超声内提升骨刀在上颌窦内提升术中的临床应用

目的:评价超声内提升骨刀在上颌窦内提升术中的技术优势。方法:16例上颌后牙缺失患者,上颌窦底剩余牙槽骨骨量为4～7 mm,采用超声内提升骨刀行上颌窦底黏膜内提升术,同期植入种植体30枚,术后6个月上部结构修复。随访18个月。结果:术中无1例上颌窦黏膜破裂,术中、术后患者均无头晕、头痛等不适,术后鼻腔无出血,也无骨粉等异物排出;术后种植体稳固,种植体周围牙龈组织健康,无一脱落,咀嚼功能恢复满意。数字曲面断层片显示种植体周围骨未见低密度影,无上颌窦炎症影像;术后18个月种植体末端骨高度(2.1±1.5)mm,窦底提升(3.6±1.8)mm,种植体边缘骨吸收(1.27±0.56)mm。结论:采用超声内提升骨刀代替骨凿技术行上颌窦底黏膜内提升术,具有高效、快速、患者不适感轻、不损伤窦底黏膜的优点,值得在临床上推广。     

Localized Management of Sinus Floor Technique for Implant Placement in Fresh Molar Sockets

Background: The use of osteotome for vertical bone augmentation and localized sinus elevation with minimal surgical trauma represents a suitable procedure to increase the vertical dimension of available bone for implant placement. Purpose: The aim of this study was to report clinical and radiographic results of localized management of sinus floor (LMSF) in fresh molar sockets at 13‐year follow‐up. Materials and Methods: Fifty‐three patients, needing one or two maxillary molar extraction, were enrolled in this study. LMFS procedure was performed and 68 implants were positioned. A presurgical distance from the alveolar crest to the floor of the maxillary sinus and the amount of new radiopacity between the sinus floor and alveolar crest were measured from the mesial and distal surfaces of each dental implant surface. Results: After a mean follow‐up period of 9.76 ± 5.27 years (ranged from 4 to 17 years) a survival rate of 100% was reported. Mean bone height at temporary prosthesis placement was 7.99 ± 1.16 mm. They were stable over time, reporting a mean value of 8.01 ± 1.46 mm at 13‐year follow‐up. Conclusions: The results of this study demonstrated that LMSF procedure in fresh molar sockets allowed to expand the dimensions of resorbed posterior maxillary alveolar bone both vertically and horizontally with a success rate of 100% of implant osseointegration over time.     

Sinus floor elevation via the maxillary premolar extraction socket with immediate implant placement: a case series

Background: When immediate implant placement is considered for teeth with close proximity to the sinus floor, apical extension of the osteotomy is significantly limited, and often a staged approach is used. Implant placement into fresh extraction sockets and sinus floor manipulation using bone‐added osteotome sinus floor elevation with implant placement are techniques most often used independently or sequentially. Very few reports have described the combined use of immediate implant placement in fresh sockets and the bone‐added osteotome sinus floor elevation technique. Methods: We present five cases in which a maxillary premolar was extracted and an implant placed into the extraction site with simultaneous abfracture of the sinus floor using osteotomes. All teeth were extracted atraumatically, and sockets carefully debrided and checked for integrity of the walls. After ideal osteotomy preparation, particulate bone graft was placed in the osteotomy and appropriately sized osteotomes were used for sinus floor elevation. After sufficient elevation, implant placement was completed and particulate bone was packed in the bone–implant gap when indicated. Results: All implants were restored after a minimum healing period of 6 months. At the time of final restoration, bone was seen surrounding the implants from the apical portion to the most coronal thread. All five implants healed without complications and were in function for periods ranging from 6 to 12 months. Conclusions: Immediate implant placement with simultaneous osteotome sinus floor elevation is an advantageous combination of two successfully used techniques. This combined approach can significantly reduce the treatment time for implant therapy in teeth with close sinus proximity and provide the operator with the ability to place implants of desired length.     

