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。     

Bio-Oss骨粉单独应用于上颌窦提升的临床效果评价

目的:评价单独应用Bio-Oss骨粉完成上颌窦提升并同期或延期进行牙种植的临床效果.方法:收集需要进行上颌窦外提升以完成种植修复的病例资料,单独应用Bio-Oss骨粉完成上颌窦提升,同期或延期植入种植体,通过临床和X线检查评价种植体和移植骨的稳定性.结果:共收集30个病例,完成39侧上颌窦提升.平均植入Bio-Oss骨粉1.3±0.24克.共植入种植体68颗,同期植入45颗,延期植入23颗.平均随访18.5±3.4个月,2颗种植体分别在术后2年和3年因种植体周围炎丧失.其他种植体在最后一次随访中均无明显动度,移植骨高度无显著改变.结论:Bio-Oss骨粉单独应用于上颌窦外提升手术可形成新骨,并具有长期稳定性.     

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。     

上颌窦外提升技术在种植修复中的应用

目的:研究上颌窦外提升技术在上颌后牙区种植高度不足时的应用及临床效果.方法:2005年7月至2011年7月共完成52例、84枚种植体的上颌窦外提升种植修复病例.随访5年以上13例、3年以上24例、1年以上8例、1年以内7例.观察方法为临床检查和X线检查.患者上颌后牙区牙槽嵴顶至上颌窦底之间剩余骨高度小于7mm,无法植入足够长度的种植体,因此采用上颌窦外提升技术同期植入种植体.术中使用了Bio-Oss骨粉作为骨移植材料,采用非埋入式种植技术,6个月后进行修复.结果:总计52例患者,2例发生上颌窦黏骨膜破裂,但术后观察未发生上颌窦感染等并发症.84枚种植体均获得良好的骨结合并已完成种植修复,至2011年12月为止,无种植体脱落,患者对修复效果满意.结论:上颌窦外提升技术安全可行,是解决上颌后牙区骨高度不足时种植修复难题的有效方法.     

上颌窦开放式提升牙槽嵴骨增量技术应用体会

目的：总结上颌窦开放式提升临床应用体会。方法：8例患者11个上颌窦进行了上颌窦开放式提升并植入骨替代材料。其中7个上颌窦采用自体骨加Bio-Oss小牛骨粉混合后植入，4个上颌窦单纯采用Bicr-Oss小牛骨粉植入．术后1、3、6、9个月摄颌骨全景片观察骨再生和改建情况。结果：术后6—9个月，X光片显示上颌窦内骨替代材料完成骨改建、单纯采用小牛骨粉植入者骨的再生和改建略慢于混合植入者。所有患者皆6—9个月内顺利完成了种植体植入及修复。结论：采用开放式提升技术进行上颌骨后部的骨增量是一种很有效的手术方式。     

上颌窦内自体骨块与颗粒骨联合移植同期种植体植入的临床探讨

目的：探讨上颌窦开放式提升中自体骨块与颗粒骨联合移植同期种植体植入的临床应用方法及效果。方法：5例患者5侧上颌窦在进行上颌窦开放式提升中取自体上颌结节处骨块移植入上颌窦底并联合植入颗粒骨代用品,同期植入种植体,6—7月后行Nobel Replace Ti—Unite种植体上部修复。分别与术后即刻、5月及12月行临床及X线效果观察。结果：5侧经开放式提升的上颌窦窦底提升在7.1-12．0mm间,平均10．48mm;植入的5个种植体,X线示种植体与周围骨结合良好,种植体无松动,效果满意。结论：上颌窦内自体骨块与颗粒骨联合移植同期种植体植入术,解决了上颌后牙区垂直骨量不足难以同期种植的难题,扩大了种植临床适应症。     

Bio-Oss骨粉在上颌窦内提升同期牙种植术中的应用

目的：评价上颌窦内提升,Bio-Oss骨粉植入同期牙种植术修复单个上磨牙缺失的方法和效果.方法：对10例上颌第一磨牙缺失剩余牙槽嵴高度不足患者行上颌窦内提升,Bio-Oss骨粉植入同期牙种植术.随诊观察1年.结果：6个月后,x线片显示植入Bio-Oss骨粉均已改建形成新骨,种植体与Bio-Oss骨粉改建形成的新骨形成紧密的骨性结合.种植体植入6个月后行上端修复,修复后随诊1年均达到种植成功标准.结论：上颌窦内提升Bio-Oss骨粉植入同期牙种植术修复单个上后磨牙缺失,操作简单,效果肯定,值得临床推广.     

