种植修复体𬌗设计

doi:10.12337/zgkqzzxzz.2025.08.012

摘要/Abstract

摘要： 种植修复是牙列缺损及牙列缺失的主要修复方法之一,其牙合设计是影响修复效果及种植成功率的重要因素。目前种植修复设计种类繁多,部分设计已达成基本共识,而针对无牙颌种植等复杂设计尚缺乏充分的循证医学证据,临床工作中也缺乏共识性结论。本综述从种植义齿与天然牙的差异出发,回顾咬合力与种植体骨吸收及机械并发症的关系,系统综述不同类型种植修复体的牙合设计,归纳各种修复类型牙合设计的总体原则,以期助益临床决策。

关键词: 种植, 牙合设计, 咬合过载, 并发症

Abstract: Dental implant restoration is one of the primary methods for repairing dentition defects and edentulism, and its occlusal design is a critical factor influencing the restoration outcome and the implant success rate. Due to the differences in biomechanical properties between dental implants and natural teeth, the rational distribution of occlusal forces becomes a key issue in implant restoration design. This review begins with the differences between implant prostheses and natural teeth, analyzes the association between occlusal forces and peri-implant bone resorption, as well as mechanical complications, and summarizes the occlusal design principles for different types of implant restorations, aiming to provide references for clinical decision-making.

Key words: Implant, Occlusal design, Occlusal overload, Complication

王千辰,曹烨,葛严军. 种植修复体𬌗设计[J]. 中国口腔种植学杂志, 2025, 30(4): 399-404. DOI: 10.12337/zgkqzzxzz.2025.08.012

Wang Qianchen, Cao Ye, Ge Yanjun. Occlusal design of implant restorations[J].Chinese Journal of Oral Implantology, 2025, 30(4): 399-404.DOI: 10.12337/zgkqzzxzz.2025.08.012.

