임플란트의 생존율에 영향을 미치는 국소적 인자에 대한 19년간의 후향적 연구
The effects of local factors on the survival of dental implants: A 19 - year retrospective study
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연구 목적: 임플란트의 성공과 실패는 숙주 관련 요인, 위치 관련 요인, 수술 관련 요인, 임플란트 관련 요인, 수복물 관련 요인 등 다양한 인자에 의해 결정된다. 본 연구는 그 중 임플란트의 식립 위치, 골질, 임플란트 표면, 길이 및 직경, 초기 안정성, 보철물 유형이 생존율에 미치는 영향을 평가하여, 임플란트의 예후를 예측하는데 도움을 주고자한다. 연구 재료 및 방법:1991년 2월부터 2009년 5월 사이에 연세대학교 치과대학병원에서 5인의 외과의가 임플란트 수술을 시행하고, 1인의 보철 전문의에 의해 보철 수복이 이루어져 적어도 6개월 이상 보철물에 대한 주기적인 검사가 이루어진 879명환자, 2796개의 임플란트에 대한 후향적 연구를 시행하였다. 진료 기록부 및 방사선 사진을 통해 환자의 식립 당시 나이와 성별, 임플란트의 제조회사, 표면, 직경 및 길이, 식립 부위 및 골질, 초기 안정성, 보철물의 유형, 생존 기간에 관한 자료를 수집하였다. 이를 통해, 임플란트의 성공과 실패에 영향을 미치는 국소 인자의 유형, 분포 및 국소 인자와 생존율 간의 관계를 연구하였다. 생존율 분석은 Kaplan-Meier 생존 분석법을 이용하였으며, 평가 인자 내 항목들의 생존율 비교는 Chi-square test를 사용하였다. 또한, 임플란트의 실패 위험성을 평가하기 위해 오즈비 (odds ratio)를 구하였다. 결과: 1. 총 879명에게 식립된 2796개의 임플란트 중 150개가 실패하여 누적 생존율은 94.64%로 나타났다. 그 중 기계 절삭 표면 임플란트의 누적 생존율은 91.76%, 거친 표면 임플란트의 누적 생존율은 96.02% 이었다. 2. 식립위치, 임플란트의 표면 특성, 기계 절삭 표면 임플란트의 직경, 초기 안정성, 보철물 유형, 환자의 연령 및 성별이 생존율에 미치는 영향은 통계학적으로 유의하였다 (P< .05). 3. 식립 부위의 골질, 임플란트 제조사별 거친 표면 특성, 임플란트의 길이 및 기계 절삭 표면을 제외한 거친 표면 임플란트의 직경이 생존율에 미치는 영향은 통계학적으로 유의하지 않았다 (P> .05). 4. 특히, 실패율이 높은 경우는 상악 구치부에 식립 시 (8.84%), 기계 절삭 표면의 임플란트 식립 시 (8.24%), 기계 절삭 표면 임플란트 중 wide 직경을 사용하는 경우 (14.47%), 초기 고정이 불량한 경우 (28.95%), 상악에 implant retained overdenture (기계 절삭 표면 26.69%; 거친 표면 10%) 및 telescopic denture (기계 절삭 표면 100%; 거친 표면 27.27%)로 수복하는 경우, 60 - 79세 환자에게 식립하는 경우 (6.90%), 남성에게 식립하는 경우 (6.36%) 이었다.
