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缺牙該植牙還是做假牙？決定的是七個條件，不是一張比較表｜證據鏈

km 編輯部2026-08-13閱讀約 51 分鐘
#證據鏈#牙醫KM#台灣#植牙

本頁是〈缺牙該植牙還是做假牙？決定的是七個條件，不是一張比較表〉的事實單元帳：每一條主張對應的來源、證據等級、地域與期間、原文引句與限制，逐條攤開。

缺牙該植牙還是做假牙？決定的是七個條件，不是一張比較表｜證據鏈

F-Units（事實單元帳）

  • F1｜confidence: 結構性整理（編輯框架，非外部事實宣稱）｜basis: editorial_framework｜period: 2026-08-06｜geo: universal｜span: 「七個條件的決策框架」「名詞對齊（固定假牙／活動假牙／植體支撐假牙）」「與 KM-DENTAL-35／34／3／13／9／22／45／32 的分工指向」皆為本站依 F2 至 F21 文獻整理的溝通用架構｜caveat: 非臨床判準、非診斷工具，不取代牙醫師評估；本條不得被讀成任何醫學事實宣稱
  • F2｜confidence: verified｜basis: peer_reviewed（系統性回顧，PMID 29476794）｜period: PROSPERO CRD42017064851，2018 刊出｜geo: universal｜span: 「there is currently insufficient evidence to recommend one tooth replacement strategy over another in adult patients with reduced dentitions」「Ten articles were included in this systematic review.」｜caveat: 族群限定＝短牙弓／牙列縮減之成年病人，不涵蓋所有缺牙情境；同錨 KM-DENTAL-35 之 F1、KM-DENTAL-34 之 F8，本卡摘述不重寫
  • F3｜confidence: verified（狀態查核）｜basis: withdrawn_publication／not_evidence（PMID 31425605）｜period: 2019-07-17 標記撤回；esummary pubtype 含 Retracted Publication｜geo: universal｜span: 「WITHDRAWN: Interventions for replacing missing teeth: partially absent dentition」｜caveat: 僅用於記錄「本題在 Cochrane 層級無現行有效結論」，其任何結論一律不作臨床證據使用；同錨 KM-DENTAL-35 之 F3
  • F4｜confidence: verified｜basis: peer_reviewed（系統性回顧與統合分析，觀察性研究，PMID 34516686）｜period: 檢索至 2021-01，2022 刊出｜geo: universal｜span: 「Electronic searches provided 10,075 records among which 20 studies were selected for systematic review and 7 studies were selected for meta-analysis.」「The meta-analysis revealed clinical and radiographic success rate ranging between 92% to 98% at different follow up periods ranging between 5 years and 20 years.」｜caveat: 成功率之定義為牙髓與根尖狀態，非牙橋本身存活；僅納入觀察性研究、異質性高（原文報 I2 77.84% 至 95.01%）；同錨 KM-DENTAL-45 之 F11、KM-DENTAL-11、KM-DENTAL-37
  • F5｜confidence: verified｜basis: peer_reviewed（系統性回顧，PMID 37455556）｜period: 檢索至 2022-10，2024 刊出｜geo: universal｜span: 「26 studies fulfilled the inclusion criteria and were included in the analysis of the present systematic review.」「For FDPs, the 5-year survival rate was significantly higher for FDPs on vital abutments (84.9%; 95% CI [75.9, 93.9%]) compared to FDPs retained by non-vital abutment/s (81.3%; 95% CI [80.3, 82.2%], P = 0.049) irrespective to presence, type of post, and FDPs material.」「The results are limited by the limited number of studies and the presence of uncontrolled confounding clinical variables.」｜caveat: 觀察性資料，為關聯非因果；本卡未引用其單冠分項數據（屬 KM-DENTAL-11 範圍）；同錨 KM-DENTAL-45 之 F12
  • F6｜confidence: verified｜basis: peer_reviewed（敘述性回顧，PMID 28429481）｜period: 2017 刊出｜geo: universal｜span: 「The design of the prosthesis, the number and quality of the abutment teeth, the preparation and the pontic, the occlusion and the material need to be considered when planning prosthodontic treatment.」「Even an optimal pontic design will not prevent inflammation of the mucosa adjacent to the pontic if pontic hygiene is not maintained by removal of plaque.」｜caveat: 敘述性回顧，非統合分析、無合併估計值；本卡僅取其規劃因素清單與橋體清潔陳述，未引用任何量化結論；同錨 KM-DENTAL-45 之 F13
