2种上颌窦提升术在牙种植中的应用

目的：比较2种上颌窦提升术同期植入种植体的临床疗效.方法：采用2种上颌窦提升技术,对31例42颗垂直骨量不足的上颌后牙行上颌窦提升术及同期种植体植入术.术后1、3、6个月检查上颌窦及种植体骨结合情况.结果：无种植体松动、脱落及上颌窦炎发生,X线检查种植体与周围组织均形成良好的骨性结合,术后6个月完成义齿修复.经6～36个月随访观察,临床效果良好.结论：掌握适应证和手术技巧,2种上颌窦提升术同期植入种植体的临床疗效均良好.     

用于经牙槽嵴顶上颌窦提升术的山羊模型比较

目的比较波尔山羊和上海本地山羊作为上颌后牙区经牙槽嵴顶上颌窦提升术和种植治疗模型的可行性。方法10只波尔山羊和10只本地山羊,处死后6 h内取头颅进行观察。利用CBCT扫描观察上颌骨及上颌窦的解剖,记录上颌窦侧腔的宽度和可用骨高度。取上颌窦黏膜做组织学观察。采用SPSS21.0软件包对数据进行独立样本t检验。结果山羊的上颌窦底被1个前后向骨嵴分为侧腔和近中部。波尔山羊的上颌窦侧腔宽度和可用高度均大于本地山羊。结论波尔山羊更适合做经牙槽嵴顶上颌窦提升术和牙种植的动物模型。上颌第一磨牙区中点是理想的提升与种植位点。     

Assessment of the sinus lift operation by magnetic resonance imaging

OBJECTIVES: Vertical bone loss in edentulous maxillary alveolar processes may necessitate a sinus lift before the placement of dental implants. We have measured and assessed maxillary sinuses meticulously before the operation and evaluated the postoperative results of the operation with magnetic resonance imaging (MRI). METHODS: Thirteen edentulous maxillary regions in eight patients were included in the study. The patients were examined 1 week before and 3 months after the sinus lift operations using a 1.5 T superconductive MR imager that gave oblique sagittal T2-weighted images with slices 2 mm thick without a gap. RESULTS: The images that were obtained 3 months after the sinus lift operations confirmed that vertical height had increased. CONCLUSION: We obtained high quality images without any artefacts during a short examination period with a high-resolution scanner. The results showed that it is possible to assess the maxillary sinus before the sinus lift and to evaluate the postoperative results using MRI accurately in three dimensions without the risk of radiation. This makes MRI a suitable alternative to computed tomography (CT).     

A comparative study of the regenerative effect of sinus bone grafting with platelet-rich fibrin-mixed Bio-Oss® and commercial fibrin-mixed Bio-Oss®: An experimental study

Anorganic bovine bone (Bio-Oss^®) particles are one of the most popular grafting materials. The particles are often mixed with platelet-rich fibrin (PRF) or a commercial fibrin (Tisseel^®) to form a mouldable graft material. The objective of this study was to compare the potentials of PRF-mixed Bio-Oss^® and Tisseel^®-mixed Bio-Oss^® to enhance bone regeneration in a canine sinus model. Six mongrel dogs were used in this study. After elevating the sinus membrane in both maxillary sinus cavities, an implant was placed into the sinus cavity. In one of the sinus cavities, the PRF/Bio-Oss^® composite was grafted, and the Tisseel^®/Bio-Oss^® composite was grafted in the other sinus cavity. After a 6 month healing period, bone formation in the graft sites and bone-implant contact were evaluated. The mean osseointegration rate was 43.5 ± 12.4% and new bone formation rate 41.8 ± 5.9% in the PRF/Bio-Oss^® composite sites. In the Tisseel^®/Bio-Oss^® composite sites they were 30.7 ± 7.9% and 31.3 ± 6.4%. There were statistically significant differences between the groups. The findings from this study suggest that when platelet-rich fibrin is used as an adjunct to Bio-Oss^® particles for bone augmentation in the maxillary sinus, bone formation in the graft sites is significantly greater than when Tisseel^® is used.     