参考文献

[1] Curtis DA, Sharma A, Finzen FC, et al.Occlusal considerations for implant restorations in the partially edentulous patient[J]. J Calif Dent Assoc, 2000,28(10):771-778. DOI: 10.1080/19424396.2000.12223125.
[2] Esposito M, Hirsch JM, Lekholm U, et al.Biological factors contributing to failures of osseointegrated oral implants(Ⅱ). Etiopathogenesis[J]. Eur J Oral Sci, 1998,106(3):721-764. DOI: 10.1046/j.0909-8836.t01-6-.x.
[3] Koyano K, Esaki D.Occlusion on oral implants: current clinical guidelines[J]. J Oral Rehabil, 2015,42(2):153-161. DOI: 10.1111/joor.12239.
[4] Taylor TD, Wiens J, Carr A.Evidence-based considerations for removable prosthodontic and dental implant occlusion: a literature review[J]. J Prosthet Dent, 2005,94(6):555-560. DOI: 10.1016/j.prosdent.2005.10.012.
[5] Trulsson M.Sensory-motor function of human periodontal mechanoreceptors[J]. J Oral Rehabil, 2006,33(4):262-273. DOI: 10.1111/j.1365-2842.2006.01629.x.
[6] Yan C, Ye L, Zhen J, et al.Neuroplasticity of edentulous patients with implant-supported full dentures[J]. Eur J Oral Sci, 2008,116(5):387-393. DOI: 10.1111/j.1600-0722.2008.00557.x.
[7] Klineberg I, Calford MB, Dreher B, et al.A consensus statement on osseoperception[J]. Clin Exp Pharmacol Physiol, 2005,32(1-2):145-146. DOI: 10.1111/j.1440-1681.2005.04144.x.
[8] Jacobs R, van Steenberghe D. Comparative evaluation of the oral tactile function by means of teeth or implant-supported prostheses[J]. Clin Oral Implants Res, 1991,2(2):75-80. DOI: 10.1034/j.1600-0501.1991.020205.x.
[9] Mühlbradt L, Ulrich R, Möhlmann H, et al.Mechanoperception of natural teeth versus endosseous implants revealed by magnitude estimation[J]. Int J Oral Maxillofac Implants, 1989,4(2):125-130.
[10] Kim Y, Oh TJ, Misch CE, et al.Occlusal considerations in implant therapy: clinical guidelines with biomechanical rationale[J]. Clin Oral Implants Res, 2005,16(1):26-35. DOI: 10.1111/j.1600-0501.2004.01067.x.
[11] Brånemark PI, Hansson BO, Adell R, et al.Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period[J]. Scand J Plast Reconstr Surg Suppl, 1977,16:1-132.
[12] Yuan JC, Sukotjo C.Occlusion for implant-supported fixed dental prostheses in partially edentulous patients: a literature review and current concepts[J]. J Periodontal Implant Sci, 2013,43(2):51-57. DOI: 10.5051/jpis.2013.43.2.51.
[13] Frost HM.A 2003 update of bone physiology and Wolff's law for clinicians[J]. Angle Orthod, 2004,74(1):3-15. DOI: 10.1043/0003-3219(2004)074<0003:AUOBPA>2.0.CO;2.
[14] Naert I, Duyck J, Vandamme K.Occlusal overload and bone/implant loss[J]. Clin Oral Implants Res, 2012,23(Suppl 6): S95-S107. DOI: 10.1111/j.1600-0501.2012.02550.x.
[15] Brizuela-Velasco A, Pérez-Pevida E, Jiménez-Garrudo A, et al.Mechanical characterisation and biomechanical and biological behaviours of Ti-Zr binary-alloy dental implants[J]. Biomed Res Int, 2017,2017:2785863. DOI: 10.1155/2017/2785863.
[16] Robau-Porrua A, Pérez-Rodríguez Y, Soris-Rodríguez LM, et al.The effect of diameter, length and elastic modulus of a dental implant on stress and strain levels in peri-implant bone: a 3D finite element analysis[J]. Biomed Mater Eng, 2020,30(5-6):541-558. DOI: 10.3233/BME-191073.
[17] Cordeiro JM, Faverani LP, Grandini CR, et al.Characterization of chemically treated Ti-Zr system alloys for dental implant application[J]. Mater Sci Eng C Mater Biol Appl, 2018,92:849-861. DOI: 10.1016/j.msec.2018.07.046.
[18] Rieger MR, Adams WK, Kinzel GL.A finite element survey of eleven endosseous implants[J]. J Prosthet Dent, 1990,63(4):457-465. DOI: 10.1016/0022-3913(90)90238-8.