Abstract
Purpose: The aim of this retrospective study was to provide long-term data about the correlation between multifactorial local factors and the survival of implants. Material and methods: During 19 years (1991 to 2009), 2796 implants were placed in 879 patients. From dental charts and radiographs, the following data were collected: patient’s age at implant placement, gender, implant system, surface, length, diameter, location of implant placement, bone quality, primary stability, type of prosthesis. The correlations between these data and implant survival were analyzed. Statistical analysis was performed using Kaplan-Meier survival analysis, Chi-square test, odds ratio. Results: 1. Among the 2796 implants, 150 implants failed that resulted in a cumulative survival rate of 94.64%. The cumulative survival rate of smooth surface implants (91.76%) was lower than rough surface implants (96.02%). 2. Anatomic location, implant surface, diameter of smooth surface implant, primary stability, type of prosthesis, patient’s age and gender were significantly associated with implant survival (P < .05). 3. No significant difference in implant survival was found in relation to the following factors: implant length, bone quality, diameter of rough surface implants and type of rough surface according to implant manufacturer (P < .05). Conclusions: Local factors such as anatomic location, implant surface, diameter of smooth surface implant, primary stability and type of prosthesis have a significant effect on implant survival.
참고문헌 (42)
- Adell R, "A 15-year study of osseointegrated implants in the treatment of the edentulous jaw", Int J Oral Surg, 10, pp.387~416 (1981)
- Adell R, "Long-term follow-up study of osseointegrated implants in the treatment of totally edentulous jaws", Int J Oral Maxillofac Implants, 5, pp.347~359 (1990)
- Buser D, "Long-term evaluation of nonsubmerged ITI implants. Part 1: 8-year life table analysis of a prospective multi-center study with 2359 implants", Clin Oral Implants Res, 8, pp.161~172 (1997)
- Esposito M, "A 5-year follow-up comparative analysis of the efficacy of various osseointegrated dental implant systems: a systematic review of randomized controlled clinical trials", Int J Oral Maxillofac Implants, 20, pp.557~568 (2005)
- Romeo E, "Long-term survival and success of oral implants in the treatment of full and partial arches: a 7-year prospective study with the ITI dental implant system", Int J Oral Maxillofac Implants, 19, pp.247~259 (2004)
- Han DH, "Longitudinal clinical study on the efficacy of osseointegrated dental implants in partially edentulous Korean patients: an 8-years prospective study", J Korean Acad Prosthodont, 39, pp.698~708 (2001)
- 서지영, "임플랜트 지지 고정성 국소의치의 임상적, 방사선학적 평가", 대한치과보철학회지, 44(4), pp.394~404 (2006), 대한치과보철학회
- el Askary AS, "Why do dental implants fail? Part I", Implant Dent, 8, pp.173~185 (1999)
- el Askary AS, "Why do dental implants fail? Part II", Implant Dent, 8, pp.265~277 (1999)
- Albrektsson T, "Osseointegrated titanium implants. Requirements for ensuring a long-lasting, direct bone-to-implant anchorage in man", Acta Orthop Scand, 52, pp.155~170 (1981)
- Esposito M, "Biological factors contributing to failures of osseointegrated oral implants. (II). Etiopathogenesis", Eur J Oral Sci, 106, pp.721~764 (1998)
- Tonetti MS, "Pathogenesis of implant failures", Periodontol 2000, 4, pp.127~138 (1994)
- Albrektsson T, "Osseointegrated oral implants. A Swedish multicenter study of 8139 consecutively inserted Nobelpharma implants", J Periodontol, 59, pp.287~296 (1988)
- Buser D, "Tissue integration of non-submerged implants. 1-year results of a prospective study with 100 ITI hollowcylinder and hollow-screw implants", Clin Oral Implants Res, 1, pp.33~40 (1990)
- Cochran DL, "The use of reduced healing times on ITI implants with a sandblasted and acid-etched (SLA) surface: early results from clinical trials on ITI SLA implants", Clin Oral Implants Res, 13, pp.144~153 (2002)
