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缺牙一定要植牙嗎？沒錢補怎麼辦？｜證據鏈

km 編輯部2026-08-13閱讀約 55 分鐘
#證據鏈#牙醫KM#台灣#植牙

本頁是〈缺牙一定要植牙嗎？沒錢補怎麼辦？〉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。

缺牙一定要植牙嗎？沒錢補怎麼辦？｜證據鏈

F-Units（事實單元帳）

  • F1｜confidence: verified｜basis: peer_reviewed（PMID 29476794，系統性回顧）｜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. Of these, four were analyses of different outcomes from a multicentre randomized controlled trial in Germany, whilst one study was the pilot phase for this trial.」｜caveat: 族群限定＝短牙弓／牙列縮減之成年病人（標題為 shortened dental arches、結論句為 reduced dentitions），不涵蓋所有缺牙情境；納入 10 篇，作者明言高品質隨機對照試驗數量不足。同錨 KM-DENTAL-34 之 F8，本卡摘述不重寫
  • F2｜confidence: verified｜basis: clinical_guideline（PMID 35688447，EFP S3 等級臨床實務指引）｜period: 2022 刊出，13 篇委託系統性回顧｜geo: universal｜span: 「which require additional interventions following completion of active periodontal therapy」「Prior to treatment planning, it is critically important to undertake a definitive and comprehensive diagnosis and case evaluation, obtain relevant patient information, and engage in frequent re-evaluations during and after treatment」「recommendations for different interventions, including orthodontic tooth movement, tooth splinting, occlusal adjustment, tooth- or implant-supported fixed or removable dental prostheses and supportive periodontal care」｜caveat: 該指引之適用族群為第 IV 期牙周炎病人，非所有缺牙者；本卡引用其治療順序結構，未引用任何個別處置的療效數字。2026-08-06 以 PubMed 標題欄位檢索 periodontitis 與 S3 level，確認近三年僅一筆英國落地版（PMID 40555302），本篇為現行版
  • 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31425605）｜period: 2019-07-17 標記撤回；esummary pubtype 含 Retracted Publication｜geo: universal｜span: 「WITHDRAWN: Interventions for replacing missing teeth: partially absent dentition」｜caveat: 本條僅用於記錄一件事——本題在 Cochrane 層級無現行有效結論；其任何結論一律不作臨床證據使用。版本鏈以 CD003814 檢索得 2 筆（22336794 為 2012 年版、31425605 為 2019 年撤回版），撤回者為版本鏈末端
  • F4｜confidence: verified｜basis: peer_reviewed（PMID 23062124，系統性回顧與統合分析）｜period: 2006 至 2011 檢索，2012 刊出，納入 46 篇｜geo: universal｜span: 「survival of implants supporting SCs at 5 years amounted to 97.2% (95% CI: 96.3-97.9%), and at 10 years amounted to 95.2% (95% CI: 91.8-97.2%)」「The survival of implant-supported SCs was 96.3% (95% CI: 94.2-97.6%) after 5 years and 89.4% (95% CI: 82.8-93.6%) after 10 years」「Technical complications reached a cumulative incidence of 8.8% (95% CI: 5.1-15.0%) for screw-loosening, 4.1% (95% CI: 2.2-7.5%) for loss of retention, and 3.5% (95% CI: 2.4-5.2%) for fracture of the veneering material after 5 years」「technical, biological, and aesthetic complications were frequent」｜caveat: 存活率非成功率，不等於個人預期。同錨 KM-DENTAL-34 之 F16；本卡 span 已依 2026-08-06 全線鐵則改為原文詞序逐字，不沿用 #34 舊版倒置寫法
  • F5｜confidence: verified｜basis: peer_reviewed（PMID 38762079，傘狀回顧）｜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」「Eight associations, diabetes mellitus, hyperglycaemia, lack of prophylaxis, history of chronic periodontal disease, ongoing or history of periodontal disease」｜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
