上颌窦底外提升植骨术49例牙种植的临床分析

目的:观察比较上颌窦底外提升植骨术同期或延期牙种植的临床效果.方法:对2003-04-2009-12在烟台市口腔医院种植中心就诊的49例行上颌窦底外提升植骨术,同期或延期牙种植的患者进行临床效果评价,随访观察时间为1～7年,采用寿命表法及x2检验进行统计学分析.结果:49例患者无1人失访,上颌窦底外提升植骨术同期牙种植...     

自体植骨上颌窦底提升同期种植体植入术近期疗效观察

目的:评价自体骨开窗式上颌窦提升术对上颌后牙区牙槽骨高度严重不足(高度4～6mm)的患者种植治疗的近期疗效。方法:对4例上颌后牙骨量不足(高度4～6mm)而需种植修复的病例,实施自体植骨的开窗式上颌窦提升术,并同期植入种植体共9枚。自体移植骨来自种植窝制备时中空钻取骨,在需做牙槽嵴修整处的牙槽骨棘取骨,如不够再用刮骨器取骨或从颏部手术取骨,将所取之骨碾碎备用。结果:术后7个月拍片,均显示骨性愈合;冠修复后行使功能18～24个月效果理想。结论:自体取骨植骨用于上颌窦提升,可扩大种植手术适应证,降低种植成本。     

上颌窦侧壁开窗提升术中应用CGF的骨增量影像学评价与临床对照研究

目的:探讨CGF在上颌窦底侧壁开窗提升术中的临床疗效和在Minics软件三维重建介导下的影像学变化.方法:收集因上颌后牙区骨量不足(<5 mm)拟行上颌窦侧壁开窗提升术的患者20例分为2组:实验组10例(CGF联合骨替代材料组)和对照组10例(仅使用骨替代材料组).本研究为临床对照研究,通过Minics 19.0软件三...     

Histological Outcomes on the Development of New Space‐making Devices for Maxillary Sinus Floor Augmentation

Background: Previous studies have pointed out that the mere elevation of the maxillary sinus membrane promotes bone formation without the use of augmentation materials. Purpose: This experimental study aimed at evaluating if the two‐stage procedure for sinus floor augmentation could benefit from the use of a space‐making device in order to increase the bone volume to enable later implant installation with good primary stability. Materials and Methods: Six male tufted capuchin primates (Cebus apella) were subjected to extraction of the three premolars and the first molar on both sides of the maxilla to create an edentulous area. The sinuses were opened using the lateral bone‐wall window technique, and the membrane was elevated. One resorbable space‐making device was inserted in each maxillary sinus, and the bone window was returned in place. The animals were euthanatized after 6 months, and biopsy blocks containing the whole maxillary sinus and surrounding soft tissues were prepared for ground sections. Results: The histological examination of the specimens showed bone formation in contact with both the schneiderian membrane and the device in most cases even when the device was displaced. The process of bone formation indicates that this technique is potentially useful for two‐stage sinus floor augmentation. The lack of stabilization of the device within the sinus demands further improvement of space‐makers for predictable bone augmentation. Conclusions: It is concluded that (1) the device used in this study did not trigger any important inflammatory reaction; (2) when the sinus membrane was elevated, bone formation was a constant finding; and (3) an ideal space‐making device should be stable and elevate the membrane to ensure a maintained connection between the membrane and the secluded space.     

上颌窦提升同期种植的研究现状

<正>上颌后牙区骨量不足限制了种植修复的应用,主要与牙缺失后牙槽骨吸收和萎缩、上颌窦进一步气化使窦底位置过低等有关。种植体难以取得初期稳定性,植入时极易穿破上颌窦黏膜进入窦腔,引起感染,导致种植失败[1]。Tatum[2]在20世纪80年代     

Maxillary Sinus Floor Augmentation Surgery with Autogenous Bone Grafts as Ceiling: A Pilot Study and Test of Principle

Background: Studies have pointed out that the mere elevation of the maxillary sinus membrane might suffice to allow for bone formation indicating the additional use of augmentation materials to be redundant. Purpose: The purpose of this study was to assess whether elevation of the sinus mucosal lining combined with applying an autologous bone graft as a ceiling and placement of a short implant would allow for bone formation around the implant thus surpassing the need for applying augmentation materials around the installed implants. Materials and Methods: Fourteen consecutive patients were subjected to maxillary sinus floor elevation surgery and simultaneous placement of an implant. Using the lateral bone‐wall window technique, the membrane was exposed and elevated. Next, a bone graft taken from the zygomatic rim was placed as a ceiling above the inserted implant to ensure that the sinus membrane would not collapsed around a significant part of the implant. Finally, the bone window was returned in place. After connecting the healing abutment, the wound was closed. Results: All implants were stable and no implants were lost. There were no complications after harvesting the bone graft. Radiographic evaluation showed a bone gain of 3.2 ± 0.9 mm after 3 months and 3.6 ± 0.9 mm after 1 year. Less than 6% of the implant was not covered by bone after 1 year. Conclusion: Maxillary sinus membrane elevation and simultaneous placement of short endosseous implants with a bone graft as a ceiling on top of the implant result in predictable bone formation around the implant and good osseointegration on radiographs.     