[19] 宫苹. 牙缺失种植修复并发症与咬合[J]. 中华口腔医学杂志, 2018,53(12): 800-804. DOI:10.3760/cma.j.issn.1002-0098.2018.12.002.
Gong P.Role of occlusion in complications of implant rehabilitation[J]. Chin J Stomatol, 2018,53(12): 800-804. DOI: 10.3760/cma.j.issn.1002-0098.2018.12.002.
[20] Kozlovsky A, Tal H, Laufer BZ, et al.Impact of implant overloading on the peri-implant bone in inflamed and non-inflamed peri-implant mucosa[J]. Clin Oral Implants Res, 2007,18(5):601-610. DOI: 10.1111/j.1600-0501.2007.01374.x.
[21] Isidor F.Influence of forces on peri-implant bone[J]. Clin Oral Implants Res, 2006,17(Suppl 2):S8-S18. DOI: 10.1111/j.1600-0501.2006.01360.x.
[22] Quirynen M, Naert I, van Steenberghe D. Fixture design and overload influence marginal bone loss and fixture success in the Brånemark system[J]. Clin Oral Implants Res, 1992,3(3):104-111. DOI: 10.1034/j.1600-0501.1992.030302.x.
[23] Lindquist LW, Carlsson GE, Jemt T.A prospective 15-year follow-up study of mandibular fixed prostheses supported by osseointegrated implants. clinical results and marginal bone loss[J]. Clin Oral Implants Res, 1996,7(4):329-336. DOI: 10.1034/j.1600-0501.1996.070405.x.
[24] Akça K, Uysal S, Cehreli MC.Implant-tooth-supported fixed partial prostheses: correlations between in vivo occlusal bite forces and marginal bone reactions[J]. Clin Oral Implants Res, 2006,17(3):331-336. DOI: 10.1111/j.1600-0501.2005.01169.x.
[25] Graves CV, Harrel SK, Nunn ME, et al.The association between occlusal status and the soft and hard tissue conditions around single-unit dental implants[J]. Int J Periodontics Restorative Dent, 2019,39(5):651-656. DOI: 10.11607/prd.4184.
[26] Zhang R, Hao X, Zhang K.Evaluation of two different occlusal patterns on single posterior implant-supported crowns: a 12-month prospective study of occlusal analysis[J]. J Prosthet Dent, 2024,132(6):1277-1284. DOI: 10.1016/j.prosdent.2022.11.026.
[27] Di Fiore A, Montagner M, Sivolella S, et al.Peri-implant bone loss and overload: a systematic review focusing on occlusal analysis through digital and analogic methods[J]. J Clin Med, 2022,11(16):4812. DOI: 10.3390/jcm11164812.
[28] Lee SJ, Alamri O, Cao H, et al.Occlusion as a predisposing factor for peri-implant disease: a review article[J]. Clin Implant Dent Relat Res, 2023,25(4):734-742. DOI: 10.1111/cid.13152.
[29] Lee DW, Kim NH, Lee Y, et al.Implant fracture failure rate and potential associated risk indicators: an up to 12-year retrospective study of implants in 5,124 patients[J]. Clin Oral Implants Res, 2019,30(3):206-217. DOI: 10.1111/clr.13407.
[30] Adler L, Buhlin K, Jansson L.Survival and complications: a 9- to 15-year retrospective follow-up of dental implant therapy[J]. J Oral Rehabil, 2020,47(1):67-77. DOI: 10.1111/joor.12866.
[31] Box VH, Sukotjo C, Knoernschild KL, et al.Patient-reported and clinical outcomes of implant-supported fixed complete dental prostheses: a comparison of metal-acrylic, milled zirconia, and retrievable crown prostheses[J]. J Oral Implantol, 2018,44(1):51-61. DOI: 10.1563/aaid-joi-D-17-00184.
[32] Kamio S, Komine F, Taguchi K, et al.Effects of framework design and layering material on fracture strength of implant-supported zirconia-based molar crowns[J]. Clin Oral Implants Res, 2015,26(12):1407-1413. DOI: 10.1111/clr.12468.
[33] Shim HW, Yang BE.Long-term cumulative survival and mechanical complications of single-tooth ankylos implants: focus on the abutment neck fractures[J]. J Adv Prosthodont, 2015,7(6):423-430. DOI: 10.4047/jap.2015.7.6.423.
