不同形式的种植覆盖义齿对无牙颌基托形变的影响

徐英 孙永瀛 刘心昀

[摘要]目的：探討不同形式的附着体对种植覆盖义齿基托形变的影响。方法：选取笔者医院口腔科2015年1月-2018年12月收治的30例下颌无牙颌患者，所有患者经双种植体植入治疗6个月后根据相应适应证分别给予杆卡式种植覆盖义齿（A组，n=10例）、球帽式种覆盖义齿（B组、n=10例）、弹性伸缩式（Locator）种植覆盖义齿（C组，n=10例），采用线性应变仪于佩戴义齿3个月后分别测量无食物咬合、软食物咬合、硬食物咬合过程中对义齿基托形变的影响。结果：在无食物咬合期A组1、2、3、4、5、6号通道微应变显著强于B、C组（P<0.05），B组1、2号通道微应变显著强于C组（P<0.05），3、4、5、6号通道微应变显著弱于C组（P<0.05）;在硬食物咬合期A组1、2、3、4、5号通道微应变显著强于B、C组（P<0.05），B组1、4号通道微应变显著强于C组（P<0.05），5号通道微应变显著弱于C组（P<0.05）;在软食物咬合期A组1、2、3、4、5号通道微应变显著强于B、C组（P<0.05），B组6号通道微应变显著强于C组（P<0.05），2、4、5号通道微应变显著弱于C组（P<0.05）。 结论：建议将球帽式种植覆盖义齿以及弹性伸缩式（Locator）种植覆盖义齿用于下颌无牙颌患者双种植体植入治疗，可降低义齿基托变形风险。

[关键词]附着体;义齿基托;种植体覆盖义齿;形变

[中图分类号]R782.12    [文献标志码]A    [文章编号]1008-6455（2021）03-0117-04

Influence of Denture Base Deformation with Different Attachments of Implant Overdentures

XU Ying1， SUN Yong-ying2， LIU Xin-yun3

（1.Department of Stomatology， Nanjing Tongren Hospital， Nanjing 210001， Jiangsu， China;2. Department of Stomatology， Zhongda Hospital Southeast University， Nanjing 210009，Jiangsu，China;3. School of Stomatology，Zunyi Medical University，Zunyi 563003， Guizhou， China）

Abstract： Objective  To investigate the influence of denture base deformation with different attachments of implant overdentures. Methods 30 edentulous mandible patients received implants in our hospital from January 2015 to December 2018 were enrolled， and divided into three groups according to the corresponding indications after 6mon of treatment， each with 10 cases. Group A received bar implant overdentures， group B received stud implant overdentures， and group C received Locator implant overdentures. After wearing each implant overdenture for 3 months， effect strain registrations on denture base deformation were evaluated during clenching without food and during clenching on soft and hard foods. Results Microstrain values at channel 1， 2， 3， 4， 5 and 6 during clenching without food of group A were significantly higher than those of group B and C （P<0.05）. Microstrain values during clenching without food of group B at channel 1 and 2 were significantly higher than those of group C （P<0.05）， and were significantly lower than those of group C at channel 3， 4， 5 and 6 （P<0.05）. Microstrain values at channel 1， 2， 3， 4 and 5 during clenching on hard food of group A were significantly higher than those of group B and C （P<0.05）. Microstrain values during clenching on hard food of group B at channel 1 and 4 were significantly higher than those of group C （P<0.05）， and were significantly lower than those of group C at channel 5 （P<0.05）. Microstrain values at channel 1， 2， 3， 4 and 5 during clenching on soft food of group A were significantly higher than those of group B and C （P<0.05）. Microstrain values during clenching on soft food of group B at channel 6 were significantly higher than those of group C （P<0.05）， and were significantly lower than those of group C at channel 2， 4 and 5 （P<0.05）. Conclusion Stud and Locator attachments are recommended to be used for twoimplant mandibular over dentures as their associations with reduced denture base deformation.

Key words：attachment; denture base; implant overdenture; deformation

种植覆盖义齿指通过植入颌骨内的种植体为义齿提供支持、固位，以修复缺失牙齿以及缺损组织的解剖结构和功能，且患者可以自行摘戴的修复形式[1]。目前双种植体覆盖义齿是临床治疗下颌无牙颌患者的常用修复方法。附着体是种植覆盖义齿的关键部件之一，直接关系到覆盖义齿的固位以及稳定。临床常用的附着体类型包括杆卡式、球帽式、套筒冠式、磁性附着体以及弹簧伸缩式（Locator）附着体等。但附着体的选择应考虑多方面，如上下颌骨解剖形态、无牙颌牙槽嵴萎缩情况、有效咬合高度、义齿稳定性等，若附着体形式选择不当，可能引起义齿基托变形甚至发生义齿基托断裂、种植体修复失败等[2]。临床研究指出[3]，由于附着体周围丙烯酸树脂厚度不足，在靠近下颌覆盖义齿的种植体相邻区域更易发生种植覆盖义齿基托变形。……