국내에서 제작된 고정성 보철물의 수명과 실패 요인 및 양상

LONGEVITY AND FAILURE ANALYSIS OF FIXED RESTORATIONS SERVICED IN KOREA

  • 신우진 (연세대학교 치과대학 치과보철학교실) ;
  • 전영식 (연세대학교 치과대학 치과보철학교실) ;
  • 이근우 (연세대학교 치과대학 치과보철학교실) ;
  • 이호용 (연세대학교 치과대학 치과보철학교실) ;
  • 한동후 (연세대학교 치과대학 치과보철학교실)
  • Shin Woo-Jin (Department of Prosthodontics, College of Dentistry, Yonsei University) ;
  • Jeon Young-Sik (Department of Prosthodontics, College of Dentistry, Yonsei University) ;
  • Lee Keun-Woo (Department of Prosthodontics, College of Dentistry, Yonsei University) ;
  • Lee Ho-Yong (Department of Prosthodontics, College of Dentistry, Yonsei University) ;
  • Han Dong-Hoo (Department of Prosthodontics, College of Dentistry, Yonsei University)
  • 발행 : 2005.04.01

초록

Statement of problem. Every effort has been continually made to obtain objectivity in measuring the longevity of fixed restorations, such as by establishing unified judgement standard for deciding success and adopting statistical method that analyzes the data of successful and failed cases at the same time. In Korea, however desired level of development has not to be made in this field yet. Purpose. This study, adopting California Dental Association (CDA) quality evaluation system, established objective standard for deciding success, and inferred the longevity of fixed restorations and their failure analysis through adopting Kaplan-Meier survival analysis. Material and method. In order to assess the longevity of flxed restorations serviced in Korea and causes of failure, a total of 1109 individuals (aged 15-74, 716 women and 393 men loaded with 2551 unit fixed restorations, and 1934 abutments) who lived in Kyung-In Province were examined and the findings were as follows : Results. 1. Length of service of fixed restorations serviced in Korea was 6.86$\pm$0.15 yr (mean), 5.5 yr (median), and the rate of success was 65.82% in 5 year survival, and 21.15% in 10 year survival. 2. When there was patient's need for replacing old prosthetics, longevity of fixed restorations was 7.51$\pm$0.27 yr (mean), 7 yr (median), and the rate of success was 61.08% in 5 year survival, and 17.57% in 10 year survival. 3. Longevity of fixed restorations was longest in the over-sixty age group(9.21$\pm$0.66) and that of the teen age group(3.39$\pm$0.28) was shortest (p<0.05). 4. Longevity of fixed restorations of women (7.38$\pm$0.18 years) was longer than that of men (6.00$\pm$0.26) (p<0.05). 5. As for the provider factor (such as unlicensed performers, university hospitals, and private clinic), there was no statistically significant difference in longevity of fixed restorations. 6. Defective margin (34.78%). periodontal disease (12.15%), periapical involvement (11.73%), was the most frequent causes of failure and poor esthetics group showed the longest life above all (p<0.05). Actual frequent causes of failure after removing old prosthetics were defective margin, periapical involvement, periodontal disease and uncemented restoration. In 75.67% of the cases, abutment state after removing old prosthetics was good enough for loading another prosthetics. 7. There was found to have statistically significant influence between longevity of single crown (6.35$\pm$0.20 yr) and that of 3 unit fixed restorations (7.60$\pm$0.30 y) (p<0.05). In each case the most frequent cause of failure was defective margin. 8. The number of cantilever pontic, pontic/abutment ratio, oral hygiene status were found to have no statistically significant influence on longevity of fixed restorations in all groups (p>0.05). 9. Longevity of fixed restorations made of non precious metal was longest (9.60$\pm$0.40 yr) semi precious and precious trailing behind(p<0.05). 10. Group function group (37.04%) and partial group function group (44.62%) were predominant in frequency but showed no correlation between them and among different types of occlusal plane and different types of occlusal surface (p>0.05). 11. Longevity of fixed restorations was longest in the centric interference group(9.35$\pm$0.62) (p<0.05) among different types of occlusal interference. Conclusion. We found that longevity of fixed restorations serviced in Korea is affected by age, gender and type of material, and that most frequent cause of failure is defective margin. In order to assess the accurate longevity of axed restorations, unified research design. overcoming inter-observer difference and establishing the objective research items are needed. Furthermore, it is thought that prospective approach through thorough study and regular follow-ups is needed just from the start of research. Nationwide detailed studies on length of service of fixed restorations manufactured in Korea are hoped to be conducted hereafter.