  • F6｜confidence: verified｜basis: peer_reviewed（PMID 40512526，傘狀回顧）｜period: 2025-09-26 刊出｜geo: universal｜span: 「Ten relevant patient-related risk factors for peri-implantitis were identified. While some of them are modifiable (smoking, bleeding on probing, plaque control, number of sites with PPD ≥ 5 mm, recall frequency, and occlusal overload), others are not (history of periodontitis, implant location, number of teeth lost, and systemic diseases)」「or to forgo implant therapy in high-risk conditions」｜caveat: 該回顧本身指出各系統性回顧間的相對影響差異甚大、易被高估；本卡不引用任何單一風險因子的效應量。此篇較 F5（2024）為新，兩者並陳而非取代
  • F7｜confidence: verified｜basis: clinical_guideline（PMID 37271498，EFP S3 等級臨床實務指引）｜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」「Prevention of peri-implant diseases should commence when dental implants are planned, surgically placed and prosthetically loaded」｜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」的結構性事實，不作療效宣稱
  • F8｜confidence: verified｜basis: peer_reviewed（PMID 25935732，系統性回顧與統合分析）｜period: 2006 至 2013 檢索，2015 刊出｜geo: universal｜span: 「Forty studies reporting on 1796 metal-ceramic and 1110 all-ceramic FDPs fulfilled the inclusion criteria」「an estimated 5-year survival rate of metal-ceramic FDPs of 94.4% (95% CI: 91.2-96.5%)」「the survival rate of densely sintered zirconia FDPs was 90.4% (95% CI: 84.8-94.0%) in 5 years of function」「A significantly higher incidence of caries in abutment teeth was observed for densely sintered zirconia FDPs compared to metal-ceramic FDPs」「Significantly more framework fractures were reported for reinforced glass ceramic FDPs (8.0%) and glass-infiltrated alumina FDPs (12.9%) compared to metal-ceramic FDPs (0.6%) and densely sintered zirconia FDPs (1.9%) in 5 years in function」「The estimated survival rate of reinforced glass ceramic FDPs was 89.1% (95% CI: 80.4-94.0%), the survival rate of glass-infiltrated alumina FDPs was 86.2% (95% CI: 69.3-94.2%) and the survival rate of densely sintered zirconia FDPs was 90.4% (95% CI: 84.8-94.0%) in 5 years of function.」｜caveat: 多單位固定假牙；材料別差異大。同錨 KM-DENTAL-34 之 F17
  • F9｜confidence: verified｜basis: peer_reviewed（PMID 23062127，經濟面向系統性回顧）｜period: 2012 刊出｜geo: universal｜span: 「Initial costs for single implant crowns and FDPs on teeth were similar, but varied between tariff systems」「Failure rates reported with single implant crowns and FDPs on teeth were similar」「The utility for the patient to keep healthy adjacent teeth unprepared makes the implant crown more economic」｜caveat: 費用制度依各國而異，本卡不引用任何金額，也不把該結論轉換成台灣情境。同錨 KM-DENTAL-34 之 F18
  • F10｜confidence: verified｜basis: peer_reviewed（PMID 34761421，系統性回顧）｜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；族群限牙周炎病人。同錨 KM-DENTAL-34 之 F15
  • F11｜confidence: verified｜basis: peer_reviewed（PMID 26066662，系統性回顧）｜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%)」「more artificial teeth in RDPs resulted in better performance」｜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
  • F12｜confidence: verified｜basis: peer_reviewed（PMID 17002745，文獻回顧）｜period: 1966 至 2005-11 檢索，2006 刊出｜geo: universal｜span: 「no clinically significant differences between subjects with shortened dental arches of three to five occlusal units and complete dental arches regarding variables such as masticatory ability, signs and symptoms of temporomandibular disorders, migration of remaining teeth, periodontal support, and oral comfort」｜caveat: 敘事性回顧（非統合分析），主要納入單一研究群作品。短牙弓的完整討論屬 KM-DENTAL-34，本卡僅摘述
