不使用植骨材料的上颌窦内提升术同期牙种植的临床研究

目的 评估不使用植骨材料的经牙槽嵴上颌窦提升术同期植入种植体的存留率,并分析相关影响因素.方法 收集2009-2012年接受上颌窦内提升术不使用植骨材料同期植入Bicon（R）种植体的病例46例,共植入种植体62枚,随访12 ～ 39个月,用Buser存留标准评估种植体存留率,记录边缘骨水平变化、剩余牙槽嵴高度、上颌窦底提升高度、随访时间、并发症等指标,分析可能的影响因素.结果 46例62枚种植体存留率98.39％,1枚种植体6个月时发现骨结合不良.术前测量剩余牙槽嵴高度范围2.83～9.83 mm,术后测量窦底提升范围1.00 ～ 4.86 mm,近、远中边缘骨水平平均变化为（-0.12±0.72）mm（t近中=-1.29,P近中=0.20）,（-0.06±0.65）mm（t远中=-0.68,P远中=0.50）.结论 上颌窦内提升术不使用植骨材料同期植入种植体存留率高,种植体周牙槽骨稳定,长期效果有待进一步观察.     

Comparison of implant survival following sinus floor augmentation procedures with implants placed in pristine posterior maxillary bone: a systematic review

Sinus augmentation is a commonly used procedure in implant dentistry. However, a general consensus on implant survival after this procedure is still lacking. The objective of this study was to systematically review implant survival following sinus augmentation procedures compared with conventional implant placement in the posterior maxilla. Following the production of a detailed protocol, screening and quality assessments of clinical trials were conducted in duplicate and independently. The search yielded 579 abstracts and 93 were selected for full-text screening. Six publications (five studies) fulfilled all the inclusion criteria and were relevant to the study. Heterogeneity of the selected papers prevented meta-analysis. Implant survival ranged from 73% to 100% for non-augmented sinuses and from 36% to 100% for augmented sinuses in patient-based data. From implant-based data, survival varied between 75% and 100% for both non-augmented and augmented areas. Implant survival appears to show greater variability in grafted sinuses than in the posterior maxilla. However, prospective studies with larger patient numbers and control of confounding factors are urgently needed to provide definitive data on this important procedure.     

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.     

应用共振频率分析技术评价犬上颌窦提升术后种植体骨结合状况

目的:研究种植体稳定系数（implant stability quotient, ISQ）评估种植体骨结合状况的有效性和可靠性,评价超声共振频率分析（resonance frequency analysis,RFA）技术作为种植体负载时机评价指标的可行性。方法:经腭入路行犬上颌窦提升术同期植入种植体,模拟骨量不足状态下的上颌后牙区种植动物模型,并于术后即刻、4、 8、12周对种植体稳定性进行测量。采用影像学检查、组织形态学分析和临床指标分析,进一步验证ISQ值与种植体骨结合状态的相关性,从而对RFA技术临床应用的有效性和可靠性进行评价。采用SAS 9.4 软件包进行Pearson相关性分析。结果:全部种植体骨结合成功。种植体植入即刻ISQ值达65左右,术后4、 8、12周,逐渐升高至67以上。在整个测量过程中,未发现任何种植体松动现象。各种植体稳定性在整个实验过程中的变化趋势基本一致,骨结合率无明显差异。ISQ值与剩余骨高度（residual bone height,RBH）间无显著相关性。结论:ISQ值与RBH之间无明显相关性,ISQ值不是评估种植体骨结合状态的有效手段,RFA技术作为种植体负载时机选择的依据缺乏足够的证据支持。     

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.     

骨挤压上颌窦提升术中骨挤压器距上颌窦底不同距离的三维有限元分析

目的：对比研究当骨挤压器距上颌窦底不同距离时,骨挤压器-骨组织界面及上颌窦底的应力和位移情况。方法：采用三维有限元方法。结果：骨挤压器距上颌窦底的距离为1mm时,上颌窦底位移、拉应力、压应力最大,骨挤压器-骨组织界面位移最小;骨挤压器距上颌窦底2．5mm时,骨挤压器-骨组织界面最大位移大于骨挤压器距上颌窦底4mm,但是骨挤压器距上颌窦底4mm时上颌窦底的拉应力、压应力和位移均小于骨挤压器距上颌窦底2．5mm时的效果。结论：骨挤压器顶端距上颌窦底的距离不同,模型所受的应力和位移不同。骨挤压器距上颌窦底1mm时,提升效率低,发生黏膜穿孔的几率高,临床上需谨慎应用。     

