两种上颌窦底提升术的短期临床效果研究

目的    研究上颌后牙区剩余牙槽骨高度为3 ~ < 4 mm时,行经牙槽嵴顶上颌窦底提升或侧壁开窗上颌窦底提升同期种植体植入的短期临床效果。方法    选择2016年1月至2018年12月于西安交通大学口腔医院种植科行经牙槽嵴顶上颌窦底提升和侧壁开窗上颌窦底提升同期种植体植入的患者45例（50侧上颌窦,上颌后牙区剩余牙槽骨高度为3 ~ < 4 mm）,于术前、术后当日或术后第2天及术后6 ~ 9个月的愈合期后行影像学检查,比较两种术式的上颌窦底新骨形成高度、上颌窦底黏膜穿孔率及种植体早期成功率。结果   采用经牙槽嵴顶上颌窦底提升或侧壁开窗上颌窦底提升同期种植体植入的分别有19例和26例（上颌窦分别为21、29侧）患者;上颌窦底黏膜穿孔率分别为4.76%和0,差异无统计学意义（P > 0.05）。经过6 ~ 9个月的愈合期,两种术式上颌窦底新骨形成高度分别为（5.18 ± 0.48）mm和（7.32 ± 0.84）mm,差异有统计学意义（P < 0.05）;两种术式种植体早期成功率分别为95.83%和100%,差异无统计学意义（P > 0.05）。结论    当上颌后牙区剩余牙槽骨高度为3 ~ < 4 mm时,两种术式均安全可靠,早期成功率高。     

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。     

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。     

冲顶式上颌窦提升的临床评价及相关问题探讨

目的:评价经牙槽嵴顶入路行冲顶式上颌窦提升同期植入牙种植体的临床疗效及相关影响因素.方法:25例上颌后牙缺失的患者接受冲顶式上颌窦提升术同期植骨并植入牙种植体,共植入种植体51颗,采用自体骨和人工骨的混合骨粉作为植骨材料,术后随访1-3年.结果:原牙槽嵴高度为4-8.9mm,术后提升上颌窦底高度2～6mm,平均提升高度3.98mm.种植体长度在8-13mm之间,平均11.5mm.有一例术后24 h有轻微鼻腔出血,所有病例均未发生上颌窦穿孔.三颗种植体在二期修复前松动,拔除后有两颗重新植入获得良好的骨整合效果.所有病例均在术后6-18个月行固定义齿修复,在随访期内未发现种植体或上部结构松动.结论:冲顶式上颌窦底提升同期牙种植体植入术较开窗式上颌窦提升创伤小,操作步骤简单,避免了二次手术,节约了患者的时间和费用,可以广泛应用于垂直骨量相对不足的上颌后牙区.     

种植床自体骨移植在上颌窦闭合式提升中的临床应用

目的评价种植床自体骨植骨行上颌窦闭合式提升后同期植入种植体的临床效果。方法对上颌后牙缺失后剩余牙槽骨高度在6-10mm患者,用中空圆柱钻制备种植床,收集种植床自体骨,行上颌窦闭合式挤压提升后,植入自体骨和ITI种植体,6-9个月后行上部结构修复。结果17例患者共植入25颗种植体,平均提升上颌窦底高度为3.4mm(2-4mm),修复后追踪观察6-36个月,l颗种植体修复6个月后松动拔除。其余24颗种植体平均负载21个月,种植体稳定,未见明显骨吸收,所有病例均无上颌窦并发症。结论严格掌握适应证,种植床自体骨植骨上颌窦闭合式提升同期植入种植体,创伤小、操作较简单,无须开辟第2手术区。     

