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Comparative study on the Cumulative Survival Rate of Posterior Maxillary Implants by the sinus graft approaches

Title
Comparative study on the Cumulative Survival Rate of Posterior Maxillary Implants by the sinus graft approaches
Other Titles
상악동 골이식술을 병행하여 식립한 상악 구치부 임플란트의 누적생존율에 대한 후향적 연구
Authors
Xiuyan Liu
Issue Date
2012
Department/Major
임상치의학대학원 임상치의학과임플란트치의학전공
Publisher
이화여자대학교 임상치의학대학원
Degree
Master
Advisors
김명래
Abstract
Purpose: The purpose of this retrospective study is to evaluate and compare the long-term cumulative survival rate and the prognostic factors associated with the sinus floor elevations performed by the crestal and the lateral approach technique. Material and methods: A total of 508 from 2152 implants were placed after sinus floor elevation in 276 patients at Ewha Womans University Mokdong hospital from 2001 to 2011. The sinus floor elevation was performed by the crestal or the lateral approach technique. 193 implants were placed with the crestal sinus floor elevation (CSFE) in 127 patients, and 315 implants were placed after lateral sinus floor elevation (LSFE) in 149 patients. The cumulative survival rate of implants was determined according to the Kaplan-Meier lifetime analysis. Each of the prognostic factors was evaluated by the Log-rank test (p<0.05). The multivariate analysis was carried out with the Cox proportional hazards regression model(p<0.05). Results: 1. The cumulative survival rate was 95.7% for the implants which were placed with the crestal technique, and 93.6% for those which were placed with the lateral approach technique (p<0.05). 2. For the crestal sinus floor elevation (CSFE), there were statistically significant differences among the three groups of remaining bone height (RBH). For the lateral sinus floor elevation (LSFE), there were no statistically significant differences in the three groups of RBH, although the probability of implant failure in the 1st group (<5mm) and 2nd group (5mm≤<7mm) were greater than the 3rd group (≥7mm). 3. For the crestal sinus floor elevation (CSFE), the survival rate of first group (TYPEⅢ) was 93.75% and the survival rate of second group (TYPE Ⅳ) was 87.23% (p=0.003). For the lateral sinus floor elevation (LSFE), the survival rate of first group (TYPEⅢ) was 91.69% and the survival rate of second group (TYPE Ⅳ) was 88.17% (p=0.004). 4. For the crestal sinus floor elevation (CSFE), the survival rate of first group (Simultaneous implantation) was 92.87%, while the survival rate of second group (Delayed implantation) was 100% (p=0.032). For the lateral sinus floor elevation (LSFE), the survival rate of first group (Simultaneous implantation) was 91.05% while the survival rate of second group (Delayed implantation) was 92.97% (p=0.049). Conclusion: 1. The ten-year cumulative survival rate of posterior maxillary implants by crestal sinus floor elevation was 95.7%, while the ten-year cumulative survival rate of posterior maxillary implants by lateral sinus floor elevation was 93.6% (p<0.05). 