키워드

참고문헌

  1. Allan DN. The Durability of conservative restorations. Br Dent J 1969;126:172-7
  2. Bentley C, Drake CW. Longevity of restorations in a dental school clinic. J Dent Educ 1986;50:594-600
  3. Cheung GSP. A preliminary investigation into the longevity and causes of failure of single unit extracoronal restorations. J Dent 1991;19:160-3 https://doi.org/10.1016/0300-5712(91)90006-K
  4. Karlsson S. Failures and length of service in fixed prosthodontics after long-term function. A longitudinal clinical study. Swed Dent J 1989;13:185-92
  5. Lindquist E, Karlsson S. Success rate and failures for fixed partial dentures after 20 years of service: part I. Int J Prostho 1998;11:133-8
  6. Odman PA ,Karlsson S. Follow-up study of patients with bridge constructions performed by private dental surgeons and at a university clinic, 8 years following insertion. J Oral Rehabil 1988;15:55-63 https://doi.org/10.1111/j.1365-2842.1988.tb00146.x
  7. Moon HY. A study on the life expectation of dental restorations. Korean academy of oral health 1985;9:51-74
  8. Korean Academy of prosthodontics. Survey and analysis on the life of prosthetics. Korean Academy of Prosthetics 2001;1-11
  9. Trapozzano VR. Selecting the correct restoration. Dent Clin North Am 1960;259-75
  10. Moore DL, Stewart JL. Prevalence of defective restorations. J Prosthet Dent 1967;17:372-8 https://doi.org/10.1016/0022-3913(67)90008-X
  11. Brown MH. Causes and prevention of fixed prosthodontic failure. J Prosthet Dent 1973;30:617-23
  12. Ryge G, Snyder M. Evaluating the clinical quality of restorations. J Am Dent Assoc 1973;87:369-77
  13. Elderlon RJ. The causes of failure of restorations: A lileralure review. J Dent 1976;4:257-63 https://doi.org/10.1016/S0300-5712(76)80002-4
  14. Elderton RJ. The prevalence of failure of restorations: a literature review. J Dent 1976;4:207-10 https://doi.org/10.1016/0300-5712(76)90049-X
  15. Cohen PA. Meta-analysis: application to clinical dentistry and dental education. J Dent Educ 1992;56:172-5
  16. Schwartz NL, Whitsett LD, Berry TG, Stewart JL. Unserviceable crowns and fixed partial dentures: life-span and causes for loss of serviceability. J Am Dent Assoc 1970;81:395-401
  17. Palmqvist S, Swartz B. Artificial crowns and fixed partial dentures 18 to 23 years after placement. Int J Prosthodont 1993;6:279-85
  18. Valderhaug JA. A 15-year clinical evaluation of fixed prosthodontics. Acta Odontol Scand 1991;49:35-40 https://doi.org/10.3109/00016359109041138
  19. California Dental Association: Quality Evaluation for Dental Care. Guidelines for the Assessment of Clinical Quality and Professional Performance. The California Dental Association 1977;Los Angeles
  20. Glantz P-O, Nilner K, Jendresen MD, Sundberg H. Quality of fixed prostho-dontics after 15 years. Acta Odontol Scand 1993;51:247-52 https://doi.org/10.3109/00016359309040574
  21. Glantz P-O, Ryge G, Jendresen MD, Nilner K. Quality of extensive fixed prosthodontics after 5 years. J Prosthet Dent 1984;52:475-9 https://doi.org/10.1016/0022-3913(84)90327-5
  22. Creugers N, Kayser A, Van't Hof MA. A meta-analysis of durability data on conventional fixed ridges. Community Dent Oral Epidemiol 1994;22:448-52 https://doi.org/10.1111/j.1600-0528.1994.tb00795.x
