Neposredno opterećenje posteriornih implantata u mandibuli primenom definitivnog i privremenog nosača: šestomesečni rezultati prospektivnog randomizovanog kontrolisanog split-mouth kliničkog istraživanja
Sažetak
Uvod/Cilj. S obzirom na to da česta manipulacija nosačem (abutment-om) tokom neposrednog opterećenja može imati negativan uticaj na okolna tvrda i meka tkiva oko implantata, u svakodnevnu kliničku praksu uveden je i dokumentovan koncept „jedan po jedan nosač” (one abutment at one time – OAO). Cilj rada bio je da se tokom perioda praćenja od šest meseci procene promene u nivou periimplantne marginalne kosti, kliničkim i radiografskim parametrima i perspektivi pacijenata. Metode. Studija je osmišljena kao randomizovano kontrolisano kliničko ispitivanje. Pacijenti sa bilateralno zalečenim mestima u posteriornoj mandibuli dobili su implantate prečnika ne manjeg od 3,5 mm i dužine od najmanje 8 mm. Na osnovu randomizacije, pacijenti su podeljeni u testiranu grupu i kontrolnu grupu. Pacijenti u testiranoj grupi dobili su implantate neposredno opterećene odgovarajućim definitivnim nosačom, dok su pacijenti u kontrolnoj grupi dobili implantate na koje su postavljene kapice za zarastanje, a zatim privremeni nosači. Implantati su u prvih sedam dana neposredno opterećeni privremenim zubnim nadoknadama koje su postavljene preko definitivnih nosača u testiranoj grupi i preko privremenih nosača u kontrolnoj grupi. Praćeni klinički parametri bili su dubina sondiranja, krvarenje na provokaciju, nivo pripojnog epitela, plak indeks i širina keratinizovanog tkiva. Zabeleženi su rezultati upitnika mere ishoda i percepcije od strane pacijenata i upitnika o zadovoljstvu i uticaju na oralno zdravlje (Oral Health Impact Profile 19 – OHIP-19). Rezultati. Od ukupno 24 uključena pacijenta, 22 su završila šestomesečno praćenje. Gubitak kosti oko implantata između ispitivanih grupa bio je uporediv (mezijalno: t = -0,798, df = 21, p = 0,434; distalno: t = 1,688, df = 21, p = 0,106), bez statističke međugrupne značajnosti. Ukupni rezultati OHIP-19 upitnika značajno su se smanjili posle tri meseca i ostali slični šest meseci nakon ugradnje implantata u obe grupe, bez statistički značajne kliničke promene među grupama. Zaključak. Pimena OAO koncepta opterećenja privremenim nosačom pokazala je uporedivu efikasnost u pogledu neposrednog opterećenja posteriornih pojedinačnih implantata.
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