  • F13｜confidence: verified｜basis: peer_reviewed（PMID 29316570，多中心隨機對照試驗 10 年結果）｜period: 2018 刊出｜geo: universal｜span: 「The number of teeth lost was higher than expected」「The results suggest an overestimation of the influence of the prosthetic management of the bilateral SDA」「In treatment decisions, patient preferences should be considered with appropriate weight」｜caveat: 152 人中 82 人達 10 年檢查，流失率高。同錨 KM-DENTAL-34 之 F13
  • F14｜confidence: verified｜basis: peer_reviewed（PMID 37001792，系統性回顧）｜period: 檢索至 2022-11-06，2023 刊出｜geo: universal｜span: 「No significant difference was recorded in the nutritional status of patients rehabilitated using the SDA concept compared with RPDs」「Higher costs for treatment provision and maintenance for patients in the RPD group was found when compared to SDA treatment」「SDA therapy may be considered as a feasible treatment concept in older adults especially in those with complex medical statuses and limited finances」｜caveat: 僅 4 篇報告（來自 2 個研究），未能統合分析；成本結論不可轉換為任何地區價格；原文語氣為 may be considered（可被考慮），本卡不得改寫成「適合」或「建議」，且族群限年長者。同錨 KM-DENTAL-34 之 F11
  • F15｜confidence: verified｜basis: peer_reviewed（PMID 40552466，系統性回顧）｜period: PROSPERO CRD42024584113，2025-06-24 刊出｜geo: universal｜span: 「Out of 1,876 initial records, 12 studies met inclusion criteria: 7 cohort studies, 4 case-control studies, and 1 randomised controlled trial」「Both RCT and DIs demonstrated high survival rates, with RCT slightly outperforming DIs in terms of success」「Failure rates ranged from 0.7% to 12.0%, with no significant differences between treatments. DIs were associated with a higher frequency of postoperative interventions and complications」「The decision between treatments should consider clinical factors, patient preferences, cost, accessibility, potential complications, and patient-centred outcomes. Shared decision-making is essential for optimal patient care」｜caveat: 因異質性未能統合分析，結果為質性合成；DIs＝dental implants、RCT 在該文中指 root canal therapy
  • F16｜confidence: verified｜basis: peer_reviewed（PMID 38443242，系統性回顧）｜period: 檢索至 2023-07，2025-03 刊出（電子版 2024-03-04）｜geo: universal｜span: 「Three included studies revealed no difference in survival rate between endodontically treated teeth and implant-supported prostheses during the first 3 years, but the survival of endodontically treated teeth declined over time with a higher failure rate than implant-supported prostheses」「In contrast, the other 3 included studies reported lower survival rate for implant-supported prostheses and more complications」「Whether implant-supported prostheses or endodontically treated teeth are better in terms of survival outcome is unclear」｜caveat: 8 篇觀察性研究（3 篇回溯性世代、5 篇病例對照），無隨機對照試驗
  • F17｜confidence: verified｜basis: clinical_guideline（PMID 32383274，EFP S3 等級臨床實務指引）｜period: 2020 刊出，15 篇委託系統性回顧；PubMed 註記有 2021 年勘誤（J Clin Periodontol 2021;48:163）｜geo: universal｜span: 「pre-established stepwise approach to therapy that, depending on the disease stage, should be incremental, each including different interventions」「Consensus was achieved on recommendations covering different interventions, aimed at (a) behavioural changes, supragingival biofilm, gingival inflammation and risk factor control; (b) supra- and sub-gingival instrumentation, with and without adjunctive therapies; (c) different types of periodontal surgical interventions; and (d) the necessary supportive periodontal care to extend benefits over time」｜caveat: 適用族群為第 I 期至第 III 期牙周炎；本卡引用其階梯式療程結構，不引用任何個別處置的療效數字