上颌复合体两种工况下上颌窦区三维有限元分析

目的：了解正常上颌复合体在不同状态相同载荷条件下，上颌窦区的应力分布变化情况，进一步探讨其本身的生物力学行为特征。方法：在自主建立的三维有限元模型基础上，利用ANSYS软件分别模拟张口位和正中咬合时上颌复合体的边界条件，计算并绘制出2种工况下上颌窦区各种应力的数据和图像。结果：正常上颌窦在正中咬合和张口位2种状态下，双侧第一磨牙受垂直集中压力作用，其各部位应力值均较小；当受到相同的载荷作用时，应力大小是不相等的。正中咬合时应力值小于张口位。结论：正常上颌窦各壁应力值在2种工况下均远远小于加载力，其中张口位应力分布不如正中咬合时均匀。     

A prospective 1-year clinical and radiographic study of implants placed after maxillary sinus floor augmentation with bovine hydroxyapatite and autogenous bone.

PURPOSE: The purposes of this study were 1) to evaluate the survival rate of implants placed in maxillary sinuses augmented with bovine hydroxyapatite and autogenous bone 6 months before implant surgery and 2) to estimate dimensional changes of the bone graft with time using a new radiographic method. PATIENTS AND METHODS: Thirty maxillary sinuses in 20 consecutive patients with severe resorption (mean, 3.8 mm of remaining alveolar bone) were augmented with a mixture of 80% bovine hydroxyapatite and 20% autogenous bone mixed with fibrin glue to enable the placement of screw-shaped dental implants. After 6 months of primary healing, 108 implants were placed and followed with clinical and radiographic examinations during the first year of loading. Measurements of changes in height, width, and length of the grafted material were made on tomographic Scanora (Soredex Orion Corporation Ltd, Helsinki, Finland) and panoramic radiographs taken 3 and 12 months after grafting and after 1 year of bridge loading. RESULTS: Ten implants in 6 patients were lost during the study (9 before loading and 1 after 1 year of functional loading), for a survival rate of 90.7%. All patients received fixed restorations, and the bridge survival rate was 100% after 1 year of loading. Small (<10%) but statistically significant dimensional changes in the grafted material were seen during the study period. CONCLUSIONS: Acceptable short-term results can be obtained with implants placed after the use of bovine hydroxyapatite and autogenous bone for maxillary sinus floor augmentation. These grafts show good resistance to resorption.     

Systematic review of survival rates for implants placed in the grafted maxillary sinus

Based on a systematic review of the literature from 1986 to 2002, this study sought to determine the survival rate of root-form dental implants placed in the grafted maxillary sinus. Secondary goals were to determine the effects of graft material, implant surface characteristics, and simultaneous versus delayed placement on survival rate. A search of the main electronic databases was performed in addition to a hand search of the most relevant journals. All relevant articles were screened according to specific inclusion criteria. Selected papers were reviewed for data extraction. The search yielded 252 articles applicable to sinus grafts associated with implant treatment. Of these, 39 met the inclusion criteria for qualitative data analysis. Only 3 of the articles were randomized controlled trials. The overall implant survival rate for the 39 included studies was 91.49%. The database included 6,913 implants placed in 2,046 subjects with loaded follow-up time ranging from 12 to 75 months. Implant survival was 87.70% with grafts of 100% autogenous bone, 94.88% when combining autogenous bone with various bone substitutes, and 95.98% with bone grafts consisting of bone substitutes alone. The survival rate for implants having smooth and rough surfaces was 85.64% and 95.98%, respectively. Simultaneous and delayed procedures displayed similar survival rates of 92.17% and 92.93%, respectively. When implants are placed in grafted maxillary sinuses, the performance of rough implants is superior to that of smooth implants. Bone-substitute materials are as effective as autogenous bone when used alone or in combination with autogenous bone. Studies using a split-mouth design with one variable are needed to further validate the findings.     