自体植骨上颌窦底提升同期种植体植入术近期疗效观察

目的:评价自体骨开窗式上颌窦提升术对上颌后牙区牙槽骨高度严重不足(高度4～6mm)的患者种植治疗的近期疗效。方法:对4例上颌后牙骨量不足(高度4～6mm)而需种植修复的病例,实施自体植骨的开窗式上颌窦提升术,并同期植入种植体共9枚。自体移植骨来自种植窝制备时中空钻取骨,在需做牙槽嵴修整处的牙槽骨棘取骨,如不够再用刮骨器取骨或从颏部手术取骨,将所取之骨碾碎备用。结果:术后7个月拍片,均显示骨性愈合;冠修复后行使功能18～24个月效果理想。结论:自体取骨植骨用于上颌窦提升,可扩大种植手术适应证,降低种植成本。     

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。     

Long‐term results after lateral and osteotome technique sinus floor elevation: a retrospective analysis of 2190 implants over a time period of 15 years

Background: During a time period of 15 years (1992–2007), 2190 implants were inserted in 983 patients after sinus floor elevation. Materials and methods: One thousand two hundred and seven implants (461 patients) were placed into sites, in which the sinus was augmented using the lateral approach (LSFE), and 983 implants (522 patients) in sites augmented with the osteotome technique. Bovine bone mineral (n=1217), β‐tricalcium phosphate (n=126), and in some cases, only autogenous bone were used for augmentation in the LSFE. Generally, bone chips that were collected during the preparation of the osteotomy were added to the bone substitutes. No additional augmentation materials were used for augmentation with the osteotome technique. A retrospective analysis of the treatment results was assessed by patients documentations that were recorded in the impDAT(R) – Program and by the evaluation of pre‐, and post‐surgical orthopantomograms. Results: The implant survival analysis according to Kaplan–Meier showed 97.1% after 176 months of loading for both sinus floor elevation techniques. Discussion and conclusion: The evaluation with respect to the augmentation material used did not reveal significant differences in the implant survival rate and in both cases remodelling processes could be observed in the augmented area. To cite this article:
Tetsch J, Tetsch P, Lysek DA. Long‐term results after lateral and osteotome technique sinus floor elevation: a retrospective analysis of 2190 implants over a time period of 15 years.
Clin. Oral Impl. Res. 21 , 2010; 497–503.
doi: 10.1111/j.1600‐0501.2008.01661.x     

Graft‐Free Maxillary Sinus Floor Elevation: A Systematic Review and Meta‐Analysis

Background: This systematic review and meta‐analysis aims to investigate survival rates of dental implants placed simultaneously with graft‐free maxillary sinus floor elevation (GFSFE). Factors influencing amount of vertical bone gain (VBG), protruded implant length (PIL) in sinus at follow‐up (PILf), and peri‐implant marginal bone loss (MBL) are also evaluated. Methods: Electronic and manual searches for human clinical studies on simultaneous implant placement and GFSFE using the lateral window or transcrestal approach, published in the English language from January 1976 to March 2016, were conducted. The random‐effects model and mixed‐effect meta‐regression were used to analyze weighted mean values of clinical parameters and evaluate factors that influenced amount of VBG. Results: Of 740 studies, 22 clinical studies were included in this systematic review. A total of 864 implants were placed simultaneously with GFSFE at edentulous sites having mean residual bone height of 5.7 ± 1.7 mm. Mean implant survival rate (ISR) was 97.9% ± 0.02% (range: 93.5% to 100%). Weighted mean MBL was 0.91 ± 0.11 mm, and it was significantly associated with the postoperative follow‐up period (r = 0.02; R² = 43.75%). Weighted mean VBG was 3.8 ± 0.34 mm, and this parameter was affected significantly by surgical approach, implant length, and PIL immediately after surgery (PILi) (r = 2.82, 0.57, 0.80; R² = 19.10%, 39.27%, 83.92%, respectively). Weighted mean PILf was 1.26 ± 0.33 mm (range: 0.3 to 2.1 mm). Conclusion: Within limitations of the present systematic review, GFSFE with simultaneous implant placement can achieve satisfactory mean ISR of 97.9% ± 0.02%.     

