上颌窦宽度与角度对上颌窦底提升术后成骨效果的影响

上颌窦底提升术是增加垂直骨高度的可靠的选择之一,移植物稳固需要足够的血管生成,新生血管长入并参与成骨和骨重塑的细胞迁移。这类生物学行为在很大程度上取决于上颌窦腔的三维尺寸,包括剩余骨高度（RBH）、上颌窦膜厚度、上颌窦宽度和上颌窦角度等。不同研究报道了窦腔颊-腭侧宽度对成骨效果的影响,结果不尽相同。上颌窦的三维解剖形态在骨增量手术后的条件性愈合和矿化过程中的作用尚不清楚。本研究就上颌窦窦腔颊-腭侧宽度、上颌窦角度等对窦底提升术后成骨效果的影响做一综述,旨在为临床医生术前进行风险评估和结果预判提供理论参考。     

上颌窦宽度及角度预测经牙槽嵴顶上颌窦底提升术骨移植稳定性的价值

目的: 探讨通过锥形束CT（CBCT）测量上颌窦宽度及角度,评估牙槽嵴顶上颌窦底提升术骨移植稳定性的价值。方法: 选取行经牙槽嵴顶上颌窦底提升术并同期种植的78例患者为研究对象。所有患者术前、术后6个月均行CBCT检查,测量上颌窦宽度、角度及根端骨吸收量。分析影响牙槽嵴顶上颌窦底提升术骨移植稳定性的因素,评估上颌窦宽度、上颌窦角度预测牙槽嵴顶上颌窦底提升术骨移植稳定性的价值。采用SPSS 18.0软件包对数据进行统计学分析。结果: 术后6个月种植体根端骨平均吸收量为（1.81±0.26）mm,其中,49例≤1.81 mm,29例>1.81mm。Logistic多因素回归分析显示,上颌窦宽度、上颌窦角度是影响牙槽嵴顶上颌窦底提升术骨移植稳定性的独立因素（OR：3.873、4.518,95%CI：1.594~9.412、1.859~10.979,P<0.05）。ROC曲线分析显示,上颌窦宽度、上颌窦角度及两者联合预测牙槽嵴顶上颌窦底提升术骨移植稳定性的AUC分别为0.764、0.742和0.908。结论: 上颌窦宽度和角度是影响牙槽嵴顶上颌窦底提升术骨移植稳定性的指标,两者联合预测术后骨移植稳定性效能良好。     

经牙槽嵴顶上颌窦底提升术植骨与否的研究进展

上颌后牙区常因骨量不足而成为种植的难点区域,常用的解决办法为上颌窦侧壁开窗窦底提升术和经牙槽嵴顶上颌窦底提升术。经牙槽嵴顶上颌窦底提升术因为手术操作简单、创伤小、愈合时间短、术后不适感少等优点逐步得到广泛应用。该技术早期应用常伴有同期植骨,但由于骨替代材料存在感染、低吸收率及引发上颌窦再气化等风险,近些年来临床上开始主张经牙槽嵴顶上颌窦底提升时不再植骨。目前对经牙槽嵴顶上颌窦底提升术中植骨与不植骨的愈合状况和临床疗效等方面都有较多的研究报道。本文就经牙槽嵴顶上颌窦底提升术是否需要同期植骨的研究进展做如下综述。     

上颌窦外提升术研究进展

因上颌窦腔气化、牙槽骨吸收等生理性及病理性原因,上颌后牙区种植术常常面临垂直骨量不足的问题,从而使得该区域的牙种植术面临很大的限制和挑战。上颌窦提升术是指通过手术提升上颌窦底壁的黏膜,形成容纳血液和骨移植材料的空间,从而满足种植术垂直骨量的需求。目前临床上常用的有经牙槽嵴顶的上颌窦内提升术以及经侧壁开窗的上颌窦外提升术。该文将对上颌窦外提升术中相关的上颌窦解剖结构、术前影像学检查、手术步骤及术式等作一综述。     