上颌窦侧壁开窗植骨种植术的护理配合

目的 总结上颌窦侧壁开窗提升术围术期内开展整体优质护理的经验与体会。方法 选择2010年1月—2016年12月在我院口腔第一门诊行上颌窦底侧壁开窗提升术的患者26例,通过分析上颌窦侧壁开窗提升术的术前准备、术中配合及术后护理等围术期护理配合联合心理护理,总结整体护理的经验体会。结果 26例患者术后均获得有效的骨增量效果,无并发症发生。上颌窦侧壁开窗提升术围术期间有针对性护理配合和心理护理,是必要和有效的。结论 充分周全的术前准备、到位的心理护理,术中精准的护理配合以及术后精心护理随访,对上颌窦侧壁开窗提升术的成功具有重要作用。     

黄金比例在上颌窦外提升术及同期种植体植入术中的应用评价

目的： 评价黄金比例在上颌窦外提升术及同期种植体植入术中的应用效果。方法： 选择2016年7月—2017年10月青岛大学附属医院西海岸院区种植科上颌磨牙缺失且剩余牙槽骨高度（residual bone height,RBH）约2.0～5.0 mm的患者15例,进行上颌窦外提升术。采用黄金比例确定种植体长度为11～12 mm,行同期种植体植入术,追踪其术后3～6个月愈合及骨结合情况。结果： 15例患者共植入21颗种植体,患者自我感觉良好。影像学检查可见种植体与周围骨组织结合良好,无1例患者发生上颌窦炎、种植体松动、脱落或种植体周围炎等并发症。术后6个月行种植修复,所有患者均能正常行使咀嚼功能,种植体周围软组织色泽、形态、质地无改变。结论： 运用黄金比例在上颌窦外提升术后同期植入种植体,可有效解决上颌后牙区RBH严重不足问题,为种植体长度选择提供依据。     

Treatment of bisphosphonate-related osteonecrosis of the jaw using platelet-rich fibrin

Background: Bisphosphonates are commonly prescribed antiresorptive agents for the management of patients with osteoporosis, Paget’s disease, multiple myeloma, and metastatic tumors. Platelet-rich fibrin (PRF) is a second generation platelet concentrate, and has the ability of regulating the inflammation and stimulation of chemotactic agents. The aim of this report is to present the treatment of Stage-3 bisphosphonate-related osteonecrosis of the jaw (BRONJ) by PRF.

Clinical Presentation: A 77-year-old male patient with Stage-3 BRONJ was treated with minimal surgical operations and PRF membrane. The patient was followed up for 18 months, and there was no recurrence or exposure.

Conclusion: PRF may promote the healing of both bone and soft tissues even in Stage-3 patients. This technique is an alternative treatment modality for the closure of bone exposure and tissue healing in BRONJ patients.     

Comparison of two bone substitute biomaterials consisting of a mixture of fibrin sealant (Tisseel®) and MBCP™ (TricOs®) with an autograft in sinus lift surgery in sheep

Objectives: The aim of this study was to assess the efficacy and safety of macroporous biphasic calcium phosphate (MBCP^?)/fibrin grafts (TricOs^®)/(Tisseel^®) for sinus lift augmentation in sheep. Autologous bone grafts were used as a positive control, and dental implants were placed to assess the efficiency of the composite. Materials and methods: A total of 12 adult sheep (24 maxillary sinuses) were randomized to receive sinus lift augmentation with MBCP^?/fibrin grafts obtained by either simultaneous or sequential addition of thrombin and fibrinogen to MBCP^?, or autologous bone grafts. Six months post‐sinus lift surgery, dental implants were placed. At 6 months post‐sinus lift and 3 months after dental implant placement, the characteristics of newly formed bone and dental implant stability were assessed. The methods used were radiography, scanning electron microscopy, light microscopy, micro‐CT analysis, radio frequency analysis (RFA), and image analysis. Results: There were no clinical adverse events in the post‐operative period. New bone formation was similar for MBCP^?/fibrin grafts and autografts at 21–20% and 20%, respectively, at 6 months, and at 34–35% and 35%, respectively, at 9 months. Implantability of dental implants was better at the time of placement with MBCP^?/fibrin grafts than autografts at 81–88% and 69%, respectively. Three months after placement, RFA showed better implantability with MBCP^?/fibrin grafts than with autografts at 75–82% and 71%, respectively. The bone contact measurements were around 50% for the three groups, without significant differences. Conclusions: This study shows that following sinus lift augmentation in sheep, MBCP^?/fibrin grafts support new bone formation that is comparable to autografts, while providing better support for the dental implants.     

