牙周炎患者上颌窦提升术同期牙种植的临床观察

目的：对牙周炎患者行上颌窦内提升术同期植入种植体的临床效果进行评价。方法：收集2007年7月～2013年7月因上颌后牙缺失的慢性牙周炎患者25例,行单纯上颌窦内提升术并同期植入种植体43枚,修复后随访观察6～70个月。结果：观察期内种植体总留存率97．67％,窦底提升高度≥6mm者种植体留存率为94．44％。42枚种植体成功负载,无松动或脱落。所有牙周炎患者在随访期内均未发生上颌窦炎症,曲面断层片显示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。种植体周围软组织健康,无炎症,牙周探诊龈沟出血指数（SBI）0—1度。结论：对剩余骨高度不足的慢性牙周炎患者,上颌窦内提升术同期植入种植体可获得满意的临床效果。     

牙周炎患者行冲压式上颌窦底提升种植术的临床疗效观察

目的:评价冲压式上颌窦底提升术同期植入种植体修复中、重度慢性牙周炎患者上颌后牙缺失骨量不足的临床疗效.方法:选择中、重度慢性牙周炎伴上颌后牙缺失患者35例,剩余牙槽骨高度平均(5.95±1.19)mm.采用经牙槽突进路上颌窦底提升术不植骨同期植入Straumanns@种植体47颗,分别于3～6个月后行上部修复,随访期为6～30个月,通过影像学及临床PD、PLI、BOP等评价指标,评价种植体修复后的临床疗效.结果:观察期内种植体的留存率为95.74％,45颗种植体成功负载,种植体稳定,骨结合良好.术中2颗种植体发生上颌窦黏膜破裂,穿孔率为4.26％.随访期内,种植体周围组织状况良好,PD平均为(3.22±1.07)mm,平均累积边缘骨丧失为(1.38±0.59)mm.结论:对中、重度慢性牙周炎患者,冲压式上颌窦底提升不植骨同期牙种植术能有效修复上颌后牙区骨高度不足的牙缺失,短期疗效可靠,长期疗效需进一步观察.     

冲压式上颌窦底提升术同期种植临床分析

目的:探讨上颌后牙区采用冲压式上颌窦底提升术植骨与不植骨同期种植的效果。方法:2001年1月—2007年12月,共完成冲压式上颌窦底提升种植修复病例91例,男35例,女56例,随机分为2组,植骨组47例,植入57颗种植体;不植骨组44例,植入种植体51颗,共植入108颗种植体。上颌窦底剩余牙槽骨高度为5～11mm,提升幅度为2～6mm。平均随访56.8个月。35例患者(41颗种植体)于后期随访中行锥形束CT(CBCT)和根尖片,观察种植体新骨形成量和种植体突出窦底高度,应用SPSS17.0软件包对数据进行方差分析和t检验。结果:植骨组7颗种植体脱落,存留率为87.7%;不植骨组3颗种植体脱落,存留率为94.1%。CBCT扫描显示,提升幅度为2～4mm时,植骨组新骨形成高度为(2.7±1.3)mm,不植骨组为(2.4±1.5)mm,2组间无统计学差异;提升幅度为4～6mm时,植骨组新骨形成高度为(3.5±1.3)mm,不植骨组为(1.3±0.4)mm,植骨组比不植骨组新骨形成高度显著增加。结论:在上颌后牙缺失区采用冲压式上颌窦底提升、不植骨同期种植是安全可行的,植骨材料对于促进新骨形成并非必须,然而提升幅度较大时,植骨能获得更多的骨量。     

Computed tomographic evaluation of sinus augmentation with simultaneous endosseous implant placement

Computed tomography (CT) has become the gold standard by which a comprehensive implant treatment plan is determined and a postoperative assessment of cancellous and cortical bone is achieved. A patient with an insufficient alveolar bone height and sinus pneumatization was treated for the simultaneous placement of implants with sinus augmentation. CT scans were used not only for the presurgical evaluation, but also for the postoperative radiographic observation. The new sinus floor seemed to be more defined as time goes on and the decrease in alveolar bone height could not be found. The cortication and remodeling of the buccal window were apparent in the 10-month postoperative CT scan. No significant change in alveolar bone height was seen between the 6- and 10-month postoperative measurements. Implants placed simultaneously with the sinus augmentation procedure were maintained in a healthy condition up to 18 months and it was shown that CT scans can serve as a good follow-up tool in assessing postoperative results.     