Osteotome sinus floor elevation with or without grafting: a preliminary clinical trial

Objectives: This clinical trial aimed (1) to evaluate the predictability of the osteotome sinus floor elevation (OSFE) technique, (2) to study the influence of simultaneous grafting on the clinical success of placing dental implants in the posterior maxilla using OSFE and (3) to observe the bone changes in the elevated space with OSFE without grafting. Material and methods: Two hundred and eighty Straumann^® implants were placed in the posterior maxillae of 202 patients using OSFE. One hundred and ninety‐one implants were placed in 125 patients without grafting. The implants were allowed to heal for 3–4 months for non‐grafted implants and for 6–8 months for grafted cases. For radiographic analyses, periapical and panoramic radiographs were taken of 30 implants at 3 and 9 months to assess the bone changes for the elevated sites without grafting. Results: Two hundred and sixty‐eight of 280 implants fulfilling the survival criteria represented a cumulative survival rate of 95.71%. The residual bone height (RBH) was 5.6±2.5 mm for the non‐grafted group and 4.7±2.1 mm for the grafted group. The perforation rate was 4.29%. No significant differences were found between the two groups in RBH, survival rate or membrane perforation rate. The radiographic analyses demonstrated that new bone formation in the elevated sinus was visible and the endo‐sinus bone gain was 2.26±0.92 mm and 2.66±0.87 mm at 3‐ and 9‐ month follow‐up, respectively. Crestal bone loss (CBL) was 0.89±0.5 and 1.2±0.48 mm at 3 and 9 months. For the two test groups, RBH did not have a significant influence on the survival of the implants. At the 9‐month follow‐up, the endo‐sinus bone gain and CBL were not significantly correlated to RBH. The implant protrusion length was significantly correlated to the endo‐sinus bone gain. Conclusions: The findings of this study indicated that uneventful osseointegration may be predictable on applying OSFE whether with or without grafting in atrophic posterior maxilla. Spontaneous new bone formation seemed to be expected with implants placed using OSFE without simultaneous grafting. To cite this article:
Lai H‐C, Zhuang L‐F, Lv X‐F, Zhang Z‐Y, Zhang Y‐X, Zhang Z‐Y. Osteotome sinus floor elevation with or without grafting: a preliminary clinical trial.
Clin. Oral Impl. Res. 21 , 2010; 520–526.
doi: 10.1111/j.1600‐0501.2009.01889.x     

Osteotome sinus floor elevation with concentrated growth factor and simultaneous implant placement with or without bone grafting: a retrospective study

The aim of this study was to compare the clinical effects of osteotome sinus floor elevation (OSFE) combined with concentrated growth factor (CGF) and simultaneous implant placement with or without bone grafting in the maxillary posterior region, where the residual bone height (RBH) was 4–6 mm. A total of 44 patients who underwent OSFE combined with CGF and the simultaneous placement of 60 implants (group A, 31 implants with bone grafting; group B, 29 implants without bone grafting) were included in this retrospective study. The clinical indicators of implants were observed for 24 months. Sinus floor lift height was 6.02 ± 0.99 mm in group A and 5.81 ± 0.72 mm in group B (P = 0.360) after surgery. There was no significant difference in the vertical bone resorption between the two groups at 24 months (P = 0.097). Postoperative pain at 14 days (visual analogue scale) was significantly greater in patients with bone grafting when compared to those without bone grafting (P < 0.001). There was no significant difference in marginal bone loss (MBL) between the two groups (P = 0.707 for MBL during the first 12 months, P = 0.922 for MBL during months 12–24). The implant success rate was 100% with or without bone grafting. The technique of OSFE with CGF, either with or without bone grafting, is safe and reliable in patients with RBH 4–6 mm.     

上颌窦底提升不同高度对种植义齿受力影响的三维有限元分析

目的:研究上颌窦底提升后种植义齿修复时,不同提升高度对种植体-骨界面应力状况的影响,为其临床应用提供生物力学参考依据。方法:采用健康志愿者的CT扫描数据,通过Mimics 11.0软件,建立上颌第一磨牙缺失、含上颌窦的上颌骨三维有限元模型,并模拟植入10 mm长标准种植体1枚。模拟上颌骨骨量不足,建立上颌窦底分别提升2、4、6 mm的种植义齿模型,并以无需窦底提升的种植义齿模型为对照。分别从垂直、颊向30°和舌向30°三个方向,对种植义齿上部结构牙冠咬合面中心点施加100 N的集中载荷,用三维有限元分析方法对不同模型的种植体-骨界面进行应力分析。结果:各模型在同一加载条件下,皮质骨的应力最大,松质骨和人工骨的应力值接近。随着窦底提升高度的增高,种植体颈部周围骨组织的应力总体呈先降后升的趋势,在提升高度为4 mm时最小。颊舌向加载时产生的应力远大于垂直载荷下产生的应力。结论:上颌骨后部骨量不足时,上颌窦底提升植骨可以大大改善种植体-骨界面内应力,植骨高度为4 mm时,种植体-骨界面应力总体最小;垂直载荷更有利于种植体-骨界面的应力分布状况,在临床设计种植义齿上部结构时应尽量减小或避免斜向载荷。     

