Five Years Follow-up of Short Implants Placed in Atrophic Maxilla with Simultaneous Sinus Floor Transcrestal Elevation

ObjectiveMany authors have tried to face the anatomical limitations resulting from maxillary bone atrophy. Up to five millimeters bone height, the lateral sinus floor elevation is the most commonly used and validated strategy to achieve the prosthetic rehabilitation. However, the disadvantages of this technique are its invasiveness and delayed rehabilitation. The aim of this paper was to assess 5 years clinical outcome of implants placed with a technique that allows the percrestal sinus floor elevation and the immediate implant placement.Materials and Methods30 transcrestal sinus floor elevations with immediate implant placement were performed in severely atrophic maxillae. Implant survival, marginal bone level variation, harvested bone height variation and periodontal indices were assessed.ResultsAfter a five year follow up none of the thirty implants were lost. The mean value of vertical harvested bone loss was 5%. The mean crestal bone loss was -0.33 mm (Standard Deviation (SD) 0.11 mm). The mean value of periodontal indices was respectively: PD 1.22 mm (SD 0.72 mm), PI 17.47% (SD 15.01 mm), BOP 9, 87%.,(SD 19.17 mm).ConclusionThe results obtained are comparable with success criteria in implant rehabilitation. The reported technique proved to be successful in the population observed, with minimal trauma and reduced invasiveness.     

上颌窦提升术在重度萎缩上颌骨牙种植中的应用

目的：寻找上颌后牙区骨量不足，种植体易穿上颌窦的解决方法。方法：4例5侧上颌窦行上颌窦底提升、植骨、同期或延期种植体植入要，术后当天1、3、6、12月检查上颌窦与种植体界面结合情况。结果：种植体无松动或脱落，X线显示上颌窦无液平面，种植体周围无阴影。结论：上颌窦提升术可有效解决上颌后部牙缺失后骨量不足，种植易失败的难题。     

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。     

改良上颌窦底提升术的临床应用

目的:评价改良上颌窦底提升术在处理上颌后牙区垂直骨量不足中的应用及临床效果。方法:65名上颌后牙缺失患者,共103个植入位点。上颌窦底下方的剩余牙槽骨高度为2～9mm。其中,30例剩余骨高度为5～9mm的患者,采用超声骨刀行上颌窦底内提升术;35例剩余骨高度为2～5mm的患者,行侧壁小开窗上颌窦底提升术。同期或延期植入种植体,随访9-30个月。结果:术后6个月,行上颌窦底内提升术的患者,平均提升高度为4.43mm(2.22～5.47mm);行上颌窦底外提升术的患者,平均提升高度为5.95mm(4.16～12.85mm)。103个种植位点中仅2例在术中发现黏膜穿孔,1例在戴牙后3个月出现种植体松动,其余种植体均形成良好骨结合,存留率为99%。结论:上颌窦底提升术能够有效促进上颌窦内成骨,增加上颌后牙区骨高度,超声骨刀及外提升术中小开窗术式的应用,可显著降低术中并发症的发生率、缩短手术时间、减轻患者术后反应。     

Bicon短种植体在上颌后牙区骨量不足病例中的临床应用

目的：评估Bicon短种植体在上颌后牙区骨高度不足病例种植修复的临床效果。方法：选择上颌后牙区骨高度1．7—8ram的病例62例,共植入Bicon短种植体252枚,其中植入长度6ram的种植体192枚,长度8mm的种植体60枚。其中上颌窦区牙槽骨高度不足的患者行经牙槽嵴上颌窦底提升术同期植入种植体,部分植体使用上颌窦基台固位。3—6个月后完成永久修复。结果：62例252枚Bicon短种植体均获得了良好的骨结合,9—26个月的随访观察及X光片和牙科CT检查,临床效果良好,种植体周围骨组织稳定。结论：Bicon短种植体在上颌后牙区骨量不足病例种植修复中临床效果肯定。     

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。     

上颌窦内提升植骨及同期牙种植术在严重上颌骨萎缩中的应用

目的:评价上颌窦内提升同期牙种植术在上颌牙槽骨高度严重不足的临床应用.方法:对25例上颌窦底牙槽骨剩余高度1.9-5.0mm(平均高度3.5mm)的牙缺失患者采用空心环柱形切骨锯在种植区切骨、取骨,用骨挤压器对上颌窦底提升后,将圆柱状骨芯研磨成颗粒后,将自体骨颗粒或混合羟基磷灰石的颗粒植入上颌窦底,再置入种植体,术后1、3、6、12、18、24个月后复查.结果:共29枚种植体植入,其中窦底提升5-8mm后(平均6.45mm)植入27枚,上颌窦穿孔后盖膜植骨同期植入2枚.分别植入18枚Replace和11枚Xive种植体,全部一期愈合,术后3-6月大部分病例的X线片显示种植体与新骨形成紧密的骨性结合,术后1.5-6月完成种植修复,效果理想.术后18-30月留存率100%.结论:上颌牙槽骨高度严重不足的病例中采用上颌窦内提升,结合原位取骨、植骨,同期牙种植的方法能有效解决上颌后牙区骨量严重不足时的牙种植问题.     

