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缺牙该种植牙还是做义齿？关键是七项条件，而不是一张比较表｜證據鏈

km 編輯部2026-08-13阅读约 51 分钟
#證據鏈#牙醫KM#台灣#植牙

本頁是〈缺牙该种植牙还是做义齿？关键是七项条件，而不是一张比较表〉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。

缺牙该种植牙还是做义齿？关键是七项条件，而不是一张比较表｜證據鏈

F-Units（事实单元帐）

  • F1｜confidence: 结构性整理（编辑框架，非外部事实宣称）｜basis: editorial_framework｜period: 2026-08-06｜geo: universal｜span: 「七个条件的决策框架」「名词对齐（固定修复体／活动义齿／种植体支持义齿）」「与 KM-DENTAL-35／34／3／13／9／22／45／32 的分工指向」皆为本站依 F2 至 F21 文献整理的沟通用架构｜caveat: 非临床判准、非诊断工具，不取代牙医评估；本条不得被读成任何医学事实宣称
  • F2｜confidence: verified｜basis: peer_reviewed（系统评价，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: 人群限定＝短牙弓／牙列缩减之成年患者，不涵盖所有缺牙情境；同锚 KM-DENTAL-35 之 F1、KM-DENTAL-34 之 F8，本卡摘述不重写
  • F3｜confidence: verified（状态查核）｜basis: withdrawn_publication／not_evidence（PMID 31425605）｜period: 2019-07-17 标记撤回；esummary pubtype 含 Retracted Publication｜geo: universal｜span: 「WITHDRAWN: Interventions for replacing missing teeth: partially absent dentition」｜caveat: 仅用于记录「本题在 Cochrane 层级无现行有效结论」，其任何结论一律不作临床证据使用；同锚 KM-DENTAL-35 之 F3
  • F4｜confidence: verified｜basis: peer_reviewed（系统评价与荟萃分析，观察性研究，PMID 34516686）｜period: 检索至 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: 成功率之定义为牙髓与根尖状态，非牙桥本身存活；仅纳入观察性研究、异质性高（原文报 I2 77.84% 至 95.01%）；同锚 KM-DENTAL-45 之 F11、KM-DENTAL-11、KM-DENTAL-37
  • F5｜confidence: verified｜basis: peer_reviewed（系统评价，PMID 37455556）｜period: 检索至 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: 观察性数据，为关联非因果；本卡未引用其单冠分项数据（属 KM-DENTAL-11 范围）；同锚 KM-DENTAL-45 之 F12
  • F6｜confidence: verified｜basis: peer_reviewed（叙述性综述，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: 叙述性综述，非荟萃分析、无合并估计值；本卡仅取其规划因素清单与桥体清洁陈述，未引用任何量化结论；同锚 KM-DENTAL-45 之 F13
  • F7｜confidence: verified｜basis: peer_reviewed（系统评价，PMID 34773513）｜period: 检索 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: 纳入 19 篇，其中 14 篇限 Kennedy Class I、仅 1 篇单独探讨 Class II，作者明言 Class I 与 II 之比较无定论；本卡刻意未引用其种植体存留率数值（原文为范围值非合并估计，且各选项存留率属 KM-DENTAL-35 范围）；本卡不以此主张种植体辅助形态优于其他选项
  • F8｜confidence: verified｜basis: peer_reviewed（系统评价，PMID 26066662）｜period: 2003 至 2014 检索，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 对后牙咬合、ESDA＝0 至 2 对；纳入研究数少；同锚 KM-DENTAL-34 之 F14、KM-DENTAL-35 之 F11，本卡摘述不重写