2. The less RBH lowered the implant survival rate. After the crestal sinus floor elevation (CSFE), the survival rate of the group RBH≥7 (96.89%) was higher than the group 5≤RBH<7 (91.07%) and the group RBH<5 (31.23%). After the lateral sinus floor elevation (LSFE), the survival rate of the group RBH≥7 (95.22%) was higher than the group 5≤RBH<7 (91.31%) and the group RBH<5 (88.76%). 3. After the crestal sinus floor elevation (CSFE), the survival rate of TYPE Ⅲ bone was 93.75% and the survival rate of TYPE Ⅳ bone was 87.23%. After the lateral sinus floor elevation (LSFE), the survival rate of TYPE Ⅲ bone was 91.69% and the survival rate of TYPE Ⅳ bone was 88.17%. 4. After the crestal sinus floor elevation (CSFE), the survival rate of Simultaneous group was 92.87%, and the survival rate of Delayed group was 100%. After the lateral sinus floor elevation (LSFE), the survival rate of Simultaneous group was 91.05% and the survival rate of Delayed group was 92.97%. 5. There were no significant differences were observed among the different groups divided by age, location and length of implant.;연구목적: 본 연구의 목적은 치조정 접근 또는 측방 접근에 의한 상악동저 거상술을 병행하여 식립한 상악 구치부 임플란트에서 장기적 누적생존율과 생존기간에 영향을 미치는 인자를 평가하고 비교하기 위함이다. 재료 및 방법: 2001년부터 2011년까지 이화의료원 부속 목동병원 구강악안면외과와 치주과에 내원하여 상악 구치부에 상악동저 거상술을 동반하여 임플란트를 식립한 환자 421명, 임플란트 1740개를 대상으로 하였다. 이 중 치조정 접근법에 의한 경우 환자 93명, 임플란트 218개, 측방접근법에 의한 경우 환자 122명, 임플란트 218개였다. 임플란트에 대한 누적생존율을 구하기 위해 Kaplan-Meier 법을 사용하였고, 생존곡선 간의 차이는 로그순위 검정법(Log-rank test)으로 비교하였다(p<0.05). 각 지표에 해당하는 변수는 Cox 비례위험 회귀모형(Cox proportional hazards regression model)을 적용하여 다변량 분석을 실시하였다. 결과: 1. 치조정 접근을 통해 식립한 임플란트의 누적생존율은 95.7%, 측방접근의 경우는 93.6%였다. 이는 통계적으로 유의한 차이를 나타내지 않았다. 2. 치조정 접근을 통해 식립한 임플란트에서 잔존골 높이는 통계적으로 유의한 차이를 나타내었다. 측방접근의 경우 5mm미만, 5mm이상 7mm미만 그룹의 임플란트 실패율이 7mm 이상의 그룹보다 높게 나타났으나, 이는 통계적으로 유의하지 않았다. 3. 치조정 접근을 통해 식립한 임플란트에서 골질은 통계적으로 유의한 차이를 나타내었다(p=0.003). 3형에서 생존율은 93.75%, 4형에서 생존율은 87.23%였다. 측방 접근의 경우 3형의 경우 91.69%, 4형의 경우 88.17%의 생존율을 나타내었고, 통계적으로 유의하였다(p=0.004). 4. 식립 시기에 따른 변수의 경우 치조정 접근을 통해 상악동저 거상술과 동시에 식립한 임플란트에서 92.87%, 지연 식립한 경우 100%의 생존율을 나타내었다(p=0.032). 측방 접근의 경우 동시 식립하였을 때 91.05%, 지연 식립하였을 때 92.97%의 누적생존율을 보였고, 이는 통계적으로 유의하였다(p=0.049). 결론: 1. 상악 구치부에서 상악동 골이식술을 동반하여 식립한 임플란트에서 10년간 누적생존율은 치조정 접근법에 의한 경우 95.7%, 측방 접근법에 의한 경우 93.6%였다. 2. 잔존골 높이가 낮을 경우 임플란트 생존율은 낮게 나타났다. 치조정 접근에 의한 경우 잔존골 높이는 7mm 이상일 때 96.89%로, 5mm 미만 31.23%, 5mm 이상 7mm 미만 91.07%보다 높았다. 측방 접근에 의한 경우 잔존골 높이 7mm 이상인 경우 95.22%로, 5mm 미만 88.76%, 5mm 이상 7mm 미만 91.31%보다 높았다 3. 골질은 임플란트 생존율에 영향을 미치는 인자로 평가되었다. 치조정 접근에 의한 경우 3형 골질에서 생존율 93.75%, 4형 골질에서 87.23%였다. 측방 접근에 의한 경우 3형 골질에서 91.69%, 4형 골질에서 88.17%였다. 4. 동시 식립한 경우가 지연 식립한 경우보다 임플란트 생존율이 낮았다. 치조정 접근법에서 동시 식립한 임플란트는 누적 생존율 92.87%, 지연 식립한 경우 100%였다. 측방 접근법에서 동시 식립은 91.05%, 지연식립은 92.97%였다. 5. 임플란트 실패의 위험인자로서 환자의 연령, 임플란트 식립 위치, 임플란트 고정체의 길이는 유의한 차이를 나타내지 않았다.
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