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。     

上颌窦底提升植骨术中囊肿的处理策略

上颌窦底提升植骨术作为一种可靠的治疗方法,通过剥离提升上颌窦底壁的黏膜,形成容纳血液和骨移植材料的空间,从而增加上颌后部骨高度以满足种植体植入的需求。该技术包括经外侧壁开窗入路提升和经牙槽嵴顶入路提升两种术式,受诸如上颌窦底黏膜厚度、窦底解剖形态、上颌窦病变等的影响,其中上颌窦囊肿的存在会增加治疗的难度和手术风险。目前对于上颌窦底提升术中是否对囊肿进行处理以及如何进行处理仍存在争议,本文将针对上颌窦底提升植骨种植术中遇到的上颌窦囊肿问题的不同处理策略做一概述。     

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。     

经牙槽嵴顶入路微创上颌窦内提升植骨同期种植技术

因龋病、牙周病等原因导致的上颌后牙缺失通常伴有牙槽骨的缺失,而牙齿缺失后上颌窦腔的气化、扩大加重了牙槽骨的吸收,导致剩余骨量不足是上颌后牙区行种植修复遇到的主要难题。临床上可通过上颌窦底提升植骨增加骨量为提高种植修复成功率创造有利条件。简单、快速、有效的上颌窦提升植骨种植技术一直是临床上研究的热点。与经上颌窦外侧壁开窗入路植骨种植技术相比,经牙槽嵴顶入路上颌窦提升植骨种植技术具有创伤更小、手术时间缩短、并发症更少等优点,但存在着术中微小黏膜穿孔不易被发现的缺点,故寻找更安全可靠的技术也是临床上研究的重点之一。文章结合北京大学口腔医院种植科临床病例研究对临床上3种经牙槽嵴顶入路微创上颌窦底提升植骨种植技术的方法、技术要点、并发症及处理措施进行报告,为上颌后牙缺失患者的种植修复治疗提供参考。     

上颌窦提升术的历史、现状和发展

上颌后牙区的种植常常受限于垂直骨高度的不足,上颌窦提升术是解决上颌后牙区骨量严重不足的有效手段,可为种植体的成功植入打下基础。20世纪60年代,美国Philip Boyne教授提出侧壁开窗法即柯-陆技术来提升上颌窦黏膜,以增加上颌后牙区的骨量,1994年,Summers报道了骨凿技术（经牙槽嵴顶技术）,这是一种微创的上颌窦底提升术,逐渐发展成为如今上颌窦提升技术的两大主流方法,即上颌窦外提升术和上颌窦内提升术。本文回顾了上颌窦提升技术的历史和现状,从上颌窦提升的手术方法、手术适应证、手术器械等方面的发展进行了综述。     

上颌窦腭侧壁扩张提升上颌窦底的临床效果研究

目的观察经牙槽嵴顶入路上颌窦腭侧壁扩张提升上颌窦底的临床效果。方法收集24例上颌后牙缺失患者,采用经牙槽嵴顶入路上颌窦腭侧壁扩张提升上颌窦底,不植骨同期植入种植体的手术方式,共植入37颗种植体。在6个月和12个月进行随访,统计种植体的成功率,拍摄CBCT测量种植体根部新骨形成的高度。结果 6个月复诊时,1颗种植体出现松动取出,其余36颗种植体正常行使功能,1年成功率97.3%。受植区平均牙槽骨高度为(6.7±0.8)mm,上颌窦底提升高度为(4.2±0.6)mm。上颌窦底种植体周围有新骨形成,6个月平均成骨2.1 mm,12个月平均成骨2.3 mm。结论上颌后牙区骨量不足时采用上颌窦腭侧壁扩张提升上颌窦底不植骨同期种植的手术方式是可行的,上颌窦黏膜具有潜在的成骨能力。     

An animal model for sinus floor elevation with great elevation heights. Macroscopic,microscopic, radiological and micro‐CT analysis: ex vivo

