Parmar Nidhi
Eastman Dental Institute, London, UK.
Evid Based Dent. 2025 Mar;26(1):15-16. doi: 10.1038/s41432-025-01108-9. Epub 2025 Jan 29.
A retrospective cohort study assessing the mid-to-long-term outcomes and risk factors affecting the prosthetic success and survival of implant-supported cross-arch fixed dental prostheses (IFCDPs) with monolithic zirconia frameworks.
Forty-seven patients received a total of 51 cross-arch prostheses (27 maxillary and 24 mandibular prostheses), supported by 302 implants. Comprehensive clinical and radiographic records were available over a follow-up period ranging from 5 to 13 years. A strict inclusion criteria ensured the use of screw-retained implants and monolithic zirconia frameworks fabricated using standardised CAD/CAM protocols, without cemented titanium bases. Exclusion criteria included systemic conditions affecting healing, bruxism, uncontrolled periodontitis, smoking, and significant health changes during the follow-up period.
Descriptive statistics summarised implant and prosthesis outcomes, while complications were evaluated for peri-implantitis at an implant level and framework fractures at a prosthesis level. Peri-implantitis was identified through clinical signs, including bleeding on probing, suppuration, and radiographic evidence of bone loss. Prosthetic outcomes were classified using the modified USPHS criteria. Mixed-effects Cox regression models were applied to analyse risk factors. Hazard ratios were calculated for peri-implantitis and framework fractures, with statistical significance set at p < 0.05.
The implant survival rate was 97.64%, with peri-implantitis observed in 27 implants, predominantly in the mandible, resulting in an overall implant success rate of 91.06%. Prosthesis survival was 82.35%, with nine framework fractures reported, eight of which occurred in mandibular prostheses. The mandible was identified as a significant risk factor for both framework fractures (HR = 11.64, p = 0.024) and peri-implantitis (HR = 10.88, p = 0.003).
IFCDPs with monolithic zirconia-based frameworks exhibited favourable clinical outcomes over a 5-13-year period. However, mandibular prostheses were more prone to framework fractures and peri-implantitis, highlighting the need to consider mandibular flexure in prosthetic design to enhance long-term success and durability.
一项回顾性队列研究，评估采用整体式氧化锆框架的种植体支持的跨牙弓固定义齿（IFCDP）的中长期疗效及影响其修复成功和存留的危险因素。
47例患者共接受了51副跨牙弓义齿（27副上颌义齿和24副下颌义齿），由302颗种植体支持。在5至13年的随访期内有全面的临床和影像学记录。严格的纳入标准确保使用螺丝固位种植体以及采用标准化CAD/CAM方案制作的整体式氧化锆框架，无粘结钛基底。排除标准包括影响愈合的全身状况、磨牙症、未控制的牙周炎、吸烟以及随访期间的重大健康变化。
描述性统计总结种植体和义齿的疗效，同时在种植体水平评估种植体周围炎并发症，在义齿水平评估框架骨折。通过临床体征（包括探诊出血、化脓以及骨吸收的影像学证据）识别种植体周围炎。使用改良的美国公共卫生服务（USPHS）标准对修复疗效进行分类。应用混合效应Cox回归模型分析危险因素。计算种植体周围炎和框架骨折的风险比，设定统计学显著性为p < 0.05。
种植体存留率为97.64%，27颗种植体出现种植体周围炎，主要在下颌，整体种植体成功率为91.06%。义齿存留率为82.35%，报告9例框架骨折，其中8例发生在下颌义齿。下颌被确定为框架骨折（HR = 11.64，p = 0.024）和种植体周围炎（HR = 10.88，p = 0.003）的显著危险因素。
采用整体式氧化锆框架的IFCDP在5至13年期间显示出良好的临床疗效。然而，下颌义齿更容易发生框架骨折和种植体周围炎，突出了在修复设计中考虑下颌弯曲以提高长期成功率和耐用性的必要性。
