原位取骨上颌窦内提升同期牙种植在严重上颌骨萎缩病例中的应用

目的:评价上颌窦内提升同期牙种植术在上颌牙槽骨高度严重不足的临床应用.方法:对20例上颌窦底牙槽骨剩余高度4.0-7.0mm(平均高度5.4mm)的牙缺失患者采用空心环柱形切骨锯在种植区切骨、取骨,用骨挤压器对上颌窦底提升后,将圆柱状骨芯研磨成颗粒后,将自体骨颗粒或混合羟基磷灰石的颗粒植入上颌窦底,再置入种植体,术后1、3.6、12、18、24个月后复查.结果:共28枚Replace种植体植入,其中窦底提升3-6mm后(平均4.6mm)植入27枚,上颌窦穿孔后同期植入种植体1枚,全部一期愈合,术后3月X线片显示种植体与新骨形成紧密的骨性结合,术后3-6月完成种植修复,效果理想.术后24个月留存率100%.结论:上颌牙槽骨高度严重不足的病例中采用上颌窦内提升,结合原位取骨、植骨,同期牙种植的方法能有效解决骨量严重不足时牙种植问题.     

非开窗式上颌窦底提升术同期种植体植入技术的临床应用

目的:采用非开窗式上颌窦提升术并同期种植体植入。方法:对21例上颌后牙区牙槽脊顶距离上颌窦底5-8mm,牙缺失的病人进行非开窗式上颌窦底提升术,同期种植体植入,术前,曲面断层片测量牙槽骨高度,提升2￣6毫米窦底放置bio-oss人工骨。结果:共植入29颗种植体,半年后种植体与骨结合满意,义齿修复后效果良好。结论:非开窗式上颌窦底提升术同期牙种植体植入术手术简便,创伤小,术后反应小。     

上颌窦内提升术种植修复上颌后牙缺失的临床观察

目的:评价上颌窦内提升术并同期植入种植体在上颌后牙区缺失修复中的应用效果。方法:2008年至2010年共完成上颌窦内提升术并同期植入种植体临床病例20例。男12例,女8例,年龄18-65岁。术前CT示:牙槽嵴顶至上颌窦底距离为5-8mm,行上颌窦内提升术,平均提升上颌窦底高度3.8mm(2-5mm),共植入38枚种植体,种植体植入6个月后完成义齿修复。结果:所有患者术后未出现上颌窦炎症,一例术中窦膜穿孔,将种植窝放入明胶海绵,同期植入种植体完成种植手术,术后3天术区疼痛,无其他明显症状。38枚种植体平均负载18个月,种植体稳定,行使功能良好,未见明显骨吸收。结论:对于骨高度不足的患者,行上颌窦内提升术,并同期植入种植体的方法可靠,具有好的疗效,可扩大种植牙的适应症范围。     

上颌窦内提升植骨及同期牙种植术在严重上颌骨萎缩中的应用

目的:评价上颌窦内提升同期牙种植术在上颌牙槽骨高度严重不足的临床应用.方法:对25例上颌窦底牙槽骨剩余高度1.9-5.0mm(平均高度3.5mm)的牙缺失患者采用空心环柱形切骨锯在种植区切骨、取骨,用骨挤压器对上颌窦底提升后,将圆柱状骨芯研磨成颗粒后,将自体骨颗粒或混合羟基磷灰石的颗粒植入上颌窦底,再置入种植体,术后1、3、6、12、18、24个月后复查.结果:共29枚种植体植入,其中窦底提升5-8mm后(平均6.45mm)植入27枚,上颌窦穿孔后盖膜植骨同期植入2枚.分别植入18枚Replace和11枚Xive种植体,全部一期愈合,术后3-6月大部分病例的X线片显示种植体与新骨形成紧密的骨性结合,术后1.5-6月完成种植修复,效果理想.术后18-30月留存率100%.结论:上颌牙槽骨高度严重不足的病例中采用上颌窦内提升,结合原位取骨、植骨,同期牙种植的方法能有效解决上颌后牙区骨量严重不足时的牙种植问题.     