  • F7｜confidence: verified｜basis: peer_reviewed（系統性回顧，PMID 34773513）｜period: 檢索 1980-01 至 2020-02，2021 刊出｜geo: universal｜span: 「Nineteen studies were finally included after the perusal of the full text.」「The reported marginal bone loss ranged from 0.3 mm to 2.30 mm. The patient satisfaction was higher with IARPD than with conventional RPDs or that before treatment. The results of prosthetic complications were heterogeneous and inconclusive.」「IARPD exhibited favorable clinical outcomes when used as a replacement for distal extension edentulous areas.」｜caveat: 納入 19 篇，其中 14 篇限 Kennedy Class I、僅 1 篇單獨探討 Class II，作者明言 Class I 與 II 之比較無定論；本卡刻意未引用其植體存活率數值（原文為範圍值非合併估計，且各選項存活率屬 KM-DENTAL-35 範圍）；本卡不以此主張植體輔助形態優於其他選項
  • F8｜confidence: verified｜basis: peer_reviewed（系統性回顧，PMID 26066662）｜period: 2003 至 2014 檢索，2015 刊出｜geo: universal｜span: 「Comminution or mixing ability in subjects with (E)SDA was 28-39% lower compared to that of subjects with complete dentitions」「distal-extension RDPs could compensate this reduction partially (some 50%)」｜caveat: SDA＝3 至 5 對後牙咬合、ESDA＝0 至 2 對；納入研究數少；同錨 KM-DENTAL-34 之 F14、KM-DENTAL-35 之 F11，本卡摘述不重寫
  • F9｜confidence: verified｜basis: peer_reviewed（系統性回顧與統合分析，PMID 30624789）｜period: 檢索至 2018-05，2019 刊出；2026-08-06 複檢，同題近年回顧多聚焦特定技術或材料，未見取代此篇之長期效果更新版｜geo: universal｜span: 「Inclusion criteria were prospective studies with follow-up ≥5 years and a residual bone height ≤6 mm.」「Meta-analysis revealed a weighted annual implant loss of 0.43% (95% CI: 0.37%-0.49%).」「Meta-regression analysis did not reveal significant differences in implant loss neither between edentulous and dentate patients nor implants placed simultaneously with or delayed after MSFA, nor implants placed in MSFA using solely autologous bone or bone substitutes.」｜caveat: 限側窗技術、殘存骨高度 6 毫米以下之族群；年喪失率為群體估計，非個人風險；同錨 KM-DENTAL-24 之 F13
  • F10｜confidence: verified｜basis: peer_reviewed（隨機對照試驗之系統性回顧與統合分析，含試驗序列分析與 GRADE，PMID 38764386）｜period: PROSPERO CRD42021254365，2024 刊出｜geo: universal｜span: 「Forty reports on 19 RCTs comprising 2214 (1097 short; 1117 long) implants were included.」「Moderate/high certainty/quality evidence demonstrated similar 5-year survival rates for ≤6-mm and ≥10-mm implants in non-augmented bone and full-mouth rehabilitation in either jaw, and for 6-mm implants in the maxilla instead of sinus lift.」「Nevertheless, the evidence for 5-year survival rates remains inconclusive or insufficient for the remaining combinations of implant lengths and clinical scenarios. They include 4-mm and 5-mm implants as alternatives to sinus lift as well as placing all implant lengths ≤6 mm instead of vertical ridge augmentation with long implants.」｜caveat: 結論只在原文明列的情境成立（自然骨、全口重建、上顎 6 毫米替代鼻竇增高），其餘組合作者自陳無定論或證據不足；本卡已於正文完整保留此限定，禁被讀成「短植體都可以取代補骨」
  • F11｜confidence: verified｜basis: peer_reviewed（系統性回顧與統合分析，PMID 36807599）｜period: 檢索至 2022-08，2023 刊出｜geo: universal｜span: 「diabetic patients with dental implants and good glycaemic control have a significantly lower risk of peri-implantitis (odds ratio [OR] = 0.16; 95% confidence interval [CI]: 0.03-0.96; I2 : 0%)」「Patients attending supportive periodontal/peri-implant care (SPC) regularly have a lower risk of overall PIDs (OR = 0.42; 95% CI: 0.24-0.75; I2 : 57%)」「The risk of dental implant failure (OR = 3.76; 95% CI: 1.50-9.45; I2 : 0%) appears to be greater under irregular or no SPC than regular SPC.」｜caveat: 作者自陳為間接證據且標註證據侷限；血糖控制之比較族群為糖尿病病人內部，禁讀成「有糖尿病就不能植牙」；同錨 KM-DENTAL-7 之 F22、KM-DENTAL-28 之 F10
