즉시 혹은 조기하중 임프란트에 관한 후향적 연구
Retrospective Clinical Study of Immediate or Early Loading of Implants
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임프란트 식립 후 골유착을 얻기 위해서는 하중이가해지지 않는 상태에서 일정 치유기간을 부여하는 것이 원칙으로 되어 있다. 즉 조기에 하중이 가해질 경우임프란트-골 계면에 섬유성 조직이 개입하면서 골유착을 얻지 못하는 것으로 알려져 있다1). 또한 여러 문헌에서 임프란트 식립 후의 과도한 하중이 가해질 경우, 방사선학적으로 수평 및 수직 변연골 흡수를 보였다는 보고가 있다2). 전통적으로 machined-surface 임프란트에서는식립 이후 성공적인 임프란트 골유착을 위해서 통상상악 6개월, 하악 3개월 정도의 치유 기간이 추천되어왔다3). 특히 Albrektsson 등은 임프란트 식립 후 처음 1개월이 가장 중요하며 이 기간 중에 과도한 하중을 가하면 골생성과 골흡수 간의 균형이 파괴되어 결국 섬유성 결합조직이 생기면서 골유착 실패로 이어질수 있다고 하였다4). 그러나 최근 들어 특별히 설계된micro-tophographic 임프란트에서는 치유 기간을 단축했을 때 골·임프란트 접촉 면적이 증가하는결과를 보이는 조직학적 연구들이 발표되었다. 임프란트의 표면 디자인, 시간이 절약되는 수술 기법 및 보철적인 기술 등의 활용으로 환자들은 이전보다 무치악으로 지내는 기간을 단축하고 보다 빨리 기능을 회복하는 것이 가능해졌다3). 저자 등은 임프란트 식립 후 임시 수복물 장착을 통해 즉시 혹은 조기 하중을 가한 증례들을 대상으로 하중 기간 및 부위, 상부 보철물의 종류에 따른 치조정수직 골흡수 및 합병증의 발생을 조사하고자 본 연구를 시행하게 되었다.
Abstract
Introduction. In this study, we applied the immediate loading to implant using temporary prosthesis, and compared the treatment results by each placement site, amongst pre-loading period. The study was intended to search for occurrence of complications and the amount of marginal bone resorption. Materials and Methods. We retrospectively reviewed the medical records of 99 cases of implants from 29 patients who were treated at Seoul National University Bundang Hospital from September 2003 to September 2008. We grouped all the cases by placement arches and pre-loading periods, and subdivided each group by placement site(anterior/posterior), type of prosthesis(fullmouth cross splinting/Partial multiple splinting, Single). Results. In the cases of anterior maxilla, the average amounts of marginal bone resorption showed 1.71±0.71mm in group 1,and 1.44±0.69㎜ in group 2, which means they revealed no statistically significant difference between group 1 and group 2(p=0.646). In the cases of posterior maxilla, the average amounts of marginal bone resorption showed 1.25±0.72㎜ in group 1,and 1.14±1.15㎜ in group 2, which means they were not statistically significant. In the cases of anterior mandible, there was no cases classified as group 4, but the average amounts of marginal bone resorption in group 3 showed 1.38±0.79㎜. In the cases of posterior mandible, Group 3 showed 1.39±0.64㎜, and group 4 showed 1.84±1.19㎜ as amounts of marginal bone resorption,which means they revealed no statistically significant difference between group 3 and group 4(p=0.210). The survival rate of group1 was 97.14%, 92.1% of group3, and 100% of group 2 and group4. According to each type of prosthesis, each average amount of marginal bone resorption revealed no statistically significant difference in maxilla(p=0.575) in mandible(p=0.206). Conclusion. It is concluded that the marginal bone resorption and the rate of complications might not be affected by placement sites and pre-loading periods. The marginal bone resorption and the rate of complications might vary as different bone quality of placement site and implant system, diameter, length, etc. It is suggested that the proper placement of immediate loading implants decreases the whole treatment period and any inconvenience occurred to patients.
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