자연치 부분 결손 환자에서 테이퍼 형태의 국산 임플란트(OSSTEM GS III)의 즉시하중 성공률에 대한 지연하중군과의 비교 임상연구

Clinical Comparison of Immediately Loaded and Delayed Loaded OSSTEM GS III Implant in Partially Edentulous Patients

  • 권민정 (분당서울대병원 치과보철과) ;
  • 김영균 (분당서울대병원 구강악안면외과) ;
  • 여인성 (서울대학교 치과병원 치과보철과) ;
  • 이양진 (분당서울대병원 치과보철과)
  • Kwon, Min-Jung (Department of Prosthodontics, Section of Dentistry, Seoul National University Bundang Hospital) ;
  • Kim, Young-Kyun (Department of Oral & Maxillofacial surgery, Section of Dentistry, Seoul National University Bundang Hospital) ;
  • Yeo, In-Sung (Department of Prosthodontics, Seoul National University Dental Hospital) ;
  • Yi, Yang-Jin (Department of Prosthodontics, Section of Dentistry, Seoul National University Bundang Hospital)
  • 투고 : 2011.06.05
  • 심사 : 2011.09.25
  • 발행 : 2011.09.30

초록

구치부 부분 결손 환자에서 즉시하중군과 지연하중군의 임상적 성공률을 측정하기 위한 전향적 연구가 계획되었다. 즉시하중군에서는 17명의 환자에 42개의 GSIII 임플란트(Osstem, Korea)를 식립하고 48시간 안에 하중을 가하였다. 대조군인 지연하중군에서는 15명의 환자에 27개의 GSIII 임플란트를 식립하고 평균 $2.6{\pm}1.7$개월 후에 하중을 가하였다. 하중 전 1차안정성을 ISQ로 측정하였고 임상증상, 동요도, 연조직 반응을 식립 직후, 3개월 후, 6개월 후, 12개월 후에 평가하였다. 변연골 흡수량은 치근단 방사선 영상으로 측정하였고 Mann-Whitney test (${\alpha}$=0.05)와 repeated measured ANOVA (${\alpha}$=0.05)로 두 군의 차이를 검정하였다. 식립 직후 실험군과 대조군의 ISQ는 각각 $80.3{\pm}7.1$$69{\pm}17$이었다. 실험군은 95.23%의 성공률을, 대조군은 100% 성공률을 나타냈다. 3개월과 6개월 후 실험군의 변연골 흡수량은 대조군에 비해 유의성 있게 컸다(p<0.05). 하지만 12개월 후 두 군의 차이는 관찰되지 않았다 (p>0.05). 변연골 흡수량은 성별과 식립위치에 따른 차이가 없었다 (p>0.05). 실험의 한계 내에서, 1차안정성이 획득된다면 구치부 식립 GSIII 임플란트의 즉시하중은 예지성 있는 치료법이라고 여겨진다.

This prospective study was designed to compare clinical outcomes of immediately loaded implant with delayed loaded implant in partially posterior edentulous patients. For test group, 42 GS III (Osstem, Korea) implants in 17 patients were loaded within 48 hours after the placement. Control group was 27 implants in 15 patients loaded at $2.6{\pm}1.7months$ from the placement surgery. Before loading, primary stability was evaluated by ISQ value. Clinical symptoms, mobility, soft tissue state was evaluated at baseline, 3 months, 6 months and 12 months of loading. Marginal bone level change was also measured with periapical radiographs. Mann-Whitney test (${\alpha}$=0.05) and repeated measured ANOVA (${\alpha}$=0.05) was used for marginal bone level change between two groups. At the baseline, mean ISQ value of test group and control group was $80.3{\pm}7.1$ and $69{\pm}17$ respectively. Test group showed 95.23% of success rate and 100% of control group was successful. At 3 and 6months of loading, significantly more bone resorption was observed in test group than in control group (p<0.05). However, there was no significant difference in the bone level change at 12months of loading between two groups (p>0.05). Marginal bone level change showed no significant difference with gender and location (p>0.05). Within the limitation of this study, when primary stability was obtained, immediate loading of GS III implant at posterior region could be predictable treatment option.