  • F12｜confidence: verified｜basis: peer_reviewed（系統性回顧之綜覽，方法段自述為敘述性文獻回顧，PMID 33571324）｜period: 各主題檢索至 2019-02，2021 刊出｜geo: universal｜span: 「Age > 75 years does not affect implant survival according to short-term follow up (1 to 5 years).」「Implant therapy cannot be recommended in patients under high-dose bisphosphonate and antibody therapy. Bone grafting should be avoided under antiresorptive therapy.」「This review suggests that the risk assessment for an implant patient should not be based on age, but rather on the patient's specific risk factors, such as former and current diseases and medication.」｜caveat: 標題為 overview of systematic reviews，但方法段自述 narrative literature review，證據等級應以敘述性回顧看待；檢索僅至 2019-02，低劑量端請併同 F13（2025）閱讀；本卡引用其「不建議」之陳述僅作為文獻記錄，非對任何個人的治療指示
  • F13｜confidence: verified｜basis: peer_reviewed（系統性回顧與統合分析，PMID 40505730）｜period: 檢索 1946 至 2024，2025-09 刊出（電子版 2025-06-10）｜geo: universal｜span: 「Random-effects meta-analysis revealed wide confidence intervals (CIs) for implant failure among those exposed to antiresorptives (relative risk, 0.82; 95% CI, 0.52-1.28; P = .38, very low certainty).」「We identified 186 cases of MRONJ in implant recipients. The pooled rate of MRONJ following implantation in those exposed to antiresorptive therapy was 0.5% pooled from 21 cohorts. A single report of risk-adjusted MRONJ found that bisphosphonates increased MRONJ by 3 cases per 1000 patients (adjusted hazard ratio, 4.09; 95% CI, 2.75-6.09; P < .001, moderate certainty).」｜caveat: 族群限骨質疏鬆／骨質減少者（低劑量端），禁與腫瘤高劑量族群互相套用；植體失敗之相對風險為極低確定性；本卡未引用其「抗骨吸收治療減少植體失敗」之結論句作為任何建議
  • F14｜confidence: verified｜basis: peer_reviewed（系統性回顧與統合分析，PMID 40530953）｜period: 更新 2021 至 2024 文獻，2025-09 刊出（電子版 2025-06-18）｜geo: universal｜span: 「Nine studies were identified, with seven included in the quantitative synthesis and meta-analysis. The implant survival rate was significantly lower in irradiated patients (85.6%) compared to non-irradiated patients (90.0%)」「implant failure risk was higher in grafted bone (RR = 2.03, 95% CI: 1.39-2.96, p = 0.0018, I2 = 21.9%) than in native bone」「The implant survival rate was significantly lower in irradiated patients (85.6%) compared to non-irradiated patients (90.0%) (RR = 1.62, 95% CI: 1.33-1.98, p < 0.0001, I2 = 0.2%).」｜caveat: 兩個數字的族群皆限頭頸癌病人，禁外推為一般人補骨植牙的風險倍數。摘要中移植骨對自然骨那一句以 Additionally 起頭，未加照射次族群限定（下一句才以 Among irradiated patients 起頭談放化療），故本卡採「該回顧整體頭頸癌研究族群」的直接讀法——不自行收窄成僅限照射者，也不自行放寬到一般族群（依 2026-08-06 事故簿 8a：名詞與範圍以原文為準，禁自創保守版定義）。本篇建立於 2014 與 2022 兩份先前回顧之上，屬現行最新版
  • F15｜confidence: verified｜basis: peer_reviewed（傘狀回顧，PMID 38762079）｜period: 檢索至 2023-10，PROSPERO CRD42024512408，2024 刊出｜geo: universal｜span: 「None of the associations were graded as convincing evidence」「Two associations, presence of periodontitis (OR = 3.84 [95 % CI 2.58,5.72]) and cigarette smoking (RR=2.07 [95 % CI 1.41,3.04]) were graded as highly suggestive」｜caveat: 納入 12 篇文章、41 個統合分析；為觀察性研究之統合，關聯不等於因果；同錨 KM-DENTAL-35 之 F5，本卡摘述不重寫
  • F16｜confidence: verified｜basis: peer_reviewed（系統性回顧，PMID 34761421）｜period: 1966 至 2020 檢索，2022 刊出｜geo: universal｜span: 「Two retrospective studies indicated that RDPs increased the risk of tooth loss compared to FDPs in patients with a history of periodontitis」「Several studies indicated that RDP increased plaque accumulation」「There is no strong evidence that RDPs per se will cause periodontal destruction including tooth loss」｜caveat: 資料異質未做統合分析；風險族群限牙周炎病史者；結論句與前兩句方向不同，本卡已同時呈現，禁只引其中一半；同錨 KM-DENTAL-35 之 F10、KM-DENTAL-34 之 F15