自体原位取骨植骨上颌窦提升同期种植体植入术的临床研究

目的:通过原位取骨、植骨、同期植入CDIC种植体,以解决上颌后牙区因上颌窦过大或牙槽嵴严重萎缩导致骨量不足的问题。方法:采用空心环柱形切骨锯在所需种植区域取骨,将圆柱状骨块取出后研磨成颗粒。在使用骨膨胀器对上颌窦底提升后,将骨颗粒和CDIC种植体一起置入预备好的种植窝。结果:对3例患者实施手术,共植入种植体6枚,术后全部为一期愈合,无并发症,种植修复效果理想。结论:采用自体原位取骨上颌窦提升术同期植入CDIC种植体,可以通过微创操作有效地解决上颌后牙区骨量不足的问题。和传统的上颌窦侧方开窗、提升、植骨相比,它不但降低了手术操作的复杂程度,同时也使患者的痛苦减小到最低。     

闭合式上颌窦提升术在种植修复中的应用体会

目的 探讨闭合式上颌窦提升术在上颌后牙区骨量不足患者种植修复中的临床疗效。方法 选择我院2009年至2012年上颌后牙区20例牙槽骨高度不足种植患者,采用闭合式上颌窦提升技术,同期植入27颗种植体,随访至少12个月。选择20例条件相近病例,行开放式上颌窦提升同期种植体植入作为对照组。结果 随访期间,26枚种植体均获得了良好的骨结合,种植修复取得了较好的临床效果。1枚种植体二期手术时,被纤维组织包裹,松动。种植体成功率96.30%。实验组植入骨吸收量小于对照组（P＜0.05）。结论 选择合宜的外科操作技巧,在上颌萎缩后牙区采取闭合式上颌窦提升术同期植入种植体的方法能大大缩短患者的治疗时间,取得很高的成功率以及良好的临床效果。     

上颌后牙区即刻种植及同期上颌窦提升的临床应用

目的:探讨上颌后牙区即刻种植及同期上颌窦内提升的临床效果. 方法:选择上颌后牙区即刻种植病例57例,其中上颌后牙区上颌窦底骨高度为(3.2±0.6)mm,微创拔除患牙后,行单纯上颌窦内提升同期牙种植术,植入德国XIve种植体21枚,德国Ankylos种植体45枚,种植体与拔牙窝骨壁之间的间隙植入自体骨或人工骨代用品,缝合固定胶原塞以关闭拔牙窝. 种植手术后至少5~6个月完成永久修复,随访6~24个月. 结果:临床随访期内种植体存留率100%,57例患者上颌窦底提升高度3~5 mm. 66枚种植体成功负载,种植体稳定,骨结合状况良好. 57例患者均达到良好的临床和放射学上的骨结合并成功负载. 结论:上颌后牙区即刻种植及上颌窦内提升术不仅能有效治疗上颌窦底牙槽骨高度不足的上颌后牙区,而且缩短治疗过程,简化手术操作,获得较为理想的临床效果.     