키워드

참고문헌

  1. Branemark PI, Hansson B, Adell R, Breine U, Linstrom J, Hallen O, Ohman A. Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period. Scand J Plast Reconstr Surg 1977; 16: 1132.
  2. Albrektsson T, Hansson T, Lekholm T. Osseointegrated dental implants. Dent Clin North Am 1986; 30: 15174.
  3. Adell R, Lekholm U, Rockler B, Branemark PI. A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg 1981;10: 387416.
  4. Szmukler-Moncler S, Salama S, Reingewirtz Y, Dubruille JH. Timing of loading and effect of micro-motion on bone-implant interface: A review of experimental literature. J Biomed Mater Res A. 1998; 43: 192203.
  5. Eccellente T, Priombino M, Piattelli A, D'Alimmonte E, Perrotti V, lezzi G..Immeditate loading of dental implants in the edentulous maxilla. Quintessence Int. 2011 Apr;24(4):281-9.
  6. Malchiodi L, Ghensi P, Cucchi A, Corrocher G..A comparative retrospective study of immediately loaded implants in postextractio sites versus healed sites: results after 6 to 7 years in the maxilla. Int J Oral Maxillofac Implants. 2011 Mar-Apr; 26(2): 373-84.
  7. Esposito M, Grusovin G, Polyzos IP, Felice P, Worthington HV.Interventions for replacing missing teeth: dental implants in fresh extraction sockets (immediate, immediate-delayed and delayed implants)., Cochrane Database Syst Rev. 2010 Sep 8;(9): CD005968.
  8. Brunski JB. Biomechanical factors affecting the bone- dental implant interface. Clincal Materials 1992; 3:153-201.
  9. Lemons J. Biomaterilas in Implant Dentistry Conetmporary Implant Dentistry. St Louis: Mosby, 1993.
  10. Glauser R, Sennerby L, Meredith N, Re A, Lundgren A, Gottlow J, Hmmerle CH.Resonance frequency analysis of implants subjected to immediate or early functional occlusal loading. Successful vs. failing implants. Clin Oral Implant Res. 2004;15:42834.
  11. Misch CE,Strong T, Bidez MW. Scientific rationale for dental implant design. In : Misch C.E., ed. Contemporary Implant Dentistry. 3 edition St Louis: Mosby. 2008; 200-9.
  12. Coelho PG, Bonfante EA, Pessoa RS, Marin C, Granato R, Giro G, Witek L, Suzuki M. Characterization of five different implant surfaces and their effect on osseointegration: a study in dogs. J Periodontol. 2011 May; 82(5): 742-50. https://doi.org/10.1902/jop.2010.100520
  13. Kim YM, Kim SG, Lim SC. Histometric analysis of immediate implantation and immediate loading of CMP and RBM implants after tooth extraction on dogs. Materials Science Forum, 2008, 3, 587-8.
  14. Van de Velde T, Collaert B, Sennerby L, De Bruyn H. Effect of implant design on preservation of marginal bone in the mandible. Clin Implant Dent Relat Res. 2010 Jun 11 12(2):134-41.
  15. Vandamme K, Naert I, Geris L, Vander Sloten J, Puers R, Duyck J. Influence of controlled immediate loading and implant design on peri-implant bone formation. J Clin Periodontol 2007;34:172-81.
  16. Attard NJ, Zarb GA. Immediate and early implant loading protocols: a literature review of clinical studies.Prosthet Dent. 2005 Sep;94(3):242-58. https://doi.org/10.1016/j.prosdent.2005.04.015
  17. Svhnitman P, Wohrle PS, Rubenstein JE, Dasilva JD, Wang NH. Ten years results for Branemark implants immediately loaded with fixed prostheses at implant placement. Int J of Oral and Maxillofac implants 1997 12:495-503.
  18. Babbusch CA, Kent J, Misiek D. Titanium plasma sprayed screw implants for the reconstruction of the edentulous mandible. J of Pral and Maxillofac Surg 1986, 44:274-82. https://doi.org/10.1016/0278-2391(86)90078-9
  19. Schincaglia GP, Marzola R, Giovanni GF, Chiara CS, Scotti R. Replacement of mandibular molars with single-unit restorations supported by wide body implants: immediate versus delayed loading. A randomized controlled study. Int J Oral Maxillofac Implants. 2008 May-Jun;23(3)474-80.
  20. Elsyad MA, Al-Mandy YF, Fouad MM. Marginal bone loss adjacent to conventional and immediate loaded two implant supporting a ball-retained mandibular overdenture: a 3-year randomized conical trial. Clin Oral Implants Res 2011 Apr 19.
  21. Hermann JS, Buser D, Schenk RK, Schoolfield JD, Cochran DL. Biologic width around one- and two- piece titanium implants. Clin Oral Implants Res 2001;12:55971.