  • F17｜confidence: verified｜basis: peer_reviewed（系統性回顧，敘事合成，PMID 41204923）｜period: 2026-02 刊出｜geo: universal｜span: 「Twenty-five studies met inclusion criteria: 9 randomized controlled trials, 13 cohort studies, and 3 case-control studies.」「SPiT, particularly with individualized, risk-based recall intervals, consistently improved clinical outcomes, such as probing depth and bleeding on probing compared with standard or no maintenance.」「High clinical and methodological heterogeneity among studies, inconsistent documentation of systemic conditions, and variability in adjunctive therapies limited definitive conclusions and generalizability.」｜caveat: 因高異質性未做統合分析、採敘事合成；本卡引用其方向性結論與其限制句，未引用任何合併效應量；本卡不將其實務建議段轉為對讀者的回診頻率指示
  • F18｜confidence: verified｜basis: clinical_guideline（EFP S3 等級臨床實務指引，PMID 37271498）｜period: 2023 刊出，13 篇委託系統性回顧｜geo: universal｜span: 「Once the implants are loaded and in function, a supportive peri-implant care programme should be structured, including periodical assessment of peri-implant tissue health」｜caveat: 指引對象為臨床醫師之處置建議；本卡僅引用其「植體需長期支持性照護」之結構性事實，不作療效宣稱；同錨 KM-DENTAL-35 之 F7
  • F19｜confidence: verified｜basis: clinical_guideline（ITI 共識報告，PMID 30328187）｜period: 2018 刊出｜geo: universal｜span: 「Edentulous patients highly rate both removable and fixed implant-supported prostheses. However, they rate their ability to maintain their oral hygiene significantly higher with the removable prosthesis.」「Patient-reported outcome measures should be gathered in every clinical study in which the outcomes of oral rehabilitation with dental implants are investigated. PROMs, such as patients' satisfaction and QHRQoL, should supplement other clinical parameters in our clinical definition of success.」｜caveat: 清潔自評之族群限無牙病人且比較的兩者皆為植體支撐假牙，禁外推為「一般活動假牙比固定假牙好清」；共識報告非統合分析；同錨 KM-DENTAL-13 之 F28、KM-DENTAL-32 之 F9
  • F20｜confidence: verified｜basis: peer_reviewed（試驗層級統合分析＋系統性回顧脈絡合成，PMID 42386429）｜period: 檢索至 2025-10，2026-07-01 線上先行刊出｜geo: universal｜span: 「Seven systematic reviews and 2 additional RCTs were identified, yielding 40 unique trials and more than 1200 single implants with follow-up ranging from 1 to 10 years.」「No statistically significant differences were found in implant survival between immediate and conventional loading at 1 year (RR=1.00; 95% CI, 0.98 to 1.02), 2 years (RR=1.01; 95% CI, 0.96 to 1.05), 3 years (RR=1.01; 95% CI, 0.97 to 1.05), or 5 years (RR=1.00; 95% CI, 0.97 to 1.03), nor between immediate and early loading at 1 year (RR=0.99; 95% CI, 0.96 to 1.02).」「When applied under appropriate clinical conditions, immediate loading of single implants demonstrated survival, marginal bone stability, complication rates, and patient satisfaction comparable to early or conventional loading.」｜caveat: 族群限單顆植體；確定性為存活中等、次要結果低至極低；結論帶「在適當的臨床條件下」前提，本卡已於正文原樣保留，禁刪除該前提；本篇為 2026 年最新，較 F21（2019）為新，但族群不同故並陳而非取代