Radiographic comparison between Densah burs and osteotome for graftless internal sinus lifting with simultaneous implant placement: a randomized clinical trial

Implant placement in the posterior maxilla is not an easy procedure, not only due to the low quality of bone, but also the physiological pneumatization, which decreases the remaining bone height to the maxillary sinus. Sinus lifting is an alternative for implant placement in these cases. The aim of this study was to radiographically compare the effect of Densah densifying burs versus osteotome in transcrestal sinus lifting. Twelve patients with missing premolars or molars and limited residual bone height were enrolled in the study and divided equally (by coin toss) into two groups: group A underwent densifying bur sinus lifting and group B underwent osteotome sinus lifting. Follow-up was performed over 6 months. Bone density (measured around the implant and at the implant apex) and bone height gain (measured using three reference points across the implant length) were measured using OnDemand 3D software. Bone density around the implant was found to be significantly higher for the densifying burs (P = 0.010); however, no significant difference in bone height gain (P = 0.985) or apical bone density (P = 0.337) was detected between the two groups. Densifying burs significantly improved bone density around dental implants, but did not prove to provide a significantly higher bone height gain or apical density compared to osteotomes in graftless internal sinus lifting.Trial registration numberClinical trial.gov registration ID #NCT04688957.     

Platelet-rich plasma for bone graft enhancement in sinus floor augmentation with simultaneous implant placement: patient series study

The use of autologous platelet-rich plasma (PRP) as a source for growth factors in bone grafting is a relatively new and promising technique. Early controlled studies indicate that combining PRP with autologous bone grafts significantly enhances the rate of bone formation and maturation. The study consisted of 105 patients who required sinus augmentation with crestal bone height of less than 5 mm in the posterior maxilla. All patients received a composite bone graft that consisted of 30% to 40% autogenous bone harvested from the lateral wall of the maxilla zygomatic-maxillary buttress and the tuberosity and 60% to 70% xenograft. A total of 50 mL of blood was obtained from each patient before the surgical treatment for preparation of 10 mL of PRP. The graft-PRP mixture was activated by human thrombin. All sinus augmentations were carried out simultaneously with dental implants. At 6 months postoperatively, implants were exposed showing no clinical evidence of crestal bone loss around the implants both clinically and radiographically. All implants were clinically osseointegrated and loaded with fixed porcelain fused to metal prosthesis. The use of PRP in augmenting the severely atrophic posterior maxilla has obvious clinical benefits in terms of reducing the healing period of bone maturation, better graft handling, and accelerated soft tissue healing.     

单纯上颌窦内提升术同期牙种植的临床应用

目的:研究单纯上颌窦内提升术同期牙种植修复上颌后牙缺失骨高度不足病例的临床疗效.方法:上颌后牙缺失病例50例.种植区剩余牙槽骨高度为(5.2±2.2)mm,行单纯上颌窦内提升同期牙种植术,共植入67枚Straumann SLA种植体.术后3～6个月上部结构修复,观察种植体的稳定性、种植体周围骨结合及骨量改变情况.随访期为(12.8±5.6)个月.结果:观察期内种植体的留存率为97.01%,65枚种植体成功负载,种植体稳定,骨结合状况良好,无不良自觉症状.术中4枚种植体发生上颌窦黏膜破裂,穿孔率为4.48%.术后当天与术后6个月X线显示上颌窦内种植体周围骨高度增加(2.5±1.3)mm,边缘骨丧失(1.1±0.7)mm.结论:单纯上颌窦内提升同期牙种植术能有效治疗上颌后牙缺牙区上颌窦底牙槽骨高度不足的牙缺失,对窦底骨高度极度不足(<4mm)亦有治疗可能.     