  • F18｜confidence: verified｜basis: peer_reviewed（PMID 33648772，系統性回顧）｜period: 2022 刊出｜geo: universal｜span: 「Three studies (4396 extractions in total) could be included for the risk of bias assessment and qualitative data synthesis」「caries with the proportion of all extractions ranging from 36.0% to 55.3%, periodontitis from 24.8% to 38.1%, trauma from 0.8% to 4.4%, periapical disease from 7.3% to 19.1%」｜caveat: 僅 3 篇納入；該文另指出「非牙科與非醫療動機之拔牙」缺乏可靠估計，本卡未引用該段。同錨 KM-DENTAL-30
  • F19｜confidence: verified｜basis: peer_reviewed（PMID 33053198，Cochrane 系統性回顧 CD004346.pub5）｜period: 檢索至 2020-01-17，2020-10-14 刊出｜geo: universal｜span: 「We included two studies with data from 1736 participants」「there is little to no difference between risk-based and 6-month recall intervals in the number of tooth surfaces with any caries, gingival bleeding and oral-health-related quality of life over a 4-year period (high-certainty evidence)」「The available evidence on recall intervals between dental check-ups for children and adolescents is uncertain. The two trials we included in the review did not assess adverse effects of different recall strategies」｜caveat: 版本鏈以 CD004346 檢索得 4 筆（15846709／17943814／24353242／33053198），pub5 為現行版，pubtype 無撤回標記；受試者限規律回診者（成人試驗定義為前兩年內至少就診一次），不可外推到長期未就醫者；該回顧未研究未補綴缺牙區的追蹤間隔，本卡不得以它支持任何缺牙追蹤頻率
  • F20｜confidence: verified｜basis: peer_reviewed（PMID 42131949，系統性回顧與統合分析）｜period: 2026-05-14 線上先行刊出｜geo: universal｜span: 「Fifty articles comprising 55 population-based cohorts (287 750 participants from 37 countries) were included」「Individuals with nonfunctional dentition had approximately twice the odds of impaired OHRQoL compared with those with functional dentition [pooled adjusted odds ratio (OR) = 2.08; 95% CI 1.72-2.52; I2 = 70.6%]」「Certainty of evidence for OHRQoL outcomes was rated as moderate」｜caveat: 多數納入研究為橫斷面設計，關聯不等於因果；epubdate 2026-05-14 早於本卡日期。同錨 KM-DENTAL-30
  • F21｜confidence: verified｜basis: peer_reviewed（PMID 33345687，系統性回顧與統合分析）｜period: 2009 至 2019 檢索，2022 刊出（電子版 2020-12-21）｜geo: universal｜span: 「individuals who were completely edentulous or who lacked functional dentition had a 21% increased likelihood of being at risk of malnutrition or being malnourished, as compared with those who were dentulous or had functionally adequate dentition (risk ratio, 1.21; 95% CI, 1.11 to 1.32; I2 = 70%)」「Findings were limited by heterogeneity, risk of bias, and overall quality of the studies reviewed」｜caveat: 族群限居住於已開發國家、年齡 60 歲以上者；7 篇納入、6 篇進入統合分析
  • F22｜confidence: verified｜basis: peer_reviewed（PMID 34210202，系統性回顧）｜period: 2022 刊出（電子版 2021-07-02）｜geo: universal｜span: 「41 studies were included in the synthesis (14 rated good quality, 20 fair, and 7 poor)」「The balance of data supported a positive impact of wearing full (5/7 studies) or partial (3/3 studies) dentures (vs. no dentures) on nutritional status, though no clear direction of effect was detected for the impact of dentures on dietary intake」「The balance of data clearly showed that objective measures of eating function were compromised in full (14/15 studies) and partial (6/7 studies) denture wearers as compared with the dentate」｜caveat: 以計票法與敘事合成，未做統合分析；納入研究品質不一
