单纯锥度固位种植体早期失败的危险因素分析

doi:10.7518/hxkq.2025.2025045

摘要/Abstract

摘要：

目的探讨单纯锥度固位种植体早期失败的相关危险因素，以期为临床工作提供理论指导依据。方法收集2021年1月—2024年6月就诊于南昌大学第四附属医院口腔科，植入单纯锥度固位种植体且病历资料完整的病例，分析患者相关因素（性别、年龄、吸烟史、高血压史、糖尿病史）、种植体相关因素（种植体长度、直径、表面处理）及手术相关因素（植入部位、种植时机、同期上颌窦底内提升术、同期骨增量术）对种植体早期失败的影响。采用单因素和多因素分析，探讨单纯锥度固位种植体早期失败的潜在危险因素。结果研究共纳入1 681名患者的3 533颗单纯锥度固位种植体，其中49名患者的53颗种植体发生早期失败，早期失败率在患者水平为2.9%，在种植体水平为1.5%。多因素分析显示，吸烟（OR=2.148，P=0.021）、下颌前牙区（OR=3.669，P=0.006）、上颌后牙区（OR=2.191，P=0.033）是单纯锥度固位种植体早期失败的危险因素。在单因素分析中，同期上颌窦底内提升术具有较高早期失败风险，然而在多因素分析中该影响不再明显（P>0.05）。结论吸烟、下颌前牙区、上颌后牙区是单纯锥度固位种植体早期失败的危险因素，在术前治疗方案中应综合考虑。

关键词: 单纯锥度固位, 早期失败, 危险因素, 种植体

Abstract:

Objective To explore the related risk factors of early failure of simple taper retentive implants, and to provide theoretical guidance for clinical work. Methods Collect cases of patients who visited the Department of Stomatology of the Fourth Affiliated Hospital of Nanchang University from January 2021 to June 2024, received simple taper retentive implants, and had complete medical records. Taking the implants as the unit, analyze the influence of patient-related factors (gender, age, smoking history, hypertension history, diabetes history), implant-related factors (implant length, implant diameter, implant surface treatment), and surgical-related factors (implant site, implant timing, simultaneous maxillary sinus floor elevation, simultaneous bone augmentation) on the early failure of implants. Univariate analysis and multivariate analysis were adopted to explore the potential risk factors for early failure of simple taper retentive implants. Results A total of 3,533 simple taper retentive from 1,681 patients were included during the study period. Among them, 53 implants from 49 patients experienced early failure, with an early failure rate of 2.9% at the patient le-vel and 1.5% at the implant level. Multivariate analysis revealed that smoking (OR=2.148, P=0.021), the anterior mandibular region (OR=3.669, P=0.006), and the posterior maxillary region (OR=2.191, P=0.033) were risk factors for early failure of simple taper retentive implants. In the univariate analysis, simultaneous maxillary sinus floor elevation had a higher risk of early failure, but this effects was no longer significant in the multivariate analysis (P>0.05). Conclusion Smoking, the anterior mandibular region, and the posterior maxillary region are risk factors for the early failure of simple taper retentive implants, and could be comprehensively considered in the preoperative treatment plan.

Key words: simple taper retention, early failure, risk factor, implant

中图分类号:

R783.4

张旭, 万曾玄, 魏士博, 于飞, 曹宁, 曹良伟, 吴昊, 郭水根, 魏洪武. 单纯锥度固位种植体早期失败的危险因素分析[J]. 华西口腔医学杂志, 2025, 43(6): 780-788.

Zhang Xu, Wan Zengxuan, Wei Shibo, Yu Fei, Cao Ning, Cao Liangwei, Wu Hao, Guo Shuigen, Wei Hongwu. Analysis of risk factors for early failure of simple taper retentive implants[J]. West China Journal of Stomatology, 2025, 43(6): 780-788.