闭合式上颌窦底提升术同期种植体植入临床应用分析

目的探讨采用闭合式上颌窦提升术进行上颌窦底提升及同期种植体植入的效果及技术特点。方法对56例患者共64枚种植体应用骨挤压技术经牙槽嵴顶入路行闭合式上颌窦底提升术及同期种植体植入术。观察方法为临床检查和X线片检查。结果全部患者均在术后6个月完成义齿修复。随访时间8个月-5年,平均19.4个月,发现有3例鼻腔出血;义齿修复后种植体无松动及脱落。术后X线片检查种植区窦底高度平均提升(3.85±0.12)mm,种植体周围无阴影,形成良好的骨结合。结论闭合式上颌窦底提升术较传统的开放式上颌窦提升术简化了手术步骤,缩短了手术时间,减轻了患者术后反应,是一种简单有效的窦底提升技术。     

Ridge-splitting technique with simultaneous implant placement

Bone augmentation procedures are routinely required before dental implant placement. Several techniques for this procedure may be considered, such as guided bone regeneration, bone block grafting, and ridge splitting for bone expansion. These case reports describe the technique for ridge splitting and gradual expansion in the maxilla and the mandible. Simultaneously, dental implants were placed within the split ridge, surrounded by the particulate bone graft and covered by a resorbable membrane. Six months later, the implants were uncovered followed by impression and final restoration with implant-supported porcelain-fused-to-metal crowns.     

上颌窦底微创提升的短期临床疗效评价

目的：通过临床试验评估一种上颌窦底微创提升技术的疗效。方法试验组11例患者的上颌后牙区行上颌窦底微创提升技术并同期植入短种植体14枚。对照组10例患者进行了使用扩孔钻的上颌窦冲顶技术并同期植入短种植体13枚。两组患者术后6个月行暂冠修复,进行咬合训练及软组织塑形,3个月后永久修复。术后定期复诊,检查患者的上颌窦、种植体骨结合情况,并使用锥形束CT（CBCT）测量骨增量水平。结果试验组及对照组均无种植体松动、脱落及上颌窦炎发生,CBCT显示种植体与周围组织形成良好的骨性结合。经2~28个月随访观察,临床效果良好。试验组和对照组平均窦底垂直骨增量分别为5.87和5.45 mm。结论上颌窦底微创提升联合短种植体同期植入是一种创伤小、操作简单、行之有效的上颌后牙区种植外科技术,可用于上颌窦底垂直骨量严重不足,余留牙槽骨高度不足4 mm的病例。     

上颌窦底提升不植骨同期植入种植体的临床疗效观察

目的 观察冲压式上颌窦底提升术(osteotome sinus floor elevation,OSFE)不植骨并同期植入种植体的临床疗效及技术特点.方法 自2000年1月至2008年12月对65例患者经牙槽嵴顶入路,行OSFE并同期行种植体植入术,共植入96枚种植体,手术过程中上颌窦内不植入任何骨充填材料.缺牙区牙槽骨可用骨高度为5～8 mm,平均(6.78 4±1.04)mm.观察方法 为临床和X线片检查.对种植体凸入上颌窦内不同长度、安底改建情况进行卡方检验.结果 除1例单牙种植术后15 d因种植体松动、牙龈红肿取出种植体,其余64例患者随访>5年12例,>3年14例,>2年28例,>1年lO例,平均随访33.4个月.96枚种植体中除1枚于种植15 d后松动取bm外,其余种植体均获得良好的骨结合并完成上部义齿修复,种植体周围软组织无炎症,咀嚼功能良好.种植体凸入上颌窦内1～5 mm,平均2.57 mm,51枚(54%)种植体根方有不同程度的新骨形成,33枚(35%)种植体根方形成了新的上颌窦底,11枚(12%)种植体根周末见明显新骨形成.统计分析显示,种植体凸入上颌窦内的长度与上颌窦底骨改建差异无统计学意义(x2=6.113,P=0.191).结论 应严格把握OSFE适应证;OSFE时不植骨并同期植人种植体的短期临床效果是可预期的;新的窦底形成与上颌窦底提升高度无明显相关性.

