摘要
目的：评估应用椅旁数字化加工技术单牙即刻种植即刻修复的初步临床效果，为椅旁数字化技术应用于即刻种植即刻修复提供参考。方法采用前瞻性自身对照试验设计，纳入2016年1至6月就诊于北京大学口腔医学院·口腔医院种植科，单颗前牙或前磨牙无法保留且满足即刻种植即刻修复条件的患者13例（平均年龄35.5岁），拔牙后即刻种植，共植入13枚种植体；同一牙位种植体分别采用椅旁计算机辅助设计与辅助制作系统加工制作螺丝固位二硅酸锂修复体（试验组）和传统加工方法制作螺丝固位树脂临时修复体（对照组）。按照随机数字表法将两组修复体在患者口内随机试戴。由不知分组情况的患者本人对两组修复效果满意度打分并选择其中一种修复体，由医师完成修复体戴入。记录修复体就位和调改情况以比较两组修复体的临床精度；使用白色美学评分（white esthetic score，WES）评估修复体的美学效果；同时记录临床修复时间。使用Wilcoxon配对符号秩检验对结果进行统计学分析。结果所有患者均于手术当日完成患牙微创拔除、不翻瓣即刻种植和即刻修复，两组临时修复体均可顺利试戴就位。患者对试验组修复体满意度评分[（8.6±0.8）分]显著高于对照组[（7.1±0.6）分]（P〈0.05），全部患者均选择戴入椅旁数字化方法制作的临时修复体。试验组WES[（7.5±1.1）分]略低于对照组[（7.9±0.9）分]，差异无统计学意义（P〉0.05）。工作流程全程所需时间试验组[（131.9±5.0）min]显著低于对照组[（205.2±6.3）min]（P〈0.05）。修复体加工时间试验组[（113.5±6.3）min]显著低于对照组[（185.6±6.6）min]（P〈0.05）；印模时间试验组[（7.5±0.8）min]显著低于对照组[（11.7±1.1）min]（P〈0.05）；修复体椅旁调改耗时试验组[（11.0±2.1）min]显著高于对照组[（8.0±2.8）min]（P〈0.05）。在3～6个月的随访观察期内，种植体存留率为100%。4例患者的即刻修复体螺丝松动，紧固后均未再松动。结论使用椅旁数字化系统一次就诊完成单牙即刻种植即刻修复的临床流程可行，可大大缩短临床修复时间尤其是修复体制作时间，患者满意度高，观察期内取得了良好的初步临床效果。
Objective To evaluate the primary clinical outcomes of immediate provisionalization with a monolithic crown utilizing a novel chairside computer aided design and computer aided manufacture （CAD/CAM） workflow for single tooth immediate implant placement. Methods This pilot study was a prospective within-subjects design. Thirteen consecutive patients were included and diagnosed with untreatable single incisor or premolar with fine general and local anatomical conditions. The trial was conducted at Department of Implantology, Peking University School and Hospital of Stomatology, Beijing, between January 2016 and June 2016. The teeth were extracted atraumatically and implants were immediately placed in the fresh sockets. Two screw-retained interim crowns were fabricated for the same site utilizing different workflows, a monolithic lithium disilicate （LS2） crown produced by CEREC （Sirona, Germany） chairside CAD/CAM system （CER group） and a manually fabricated resin crown utilizing conventional workflow （CONV group） respectively. The patients were blinded to the group allocation of the two interim crowns. After the clinical try-in for both crowns in a randomized sequence, the patients＇ level of satisfaction was assessed with a virtual analogue scale （VAS） questionnaire. The restorations chosen by patients themselves were seated in the implants by one experienced prosthodontist. The accuracy, aesthetic effect and clinical time consumption of both groups were compared. Statistical analyses were performed with the Wilcoxon signed rank test. Results All patients were treated with atraumatic tooth extraction, immediate implant placement using flapless surgery and immediate provisionalization in a single visit. The interim crowns of both groups could be fitted with or without slight adjustments. For each patient, the interim crown of CER group was chosen to be seated with a relatively higher VAS result. The white esthetic score （WES） results demonstrated no statistically significant difference between CER group （7.5±1.1） and CONV group （7.9±0.9） （P〉0.05）. The mean total work time was significantly different resulting in （131.9±5.0） min for CER group and （205.2±6.3） min（P〈0.05）. The major difference lied in the laboratory work time, resulting in （113.5±6.3） min for CER group which was significantly shorter than （185.6±6.6） min for CONV group. As for impression taking time, the CER group （7.5±0.8） min was significantly shorter than CONV group （11.7± 1.1） min （P〈0.05）. However, analysis for clinical adjustment time showed a significantly longer time for CER group [（11.0 ± 2.1） min vs （8.0 ± 2.8） min, P〈0.05]. After 3-6 months of observation, the overall survival rate was 100%. Screw loosening occurred in 4 patients and was tightened again. No other major complication soccurred. Conclusions The full digital workflow utilizing CEREC chairside CAD/CAM system to fabricate interim crowns after immediate implant placement in one single visit was feasible. It was more time-efficient and could effectively shorten the laboratory work time compared to the conventional workflow. Patients demonstrated high satisfaction and there was no statistical difference in WES results compared to the conventional workflow. Favorable clinical outcomes were gained in this short-term follow-up study.
作者
田杰华
邸萍
林野
张宇
魏冬豪
崔宏燕
Tian Jiehua Di Ping Lin Ye Zhang Yu Wei Donghao Cui Hongyan(Department of Implantology, Peking University School and Hospital of Stomatology ＆ National Engineering Laboratory for Digital and Material Technology of Stomatology ＆ Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China)
出处
《中华口腔医学杂志》
CAS
CSCD
北大核心
2017年第1期3-9,共7页
Chinese Journal of Stomatology
基金
第五期中央保健科研课题（w2013BJ42）
关键词
即刻负荷牙种植体
义齿
局部
即刻
放射摄影术
牙科
数字
椅旁
Immediate dental implantal loading
Denture,partial,immediate
Radiography,dental,digital
Chairside