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参考文献 48

[1]	Lin ZZ, Jiang ZT, Jia SR, et al. Analysis of risk factors related to early implant failure: a retrospective study[J]. J Prosthet Dent, 2024: S0022-S3913(24)00304-4.
[2]	Munakata M, Kataoka Y, Yamaguchi K, et al. Risk factors for early implant failure and selection of bone grafting materials for various bone augmentation procedures: a narrative review[J]. Bioengineering (Basel), 2024, 11(2): 192.
[3]	Esposito M, Hirsch JM, Lekholm U, et al. Biological factors contributing to failures of osseointegrated oral implants. (I). Success criteria and epidemiology[J]. Eur J Oral Sci, 1998, 106(1): 527-551.
[4]	汤初凉, 赵世凯, 黄翠. 莫氏锥度连接在口腔种植中的应用特点及研究进展[J]. 中华口腔医学杂志, 2017, 52(1): 59-62.
	Tang CL, Zhao SK, Huang C. Features and advances of Morse taper connection in oral implant[J]. Chin J Stomatol, 2017, 52(1): 59-62.
[5]	任碧晖, 郭水根, 徐业豪, 等. 单纯锥度固位种植体应用于后牙区即刻种植5~7年的临床疗效[J]. 华西口腔医学杂志, 2023, 41(3): 341-349.
	Ren BH, Guo SG, Xu YH, et al. Clinical efficacy of simple taper retentive implants in immediate posterior dental implantation for 5-7 years[J]. West China J Stomatol, 2023, 41(3): 341-349.
[6]	Yari A, Fasih P, Alborzi S, et al. Risk factors associated with early implant failure: a retrospective review[J]. J Stomatol Oral Maxillofac Surg, 2024, 125(4): 101749.
[7]	Wu XY, Chen S, Ji W, et al. The risk factors of early implant failure: a retrospective study of 6 113 implants[J]. Clin Implant Dent Relat Res, 2021, 23(3): 280-288.
[8]	Staedt H, Rossa M, Lehmann KM, et al. Potential risk factors for early and late dental implant failure: a retrospective clinical study on 9 080 implants[J]. Int J Implant Dent, 2020, 6(1): 81.
[9]	Bornstein MM, Cionca N, Mombelli A. Systemic conditions and treatments as risks for implant therapy[J]. Int J Oral Maxillofac Implants, 2009, 24(): 12-27.
[10]	Chrcanovic BR, Albrektsson T, Wennerberg A. Reasons for failures of oral implants[J]. J Oral Rehabil, 2014, 41(6): 443-476.
[11]	Alsaadi G, Quirynen M, Michiles K, et al. Impact of local and systemic factors on the incidence of failures up to abutment connection with modified surface oral implants[J]. J Clin Periodontol, 2008, 35(1): 51-57.
[12]	Baqain ZH, Moqbel WY, Sawair FA. Early dental implant failure: risk factors[J]. Br J Oral Maxillofac Surg, 2012, 50(3): 239-243.
[13]	黄江琴, 王轶, 岑雯, 等. 种植体植入深度对边缘骨水平影响的临床研究[J]. 中国口腔种植学杂志, 2019, 24(1): 14-18.
	Huang JQ, Wang Y, Cen W, et al. Clinical study of the effect of implants with different implanting depth on marginal bone level[J].Chin J Oral Implant, 2019, 24(1):14-18.
[14]	夏勋, 胡常琦, 黄江琴, 等. 短种植体冠根比对骨改建的影响: 5年临床观察[J]. 口腔医学研究, 2020, 36(7): 683-687.
	Xia X, Hu CQ, Huang JQ, et al. Effect of crown-root ratio of short implants on bone remodeling: a 5-year clinical observation[J]. J Oral Sci Res, 2020, 36(7): 683-687.
[15]	Coelho PG, Suzuki M, Marin C, et al. Osseointegration of plateau root form implants: unique healing pathway leading to haversian-like long-term morphology[J]. Adv Exp Med Biol, 2015, 881: 111-128.
[16]	Chrcanovic BR, Kisch J, Albrektsson T, et al. Factors influencing early dental implant failures[J]. J Dent Res, 2016, 95(9): 995-1002.