Abstract：

Objective To investigate the clinical results of osteotome sinus floor elevation(OSFE)without grafting combined with simultaneous implant placement.Methods A total of 65 patients underwent maxillary sinus floor elevation from alveolus without any bone grafting from January 2000 to December 2008 and 96 implants were placed in the maxillary posterior edentulous region simultaneously.Clinical and radiography examinations were performed.The residual bone height ranged from 5 to 8 mm and the mean bone height was(6.78±1.04)mm.The mean following period was 33.4 months.Statistical analysis was perfbrmed by chi square test.Results Ninety-five of 96 implants were clinically stable and functioned without any pain and other complaints.One implant Was extracted 15 days after operation because of mobility and the other implants obtained osseointegration.The mean implant protrusion lengh Was 2.6 mm,ranging from 1 to 5 mm.Different degree of new bone formation was observed in 51(54%)of implants.New maxillary sinus floor outline Was observed in 33(35%)of implants and there was no obvious new bone in 11(12%)of implants.There Was no significant deference between the implant protrusion length and sinus floor remodeling.Conclusions Under strict indications,the clinical results of OSFE without bone grafting combined with simultaneous implant placement were predictable in short term.The new sinus floor formation was not related to the implant protrusion length.     

Healing in smokers versus nonsmokers: survival rates for sinus floor augmentation with simultaneous implant placement

PURPOSE: Evidence suggests that smoking is detrimental to the survival of dental implants placed in grafted maxillary sinuses. Studies have shown that improving bone quantity and quality, using rough-surfaced implants, and practicing good oral hygiene may improve outcomes. In this prospective study, the long-term survival rates of implants placed simultaneously with sinus grafting in smokers and nonsmokers were compared. MATERIALS AND METHODS: Implants with roughened surfaces were immediately placed into maxillary sinus grafts in patients with 1 to 7 mm of residual bone. A total of 2132 simultaneous implants were placed into the grafted sinuses of 226 smokers (627 implants) and 505 nonsmokers (1505 implants). A majority of the patients received a composite graft consisting of 50% autogenous bone. In both smokers and nonsmokers, approximately two thirds of the implants had microtextured surfaces; the remainder had hydroxyapatite-coated surfaces. The implants were restored and monitored during clinical follow-up for up to 9 years. RESULTS: Cumulative survival of implants at 9 years was 97.9%. There were no statistically significant differences in implant failure rates between smokers and nonsmokers. DISCUSSION: Implant survival was believed to depend on the following aspects of the technique used: creation of a large buccal window to allow access to a large recipient site; use of composite grafts consisting of at least 50% autogenous bone; meticulous bone condensation; placement of long implants (i.e., 15 mm); use of implants with hydroxyapatite-coated or microtextured surfaces; use of a membrane to cover the graft and implants; antibiotic use and strict oral hygiene; use of interim implants and restricted use of dentures; and adherence to a smoking cessation protocol.     

Simultaneous endoscopic endonasal sinus surgery and sinus augmentation with immediate implant placement: A retrospective clinical study of 23 patients

ObjectiveThe aim of this study was to evaluate the efficacy of simultaneous endoscopic endonasal sinus surgery and sinus augmentation with immediate implant placement.Patients and methodsThe study patients (n = 23) were partially or completely edentulous in the posterior maxilla and required maxillary sinus augmentation. All included patients had a sinus pathology confirmed clinically and radiographically. The technique of simultaneous endoscopic endonasal sinus surgery and sinus augmentation was used in 15 patients, with eight endonasal sinus surgery procedures being performed 2–3 months before sinus augmentation. Where possible, implants were placed during the same surgical procedure (with a ridge bone height of at least 4 mm).ResultsThere were no any major intraoperative complications. Implants placed in the reconstructed areas were shown to integrate normally, and postoperative occlusal function and aesthetics were favorable. Of the 95 implants placed in these 23 patients, two failed to osseointegrate.ConclusionThe method of simultaneous endoscopic endonasal sinus surgery and sinus augmentation with immediate implant placement leads to a reduction in postoperative complications, significantly shortening the rehabilitation period for patients with maxillary sinus diseases and insufficient bone tissue.     