上颌窦内提升不植骨同期种植术——3年临床回顾性研究

目的:评价上颌窦内提升不植骨同期牙种植术的临床效果。方法:收集38例上颌窦区域牙缺失患者,采用上颌窦内提升不植骨同期牙种植手术方式,共植入58颗种植体。在植入后6个月、1年和3年随访,统计种植体的成功率以及拍摄全景片测量上颌窦成骨的高度。结果:1年时,1颗种植体未形成骨结合脱落。3年时,另1颗种植体出现松动取出。其余56颗种植体正常行使功能,3年成功率96.6%。受植区平均牙槽骨高度为(5.8±0.2) mm,术后上颌窦内提升高度为(5.1±0.3)mm。上颌窦内种植体周围见新骨形成,6个月平均成骨2.4 mm,1年平均成骨2.8 mm,3年与1年成骨无明显变化。结论:上颌窦内提升不植骨同期牙种植手术方式是可行的,上颌窦黏膜具有潜在的成骨能力。     

Maxillary sinus floor elevation using the (transalveolar) osteotome technique with or without grafting material. Part I: implant survival and patients' perception

Objectives: To analyze the survival and success rates of implants installed utilizing the (transalveolar) osteotome technique, to compare peri‐implant soft tissue parameters and marginal bone levels of osteotome‐installed implants with implants placed using standard surgical procedures, and to evaluate patient‐centered outcomes. Material and methods: During 2000 to 2005, 252 Straumann^® dental implants were inserted in 181 patients. The surgical technique was a modification of the original osteotome technique presented by Summers. In addition to the clinical examination, the patients were asked to give their perception of the surgical procedure, utilizing a visual analogue scale. Results: The cumulative survival rate of the osteotome‐installed implants after a mean follow‐up time of 3.2 years, was 97.4% (95% confidence intervals: 94.4–98.8%). From the 252 implants inserted, three were lost before loading and another three were lost in the first and second year. According to residual bone height the survival was 91.3% for implant sites with ≤4 mm residual bone height, and 90% for sites with 4 mm and 5 mm, when compared with that of 100% in sites with bone height of above 5 mm. According to implant length the survival rates were 100% for 12 mm, 98.7% for 10 mm, 98.7% for 8 mm and only 47.6% for 6 mm implants. Soft tissue parameters (pocket probing depth, probing attachment level, bleeding on probing and marginal bone levels) did not yield any differences between the osteotome‐installed and the conventionally placed implants. More than 90% of the patients were satisfied with the implant therapy and would undergo similar therapy again if necessary. The cost associated with implant therapy was considered to be justified. Conclusion: In conclusion, the osteotome technique was a reliable method for implant insertion in the posterior maxilla, especially at sites with 5 mm or more of preoperative residual bone height and a relatively flat sinus floor.     

冲压法上颌窦底提升术在剩余牙槽嵴高度小于5 mm时植入体的稳定性研究

目的：观察剩余牙槽骨高度小于5 mm时运用冲压法上颌窦底提升术植入体的稳定性。方法：应用冲压法上颌窦底提升术同期种植修复患者65例分为两组,A组：剩余牙槽嵴高度＜5 mm,B组：患者剩余牙槽嵴高度5~10 mm。在种植体植入后及修复前分别测量种植体近中、远中、颊侧、舌侧的稳定系数,取平均值记录为该种植体的稳定系数,比较两组间种植体稳定系数在植入后和修复前有无差异。同时分析不同长度和直径的种植体在稳定性方面的差异。结果：A组植入种植体30枚（完成修复29枚）,B组植入种植体54枚（完成修复54枚）,A组种植体存留率为96.67%,B组为100．00%。A组的剩余牙槽嵴高度3.89±0.72 mm,B组为7.79±1.52 mm。A组种植体的稳定系数由种植体植入后的67.28±1.70增加到种植体修复前的76.31±2.22,B组种植体的稳定系数由种植体植入后的69.51±1.60增加到种植体修复前的76.65±2.49。8 mm与10 mm长的种植体在修复前的稳定性系数分别为76.75±2.71和76.51±2.37。直径4.1 mm与4.8 mm的种植体在修复前的稳定性系数分别为76.62±2.39和76.16±2.40。结论：上颌后牙缺失剩余牙槽骨高度＜5 mm时,运用冲压法上颌窦底提升术植入种植体的稳定性是可以预期的。     