上颌窦底骨切开提升术及同期牙种植体植入

目的：介绍经牙槽嵴顶进路行上颌窦底骨切开提升术,并同期植入牙种植体的方法与疗效。方法：对31例上颌后牙牙槽骨剩余高度5～10mm（平均高度7.1mm）的牙缺失者行上颌窦底骨切开提升术,同期植入牙种植体。术前摄X片测定牙槽骨高度,提升高度1～2mm者,仅植入种植体,提升高度超过3mm者,窦底放置Bio-Oss人工骨。结果：共植入40枚牙种植体,窦底提升1～2mm5枚,超过3mm者35枚,窦底平均提升3.70mm。分别植入Frialit-2种植体10枚,Xive种植体8枚,ITI种植体22枚。术后无术区感染和上颌窦炎症。X线片示种植体处窦底骨板呈半球状隆起,半年后见种植体与骨结合满意。结论：⑴经牙槽嵴顶行上颌窦底骨切开提升,可同期植入牙种植体,手术操作简便,创伤小。⑵牙槽骨剩余高度5～10mm为窦底骨切开提升术的适应症。⑶窦底提升2mm以内者无需植入骨替代材料,术后4月可行义齿修复;提升3～6mm时需放置植入物,义齿修复应延迟在术后6～8月进行。     

不使用骨移植材料的上颌窦内提升同期牙种植术

目的：探讨上颌后牙区种植,骨高度不足病例采用经牙槽嵴顶入径的上颌窦提升技术,不植入骨移植材料,同期进行种植体植入的可行性。方法：采用经牙槽嵴顶入径,以骨凿技术进行闭合式上颌窦提升,在提升后的空间内不植入任何骨移植材料,并同期植入种植体,修复完成后经1、3、6、12、24个月随访,拍摄全颌曲面断层片和根尖片评价种植体颈缘骨水平变化,窦底提升后骨高度变化以及种植体周围骨整合情况。结果：所有病例在观察期内均未发生上颌窦炎症,种植体根尖部与窦底之间可见新骨生成,种植体周围骨整合良好,窦底提升后上颌窦底至牙槽嵴顶的骨量明显增加。结论：经牙槽嵴顶入径,采用骨凿技术进行上颌窦底提升术后,不植入骨移植材料,在6月后的X线片上可观察到窦底骨高度由于新骨的生成而增加,种植体根尖部被新生的骨组织包绕并形成骨结合。     

经牙槽嵴顶行上颌窦底提升同期植入种植体的疗效评价

目的:观察使用骨挤压器经牙槽嵴顶入路提升上颌窦底、同期植入种植体的临床效果。方法:对104例单侧或双侧上颌后牙缺失患者,经牙槽嵴顶入路行上颌窦底提升,同期植入种植体,共126颗。全部病例均行X线曲面断层片,其中30例在后期随访中行螺旋CT扫描及三维重建。结果:上颌窦剩余牙槽骨平均高度为9.16mm(5～11mm),用骨挤压器平均提升上颌窦底高度3.95mm(2～6mm),无1例上颌窦黏膜穿孔。随访16～82个月,成功率达100%,所有病例均无上颌窦并发症。CT扫描及三维重建显示,种植体顶端有一层完整骨质覆盖,种植体完全埋入骨质中。结论:应用骨挤压器,经牙槽嵴顶入路行上颌窦提升同期植入种植体,与上颌窦外提升术相比,手术创伤小、操作简便、并发症少,其近、远期效果均满意;螺旋CT扫描及三维重建可作为上颌窦提升种植体植入术后判断手术效果的有效手段。     