闭合式上颌窦挤压提升同期人工牙种植修复45例分析

目的：观察使用Summers骨凿或骨挤压器经牙槽嵴顶闭合式抬高上颌窦底、同期植入种植体的临床效果。方法：对41例45侧后牙缺失患者行上颌窦闭合式提升，必要时植自体骨或人工骨，同时植入种植体。结果：45侧上颌窦剩余牙槽骨平均高度为6．8mm(5～9mm)，用骨凿平均提升上颌窦底高度3．5mm(2～6mm)。2侧上颌窦黏膜被钻穿孔，放弃牙种植。其余43侧上颌窦共植入63颗种植体，长度10～15mm。Ⅱ期手术时，5颗种植体松动拔除。追踪12～48个月，修复后1颗种植牙松动拔除，1颗进行性骨吸收，总成功率达88．9％。所有病例均无上颌窦并发症：结论：上颌窦内提升技术较开窗式上颌窦提升创伤小，操作步骤简单，对有适量剩余牙槽骨的上颌窦区种植可以考虑使用；但由于存在窦底黏膜穿孔风险，技术要求高，同时必须有专用的器械，应慎重使用。在严格控制适应证、掌握种植外科技巧的情况下，开展上颌窦内提升技术是可行的，可以取得较高的成功率。     

上颌窦黏膜囊肿对牙槽嵴顶入路上颌窦底提升术的影响

目的研究牙槽嵴顶入路上颌窦底提升术后,上颌窦内黏膜囊肿的变化和囊肿区种植体周围的成骨情况,探讨上颌窦黏膜囊肿对牙槽嵴顶入路上颌窦底提升术的影响。 方法选取12例上颌后牙缺失骨量不足并患有上颌窦黏膜囊肿的患者,在不摘除窦腔内黏膜囊肿的情况下,经牙槽嵴顶入路提升上颌窦底同期植入种植体14枚。术前测量上颌窦底高度,术后当日测量种植体穿入窦底长度,术后1年测量穿入窦腔内的种植体周围成骨高度,观察黏膜囊肿对种植体周围成骨的影响。采用配对样本t检验对比术前-术后当日及术前-术后6个月黏膜囊肿投影面积变化,评估手术创伤与黏膜囊肿的相互的影响。 结果通过牙槽嵴顶入路上颌窦底提升术植入的种植体在含有上颌窦黏膜囊肿的上颌后牙区种植体周围成骨良好,术后6个月时全部14枚种植体形成良好骨结合。术前上颌窦底高度为（5.5 ± 1.4）mm,术中种植体穿入上颌窦长度为（2.9 ± 1.3）mm,上颌窦底厚度平均增加了（1.8 ± 1.0）mm。根据测量结果计算黏膜囊肿投影面积,术前（201.2 ± 184.0）mm²,术后当日（133.6 ± 187.6）mm²,术后6个月（134.5 ± 107.1）mm²。术前-术后6个月的成对差分均值及标准差[（66.6 ± 142.8）mm²]明显增大,说明术后6个月时黏膜囊肿的体积呈现出多样化的表现。术前-术后当日的黏膜囊肿投影面积相比显著减小,差异有统计学意义（t= 2.685,P= 0.021）,术前-术后6个月的黏膜囊肿投影面积差异无统计学意义（t= 1.617,P= 0.134）。手术短期内会对上颌窦内黏膜囊肿造成一定的创伤,但未对上颌窦黏膜囊肿产生激惹、恶化等不良影响。 结论上颌窦内黏膜囊肿的存在不影响牙槽嵴顶入路上颌窦底提升术的实施与种植体周围成骨。     

超声骨刀在上颌窦内提升术中的应用

目的:探讨超声骨刀在上颌窦底内提升种植术中应用的效果和技术特点。方法:30名患者共36颗上颌磨牙缺失,牙槽嵴顶至上颌窦底之间的剩余骨高度2～8 mm,以超声骨刀行上颌窦底内提升术,同期或延期植入种植体。结果:24名患者植骨同时植入28枚种植体。6例因剩余牙槽骨高度少于5 mm先行上颌窦提升植骨术,6个月后延期植入8枚种植体。平均上颌窦底提升高度为426 mm(213～540 mm)。36个上颌窦提升位点,仅1例出现上颌窦黏膜穿孔,以Bio-Gide胶原膜修补。术后随访未发现种植体周围阴影或快速骨吸收。所有病例随访3～17个月,未见种植体脱落或松动现象。结论:超声骨刀上颌窦内提升术简单易学,避免了开窗式上颌窦提升术的术后反应,降低了上颌窦黏膜穿孔的机率,值得在临床上推广应用。     

