상악 임플란트 오버덴처의 보철적인 형태에따른 임상적 결과의 문헌적 고찰

최승희,김선재,장재승 대한구강악안면임플란트학회 2018 대한구강악안면임프란트학회지 Vol.22 No.2

Background: The two-implant overdenture should be considered as the first treatment option for mandibular edentulous patients. But for the maxilla, there is no widely accepted consensus yet. In this study, implant survival rate, clinical evaluations, marginal bone loss of the maxillary overdenture were investigated. Materials and Methods: “Maxillary overdenture” was the key word of this study, and with the combination of “attachment system”, “implant number”, “implant survival rate”, “clinical evaluation” and “marginal bone loss”, 21 journals were searched by “Pubmed”. Results: There were no differences in the survival rate according to the attachment systems and implant numbers. Especially, maxillary overdentures with four or more implants showed excellent results. Clinical parameters and marginal bone loss were not affected by attachment systems and implant numbers. Conclusion: For successful maxillary implant overdenture treatment, four or more implants can be considered using various attachment systems. I. 서론 : McGill consensus1에서 하악 무치악 환자에서 첫 번째 치료 옵션으로 두 개의 임플란트를 이용한 피개의치가 고려되어야 한다고 발표했다. 기존 총의치에 비해 동요도가 적고, 하악 전치부에서의 높은 임플란트 생존율, 잔존골 흡수를 줄일 수 있다는 장점들이 있다고 하였다. 또한 두 개의 임플란트를 이용한 피개의치 착용 시 기존 총의치에 비해 여러 측면에서 더 높은 만족도를 보였다. 이에 비해 상악 피개의치의 경우에는 아직 의견 일치가 없고, 연구가부족한 상황이다. Raghoebar 등2은 체계적 고찰연구에서 임플란트 개수, 임플란트 연결 유무에 따라 임플란트와 피개의치의 생존율을 비교해 보았다. 4개 이상의 임플란트를 연결하여 피개의치를 제작할 때높은 임플란트와 피개의치 생존율을 보였고, 4개 이하의 임플란트를 연결하지 않고 피개의치를 제작할때 낮은 임플란트, 피개의치 생존율을 보였다. 또, 더 넓게 분포된 임플란트를 통한 피개의치 제작의 경우 더 좋은 예후를 보였다. Sadowsky3는 체계적 고찰연구에서 상악 피개의치에 대해 임플란트 개수, 임플란트 생존율, 고정 설계방식, 임플란트 실패와 부작용에 미치는 영향 등을 조사하였다. 연구 결과에 의하면 임플란트 개수에 대해서는 명확한 기준이 없었고, 구개 피개 없이 성공적인 피개의치 치료를 위해서는 4개 이상의 임플란트를 식립해야 한다고 하였다.D udley4 또한 그의 논문에서 상악에서 임플란트개수, 연결 유무, 부착장치 종류, 환자 만족도, 유지 관리 등 여러 측면에서 피개의치에 대해 조사하였으나 결론적으로 많은 논문에서 결과가 일치하지 않고 기준이 명확하지 않다고 발표하고 있다. Jemt 등5 은 피개의치를 위한 임플란트 개수는 상악에서 하악보다 많이 필요하다고 하였다. 이는 상악 골질이 하악 골질보다 좋지 않은 데서 비롯한 이론이다. 하악에서는 2개 이상의 임플란트를 이용한 피개의치가추천되는 반면, 상악에서는 최소한 4개의 임플란트를 이용해야 한다는데 대부분의 논문에서 동의하고있는 바이다. 4개 이상의 임플란트를 이용하는 경우에서는 임플란트 생존율에 큰 차이는 없다고 보고하고 있다. 이 외에도 몇몇 연구들이 상악 피개의치에 대한 기준을 제시하고 있으나, 아직 많은 연구들이 진행되지 않은 상황이고, 명확한 기준이 제시되지 않고 있다. 이에 본 논문에서는 상악 피개의치에서 부착장치시스템, 임플란트 개수에 따른 예후를 임플란트 생존율, 임상적 평가, 변연골 흡수 측면에서 여러 논문들을 참고로 정리하고자 한다. V. 결론 : 다양한 부착장치를 4개 이상의 임플란트를 이용하여 상악 임플란트 피개의치를 제작한다면 임상적으로 성공적인 결과를 얻을 수 있을 것이다 .

