目的:选择四个或六个植入物来支持直接全足弓固定假体(FAFP)在世界范围内仍然存在争议。本研究旨在分析和比较All-on-4和All-on-6的长期结果。
方法:这项回顾性队列研究纳入了217名患者,这些患者使用1222种植入物支持271种FAFP,包括由4个植入物(All-on-4组)支持的202个假体和由6个植入物(All-on-6组)支持的69个假体,并随访3-13年。种植体存活,假体存活,并发症,评估并比较两组的种植体边缘骨丢失(MBL)。患者特征包括年龄,性别,下巴,牙列相反的情况,吸烟习惯,磨牙症,骨的数量和质量,悬臂长度(CL),假体材料,并对其口腔卫生情况进行分析,评估其对两组临床结果的影响。六位外科医生和三位执行FAFP超过5年的修复医生被邀请进行问卷调查,评估患者和临床医生对植入物数量的相关影响。
结果:一般来说,All-on-4组显示植入物存活率与All-on-6组无显着差异(植入物水平:风险比[HR]=1.0[95%置信区间(CI):0.8-1.2],P=0.96;假体水平:HR=0.8[95%CI:0.3-1.8],P=0.54),假体存活率(比值比[OR]=0.8[95%CI:0.3-2.8],P=0.56),生物并发症(OR=0.9[95%CI:0.5-1.8],P=0.78),临时假体的技术并发症(OR=1.3[95%CI:0.7-2.3],P=0.42),确定性假体的技术并发症(OR=1.1[95%CI:0.6-2.2],P=0.33)和第一,5th,10年MBL(P=0.65,P=0.28,P=0.14)。然而,对于特定的协变量,包括老年患者,相对的自然/固定牙列,吸烟,磨牙症,长CL,骨密度低,和所有丙烯酸临时假体,在某些临床测量中,All-on-6比All-on-4更可预测。种植体修复医生和中等经验的临床医生对All-on-6有显著的偏好(P<0.05)。
结论:基于这项研究,长期临床结果显示,All-on-4和All-on-6组之间没有显着差异。然而,对于一些特定的特征,在某些临床测量中,All-on-6似乎比All-on-4更可预测。对于临床医生的决策,中等经验的临床医生和种植体修复医生对All-on-6表现出明显的偏好。
OBJECTIVE: Choosing four or six implants to support immediate full-arch fixed prostheses (FAFPs) is still controversial worldwide. This study aims to analyze and compare the long-term results of All-on-4 and All-on-6.
METHODS: This retrospective cohort study enrolled 217 patients rehabilitated with 1222 implants supporting 271 FAFPs, including 202 prostheses supported by 4 implants (All-on-4 group) and 69 prostheses supported by 6 implants (All-on-6 group), and followed up for 3-13 years. Implant survival, prosthesis survival, complications, and implant marginal bone loss (MBL) were evaluated and compared between two groups. Patient characteristics including age, gender, jaw, opposite dentition condition, smoking habit,
bruxism, bone quantity and quality, cantilever length (CL), prosthesis material, and oral hygiene were analyzed to assess their influence on the clinical results of the two groups. Six surgeons and three prosthodontists who performed FAFPs more than 5 years were invited for questionnaires, to assess patient- and clinician-related influences on implant number.
RESULTS: In general, All-on-4 group indicated no significant difference with All-on-6 group in the implant survival (implant-level: hazard ratio [HR] = 1.0 [95% confidence interval (CI): 0.8-1.2], P = 0.96; prosthesis-level: HR = 0.8 [95% CI: 0.3-1.8], P = 0.54), prosthesis survival (odds ratio [OR] = 0.8 [95% CI: 0.3-2.8], P = 0.56), biological complications (OR = 0.9 [95% CI: 0.5-1.8], P = 0.78), technical complications of provisional prosthesis (OR = 1.3 [95% CI: 0.7-2.3], P = 0.42), technical complications of definitive prosthesis (OR = 1.1 [95% CI: 0.6-2.2], P = 0.33) and the 1st, 5th, and 10th year MBL (P = 0.65, P = 0.28, P = 0.14). However, for specific covariates, including elderly patients, opposing natural/fixed dentition, smoking,
bruxism, long CL, low bone density, and all acrylic provisional prostheses, All-on-6 was more predictable in some clinical measurements than All-on-4. The implant prosthodontists and the medium-experienced clinicians showed significant preference for All-on-6 (P < 0.05).
CONCLUSIONS: Based on this study, the long-term clinical results showed no significant difference between All-on-4 and All-on-6 groups in general. However, for some specific characteristics, All-on-6 seemed to be more predictable in some clinical measurements than All-on-4. For the clinicians\' decision-making, medium-experienced clinicians and the implant prosthodontists showed significant preference for All-on-6.