以早期負荷模式製作4支口腔植體支撐覆蓋式義齒於下顎全無牙之患者

Early Loading of 4 Inter-Foraminal Dental Implants Supporting an Overdenture in the Completely Edentulous

利用口腔植體之支撐來製作覆蓋式義齒應用於下顎全無牙之患者，經多年來之印證，有相當高的成功率，而且大幅度改善了患者的生活品質。但過去兩階段式植牙的方式，強調3~6個月無負荷的恢復期以避免影響骨整合，但也因此延遲了患者享用正式假牙的時程，造成過渡期患者極大的不便與抱怨。秀傳醫院牙科自民國91年7月起，開始應用早期負荷模式於下顎全無牙的患者的覆蓋式義齒的製作。方法是：手術將4支人工牙根植入患者下顎雙側頦孔之間，並當場利用事先已製好的下顎全口義齒當作印模托，印出主模型，同時取得上下顎之間關係，之後於技工室製作桿夾附連體及覆蓋式義齒，並於手術後7~14天內完成假牙的試戴。本報告選取之病例為義齒開始負荷後超過19個月的所有個案，共有21例，共植入83支人工牙根，加以追蹤評估，其中負荷後最久的為62個月，平均為41個月，在追蹤期中僅有1個個案，2支人工牙根失敗被移除，人工牙根整體存活率為97.6﹪（81/83），其餘所有個案，植體在X光檢查及臨床檢視下皆顯示健康、正常，義齒也都維持正常功能，患者滿意度極高。根據本報告，應用4支人工牙根早期負荷模式的下顎全無牙患者的覆蓋式義齒，應是一種可預測且相當可靠的術式，可以在短期內就嘉惠下顎全無牙的患者，值得推廣。

Long-term studies have documented the successful treatment of edentulous mandible with implant supported overdenture, however, a 3 to 6 months non-loading healing period is suggested in the traditional protocol, the waiting period is quite long and the patient undergoes a lot of suffering, causing the patient to hesitate to receive such kind of treatment. This study collected 21 patients, each patient received 4 dental implants in the edentulous mandible between mental foramens, and a bar and clips type of implant supported overdenture was delivered for early loading about two weeks after implant placement. Eighty-three screw-type (67 F-2 Synchro stepped screw and 16 Xive S plus screw) implants were placed for the 21 patients, followed for a minimum of 19 months to a maximum of 62 months, with a mean follow-up of 41 months. During the follow-up, 2 implants in one patient failed, the overall survival rate was 97.6% (81/83 implants), all other implants were healthy and functioned normally in radiographic and clinical evaluation, and patients were all satisfactory over the treatment model.Results from this study demonstrated that early loading of 4 inter foraminal dental implants supporting an overdenture in the completely edentulous mandible is a predictable and reliable treatment model, this model is not a sensitive technique of the dentist, and it gained high satisfaction of the patient, proving it to be a worthy recommendation.