  23. Scurria MS, Bader JD. Shugars DA. Meta-analysis of fixed partial denture survival: Prostheses and abutment. J Prosthet Dent 1998;79:459-64 https://doi.org/10.1016/S0022-3913(98)70162-3
  24. Marynuik GA. In search of treatment longevity - a 30-year perspective. J Am Dent Assoc 1984;109:739-44
  25. Simmens RJ. Confronting publication bias: A cohort design for meta-analysis. Statistics in medicine 1987;6:11-25 https://doi.org/10.1002/sim.4780060104
  26. Reuter JE ,Brose MO. Failures in full crown retained dental bridges. Br Dent J 1984;157:61-3 https://doi.org/10.1038/sj.bdj.4805411
  27. Cheung GS, Dimmer A, Mellor R ,Gale M. A clinical evaluation of conventional bridge-work. J Oral Rehabil 1990;17:131-6 https://doi.org/10.1111/j.1365-2842.1990.tb01401.x
  28. Coornaert J, Adriaens P, De Boever J. Long-term clinical study of porcelainfused-to-gold restorations. J Prosthet Dent 1984;51:338-41 https://doi.org/10.1016/0022-3913(84)90217-8
  29. Leempoel PJB, Eschen S, De Haan AFJ, Van't Hof MA. An evaluation of crowns and bridges in a general dental practice. J Oral Rehabil 1985: 12: 515-28 https://doi.org/10.1111/j.1365-2842.1985.tb01299.x
  30. Walton JN, Gardner FM, Agar JR. A survey of crown and fixed partial denture failures: Length of service and reasons for replacement. J Prosthet Dent 1986;56:416-21 https://doi.org/10.1016/0022-3913(86)90379-3
  31. Foster LV. Failed conventional bridge work from general dental practice: Clinical aspects and treatment needs of 142 cases. Br Dent J 1990;168:199-201 https://doi.org/10.1038/sj.bdj.4807133
  32. Randow K, Glantz PO, Zoger B. Technical failures and some related clinical complications in extensive fixed prosthodontics. An epidemiological study of long-term clinical quality. Acta Odontol Scand 1986;44:241-55 https://doi.org/10.3109/00016358608997726
  33. Broughton AM, Smales RJ. Comparison of dental needs with the treatments actually received. Aust Dent J 1991;36:223-30 https://doi.org/10.1111/j.1834-7819.1991.tb04708.x
  34. Marynuik GA, Kaplan SA. Longevity of restorations: Survey results of dentists' estimates and attitudes. J Am Dent Assoc 1986;112:39-45
  35. Marynuik GA. Clinician's perceptions of restoration longevity. J Dent Educ 1985;49:769-72
  36. Davies JA. Dental restorations longevity: a critique of the life table method of analysis. Community Dent Oral Epidemiol 1987;15:202-8 https://doi.org/10.1111/j.1600-0528.1987.tb00519.x
  37. Leempoel PJB, Van't Hof MA, De Haan AFJ. Survival studies of dental restorations: criteria, methods and analyses. J Oral Rehabil 1989;16:387-94 https://doi.org/10.1111/j.1365-2842.1989.tb01355.x
  38. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J American Statistical Association 1958;53:457 https://doi.org/10.2307/2281868
  39. Cox DR. Regression models and life tables. J Royal Statistical Society B 1972;34:187
  40. Loe H. The Gingival Index. the Plaque Index and the Retention Index systems. J Periodontol 1967;38:610 https://doi.org/10.1902/jop.1967.38.6.610
  41. Dawson AS, Smales RJ. Restoration longevity in an australian defence force population. Aust Dent J 1992;37:196-200 https://doi.org/10.1111/j.1834-7819.1992.tb00742.x
  42. Mjor IA, Jokstad A, Qvist V. Longevity of posterior restorations. Int Dent J 1990;40:11-17