  22. Cochran DL, Nummikoski PV, Schoolfield JD, Jones AA, Oates TW. A prospective multicenter 5-year radiographic evaluation of crestal bone levels over time in 596 dental implants placed in 192 patients. J Periodontol 2009; 80:72533.
  23. Astrand P, Engquist B, Dahlgren S, Grondahl K, Engqust E, Feldmann H. Astra Tech and Branemark system implants: a 5-year prospective study of marginal bone reactions. Clin Oral Implants Res 2004;5:413-20.
  24. Daniel L, Zvi L. Innovations in dental implant design for current therapy. Pral Maxillofac surg Clin N Am 2011;23:193-200. https://doi.org/10.1016/j.coms.2011.02.001
  25. Le Guehennec, A. Soueidan, P. Layrolle, Y. Amouriq. Review: Surface treatments of titanium dental implants for rapid osseointegration. Dent Materials 2007;23:844-854. https://doi.org/10.1016/j.dental.2006.06.025
  26. O'Sullivan D, Sennerby L, Meredith N. Influence of implant taper on the primary and secondary stability of osseointegrated titanium implants. Clin Implant Dent Rel Res. 2004; 15:474-480.
  27. Linus Chong, Ahmed Khocht, Effect of implant design on imitial stability of tapered implants J Oral Implantol. 2009; 35(3):130-5. https://doi.org/10.1563/1548-1336-35.3.130
  28. Lee DW, Choi YS, Park KH, Kim CS, Moon IS. Effect of micro -thread on the maintenance of marginal bone level: A 3-year prospective study. Clin Oral Implants Res 2007;18:46570.
  29. De Bruyn H, Collaert B. Effect of microthread design on preservation of marginal bone loss. Appl Osseointegration Res 2008;7:3848.
  30. Song DW, Lee DW, Kim CK, Park KH, Moon IS.Comparative analysis of peri-implant marginal bone loss based on microthread location: a 1-year prospective study after loading. Periodontol. 2009 Dec;80(12):1937-44. https://doi.org/10.1902/jop.2009.090330
  31. Lekholm U, Zarb GA. Patient selection. In: Branenmark PI, Zarb GA, Albrektsson T, editors. Tissue-integrated prostheses: osseointegration in clinical dentistry. Chicago: Quintessence; 1985. p.199209.
  32. Piatelli M, Scarano A, Paolantonio M, Iezzi G, Petrone G, Piatelli A. Bone response to machined and resorbable blast material titanium implants: an experimental study in rabbits. J Oral Implantol 2002;28:2-8. https://doi.org/10.1563/1548-1336(2002)028<0002:BRTMAR>2.3.CO;2
  33. Lindeboom JA, Frenken JW, Dubois K, Frank M, Abbink I, Kroon FH. Immediate loading versus immediate provisionalization of maxillary single-tooth replacements: a prospective randomized study with Biovomp implants. J Oral and Maxillofac Surg 2006;64(6)936-42. https://doi.org/10.1016/j.joms.2006.02.015
  34. Romanos GE, Nentwig GH. Immediate functional loading in the maxilla using implants with platform "shifting". Fiveyear results. International Journal of Oral and Maxillofacial Implants 2009;24:110612.
  35. Crespi R, Cappare P, Gherlone E, Romanos GE. Immediate versus delayed loading of dental implants placed in fresh extraction sockets in the maxillary esthetic zone: a clinical comparative study. Int J Oral Maxillofac Implants. 2008;23:7538.
  36. Calandriello R, Tomatis M, Rangert B.Immediate functional loading of Branemark System implants with enhanced initial stability: a prospective 1- to 2-year clinical and radiographic study. Clin Implant Dent Relat Res. 2003;5 Suppl 1:10-20. https://doi.org/10.1111/j.1708-8208.2003.tb00011.x
  37. Glauser R, Lundgren AK, et al. Immediate occlusal loading of BranemarkTiUnite implants placed predominantly in soft bone: 1-year results of a prospective clinical study. Clin Implant Dent Relat Res 2003; 5(suppl 1): 47-55.
  38. Tarnow DP, Emtiaz S, Classi A. Immediate loading of threaded implants at stage 1 surgery in edentulous arches: ten consecutive case reports with 1- to 5-year data. Int J Oral Maxillofac Implants. 1997;12:31924.
  39. Ledermann PD, Schenk RK, Buser D. Long-lasting osseointegration of immediately loaded, bar-connected TPS screws after 12 years of function: a histologic case report of a 95-year-old patient. Int J Periodontics Restorative Dent. 1998;18:55263.
  40. Rocci A, Martignoni M et al. Immediate loading in the maxilla using flapless surgery, implants placed in predetermined positions, and prefabricated provisional restorations: A retrospective 3-year clinical study. Clin Implant Dent Relat Res 2003: 5(suppl 1): 29-36.