上颌窦外提升术在口腔种植术中的应用

目的:探讨上颌窦提升术在口腔种植术中的应用以扩大口腔种植术中的应用范围。方法:25例患者通过上颌窦提升术同期或延期植入种植体31枚,术中患者使用了Bio-Oss胶原质作为骨移植材料,采用非埋入式种植技术。结果:术后6个月,上颌窦底提高4-6mm,所有病例完成修复后,随访6-24各月,x线检查窦底骨质无明显吸收,种植体骨结合良好,无松动脱落,修复效果满意。结论:上颌窦提升术扩大了口腔种植术的应用范围。     

上颌窦底提升同期植入种植体过程中超声骨刀和植骨量的作用

目的:评价应用超声骨刀进行上颌窦底开放式外提升同期植入种植体,以及不同植骨量对种植效果的影响。方法:对21例上颌后牙槽骨高度不足患者随机分成两组,应用超声骨刀进行上颌窦底开放式外提升同期植入种植体,将A组11例患者进行全量骨粉植入,B组10例患者进行半量骨粉植入,6-12个月后检查种植体的稳定性和骨愈合情况。结果:A、B两组25颗种植体与周围组织均形成良好的骨性结合,无上颌窦炎发生,两组间无显著差异。结论:应用超声骨刀行上颌窦底提升术可精确地完成手术,术中半量或全量植骨均能达到较好的临床效果。     

上颌窦提升术同期或延期牙种植的早期临床评价

目的对上颌窦提升术同期或延期牙种植进行早期临床评价。方法37例患者38侧上颌窦进行上颌窦提升同期或延期牙种植,种植体上部结构修复完成后6～36个月定期复查。结果观察期内同期牙种植27侧上颌窦共59颗种植体,松动、脱落1颗,成功率为98.3%。延期牙种植上颌窦11侧共23颗种植体,全部成功。除1颗失败种植体外,其余同期或延期植入的种植体均无松动或脱落,经X线片检查显示植入骨材料改建良好,种植体周围未见明显骨吸收阴影。结论上颌窦提升术同期或延期牙种植的早期临床效果无明显差异。     

A clinical long-term radiographic evaluation of graft height changes after maxillary sinus floor augmentation with a 2:1 autogenous bone/xenograft mixture and simultaneous placement of dental implants

The aim of the present study was to assess long-term changes in sinus-graft height after maxillary sinus floor augmentation and simultaneous placement of implants. A total of 191 patients who underwent maxillary sinus floor augmentation were radiographically followed for up to about 10 years. A 2 : 1 mixture of autogenous bone and bovine xenograft (Bio-Oss) was used as the graft material. Sinus-graft height was measured using 294 panoramic images immediately after augmentation and up to 108 months subsequently. Changes in sinus-graft height were calculated with respect to implant length and original sinus height. Patients were divided into three groups based on the height of the grafted sinus floor relative to the implant apex: Group I, in which the grafted sinus floor was above the implant apex; Group II, in which the implant apex was level with the grafted sinus floor; and Group III, in which the grafted sinus floor was below the implant apex. After augmentation, the grafted sinus floor was consistently located above the implant apex. After 2-3 years, the grafted sinus floor was level with or slightly below the implant apex. This relationship was maintained over the long term. Sinus-graft height decreased significantly and approached original sinus height. The proportion of patients classified as belonging to Group III reached a maximum from year 3 onwards. The clinical survival rate of implants was 94.2%. All implant losses occurred within 3 years after augmentation. We conclude that progressive sinus pneumatization occurs after augmentation with a 2 : 1 autogenous bone/xenograft mixture, and long-term stability of sinus-graft height represents an important factor for implant success.     

上颌窦外提升在口腔种植术中的应用

目地：探讨上颌窦外提升术在口腔种植手术中的应用,以扩大口腔种植术的适应证。方法：2007年5月-2012年12月对41例患者,通过上颌窦外提升术同期或延期植入86枚Itl种植体,使用Bio—Oss人工骨作为骨移植材料,采用非埋入式种植技术。结果：41例患者中2例发生上颌窦黏膜破裂,86枚种植体均完成种植修复,随访至2012年底,种植修复体无松动脱落,临床修复效果满意。结论：上颌窦外提升术可以扩大口腔种植的适应症。     

Bone reactions to anorganic bovine bone (Bio-Oss) used in sinus augmentation procedures: a histologic long-term report of 20 cases in humans