  • F23｜confidence: verified｜basis: peer_reviewed（PMID 37837498，系統性回顧）｜period: 2023 刊出（電子版 2023-10-14）｜geo: universal｜span: 「Of the 1517 articles identified in the initial search, 12 were selected for the final review」「a consistent pattern of improvement in nutritional status was not observed when they did not receive dietary advice」「Isolated prosthetic rehabilitation may not have the effect of exerting a change in nutritional status of edentulous elderly patients」｜caveat: 族群限 60 歲以上、追蹤至少 1 個月之隨機臨床試驗；結論限無牙年長者
  • F24｜confidence: verified｜basis: peer_reviewed（PMID 17559530）｜period: 2007 刊出｜geo: universal｜span: 「Supraeruption was found in 92% of subjects' unopposed teeth」｜caveat: 100 例＋100 對照之就診族群研究，非社區普查。本條摘述自 KM-DENTAL-34（該卡為此題 canonical），本卡不重寫其完整分析
  • F25｜confidence: verified｜basis: peer_reviewed（PMID 22211303，系統性回顧）｜period: 2012 刊出，納入 20 篇｜geo: universal｜span: 「horizontal dimensional reduction (3.79 ± 0.23 mm) was more than vertical reduction (1.24 ± 0.11 mm on buccal, 0.84 ± 0.62 mm on mesial and 0.80 ± 0.71 mm on distal sites) at 6 months」｜caveat: 限未經處置之自然癒合拔牙窩。同錨 KM-DENTAL-34 之 F24 與 KM-DENTAL-28
  • F26｜confidence: verified｜basis: peer_reviewed（PMID 42021242，質性研究）｜period: 2026-04-23 刊出；試驗註冊 ISRCTN26302774｜geo: universal｜span: 「a purposive sample of 15 older partially dentate patients」「Each patient received resin-bonded bridgework (RBB) to restore them to a functional dentition of 10 occluding pairs」「the patients indicated concern that the SDA treatment provided in the clinical study would not be available to them in a primary care setting」｜caveat: 質性訪談、n=15、族群限先前參加該試驗的年長者，且研究地點在愛爾蘭與北愛爾蘭；受訪者對可近性的擔憂為當地情境，本卡不外推到台灣
  • F27｜confidence: verified（2026-08-06 以 ego-browser 實載，逐字對得上）｜basis: law｜period: 現行條文（法規整編資料截止日：民國 115 年 07 月 31 日）｜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
  • 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 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
  • F29｜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
  • F30｜confidence: verified（2026-08-06 以 ego-browser 實載，頁面標題與 4 筆檔案清單逐字讀取）｜basis: official_statement｜period: 頁面所列生效日 115.07.01、更新日 115.06.24｜geo: TW｜span: 衛生福利部中央健康保險署「全民健康保險醫療服務給付項目及支付標準」公告頁，列有支付標準壓縮檔等 4 筆資料｜caveat: 本卡未下載檔案逐項比對，僅將其定位為查證管道，不代為判定任何項目是否給付
  • F31｜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；其他縣市頁面放量前逐一補驗
  • F32｜confidence: verified（2026-08-06 以 ego-browser 實載並逐字讀取；頁面標示資料更新 115-05-29）｜basis: official_statement｜period: 頁面現況｜geo: TW｜span: 臺北市政府社會局「中低收入老人假牙補助」：補助態樣含活動假牙、固定假牙、活動假牙維修三類；服務對象為列冊該市之低收入戶、中低收入戶、領有中低收入老人生活津貼、收容安置補助、身心障礙者生活補助費等身分別，並分別訂有年滿五十五歲或六十五歲以上之年齡門檻；備註載明「後牙區連續缺牙超過三顆（含）僅核予活動假牙」「活動及固定假牙裝置補助，同一牙位五年內（以裝置完成日起算）不得重複申請」；應備文件由該局每年公告｜caveat①：本站不轉載該辦法之任何補助金額。caveat②：僅臺北市一縣市例證，其他縣市規定不同，本卡未逐一查證。caveat③：「後牙區連續缺牙超過三顆僅核予活動假牙」為補助核定之行政規則，非臨床適應症判準。caveat④：中央層級同性質計畫名稱本卡未實測驗證，故不引用。同錨 KM-DENTAL-13
  • F33｜confidence: verified｜basis: internal_dataset｜period: 2025-03 至 2026-08 GSC｜geo: TW｜span: backlog #35「缺牙沒錢補」「拔牙後一定要植牙嗎」「缺牙一定要植牙嗎」「沒有牙根一定要植牙嗎」「牙齒掉了一定要植牙嗎」「一定要植牙嗎」等 6 詞項合計曝光 103,429，跨 2 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
  • F34｜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: 「兩個問題的拆解」與「六個條件清單」為本站依 F1 至 F26 文獻整理的溝通用架構｜caveat: 非臨床判準、非診斷工具，不取代醫師評估
  • F35｜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

