摘要
目的:通过牙周病伴糖尿病失牙患者种植义齿修复综合治疗的长期观察,了解糖尿病患者接受种植治疗后可能产生的效果以及探讨实施种植义齿修复的风险和处理对策。材料和方法:本中心统计了2000至2008年间在所属医疗机构接受种植义齿治疗的1240例牙周病患者(平均每人缺牙超过3枚),其中确诊为II型糖尿病的患者有248例,共植入牙种植体1190枚(CDIC 857枚,Replace 333枚),约占牙周病患者总数的20%;男性136例,女性112例;最低年龄28岁,最高年龄93岁,平均53岁。该类型患者种植治疗前的空腹血糖水平最高者为12.3mmol/L;最低为6.3mmol/L;平均水平8.3mmol/L;种植术前控制血糖平均水平≤7.4mmol/L。术前对患者局部骨量水平进行检测评估,全部病例符合牙种植手术最基本要求,酌情采用即刻种植和延期种植两种手术方式;选用CDIC和Replace两个牙种植体系统;种植术式基本采用不翻瓣和骨膨胀的微创植入术;义齿修复时间选择在术后6个月进行;种植术前和术后针对患者具体情况给予控制高血糖可能导致风险的相应对策和补充措施。结果:本次研究病例统计为1-8年的在院治疗病例,其中种植义齿修复前(术后6个月时间内)植体脱落数量有6枚(约5‰),术后1年存留率为98.4%、5年存留率为95.4%、8年存留率为89.4%,保存种植体及种植义齿使用最长时间>96月,最短时间1月。患者空腹血糖水平控制平稳,均无较大波动。患者对种植义齿修复的满意度较高。讨论:国内外学者的研究表明,糖尿病的高发病率是直接导致牙周病患者增加和失牙率升高的重要因素之一。在牙列缺损或缺失的患者中,同时伴有糖尿病的患者其缺牙情况较单纯因龋病或根尖周病而致的牙列缺损或缺失情况为多、牙槽骨吸收严重、余留天然牙条件较差、传统固定桥和活动义齿修复困难等特点。从牙周病伴糖尿病患者(Ⅱ型糖尿病)的义齿修复治疗方式选择而言,有效控制其血糖水平在一个相对稳定或接近正常范围时,口腔及牙槽骨等局部条件允许,是可以采用种植义齿修复治疗,非绝对禁忌。长期的临床观察也表明,植入体可以达到与未患糖尿病患者相似的骨结合水平。本中心针对牙周病伴糖尿病的失牙患者,采用了血糖水平监测控制、即刻种植或即刻修复的风险控制、抗生素应用的控制、修复时间的控制、不良生活习惯风险的控制以及定期口腔及种植义齿的保健维护等多种风险综合控制措施,确保了该类患者种植义齿的较好应用。结论:在严格掌控适应症的选择和风险控制的情况下,牙周病伴(Ⅱ型)糖尿病患者也能像正常牙缺失患者一样享有接受种植治疗的机会。
Object：To discuss the effectiveness,risk and therapeutic strategy of dental implant integrative therapy in periodontal disease patients with diabetes with 8 years follow-up.Methods：We searched 1240 periodontal disease outpatients to follow up 248（20%）periodontal disease patients with confirmed Type II diabetes from 2000 to 2008 after dental implantation.The total dental implants number of Type II diabetes with periodontal disease patients are 1190.（857 CDIC implants and 333 Replace implants）.In 248 patients,136 are male and 112 are female,,whose ages are from 28 to 93 years old.The fasting blood-glucose level were from 6.3 mmol/Lto12.3mmol/L.We controlled the fasting blood-glucose level below 7.4 mmol/L in all patient before the operation.The local bone conditions of all the patients were evaluated to accord the basic request of implantation operation.Immediate implanting or delayed implanting were used by flapless and bone expanding techniques with CDIC or Replace implants.The clinical decision making are based on doctor＇s experience and patients＇ will.The time of crowns rehabilitation are at least 6 months after implantation Individual glycaemic control therapies throughout dental implant process are essential for subsistence ratio.Results：After 8 years follow-up,only 6 implants lost before the crowns were rehabilitated.1-year subsistence ratio of the implants is 98.4%,5-year subsistence ratio of the implants is 95.4%,8-year subsistence ratio of the implants is 89.4%.The blood sugar of limosis of all the patients was controlled stably.Most patients were satisfied with the effects of the implant.Discussion：Many researches had indicated that diabetes is one of the most important reasons that caused the periodontal disease and tooth absence increasing.The diabetes patients are in poor local bone condition with high operation risk than other periodontal disease patients.But diabetes was not the absolute contraindication of dental implant.Long-term clinical observation indicated that the implants of the diabetes patient could attain the Osseo integration with effective control of blood sugar and good maintainability of local bone condition.Our centre used integrative measures to control the implant risks,including blood sugar control,immediate implant with risk evaluation,antibiotics application,time control of the rehabilitation and hygiene maintenance of oral and implants.This could ensure the implants success ratio of these patients.Conclusion：Periodontal disease patients with Type Ⅱ diabetes can also have the opportunity to accept the dental implant with good subsistence ratio,when the operation risk factors are evaluated and controlled strictly.
出处
《中国口腔种植学杂志》
2010年第3期110-111,共2页
Chinese Journal of Oral Implantology