- Bryant SR, "The effects of age, jaw site, and bone condition on oral implant outcomes", Int J Prosthodont, 11, pp.470~490 (1998)
- Shirota T, "The effect of aging on the healing of hydroxylapatite implants", J Oral Maxillofac Surg, 51, pp.51~56 (1993)
- Smith RA, "Risk factors associated with dental implants in healthy and medically compromised patients", Int J Oral Maxillofac Implants, 7, pp.367~372 (1992)
- Schwartz-Arad D, "Failure causes, timing, and cluster behavior: an 8-year study of dental implants", Implant Dent, 17, pp.200~207 (2008)
- Wagenberg B, "A retrospective study of 1925 consecutively placed immediate implants from 1988 to 2004", Int J Oral Maxillofac Implants, 21, pp.71~80 (2006)
- Misch CE, "Short dental implants: a literature review and rationale for use", Dent Today, 24, pp.64~66 (2005)
- Renouard F, "Impact of implant length and diameter on survival rates", Clin Oral Implants Res, 17, pp.35~51 (2006)
- Ivanoff CJ, "Influence of variations in implant diameters: a 3- to 5-year retrospective clinical report", Int J Oral Maxillofac Implants, 14, pp.173~180 (1999)
- Shin SW, "A retrospective study on the treatment outcome of wide-bodied implants", Int J Prosthodont, 17, pp.52~58 (2004)
- Meredith N, "The application of resonance frequency measurements to study the stability of titanium implants during healing in the rabbit tibia", Clin Oral Implants Res, 8, pp.234~243 (1997)
- Huwiler MA, "Resonance frequency analysis in relation to jawbone characteristics and during early healing of implant installation", Clin Oral Implants Res, 18, pp.275~280 (2007)
- Rabel A, "Clinical study on the primary stability of two dental implant systems with resonance frequency analysis", Clin Oral Investig, 11, pp.257~265 (2007)
- 박주희, "The effect of various thread designs on the initial stability of taper implants", The Journal of Advanced of Prosthodontics, 1(1), pp.19~25 (2009), 대한치과보철학회
- O’Sullivan D, "Measurements comparing the initial stability of five designs of dental implants: a human cadaver study", Clin Implant Dent Relat Res, 2, pp.85~92 (2000)
- Alves CC, "Tapered implants: from indications to advantages", Int J Periodontics Restorative Dent, 29, pp.161~167 (2009)
- Iezzi G, "Bone response to submerged, unloaded implants inserted in poor bone sites: a histological and histomorphometrical study of 8 titanium implants retrieved from man", J Oral Implantol, 31, pp.225~233 (2005)
- 김남숙, "Comparion of stability in titanium implants with different surface topographies in dogs", The Journal of Advanced of Prosthodontics, 1(1), pp.47~55 (2009), 대한치과보철학회
- Cochran DL, "The evidence for immediate loading of implants", J Evid Based Dent Pract, 6, pp.155~63 (2006)
- Goodacre CJ, "Clinical complications with implants and implant prostheses", J Prosthet Dent, 90, pp.121~132 (2003)
- Bryant SR, "Does the type of implant prosthesis affect outcomes for the completely edentulous arch?", Int J Oral Maxillofac Implants, 22, pp.117~139 (2007)
- Weber HP, "Does the type of implant prosthesis affect outcomes in the partially edentulous patient?", Int J Oral Maxillofac Implants, 22, pp.140~172 (2007)
- Esposito M, "Differential diagnosis and treatment strategies for biologic complications and failing oral implants: a review of the literature", Int J Oral Maxillofac Implants, 14, pp.473~490 (1999)
- Weaver AL, "The effects of smoking on the survival of smooth- and rough-surface dental implants", Int J Oral Maxillofac Implants, 23, pp.1117~1122 (2008)
- Esposito M, "Biological factors contributing to failures of osseointegrated oral implants. (I). Success criteria and epidemiology", Eur J Oral Sci, 106, pp.527~551 (1998)
- Rabel A, "Clinical study on the primary stability of two dental implant systems with resonance frequency analysis", Clin Oral Investig, 11, pp.257~265 (2007)
- Chuang SK, "Frailty approach for the analysis of clustered failure time observations in dental research", J Dent Res, 84, pp.54~58 (2005)
- Weyant RJ, "An assessment of survival rates and withinpatient clustering of failures for endosseous oral implants", J Dent Res, 72, pp.2~8 (1993)