來源清單

取用日期均為 2026-08-06。PubMed 條目以 E-utilities efetch 取得摘要原文逐字對照，並以 esummary 逐筆檢視 pubtype（除第 3 條外均無撤回標記）；台灣官方與法規頁面以 ego-browser 實載並讀取 innerText 逐字比對。

  1. McLister C, et al. Effectiveness of prosthodontic interventions and survival of remaining teeth in adult patients with shortened dental arches — A systematic review. J Dent. 2018. PMID 29476794
  2. Herrera D, et al. Treatment of stage IV periodontitis: The EFP S3 level clinical practice guideline. J Clin Periodontol. 2022. PMID 35688447
  3. WITHDRAWN: Interventions for replacing missing teeth: partially absent dentition. Cochrane Database Syst Rev. 2019. PMID 31425605（**已撤回，本卡標為非證據**）
  4. Jung RE, et al. Systematic review of the survival rate and the incidence of biological, technical, and aesthetic complications of single crowns on implants. Clin Oral Implants Res. 2012. PMID 23062124
  5. Giok KC, et al. Risk factors for Peri-implantitis: An umbrella review of meta-analyses of observational studies and assessment of biases. J Dent. 2024. PMID 38762079
  6. Tarce M, Quirynen M. Peri-implantitis Risk Assessment (PiRA) Part 1: Umbrella Review. Int J Oral Maxillofac Implants. 2025. PMID 40512526
  7. Herrera D, et al. Prevention and treatment of peri-implant diseases — The EFP S3 level clinical practice guideline. J Clin Periodontol. 2023. PMID 37271498
  8. Pjetursson BE, et al. All-ceramic or metal-ceramic tooth-supported fixed dental prostheses? Part II: Multiple-unit FDPs. Dent Mater. 2015. PMID 25935732
  9. Scheuber S, et al. Implants versus short-span fixed bridges: survival, complications, patients' benefits. A systematic review on economic aspects. Clin Oral Implants Res. 2012. PMID 23062127
  10. Gotfredsen K, et al. Efficacy and risks of removable partial prosthesis in periodontitis patients: A systematic review. J Clin Periodontol. 2022. PMID 34761421
  11. Liang S, et al. Effects of removable dental prostheses on masticatory performance of subjects with shortened dental arches: A systematic review. J Dent. 2015. PMID 26066662
  12. Kanno T, Carlsson GE. A review of the shortened dental arch concept focusing on the work by the Käyser/Nijmegen group. J Oral Rehabil. 2006. PMID 17002745
  13. Walter MH, et al. The Randomized Shortened Dental Arch Study: Tooth Loss Over 10 Years. Int J Prosthodont. 2018. PMID 29316570
  14. Funke N, et al. Impact of shortened dental arch therapy on nutritional status and treatment costs in older adults: A systematic review. J Dent. 2023. PMID 37001792
  15. Borda MF, et al. Comparative outcomes of endodontically treated teeth versus dental implant-supported prostheses: a systematic review. Acta Odontol Scand. 2025. PMID 40552466
  16. Sinsareekul C, et al. Survival, complications, and patient-reported outcomes of endodontically treated teeth versus dental implant-supported prostheses: A systematic review. J Prosthet Dent. 2025. PMID 38443242
  17. Sanz M, et al. Treatment of stage I-III periodontitis — The EFP S3 level clinical practice guideline. J Clin Periodontol. 2020. PMID 32383274
  18. Broers DLM, et al. Reasons for Tooth Removal in Adults: A Systematic Review. Int Dent J. 2022. PMID 33648772
  19. Fee PA, et al. Recall intervals for oral health in primary care patients. Cochrane Database Syst Rev. 2020, CD004346.pub5. PMID 33053198
  20. Leite FRM, et al. Tooth Loss and Edentulism Are Associated With Poorer Quality of Life: A Systematic Review and Meta-Analyses. J Periodontal Res. 2026. PMID 42131949
  21. Zelig R, et al. Tooth Loss and Nutritional Status in Older Adults: A Systematic Review and Meta-analysis. JDR Clin Trans Res. 2022. PMID 33345687
  22. Moynihan P, Varghese R. Impact of Wearing Dentures on Dietary Intake, Nutritional Status, and Eating: A Systematic Review. JDR Clin Trans Res. 2022. PMID 34210202
  23. Brígido JA, et al. The effect of prosthetic rehabilitation with or without dietary advice on nutritional status in elderly patients: a systematic review. Aging Clin Exp Res. 2023. PMID 37837498
  24. Craddock HL, Youngson CC. Occlusal changes following posterior tooth loss in adults. Part 1. J Prosthodont. 2007. PMID 17559530
  25. Tan WL, et al. A systematic review of post-extractional alveolar hard and soft tissue dimensional changes in humans. Clin Oral Implants Res. 2012. PMID 22211303
  26. Meaney S, et al. Patient perceptions of prosthodontic management options for partially dentate older adults: a qualitative study. BMC Oral Health. 2026. PMID 42021242
  27. 全民健康保險法 第 51 條（全國法規資料庫）
  28. 醫療法 第 81 條（全國法規資料庫）
  29. 醫療法 第 87 條（全國法規資料庫）
  30. 衛生福利部中央健康保險署「全民健康保險醫療服務給付項目及支付標準」公告頁
  31. 政府資料開放平臺：臺北市醫療收費標準（提供機關：臺北市政府衛生局）
  32. 臺北市政府社會局「中低收入老人假牙補助」
  33. 內部數據：`analysis/reports/km-dental-backlog.md` #35 附錄（詞×站×曝光逐筆可對帳）
  34. 編輯框架：本站「兩個問題」拆解與「六個條件」清單（無外部來源，標示為結構性整理）
  35. 跨卡已驗事實：`km-compliance/VERIFIED-FACTS.md`「醫材比價網不含牙科」（2026-08-05 實測）

