無歯顎患者を対象としたACP分類の臨床応用の評価

[Evaluation of clinical application of ACP classification for edentulous patients].

抄録

目的:

完全無歯顎患者に対するAmerican College of Prosthodonticsの分類システムの臨床応用を評価し、臨床家による各症例の一般的な難易度の評価と患者の義歯満足度の評価との関係を分析することを目的とする。

OBJECTIVE: To evaluate clinical application of American College of Prosthodontics classification system for complete edentulism; and to analyze the relationship between clinician's rating of general degree of difficulty of each case and patients' rating of denture satisfaction.

方法は以下の通りです。:

American College of Prosthodontics（ACP）による完全無歯顎症の分類を用いて，無歯顎患者117名を臨床的に検討した．パノラマX線写真で患者の下顎の最小高さを測定した．臨床家は，各症例の一般的な難易度をビジュアル・アナログ・スケールで評価した．義歯装着後6ヶ月目に，患者はMcgill満足度ビジュアルアナログスケール（VAS）を用いて義歯を評価した．臨床家による一般的な難易度の評価と下顎骨の高さとの関係を分析するために，多変量線形回帰分析を行い，下顎骨の隆起形状や軟組織の質などの交絡因子を調整した．また，臨床家の症例難易度評価と患者の義歯満足度評価との相関関係をPearson相関分析により解析した．

METHODS: One hundred and seven edentulous patients were examined clinically using American College of Prosthodontics (ACP) classification for complete edentulism. The least heights of patients' mandible were measured on panoramic radiographs. Clinician rated general degree of difficulty of each case on visual analogue scale. Six month following denture delivery, patients rated their denture using Mcgill satisfaction Visual Analog Scale (VAS). Multivariate linear regression analysis were conducted to analyze the relationship between clinician's rating of general degree of difficulty and mandibular bone height adjusting for confounding factors such as mandibular ridge form, soft tissue quality etc. Pearson correlation analysis was conducted to analyze the correlation between clinician's rating of case difficulty and patients' rating of denture satisfaction.

結果:

全症例の約80％（83/105）に高度な残存歯根吸収が認められました。パノラマX線写真を用いて下顎骨の高さを測定したところ，検査者間の信頼性は0.96，検査者間の信頼性は0.90であった．下顎骨の高さが低く，リッジフォームが好ましくない（ナイフリッジ，イレギュラーリッジ），軟組織が可動性である，以前の義歯の装着期間が長いなどの条件を満たす症例は，難易度が高いと評価された．また，臨床家が評価した難易度と患者が評価した義歯の満足度との間には，有意な相関関係は認められなかった（r＜0.1）．臨床医は，患者の下顎骨の高さが11mmより低い症例を，患者の下顎骨の高さが11mmより高い症例よりも8.8％～16.1％難易度が高いと評価した（P＜0.05）．

RESULTS: Advanced residual ridge resorption were found in around 80% (83/105) of all the cases. When the least mandibular bone height were measured on panoramic radiographs, intra-examiner reliability was 0.96, inter-examiner reliability was 0.90. Cases were rated as more difficult when patients showed lower mandibular bone height, unfavorate ridge form (knife ridge and irregular ridge), mobile soft tissue and longer period of wearing time of their previous dentures. No significant correlation (r<0.1) was found between clinician's rating of degree of difficulty of each case and patients' rating of denture satisfaction 6 month following delivery of prostheses. Clinician rated cases in which patient's mandibular bone height was lower than 11 mm as 8.8%-16.1% more difficult than those in which patient's mandibular bone height was higher than 11 mm (P<0.05).

おわりに:

完全無歯顎症のACP分類は，検査者間の信頼性が高く，無歯顎症患者の口腔状態を臨床的に評価するための有用なツールであると考えられた．しかし，臨床家による症例の難易度評価と患者の義歯満足度評価との間には，有意な相関関係は認められなかった．

CONCLUSION: ACP classification for complete edentulism showed good intra- and inter-examiner reliability, and is an useful tool for clinical evaluation of edentulous patients' oral condition. However, there was no significant correlation between clinicians' rating of difficulty of cases and patients' rating of denture satisfaction.