Osteotome Sinus Floor Elevation without Bone Grafts – A 3‐Year Retrospective Study with Astra Tech Implants

Background: The bone support for implants in the posterior part of the maxilla is often poor. This condition may be treated with augmentation of the maxillary sinus floor. The most common technique used is to elevate the sinus floor by inserting a bone graft through a window opened in the lateral antral wall. In 1994, a less‐invasive technique using osteotomes was suggested by Summers. Purpose: The aim of this study was to evaluate the clinical and radiographic outcome of implants placed in the posterior maxilla with the osteotome sinus floor elevation (OSFE) technique without grafting. Materials and Methods: The study population comprised 36 consecutive patients in whom 53 implants were inserted with the OSFE technique. The indication for sinus floor elevation was that the bone height below the maxillary sinus was considered to be 10 mm or less. Results: The mean height of the alveolar process in the intended implant sites was 6.3 ± 0.3 mm, and the mean elevation of the sinus floor was 4.4 ± 0.2 mm. Two implants in edentulous patients were lost at the 1‐year follow‐up, and one more at the 3‐year examination. The remaining 50 implants inserted were in function, giving a 3‐year cumulative survival rate of 94%. Implants used in single‐tooth replacements and in partially edentulous cases had a 100% survival rate. The marginal bone level at the time of loading of the implants was 0.1 ± 0.04 mm below the reference point. One year later, the corresponding value was 0.5 ± 0.06 mm. The mean bone loss between the two examinations was 0.4 ± 0.05 mm. At the final examination after 3 years, the mean bone level was situated 0.6 ± 0.09 mm below the reference point, indicating a nonsignificant change between 1 year and 3 years. Conclusions: The OSFE technique, without bone grafts, was found to produce predictable results in the treatment of 36 patients with restricted bone volume in the posterior part of the maxilla.     

Influence of low-level laser treatment on bone regeneration and osseointegration of dental implants following sinus augmentation. An experimental study on sheep

Objectives: The aim of this experimental study was to evaluate if low‐level laser treatment (LLLT) enhances bone regeneration and osseointegration of dental implants in a sinus graft model. Material and methods: Twelve sheep underwent a bilateral sinus floor elevation procedure with cancellous bone from the iliac crest. Implant insertion followed 4 weeks (six sheep) and 12 weeks (six sheep) later. Sixteen weeks after second‐stage surgery, animals were sacrificed. Unilaterally, the grafted sinus and during the second‐stage surgery the implant sites were irradiated intraoperatively and three times during the first postoperative week with a diode laser (75 mW, 680 nm). The overall energy density per irradiation was 3–4 J/cm². Biopsies of the augmented area were obtained during implant insertion and after scarification. Results: Bone regeneration within the grafted sinus histomorphometric analysis hardly differed between control and test side both 4 and 12 weeks after sinus grafting. Osseointegration measurements resulted in a significantly higher bone/implant contact (BIC) on the test side (P=0.045). Further evaluation of peri‐implant bone tends to amount in significant higher percentage on the laser side (P=0.053). Conclusion: The presented experimental study on sheep did not confirm a positive LLLT effect on bone regeneration within a cancellous sinus graft. Nevertheless, LLLT possibly has a positive effect on osseointegration of dental implants inserted after sinus augmentation.     

Evaluation of Different Methods of Indirect Sinus Floor Elevation for Elevation Heights of 10 mm: An Experimental Ex Vivo Study

Objective: The aim of this study was to macroscopically and microscopically evaluate different methods of indirect sinus floor elevation regarding elevation heights of 10 mm. Materials and Methods: Four different methods of indirect sinus floor elevation‐osteotome sinus floor elevation (OSFE), bone added osteotome sinus floor elevation (BAOSFE), piezo‐ surgical sinus floor elevation (PSFE), and sinus floor elevation with an inflatable balloon, balloon‐lift‐control system (BLC) – were macroscopically and microscopically investigated ex vivo using 36 bisected pigs’ heads. Results: OSFE and BAOSFE perforated the Schneiderian membrane, whereas the inflatable balloon caused no laceration. PSFE elevated the mucosa without laceration as well, but was technically restricted to an elevation height of 5 mm. BAOSFE, PSFE, and BLC separated the mucosa, leaving the periosteum on the bone. OSFE completely lifted the soft tissue from the bone, including the periosteum. Conclusions: The results of this study indicate that balloon elevation of the sinus floor may extend the indication for indirect sinus floor elevation for elevation heights of up to 10 mm. The histological elevation layer seems to be non‐uniform in the different sinus floor elevation methods. Further in vivo experiments have to prove these findings as well as their relevance regarding the clinical outcome of sinus floor augmentation.     