[17]	张智勇, 孟甜, 陈全, 等. 种植体早期失败病例回顾性分析[J]. 北京大学学报(医学版), 2018, 50(6): 1088-1091.
	Zhang ZY, Meng T, Chen Q, et al. Retrospective ana-lysis of early dental implant failure[J]. J Peking Univ (Health Sci), 2018, 50(6): 1088-1091.
[18]	Manzano G, Montero J, Martín-Vallejo J, et al. Risk factors in early implant failure: a meta-analysis[J]. Implant Dent, 2016, 25(2): 272-280.
[19]	张磊, 张林, 尹伟, 等. 种植体修复前失败的影响因素分析[J]. 江苏医药, 2023, 49(3): 228-233.
	Zhang L, Zhang L, Yin W, et al. An analysis of risk factors for implants failure before abutment connection[J]. Jiangsu Med J, 2023, 49(3): 228-233.
[20]	Ma L, Zwahlen RA, Zheng LW, et al. Influence of nicotine on the biological activity of rabbit osteoblasts[J]. Clin Oral Implants Res, 2011, 22(3): 338-342.
[21]	杨晶晶. 吸烟对单纯锥度固位种植体临床疗效影响的研究[D]. 南昌: 南昌大学, 2023.
	Yang JJ. Study of the effect of smoking on the clinical efficacy of simple taper-retainer implants[D]. Nanchang: Nanchang University, 2023.
[22]	Chrcanovic BR, Kisch J, Albrektsson T, et al. Analysis of risk factors for cluster behavior of dental implant fai-lures[J]. Clin Implant Dent Relat Res, 2017, 19(4): 632-642.
[23]	Olmedo-Gaya MV, Manzano-Moreno FJ, Cañaveral-Ca-vero E, et al. Risk factors associated with early implant failure: a 5-year retrospective clinical study[J]. J Prosthet Dent, 2016, 115(2): 150-155.
[24]	Grisar K, Sinha D, Schoenaers J, et al. Retrospective analysis of dental implants placed between 2012 and 2014: indications, risk factors, and early survival[J]. Int J Oral Maxillofac Implants, 2017, 32(3): 649-654.
[25]	Noguerol B, Muñoz R, Mesa F, et al. Early implant fai-lure. Prognostic capacity of periotest: retrospective stu-dy of a large sample[J]. Clin Oral Implants Res, 2006, 17(4): 459-464.
[26]	Krisam J, Ott L, Schmitz S, et al. Factors affecting the early failure of implants placed in a dental practice with a specialization in implantology—a retrospective study[J]. BMC Oral Health, 2019, 19(1): 208.
[27]	刘晓强, 杨洋, 周建锋, 等. 640例单牙种植术对血压和心率影响的队列研究[J]. 北京大学学报(医学版), 2021, 53(2): 390-395.
	Liu XQ, Yang Y, Zhou JF, et al. Blood pressure and heart rate changes of 640 single dental implant surgeries[J]. J Peking Univ (Health Sci), 2021, 53(2): 390-395.
[28]	Manrique N, Pereira CC, Luvizuto ER, et al. Hypertension modifies OPG, RANK, and RANKL expression during the dental socket bone healing process in spontaneously hypertensive rats[J]. Clin Oral Investig, 2015, 19(6): 1319-1327.
[29]	Ferreira Bastos M, Vasconcelos de Araújo I, Vilhena Brilhante F, et al. Effects of lercanidipine on bone density and bone repair in spontaneously hypertensive rats[J]. Implant Dent, 2013, 22(1): 49-54.
[30]	Hamadé L, El-Disoki S, Chrcanovic BR. Hypertension and dental implants: a systematic review and meta-analysis[J]. J Clin Med, 2024, 13(2): 499.
[31]	da Rocha Costa Coelho T, Almeida de Azevedo R, Bor-ges Maia WW, et al. Evaluation of the association of early implant failure with local, environmental, and syste-mic factors: a retrospective study[J]. J Oral Maxillofac Surg, 2021, 79(6): 1237-1245.
[32]	Masri D, Bar-Hai D, Masri-Iraqi H, et al. Early implant failure in patients using antihypertensive medications: a retrospective cohort study[J]. Int Dent J, 2025, 75(2): 1081-1087.