上颌窦底冲压提升在口腔种植修复中的应用与技巧

目的:探讨上颌窦底冲压提升技术在上颌后牙区种植修复中应用技巧及临床效果.方法:2001年5月至2008年12月共完成56例、67侧、114枚种植体的上颌窦底冲压提升种植修复病例.随访5年以上5例、3年以上15例、2年以上21例、1年以上15例,平均随访27个月.观察方法为临床检查和X线检查.患者上颌后牙区牙槽嵴顶至上颌窦底之间剩余骨高度在5-8mm之间,因此采用上颌窦底冲压提升上颌窦底骨板及黏骨膜高度在2-5mm.术中部分患者使用了少量细颗粒的Bio-Oss骨移植材料,采用埋入式种植技术,4-6个月后进行Ⅱ期手术及修复.手术技巧为采用德国凹形平行带刃骨挤压器,逐级冲压备洞的方法.结果:总计56例患者,5例发生上颌窦黏骨膜穿破,但术后观察未发生上颌窦感染等并发症.1例患者在修复后1年半脱落,有1例在Ⅱ期手术中植体松动,即刻改用直径大一号的种植体植入获得良好的出其稳定性并上愈合基台6个月后修复成功.114枚种植体中有2枚脱落,存留率为98.25%.结论:上颌窦底提升种植技术,只要方法正确并积累经验掌握技巧,可以达到简易、安全、手术创伤小的效果.     

改良上颌窦底内提升术的临床效果观察

目的 :评估一种改良上颌窦底内提升术在口腔种植修复中的临床效果。方法 :在2016-12—2018-07期间,于56例上颌后牙缺失患者共83个位点,行穿牙槽嵴顶四周剥离上颌窦底提升术。术前CBCT测量剩余骨高度(residual bone height, RBH),术中植骨,同期或延期植入种植体。术后即刻拍摄CBCT测量上颌窦底提升高度并观察窦底黏膜完整性。术后至少4个月完成修复,随访观察种植体存留率。结果:3个位点术中因上颌窦黏膜破裂改为侧壁开窗上颌窦底提升术,位点黏膜破裂率为3.61%。其余80个位点术后即刻CBCT显示其中5个位点上颌窦底黏膜破裂,位点黏膜破裂率为6.02%。80个位点中76个位点同期种植,3个位点延期种植,1个位点放弃种植。种植体直径为4.0～5.1 mm,平均(4.73±0.35) mm,长度为8.0～11.5 mm,平均(10.27±0.69) mm。上颌窦底黏膜未破裂的75个位点,术前RBH为0.88～9.27 mm,平均(5.57±1.91)mm;上颌窦底提升高度为4.54～15.14 mm,平均(8.09±1.99) mm。手术至修复时间为4～15个月,平均(7.14±2.06)个月,修复后随访时间为1～20个月,平均(9.36±4.60)个月。2枚种植体于修复前脱落,1枚种植体于修复后脱落,总体种植体存留率96.25%。结论:穿牙槽嵴顶四周剥离,行上颌窦底内提升创伤小,相对安全可靠,短期种植修复效果满意。     

上颌后牙区不同剩余骨高度行经牙槽嵴顶提升术同期植入种植体的临床效果研究

目的 探讨上颌窦底不同剩余骨高度(residual bone hight,RBH)行经牙槽嵴顶上颌窦底提升术同期植入种植体以及术中应用浓缩生长因子(concentrated growth factors,CGF)的临床应用效果.方法 纳入我院2014年1月至2017年12月上颌后牙区牙槽骨剩余骨高度不足患者38例,根据不同的RBH以及术中是否应用CGF将38例患者分为四组.A组:3 mm≤RBH<5 mm,经牙槽嵴顶上颌窦底提升术后同期植入种植体7例.B组:3 mm≤RBH<5 mm,经牙槽嵴顶上颌窦底提升术+CGF后同期植入种植体9例.C组:5 mm≤RBH<8 mm,经牙槽嵴顶上颌窦底提升术后同期植入种植体12例.D组:5 mm≤RBH<8 mm,经牙槽嵴顶上颌窦底提升术+CGF后同期植入种植体10例.种植术后即刻、6个月、12个月、24个月时复查CBCT检查种植体颈缘骨水平变化,窦底提升后骨高度变化,种植体骨结合及新骨形成的情况,有无种植体周围炎,种植体及修复体的稳定性,种植义齿的并发症.结果 38例病例无上颌窦炎症反应及上颌窦黏膜穿孔,种植体骨结合良好,永久修复后种植体及修复体稳定,术后一年种植体颈缘骨水平稳定.A、B组间,C、D组间种植体稳定系数(ISQ)的平均值在术后4个月和6个月差异有统计学意义(P<0.05).A、B组间,C、D组间在术后以及随访的24个月内的上颌窦底骨提升量差异均有统计学意义(P<0.05),且应用CGF组窦底骨提升量分别高于A组、C组.结论 在3 mm≤RBH<8 mm时,经牙槽嵴顶上颌窦底提升术同期种植后可获得良好的骨结合,在术中应用CGF可促进上颌窦内提升同期种植后新骨形成,加快骨结合,有效增加窦底骨高度,增强种植体稳定性.     