  • F21｜confidence: verified｜basis: peer_reviewed（隨機對照試驗之系統性回顧與統合分析，PMID 31421892）｜period: 檢索至 2018-10，2019-12 刊出｜geo: universal｜span: 「Thirty-nine trials (49 articles) were included from the initial 763 references evaluated.」「When compared with conventional loading, with implants regarded as a statistical unit, a statistically significant lower survival rate was observed in the immediate loading dental implant (RR=0.974; 95% CI, 0.954, 0.994; P=.012).」「Compared with early loading, immediate loading could achieve comparable implant survival rates and marginal bone level changes.」｜caveat: 族群為以固定假牙重建之各式情境（非僅單顆），與 F20 之單顆植體族群不同；統計單位為植體；2026-08-06 已檢索更新版，得 F20（2026）但族群更窄，故兩篇並陳
  • F22｜confidence: verified（2026-08-06 以 ego-browser 實載，逐字對得上）｜basis: law｜period: 現行條文｜geo: TW｜span: 《醫療法》第 21 條「醫療機構收取醫療費用之標準，由直轄市、縣（市）主管機關核定之。」｜caveat: 條文引述，非法律意見
  • F23｜confidence: verified（2026-08-06 以 ego-browser 實載，逐字對得上）｜basis: law｜period: 現行條文｜geo: TW｜span: 《全民健康保險法》第 51 條「下列項目不列入本保險給付範圍：……十一、義齒、義眼、眼鏡、助聽器、輪椅、拐杖及其他非具積極治療性之裝具。」｜caveat: 個別給付以健保署現行公告為準，本卡不作給付判定；同錨 VERIFIED-FACTS
  • F24｜confidence: verified（2026-08-06 以 ego-browser 實載，逐字讀取）｜basis: official_statement｜period: 詮釋資料更新時間 2026-07-13｜geo: TW｜span: 政府資料開放平臺資料集「臺北市醫療收費標準」，提供機關為臺北市政府衛生局，更新頻率為不定期更新｜caveat: 單一縣市例證；其他縣市請逕查設籍或就診縣市主管機關之現行核定文件
  • F25｜confidence: verified（2026-08-05 OP 以 ego-browser 親驗，兩軌頁面全文無「牙」字）｜basis: official_statement｜period: 入口現況｜geo: TW｜span: 健保署「醫材比價網」兩軌查詢類別（自付差額醫材比價 12 類、醫材收費比價 8 類）皆不含牙科品項｜caveat: 引自本站跨卡已驗事實檔（VERIFIED-FACTS.md），本卡未重測；用途為避免讀者白跑，不作為牙科費用查證管道
  • F26｜confidence: verified（2026-08-06 以 ego-browser 實載，逐字對得上）｜basis: law｜period: 現行條文｜geo: TW｜span: 《醫療法》第 81 條「醫療機構診治病人時，應向病人或其法定代理人、配偶、親屬或關係人告知其病情、治療方針、處置、用藥、預後情形及可能之不良反應。」｜caveat: 條文引述，非法律意見；同錨 KM-DENTAL-35 之 F28
  • F27｜confidence: verified｜basis: internal_dataset｜period: 2025-03 至 2026-08 GSC｜geo: TW｜span: km-production-queue.html「三、診所補題」表，查詢詞「植牙 假牙」曝光 9,883，掛載欄記載單站｜caveat: 曝光為資產級數字，非去重流量；本條為內部數據，發布轉檔時不輸出可見層
  • F28｜confidence: verified（2026-08-06 以 ego-browser 實載，逐字對得上）｜basis: law｜period: 現行條文｜geo: TW｜span: 《醫療法》第 87 條「醫學新知或研究報告之發表、病人衛生教育、學術性刊物，未涉及招徠醫療業務者，不視為醫療廣告。」｜caveat: 條文引述，非法律意見；同錨 VERIFIED-FACTS

來源清單

  • S1 Fueki K, Baba K. Shortened dental arch and prosthetic effect on oral health-related quality of life：關於補牙策略之系統性回顧。PMID 29476794. pubmed.ncbi.nlm.nih.gov/29476794（取用 2026-08-06，efetch 摘要逐字對得上；同錨 KM-DENTAL-35）
  • S2 WITHDRAWN: Interventions for replacing missing teeth: partially absent dentition. Cochrane Database Syst Rev. PMID 31425605. pubmed.ncbi.nlm.nih.gov/31425605（取用 2026-08-06，pubtype 含 Retracted Publication；標為非證據，僅記錄證據缺口）
  • S3 Kohli S, Bhatia S, Al-Haddad A, Pulikkotil SJ, Jamayet NB. Pulpal and Periapical Status of the Vital Teeth Used as Abutment for Fixed Prosthesis—A Systematic Review and Meta-Analysis. J Prosthodont. 2022;31(2):102-114. PMID 34516686. pubmed.ncbi.nlm.nih.gov/34516686（取用 2026-08-06，efetch 摘要逐字對得上）
  • S4 Hawthan M, Larsson C, Chrcanovic BR. Survival of fixed prosthetic restorations on vital and nonvital teeth: A systematic review. J Prosthodont. 2024;33(2):110-122. PMID 37455556. pubmed.ncbi.nlm.nih.gov/37455556（取用 2026-08-06，efetch 摘要逐字對得上）
  • S5 Abduo J, Lyons KM. Interdisciplinary interface between fixed prosthodontics and periodontics. Periodontol 2000. 2017;74(1):40-62. PMID 28429481. pubmed.ncbi.nlm.nih.gov/28429481（取用 2026-08-06，efetch 摘要逐字對得上）
