Early functional loading at 5 days for Brånemark implants placed into edentulous mandibles: a prospective, open-ended, longitudinal study.
Early functional loading at 5 days for Brånemark implants placed into edentulous mandibles: a prospective, open-ended, longitudinal study.
复制标题
Brånemark 种植体植入无牙颌下颌骨后 5 天的早期功能负荷：一项前瞻性、开放式、纵向研究。
DOI：
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发表时间：
2003
期刊：
影响因子：
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通讯作者：
Scott Huffstetlert
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文献类型：
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作者：
W. Becker;B. Becker;Scott Huffstetlert
背景
传统上，放置在下颌骨中的种植体需要 3 至 4 个月的时间才能愈合，然后再进行负重。上颌骨的愈合时间通常需要 5 至 6 个月。本研究的目的是评估无牙颌下颌骨中 4 至 6 个种植体的植入情况。将种植体放置在颏孔之间，以支撑非金属、加固、固定、种植体支撑的临时假体。使用一种独特的方法将现有的假牙转换成固定的、种植体支持的矫治器。植入物在早期（5 天）就已发挥功能。
方法
20 名下颌无牙颌或下颌剩余 2 至 3 颗牙齿的患者参加了这项开放式前瞻性研究。对现有的不带烤瓷牙的假牙进行了修改，以用作手术导板。这些假牙被用作临时固定假牙。康复 3 至 4 个月后，患者将接受由转诊牙医制作的金属强化矫治器。种植体安装后，将修复基台固定到种植体上，并在无反扭矩的情况下拧紧至 20 Ncm。骨质量和数量以及种植体尺寸和位置均输入计算机数据库。将印模帽固定在基台上，并使用改良的义齿进行拾取印模。制作印模后，将种植体复制品安装到印模帽上并浇注铸件。金圆柱体被加工成义齿的组织侧。使用实验室螺钉将带金圆柱体的义齿固定到基台复制品上。种植手术后 5 天，对假牙进行加工、抛光和插入。拍摄射线照片以验证金圆柱体与修复基台的正确配合（基线）。每次随访时均拍摄射线照片，用于测量牙槽嵴骨水平的变化。
结果
20 名患者在全无牙颌下颌骨中植入了 92 个机械加工表面的商业纯钛种植体。在植入的种植体总数中，有 2 颗在 0 至 1 年内丢失，1 颗在 1 至 2 年内丢失。对 20 名患者总共 90 个种植体进行了 0 至 1 年的随访。对 14 名患者进行了 1 至 2 年的随访，7 名患者进行了 2 至 3 年的随访，2 名患者进行了 3 至 4 年的随访。一名患者在加载 9 个月后死亡（4 个种植体加载，2 个卧式种植体）；另一位则在 1 至 2 年内死亡。总共 6 个植入物仍被掩埋（枕木）。 2年累计成功率为96.3%。种植牙桥的存活率为 100.00%。 11 名患者 5 天时的平均牙槽嵴骨水平为 2.1 毫米（SD 0.526，SE 平均 0.159）（已故患者无法进行测量），而平均 15 个月时的平均水平为 1.96 毫米（SD 0.585，SE 平均 0.176）。第 5 天的测量值与平均 15 个月的测量值之间的差异不显着 (P < 0.683)。
结论
这项研究的结果表明，在种植体植入后 5 天内即可放置 4 至 5 个种植体并进行加载，成功率很高 (96.3%)。临时和最终假肢的成功率为 100%。已经描述了一种使用非金属强化假牙作为临时固定、临时假牙的简单且可能具有成本效益的方法。制作假体的印模和配准可以在种植体安装时进行，这种方法足够准确，可以进行临时修复体。改良假牙可作为临时固定、种植体支持的修复体，使用期限长达 30 个月。 X 射线测量结果表明牙槽嵴骨水平平均可稳定长达 15 个月。
BACKGROUND
Traditionally, implants placed in the mandible heal for 3 to 4 months before they are loaded. In maxillae, healing time usually takes 5 to 6 months. The purpose of this study was to evaluate placement of 4 to 6 implants in edentulous mandibles. The implants were placed between mental foramina for support of non-metal, reinforced, fixed, implant-supported provisional prostheses. A unique method was used to convert existing dentures into fixed, implant-supported appliances. The implants were functionally loaded early (5 days).
METHODS
Twenty patients with edentulous mandibles or with 2 to 3 remaining mandibular teeth were enrolled in this open-ended, prospective study. Existing dentures without porcelain teeth were modified for use as a surgical guide. These dentures were used as temporary fixed prostheses. Patients were to have metal-reinforced appliances fabricated by the referring dentists after 3 to 4 months of healing. After implant installation, prosthetic abutments were fixed to the implants and tightened to 20 Ncm without counter torque. Bone quality and quantity as well as implant size and position were entered into a computer database. Impression copings were attached to the abutments, and the modified denture was used for a pick-up impression. After the impression was made, implant replicas were fitted to the impression copings and casts were poured. Gold cylinders were processed into the tissue side of the denture. Laboratory screws were used to attach the denture with gold cylinders to abutment replicas. The dentures were processed, polished, and inserted 5 days after implant surgery. Radiographs were taken to verify proper fit of the gold cylinders to the prosthetic abutments (baseline). Radiographs were taken at each follow-up visit and were used to measure changes in crestal bone levels.
RESULTS
Twenty patients received 92 machined-surface commercially pure titanium implants in fully edentulous mandibles. Of the total number of implants placed, two were lost between 0 to 1 year and one between 1 to 2 years. Twenty patients with a total of 90 implants were followed between 0 to 1 year. Fourteen patients have been followed between 1 to 2 years, 7 between 2 to 3 years, and 2 between 3 to 4 years. One patient died after 9 months of loading (4 implants loaded, 2 sleeper implants); another died between 1 to 2 years. A total of 6 implants remained buried (sleepers). At 2 years, the cumulative success rate is 96.3%. Survival of the implant bridges is 100.00%. The mean crestal bone level at 5 days for 11 patients was 2.1 mm (SD 0.526, SE mean 0.159) (measurements were not available for the deceased patient), while the mean level at an average of 15 months was 1.96 mm (SD 0.585, SE mean 0.176). Differences between the measurements taken at 5 days with those taken at an average of 15 months were not significant (P < 0.683).
CONCLUSIONS
Results of this study indicate that 4 to 5 implants can be placed and loaded within 5 days of implant insertion with high success (96.3%). Success rates for the interim and final prosthesis are 100%. A simple, possibly cost-effective method of using non-metal reinforced dentures as interim fixed, provisional dentures has been described. Impressions and registrations for making the prosthesis can be made at the time of implant installation, and this method is accurate enough to make provisional restorations. The modified denture can function as an interim fixed, implant-supported prosthesis for up to 30 months. Results of x-ray measurements indicate stable crestal bone levels for up to an average of 15 months.
DOI：
10.1016/0267-6605(92)90049-y
发表时间：
1992-01-01
期刊：
Clinical Materials
影响因子：
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作者：
BRUNSKI J B
通讯作者：
BRUNSKI J B