Relationship between implant design and marginal bone loss around oral implants: current situation and controversy

doi:10.3969/j.issn.2095-4344.2014.21.022

Abstract

Abstract:

BACKGROUND: Marginal bone loss around oral implants may represent a threat to implant stability and aesthetics. In addition to two major factors (overloading and infection), implant design play a role of critical factor.
OBJECTIVE: To review the relationship between implant design and marginal bone loss around oral implants
METHODS: PubMed, SCI database and CNKI (2000-01/2013-12) were retrieved for articles about the relationship between implant design and marginal bone loss around oral implants, with the key words of “implant design, marginal bone loss, bone loss, bone defect” in English and Chinese, respectively. Independent literatures and repetition research with this review were excluded were excluded. According to the inclusive and exclusion criteria, 43 articles were included in result analysis.
RESULTS AND CONCLUSION: Avoiding bone loss is to ensure the health of soft and hard tissue around implant and it is the basic requirement of aesthetic restoration. Optimizing implant design has a great impact on marginal bone loss around oral implants. We should try to consider the following factors during implant restoration: the size of the implant, a reasonable choice of different implant neck design, one-piece implant, abutment and implant design-abutment connections.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

全文链接：

Key words: biocompatible materials, dental implants, alveolar bone loss

CLC Number:

R318

Li Ping, Dai Jing-tao, Li An, Tang You-chao. Relationship between implant design and marginal bone loss around oral implants: current situation and controversy [J]. Chinese Journal of Tissue Engineering Research, 2014, 18(21): 3406-3411.

Figures/Tables 6

2.2.1 骨水平种植体颈部设计骨水平种植体的设计理念是种植体平台与牙槽嵴顶齐平或位于根方(图2)。种植体颈部设计采用光滑表面，其主要基于菌斑易于附着在粗糙表面的假说。事实上，有学者对于光滑颈部设计与微螺纹颈部设计的骨水平种植体的临床研究发现，二者在探诊深度上存在显著性差异，粗糙表面更加有利于结缔组织和上皮组织附着，能有效减少边缘骨吸收[6]。种植体颈部采用微螺纹设计与传统光滑颈部设计相比较，更有利于种植体颈部骨量的长期维持。Meriç等[7]利用三维有限元应力分析，研究表明微螺纹种植体颈部设计能有效改变种植体颈部的应力分布，将种植体传递给骨-种植体界面的剪切力转变为压应力或拉应力，从而减少了基台连接部和种植体周围骨密质的应力。Abrahamsson等[8]通过动物实验研究还发现微螺纹颈部结构能为骨结合提供更好的条件，减少种植体颈部骨吸收。同样，Lee等[9]临床前瞻性研究证实了在种植负载后，微螺纹颈部设计有利于种植体边缘骨水平维持。 2.2.2 软组织水平种植体颈部设计软组织水平种植体是指种植体颈部位于软组织之内，平台可以位于牙槽嵴表面的软组织之内或软组织之外。软组织水平种植体存在光滑颈部，其部分植入牙槽嵴，或完全位于软组织内，则光滑颈部发生软组织愈合(即软组织封闭)。与骨组织种植体相比，软组织水平种植体平台的垂直向位置向冠方转移，使种植体平台与基台的微间隙向冠方移位，避免连接处的微动和微间隙处的病原微生物对种植体周围骨组织的刺激，将有利于保持种植体周围软组织结合与骨结合的长期稳定[10]。但是，刘健等[11]研究发现，在排除了负重条件和表面处理技术等影响因素下，就种植体边缘骨吸收而言，骨水平种植体肯定会明显优于软组织水平种植体。 2.3 种植体-基台连接基台与种植体的连接方式称为基台连接，种植体平台中心存在向冠方凸起或凹陷到种植体内部的结构设计，分别称为外基台连接和内基台连接。基台与种植体的接触边界称为种植体-基台界面，其所形成的间隙称为微间隙。该处有处有明显的炎症细胞聚集，并且在微间隙上下0.5-0.75 mm 范围构成炎性结缔组织渗漏带[12]。故种植体-基台连接处微间隙内的微生物聚集及渗透，引起种植体周围炎症，并最终导致炎症细胞趋化聚集、促进破骨细胞形成和生长，引起种植体周围骨吸收。若种植体-基台连接处远离牙槽嵴骨，则能减少种植体周围边缘骨吸收[13]。 "

2.3.3 平台转移近年来，Baumgarten[17]和Porter 等[18]相继提出平台转移概念：在骨水平种植体平台上，基台直径小于平台直径，使基台连接位置向种植体平台中心内移(图4)。大部分临床试验及动物实验表明，平台转移技术可以有效降少种植体周围的垂直向骨吸收。Calvo-Guirado等[19]进行前瞻性临床研究，评估64颗前牙美学区的平台转移种植体的骨吸收情况，观察5年后发现种植体边缘骨水平稳定且美学效果良好，平均骨吸收为(0.97±0.39) mm，同时发现仅少数患者唇侧牙龈退缩。同样，有研究表明平台转移种植体在功能负重 12个月后，平台转移设计可以有效减少种植体颈部骨吸收，维持种植体周围骨组织的稳定性[20]。Farronato 等[21]通过动物实验证实，在种植体平台与牙槽嵴顶齐平下，平台转移种植体结合上皮宽度较窄，而其对结缔组织影响不大。此外，平台转移导致牙槽嵴顶吸收平均为0.58 mm。Çimen等[22]利用三维有限元分析发现，平台转移能够将骨-种植体界面应力有效转移，降低种植体颈部周围骨组织应力，从而维持种植体周围边缘骨稳定，但也存在基台和基台螺丝折断的风险。 2.4 种植体的尺寸种植体的尺寸包括种植体的直径与长度。 2.4.1 种植体直径种植体体部直径：对螺纹种植体而言，种植体体部直径分为不包含螺纹的内径和包含螺纹的外径，习惯上将种植体外径称为种植体体部直径，临床上简称为“种植体直径”。早期种植体设计，常规使用直径3.75 mm的螺纹状种植体，壁厚度为0.4 mm，通常被称为标准直径种植体。大直径种植体(粗种植体)直径大于4.5 mm，而小直径种植体(细种植体)直径小于3.5 mm[23]。种植体直径增加，表面积显著增加，直径每增加 1 mm表面积约增加25%。根据三维有限元分析，增加种植体表面积可以减少骨结合界面应力集中[24]。Jang等[25]进行影响种植体存留率的回顾性研究发现，粗种植体可以增加骨-种植体接触界面的面积，相应减少单位面积内应力分布，从而更有利于减少种植体周围蝶形骨吸收。有学者认为，在长期负载情况下，种植体周围骨皮质会出现应力峰值，而骨界面应力值与种植体直径与长度均呈负相关。在保证种植体周围足够骨量的前提下，大直径种植体明显增加了骨-种植体接触面积，以最大限度地减小单位面积内的应力，从而能减少种植体周围骨的丧失，发挥种植体的支持和固位作用[26]。种植体平台直径：种植体颈部为种植体的冠方部分，最冠方称为种植体平台。种植体平台直径小于体部直径。种植体平台直径小于体部直径，为一种新的种植体颈部形态设计(如Bicon，NobelActive)。其设计理念为尽可能地增加种植体平台周围的骨量，并改善软组织附着质量。"

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