內部引用鏈

  • 缺牙不補會發生什麼、短牙弓的完整討論（本題 canonical，本卡不重寫）：臼齒拔掉可以不補嗎？會怎樣？（KM-DENTAL-34）
  • 活動假牙的費用組成、維護與地方補助細節：活動假牙要多少錢？（KM-DENTAL-13）
  • 固定假牙（牙橋、牙冠）的費用組成與報價單讀法：做一顆固定假牙要多少錢？（KM-DENTAL-03）
  • 植牙費用的組成與變因：植牙一顆到底多少錢？（KM-DENTAL-09）
  • 修磨較少的黏著式牙橋是什麼、適合誰：黏著式（馬里蘭）牙橋是什麼？適合誰？（KM-DENTAL-22）
  • 多顆缺牙、整口重建的費用怎麼問：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；F3 為撤回文獻，任何情況下不得被改寫成臨床證據；F32 之補助金額一律不得補回可見層；F35 沿用跨卡已驗結論，若 VERIFIED-FACTS 更新須同步。

FAQ

缺一顆牙，一定要植牙嗎？
**不一定。** 一份以短牙弓／牙列縮減成年病人為對象的系統性回顧結論寫明，目前證據不足以推薦任一種補牙策略優於其他策略 [F1]；而涵蓋更廣「部分缺牙」族群的那份 Cochrane 回顧已撤回，沒有現行有效結論 [F3]。植牙的植體 5 年存活率在統合分析中為 97.2% [F4]，但同一份回顧也記錄技術性、生物性與美觀併發症頻繁出現 [F4]；牙周炎與吸菸是高度提示的植體周炎風險因子 [F5]，且植體負重後需要結構化的支持性照護 [F7]。牙橋、活動假牙、以及在特定條件下不補回後段大臼齒，都是文獻中討論過的處理方式 [F8][F10][F12]。哪一種適合你，須由牙醫師評估。
1 本欠損したら、必ずインプラントが必要ですか？ — **必ずしもそうではありません。** 短縮歯列・歯列縮減の成人を扱った系統的レビューは、どの補綴戦略をほかより推奨するにも現時点のエビデンスが不十分としています [F1]。より広い部分欠損歯の集団を扱う Cochrane レビューは撤回され、現在有効な結論はありません [F3]。メタ解析はインプラントの 5 年生存率を 97.2% と報告しましたが [F4]、同レビューは技術的、生物学的、審美的合併症も頻繁と記録しました [F4]。歯周炎と喫煙はインプラント周囲炎の高度に示唆的なリスク因子で [F5]、荷重後には構造化された支持的ケアが必要です [F7]。ブリッジ、可撤式義歯、そして一定の条件では後方大臼歯を補わないことも、文献で扱われる方法です [F8][F10][F12]。どれが合うかは歯科医師の評価が必要です。
If I am missing one tooth, do I definitely need an implant? — **Not necessarily.** A systematic review of adults with shortened dental arches/reduced dentitions says current evidence is insufficient to recommend any replacement strategy over another [F1]. The Cochrane review covering the broader population with partial tooth loss has been withdrawn, leaving no current valid conclusion [F3]. Meta-analysis reported 5-year implant survival of 97.2% [F4], but the same review recorded frequent technical, biological, and aesthetic complications [F4]. Periodontitis and smoking are highly suggestive peri-implantitis risk factors [F5], and structured supportive care is needed after loading [F7]. Bridges, removable dentures, and—in specified circumstances—not replacing posterior molars are all approaches discussed in the literature [F8][F10][F12]. A dentist must assess which suits you.
我真的沒有錢，是不是只能先放著？
**「先放著」和「有計畫地暫緩」是兩回事。** 文獻上，拔牙指徵中齲齒佔 36.0% 至 55.3%、牙周炎佔 24.8% 至 38.1% [F18]——會讓你再多缺一顆的，通常是這兩件事，所以在有限的預算下，先控制它們的順序高於補回已缺的位置。牙周治療本身就是階梯式的療程結構 [F17]，而牙周炎造成的功能後果，指引也把重建排在完成主動牙周治療之後 [F2]。此外，一份針對年長者的系統性回顧在臨床意義段寫的是：短牙弓治療「可被考慮」為年長者的可行治療概念，特別是在病況複雜與財力有限者身上 [F14]——這是保留語氣的研究層級建議，族群限年長者，且該回顧僅納入 4 篇報告；適不適用你，仍須由牙醫師依你的口內條件判斷。
本当に費用がありません。当面は放っておくしかないですか？ — **「放っておく」と「計画して延期する」は異なります。** 文献では、抜歯適応のうち、う蝕は 36.0% 〜 55.3%、歯周炎は 24.8% 〜 38.1% を占めます [F18]。これらは次の歯を失う原因になり得るため、予算が限られるなら欠損部を補う前にコントロールします。歯周治療自体に段階構造があり [F17]、指針は活動性歯周治療の完了後に機能的な結果の再建を置いています [F2]。高齢者の系統的レビューは、短縮歯列治療が、複雑な医学的状態や限られた経済的余裕がある人で実行可能な概念として「考慮され得る」と慎重に記しています [F14]。これは慎重な研究レベルの表現で、対象は高齢者、組み入れ報告は 4 件だけです。口腔内の条件に当てはまるかは歯科医師が判断します。