短种植体在后牙区种植修复的临床观察

目的： ITI短种植体在上下颌后牙区的临床观察及效果评价。方法：选择2005年10月至2013年10月间,在我院接受上下颌后牙区短种植体手术治疗的患者26例,共31枚种植体。随访4月-8年,观察指标包括X线片、临床检查,软组织（指标：牙槽骨吸收情况、牙龈指数、探针深度）等。结果：观察期间未发现短种植体出现松动、断裂,种植部位出现疼痛不适等情况,种植体愈合良好。修复后患者咀嚼功能恢复良好,种植体周围软组织健康,患者对短种植体的修复满意。结论：只要严格选择适应症,规范手术操作,短种植体在一定程度上能解决牙槽骨高度不足的问题,避免复杂的外科手术,减少创伤。     

上颌后牙区游离端连续缺失且垂直骨量不足3 mm时种植治疗选择考量

上颌后牙区由于牙槽骨常常有明显吸收且上颌窦的持续气化,常需要进行骨增量。传统观点认为剩余骨高度是影响提升上颌窦底提升术成功率的重要因素,其中经牙槽嵴顶的上颌窦底提升术被认为用于剩余骨高度大于4～5 mm患者中,才具有较高的成功率。近年来,随着倾斜种植体概念的提出,有学者认为倾斜种植体的植入可以充分利用患者的剩余骨量,避免植骨等操作,可做为上颌后牙区骨高度不足时的一项选择治疗方案。本文通过对近年来文献的回顾,在循证依据的支持下,对上颌后牙连续缺失且骨高度不足3 mm时选择上颌窦底提升或者倾斜种植体这两种手术方案进行了比较。     

密度不同的颌骨内单个种植体稳定性的测量观察

目的探讨颌骨不同密度单个种植体稳定性的变化规律，为早期负载提供依据。方法50例牙列缺损患者，共植入104枚ITI大颗粒酸蚀喷砂表面处理种植体，按种植区骨密度进行分组。在术中、术后1、4．6、8、12周进行共振频率分析，记录种植稳定值。结果骨密度对种植体初期稳定性有显著的影响（P〈0．001），Ⅰ类骨初期稳定性明显高于Ⅳ类骨，12周各组稳定性的差异无统计学意义。6周和12周稳定性比较，Ⅰ类骨和Ⅱ、Ⅲ类骨比较，差异无统计学意义（P〉0．05），与Ⅳ类骨比较，差异有统计学意义（P〈0．001）。结论Ⅰ、Ⅲ类骨种植体早期负载具有可行性。     

Endosseous dental implants can be placed at the time of maxillary sinus floor augmentation by means of a modified trephine and osteotome technique

J Evid Base Dent Pract 2002;2:279-80     

Micro-CT evaluation of the cortical bone micro-architecture in the anterior and posterior maxilla and the maxillary sinus floor

Objectives

To perform a within-subject comparison of the cortical bone micro-architecture of the maxillary sinus floor (MSF) to that of the buccal aspect of the anterior and posterior maxilla.

Methods

Micro-CT scans of the buccal aspect of the anterior and posterior maxilla and of the MSF in 14 human anatomical specimens were recorded. Within-subject comparisons were performed for cortical thickness (Ct.Th) and porosity (Ct.Po), average pore volume (AvgPo.V), and pore density (Po.Dn).

Results

The MSF presented the lowest and the anterior maxilla the highest Ct.Th, while Ct.Po was significantly higher at the MSF compared to the posterior maxilla (p = 0.021). No relevant differences were recorded for AvgPo.V and Po.Dn among regions (p > 0.067). Further, an increased Ct.Th at the MSF was significantly associated with a lower Po.Dn, while a higher Ct.Th and an increased AvgPo.V in the anterior maxilla were associated with a higher Ct.Th and an increased AvgPo.V, respectively, in the posterior maxilla and MSF. Finally, within each region, the AvgPo.V was associated positively with Ct.Po and negatively with Po.Dn.

Conclusions

The cortical bone of the MSF is slightly less thick and slightly more porous compared to the cortical bone at the buccal aspect of the anterior and posterior maxilla.

Clinical relevance

During lateral and vertical bone augmentation procedures, the cortical recipient bone is perforated several times to open the bone marrow compartment to facilitate provision of osteoinductive cells and molecules in the augmented space. Whether it is meaningful to approach the MSF in a similar way during MSF augmentation procedures or whether the slightly more porous structure of the MSF observed herein reduces the cortical barrier function already sufficiently has to be assessed in future clinical trials.