[33]	Friberg B, Jemt T, Lekholm U. Early failures in 4 641 consecutively placed Brånemark dental implants: a stu-dy from stage 1 surgery to the connection of completed prostheses[J]. Int J Oral Maxillofac Implants, 1991, 6(2): 142-146.
[34]	Naert I, Koutsikakis G, Duyck J, et al. Biologic outcome of implant-supported restorations in the treatment of partial edentulism. part I: a longitudinal clinical evaluation[J]. Clin Oral Implants Res, 2002, 13(4): 381-389.
[35]	章惠娅, 林国芬, 管叶, 等. 种植体早期失败的相关因素分析[J]. 口腔医学, 2020, 40(6): 526-530.
	Zhang HY, Lin GF, Guan Y, et al. Analysis of factors related to early failure of implants[J]. Stomatology, 2020, 40(6): 526-530.
[36]	Alsaadi G, Quirynen M, Komárek A, et al. Impact of local and systemic factors on the incidence of oral implant failures, up to abutment connection[J]. J Clin Periodontol, 2007, 34(7): 610-617.
[37]	Geckili O, Bilhan H, Geckili E, et al. Evaluation of possible prognostic factors for the success, survival, and fai-lure of dental implants[J]. Implant Dent, 2014, 23(1): 44-50.
[38]	Yang Y, Hu HT, Zeng MY, et al. The survival rates and risk factors of implants in the early stage: a retrospective study[J]. BMC Oral Health, 2021, 21: 293.
[39]	Carr AB, Arwani N, Lohse CM, et al. Early implant fai-lure associated with patient factors, surgical manipulations, and systemic conditions[J]. J Prosthodont, 2019, 28(6): 623-633.
[40]	Pierrisnard L, Renouard F, Renault P, et al. Influence of implant length and bicortical anchorage on implant stress distribution[J]. Clin Implant Dent Relat Res, 2003, 5(4): 254-262.
[41]	张皖婷, 何家才. 82颗失败种植体的影响因素分析[J]. 中国口腔种植学杂志, 2022, 27(1): 28-33.
	Zhang WT, He JC. Analysis of the impact factors of 82 cases of failed dental implants[J]. Chin J Oral Implant, 2022, 27(1): 28-33.
[42]	刘秋阳, 林海燕. 种植体早期失败的研究进展[J]. 中国现代医药杂志, 2023, 25(11): 91-95.
	Liu QY, Lin HY. Research progress on early implant fai-lure[J]. Mod Med J China, 2023, 25(11): 91-95.
[43]	Kang DY, Kim M, Lee SJ, et al. Early implant failure: a retrospective analysis of contributing factors[J]. J Perio-dontal Implant Sci, 2019, 49(5): 287-298.
[44]	Jang HW, Kang JK, Lee K, et al. A retrospective study on related factors affecting the survival rate of dental implants[J]. J Adv Prosthodont, 2011, 3(4): 204-215.
[45]	Mohajerani H, Roozbayani R, Taherian S, et al. The risk factors in early failure of dental implants: a retrospective study[J]. J Dent (Shiraz), 2017, 18(4): 298-303.
[46]	张旭, 魏士博, 于飞, 等. 单纯锥度固位种植体在后牙区慢性根尖感染患牙即刻种植的5年临床观察[J]. 华西口腔医学杂志, 2024, 42(6): 764-772.
	Zhang X, Wei SB, Yu F, et al. Immediate implantation of simple taper retentive implants in chronic apical infected teeth in the posterior region: a 5-year clinical observation[J]. West China J Stomatol, 2024, 42(6): 764-772.
[47]	叶秋萍, 刘逢佳, 叶淑华, 等. 种植体早期失败相关因素的临床回顾性分析研究[J]. 口腔医学, 2018, 38(2): 138-142.
	Ye QP, Liu FJ, Ye SH, et al. A retrospective analysis of risk factors for early implant failure[J].Stomatology, 2018, 38(2): 138-142.
[48]	Clauser T, Lin GH, Lee E, et al. Risk of early implant failure in grafted and non-grafted sites: a systematic review and meta-analysis[J]. Int J Oral Implantol (Berl), 2022, 15(1): 31-41.