Anatomic and histological analysis in a goat model used for maxillary sinus floor augmentation with simultaneous implant placement

Objectives: The aim of the present study was to carry out an anatomic survey on the goat maxillary sinus in order to provide accurate and definite anatomic parameters for the design of sinus floor elevation and dental implantation studies in this valuable preclinic animal model. Material and methods: The anatomic topographic structure of the maxillary sinuses was studied bilaterally in 10 adult goats by a gross survey as well as a histological analysis with parasagittal or coronal sections. Then following parameters were defined and measured: (1) maxillary alveolar height (MAH): vertical height from the alveolar crest to the sinus floor; (2) sinus lateral floor width (SLFW): horizontal distance from the lateral border of the anteroposterior bone crest to the sinus lateral wall; (3) infraorbital canal diameter (ICD); and (4) maxillary sinus volume (MSV): the volume occupied by water injected into the sinus. The data were presented with mean±SD on both sides. Results: The goat has a maxillary sinus similar to humans, with a slender pyramidal shape that pneumatizes the entire maxilla, and a sinus wall covered with a mucosal lining. From the maxillary sinus floor, there is an anteroposterior bone crest protruding with the infraorbital canal enveloped. It divides the maxillary sinus floor into two parts. The SLFW of the lateral part of the maxillary sinus floor becomes broader, about 5.905±1.475 mm in the third premolar site, and the MAH increases towards the posterior area, where the maxillary sinus floor is close to the related teeth roots. According to original metrical data, we also proposed a possible operation procedure for sinus floor augmentation. Conclusions: There is enough space in the lateral floor of the maxillary sinus for dental implantation, and the third premolar area might be a suitable position suggested for maxillary sinus augmentation with simultaneous implant placement in a goat model. To cite this article:
Zou D, Guo L, Lu J, Zhang X, Zhang Z, Jiang X. Anatomic and histological analysis in a goat model used for maxillary sinus floor augmentation with simultaneous implant placement.
Clin. Oral Impl. Res. 21 , 2010; 65–70.     

上颌窦冲顶提升术同期种植体植入的临床研究

目的 研究上颌窦冲顶提升术不植骨同期植入种植体的临床效果及种植特点。方法 43例患者,牙槽嵴顶距窦底骨高度为5～10mm。经上颌窦冲顶提升术不植骨植入56颗ITI种植体。结果 术后X片显示上颌窦底抬高(2.50±1.70)mm。所有患者未发生上颌窦炎的并发症,种植体稳固,X线片显示骨结合良好。所有种植体术后3～4个月均完成种植修复,可正常负重;种植体存留率100%。结论 在选择好适应证及良好的手术操作配合下,上颌窦冲顶提升术不植骨同期植入种植体可以获得很好的种植成功率。     

Intrasinusal locking technique: a novel use of the ring block technique at sinus perforations for simultaneous implant placement

Ten patients who underwent sinus lift surgery with simultaneous implant placement using the intrasinusal locking technique were evaluated retrospectively. All patients were scheduled for sinus floor elevation procedures with simultaneous implant placement. Schneiderian membrane perforation occurred during the lifting procedure, and conventional methods failed to repair the perforation. Therefore, an autogenous bone ring was placed at the base of the maxillary sinus and was locked to the alveolar crest with a dental implant. Marginal resorption around the dental implants was measured on panoramic radiographs. Prosthetic rehabilitation was performed at 6 months postoperative. The overall survival rate of the implants over a mean follow-up of 24.3 months was 90%. One case failed due to resorption of the alveolar crest around the implant as a result of infection; the implant and the adjacent ring were removed at 1 month postoperative. At the time of writing, the nine implants placed using the documented technique continue to function well, without any signs of peri-implant disease. The proposed approach allows for simultaneous dental implant placement in the extremely atrophic maxilla, even if there is extensive perforation of the Schneiderian membrane.