  43. Paterson N. The longevity of restorations: A study of 200 regular attenders in a General Dental Practice. Br Dent J 1984;157 23-8
  44. Priest G, An 11-year reevaluation of resin-bonded fixed partial dentures. Int J Periodont Rest Dent 1995;15:238-47
  45. Priest GF. Failure rates of restorations for single-tooth replacement. Int J Prostho 1996;9:38-45
  46. Smales RJ, Berekally TL, Webster DA. Predictions of resin-bonded bridge survivals, comparing two statistical models. J Dent 1993;21:147-9 https://doi.org/10.1016/0300-5712(93)90024-K
  47. Torbjorner A, Karlsson S, Odman P. Survival rate and failure characteristics for two post designs. J Prosthet Dent 1995;73:439-44 https://doi.org/10.1016/S0022-3913(05)80072-1
  48. York AK, Arthur JS. Reasons for placement and replacement of dental restorations in the United States Navy Dental Corps. Oper Dent 1993;18:203-10
  49. Walton TR. A 10-year longitudinal study of fixed prosthodontics: 1. Protocol and patient profile. lnt J Prosthodont 1997;10:325-31
  50. Roberts DH. The failure of retainers in bridge prostheses. An analysis of 2,000 retainers. Br Dent J 1970;128:117-24 https://doi.org/10.1038/sj.bdj.4802433
  51. Greg L, Michael RA, William EL, Lisa HR. Longevity of partial dentures. J Prosthet Dent 1997;78:127-3l https://doi.org/10.1016/S0022-3913(97)70115-X
  52. Drake CW, Marynuik CA, Bentley C. Reasons for restoration replacement: differences in practice patterns. Quintessence Int 1990;21:125-30
  53. Elderton RJ, AI-Ansary AL. Influence of the dentist in the survival of dental restorations. J Dent Res, 1991;70:Sp Iss: 684:Abstr 123
  54. Hawthorne WS, Smales RJ. Factors influencing long-term restoration survival in three private dental practies in Adelaide. Aust Dent J 1997;42:59-63 https://doi.org/10.1111/j.1834-7819.1997.tb00099.x
  55. Mahmood S, Smales R, Longevity of dental restorations in selected patients from different practice environment. Aust Dent J 1994;39:15-7 https://doi.org/10.1111/j.1834-7819.1994.tb05539.x
  56. Maupome G, Sheiham A. Criteria for restoration replacement and restoration life-span estimates in an educational environment. J Oral Rehabil 1998;25:896-901
  57. Hatzikyriakos AH, Reisis GI, Tsingos N. A 3-year postoperative clinical evaluation of posts and cores beneath existing crowns. J Prosthet Dent 1992;67:454-8 https://doi.org/10.1016/0022-3913(92)90072-I
  58. Karlsson S. A clinical evaluation of fixed bridges. 10 years following insertion. J Oral Rehabil 1986;13:423-32 https://doi.org/10.1111/j.1365-2842.1986.tb01304.x
  59. Sundh B. Odman P. A study of fixed prosthodontics performed at a university clinic 18 years after insertion. Int J Prosthodont 1997;10:513-9
  60. Ericson G, Nilson H, Bergman B. Cross-sectional study of patients fitted with fixed partial dentures with special reference to the caries situation. Scand J Dent Res 1990;98:8-16
  61. Bergenholtz C, Nyman S. Endodontic complications following periodontal and prosthetic treatment of patients with advanced periodontal disease. J Periodontol 1984;55:63-8 https://doi.org/10.1902/jop.1984.55.2.63
  62. Goodacre CJ, KJ Spolnik. The prosthodontic management of endodontically treated teeth: A literature review. Part 1. Sucess and failure data, treatment conceps. J Prosthod 1994;3:243-50 https://doi.org/10.1111/j.1532-849X.1994.tb00162.x