Sinus floor elevation via the maxillary premolar extraction socket with immediate implant placement: a case series

Background: When immediate implant placement is considered for teeth with close proximity to the sinus floor, apical extension of the osteotomy is significantly limited, and often a staged approach is used. Implant placement into fresh extraction sockets and sinus floor manipulation using bone‐added osteotome sinus floor elevation with implant placement are techniques most often used independently or sequentially. Very few reports have described the combined use of immediate implant placement in fresh sockets and the bone‐added osteotome sinus floor elevation technique. Methods: We present five cases in which a maxillary premolar was extracted and an implant placed into the extraction site with simultaneous abfracture of the sinus floor using osteotomes. All teeth were extracted atraumatically, and sockets carefully debrided and checked for integrity of the walls. After ideal osteotomy preparation, particulate bone graft was placed in the osteotomy and appropriately sized osteotomes were used for sinus floor elevation. After sufficient elevation, implant placement was completed and particulate bone was packed in the bone–implant gap when indicated. Results: All implants were restored after a minimum healing period of 6 months. At the time of final restoration, bone was seen surrounding the implants from the apical portion to the most coronal thread. All five implants healed without complications and were in function for periods ranging from 6 to 12 months. Conclusions: Immediate implant placement with simultaneous osteotome sinus floor elevation is an advantageous combination of two successfully used techniques. This combined approach can significantly reduce the treatment time for implant therapy in teeth with close sinus proximity and provide the operator with the ability to place implants of desired length.     

上颌窦提升一期种植术9例报道

目的 观察上颌窦提升一期种植术治疗上凳后牙缺失牙槽嵴严重吸收患者的临床疗效。方法 对9例上颌后牙区垂直骨量不足患者行10侧上凳窦提升术及同期种植体植入术。结果 术后无种植体松动、脱落，X线检查无上颌窦炎症，种植体与周围组织均形成良好的骨性结合，上颌窦底提升5－10mm，平均7.5mm。术后6－7月均完成义齿修复。结论 上凳窦底提升加一期种植术，可以解决上凳后牙区垂直骨量不足难以种植的问题。     

开窗植骨与闭合冲压上颌窦底提升同期种植的临床研究

目的:研究比较上后牙缺失牙槽嵴高度不足患者,根据上颌窦底牙槽嵴骨高度不同,选用开窗植骨或闭合冲压提升上颌窦底,同期种植牙的治疗效果。方法:43例(55侧)上后牙缺失患者,其中34例(40侧)窦底牙槽嵴骨高6~10 mm者行闭合冲压上颌窦底提升术,其余9例(15侧)骨高2~5 mm者行开窗植骨上颌窦底提升手术,均同期完成一期种植体植入手术。结果:所有患者术后未出现上颌窦炎症,9例行开窗植骨上颌窦底提升手术的患者,无窦膜穿孔,平均提升窦底高度5.8 mm,26颗种植体平均负载30个月,种植体稳定,骨结合状况良好。34例行闭合冲压上颌窦底提升术的患者,平均提升窦底高度4.3 mm,手术操作中有3颗发生可察觉窦膜破孔,发生率为4.1%(3/73),在73颗种植体中,有2颗种植体失败,71颗种植体平均负载23个月,种植体稳定,未见明显骨吸收,成功率97.3%(71/73)。结论:闭合冲压上颌窦底提升术是一种微创、简单、可靠用于上颌后牙上颌窦底牙槽嵴骨高度不足的种植临床技术,临床上应根据上颌窦底牙槽嵴骨高度不同,选用开窗植骨或闭合冲压提升上颌窦底。     