I truly have no money. Is my only option to leave it alone for now? — **“Leave it alone” and “defer it with a plan” are different.** In the literature, caries account for 36.0% to 55.3% of extraction indications and periodontitis for 24.8% to 38.1% [F18]. These are commonly what can lead to another missing tooth, so with a limited budget, controlling them comes before replacing the missing site. Periodontal treatment itself has a stepwise structure [F17], and guidelines place reconstruction for functional consequences after active periodontal treatment is completed [F2]. A systematic review in older adults says, cautiously, that shortened dental arch treatment “may be considered” as a feasible concept, especially for people with complex medical status and limited finances [F14]. This is a guarded, study-level statement; the population is older adults and the review included only 4 reports. A dentist must decide whether it applies to your oral condition.
沒有牙根了，是不是只剩植牙一條路？
**要先分清楚你的狀況是哪一種。** 如果牙根還在、只是嚴重損壞，那要先討論的是「治療後保留」與「拔除後重建」的取捨：一份 2025 年的系統性回顧記錄兩者失敗率介於 0.7% 至 12.0%、無顯著差異，而植體與較高頻率的術後處置與併發症相關，並寫明決策應考量臨床因素、病人偏好、費用與可近性 [F15]；另一份同年的系統性回顧則寫明哪一種在存活結果上較好並不明確 [F16]。如果牙根確實已經沒有了，那麼植牙、牙橋、活動假牙都是文獻中的選項 [F4][F8][F10]，並非只剩一條路。
歯根がなければ、残る道はインプラントだけですか？ — **まず、どの状況かを分けてください。** 歯根が残り歯が大きく損なわれているなら、まず治療後の保存と抜歯後の再建の負担を相談してください。 2025 年の系統的レビューは、失敗率 0.7% 〜 12.0%、有意差なし、インプラントでより頻繁な術後介入・合併症、臨床因子・選好・費用・利用可能性を考える必要を報告しました [F15]。別の 2025 年の系統的レビューは、生存でどちらがよいかは不明確としました [F16]。歯根が本当にない場合も、インプラント、ブリッジ、可撤式義歯はいずれも文献で扱われる選択肢であり [F4][F8][F10]、残る道が一つだけということではありません。
If there is no root, is an implant the only path left? — **First distinguish which situation you have.** If the root remains and the tooth is severely damaged, first discuss the trade-off between retention after treatment and reconstruction after extraction. A 2025 systematic review reported failure rates of 0.7% to 12.0%, no significant difference, more frequent postoperative interventions and complications with implants, and the need to consider clinical factors, preferences, cost, and accessibility [F15]. Another 2025 systematic review said which gives better survival remains unclear [F16]. If the root truly is absent, implants, bridges, and removable dentures are all literature-discussed options [F4][F8][F10], not a single remaining path.

來源錨定

引用本文

km 編輯部・《缺牙一定要植牙嗎？沒錢補怎麼辦？｜證據鏈》・IDAEO 知識庫・2026-08-13・https://km.idaeo.ai/reports/dental-missing-tooth-options-evidence

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更新 2026-08-13T14:17:27.371Z · server-rendered · four-language · IDAEO 知識庫