  63. Roberts DH. The relationship between age and the failure rate of bridge prostheses. Br Dent J 1970;128:175-7 https://doi.org/10.1038/sj.bdj.4802441
  64. Leempoel PJB, Kayser AF, Van Rossum GM, De Haan AFJ. The survival rate of bridges. A study of 1674 bridges in 40 Dutch general practices. J Oral Rehabil 1995;22:327-30 https://doi.org/10.1111/j.1365-2842.1995.tb00780.x
  65. Foster LV. The relationship between failure and design in conventional bridgework from general dental practice. J Oral Rehabil 1991;18:491 https://doi.org/10.1111/j.1365-2842.1991.tb00070.x
  66. Gustavsen F, Silness J. Clinical and radiographic observations after 6 years on bridge abutment teeth carrying pinledge retainers. J Oral Rehabil 1986;13:295-8 https://doi.org/10.1111/j.1365-2842.1986.tb00662.x
  67. Palmqvist SJ, Soderfeldt B. Multivariable analyses of factors influencing the longevity of fixed partial dentures, retainers and abutments. J Prosthet Dent 1994;71:245-50 https://doi.org/10.1016/0022-3913(94)90462-6
  68. Henry PJ, Johnston JF, Mitchell DF. Tissue changes beneath fixed partial dentures. J Prosthet Dent 1966;16:937-46 https://doi.org/10.1016/0022-3913(66)90016-3
  69. Hursey RJ. A clinical survey of the failures of crown and bridges. SC Dent J 1958;16:4-11
  70. Budtz-Jorgensen E, Isidor F. Cantilever bridges or removable partial dentures in geriatric patients: A 2-year study. J Oral Rehabil 1987;14:239-49 https://doi.org/10.1111/j.1365-2842.1987.tb00715.x
  71. Laurell L, Lundgren D, Falk H, Hugoson A. Long-term prognosis of extensive polyunit cantilevered fixed partial dentures. J Prosthet Dent 1991;66:545-52 https://doi.org/10.1016/0022-3913(91)90521-W
  72. Laurell L, Lundgren D. Periodontal ligament areas and occlusal forces in dentitions restored with cross-arch unilateral posterior two-unit cantilever bridges. J Clin Periodontol 1986;13:33-8 https://doi.org/10.1111/j.1600-051X.1986.tb01411.x
  73. Laurell L, Lundgren D. Occlusal force pattern during chewing and biting in dentitions restored with fixed bridges of crossarch extension. II. Unilateral posterior two-unit cantilevers. J Oral Rehabil 1986;13:191-203 https://doi.org/10.1111/j.1365-2842.1986.tb00651.x
  74. Laurell L, Lundgren D. Interfering occlusal contacts and distribution of chewing and biting forces in dentitions with fixed cantilever prostheses. J Prosthet Dent 1987;5:626-32
  75. Laurell L, Lundgren D. Distribution of occlusal forces along unilateral posterior two-unit cantilever segments in crossarch fixed partial dentures. J Prosthet Dent 1988;1:106-12
  76. Laurell L, Lundgren D. Influence of occlusion on posterior cantilevers. J Prosthet Dent 1992;67:645-52 https://doi.org/10.1016/0022-3913(92)90163-5
  77. Randow K, Glantz P. On cantilever loading of vital and non-vital teeth. An experimental clinical study. Acta Odontol Scand 1986;44:271-77 https://doi.org/10.3109/00016358609004733
  78. Decock V, Nayer KD, Boever JA. 18Year longitudinal study of cantilevered fixed restorations. Int J Prosthodont 1996;9:331-40
  79. Himmel R, Filo R, Assif D, Aviv I. The cantilever fixed partial denture -A literature review. J Prosthet Dent 1992;67:484-7
  80. Hochman N, Ginio I, Ehrlich J. The cantilever fixed partial denture: A 10-year follow up. J Prosthet Dent 1987;58:542-5 https://doi.org/10.1016/0022-3913(87)90381-7
