Uticaj gradivnih materijala na uspešnost implantatno-protetske terapije

Abstract

Modernu stomatologiju karakteriše ogroman napredak u tehnologiji izrade zubnih nadoknada, ali i pojava velikog broja novih gradivnih materijala. Upoređivanje dva različita materijala pod istim uslovima jedan je od načina za razumevanje različitosti između njih. Poli-etar-etar-keton je polimer koji ima mnogo potencijala u stomatologiji, kao i već uveliko poznata litijum-disilikatna staklo keramika. Ciljevi. Cilj ove doktorske disertacije je bio da se uporede stepen preživljavanja i stepen uspešnosti implantatno-protetske terapije izradom litijum-disilikatnih i poli-etar-etar-keton (PEEK) implantatno nošenih zavrtnjem retiniranih pojedinačnih kruna metodom podeljenih usta, procena estetskih svojstava i zadovoljstva zubnih nadoknada, analiza kvaliteta života subjektivnim tehnikama pacijenata pre i nakon implantatno-protetske terapije, analiza estetskih parametara mekog tkiva i estetskih parametara samih nadoknada od strane terapeuta, procena periimplantatno mekotkivnog zarastanja i periimplantatne koštane resorpcije u različitim opservacionim periodima, merenje vremena potrebnog za izradu i procena jednostavnosti izrade obe vrste nadoknada od strane zubnih tehničara. Materijal i metod. Ovo istraživanje je sprovedeno kao prospektivna randomizovana klinička studija, sa opservacionim periodom od godinu dana, tokom kojeg su u kontrolnim intervalima rezultati analizirani i međusobno poređeni. Celokupno istraživanje sprovedeno je na Klinici za stomatološku protetiku i na Klinici za oralnu hirurgiju Stomatološkog fakulteta Univerziteta u Beogradu. Na ugrađenim implantatima BlueSky®(Bredent, Senden, Nemačka), nakon perioda oseointegracije, izrađene su krunice od PEEK materijala fasetirane kompozitnim materijalima (BioHpp®) i krunice od presovane litijum-disilikatne keramike (Ips e.max press®) u cut-back body formi, fasetirane feldspatnom keramikom. Upoređivanje je izvedeno metodom podeljenih usta litijum-disilikatnih i poli-etar-etar-keton (PEEK) implantatno nošenih zavrtnjem retiniranih pojedinačnih kruna pomoću subjektivnih i objektivnih parametara. Analizirani su stepen preživljavanja i uspešnosti nadoknada, estetska procena i zadovoljstvo zubnom nadoknadom evaluirana od strane pacijenata pomoću vizuelno-analogne skale (VAS), kvalitet života analiziran OHIP testom, terapeutska analiza nadoknade pomoću CIS (Copenhagen Index Score), Mombelijev plak indeks (MPI) i indeks krvarenja (MBI), dubina periimplantatnog džepa (PPD), radiografska analiza periimplantatne koštane resorpcije, vreme potrebno za izradu obe vrsta nadoknada, kao i procena jednostavnosti izrade nadoknada vizuelnoanalognom skalama (VAS) od strane zubnih tehničara. Rezultati. Analiza kvaliteta života pre i nakon postavljanja nadoknada nošenih implantatima pokazuje statistički značajnu razliku. Rezultati VAS za estetska svojstva ne pokazuju razliku, dok rezultati zadovoljstva nadoknadom ukazuju na statistički značajnu razliku između poređenih grupa. Poređenjem dobijenih rezultata PEEK krunica i litijum-disilikatnih krunica, nije uočena statistički značajna razlika merena za MBI i MPI u nultom vremenu, kao ni nakon 6 i 12 meseci. Uočena je statistički značajna razlika za PPD nakon 12 meseci na oralnoj strani...

Expansion of new production technologies characterizes modern dentistry, as well as many new materials on the market. Comparing two materials under the same conditions is the best way for defining differences between them. Polyetheretherketone (PEEK) is a polymer that has many potential uses in dentistry, the same as already well-known lithium disilicate ceramics. Aim. The aim of this doctoral thesis was to compare lithium disilicate and polyetheretherketone (PEEK) implant screw-retained solo crowns using the split-mouth design for analyzing the success and survival rate, the esthetic and restoration satisfaction evaluation by patient subjective techniques, quality of life evaluation, aesthetic soft tissue parameters and aesthetic restoration parameters evaluated by the therapist, evaluation of peri-implant soft tissue healing and peri-implant bone resorption in different observation periods, measuring the time required for the crown production and the simplicity evaluation for production phases between the two observed groups of crowns. Materials and Methods. This study was conducted as a prospective randomized clinical study, with an observation period of one year, during which the results were analyzed and compared with each other at control intervals. The entire research was conducted at the Clinic for Dental Prosthetics and the Clinic for Oral Surgery, School of Dentistry, University of Belgrade. After the implant osseointegration period (BlueSky® (Bredent, Senden, Germany)), crowns were made of PEEK material veneered with composite materials (BioHpp®) and pressed lithium-disilicate ceramics (E.max press®) in cut-back body form veneered with feldspathic ceramic. Comparison of lithium-disilicate and poly-ether-ether-ketone (PEEK) implant-supported screw-retained crowns using split-mouth design was evaluated with subjective and objective parameters. The analyses included patient’s aesthetic assessment and dental restoration satisfaction using visual-analogue scales (VAS), quality of life using OHIP test, therapist’s aesthetic crown analysis using CIS (Copenhagen Index Score), Mombelli Plaque Index (MPI) and Bleeding Index (MBI), periimplant pocket depth (PPD), radiographic analysis of peri-implant bone resorption and time measurement required for making both types of restorations, which were evaluated by dental technicians, as well as evaluting the simplicity for production both observed groups of crowns. Results. Comparing the results between PEEK crowns and already studied lithium disilicate crowns, showed that there were no statistical significances in values of MPI and MBI clinical parameters in baseline time, after 6 and 12 months. Clinical examination of PPD showed a statistically significant difference in values of these clinical parameters measured after 12 months on the oral side. Results for VAS for the esthetics showed no statistically significant difference between the groups, while VAS for restoration satisfaction showed a statistically significant difference.