项目		n（%）
性别	男	868（51.64）
	女	813（48.36）
年龄/岁	<40	171（10.17）
	40~60	761（45.27）
	>60	749（44.56）
吸烟史	有	405（24.09）
	无	1 276（75.91）
高血压史	有	452（26.89）
	无	1 229（73.11）
糖尿病史	有	193（11.48）
	无	1 488（88.52）

项目		n（%）
植入部位	上颌前牙区	166（4.70）
	上颌后牙区	1 504（42.57）
	下颌前牙区	229（6.48）
	下颌后牙区	1 634（46.25）
种植时机	即刻种植	1 043（29.52）
	延期种植	2 490（70.48）
同期上颌窦底内提升术	有	541（15.31）
	无	2 992（84.69）
同期骨增量术	有	384（10.87）
	无	3 149（89.13）

项目		n（%）
种植体直径/mm	≤3.5	485（13.73）
	>3.5	3 048（86.27）
种植体长度/mm	≤6	980（27.74）
	>6且≤8	1 796（50.83）
	>8	757（21.43）
表面处理	HA	417（11.80）
	RBM	1 559（44.13）
	SLA	1 557（44.07）

项目		早期存留数	早期失败数	早期失败率/%	χ² 值	P值
性别	男	1 859	35	1.85	3.342	0.068
性别	女	1 621	18	1.10	3.342	0.068
年龄/岁	<40	239	1	0.42	3.024	0.220
	40~60	1 527	28	1.80
	>60	1 714	24	1.38
吸烟史	有	917	23	2.45	7.768	0.005*
吸烟史	无	2 563	30	1.16	7.768	0.005*
高血压史	有	995	18	1.78	0.736	0.391
高血压史	无	2 485	35	1.39	0.736	0.391
糖尿病史	有	468	8	1.68	0.121	0.728
糖尿病史	无	3 012	45	1.47	0.121	0.728
种植体直径/mm	≤3.5	475	10	2.06	1.200	0.273
种植体直径/mm	>3.5	3 005	43	1.41	1.200	0.273
种植体长度/mm	≤6	960	20	2.04	2.871	0.238
	>6且≤8	1 774	22	1.22
	>8	746	11	1.45
表面处理	HA	411	6	1.44	0.204	0.903
	RBM	1 534	25	1.60
	SLA	1 535	22	1.41
植入部位	上颌前牙区	164	2	1.20	12.771（Fisher精确检验）	0.004*
	上颌后牙区	1 473	31	2.06
	下颌前牙区	222	7	3.06
	下颌后牙区	1 621	13	0.80
种植时机	即刻种植	1 032	11	1.05	1.988	0.159
种植时机	延期种植	2 448	42	1.69	1.988	0.159
同期上颌窦底内提升术	有	527	14	2.59	5.114	0.024*
同期上颌窦底内提升术	无	2 953	39	1.30	5.114	0.024*
同期骨增量术	有	376	8	2.08	0.992	0.319
同期骨增量术	无	3 104	45	1.43	0.992	0.319

项目		OR值	95%CI	P值
性别	女（参照）	1.000	-	-
性别	男	1.072	0.544~2.113	0.840
吸烟史	无（参照）	1.000	-	-
吸烟史	有	2.148	1.123~4.109	0.021*
植入部位	下颌后牙区（参照）	1.000	-	-
	下颌前牙区	3.669	1.440~9.351	0.006*
	上颌后牙区	2.191	1.063~4.515	0.033*
	上颌前牙区	1.490	0.333~6.676	0.602
同期上颌窦底内提升术	无（参照）	1.000	-	-
同期上颌窦底内提升术	有	1.369	0.673~2.786	0.386