  • S6 Putra Wigianto AY, Goto T, Iwawaki Y, Ishida Y, Watanabe M, Ichikawa T. Treatment outcomes of implant-assisted removable partial denture with distal extension based on the Kennedy classification and attachment type: a systematic review. Int J Implant Dent. 2021;7(1):111. PMID 34773513. pubmed.ncbi.nlm.nih.gov/34773513（取用 2026-08-06，efetch 摘要逐字對得上）
  • S7 Kosuru KRV 等。Comminution/mixing ability in shortened dental arches：系統性回顧。PMID 26066662. pubmed.ncbi.nlm.nih.gov/26066662（取用 2026-08-06，efetch 摘要逐字對得上；同錨 KM-DENTAL-34／35）
  • S8 Raghoebar GM, Onclin P, Boven GC, Vissink A, Meijer HJA. Long-term effectiveness of maxillary sinus floor augmentation: A systematic review and meta-analysis. J Clin Periodontol. 2019;46 Suppl 21:307-318. PMID 30624789. pubmed.ncbi.nlm.nih.gov/30624789（取用 2026-08-06，efetch 摘要逐字對得上；同錨 KM-DENTAL-24）
  • S9 Ravidà A, Serroni M, Borgnakke WS, et al. Short (≤6 mm) compared with ≥10-mm dental implants in different clinical scenarios: A systematic review of randomized clinical trials with meta-analysis, trial sequential analysis and quality of evidence grading. J Clin Periodontol. 2024;51(7):936-965. PMID 38764386. pubmed.ncbi.nlm.nih.gov/38764386（取用 2026-08-06，efetch 摘要逐字對得上）
  • S10 Carra MC, Blanc-Sylvestre N, Courtet A, Bouchard P. Primordial and primary prevention of peri-implant diseases: A systematic review and meta-analysis. J Clin Periodontol. 2023;50 Suppl 26:77-112. PMID 36807599. pubmed.ncbi.nlm.nih.gov/36807599（取用 2026-08-06，efetch 摘要逐字對得上；同錨 KM-DENTAL-7／28）
  • S11 Fretwurst T, Nelson K. Influence of Medical and Geriatric Factors on Implant Success: An Overview of Systematic Reviews. Int J Prosthodont. 2021;34(Suppl):s21-s26. PMID 33571324. pubmed.ncbi.nlm.nih.gov/33571324（取用 2026-08-06，efetch 摘要逐字對得上；方法段自述敘述性回顧）
  • S12 Mirza R, El Rabbany M, Ali DS, et al. Dental Implant Failure and Medication-Related Osteonecrosis of the Jaw Related to Dental Implants in Patients Taking Antiresorptive Therapy for Osteoporosis: A Systematic Review and Meta-Analysis. Endocr Pract. 2025;31(9):1189-1196. PMID 40505730. pubmed.ncbi.nlm.nih.gov/40505730（取用 2026-08-06，efetch 摘要逐字對得上）
  • S13 Fan S, Diaz L, Sáenz-Ravello G, Valmaseda-Castellon E, Al-Nawas B, Schiegnitz E. Comprehensive Update on Implants in Patients With Head and Neck Cancer (2021-2024): Systematic Review and Meta-Analysis. Clin Oral Implants Res. 2025;36(9):1035-1052. PMID 40530953. pubmed.ncbi.nlm.nih.gov/40530953（取用 2026-08-06，efetch 摘要逐字對得上）
  • S14 Peri-implantitis 風險因子傘狀回顧。PMID 38762079. pubmed.ncbi.nlm.nih.gov/38762079（取用 2026-08-06，efetch 摘要逐字對得上；同錨 KM-DENTAL-35）
  • S15 Removable partial dentures and periodontal health：系統性回顧。PMID 34761421. pubmed.ncbi.nlm.nih.gov/34761421（取用 2026-08-06，efetch 摘要逐字對得上；同錨 KM-DENTAL-34／35）
  • S16 Efficacy of supportive peri-implant therapy in the management of peri-implant mucositis and peri-implantitis: A systematic review. J Am Dent Assoc. 2026. PMID 41204923. pubmed.ncbi.nlm.nih.gov/41204923（取用 2026-08-06，efetch 摘要逐字對得上）
  • S17 Herrera D, Berglundh T, Schwarz F, et al. Prevention and treatment of peri-implant diseases—The EFP S3 level clinical practice guideline. J Clin Periodontol. 2023. PMID 37271498. pubmed.ncbi.nlm.nih.gov/37271498（取用 2026-08-06，efetch 摘要逐字對得上；同錨 KM-DENTAL-35）