Flapless, CBCT-guided osteotome sinus floor elevation with simultaneous implant installation. I: radiographic examination and surgical technique. A prospective 1-year follow-up

Background: Survival rates of implants placed in transalveolar sinus floor augmentation sites are comparable with those placed in non‐augmented sites. Flapless implant surgery can minimize postoperative morbidity, alveolar bone resorption and crestal bone loss. The use of cone beam computerized tomography (CBCT) provides 3D presentations with reduced dose exposure. Objectives: To evaluate a flapless, CBCT‐guided transalveolar sinus floor elevation technique with simultaneous implant installation. Material and methods: Fourteen consecutive patients in need of maxillary sinus floor augmentation were enrolled in this study. Preoperative CBCT with a titanium screwpost as an indicator at the intended implant position was used to visually guide the flapless surgical procedure. Twenty one implants all with a length of 10 mm and a diameter of 4.1 and 4.8 mm were inserted and followed clinically and with CBCT for 3, 6 and 12 months postoperatively. Intraoral radiographs were taken for comparison. All patients were provided with permanent prosthetic constructions 8–12 weeks after implant surgery. Results: Ten (47.6%) implants were inserted in residual bone of 2.6–4.9 mm and 11 (52.3%) implants were inserted in residual bone of 5–8.9 mm. No implants were lost after surgery and follow‐up. There was no marginal bone loss during the follow‐up verified by CBCT. The implants penetrated on average 4.4 mm (SD 2.1 mm) into the sinus cavity and the mean bone gain was 3 mm (SD 2.1 mm). Conclusion: Flapless transalveolar sinus lift procedures visually guided by preoperative CBCT can successfully be used to enable placement, successful healing and loading of one to three implants in residual bone height of 2.6–8.9 mm. There was no marginal bone loss during the 3–12 months follow‐up. To cite this article :
Fornell J, Johansson L‐Å, Bolin A, Isaksson S, Sennerby L. Flapless, CBCT‐guided osteotome sinus floor elevation with simultaneous implant installation. I: radiographic examination and surgical technique. A prospective 1‐year follow‐up.
Clin. Oral Impl. Res. 23 , 2012; 28–34.
doi: 10.1111/j.1600‐0501.2010.02151.x     

Osteotome Maxillary Sinus Lift Using Bovine Bone and Calcium Sulfate: A Case Series

Purpose: The purpose of this longitudinal study was to evaluate the success of bovine bone and calcium sulfate (CaSO₄) as sinus augmentation material with osteotome maxillary sinus lift. Materials and Methods: Thirty‐one osteotome sinus lift procedures were performed for 18 healthy patients (7 males and 11 females). A mixture of bovine bone and CaSO₄ (ratio, 4:1) was used as sinus augmentation material with simultaneous implant placement. Implants were loaded 4 to 5 months postimplant surgery. Cases were followed for an average of 23.4 months postloading (range, 12–60 months). Results: The mean age of the study group was 49.7 ± 10.66 years. The residual height of the alveolar ridge ranged from 5.5 to 11 mm (mean, 8.16 ± 1.52 mm). Four to 5 months after implant placement, the x‐ray showed a 1.5 to 5 mm apical shift of the sinus floor (mean, 3.47 ± 0.97 mm), which was maintained to the end of the evaluation period. At 12 months postloading, crestal bone loss ranged from 0.5 to 1.5 mm (mean, 0.87 ± 0.26 mm), and pocket depth ranged from 2 to 4 mm (mean, 2.9 ± 0.67 mm). No significant change in crestal bone loss or pocket depth was noticed afterward. Conclusion: Bovine bone plus CaSO₄ can be used successfully as a sinus augmentation material with osteotome sinus elevation. The use of CaSO₄ significantly improved the handling properties of bovine bone and helped to stabilize the bone graft particles during healing.     

