完全無歯顎症における補綴修復様式と咀嚼および言語障害との関連性。韓国における全国規模の横断的研究

Prosthetic restorative modality in complete edentulism and its association with masticatory and speech discomforts: A nationwide cross-sectional study from Korea.

抄録

目的:

完全無歯顎症の治療には様々な補綴方法があるが、その治療結果には咀嚼障害や言語障害が含まれる可能性がある。本研究では、全国規模のビッグデータを用いて、完全無歯顎患者に用いられる補綴修復様式の現状を調査し、補綴修復様式と咀嚼・発音における自覚的不快感の関連性を検討することを目的とした。

PURPOSE: Completely edentulous arches can be restored using various prosthetic modalities, and the treatment outcome may include masticatory and speech discomforts. This study aimed to investigate the current status of prosthetic restoration modalities used for completely edentulous patients and investigate the association between prosthetic restoration modalities and subjective discomfort in mastication and speech by analyzing nationwide big data.

方法:

97,622人のうち、天然歯がなく、追加補綴治療の必要のない40歳以上の成人1,576人のデータを対象とした。口腔内検査データを解析し、無歯顎アーチの補綴物を以下のように分類した。CDは可撤式総義歯，ODはインプラント固定式オーバーデンチャー，IFはインプラント支持式固定式人工歯根に分類した．補綴修復様式群による咀嚼・発声の不快感を共分散分析により統計的に解析した（α＝0.05）．

METHODS: Of 97,622 individuals, data from 1,576 adults aged ≥40 years with no natural teeth and no requirement for additional prosthetic treatments were included. Oral examination data were analyzed, and the prostheses of the edentulous arches were categorized as follows: CD, removable complete denture; OD, implant-retained overdenture; and IF, implant-supported fixed dental prosthesis. Discomforts in mastication and speech according to the prosthetic restorative modality groups was statistically analyzed using analysis of covariance (α = 0.05).

結果:

最も多く使用された上顎・下顎補綴物はCD/CDで、次いでCD/OD、IF/IF、OD/OD、CD/IFであり、それぞれの加重割合は93.23％、2.48％、1.83％、1.46％、および0.84％であった。様々な共変量で調整した後でも、CD/CD群の咀嚼不快感はOD/OD（p=0.0004）およびIF/IF（p=0.0002）のそれよりも有意に大きかった。また、CD/CD群はIF/IF群に比べ、発話時の不快感が有意に大きかった（p＝0.0119）。

RESULTS: The maxillary/mandibular prosthetic restorative modality most commonly used was CD/CD, followed by CD/OD, IF/IF, OD/OD, and CD/IF, with weighted percentages of 93.23%, 2.48%, 1.83%, 1.46%, and 0.84%, respectively. Even after adjusting for various covariates, masticatory discomfort in the CD/CD group was significantly greater than that in the OD/OD (p = 0.0004) and IF/IF (p = 0.0002). The CD/CD group also had significantly greater discomfort in speech than did the IF/IF group (p = 0.0119).

結論:

両顎無歯顎患者のほとんどは，両顎の可撤式総義歯でリハビリテーションを受けたが，両アーチをインプラント支持の固定式修復物で修復した場合，咀嚼と会話の不快感は最も少なかった．

CONCLUSIONS: Most completely edentulous patients were rehabilitated with bimaxillary removable complete dentures; however, the discomforts in mastication and speech were the lowest when both arches were restored with implant-supported fixed restorations.