许小玲

【摘要】  目的  探討螺丝固位联合粘结固位在后牙区多单位种植修复中的效果。方法  选取2019年6月- 2021年4月收治的97例后牙区多单位种植修复患者为研究对象，按照种植体固位方法将其分为对照组41例和观察组56例。对照组采取单纯螺丝固位，观察组采取螺丝与粘接联合固位。比较两组患者的不良事件发生率，扭力测定分级评价，牙槽嵴宽度。结果  组合固定2年后，患者随访过程中失访、脱落共6例，对照组剩余38例，共使用了76颗修复体，观察组剩余53例，共使用了106颗修复体。对照组不良事件发生率高于观察组，差异有统计学意义（P<0.05）。两组患者扭力测定分级评价比较，观察组患者扭力测定分级3级、4级的比例高于对照组，差异有统计学意义（P<0.05）。种植前，两组患者牙槽嵴宽度比较，差异无统计学意义（P>0.05）；组合固定6个月后，两组患者牙槽嵴宽度均下降，但对照组牙槽嵴宽度小于观察组，差异有统计学意义（P<0.05）。结论  多单位种植修复中组合运用螺丝固位与粘接固位可降低远期不良事件发生率，有助于避免氧化锆冠粘接基台失败等不良反应的发生。

【关键词】  多单位种植修复；牙槽嵴宽度；螺丝固位；后牙区；粘接固位

中图分类号  R783.4    文献标识码  A    文章编号  1671-0223（2023）15--05

Effect of screw retention combined with adhesive retention in multiunit implant restoration in the posterior dental area  Xu Xiaoling. Xujinshan Stomatological Clinic， Tangshan  064100， China

【Abstract】  Objective  To explore the effect of screw retention and adhesive retention in multiunit implant restoration in the posterior dental area. Methods  97 patients with multi-unit implant restoration in the posterior dental area admitted from June 2019 to April 2021 were selected as the research subjects， and they were divided into 41 cases in control group and 56 cases in observation group according to the method of implant fixation. The control group adopted simple screw retention， and the observation group adopted screw and adhesive joint fixation. The incidence of adverse events， torsion measurement grade rating， alveolar ridge width were compared. Results  After two years of combined fixation， 6 patients were lost to follow-up and lost during follow-up， 38 remaining in the control group， 76 restorations were used， 53 remaining and 106 restorations in the observation group. The incidence of adverse events in the control group than the observation group was significant （P<0.05）. Comparing the grade evaluation of torque measurement in the two groups， the proportion of patients with grade 3 and 4 was higher than that of the control group， and the difference was statistically significant （P<0.05）. Before implantation， there was no significant difference （P>0.05）; after 6 months of the combined fixation， the width of the alveolar crest decreased， but the control group was smaller than that of the observation group （P<0.05）. Conclusion  The combination of screw retention and adhesive retention in multi-unit planting repair can reduce the incidence of long-term adverse events and help to avoid the occurrence of adverse reactions such as the failure of zirconia crown bonding abutment.

【Key words】   Multi-unit implant restoration; Width of alveolar ridge; Screw retention; Posterior tooth area; Adhesive retention

随着口腔医学的发展，种植修复技术越发成熟。有研究显示，缺失牙患者可借此技术有效恢复口腔咀嚼功能[1]。但近年来研究表明，种植体和口腔原本的上部结构会发生摩擦，引起部分机械性并发症[2]。而机械性并发症的发生率与种植体固定方式密切相关。临床研究表明种植修复螺丝固位方式若处理不当，很容易在种植后期发生螺丝松动、折断等不良事件[3-5]。并且随着负载力量增加，还会提升机械性并发症风险。但螺丝固位的优势也较多，如方便后期清洁工作，降低拆卸维护的难度等。此外，既往研究证实，单纯粘接固位有助于修复种植取模及加工制作基台时的累积偏差，相较于螺丝固位有着良好的修复宽容度，但同时也有着粘接剂外溢的缺点，容易造成口腔炎症，对软组织有一定的刺激[6]。……