上颌窦底提升不植骨同期植入种植体的临床疗效观察

目的 观察冲压式上颌窦底提升术(osteotome sinus floor elevation,OSFE)不植骨并同期植入种植体的临床疗效及技术特点.方法 自2000年1月至2008年12月对65例患者经牙槽嵴顶入路,行OSFE并同期行种植体植入术,共植入96枚种植体,手术过程中上颌窦内不植入任何骨充填材料.缺牙区牙槽骨可用骨高度为5～8 mm,平均(6.78 4±1.04)mm.观察方法 为临床和X线片检查.对种植体凸入上颌窦内不同长度、安底改建情况进行卡方检验.结果 除1例单牙种植术后15 d因种植体松动、牙龈红肿取出种植体,其余64例患者随访>5年12例,>3年14例,>2年28例,>1年lO例,平均随访33.4个月.96枚种植体中除1枚于种植15 d后松动取bm外,其余种植体均获得良好的骨结合并完成上部义齿修复,种植体周围软组织无炎症,咀嚼功能良好.种植体凸入上颌窦内1～5 mm,平均2.57 mm,51枚(54%)种植体根方有不同程度的新骨形成,33枚(35%)种植体根方形成了新的上颌窦底,11枚(12%)种植体根周末见明显新骨形成.统计分析显示,种植体凸入上颌窦内的长度与上颌窦底骨改建差异无统计学意义(x2=6.113,P=0.191).结论 应严格把握OSFE适应证;OSFE时不植骨并同期植人种植体的短期临床效果是可预期的;新的窦底形成与上颌窦底提升高度无明显相关性.

Abstract：

Objective To investigate the clinical results of osteotome sinus floor elevation(OSFE)without grafting combined with simultaneous implant placement.Methods A total of 65 patients underwent maxillary sinus floor elevation from alveolus without any bone grafting from January 2000 to December 2008 and 96 implants were placed in the maxillary posterior edentulous region simultaneously.Clinical and radiography examinations were performed.The residual bone height ranged from 5 to 8 mm and the mean bone height was(6.78±1.04)mm.The mean following period was 33.4 months.Statistical analysis was perfbrmed by chi square test.Results Ninety-five of 96 implants were clinically stable and functioned without any pain and other complaints.One implant Was extracted 15 days after operation because of mobility and the other implants obtained osseointegration.The mean implant protrusion lengh Was 2.6 mm,ranging from 1 to 5 mm.Different degree of new bone formation was observed in 51(54%)of implants.New maxillary sinus floor outline Was observed in 33(35%)of implants and there was no obvious new bone in 11(12%)of implants.There Was no significant deference between the implant protrusion length and sinus floor remodeling.Conclusions Under strict indications,the clinical results of OSFE without bone grafting combined with simultaneous implant placement were predictable in short term.The new sinus floor formation was not related to the implant protrusion length.     

Marginal Bone Loss in Implants Placed in the Maxillary Sinus Grafted With Anorganic Bovine Bone: A Prospective Clinical and Radiographic Study

Background: Sinus elevation is a reliable and often‐used technique. Success of implants placed in such situations, even with bone substitutes alone, prompted the authors of this study to strive for bone loss close to zero and research variables that cause higher or lower rates of resorption. The objective of this study is to evaluate survival rates and marginal bone loss (MBL) around implants placed in sites treated with maxillary sinus augmentation using anorganic bovine bone (ABB), and identify surgical and prosthetic prognostic variables. Methods: Fifty‐five implants were placed in 30 grafted maxillary sinuses in 24 patients. Periapical radiographs were evaluated immediately after implant placement (baseline), 6 months, and at the most recent follow‐up. MBL was calculated from the difference between initial and final measurements, taking into account a distortion rate for each radiograph compared with original implant measurements. Results: Survival rate was 98.2%, with only one implant lost (100% survival rate after loading) over a mean follow‐up time of 2.0 ± 0.9 years. MBL ranged from 0 to 2.85 mm: 75.9% of mesial sites and 83.4% of distal sites showed <1 mm of MBL, whereas 35.2% of mesial sites and 37% of distal sites exhibited no bone loss. MBL was significantly (P <0.05) greater in open‐flap compared with flapless surgery. Conclusions: Within the limitations of the present study, it was concluded that maxillary sinus elevation with 100% ABB gives predictable results, and that flapless surgery results in less MBL compared with traditional open‐flap surgery.