Objectives: Different animal models are used for research and training concerning sinus floor elevation. However, there is little information regarding an animal model for elevation heights of approximately 10 mm. The aim of this study was to explore the anatomical aspects of the maxillary sinus of adult pigs and to investigate the suitability of this animal as a model for sinus floor elevation training and research with great elevation heights. Material and methods: Thirty‐four bisected heads of adult domestic pigs were examined 6 h postmortem. Direct sinus floor elevation was performed with an elevation height of 10 mm. Localization, diameters, volume and septa of the maxillary sinus were recorded on lateral X‐rays and macroscopically. The thickness and structure of the maxillary sinus were investigated microscopically. The osseous microstructure of the lateral sinus wall was assessed microscopically and via micro‐CT. Results: The maxillary sinus of the adult pig exhibits an average length of 51±6.2 mm, a height of 31±4.1 mm, a width of 19±1.6 mm and a volume of 31±7.6 cm³. At least one septum could be observed on the floor of each sinus. The mucosal thickness amounted to a mean of 1692±138 μm, and the lateral bony wall of the sinus to a mean of 3±0.3 mm. A laceration of the Schneiderian membrane occurred in 25% during the elevation process. Conclusion: The maxillary sinus of adult domestic pigs is a suitable model for sinus floor elevation training and research with greater elevation heights of up to 10 mm. To cite this article:
Stelzle F, Benner K‐U. An animal model for sinus floor elevation with great elevation heights. Macroscopic, microscopic, radiological and micro‐CT analysis: ex vivo.
Clin. Oral Impl. Res. 21 , 2010; 1370–1378.
doi: 10.1111/j.1600‐0501.2010.01958.x     

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.     

Lamb ex vivo model for training in maxillary sinus floor elevation surgery: a comparative study with human standards

Background: Many models have been suggested for surgical training in sinus floor elevation (SFE), but information on key features that provide feedback to the trainee is scarce. The aim of this study is to compare the thickness of the lateral wall of the maxillary sinus (TLWMS) and the thickness of the Schneiderian membrane (TSM) between an animal model and the human standard. Methods: The observational study used 20 fresh lamb heads. Cone‐beam computed tomography (CT) was performed for recording the following: TLWMS, sinus lateral floor width, distance from the lateral border of the anteroposterior bone crest to the sinus wall, and height of lateral maxillary sinus. Thirty human radiologic exploration cone‐beam CTs were used for comparisons. The sinus membrane thickness was measured at three points per section and compared to those of 10 formalin‐preserved human membranes. Results: TLWMS in the animal model scored 2.25 ± 0.3 mm and was thicker than that of humans with subsinusal edentulism (Xi ? Xj = 0.3; 95% confidence interval = 0.1 to 0.4), although this difference was not considered clinically relevant. The average thickness of the sinus membrane was 485.5 ± 137.1 μm with no significant differences between sides (P = 0.12) or between the thickness of human and lamb Schneiderian membranes. Conclusions: The model based on lambs is potentially useful for training in SFE techniques because of the similarities in the TLWMS and particularly the TSM. Additional studies are needed to validate this model within a teaching environment.     

侧壁开窗上颌窦底提升术后垂直向骨增量的观察研究

目的通过观察侧壁开窗上颌窦底提升术后垂直向骨增量的变化情况,研究其相关的影响因素。方法收集上颌后牙区牙列缺损行侧壁开窗上颌窦底提升术分期种植患者资料,对纳入病例的术前剩余牙槽骨高度(residual bone height,RBH)、术后当日垂直向骨高度、术后6个月垂直向骨高度及垂直向骨增量的变化情况进行观察。结果术后6个月较术后当日垂直向骨高度有显著性降低,降低量为0.56±0.25mm;上颌窦底黏膜厚度的术后6个月较术后当日垂直向骨增量的变化量无明显差异;在不同剩余牙槽骨高度情况下,术后6个月较术后当日垂直向骨增量的变化量有统计学差异,RBH大于5mm的患者相对RBH小于5mm的患者垂直向骨增量的降低值显著增加;上颌窦宽度与术后6个月较术后当日垂直向骨增量的降低值呈正相关。结论侧壁开窗上颌窦底提升术后6个月较术后当日存在垂直向骨增量的降低现象;剩余牙槽骨高度大于5mm时垂直向骨增量的降低值显著增加;上颌窦宽度与垂直向骨增量的降低值呈正相关。     