β-磷酸三钙复合自体骨移植在上颌窦闭合式提升中的应用

目的:采用患者种植床自体松质骨复合β-磷酸三钙人工骨行上颌窦闭合式提升,同期植入种植体,评价其临床效果。方法:对上颌后牙缺失剩余牙槽骨高度在4～10mm患者行上颌窦闭合式挤压提升后,将自体骨和β-磷酸三钙人工骨按1∶1比例植入上颌窦底,同期植入ITI种植体,4～6个月后行上部结构修复。结果:16例患者共植入21颗种植体,平均提升上颌窦底高度为4.2mm(2～6mm);修复后追踪观察12～48个月,除l颗种植体植入后2周同侧上颌窦出现炎症,经抗感染治疗症状消失,6个月后行上部结构修复外,其余20颗种植体植入后无明显上颌窦并发症;所有种植体平均负载32个月,种植体稳定,未见明显骨吸收。结论:上颌窦闭合式提升自体骨复合人工骨移植同期植入种植体,成骨时间短,操作简便,能维持种植体的长期稳定,值得推广应用。     

上颌窦底提升术的临床研究

目的:研究比较上后牙缺失后牙槽嵴高度不足时根据上颌窦底牙槽嵴骨高度不同,选用不同术式和不同充填材料提升上颌窦底,进行种植修复的治疗效果.方法:89例上后牙缺失的患者,其中68例窦底牙槽嵴骨高6一lOnun者行闭合冲压上颌窦底提升术,其余21例骨高2-5mm者行开窗植骨上颌窦底提升手术,同期完成一期种植手术86例,二期完成种植手术3例.充填材料有自体颗粒骨、人工骨粉或者自体颗粒骨加人工骨粉.结果:所有患者术后未出现上颌窦炎症,21例行开窗植骨上颌窦底提升手术的患者2例术中窦膜穿孔,以可吸收生物膜修补后同期完成种植手术.平均提升窦底高度5.8mm,59颗种植体有1颗松动失败,其余种植体平均负载23个月,种植体稳定,骨结合状况良好.68例行闭合冲压上颌窦底提升术的患者,平均提升窦底高度4.1mm.植入术中有3例发生可察觉窦膜破孔,3例术后2天内鼻腔少量自发性渗血,其余无明显症状.在121颗种植体中,有2颗种植体失败,119颗种植体平均负载15个月,种植体稳定,未见明显骨吸收.结论:临床上上颌窦底骨高度不足的情况应根据上颌窦底骨高度不同,选用开窗植骨或闭合冲压提升上颌窦底,并根据需提升高度不同选用不同的充填材料,大多数可以同期种植.     

Effects of maxillary sinus floor elevation surgery on maxillary sinus physiology

In a prospective study, the effects of elevation surgery of the maxillary sinus floor on maxillary sinus physiology were assessed. Seventeen consecutive patients without preoperative anamnestic, clinical and radiological signs of maxillary sinusitis underwent sinus floor elevation surgery with iliac crest bone grafts. All patients were subjected to unilateral endoscopic examination of the maxillary sinus, taking of a biopsy specimen from the sinus floor mucosa, and collection of a sinus lavage-fluid aspirate. This triad of evaluations was performed immediately preceding the elevation procedure, and 3 months (at implant insertion) and 9 months (at uncovering of implants) postoperatively. All procedures were performed under general anesthesia. Preoperatively, three out of 17 patients showed pre-existing mucosal pathology endoscopically, while the 3- and 9-month results revealed the presence of mucosal pathology in four and two patients, respectively. The 3-month microbiological evaluation showed a significant increase in cultures with bacterial growth, while the 9-month culture results were comparable to the preoperative status of the maxillary sinus. Morphologically, neither fibrosis nor an altered inflammatory response or thickening of the epithelium and lamina propria was observed postoperatively. The number of goblet cells in the epithelial layer was increased. From this study it is concluded that the effect of maxillary sinus floor elevation surgery with autogenous bone grafts does not appear to have clinical consequences in patients without signs of pre-existing maxillary sinusitis.     

