摘要
不同系统种植体对种植体周围组织影响的对比研究
研究背景:
口腔种植修复是目前口腔医学领域中影响力最大并且发展最快的一个分支,其因美观、舒适、稳固、无需磨改邻牙、生物力学分布与天然牙最接近等优点而成为缺牙修复的首选方式。随着口腔种植技术的不断成熟,临床中应用的种植系统种类也愈发丰富,如广泛应用的ITI,3I,BLB等种植系统,不同系统种植体无论在形态结构设计、表面处理,还是手术方式、修复方法等方面都存在着差异。患者在追求种植义齿良好功能的同时,对其美学的要求也越来越高。种植系统间的差异在临床应用中对于种植体周围骨组织及软组织的影响有何不同,临床医生如何根据不同患者的情况及需要选择适宜的种植系统以获得更佳的种植修复效果,这些问题都值得进一步研究。
国内外关于不同种植体的临床研究主要集中在远期成功率的比较以及不同植入方式对远期疗效的影响,结果也大都没有显著差异,对于临床没有明确的指导意义,而对于不同系统种植体周围软硬组织稳定性的差异则少有研究。因此,检测不同系统种植体周围组织的各项指标并加以评价,总结出不同系统对种植体周围骨组织及软组织的影响具有重要意义。
目的:
本研究通过对不同系统种植体植入后一年中改良菌斑指数(mPLI)、改良龈沟出血指数(mBI)、探诊深度(PD)、种植体周围龈沟液(PICF)中天冬氨酸转氨酶(AST)水平的检测及种植体周骨吸收量的检查,并以天然牙作为对照,总结出不同系统种植体周围软硬组织的稳定性差异。为临床工作中不同患者种植系统的选择及种植体的设计提供理论依据,从而提高种植修复的临床效果和远期成功率。
方法:
选择2010年1月~2010年12月在吉林大学口腔医院种植科接受牙种植术的患者49人,共检查75枚种植体,其中3I Osseotite种植体35枚,ITI (SLA表面)种植体22枚,BLB(HA涂层)种植体18枚。分别于种植术后3,6,9和12个月时检查种植体周骨吸收量,基台连接后1,3,6和9个月时检测改良菌斑指数(mPLI)、改良龈沟出血指数(mBI)、探诊深度(PD)及种植体周围龈沟液(PICF)中天冬氨酸转氨酶(AST)水平。同时选取种植部位同颌对侧同名天然牙共32颗作为对照。统计学分析采用SPSS17.0统计软件包。
结果:
1、种植体植入3,9,12个月时,BLB种植体骨吸收量明显高于3I及ITI种植体,结果具有统计学差异(P<0.05),而3I与ITI两组骨吸收量无显著性差异(P >0.05)。
2、基台连接后6个月时,三种系统中仅有BLB种植体mBI均数明显高于天然牙(P<0.05)。基台连接后9个月时,三种系统种植体mBI均值都明显高于天然牙(P<0.05),但不同系统间无显著差异(P >0.05)。
3、基台连接后6个月和9个月时,三种系统种植体PD值均明显高于天然牙(P<0.05),但不同系统间PD均数无显著差异(P >0.05)。
4、基台连接后6个月和9个月时,仅有BLB种植体PICF中AST水平明显高于天然牙(P<0.05),而3I及ITI种植体AST水平则与天然牙无显著差异(P >0.05)。
5、三种系统种植体在基台连接后各检测时间mPLI均数都高于天然牙,但结果无显著差异(P>0.05),且mPLI值有随时间的延长而逐渐增高的趋势。
结论:
1、3I (Osseotite)和ITI (SLA表面)种植体周围骨组织及软组织稳定性均优于BLB( HA涂层)种植体。
2、三种系统种植体在植入一年中均表现出了良好的临床效果。
3、与天然牙的牙周组织相比,种植体周围软组织更薄弱,易产生炎症反应。
Comparative study of the influnces on peri-implant tissues caused by different dental implant systems
Background:Implantology has been the fastest-growing and the most influential branch of stomatology. And it has become the best choice for the tooth-missing patients with the advantages of beauty, comfort, stability, no grinding of adjacent teeth and favorable biomechanical distribution. With the development of oral implantology, there have been more different implant systems used in clinical practice, such as ITI, 3I, BLB, Replace and so on. Many differences exist among dental implant systems, including the design of topography and structure, the method of surface treatment, the way to perform operation and the material of prosthetics. At the same time, more and more patients are not only searching for better funcional effects, but also seeking to perfect aesthetic effects.
However, there are few researches on that issues. The studies on different implant systems mainly focus on the comparison of long-term success rate and the influences caused by different operation methods. It is important for us to investigate the influences on peri-implant soft tissues and bone tissues caused by the different systems and conclude how to select the most suitable system for various patients to get better functional and aesthetic effects.
Objective: We are aimed to summarize the differences of stability among peri-implant soft tissues and bone tissues of different implant systems by researching the modification plaque index(mPLI), modification sulcus bleeding index (mBI),probing depth (PD), AST level in peri-implant crevicular fluid (PICF) and the bone loss of implants in the first year after operation. Natural teeth were selected as comparison. And the research could provide theoretical basis for the selection and design of implants, so as to improve clinical effects and long-term success of dental implants.
Methods: 49 patients who accepted dental implantation in the stomatological hospital of Jilin University from January 2010 to December 2010 were selected and 75 implants were tested in all, including 35 3I implants, 22 ITI implants and 18 BLB implants. We measured the bone loss at the time of 3, 6, 9 and 12 months after operation, and tested modification plaque index (mPLI), modification sulcus bleeding index (mBI), probing depth (PD), AST level in peri-implant crevicular fluid (PICF) at the time of 1, 3, 6 and 9 months after the abutment connection. 32 natural teeth were used as comparison. Analysis of data was performed by software SPSS 17.0 and One-way ANOVA was used to compare the mean of indexes.
Results:
1. The bone loss of BLB system is more than those of 3I and ITI systems at the time of 3, 6 and 9months after operation, the result has significant differences(P<0.05).
2. Only the mBI of BLB system is higher than that of natural teeth obviously in the sixth month after abutment connection(P<0.05), and the mBI of all three systems are higher than that of natural teeth obviously in the nineth month after abutment connection(P<0.05), but there are no significant differences among three systems(P>0.05).
3. The PD of all three systems are higher than that of natural teeth obviously in the sixth and nineth month after abutment connection(P<0.05), but there are no significant differences among three systems(P>0.05).
4. Only the AST level of BLB system is higher than that of natural teeth significantly(P<0.05), the results among 3I, ITI and natural teeth have no significant differences(P>0.05).
5. The mPLI of all three systems are higher than that of natural teeth obviously at every testing time after abutment connection, but the results have no significant differences(P>0.05).
Conclusions:
1. The stability of peri-implant soft tissues and bone tissues of BLB system is not as good as that of 3I and ITI systems.
2. All three systems have good clinical function during the first year after implantation.
3.Compared with periodontal tissues of natural teeth, peri-implant soft tissue is weaker and easier to induce inflamation.
引文
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