  • F9｜confidence: verified｜basis: peer_reviewed（系统评价与荟萃分析，PMID 30624789）｜period: 检索至 2018-05，2019 刊出；2026-08-06 复检，同题近年综述多聚焦特定技术或材料，未见取代此篇之长期效果更新版｜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: 限侧窗技术、残存骨高度 6 毫米以下之人群；年丧失率为群体估计，非个人风险；同锚 KM-DENTAL-24 之 F13
  • F10｜confidence: verified｜basis: peer_reviewed（随机对照试验之系统评价与荟萃分析，含试验序列分析与 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: 结论只在原文明列的情境成立（原有骨、全口重建、上颚 6 毫米替代鼻窦增高），其余组合作者自陈无定论或证据不足；本卡已于正文完整保留此限定，禁被读成「短种植体都可以取代植骨」
  • F11｜confidence: verified｜basis: peer_reviewed（系统评价与荟萃分析，PMID 36807599）｜period: 检索至 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: 作者自陈为间接证据且标注证据局限；血糖控制之比较人群为糖尿病患者内部，禁读成「有糖尿病就不能种植牙」；同锚 KM-DENTAL-7 之 F22、KM-DENTAL-28 之 F10
  • F12｜confidence: verified｜basis: peer_reviewed（系统评价之综览，方法段自述为叙述性文献综述，PMID 33571324）｜period: 各主题检索至 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: 标题为 overview of systematic reviews，但方法段自述 narrative literature review，证据等级应以叙述性综述看待；检索仅至 2019-02，低剂量端请并同 F13（2025）阅读；本卡引用其「不建议」之陈述仅作为文献记录，非对任何个人的治疗指示
  • F13｜confidence: verified｜basis: peer_reviewed（系统评价与荟萃分析，PMID 40505730）｜period: 检索 1946 至 2024，2025-09 刊出（电子版 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: 人群限骨质疏松／骨质减少者（低剂量端），禁与肿瘤高剂量人群互相套用；种植体失败之相对风险为极低确定性；本卡未引用其「抗骨吸收治疗减少种植体失败」之结论句作为任何建议
  • F14｜confidence: verified｜basis: peer_reviewed（系统评价与荟萃分析，PMID 40530953）｜period: 更新 2021 至 2024 文献，2025-09 刊出（电子版 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: 两个数字的人群皆限头颈癌患者，禁外推为一般人植骨种植牙的风险倍数。摘要中移植骨对原有骨那一句以 Additionally 起头，未加照射次人群限定（下一句才以 Among irradiated patients 起头谈放化疗），故本卡采「该综述整体头颈癌研究人群」的直接读法——不自行收窄成仅限照射者，也不自行放宽到一般人群（依 2026-08-06 事故簿 8a：名词与范围以原文为准，禁自创保守版定义）。本篇建立于 2014 与 2022 两份先前综述之上，属现行最新版
  • F15｜confidence: verified｜basis: peer_reviewed（伞状综述，PMID 38762079）｜period: 检索至 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: 纳入 12 篇文章、41 个荟萃分析；为观察性研究之统合，关联不等于因果；同锚 KM-DENTAL-35 之 F5，本卡摘述不重写
  • F16｜confidence: verified｜basis: peer_reviewed（系统评价，PMID 34761421）｜period: 1966 至 2020 检索，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: 数据异质未做荟萃分析；风险人群限牙周炎病史者；结论句与前两句方向不同，本卡已同时呈现，禁只引其中一半；同锚 KM-DENTAL-35 之 F10、KM-DENTAL-34 之 F15
  • F17｜confidence: verified｜basis: peer_reviewed（系统评价，叙事合成，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: 因高异质性未做荟萃分析、采叙事合成；本卡引用其方向性结论与其限制句，未引用任何合并效应量；本卡不将其实务建议段转为对读者的复诊频率指示