Influence of Sinus Floor Configuration on Grafted Bone Remodeling After Osteotome Sinus Floor Elevation

Background: This study investigates influence of the sinus floor configuration on dimensional stability of grafted bone height after the osteotome sinus grafting procedure. Methods: Forty single‐tooth dental implants inserted after placement of bioglass and/or allograft into the sinus area using an osteotome technique in 37 patients were evaluated in this retrospective study. Periapical radiographs were taken using the long‐cone technique before and after implant placement. Specifically, radiographic measurements of grafted bone height at the mesial and distal side of each implant were taken, and the sinus floor configuration was classified into concave, angle, and flat according to the sinus floor profile at the implant site. Furthermore, the intruding angle, defined as the angle between the implant axis and sinus floor, was measured. Results: All implants were clinically stable during a mean follow‐up period of 39.2 months. Mean initial gain of sinus grafted bone height was 7.0 ± 1.9 mm, and later it was reduced to 4.6 ± 1.9 mm at follow‐up (P <0.001). A greater reduction in grafted bone height was revealed in the flat sinus group compared with the concave group (P <0.001). Results from the linear regression showed larger intruding angles were statistically significantly associated with a greater reduction in grafted bone height (r² = 0.55, P <0.001). Conclusion: All bioglass and/or allograft placed in the maxillary sinus after the osteotome technique underwent remodeling and shrinkage; however, the outcome of the procedure was more predictable in sinuses with a concave floor and small implant‐intruding angles.     

Sinus floor elevation using osteotomes or piezoelectric surgery

The aim of this paper is to describe a technique for sinus floor augmentation with a 1-step crestal approach where the residual bone is ≤7.5 mm. 36 implants were installed in 25 patients in the atrophic posterior maxilla immediately after sinus floor elevation. Sinus floor elevation was performed with a crestal approach using either osteotomes and burs or piezosurgery. Standardized intraoral radiographs were taken prior to surgery and 1 year after surgery. The mean residual bone height was 5.61 mm (range 3-7.5 mm). The mean gain of sinus elevation was 6.78 mm (range 3.5-10 mm) at 1 year after surgery. Two patients dropped out of the study. Of the 23 patients completing the study, one implant failed, whilst the remaining 33 implants were stable 12 months after surgery (cumulative survival rate 97%). A statistically significantly higher bone height was achieved with tapered implants compared with cylindrical implants (P < 0.05). No statistically significant differences were found in bone level using osteotomes or piezosurgery. Piezosurgery was considered to provide less discomfort for the patient and greater convenience for the surgeon.     

Bio-Oss骨粉在上颌窦提升牙种植术中的临床应用

目的：评价上颌窦提升，植Bio-Oss骨粉在上颌后牙种植的方法和效果。方法：对11例牙槽骨高度不足的上颌后牙种植进行上颌窦提升，植Bio-Oss骨粉，同期种植7例，延期种植4例。结果：6个月后，X线片显示Bio-Oss骨粉改建形成了新骨，增加了牙槽骨高度，满足了种植要求，7例同期种植可见种植体与Bio-Oss诱导的新骨形成紧密的骨性结合，种植体植入9个月后进行二期修复。结论：Bio-Oss骨粉植入提升上颌窦增加了上颌后牙区的牙槽骨高度，拓展了种植的适应证，免疫除了自体取骨手术，方法简单，值得临床推广。     

