种植体支持的固定修复体与天然牙邻面接触点丧失发生率的一项回顾性研究

doi:10.12337/zgkqzzxzz.2025.04.009

摘要/Abstract

摘要： 目的通过回访近十年进行种植修复治疗的患者,观察后牙区种植修复后邻面接触点丧失（proximal contact loss,PCL）的发病率,分析造成PCL的相关因素,为临床医生预防和处理PCL提供理论依据和临床指导。方法本研究共纳入103例在后牙区进行种植固定修复的患者,包含226颗种植体和233个邻面接触点。使用50 μm的金属检查片和牙线评估接触点紧密度。通过采用Kaplan-Meier方法、单因素log-rank检验、多因素Cox回归分析及Spearman秩相关性分析方法,评估患者基本情况、种植体位置、邻牙骨支持水平及对颌牙状态等因素与PCL的相关性。结果 PCL在患者水平的发病率为68.0%,在接触点水平的发病率为36.9%。近中PCL的发病率（46.6%）明显高于远中（15.3%）。经多因素Cox回归分析发现,食物嵌塞、边缘嵴存在高度差、种植体周炎、邻牙炎症、邻牙骨支持水平>3/8是PCL发生的相关独立风险因素。通过Kaplan-Meier方法分析发现,随着随访时间的逐渐增加,PCL的发病率逐渐升高,其中随访时间为6年时PCL在接触点水平的发病率为50.0%。通过Spearman秩相关性分析显示,PCL的间隙大小与随访时间之间存在正相关性（rs=0.303）。PCL间隙大小的平均值为0.239 mm,最大值为0.800 mm。结论食物嵌塞是引起PCL最显著的相关因素之一,但可能两者之间存在双向因果关系。随着随访时间的逐渐增加,PCL的发病率逐渐增高,PCL的间隙大小也逐渐增大。在临床上,建议患者种植后定期复查维护,医生可根据风险因素,采用调牙合、充填、重新冠修复等方法进行预防和治疗。

关键词: 种植固定义齿, 邻面接触点丧失, 食物嵌塞, 危险因素

Abstract: Objective This study aimed to observe the incidence of proximal contact loss (PCL) between implant-supported fixed prostheses and adjacent natural teeth in the posterior region and to analyze the risk factors. Methods A total of 103 patients who underwent ISFPs placement in the posterior regions were enrolled in this study, comprising 226 implants and 233 interproximal contact points. A 50 μm metal shim and dental floss were used to assess proximal contact tightness. Kaplan-Meier analysis, univariate log-rank test, multivariate Cox regression analysis, and Spearman rank correlation analysis were used to evaluate the association of patient characteristics, implant location, adjacent tooth bone support level, and opposing dentition status with PCL occurrence. Results The incidence of PCL was 68.0% at the patient level and 36.9% at the contact site level. The incidence of mesial PCL (46.6%) was significantly higher than that of distal PCL (15.3%). Multivariate Cox regression analysis showed that food impaction, marginal ridge height discrepancy, peri-implantitis, gingival inflammation, and an adjacent tooth bone support level >3/8 were independent risk factors for PCL. Kaplan-Meier analysis showed a progressive increase in PCL incidence over time, reaching 50.0% at the contact site level at the 6-year follow-up. Spearman rank correlation analysis showed that there was a positive correlation between the gap size of PCL and follow-up duration (rs=0.303). The mean PCL gap size was about 0.239 mm, and the maximum value was 0.800 mm. Conclusion This study found that food impaction was one of the most significant risk factors for PCL, although a bidirectional causal relationship may exist between the two. Over time, both PCL incidence and gap size increased progressively. Clinically, regular follow-up visits after implant placement are recommended to monitor and manage PCL. Risk-based interventions, including occlusal adjustment, restorative modifications, or crown replacement, may help prevent and treat PCL effectively.

Key words: Implant-supported fixed prosthesis, Proximal contact loss (PCL), Food impaction, Risk factors

牛燚梦,仲维剑. 种植体支持的固定修复体与天然牙邻面接触点丧失发生率的一项回顾性研究[J]. 中国口腔种植学杂志, 2025, 30(2): 151-160. DOI: 10.12337/zgkqzzxzz.2025.04.009

Niu Yimeng, Zhong Weijian. Retrospective study on the prevalence and risk factors of proximal contact loss between implant-supported fixed restorations and adjacent natural teeth[J].Chinese Journal of Oral Implantology, 2025, 30(2): 151-160.DOI: 10.12337/zgkqzzxzz.2025.04.009.

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