Cholesterol Granuloma of the Maxillary Sinus Encountered during Floor Augmentation Procedure: A Case Report

Background: Cholesterol granuloma (CG) is a foreign‐body reaction to the deposition of cholesterol crystals. Its occurrence in the paranasal sinuses is very rare. Purpose: This report describes a new case of maxillary sinus CG discovered incidentally during sinus‐floor augmentation for dental implant placement in a 60‐year‐old female patient. Materials and Methods: The preoperative clinical and radiological examinations revealed a normal maxillary antrum with no evidence of sinus pathology. After lateral osteotomy, a dark‐green, viscous soft tissue mass appeared through the thin mucous membrane inside the sinus. Enucleation and curettage of the sinus contents including the sinus membrane were performed for histopathologic analysis. The augmentation and implant placement procedures were postponed. Results: Histopathologic analysis showed several fragments of granulation tissue containing diffuse cholesterol clefts surrounded by mixed chronic inflammatory cell infiltrate including plasma cells and lymphocytes. These features were compatible with the diagnosis of CG. The patient was followed up for 3 months after the first procedure, and a second attempt of sinus augmentation and dental implant insertion was then carried out. The inserted dental implants were followed up for 6 months without any complications. Conclusions: CG of maxillary sinus can be an incidental finding. For this reason, the final diagnosis can only be achieved after examination of the material under the microscope.     

Combining Scaffolds and Osteogenic Cells in Regenerative Bone Surgery: A Preliminary Histological Report in Human Maxillary Sinus Augmentation

Purpose: The following case series evaluated the maxillary sinus augmentation responses to tissue-engineered bone graft obtained by a culture of autogenous osteoblasts seeded on polyglycolic–polylactic scaffolds and calcium phosphate.
Materials and Methods: Sinus floor augmentation was performed bilaterally in five patients (mean age 58.4 years) with tissue-engineered bone (test site – Oral Bone®, BioTissue, Freiburg, Germany) or calcium phosphate (control site – Biocoral, Novaxa Spa, Milan, Italy). Biopsies were harvested 6 months after sinus augmentation for histometric evaluation. Volumetric measurements were taken at baseline and 6 months after the surgical procedure.
Results: The mean of vertical bone gain was 6.47 ± 1.39 mm and 9.14 ± 1.19 mm to test and control sites, respectively. The histological sections depicted mature bone with compact and cancellous areas. All biopsies contained varying percentages of newly formed bone and marrow spaces. The mean of bone tissue in the grafted area was 37.32 ± 19.59% and 54.65 ± 21.17% for tissue-engineered bone and calcium phosphate, respectively.
Conclusion: Within the limits of the present report, the histological data in humans confirmed that tissue-engineered bone and calcium phosphate allowed newly formed bone after maxillary sinus augmentation.     

Accidental Displacement of Dental Implants into the Maxillary Sinus: A Report of Nine Cases

Purpose: To report on the clinical, radiological, and anatomical features of patients suffering accidental displacement of dental implants into the maxillary sinus.
Materials and Methods: A retrospective observational study of nine cases of dental implant displacement into the maxillary sinus was made. Data concerning patients' features, diagnostic criteria, and treatment performed were collected.
Results: Mean patient age was 56.7 years, and men predominated (6 : 3). Implant displacement was diagnosed in all cases by clinical and radiological examination. In seven patients, the implant was surgically removed without complications. Only three patients reported sinus symptoms following displacement.
Conclusions: The displacement of implants into the maxillary sinus is usually related with a poor surgical planning or inadequate surgical technique. Because of the anatomy and physiology of the posterior area of the maxilla, it is essential to ensure good primary stability in order to avoid this complication. If the implant migrates into the maxillary sinus, it should be removed in order to avoid sinus pathology.     

Bone Regeneration Using a Hollow Hydroxyapatite Space‐Maintaining Device for Maxillary Sinus Floor Augmentation – A Clinical Pilot Study

Background: The mere lifting of the maxillary sinus membrane by implants protruding into the sinus cavity allows the establishment of a void space for blood clot and new bone formation. Purpose: To evaluate bone formation by using a spherical, hollow, and perforated hydroxyapatite space‐maintaining device (HSMD) in a two‐stage sinus lift procedure where residual alveolar bone height was ≤2 mm. Material and Methods: Spherical, hollow, and perforated HSMDs with a diameter of 12 mm were manufactured for this pilot study. Three patients with a residual bone height of 1–2 mm, as verified clinically and radiographically, and in need of a sinus augmentation procedure prior to implant installation were selected for the study. The HSMD and bone formation was evaluated by cone beam computerized tomography (CBCT) 6 months after augmentation procedure. Implants were installed 6 to 9 months after augmentation. The implant sites were prepared by a trephine drill to obtain a specimen of HSMD and bone for histological evaluation. After implant installation, the condition of the sinus membrane adjacent to the HSMD was evaluated endoscopically. After an additional 8 weeks, fixed partial prostheses were fabricated. Results: Bone formation verified by CBCT was found around and inside the device in all three patients after 6 months. Despite the fact that residual bone before augmentation was ≤2 mm, 12‐mm‐long implants with diameter of 4.8 mm could be inserted with preservation of an intact and healthy sinus membrane verified endoscopically. Bone formation inside HSMDs was noted histologically in two out of three HSMDs. Implants were stable and without any marginal bone loss after 1 year of prosthetic loading. Conclusion: A spherical, hollow, and perforated HSMD used in sinus lift procedures can produce a void space for blood clot and new bone formation and subsequent implant installation.     