Sinus floor elevation utilizing the transalveolar approach

A transalveolar approach for sinus floor elevation with subsequent placement of dental implants was first suggested by Tatum in 1986. In 1994, Summers described a different transalveolar approach using a set of tapered osteotomes with increasing diameters. The transalveolar approach of sinus floor elevation, also referred to as ‘osteotome sinus floor elevation’, the ‘Summers technique’ or the ‘Crestal approach’, may be considered as being more conservative and less invasive than the conventional lateral window approach. This is reflected by the fact that more than nine out of 10 patients who experienced the surgical procedure would be willing to undergo it again. The main indication for transalveolar sinus floor elevation is reduced residual bone height, which does not allow standard implant placement. Contraindications for transalveolar sinus floor elevation may be intra‐oral, local or medical. The surgical approach utilized over the last two decades is the technique described by Summers, with or without minor modifications. The surgical care after implant placement using the osteotome technique is similar to the surgical care after standard implant placement. The patients are usually advised to take antibiotic prophylaxis and to utilize antiseptic rinses. The main complications reported after performing a transalveolar sinus floor elevation were perforation of the Schneiderian membrane in 3.8% of patients and postoperative infections in 0.8% of patients. Other complications reported were postoperative hemorrhage, nasal bleeding, blocked nose, hematomas and benign paroxysmal positional vertigo. Whether it is necessary to use grafting material to maintain space for new bone formation after elevating the sinus membrane utilizing the osteotome technique is still controversial. Positive outcomes have been reported with and without using grafting material. A prospective study, evaluating both approaches, concluded that significantly more bone gain was seen when grafting material was used (4.1 mm mean bone gain compared with 1.7 mm when no grafting material was utilized). In a systematic review, including 19 studies reporting on 4388 implants inserted using the transalveolar sinus floor elevation technique, the 3‐year implant survival rate was 92.8% (95% confidence interval: 87.4–96.0%). Furthermore, a subject‐based analysis of the same material revealed an annual failure rate of 3.7%. Hence, one in 10 subjects experienced implant loss over 3 years. Several of the included studies demonstrated that transalveolar sinus floor elevation was most predictable when the residual alveolar bone height was ≥ 5 mm and the sinus floor anatomy was relatively flat.     

上颌窦底内提升微创种植体植入17例临床疗效观察

目的:探讨上颌窦底内提升同期不翻瓣微创种植体植入术的临床疗效。方法:2006-09—2010-05期间,17例上颌后牙缺失患者,种植区剩余垂直骨高度(residual bone high,RBH)为5.5～9.0 mm,进行上颌窦底内提升同期不翻瓣微创种植体植入术植入后3～6个月行种植体永久修复。术后1周及1、3、6、12个月复诊,之后每6个月复诊1次,检查种植体稳定性、种植体周牙龈组织健康状况,拍摄X线片观察种植体周骨高度。结果:追踪观察6～40个月,均未见种植体松动或上颌窦炎发生,种植体周龈组织健康;X线片检查种植体骨结合良好种植体周围骨高度稳定。患者对修复效果满意。结论:上颌窦底内提升同期不翻瓣微创种植体植入近期临床效果满意,长期效果尚需进一步观察。     

经牙槽嵴顶入路两种微创上颌窦提升方法的应用及3~5年临床观察

目的:比较2种不同的经牙槽嵴顶入路上颌窦底提升方法在同期植入种植体情况下的3~5年临床观察效果。方法:采用2种上颌窦底提升技术,对70例(共81颗)垂直骨量不足的上颌后牙区种植病例行上颌窦底提升及种植体同期植入手术,术后3、6、12、18~72个月检查上颌窦及种植体骨结合情况。结果:1颗种植体因早期感染脱落,1颗种植体修复戴冠后松动取出,其余79颗种植体X线检查骨整合良好,术后4~6个月完成义齿修复,无上颌窦炎发生。经6~72(36.78±13.74)个月随访观察,临床效果良好。结论:剩余牙槽骨高度6~8mm条件下两种上颌窦底提升方法同期植入种植体的临床效果无统计学差异,而使用DASK工具经牙槽嵴顶微创上颌窦底提升技术的适应证更广泛,可用于剩余牙槽骨高度2~5mm条件,患者手术痛苦小,满意度高。