口腔疾病防治 ›› 2021, Vol. 29 ›› Issue (1): 2-10.DOI: 10.12016/j.issn.2096-1456.2021.01.001

• 专家论坛 • 上一篇    下一篇

种植初期稳定性的意义及其参数标准

许竞()   

  1. 南方医科大学口腔医院口腔颌面外科,广东 广州(510280)
  • 收稿日期:2020-03-05 修回日期:2020-06-20 出版日期:2021-01-20 发布日期:2020-11-18
  • 通讯作者: 许竞
  • 作者简介:许竞,主任医师,硕士,Email: xj463a2@163.com,Tel:86-20-84426974
    许竞,南方医科大学口腔医院口腔颌面外科主任医师,硕士研究生导师,中华口腔医学会牙槽外科专业委员会委员,《口腔疾病防治》编委。1985年毕业于西安医科大学口腔医学系,1988年毕业于华西医科大学口腔医学院口腔颌面外科学系并获口腔医学硕士学位。研究方向为微创牙槽外科和即刻种植修复。率先建立了涡轮机拔除阻生智齿的微创术式以及应用数字化技术精准定位埋伏牙微创拔除术式;对干槽症的发病机理及防治有深入研究,首次提出了医源性骨挫伤导致干槽症的病因,建立了微创清除死骨治疗干槽症的新方法,显著提高了单次手术的治愈率;运用牙槽重建技术开展各类拔牙创骨缺损的即刻种植,取得了良好的效果,并积累了丰富的经验;开发研制了牙槽外科系列手术器械,并获得多项国家专利授权。主持完成广东省科技计划项目5项,发表论文30余篇。

The significance and parameter standards of the implant primary stability

XU Jing()   

  1. Department of Oral and Maxillofacial Surgery, Stomatological Hospital , Southern Medical University, Guangzhou 510280, China
  • Received:2020-03-05 Revised:2020-06-20 Online:2021-01-20 Published:2020-11-18
  • Contact: Jing XU

摘要:

通过文献复习,梳理明确种植初期稳定性的性质、意义、测试、参数以及影响因素。种植初期稳定性即种植体-骨界面的锚固力,是一种纯粹的机械现象,其意义在于维持种植体静立不动状态,使新骨不受干扰地生长附着在种植体表面,避免纤维组织生长,最终达到骨整合。临床比较常见的初期稳定性测试方法有植入扭力(insertion torque,IT)、共振频率分析(resonance frequency analysis,RFA)的种植体稳定指数(implant stability quotient,ISQ)、叩诊试验Periotest等,以IT值更为常用,直接以IT值代替初期稳定性。目前未能就预示骨整合的初期稳定性具体参数标准形成统一认识,各个数值段初期稳定性的种植均有可能达到骨整合,但过高的初期稳定性有形成界面骨质微骨折导致骨坏死进而种植失败的可能。影响初期稳定性的因素有种植体的设计、牙槽骨骨质条件以及手术技巧三个方面。临床上在初期稳定性欠佳的情况下,即刻种植仍有获得成功骨整合的可能,需要重新审视现有测量初期稳定性手段的准确性,这直接关联临床是否能够选择正确合适的种植治疗路径。

关键词: 牙种植, 初期稳定性, 植入扭力, 骨整合, 共振频率分析, 叩诊试验, 种植体稳定指数, 主动初期稳定性, 被动初期稳定性

Abstract:

The nature, significance, parameters, influencing factors and testing of implant primary stability were studied by a literature review. Primary stability is a kind of anchorage force at the interface between the implant and bone, and it is merely mechanical. The significance of primary stability is to keep the implant unmovable so that the new bone can grow undisturbed on the surface of the implant without interference from fibrous tissue. The implant is finally bound to the bone by osseointegration. The most common assessments of primary stability are insertion torque (IT), the implant stability quotient (ISQ) of the resonance frequency analysis (RFA) and Periotest. IT is more commonly used to directly imply initial stability. At present, no consensus has been reached regarding the concrete parameters of primary stability to predict osseointegration. Implant osseointegration could be developed through all phases of primary stability. However, the excessive primary stability would cause mini-bone fractures, followed by bone necrosis at the interface and the final failure of implantation. Primary stability is influenced by three factors: implant design, bone condition of alveolar bone, and surgical technique. Under the condition of a lack of primary stability and immediate implantation, there may be the possibility of successful osseointegration. Therefore, it is necessary to re-examine the accuracy of the current elaboration on the primary stability. It is related directly to whether the clinic can choose the appropriate implant treatment path.

Key words: teeth implantation, primary satbility, insertion torque, osseointegration, resonance frequency analysis, Periotest, implant stability quotient, active primary stability, passive primary stability