsseoSpeed 3.0S和OsseoSpeed TX 3.5毫米），并用定制钛基台和粘结固位冠进行修复。连续5年每年进行临床和影像学检查。使用协方差分析（ANCOVA）和Tukey-Kramer多重比较检验测量并评估四个探诊深度。每年使用数字减法技术测量影像学边缘骨吸收，并通过ANCOVA进行评估，得出最小二乘均值。使用粉色美学评分（PES）和白色美学评分（WES）对修复体进行评估。
关于探诊深度测量，在四个位置之间发现了显著差异（P<.001），并且还发现了年份的线性效应（P=.005）。多重比较检验显示，从基线到5年随访，颊侧探诊深度的平均值低于其他三个位置中每个位置的平均值（P≤.039）。在整个5年研究期间，边缘骨吸收的最小二乘均值±标准差为0.55±0.088毫米。关于修复体评估，PES的平均评分为6.15，WES的平均评分为6.63，满分均为10分。临床可接受水平设定为总分6分。为满足5年期间的成功标准，总骨吸收不超过2.3毫米是可接受的。5年时达到成功标准的种植体数量为92%。关于存留情况，5年时仍在位、功能正常且无症状的种植体数量为100%。
基于研究结果，在5年的研究期间，种植体周围软组织探诊深度出现了显著变化。关于美学效果，在腭裂患者中使用单颗种植体替代侧切牙是一种临床可接受的治疗方法。窄直径种植体可能是一种可靠的治疗方法，用于替代腭裂患者缺失的侧切牙，在5年随访时种植体存留率为100%，成功率为92%。