[34] Gupta S, Gupta H, Tandan A.Technical complications of implant-causes and management: a comprehensive review[J]. Natl J Maxillofac Surg, 2015,6(1):3-8. DOI: 10.4103/0975-5950.168233.
[35] Coppedê AR, Faria AC, de Mattos Mda G, et al. Mechanical comparison of experimental conical-head abutment screws with conventional flat-head abutment screws for external-hex and internal tri-channel implant connections: an in vitro evaluation of loosening torque[J]. Int J Oral Maxillofac Implants, 2013,28(6):e321-e329. DOI: 10.11607/jomi.3029.
[36] Chrcanovic BR, Kisch J, Albrektsson T, et al.Bruxism and dental implant treatment complications: a retrospective comparative study of 98 bruxer patients and a matched group[J]. Clin Oral Implants Res, 2017,28(7):e1-e9. DOI: 10.1111/clr.12844.
[37] Kihara H, Hatakeyama W, Kondo H, et al.Current complications and issues of implant superstructure[J]. J Oral Sci, 2022,64(4):257-262. DOI: 10.2334/josnusd.21-0534.
[38] Yi Y, Heo SJ, Koak JY, et al.Mechanical complications of implant-supported restorations with internal conical connection implants: a 14-year retrospective study[J]. J Prosthet Dent, 2023,129(5):732-740. DOI: 10.1016/j.prosdent.2021.06.053.
[39] Murakami H, Igarashi K, Fuse M, et al.Risk factors for abutment and implant fracture after loading[J]. J Oral Sci, 2020,63(1):92-97. DOI: 10.2334/josnusd.20-0443.
[40] Berglundh T, Persson L, Klinge B. A systematic review of the incidence of biological and technical complications in implant dentistry reported in prospective longitudinal studies of at least 5 years[J]. J Clin Periodontol, 2002,29 (Suppl 3):S197-S212;discussion 232-233. DOI: 10.1034/j.1600-051x.29.s3.12.x.
[41] Sailer I, Karasan D, Todorovic A, et al.Prosthetic failures in dental implant therapy[J]. Periodontol 2000, 2022,88(1):130-144. DOI: 10.1111/prd.12416.
[42] Piattelli A, Piattelli M, Scarano A, et al.Light and scanning electron microscopic report of four fractured implants[J]. Int J Oral Maxillofac Implants, 1998,13(4):561-564.
[43] Chrcanovic BR, Kisch J, Albrektsson T, et al.Bruxism and dental implant treatment complications: a retrospective comparative study of 98 bruxer patients and a matched group[J]. Clin Oral Implants Res, 2017,28(7):e1-e9. DOI: 10.1111/clr.12844.
[44] Kinsel RP, Lin D.Retrospective analysis of porcelain failures of metal ceramic crowns and fixed partial dentures supported by 729 implants in 152 patients: patient-specific and implant-specific predictors of ceramic failure[J]. J Prosthet Dent, 2009,101(6):388-394. DOI: 10.1016/S0022-3913(09)60083-4.
[45] Misch CE, Bidez MW. Implant-protected occlusion: a biomechanical rationale[J]. Compendium, 1994, 15(11):1330, 1332, 1334 passim, quiz 1344.
[46] Goldstein G, Goodacre C, Taylor T.Occlusal schemes for implant restorations: best evidence consensus statement[J]. J Prosthodont, 2021,30(Suppl 1):S84-S90. DOI: 10.1111/jopr.13319.
[47] Weinberg LA.Reduction of implant loading with therapeutic biomechanics[J]. Implant Dent, 1998,7(4):277-285. DOI: 10.1097/00008505-199807040-00005.
[48] 许月丹, 金鑫阳, 赵维家, 等. 种植义齿的咬合设计[J].口腔医学,2020,40(12):1124-1128. DOI: 10.13591/j.cnki.kqyx.2020.12.013.
Xu YD, Jin XY, Zhao WJ, et al.Occlusal design of implant denture[J]. Stomatology, 2020, 40(12): 1124-1128. DOI:10.13591/j.cnki.kqyx.2020.12.013.
[49] O'Mahony A, Bowles Q, Woolsey G, et al. Stress distribution in the single-unit osseointegrated dental implant: finite element analyses of axial and off-axial loading[J]. Implant Dent, 2000,9(3):207-218. DOI: 10.1097/00008505-200009030-00006.