Correcting maxillary sinus deficiencies

The use of hydraulic force to condense bone particulate into the maxillary sinus is a predictable and less invasive method of site preparation for many, but not all, dental implant candidates. It is our approach in the primary indication for HSC--patients with advanced periodontitis in whom insufficient cortical bone at the alveolar ridge of the posterior maxilla stands as a detriment to effective implantation. A second indication for HSC is for those patients who suffer blood disorders or sensitivity to certain medications, such as vasoconstrictors, and in whom it is crucial to manage bleeding during surgery. In these cases, changes in the armamentarium used for the procedure can effectively accommodate special needs. Indication three refers to the patient in whom robust bone is absent in some localized area of the sinus floor, possibly as a result of a failed implant or poor post-extraction healing. Hydraulic force in this scenario is abandoned altogether in favor of a special split-thickness soft dissection and graft that has shown predictable regenerative effect. Utilizing the techniques presented in this article, real-time chair side relief is a possibility for a much wider variety of patients. All clinical cases presented were followed for 10 years to show the continued success of the Hydraulic Sinus Condensing technique, and multiple follow-ups with the patients were performed. The sinus condensing instruments referenced in this article can be purchased separately from the Dental Implant Institute. The instrument set is specifically designed to aid in performing HSC with the least risk to the patient. Suitable replacement instruments may also be found with other traditional instrument manufacturers, though it may prove difficult to use when compared to the specifically designed Hydraulic Sinus Condensing instruments.     

上颌窦囊性改变的影像分类诊断及上颌窦提升术的探讨

锥形束CT影像上常常可以发现上颌窦囊性改变的存在,这种改变是否影响上颌窦提升术的实施呢?这对临床医生造成了一定的困惑。本文结合临床上常见的各种囊性改变的锥形束CT影像表现,对上颌窦囊性改变的影像分类诊断进行介绍,并探讨囊性改变时上颌窦提升术的实施可行性、手术方式及术后黏膜的影像学改变等,以帮助临床医生作出正确判断。     

上颌窦囊性改变的影像分类诊断及 上颌窦提升术的探讨

锥形束CT影像上常常可以发现上颌窦囊性改变的存在,这种改变是否影响上颌窦提升术的实施呢?这对临床医生造成了一定的困惑。本文结合临床上常见的各种囊性改变的锥形束CT影像表现,对上颌窦囊性改变的影像分类诊断进行介绍,并探讨囊性改变时上颌窦提升术的实施可行性、手术方式及术后黏膜的影像学改变等,以帮助临床医生作出正确判断。     

Hemangioma of the maxillary sinus

Hemangiomas of the maxillary sinus are rare. Hemangiomas of the maxillary sinus with an associated phlebolith have not been previously reported. Severe bleeding can occur upon surgical removal of hemangiomas.     

Bacteriology of the maxillary sinus

The bacteriologic findings in the maxillary sinus of 20 patients who underwent surgical repositioning of the maxilla are presented. Using an open sterile surgical technique, three samples from each patient were collected prior to the planned osteotomy. The specimens included a section of the anterior bony sinus wall, an aspirate of the irrigated sinus, and a swab of the sinus membrane procured through an antral window. All specimens were cultured for aerobic and anaerobic organisms. In addition to bacterial culture samples, a portion of the sinus membrane was resected and examined microscopically for the presence of an inflammatory cell infiltrate. Eighty per cent (16/20) of the patients studied showed no bacterial growth from any sinus specimen. The remaining 20% (four of 20) had some bacterial growth, but in negligible numbers. Microscopically, all mucosal specimens showed some degree of inflammatory cell infiltrate, but the specimens where bacteria were present showed a more acute inflammatory response. It was concluded that the asymptomatic adult maxillary sinus is usually sterile, but that a few transient bacteria may exist in a clinically silent antrum. When bacteria are present, they are recognized as foreign and elicit the appropriate inflammatory responses.