  81. Nyman S. Lindhe J, Lundgren D. The role of occlusion for the stability of fixed bridges in patients with reduced periodontal tissue support. J Clin Periodontol 1975;2:53-66 https://doi.org/10.1111/j.1600-051X.1975.tb01726.x
  82. Nyman S, Lindhe J. Considerations on the design of occlusion in prosthetic rehabilitation of patients with advanced periodontal disease. J Clin Periodontol 1977;4:1-10
  83. Nyman S, Lindhe J. A longitudinal study of combined periodontal and prosthetic treatment of patients with advanced periodontal disease. J Periodontol 1979;50:163-9 https://doi.org/10.1902/jop.1979.50.4.163
  84. EI-Ebrashi MK, Craig RG, Peyton FA. Experimental stress analysis of dental restorations. Part VII: Structural design and stress analysis of fixed partial dentures. J Prosthet Dent 1970;23:177-85 https://doi.org/10.1016/0022-3913(70)90295-7
  85. Lundgren D. Prosthetic reconstruction of dentitions seriously comprised by periodontal disease. J Clin Periodontol 1991: 18:390-5 https://doi.org/10.1111/j.1600-051X.1991.tb02306.x
  86. Izikowitz L. A long-term prognosis for the free-end saddle-bridge. J Oral Rehabil 1985;12:247-62 https://doi.org/10.1111/j.1365-2842.1985.tb00641.x
  87. Schweitzer JM, Schweitzer RD, Schweitzer J. Free-end pontics used on fixed partial dentures. J Prosthet Dent 1968;20:120-30 https://doi.org/10.1016/0022-3913(68)90135-2
  88. Nyman S, Ericsson I. The capacity of reduced periodontal tissues to support fixed bridgework. J Clin Periodontol 1982;9:409-14 https://doi.org/10.1111/j.1600-051X.1982.tb02053.x
  89. Parkinson CF, Schaberg TV. Pontic design of posterior fixed partial prostheses: Is it a microbial misadventure? J Prosthet Dent, 1984;51:51-62 https://doi.org/10.1016/S0022-3913(84)80105-5
  90. Stein RS. Pontic-residual ridge relationship: A research report. J Prosthet Dent 1966;16:251-60 https://doi.org/10.1016/0022-3913(66)90080-1
  91. Lundgren D, Nyman S, Heiji L, Carlsson GE. Functional analysis of fixed bridges on abutment teeth with reduced periodontal support. J Oral Rehabil 1975;2:105-16 https://doi.org/10.1111/j.1365-2842.1975.tb01521.x
  92. Silness J, Gustavsen F. Alveolar bone loss in bridge recipients after six and twelve years. Int Dent J 1985;35:297-300
  93. Baretto MT. Failures in ceramometal fixed restorations. J Prosthet Dent 1984;51:186-91 https://doi.org/10.1016/0022-3913(84)90256-7
  94. Kikuchi M, Korioth TWP, Hannam AG. The association among occlusal contacts, clenching effort, and bite force distribution in man. Journal of Dental Research 1997;76:1316-26 https://doi.org/10.1177/00220345970760061201
  95. Strub JR Stiffler S, Scharer P. Causes of failure following oral rehabilitation: biological versus technical factors. Quintessence Int 1988: 19: 215-22,
  96. Bergman B, Lundquist P, Sjogren U, Sundquist G. Restorative and endodontic results after treatment with cast posts and cores, J Prosthet Dent 1989;61:10-5 https://doi.org/10.1016/0022-3913(89)90099-1
  97. Valderhaug J, Jokstad A, Ambjemsen E, Norheim PW, Assessment of the periapical and clinical status of crowned teeth over 25 years, J Dent 1997;25:97-105 https://doi.org/10.1016/S0300-5712(96)00008-5
  98. Cavozas E. Tissue response to fixed partial denture pontics. J Prosthet Dent 1968;20:143-52 https://doi.org/10.1016/0022-3913(68)90137-6