  • F18｜confidence: verified｜basis: clinical_guideline（EFP S3 等级临床实践指南，PMID 37271498）｜period: 2023 刊出，13 篇委托系统评价｜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: 指引对象为临床医师之处置建议；本卡仅引用其「种植体需长期支持性照护」之结构性事实，不作疗效宣称；同锚 KM-DENTAL-35 之 F7
  • F19｜confidence: verified｜basis: clinical_guideline（ITI 共识报告，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: 清洁自评之人群限无牙患者且比较的两者皆为种植体支持义齿，禁外推为「一般活动义齿比固定修复体好清」；共识报告非荟萃分析；同锚 KM-DENTAL-13 之 F28、KM-DENTAL-32 之 F9
  • F20｜confidence: verified｜basis: peer_reviewed（试验层级荟萃分析＋系统评价脉络合成，PMID 42386429）｜period: 检索至 2025-10，2026-07-01 线上先行刊出｜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: 人群限单颗种植体；确定性为存活中等、次要结果低至极低；结论带「在适当的临床条件下」前提，本卡已于正文原样保留，禁删除该前提；本篇为 2026 年最新，较 F21（2019）为新，但人群不同故并陈而非取代
  • F21｜confidence: verified｜basis: peer_reviewed（随机对照试验之系统评价与荟萃分析，PMID 31421892）｜period: 检索至 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: 人群为以固定修复体重建之各式情境（非仅单颗），与 F20 之单颗种植体人群不同；统计单位为种植体；2026-08-06 已检索更新版，得 F20（2026）但人群更窄，故两篇并陈
  • F22｜confidence: verified（2026-08-06 以 ego-browser 实载，逐字对得上）｜basis: law｜period: 现行条文｜geo: TW｜span: 《医疗法》第 21 条「医疗机构收取医疗费用之标准，由直辖市、县（市）主管机构核定之。」｜caveat: 条文引述，非法律意见
  • F23｜confidence: verified（2026-08-06 以 ego-browser 实载，逐字对得上）｜basis: law｜period: 现行条文｜geo: TW｜span: 《全民健康保险法》第 51 条「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: 个别给付以健保署现行公告为准，本卡不作给付判定；同锚 VERIFIED-FACTS
  • F24｜confidence: verified（2026-08-06 以 ego-browser 实载，逐字读取）｜basis: official_statement｜period: 诠释数据更新时间 2026-07-13｜geo: TW｜span: 政府数据开放平台数据集「臺北市醫療收費標準」，提供机关为台北市政府卫生局，更新频率为不定期更新｜caveat: 单一县市例证；其他县市请迳查设籍或就诊县市主管机关之现行核定文件
  • F25｜confidence: verified（2026-08-05 OP 以 ego-browser 亲验，两轨页面全文无「牙」字）｜basis: official_statement｜period: 入口现况｜geo: TW｜span: 健保署「醫材比價網」两轨查询类别（自付差额医材比价 12 类、医材收费比价 8 类）皆不含牙科品项｜caveat: 引自本站跨卡已验事实档（VERIFIED-FACTS.md），本卡未重测；用途为避免读者白跑，不作为牙科费用查证管道
  • F26｜confidence: verified（2026-08-06 以 ego-browser 实载，逐字对得上）｜basis: law｜period: 现行条文｜geo: TW｜span: 《医疗法》第 81 条「医疗机构诊治患者时，应向患者或其法定代理人、配偶、亲属或关系人告知其病情、治疗方针、处置、用药、预后情形及可能之不良反应。」｜caveat: 条文引述，非法律意见；同锚 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、诊所补题」表，查询词「植牙 假牙」曝光 9,883，挂载栏记载单站｜caveat: 曝光为资产级数字，非去重流量；本条为内部数据，发布转档时不输出可见层
  • F28｜confidence: verified（2026-08-06 以 ego-browser 实载，逐字对得上）｜basis: law｜period: 现行条文｜geo: TW｜span: 《医疗法》第 87 条「医学新知或研究报告之发表、患者卫生教育、学术性刊物，未涉及招徕医疗业务者，不视为医疗广告。」｜caveat: 条文引述，非法律意见；同锚 VERIFIED-FACTS