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。     

注射型富血小板纤维蛋白在上颌窦外提升术中的应用效果

目的:评价注射型富血小板纤维蛋白（injectable-platelet rich fibrin,I-PRF）在上颌窦外提升术中促进成骨的效果。方法:选取2014年6月—2015年6月就诊于江苏省常州市口腔医院种植科,上颌后部磨牙或前磨牙单颗缺失可用骨高度3~5 mm,需进行上颌窦外提升的患者46例,随机分为2组,A组窦底填塞Bio-oss骨粉,B组窦底填塞Bio-oss骨粉+ I-PRF混合物。拍摄锥形束CT（CBCT）,于术前测量剩余骨高度（residual bone height,RBH）,术后即刻、术后6个月、术后12个月测量新生骨高度（new formed bone height,NFBH）,并于术后4个月进行二期手术,术后6个月修复时测量ISQ值,比较2组成骨效果。采用SPSS 20.0软件包对数据进行统计学分析。结果:46例患者伤口均一期愈合,无感染、裂开等。CBCT检查显示,术前、术后12个月2组间RBH比较差异无统计学意义（P>0.05）,术后即刻、术后6个月,A组RBH显著高于B组（P<0.05）。术后4个月,A组ISQ值显著高于B组（P<0.05）,而术后6个月2组ISQ值无显著差异（P>0.05）。结论:I-PRF在上颌窦底外提升术中安全可靠,能够有效缩短愈合时间,增强成骨效果。     

犬上颌窦内提升植骨与不植骨的成骨效果比较

目的:比较内镜下犬上颌窦内提升植骨与不植骨的成骨效果。方法:随机将6只比格犬（共12侧上颌窦）分为2组, A组为上颌窦内提升+即刻种植（3.5 mm×8 mm）,B组为上颌窦内提升+Bio-Oss（0.8 mL）+即刻种植（3.5 mm×8 mm）。利用CT、Micro-CT以及组织学评价2组术后上颌窦内和种植体周围成骨情况。采用SAS 9.0软件包对数据进行统计学分析。结果:术后切口愈合良好,无感染等并发症发生。A组术后即刻、3个月的CT数据重建上颌窦内成骨体积和密度显著低于B组。Micro-CT和组织学切片均证实,A组的成骨仅在种植体周围的下部,而中部和上部未见明显骨质;而B组的种植体周围均包绕着适量骨质。2组中上部和中部新骨面积存在显著差异（P<0.05）;下部新骨面积无显著差异（P>0.05）。结论:上颌窦内提升不植骨时仅在窦底有一定量的新骨形成,为了达到良好的术后和远期效果,建议在行内提升术时适当植入骨粉。     

常州地区人群上颌窦内提升中的窦底骨性分隔的锥形束CT研究

目的:研究常州地区人群上颌窦底骨性分隔的发生率、部位和形态学特点,探讨上颌后牙缺失与骨性分隔的关系,以及对上颌窦内提升手术的指导意义.方法:选择124例研究对象,于术前拍摄锥形束CT(CBCT)并生成相关数据,以NNT软件测量,获取上颌窦底骨分隔的数据,利用SPSS13.0软件包对数据进行统计学分析.结果:124例患者中,42例(33.87％)存在上颌窦骨性分隔;248个上颌窦中,68个存在骨性分隔(27.42％),其中45个骨性分隔出现于上颌窦中部(66.18％),15个出现在后部(22.06％),8个出现在前部(11.76％).窦分隔的发生与性别、年龄及是否缺牙无关.结论;通过CBCT可以观察到上颌窦底骨性分隔的位置、形态,最大限度地预判手术的难易程度,提高上颌窦内提升术的成功率.     

微创不翻瓣技术在上颌窦内提升中的临床应用

目的：评价微创不翻瓣技术在上颌窦内提升中应用的临床疗效。方法：选择2010.3-2011.11期间在福建省立医院口腔种植科就诊的19例上颌后牙缺失患者,其剩余牙槽嵴高度在5.5-8.5mm间,采用微创不翻瓣技术结合上颌窦内提升术,共植入种植体26颗。术后定期复诊,随访期12个月,观察种植体稳定性,牙周组织状况以及X线片评价骨高度。结果：随访期内未发现种植体出现松动或上颌窦炎症,牙周组织健康,X线示上颌窦内骨高度增加。结论：微创技术在上颌窦内提升中的应用,短期临床效果较为理想,但长期效果尚须进一步观察研究。     

