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重度の下顎骨再置換術後の完全義歯作製には2段階印象法は必須か？咀嚼、患者満足度、調整に関する無作為化試験
Is a two-step impression mandatory for complete denture fabrication on the severely resorbed mandible? A randomized trial on mastication, patient satisfaction and adjustments.
PMID: 32437857 DOI: 10.1016/j.jdent.2020.103357.
抄録
目的:
重度の下顎骨吸収を有する無歯顎患者に従来の完全義歯（CCD）を提供する際の印象法を、(1)咀嚼能力と能力、(2)下顎CCDに対する満足度、(3)提供後の調整の観点から、1回の印象法と2回の印象法を比較した。
OBJECTIVES: To compare one- vs two-step impression procedures for the provision of conventional complete dentures (CCDs) for edentulous individuals with severe mandibular resorption, in terms of (1) masticatory performance and ability; (2) satisfaction with mandibular CCDs; and (3) post-delivery adjustments.
方法:
上顎＋下顎CCDを必要とする52例を下顎稜の印象法により無作為に2つの並行群に分けた。(SI)ストックトレーを用いた単印象（非可逆的ハイドロコロイド）、(TI)カスタムトレーを用いた2段階印象、ボーダー成形（印象コンパウンド）の後、印象自体（ポリエーテル）を行った。咀嚼能力は比色試験で評価し、患者は咀嚼能力と下顎CCD（100mm視覚アナログスケール）の満足度に関する質問に回答した。また、治療後の調整のためのセッション数も数値化した。アウトカムは出産後3ヵ月と6ヵ月で評価された。
METHODS: Fifty-two patients requiring maxillary + mandibular CCDs were randomly divided into two parallel arms according to the impression method of the mandibular ridge: (SI) single impression with stock trays (irreversible hydrocolloid); (TI) two-step impression in custom trays, with border molding (impression compound) followed by the impression itself (polyether). Mastication performance was evaluated by a colorimetric test, whereas patients answered questions on masticatory ability and satisfaction with mandibular CCDs (100-mm visual analogue scale). The number of post-delivery sessions for adjustments were also quantified. Outcomes were assessed at 3 and 6 months after delivery.
結果:
咀嚼能力は、時間に関係なく両群でほぼ同等であった（3ヵ月、P=0.62、6ヵ月、P=0.61）。患者報告（P>0.05）、すなわち咀嚼能力（一般的な咀嚼のしやすさと食品の粉砕の質、特定の食品を咀嚼する能力）、下顎CCDに対する一般的な満足度（一般的な満足度、快適さ、審美性、発話能力、正しい清掃、保持、安定性）については、有意差は認められなかった。どちらの方法でも、治療後の調整回数は同程度であった［SI：3.8回（1.7回）、TI：3.2回（1.4回）、P=0.09］。
RESULTS: The masticatory performance was similar for both groups, regardless of time (3 months, P = 0.62; 6 months, P = 0.61). No significant difference was found for patient-reported (P > 0.05), i.e. masticatory ability (general ease of chewing and quality of grinding food; ability to chew specific foods), general satisfaction with the mandibular CCD (general satisfaction, comfort, aesthetics, ability to speak and to perform correct cleaning, retention and stability). Both methods resulted in a similar number of post-delivery adjustment sessions [SI: 3.8 (1.7); TI: 3.2 (1.4); P = 0.09].
結論:
従来の方法と比較して、1回の印象から得られたCCDは、重度の下顎骨隆起の再吸収のある患者でも、同様の咀嚼性能/能力と患者の満足度を得ることができます。どちらの方法も同じ量のポストデリバリー調整を必要とします。
CONCLUSIONS: Compared to a traditional approach, CCDs obtained from a single impression achieve similar masticatory performance/ability and patient satisfaction, even in patients with severely reabsorbed mandibular ridge. Both methods demand the same amount of post-delivery adjustment.
臨床的意義:
二次印象を省略した簡便な印象法は，重度の下顎隆起再吸収患者においても，二段階印象法と同程度の満足度とOHRQoLに影響する良好な臨床品質のCCDを提供することができる（ClinicalTrials.gov: NCT02339194）．
CLINICAL SIGNIFICANCE: A simplified impression technique which eliminates the secondary impression can provide CCDs of good clinical quality, which influences the OHRQoL, and satisfaction in the same extent they would by a two-step procedure, even for patients with severely reabsorbed mandibular ridges (ClinicalTrials.gov: NCT02339194).
Copyright © 2020 Elsevier Ltd. All rights reserved.