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방사선 조사된 상악골에서 all-on-4 임플란트에 의해 지지되는 지르코니아 고정성 보철물 수복 증례
Zirconia ceramic fixed dental prosthesis with all-on-4 concept implants for irradiated maxilla: A case report 원문보기

대한치과보철학회지 = The journal of Korean academy of prosthodontics, v.55 no.2, 2017년, pp.218 - 224  

최은주 (원광대학교 치과대학 구강악안면외과학교실) ,  조혜원 (원광대학교 치과대학 치과보철학교실)

초록
AI-Helper 아이콘AI-Helper

방사선치료를 받은 상악에 임플란트 지지 고정성 보철물을 이용하여 수복하는 것은 골치유능력이 낮기 때문에 상세한 치료계획이 필요하다. All-on-4 개념에 의한 임플란트 식립은 골이식을 피하면서 임플란트를 매식할 수 있어 유리하다. 일반적으로 경사된 임플란트에는 기성 경사형 지대주를 사용해왔다. 본 임상증례에서는 computer-aided design and computer-aided manufacturing (CAD/CAM)으로 제작된 지대주를 사용하였다. 본 증례는 all-on-4 개념에 의해 임플란트를 매식하고 CAD/CAM titanium 지대주를 제작한 다음 CAD/CAM zirconia 고정성 보철물로 수복하여 좋은 결과를 얻었기에 보고하고자 한다.

Abstract ▼ AI-Helper 아이콘AI-Helper

The implant-supported fixed dental prosthesis in irradiated maxilla needs meticulous treatment planning due to low bone healing capacity. All-on-4 concept implantation can reduce the number of implants to be placed avoiding bone grafting procedure. Conventionally, prefabricated angled abutments for ...

주제어

#경사형 임플란트   #all-on-4 임플란트   #상악무치악 환자   #지르코니아 고정성 보철물  

AI 본문요약
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제안 방법

  • She wanted to restore maxilla only as a result of gloomy prognosis of maxillary and mandibular remaining teeth due to cervical caries and mobility. A complete-arch implant-supported fixed dental prosthesis for maxilla was planned after a thorough discussion with her.
  • After 6 months of healing, 4 implants were exposed and 30° angled abutments (Multi-unit abutment, Nobel Biocare AB, Göteborg, Sweden) and impression copings (Multi-unit impression copings, Nobel Biocare AB) were placed on 2 tilted implants.
  • 13 The marginal and internal adaptation of zirconia framework was confirmed with a dental explorer and evaluated with fit checker. Minor occlusal adjustments were done and the definitive complete-arch implant-supported fixed dental prosthesis was delivered using temporary cement at first and cemented using an adhesive resin cement (Rely X Unicem, 3M ESPE, Neuss, Germany) after 3 months (Fig. 8A). The patient has been seen every 6 months as a recall.
  • A 62-year-old woman was found with ulcerative lesion on the left maxillary tuberosity and diagnosed as squamous cell carcinoma (pT2N0M0) 7 years ago. Operation was performed including wide excision, elective neck dissection of level I to III, reconstruction of soft tissue defect with partial thickness of skin graft, and extraction of maxillary right posterior teeth. Adjunctive radiotherapy was done on primary site and ipsilateral neck with total irradiation of 6040cGy 2 month later.
  • After 3 months, the CAD/CAM abutments were retrieved and old provisional prostheses was redelivered. The CAD/CAM abutments and new provisional prosthesis were placed on the mounted cast and digitally scanned with a laboratory scanner (Ceramill Map400, Amann Girrbach, Koblach, Austria). Zirconia framework was designed with software (Ceramill Mind v 2.
  • The patient was satisfied with CAD-CAM zirconia fixed dental prostheses with all-on-4 concept implantation in edentulous maxilla. Since the zirconia-based fixed dental restorations exhibited 7% higher veneer chipping and less than 1% core fracture,17 the patient was scheduled for aggressive regular check-up.
  • 11,12 Since zirconia based, implant-supported fixed dental prosthesis showed high survival rate up to 100%,11 it could be a good substitute for metal-resin prosthesis. The purpose of this case report was to document a treatment procedure of maxillary edentulous patient with all-on-4 concept implantation using customized titanium abutments and cement-retained zirconia ceramic completearch fixed dental prostheses. Treatment goals were to improve mastication and esthetics.
  • The purpose of this case report was to document a treatment procedure of maxillary edentulous patient with all-on-4 concept implantation using customized titanium abutments and cement-retained zirconia ceramic completearch fixed dental prostheses. Treatment goals were to improve mastication and esthetics.
본문요약 정보가 도움이 되었나요?