Sinus floor elevation procedures to enable implant placement and integration: techniques,biological aspects and clinical outcomes

Implant treatment in an atrophied edentulous posterior maxilla constitutes a challenge for the therapeutic team. The authors of the present study acknowledge that modern micro‐rough surface implants in lengths of about 8–10 mm or longer and of different brands are similarly successful. Consequently, the authors propose that the use of different sinus floor elevation techniques should be considered when < 8 mm of bone is available below the maxillary sinus. The type of sinus floor elevation technique selected is mainly based on residual vertical bone height, marginal bone width, local intrasinus anatomy and the number of teeth to be replaced, although other factors (such as surgical training and surgical experience) may have an impact. It is proposed that a transcrestal sinus floor elevation approach can be considered as a first‐choice method for single tooth gaps in situations with sufficient width for implant placement and a residual bone height of 5–8 mm, while lateral sinus floor elevation, with or without grafting materials, is indicated when < 5 mm of bone is available and when several teeth are to be replaced. With regard to time of implant placement, a one‐stage procedure is preferred provided that high primary stability can be ensured.     

Maxillary sinus-floor elevation: an animal model

Objectives: To find an animal model for modified Caldwell–Luc procedure training. The animal model should have (1) a proper cortical thickness in the lateral wall; (2) a similar morphology and resistance of the Schneiderian membrane in humans; and, finally, (3) an oral approach. Materials and methods: Twelve fresh heads (four Merino sheep, four Murciano–Granadina goats and four Large–White pigs). Two skulls from each of these species were also used. Several three‐dimensional imagings from the skulls of each species were acquired using a C‐arm. Two fresh heads of each species were used to perform the modified Caldwell–Luc procedure. Two fresh heads of each species were firstly frozen at ?30°C for 48 h and then sawed in blocks containing only the target region of the maxillary sinus. Results: The average thickness was 2.03 mm in goat and sheep and 2.80 in pig. Releasing and elevation of the Schneiderian membrane from the sinus floor were easy in the three species. The approach of the maxillary sinus in sheep, goat and pig from the buccal vestibule required a previous surgical enlargement of the buccal vestibule. Conclusions: In conclusion, the cortical bone thickness and Schneider membrane characteristics in Merina sheep and Murciano–Granadina goat allow a perfect training for the modified Caldwell–Luc procedure. However, the approach from the oral cavity needs, in these species, a previous enlargement of the buccal vestibule. The excessive thickness of the cortical bone restricts the use of pigs for this technique.     

影响经牙槽嵴顶上颌窦底提升术成骨效果的解剖因素分析

上颌窦底提升手术是上颌后牙骨量不足时常采用的骨增量方式,根据手术进入上颌窦的路径分为经侧壁上颌窦底提升术和经牙槽嵴顶上颌窦底提升术.经牙槽嵴顶上颌窦底提升相比经侧壁上颌窦底提升有创口小、治疗时间短及患者更易接受等优势,在临床工作中被广泛应用.经牙槽嵴顶上颌窦底提升术后的骨增量效果受到多种因素的影响,其中解剖因素是最为重...     

An alternative sinus floor elevation procedure: trephine osteotomy

Today, the sinus floor elevation procedure is not only being used on a routine basis, but clinicians are reporting high success rates. The sinus floor graft has become an important option in the treatment of the edentulous posterior maxilla, where vertical bone height is less than ideal. A review of maxillary sinus floor elevation as an integral part of restoring the posterior maxillary is discussed. The related anatomy of the area and current osteotomy techniques are reviewed. This article describes a trephine osteotomy, which is an alternative technique to the existing lateral antrostomy approach currently being used.     

上颌窦提升术

上颌窦提升术是解决上颌后牙区骨量不足的常用方法。上颌窦提升术可分为上颌窦侧壁开窗术（上颌窦外提升术）和经牙槽嵴入路的上颌窦冲顶提升术（上颌窦内提升术）。本文就上颌窦提升相关解剖、上颌窦提升抗生素选择、上颌窦提升适应证把握、植骨方案选择、促生长因子的作用、上颌窦提升术的常见并发症和吸烟的影响作一论述。