The Buccofacial Wall of Maxillary Sinus: An Anatomical Consideration for Sinus Augmentation

Purpose: This study aimed to quantify the thickness of the buccofacial wall of the maxillary sinus where sinus augmentations are often performed.
Materials and Methods: Fourteen sites located 15 and 20 mm superior to the anatomical cervical line (named as groups H15 and H20, respectively) and along the long axes of the mid and the interproximal of two premolars and two molars were measured from 74 Korean hemiface cadavers.
Results: The buccofacial wall of the maxillary sinus was thinnest at the area between the maxillary second premolar and first molar in groups H15 and H20. The lowest mean thickness was 1.2 mm in both groups. The walls were thicker in males than in females, with statistically significant gender differences found at four and two sites on the anterior horizontal reference in groups H15 and H20, respectively. However, the thickness did not differ significantly with age or laterality. Incomplete septa were found in seven of the 74 specimens, and they were present in the area between the first and second molars in six (86%) of these cases.
Conclusions: These observations indicate that anatomical characteristics of the buccofacial wall thickness of the maxillary sinus need to be considered when performing a window opening procedure for sinus augmentation.     

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。     

Osteotome Maxillary Sinus Lift Using Bovine Bone and Calcium Sulfate: A Case Series

Purpose: The purpose of this longitudinal study was to evaluate the success of bovine bone and calcium sulfate (CaSO₄) as sinus augmentation material with osteotome maxillary sinus lift. Materials and Methods: Thirty‐one osteotome sinus lift procedures were performed for 18 healthy patients (7 males and 11 females). A mixture of bovine bone and CaSO₄ (ratio, 4:1) was used as sinus augmentation material with simultaneous implant placement. Implants were loaded 4 to 5 months postimplant surgery. Cases were followed for an average of 23.4 months postloading (range, 12–60 months). Results: The mean age of the study group was 49.7 ± 10.66 years. The residual height of the alveolar ridge ranged from 5.5 to 11 mm (mean, 8.16 ± 1.52 mm). Four to 5 months after implant placement, the x‐ray showed a 1.5 to 5 mm apical shift of the sinus floor (mean, 3.47 ± 0.97 mm), which was maintained to the end of the evaluation period. At 12 months postloading, crestal bone loss ranged from 0.5 to 1.5 mm (mean, 0.87 ± 0.26 mm), and pocket depth ranged from 2 to 4 mm (mean, 2.9 ± 0.67 mm). No significant change in crestal bone loss or pocket depth was noticed afterward. Conclusion: Bovine bone plus CaSO₄ can be used successfully as a sinus augmentation material with osteotome sinus elevation. The use of CaSO₄ significantly improved the handling properties of bovine bone and helped to stabilize the bone graft particles during healing.     

Maxillary Sinus Membrane Repair With Amnion–Chorion Barriers: A Retrospective Case Series

Background: Schneiderian membrane perforation is the most common complication of maxillary sinus augmentation procedures and has been associated with a variety of post‐surgical problems. Multiple techniques to repair perforated Schneiderian membranes with materials such as connective tissue, buccal fat pads, and resorbable collagen membranes have been reported in the dental literature. Although these reparative options have proven successful, they are technique sensitive and time consuming. The aim of this case series is to present a simplified method of Schneiderian membrane perforation repair with amnion–chorion membranes and results obtained from nine cases using this technique. Methods: A consecutive retrospective record review was performed of all maxillary sinus augmentation cases performed during the past 5 years by the same board‐certified private practice periodontist (DH). Results: Seventy‐seven cases were identified, with a total of 104 sinus augmentations, in which nine perforations were noted. None of the perforation cases were aborted midprocedure, and all perforations were repaired with amnion–chorion membranes. All cases were augmented with a combination of allograft and xenograft particulate bone. After an average healing time of 4.9 months, dental implants were placed in the grafted sinuses. Conclusions: This retrospective case series shows nine perforations during 104 lateral window maxillary sinus augmentation procedures. A total of 23 dental implants were placed in the augmented sinuses with perforated Schneiderian membranes, and one failure was noted according the Albrektsson success criteria. A total of 158 dental implants were placed in non‐perforated augmented sinuses, with a total of three failures noted.