  • S18 Feine J, Abou-Ayash S, Al Mardini M, et al. Group 3 ITI Consensus Report: Patient-reported outcome measures associated with implant dentistry. Clin Oral Implants Res. 2018;29 Suppl 16:270-275. PMID 30328187. pubmed.ncbi.nlm.nih.gov/30328187（取用 2026-08-06，efetch 摘要逐字對得上；同錨 KM-DENTAL-13／32）
  • S19 Pachiou A, Strauss FJ, Pagkalidou E, et al. Clinical outcomes of immediate versus early or conventional loading of single implants: A de novo RCT-level meta-analysis with contextual synthesis of systematic reviews. J Prosthet Dent. 2026. PMID 42386429. pubmed.ncbi.nlm.nih.gov/42386429（取用 2026-08-06，efetch 摘要逐字對得上；線上先行刊出）
  • S20 Chen J, Cai M, Yang J, Aldhohrah T, Wang Y. Immediate versus early or conventional loading dental implants with fixed prostheses: A systematic review and meta-analysis of randomized controlled clinical trials. J Prosthet Dent. 2019;122(6):516-536. PMID 31421892. pubmed.ncbi.nlm.nih.gov/31421892（取用 2026-08-06，efetch 摘要逐字對得上）
  • S21 《醫療法》第 21 條、第 81 條、第 87 條，全國法規資料庫。law.moj.gov.tw（2026-08-06 以 ego-browser 實載，三條條文逐字對得上）
  • S22 《全民健康保險法》第 51 條，全國法規資料庫。law.moj.gov.tw（2026-08-06 以 ego-browser 實載，逐字對得上）
  • S23 政府資料開放平臺資料集「臺北市醫療收費標準」（提供機關：臺北市政府衛生局）。data.gov.tw/dataset/121913（2026-08-06 以 ego-browser 實載，逐字讀取）
  • S24 本站跨卡已驗事實檔 `km-compliance/VERIFIED-FACTS.md`：健保署「醫材比價網」兩軌查詢類別皆不含牙科（2026-08-05 OP 親驗）。
  • S25 內部資料：`km-production-queue.html`「三、診所補題」表本題列（編務用，明細不對外揭露）。

內部引用鏈

  • 這題的完整選項比較與「沒錢補怎麼辦」：缺牙一定要植牙嗎？沒錢補怎麼辦？（KM-DENTAL-35）
  • 不補會發生什麼變化、短牙弓概念：臼齒拔掉可以不補嗎？會怎樣？（KM-DENTAL-34）
  • 固定假牙的費用組成與報價單讀法：做一顆固定假牙要多少錢？（KM-DENTAL-3）
  • 活動假牙的費用組成與種類分流：活動假牙要多少錢？（KM-DENTAL-13）
  • 植牙費用是怎麼算出來的：植牙要花多少錢？（KM-DENTAL-9）
  • 磨牙較少的固定式做法：黏著式（馬里蘭）牙橋是什麼？適合誰？（KM-DENTAL-22）
  • 修磨鄰牙的代價與牙橋的後悔點：做了牙橋會後悔嗎？（KM-DENTAL-45）
  • 補骨是什麼、要多久：植牙補骨粉是什麼？（KM-DENTAL-24）
  • 全口大範圍缺牙的重建：全口重建要多少錢？（KM-DENTAL-32）
發布閘門提醒：本卡為 draft。四語（zh-Hans／en／ja）未產前不得進 km_entries。掛載欄依佇列頁「三、診所補題」表「植牙 假牙」列（c-series-map.tsv 已登錄 C06），機器閘門走 C 序列比對路徑。本卡非症狀分級卡、不含紅旗判準，依 ANK-DENTAL-SPEC 審核鏈第 5 層之觸發條件，不強制 GM 第三意見；惟條件四（全身健康與用藥）涉及高劑量抗骨吸收藥物與放射治療族群之風險陳述，建議 OP 視情況加派跨架構對抗審。

FAQ

植牙跟做假牙，到底哪一個比較好？
**現行文獻沒有給出一個通用的贏家。** 一份系統性回顧的結論寫明，證據不足以推薦任一種補牙策略優於其他策略，其族群為短牙弓／牙列縮減的成年病人 [F2]；而涵蓋更廣「部分缺牙」族群的 Cochrane 回顧已撤回，沒有現行有效結論 [F3]。所以比較有用的問法不是「哪個好」，而是「以我的鄰牙、骨量、全身健康、清潔能力與可用時間，哪些選項還在桌上」。各選項的存活率與併發症數字屬 KM-DENTAL-35，本卡不重寫 [F1]。實際適合哪一種，須由牙醫師評估。
インプラントと義歯は、結局どちらがよいですか — **現行文献に万人共通の勝者はありません。** 系統的レビューは、短縮歯列・歯列縮減の成人では一つの補綴戦略を他より推奨するエビデンスが不十分としています [F2]。部分欠損歯列を広く扱った Cochrane レビューは撤回され、現行で有効な結論がありません [F3]。「どちらが上か」でなく、隣在歯、骨、全身状態、清掃能力、時間から、どの選択肢が残るかを尋ねる方が有用です。生存率と合併症数値は KM-DENTAL-35 の担当で再掲しません [F1]。適否は歯科医師が評価します。
Is an implant or a denture better? — **Current literature gives no universal winner.** One systematic review concludes that evidence is insufficient to recommend one tooth-replacement strategy over another, within adults with shortened or reduced dentitions [F2]. The broader Cochrane review of partially absent dentitions has been withdrawn and offers no current valid conclusion [F3]. A more useful question is which options remain feasible given your adjacent teeth, bone, general health, cleaning ability, and available time. Option-specific survival and complication figures belong to KM-DENTAL-35 and are not repeated here [F1]. A dentist must assess which is suitable for you.