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。     

Implants placed simultaneously with maxillary sinus floor augmentations in the presence of antral pseudocysts: a case report

An antral pseudocyst on the maxillary sinus has previously been a contraindication for sinus augmentation. The authors report the case of a patient with an antral pseudocyst (16.7 mm × 27.6 mm) in his left sinus, who was referred for dental implant treatment. The surgical plan was to perform the sinus augmentation after removing the cyst whilest simultaneously placing implants. During the operation the cyst could not be found in the left sinus. The sinus augmentation was carried out successfully without sinus membrane perforation and the implants were placed according to plan. Three mouths later, the cyst was still present and good osseointegration of the implants was achieved. After the implants had been in place for a year, a CT scan showed that the cyst had decreased in size. The authors conclude that it is may not be necessary to remove a sinus cyst before sinus augmentation or during the sinus augmentation operation if the patient does not have any symptoms and the cyst is not large. In cases with large lesions or an unclear diagnosis, further evaluation is needed before surgical intervention.     

3种提升材料对闭合式上颌窦底提升术上颌窦黏膜形变影响的力学分析

目的：比较3种提升材料对闭合式上颌窦底提升术上颌窦黏膜形变的影响。方法：在 ANSYS 有限元分析软件的SHELL 63单元中分别建立0．3 mm 厚度上颌窦黏膜与纯钛种植体、自体松质骨、羟基磷灰石骨粉有限元模型,分别计算3种材料提升上颌窦黏膜1～5 mm 时黏膜表面 Von mises 应力值,并进行对照分析。结果：通过对0．3 mm 厚度上颌窦黏膜提升1～5 mm 的形变与应力分析,发现应用纯钛种植体、自体松质骨与人工羟基磷灰石骨粉3种材料提升上颌窦黏膜,黏膜表面的应变相似,应力值曲线高度重叠,随着高度增加,应力增加的趋势亦基本一致,3种材料对上颌窦黏膜表面应变与应力的影响几乎没有差别。结论：使用松质骨、人工羟基磷灰石骨粉、纯钛种植体抬高上颌窦黏膜对黏膜形变是没有影响的,行闭合式上颌窦底提升手术应用种植体直接提升上颌窦黏膜是相对简易及微创的手术方式,推荐在临床工作中使用。     

Clinical and histopathological study of simus lift procedure

Sixteen sinuses of 11 patients performed by sinus lift procedure were retrospectively discussed clinically and histopathological investigations from grafted materials. Grafted materials were 10 autogenous bones harvested from 1 iliac crest and 9 chin bones, 1 non-resorbable hydroxyapatite plus mandibular alveolar ridge bone, and 1 mixed of resorbable hydroxyapatite plus human freezed dry bone. Histopathological investigation on several small speciemens taken from grafts of these different materials was performed. New bone formation, small amount of bone resorption and fibrous encapsuling tissue were observed for autogenous bone graft, but new bone formation was delayed around non-resorbable hydroxyapatite particles, and most of all grafted specimens of human freezed dry bone was replaced and encapsulated by fibrous tissues. These results showed that autogenous bone is highly recommended as graft material for sinus lift procedure. Endosseous implants were placed for 8 patients in the first group after an average period of 9.2 months of elevation, and for 2 patients in the second group at the time of elevation. One patient in the third group received a second sinus elevation to prevent maxillary sinusitis by perforating through maxillary sinus membrane following the installation. The survival rate of dental implants with sinus lift procedure was 94.1% after fabrication of prosthesis without any complication.

     

Summers骨凿提升上颌窦的临床应用

目的评价Summers骨凿在上颌窦闭合式内提升、植骨及同期牙种植术中的效果。方法对上颌后牙区牙槽骨严重吸收的66例患者,采用Summers骨凿预备种植床,植入人工骨并同期植入种植体,术后6个月完成种植修复。结果66例患者上颌窦提升高度2~5 mm,术后皆无上颌窦炎发生。牙科CT扫描显示窦内形成一圆形光滑的突起,提升部位表面光滑完整,无黏膜穿破表现。6个月后X线片显示植入的骨材料无明显吸收,种植体骨结合完成。种植修复完成12~24个月后复查,无种植体松动、脱落,牙龈组织健康,种植体上部结构功能恢复满意。X线片显示：种植体与骨结合紧密,种植体周围骨垂直吸收小于1 mm。结论Summers骨凿可安全地提升上颌窦底,并可避免异位取骨,值得临床推广。