定期支持性维护对牙列缺失患者牙槽骨吸收的影响及相关因素分析-现代医学

定期支持性维护对牙列缺失患者牙槽骨吸收的影响及相关因素分析

单位：南京大学医学院附属口腔医院, 南京市口腔医院, 南京大学口腔医学研究所, 江苏南京 210018

分类号：R783.4

出版年·卷·期（页码）：2026·54·第五期（786-793）

摘要：

目的：探讨牙列缺失患者在全口义齿修复后2年内，缺乏定期支持性维护是否与牙槽骨的加速吸收相关，并分析其相关因素。方法：回顾性纳入2020年6月至2023年12月于我院接受全口义齿修复的牙列缺失患者356例。根据随访期内是否接受定期支持性维护分为两组：规律维护组(每3~6个月复诊，2年内维护次数≥4次，n=168)与缺乏维护组(≥12个月未复诊或2年内维护次数≤1次，n=188)。主要结局为2年内牙槽骨高度和宽度吸收量，基于锥形束计算机体层摄影术(CBCT)或标准化全景片测量。采用多重线性回归分析牙槽骨吸收的相关因素。结果：2年内，缺乏维护组的牙槽骨高度吸收量为(1.42±0.84) mm，显著高于规律维护组的(0.86±0.63) mm(均数差为0.56 mm，95%CI 0.41~0.71，P<0.001)；宽度吸收方面，缺乏维护组(1.95±1.10) mm亦显著高于规律维护组(1.21±0.92) mm(均数差为0.74 mm，95%CI 0.47~1.01，P<0.001)。时间趋势分析显示，缺乏维护组在修复后第1年的吸收量占2年总吸收量的63.3%。多因素回归分析显示，缺乏维护(β=0.478，P<0.001)、吸烟(β=0.218，P=0.008)、糖尿病控制不佳(β=0.273，P=0.005)、牙周炎史(β=0.182，P=0.017)及下颌骨(与上颌骨相比，β=0.158，P=0.036)与牙槽骨吸收量增加呈正相关。年龄及性别与骨吸收量无显著相关性(P>0.05)。结论：在全口义齿修复后，缺乏定期支持性维护与牙列缺失患者2年内牙槽骨加速吸收显著相关。吸烟史、糖尿病控制不佳、牙周炎史及下颌骨是牙槽骨吸收的独立相关因素。建议将定期支持性维护纳入全口义齿修复后的常规管理方案。

Objective: To investigate whether the absence of regular supportive maintenance within 2 years after complete denture rehabilitation is associated with accelerated alveolar bone resorption in edentulous patients, and to analyze related factors. Methods:This retrospective study included 356 edentulous patients who received complete denture treatment at our institution between June 2020 to December 2023. Based on whether regular supportive maintenance was performed during follow-up, patients were divided into two groups: the regular maintenance group(follow-up every 3-6 months, with ≥4 maintenance visits within 2 years, n=168) and the lack-of-maintenance group(no follow-up for ≥12 months or ≤1 maintenance visit within 2 years, n=188). The primary outcomes were the amount of alveolar bone height and width resorption within 2 years, measured using cone-beam computed tomography(CBCT) or standardized panoramic radiographs. Multiple linear regression analysis was used to analyze factors associated with alveolar bone resorption.Results: Within 2 years, the alveolar bone height resorption in the lack-of-maintenance group was(1.42±0.84) mm, which was significantly greater than that in the regular maintenance group(0.86±0.63) mm(mean difference 0.56 mm, 95%CI 0.41~0.71, P<0.001). For width resorption, the lack-of-maintenance group(1.95±1.10) mm also showed significantly greater loss than the regular maintenance group(1.21±0.92) mm(mean difference 0.74 mm, 95%CI: 0.47~1.01, P<0.001). Time trend analysis showed that in the lack-of-maintenance group, bone resorption(1.00±0.58) mm during the first year after rehabilitation accounted for 63.3% of the total 2-year resorption(1.58±0.91) mm. Multiple regression analysis showed that lack of maintenance(β=0.478, 95%CI 0.319~0.637, P<0.001), smoking(β=0.218, 95%CI 0.057~0.379, P=0.008), poor glycemic control in diabetes(β=0.273, 95%CI 0.082~0.464, P=0.005), history of periodontitis(β=0.182, 95%CI 0.033~0.331, P=0.017), and mandibular location(vs. maxilla, β=0.158, 95%CI 0.011~0.305, P=0.036) were positively associated with increased alveolar bone resorption. Age and sex showed no significant association with bone resorption(P>0.05).Conclusion: After complete denture rehabilitation, the absence of regular supportive maintenance is significantly associated with accelerated alveolar bone resorption within 2 years in edentulous patients. Smoking, poor diabetes control, history of periodontitis, and mandibular location are independent factors associated with increased bone resorption. Regular supportive maintenance should be incorporated into the routine post-treatment management for complete denture patients.

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