Implant and root supported overdentures - a literature review and some data on bone loss in edentulous jaws

Gunnar E Carlsson 대한치과보철학회 2014 The Journal of Advanced Prosthodontics Vol.6 No.4

PURPOSE To present a literature review on implant overdentures after a brief survey of bone loss after extraction of all teeth. MATERIALS AND METHODS Papers on alveolar bone loss and implant overdentures have been studied for a narrative review. RESULTS Bone loss of the alveolar process after tooth extraction occurs with great individual variation, impossible to predict at the time of extraction. The simplest way to prevent bone loss is to avoid extraction of all teeth. To keep a few teeth and use them or their roots for a tooth or root-supported overdenture substantially reduces bone loss. Jaws with implant-supported prostheses show less bone loss than jaws with conventional dentures. Mandibular 2-implant overdentures provide patients with better outcomes than do conventional dentures, regarding satisfaction, chewing ability and oral-health-related quality of life. There is no strong evidence for the superiority of one overdenture retention-system over the others regarding patient satisfaction, survival, peri-implant bone loss and relevant clinical factors. Mandibular single midline implant overdentures have shown promising results but long-term results are not yet available. For a maxillary overdenture 4 to 6 implants splinted with a bar provide high survival both for implants and overdenture. CONCLUSION In edentulous mandibles, 2-implant overdentures provide excellent long-term success and survival, including patient satisfaction and improved oral functions. To further reduce the costs a single midline implant overdenture can be a promising option. In the maxilla, overdentures supported on 4 to 6 implants splinted with a bar have demonstrated good functional results.

Implant and root supported overdentures - a literature review and some data on bone loss in edentulous jaws

Carlsson, Gunnar E. The Korean Academy of Prosthodonitics 2014 The Journal of Advanced Prosthodontics Vol.6 No.4

PURPOSE. To present a literature review on implant overdentures after a brief survey of bone loss after extraction of all teeth. MATERIALS AND METHODS. Papers on alveolar bone loss and implant overdentures have been studied for a narrative review. RESULTS. Bone loss of the alveolar process after tooth extraction occurs with great individual variation, impossible to predict at the time of extraction. The simplest way to prevent bone loss is to avoid extraction of all teeth. To keep a few teeth and use them or their roots for a tooth or root-supported overdenture substantially reduces bone loss. Jaws with implant-supported prostheses show less bone loss than jaws with conventional dentures. Mandibular 2-implant overdentures provide patients with better outcomes than do conventional dentures, regarding satisfaction, chewing ability and oral-health-related quality of life. There is no strong evidence for the superiority of one overdenture retention-system over the others regarding patient satisfaction, survival, peri-implant bone loss and relevant clinical factors. Mandibular single midline implant overdentures have shown promising results but long-term results are not yet available. For a maxillary overdenture 4 to 6 implants splinted with a bar provide high survival both for implants and overdenture. CONCLUSION. In edentulous mandibles, 2-implant overdentures provide excellent long-term success and survival, including patient satisfaction and improved oral functions. To further reduce the costs a single midline implant overdenture can be a promising option. In the maxilla, overdentures supported on 4 to 6 implants splinted with a bar have demonstrated good functional results.

상악 임플란트 overdenture에서 anchorage system과 의치상 구개피개가 하중전달에 미치는 영향

제홍지,전영찬,정창모,임장섭,황재석,Je, Hong-Ji,Jeon, Young-Chan,Jeong, Chang-Mo,Lim, Jang-Seop,Hwang, Jai-Sug 대한치과보철학회 2004 대한치과보철학회지 Vol.42 No.4