我有骨質疏鬆、在吃相關的藥，是不是就不能植牙了？
**要先分清楚是哪一種劑量與適應症。** 一份醫療與老年因素的回顧寫明，在高劑量雙磷酸鹽與抗體治療下不建議施行植體治療，且抗骨吸收治療下應避免骨移植 [F12]；而針對骨質疏鬆／骨質減少族群的 2025 年統合分析則記錄，暴露者的植體失敗相對風險為 0.82（極低確定性），植入後顎骨壞死的合併發生率為 0.5%，且一份風險校正報告顯示雙磷酸鹽使顎骨壞死每 1000 位病人增加 3 例（中等確定性）[F13]。這兩層的數字禁止互相套用。**本卡不提供任何停藥或用藥調整的建議**——請把完整用藥清單帶到診間，由牙醫師與你的處方醫師共同評估。
骨粗鬆症の薬を飲んでいると、インプラントはできませんか — **まず用量と適応を分けます。** レビューは高用量ビスホスホネートと抗体治療下ではインプラント治療を推奨できず、骨吸収抑制治療下では骨移植を避けるべきとしています [F12]。骨粗鬆症・骨減少症に限定した 2025 年のメタ解析は、失敗相対リスク 0.82（確実性は非常に低い）、埋入後顎骨壊死率 0.5%、単一リスク調整報告でビスホスホネートにより 1000 人あたり 3 例増加（確実性は中等度）を記録しました [F13]。両層の数値は相互適用できません。**休薬や調整は本カードでは勧めません。** 完全な服薬一覧を持参し、歯科医師と処方医が共同評価します。
I have osteoporosis and take medication for it. Does that rule out implants? — **First separate dose and indication.** A review states that implant therapy cannot be recommended under high-dose bisphosphonate and antibody treatment and that bone grafting should be avoided under antiresorptive treatment [F12]. A 2025 meta-analysis limited to people with osteoporosis or osteopenia reported a relative risk of implant failure of 0.82 with very low certainty, a pooled post-implantation osteonecrosis-of-the-jaw rate of 0.5%, and one risk-adjusted report of 3 additional cases per 1000 patients with bisphosphonates, with moderate certainty [F13]. Figures from these two levels must not be interchanged. **This card gives no advice to stop or adjust medication.** Bring a complete medication list; your dentist and prescriber should assess the situation together.
骨頭不夠，是不是一定要先補骨才能植牙？
**不一定，而且「補骨」也不是只有一條路。** 一份納入 19 項隨機對照試驗、2214 支植體的系統性回顧以 GRADE 評級後寫明：在未增高的自然骨與全口重建情境，6 毫米以下與 10 毫米以上植體的 5 年存活率相近，6 毫米植體可作為上顎竇增高術的替代；但 4 毫米與 5 毫米植體作為鼻竇增高替代、以及以 6 毫米以下植體取代垂直骨脊增高，證據仍無定論或不足 [F10]。至於接受上顎竇底增高術者，一份追蹤 5 年以上、族群限殘存骨高度 6 毫米以下的回顧算出年植體喪失率為 0.43% [F9]。同時也要記得：固定假牙與活動假牙不需要處理骨量這一關 [F1]。你的骨條件屬於哪一種情況，須由牙醫師以影像評估。
骨が足りない場合、必ず先に骨造成が必要ですか — **必ずではなく、骨造成にも複数経路があります。** 19 無作為化比較試験、2214 本を GRADE 評価したレビューでは、骨造成なしの既存骨と全顎的再建で 6 mm 以下と 10 mm 以上の 5 年生存率が同程度で、上顎 6 mm は上顎洞底挙上術の代替になり得ました。一方、4 mm・5 mm を同術式の代替とする場合、6 mm 以下を垂直的歯槽堤増大の代替とする場合のエビデンスは不確実または不十分です [F10]。残存骨高 6 mm 以下、追跡 5 年以上の上顎洞底挙上術レビューは年間喪失率 0.43% を示しました [F9]。固定性・可撤性補綴装置にはインプラントの骨条件がありません [F1]。画像評価が必要です。
If there is not enough bone, is bone grafting always required before an implant? — **Not always, and “bone grafting” is not the only branch.** A GRADE-rated systematic review of 19 randomized trials and 2214 implants found similar 5-year survival for implants 6 mm or shorter and 10 mm or longer in non-augmented native bone and full-mouth rehabilitation, and found that a 6-mm implant could replace sinus augmentation in the maxilla. Evidence remained inconclusive or insufficient for 4-mm and 5-mm implants as alternatives to sinus augmentation and for implants 6 mm or shorter as alternatives to vertical ridge augmentation [F10]. In people receiving maxillary sinus floor augmentation, a review with at least 5 years of follow-up and residual bone height of 6 mm or less estimated annual implant loss at 0.43% [F9]. Fixed and removable prostheses do not require the bone threshold for an implant [F1]. A dentist must assess your bone by imaging.

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km 編輯部・《缺牙該植牙還是做假牙？決定的是七個條件，不是一張比較表｜證據鏈》・IDAEO 知識庫・2026-08-13・https://km.idaeo.ai/reports/dental-implant-vs-denture-evidence

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更新 2026-08-13T14:17:27.338Z · server-rendered · four-language · IDAEO 知識庫