[50] Davies SJ, Gray RJ, Young MP.Good occlusal practice in the provision of implant borne prostheses[J]. Br Dent J, 2002,192(2):79-88. DOI: 10.1038/sj.bdj.4801298.
[51] Morton D, Gallucci G, Lin WS, et al.Group 2 ITI consensus report: prosthodontics and implant dentistry[J]. Clin Oral Implants Res, 2018,29(Suppl 16):S215-S223. DOI: 10.1111/clr.13298.
[52] Hämmerle C, Cordaro L, Alccayhuaman K, et al.Biomechanical aspects: summary and consensus statements of group 4. the 5th EAO consensus conference 2018[J]. Clin Oral Implants Res, 2018,29(Suppl 18):S326-S331. DOI: 10.1111/clr.13284.
[53] 崔荣智, 鲍琰, 齐翊. 种植义齿的上部结构和咬合设计[J].国际口腔医学杂志,2010,37(3):369-371.
Cui RZ, Bao Y, Qi Y.Superstructure and occlusal design of implant denture[J]. Int J Stomatol, 2010, 37(3): 369-371.
[54] Younes IA, Able FB, De Moraes KC, et al.Survival rate of implants and mechanical complications for 64 implant-supported complete-arch prostheses in maxillary edentulous patients with a follow-up of up to 12 years: a cross-sectional analytical study[J]. Int J Oral Maxillofac Implants, 2024,39(6):823-828. DOI: 10.11607/jomi.10809.
[55] Freitas da Silva EV, Dos Santos DM, Sonego MV, et al. Does the presence of a cantilever influence the survival and success of partial implant-supported dental prostheses? Systematic review and meta-analysis[J]. Int J Oral Maxillofac Implants, 2018,33(4):815-823. DOI: 10.11607/jomi.6413.
[56] Thoma DS, Wolleb K, Schellenberg R, et al.Two short implants versus one short implant with a cantilever: 5-year results of a randomized clinical trial[J]. J Clin Periodontol, 2021,48(11):1480-1490. DOI: 10.1111/jcpe.13541.
[57] Horsch L, Kronsteiner D, Rammelsberg P.Survival and complications of implant-supported cantilever fixed dental prostheses with zirconia and metal frameworks: a retrospective cohort study[J]. Clin Implant Dent Relat Res, 2022,24(5):621-629. DOI: 10.1111/cid.13125.
[58] Gil A, Strauss FJ, Hämmerle C, et al.Radiographic density changes may be associated with overloading and implant loss on short implants: a 5-year analysis of a randomized controlled clinical trial[J]. Clin Implant Dent Relat Res, 2022,24(6):766-775. DOI: 10.1111/cid.13138.
[59] 王林霞, 孟玉坤. 种植修复中的牙合学问题[J].中国实用口腔科杂志,2015,8(1):13-16.
Wang LX, Meng YK.Occlusal problems in implant prosthodontics[J]. Chin J Pract Stomatol, 2015, 8(1): 13-16.
[60] Naert I, Quirynen M, van Steenberghe D, et al. A six-year prosthodontic study of 509 consecutively inserted implants for the treatment of partial edentulism[J]. J Prosthet Dent, 1992,67(2):236-245. DOI: 10.1016/0022-3913(92)90461-i.
[61] Maló P, Rangert B, Nobre M.All-on-4 immediate-function concept with Brånemark system implants for completely edentulous maxillae: a 1-year retrospective clinical study[J]. Clin Implant Dent Relat Res, 2005,7(Suppl 1):S88-S94. DOI: 10.1111/j.1708-8208.2005.tb00080.x.
[62] Rosén A, Gynther G.Implant treatment without bone grafting in edentulous severely resorbed maxillas: a long-term follow-up study[J]. J Oral Maxillofac Surg, 2007,65(5):1010-1016. DOI: 10.1016/j.joms.2006.11.023.
[63] Feine JS, Carlsson GE, Awad MA, et al.The McGill consensus statement on overdentures. Mandibular two-implant overdentures as first choice standard of care for edentulous patients[J]. Gerodontology, 2002,19(1):3-4.
[64] Lemos C, Verri FR, Gomes J, et al.Bilateral balanced occlusion compared to other occlusal schemes in complete dentures: a systematic review[J]. J Oral Rehabil, 2018,45(4):344-354. DOI: 10.1111/joor.12607.