上颌窦侧壁抬升植骨种植的临床研究

目的:探讨应用上颌窦侧壁抬升植骨方法进行种植的优缺点和近远期效果。方法:2000年1月至2006年12月对28例患者行上颌窦侧壁抬升植骨种植。上颌窦底提升高度6.9mm-14.7mm,平均11.2mm。采用人工骨Bio-Oss或自体血提取的富血小板血浆(platelet-richplasma,PRP)与人工骨Bio-Oss混合填入上颌窦,用可吸收性胶原膜Bio-Gide覆盖。共抬升32侧,植入种植体57枚,均采用固定修复。种植后追踪时间9-62个月,平均28个月。观察方法为临床检查和X线检查,采用Wheeler存留标准评估,纳入Kaplan-Meier存留曲线统计。结果:在随访过程中,一颗植体在植入7个月后松动最终取出,其余植体稳定性良好,使用正常,患者满意,据Wheeler存留标准统计存留率为98.2%。结论:当上颌后牙区牙齿缺失且余留骨量不足时,通过上颌窦侧壁开窗抬升植骨可以有效增加骨高度,满足种植的骨条件,近远期效果理想。     

改良上颌窦内提升器械在种植手术的应用

目的：探讨采用改良上颌窦内提升器械进行上颌窦内提升同期种植术的方法。方法：对20名24侧上颌窦底过低（≥5mm）病人,采用改良上颌窦内提升器械经内提升手术植入自体或人工骨,同期种植体植入。结果：术后X-线片显示平均提升5.36±1.41mm,窦底高度提升明显,达到种植手术要求,3-6个月顺利实施二期修复,疗效满意,无任何并发症发生。结论：采用改良上颌窦内提升器械进行上颌窦内提升术,方法简单,提升幅度大,安全可靠,疗效满意,值得临床推广。     

Evaluation of Three-Dimensional Volumetric Changes After Sinus Floor Augmentation with Mineralized Cortical Bone Allograft

Aim

The aim of this retrospective study was to quantify three-dimensional (3D) volumetric bone changes over a two-year period in maxillary sinuses augmented with a mineralized cortical bone allograft material (MCBA) material.

Patients and Methods

Eleven patients (6 males and 5 females) with mean of age of 51.6 (range: 46–61) years were treated to increase the vertical dimension of the alveolar crest by maxillary sinus floor augmentation procedure. Study data were collected from patient records and by analyzing preoperative radiographs and cone beam computed tomography (CBCT) scans taken within the first two weeks after maxillary sinus lift (T0), immediately before implant placement four months after grafting (T1), and after one year of implant loading (T2). All DICOM-formatted images were rendered into volumetric images using software that automatically calculated the volume of the grafted material in cubic centimeters.

Results

Mean graft volume was 16.24 ± 1.54 cm³ at T0, 14.48 ± 1.48 cm³ at T1 and 13.06 ± 1.39 cm³ at T2. Mean volume retraction resulted in 1.76 ± 0.34 cm³ ΔV1 (T0–T1) and 1.42 ± 0.4 cm³ ΔV2 (T1–T2) and was 10.83 % of the initial total volume at (T0–T1) and 9.8 % of the total volume (T1–T2).

Conclusion

The present retrospective investigation demonstrated a 20.63 % decrease in graft volume. Volumetric 3D assessment of CBCT scans with the selected software appeared to be a promising approach to quantifying long-term changes in the grafted area.     

上颌窦外提升同期种植体植入后近期效果观察

目的探讨上颌窦外提升同期植入种植体的方法及效果。方法16例患者21侧上颌窦通过外提升同期植入种植体共28枚。结果上颌窦底平均增加骨高度11.8mm,16例均已完成修复,随访3～18个月,平均随访10个月,无种植体松动脱落,咀嚼功能正常。结论上颌窦外提升同期植入种植体,疗效肯定,可明显缩短治疗周期,减少手术创伤。