Purpose: The purpose of this study was to determine the effect of anchorage systems and palatal coverage of denture base on load transfer in maxillary implant-supported overdenture. Material and methods: Maxillary implant -supported overdentures in which 4 implants were placed in the anterior region of edentulous maxilla were fabricated, and stress distribution patterns in implant supporting bone in the case of unilateral vertical loading on maxillary right first molar were compared with each other depending on various types of anchorage system and palatal coverage extent of denture base using three-dimensional photoelastic stress analysis. Two photoelastic overdenture models were fabricated in each anchorage system to compare with the palatal coverage extent of denture base, as a result we got eight models : Hader bar using clips(type 1), cantilevered Hader bar using clips(type 2), Hader bar using clip and ERA attachments(type 3), cantilevered milled-bar using swivel-latchs and frictional pins(type 4). Result: 1. In all experimental models, the highest stress was concentrated on the most distal implant supporting bone on loaded side. 2. In every experimental models with or without palatal coverage of denture base, maximum fringe orders on the distal ipsilateral implant supporting bone in an ascending order is as follows; type 3, type 1, type 4, and type 2. 3. Each implants showed compressive stresses in all experimental models with palatal coverage of denture base, but in the case of those without palatal coverage of denture base, tensile stresses were observed in the distal contralateral implant supporting bone. 4. In all anchorage system without palatal coverage of denture base, higher stresses were concentrated on the most distal implant supporting bone on loaded side. 5. The type of anchorage system affected in load transfer more than palatal coverage extent of the denture base. Conclusion: To the results mentioned above, in the case of patients with unfavorable biomechanical conditions such as not sufficient number of supporting implants, short length of the implant, and poor bone quality, selecting a resilient type attachment or minimizing the distal cantilevered bar is considered to be an appropriate method to prevent overloading on implants by reducing cantilever effect and gaining more support from the distal residual ridge.

상악 완전 무치악 환자에서 CM LOCⓇ PekktonⓇ attachment를 이용한 임플란트 유지 피개의치 수복 증례

홍문기,신수연 대한턱관절교합학회 2017 구강회복응용과학지 Vol.33 No.4

Treatment options for edentulous patients are complete denture and implant prosthesis. A two implant-retained overdenture can be considered the first treatment in the edentulous mandible, but there is no clear consensus of treatment for edentulous maxilla. Implant-retention/support overdenture shows better retention and stability than complete denture and is less expensive and more esthetic than implant-supported fixed prosthesis. CM LOC® Pekkton® attachment is a solitary type attachment and evaluated to have excellent abrasion resistance and retention with a female part made of poly-ether-ketone-ketone. Meanwhile, SR Ivocap system is injection molding method and discussed to show few changes in the vertical dimension of denture and have excellent fracture resistance. In this case, we restored maxillary arch with a four implant-retained overdenture using CM LOC® Pekkton® and SR Ivocap system, and mandibular arch with a removable partial denture. Through this procedure, satisfactory outcomes were achieved both in functional and esthetic aspects.

CAD/CAM으로 제작된 milled titanium bar와 Locator®를 이용한 상악 임플란트 유지 피개의치: 증례보고

김민정,오상천,허윤혁 대한턱관절교합학회 2014 구강회복응용과학지 Vol.30 No.1

The purpose of this case report is to introduce milled titanium bar with Locator® that made by CAD/CAM for implant supported overdenture in maxillary edentulous patients. For over 2 years, in terms of function and esthetics, satisfactory result was obtained.

CAD/CAM으로 제작된 milled titanium bar와 Locator<SUP>®</SUP>를 이용한 상악 임플란트 유지 피개의치: 증례보고

김민정(Min-Jeong Kim),오상천(Sang-Chun Oh),허윤혁(Yoon-Hyuk Huh) 대한턱관절교합학회 2014 구강회복응용과학지 Vol.30 No.1

상악 무치악 환자에서 가공 지르코니아 바와 PEKK 슬리브를 이용한 임플란트 피개의치 증례

주진석(Jin-Seok Ju),조진현(Jin-Hyun Cho),이청희(Cheong-Hee Lee) 대한턱관절교합학회 2017 구강회복응용과학지 Vol.33 No.4

상악 완전 무치악 환자에서 CM LOC<SUP>Ⓡ</SUP> Pekkton<SUP>Ⓡ</SUP> attachment를 이용한 임플란트 유지 피개의치 수복 증례

홍문기(Mun Gi Hong),신수연(Soo-Yeon Shin) 대한턱관절교합학회 2017 구강회복응용과학지 Vol.33 No.4

상악 완전 무치악에서 Locator<SUP>Ⓡ</SUP> attachment가 장착된 milled titanium bar를 이용한 임플란트 지지 피개의치

오상천(Sang-Chun Oh),한지석(Ji-Suk Han),김민정(Min-Jeong Kim) 대한턱관절교합학회 2011 구강회복응용과학지 Vol.27 No.2