Many materials are used for sinus augmentation procedures. Anorganic bovine bone (Bio-Oss) has been reported to be osteoconductive, and no inflammatory responses have been observed with the use of this biomaterial. One of the main questions pertaining to Bio-Oss concerns its biodegradation and substitution by host bone. Some investigators have observed rapid replacement by host bone, while other researchers observed slow resorptive activity or no resorption at all. The aim of the present study was to conduct a long-term histologic analysis of retrieved specimens in humans where Bio-Oss was used in sinus augmentation procedures. Specimens were retrieved from 20 patients after varying periods from 6 months to 4 years and were processed to obtain thin ground sections. Bio-Oss particles were surrounded for the most part by mature, compact bone. In some Haversian canals it was possible to observe small capillaries, mesenchymal cells, and osteoblasts in conjunction with new bone. No gaps were present at the interface between the Bio-Oss particles and newly formed bone. In specimens retrieved after 18 months and 4 years, it was also possible to observe the presence of osteoclasts in the process of resorbing the Bio-Oss particles and neighboring newly formed bone. Bio-Oss appears to be highly biocompatible and osteoconductive, is slowly resorbed in humans, and can be used with success as a bone substitute in maxillary sinus augmentation procedures.     

Histomorphometric analysis of natural bone mineral for maxillary sinus augmentation

PURPOSE: Lack of bone height in the posterior maxilla often necessitates augmentation prior to or simultaneously with dental implant placement. The purpose of this clinical study was to evaluate the use of the natural bone mineral Bio-Oss alone or in combination with autogenous bone in sinus floor elevations performed as 1- or 2-step procedures. MATERIALS AND METHODS: Thirty-eight patients required sinus augmentation. Natural bone mineral alone was used in sinus floor augmentation in 21 patients. In 13 patients, a mixture of the bone substitute and autogenous bone was used, and in 4 patients autogenous bone alone was used. In all of the patients, samples were taken for biopsy 3 to 8 months postoperatively, and bone regeneration was evaluated histologically and histomorphometrically. RESULTS: In all patients, the amount of new bone significantly increased over the observation time, while marrow areas decreased. There was no statistically significant difference in the amount of new bone formation between the Bio-Oss group (new bone 29.52% +/- 7.43%) and the Bio-Oss/autogenous bone group (new bone 32.23% +/- 6.86%). In the 4 patients treated with autogenous bone alone, a greater amount of newly formed bone was found; however, in these cases the area volume filled was smaller than in the other 2 groups. DISCUSSION: The data showed that new bone formation takes place up to 8 months after sinus floor elevation and that there is no difference in the amount of bone formation between procedures done with the bone substitute alone or with the mixture of the substitute and autogenous bone. CONCLUSION: These data suggest that predictable bone formation can be achieved with the use of Bio-Oss.     

Maxillary sinus augmentation with the xenograft Bio-Oss and autogenous intraoral bone for qualitative improvement of the implant site: a histologic and histomorphometric clinical study in humans

The aim of the present clinical study was to determine, through histologic and histomorphometric investigations of human bone specimens, whether the addition of autogenous bone to the bone substitute material Bio-Oss can produce a high-quality implant site. To improve vertical bone height, 13 sinus floor elevations were carried out in a total of 12 patients. Augmentation of the maxillary sinus floor was completed using a mixture of Bio-Oss and bone harvested intraorally from the mandibular symphysis, the retromolar space, or the tuberosity region. Following an average of 7.1 months of healing, 36 Br?nemark System implants were placed. During this surgical intervention, 23 cylinder-shaped bone biopsies were taken from the augmented maxillary region using trephine burs. Histologic analysis of the bone biopsies revealed that the Bio-Oss granulate was well-integrated into the newly formed bone; 33.1% (+/- 12.4%) of the substitute material surface was in direct contact with bone. Histomorphometric analysis of the samples revealed an average percentage proportion of bone of 18.9% (+/- 6.4%). The bovine substitute material and soft tissue occupied, respectively, 29.6% (+/- 8.9%) and 51.5% (+/- 9.4%) of the measured surface. When the implants were uncovered after an average healing phase of 6 months, all 36 implants had become osseointegrated. The combination of osteoconductive Bio-Oss and osteoinductive autogenous bone thus proved to be a material suitable for application in sinus floor augmentation.