来源清单

  • 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）。

内部引用链

  • 这题的完整选项比较与「没钱补怎么办」：缺牙一定要种植牙吗？没钱补怎么办？（KM-DENTAL-35）
  • 不补会发生什么变化、短牙弓概念：臼齿拔掉可以不补吗？会怎样？（KM-DENTAL-34）
  • 固定修复体的费用组成与报价单读法：做一颗固定修复体要多少钱？（KM-DENTAL-3）
  • 活动义齿的费用组成与种类分流：活动义齿要多少钱？（KM-DENTAL-13）
  • 种植牙费用是怎么算出来的：种植牙要花多少钱？（KM-DENTAL-9）
  • 磨牙较少的固定式做法：黏著式（马里兰）牙桥是什么？适合谁？（KM-DENTAL-22）
  • 修磨邻牙的代价与牙桥的后悔点：做了牙桥会后悔吗？（KM-DENTAL-45）
  • 植骨是什么、要多久：种植牙植骨粉是什么？（KM-DENTAL-24）
  • 全口大范围缺牙的重建：全口重建要多少钱？（KM-DENTAL-32）
发布闸门提醒：本卡为 draft。四语（zh-Hans／en／ja）未产前不得进 km_entries。挂载栏依伫列页「三、诊所补题」表「植牙 假牙」列（c-series-map.tsv 已登录 C06），机器闸门走 C 序列比对路径。本卡非症状分级卡、不含红旗判准，依 ANK-DENTAL-SPEC 审核链第 5 层之触发条件，不强制 GM 第三意见；惟条件四（全身状况与用药）涉及高剂量抗骨吸收药物与放射治疗人群之风险陈述，建议 OP 视情况加派跨架构对抗审。

FAQ

种植牙跟做义齿，到底哪一个比较好？
**现行文献没有给出一个通用的赢家。** 一份系统评价的结论写明，证据不足以推荐任一种补牙策略优于其他策略，其人群为短牙弓／牙列缩减的成年患者 [F2]；而涵盖更广「部分缺牙」人群的 Cochrane 综述已撤回，没有现行有效结论 [F3]。所以比较有用的问法不是「哪个好」，而是「以我的邻牙、骨量、全身状况、清洁能力与可用时间，哪些选项还在桌上」。各选项的存留率与并发症数字属 KM-DENTAL-35，本卡不重写 [F1]。实际适合哪一种，须由牙医评估。
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.
我有骨质疏松、在吃相关的药，是不是就不能种植牙了？
**要先分清楚是哪一种剂量与适应症。** 一份医疗与老年因素的综述写明，在高剂量双磷酸盐与抗体治疗下不建议施行种植体治疗，且抗骨吸收治疗下应避免骨移植 [F12]；而针对骨质疏松／骨质减少人群的 2025 年荟萃分析则记录，暴露者的种植体失败相对风险为 0.82（极低确定性），植入后颚骨坏死的合并发生率为 0.5%，且一份风险校正报告显示双磷酸盐使颚骨坏死每 1000 位患者增加 3 例（中等确定性）[F13]。这两层的数字禁止互相套用。**本卡不提供任何停药或用药调整的建议**——请把完整用药清单带到诊室，由牙医与你的处方医师共同评估。
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.
骨头不够，是不是一定要先植骨才能种植牙？
**不一定，而且「植骨」也不是只有一条路。** 一份纳入 19 项随机对照试验、2214 支种植体的系统评价以 GRADE 评级后写明：在未增高的原有骨与全口重建情境，6 毫米以下与 10 毫米以上种植体的 5 年存留率相近，6 毫米种植体可作为上颚窦增高术的替代；但 4 毫米与 5 毫米种植体作为鼻窦增高替代、以及以 6 毫米以下种植体取代垂直骨脊增高，证据仍无定论或不足 [F10]。至于接受上颚窦底增高术者，一份追踪 5 年以上、人群限残存骨高度 6 毫米以下的综述算出年种植体丧失率为 0.43% [F9]。同时也要记得：固定修复体与活动义齿不需要处理骨量这一关 [F1]。你的骨条件属于哪一种情况，须由牙医以影像评估。
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・《缺牙该种植牙还是做义齿？关键是七项条件，而不是一张比较表｜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