참고문헌 (17)

  1. Zarb G, Bolender C, Eckert S, Jacob R, Fenton A, Mericske-Stern R. Prosthodontic treatment for edentulous patients. 12th ed. St. Louis: Elsevier Mosby; 2004. p. 427. 

  2. Beumer J III, Curtis TA, Marunick MT. Maxillofacial rehabilitation: prosthodontic and surgical considerations. St. Louis: Ishiyaku Euro America, Inc.; 1996. p. 65-70, 85. 

  3. Malo'P, Nobre Md, Lopes A. The rehabilitation of completely edentulous maxillae with different degrees of resorption with four or more immediately loaded implants: a 5-year retrospective study and a new classification. Eur J Oral Implantol 2011;4:227-43. 

  4. Malo'P, de Arau'jo Nobre M, Lopes A, Francischone C, Rigolizzo M. "All-on-4" immediate-function concept for completely edentulous maxillae: a clinical report on the medium (3 years) and longterm (5 years) outcomes. Clin Implant Dent Relat Res 2012;14:e139-50. 

    상세보기 crossref

  5. Malo'P, de Arau'jo Nobre MA, Lopes AV, Rodrigues R. Immediate loading short implants inserted on low bone quantity for the rehabilitation of the edentulous maxilla using an All-on-4 design. J Oral Rehabil 2015;42:615-23. 

    상세보기 crossref

  6. Barnea E, Tal H, Nissan J, Tarrasch R, Peleg M, Kolerman R. The Use of Tilted Implant for Posterior Atrophic Maxilla. Clin Implant Dent Relat Res 2016;18:788-800. 

    상세보기 crossref

  7. Kim KS, Kim YL, Bae JM, Cho HW. Biomechanical comparison of axial and tilted implants for mandibular full-arch fixed prostheses. Int J Oral Maxillofac Implants 2011;26:976-84. 

    상세보기

  8. Abdulmajeed AA, Lim KG, Narhi TO, Cooper LF. Completearch implant-supported monolithic zirconia fixed dental prostheses: A systematic review. J Prosthet Dent 2016;115:672-7. 

    상세보기 crossref

  9. Papaspyridakos P, Lal K. Computer-assisted design/computerassisted manufacturing zirconia implant fixed complete prostheses: clinical results and technical complications up to 4 years of function. Clin Oral Implants Res 2013;24:659-65. 

    상세보기 crossref

  10. Rojas-Vizcaya F. Full zirconia fixed detachable implant-retained restorations manufactured from monolithic zirconia: clinical report after two years in service. J Prosthodont 2011;20:570-6. 

    상세보기 crossref

  11. Pozzi A, Holst S, Fabbri G, Tallarico M. Clinical reliability of CAD/CAM cross-arch zirconia bridges on immediately loaded implants placed with computer-assisted/template-guided surgery: a retrospective study with a follow-up between 3 and 5 years. Clin Implant Dent Relat Res 2015;17:e86-96. 

    상세보기 crossref

  12. Kern JS, Kern T, Wolfart S, Heussen N. A systematic review and meta-analysis of removable and fixed implant-supported prostheses in edentulous jaws: post-loading implant loss. Clin Oral Implants Res 2016;27:174-95. 

  13. Tsuge T, Hagiwara Y. Influence of lateral-oblique cyclic loading on abutment screw loosening of internal and external hexagon implants. Dent Mater J 2009;28:373-81. 

    상세보기 crossref

  14. Roumanas E, Nishimura R, Beumer J, Moy P, Weinlander M, Lorant J. Craniofacial defects and osseointegrated implants: Six-year follow-up report on the success rates of craniofacial implants at UCLA. Int J Oral Maxillofac Implants 1994;9:579-85. 

    상세보기

  15. Chang JS, Ji W, Choi CH, Kim S. Catastrophic failure of a monolithic zirconia prosthesis. J Prosthet Dent 2015;113:86-90. 

    상세보기 crossref

  16. Lee DH. CAD/CAM-fabricated template for locating implant abutment screws in cement-retained anatomic zirconia restorations. J Prosthet Dent 2015;114:343-5. 

    상세보기 crossref

  17. Heintze SD, Rousson V. Survival of zirconia- and metal-supported fixed dental prostheses: a systematic review. Int J Prosthodont 2010;23:493-502. 

    상세보기

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