Postoperative tomographic assessment of veneer bone grafting with implant placement in the maxillary anterior region

Various ridge augmentation and sinus lift procedures were performed in severely resorbed alveolar crests of a maxilla to provide some volume for implant treatment. It was reported that the outcome of maxillary sinus lift procedures was evaluated with conventional tomography or computerized tomography, and that grafted bone around implants markedly progressed in resorption, particularly at the implant apex. However, veneer bone grafting with implant placement has not been evaluated after treatment with imaging techniques. Therefore, the purpose of this study was to assess veneer bone grafting after maxillary anterior implant treatment. Seven patients with a mean age of 24 years, with implants placed in the maxillary anterior region with or without autogenous veneer bone grafting were postoperatively examined using conventional tomography. On tomograms, the ratio of bone-to-implant contact and the area of bone were measured in labial bones with bone grafts, and they were compared with the values without bone grafts. In cases with bone grafting, the average ratio of bone-to-implant contact was 63.6%, whereas 81.8% was formed in cases without bone grafting. The average area of bone was 12.9 mm and 23.4 mm in patients with and without bone grafting, respectively. No significant difference was found between the implants with and without bone grafts. Resorbed labial bone was observed in the maxillary anterior region with and without veneer bone grafting.     

Fungal infection as a complication of sinus bone grafting and implants: a case report

Sinus bone grafts have been used successfully to augment atrophic posterior maxilla for dental implant placement. Even though sinus bone grafting is generally considered to be a safe surgical procedure, postoperative maxillary sinus infections can occur and therefore need to be considered. Bacteria, as well as viruses and fungi, have been identified as causative agents. Because fungal infection of the maxillary sinus after sinus bone grafting is not well known, we report a case of a middle-aged male patient along with the clinical, radiographic, and histologic findings. The patient was referred from his private dentist because of failed sinus bone grafting and osseointegration of implants. The surgical approach to the sinus yielded a friable mass of brownish-red material from the sinus. Review of pathology slides revealed a noninvasive hyphal mass caused by Aspergillus and polypous mucosa. After surgical removal of the mycotic masses, sinus bone grafting, using allograft, was performed. Bone formation after the healing period was favorable and dental implants were placed. There was no recurrence of fungal sinusitis.     

上颌窦内提升术植骨与不植骨对种植体骨结合的影响

目的探讨上颌窦内提升术植骨与不植骨对种植体骨整合的影响及两者之间的差异。方法将120枚需要进行内提升手术的种植体随机平均分为两组,第一组60枚为实验组,在上颌窦内提升后植入骨材料同期植入种植体;第二组60枚为对照组,上颌窦内提升后不植骨同期植入种植体。对两组种植体进行临床追踪（平均18个月）,观察种植体骨整合、临床检查指标、种植体存留率及影像学变化。结果仅有1例种植体覆盖螺丝暴露,种植体颈部出现骨吸收。所有两组种植体均能完成修复,种植体存留率达到100%,无1例脱落。种植体均能正常行使咀嚼功能,骨整合良好。影像学检查种植体周围均有新骨生长,骨整合良好。结论上颌窦内提升术后不植骨可以取得与植骨同样的效果,可以明显减少患者的种植牙费用,是一种值得推广应用的手术方法。     

Displacement of a Dental Implant into the Pterygoid Fossa: A Clinical Report

The placement of dental implants in the pterygomaxillary region can be advantageous in maxillary complete arch fixed implant‐supported prosthetic rehabilitations to avoid bone grafting and sinus elevation surgeries. Pterygomaxillary implants improve implant biomechanics by eliminating distal cantilevers and increasing the anteroposterior spread with reported mean implant survival rates comparable to traditional implant sites. Although only minor surgical complications have been reported in the literature with the placement of dental implants in the pterygomaxillary region this clinical report describes a major surgical complication involving the displacement of a dental implant into the pterygoid fossa.     

牙列缺损患者倾斜植入种植体稳定性的影响因素分析

临床上少数牙缺失患者缺牙部位牙槽骨存在严重吸收时,应用轴向种植需采用植骨或上颌窦底提升等方法,通过增加骨量以达到种植要求,但仍具有上颌窦黏膜穿孔或损伤下颌神经管的风险。一些临床医师采用倾斜种植方法以减少增骨手术的创伤,缩短修复期。倾斜植入的种植体的稳定性一直是关注的重点,本文收集近年来的相关文献,就影响倾斜植入稳定性的因素进行综述。     

Augmentation grafting of the maxillary sinus and simultaneous implant placement in patients with 3 to 5 mm of residual alveolar bone height.

This study assessed the efficacy of augmentation grafting of the maxillary sinus with simultaneous placement of dental implants in patients with less than 5 mm of alveolar crestal bone height in the posterior maxilla prior to grafting, although the procedure has traditionally been contraindicated based on empirical data. A total of 160 hydroxyapatite-coated implants was placed into 63 grafted maxillary sinuses in 63 patients whose crestal bone height in this region ranged from 3 to 5 mm. Patients were followed for 2 to 4 years after the placement of definitive prostheses. There were no postoperative sinus complications. Following uncovering of the implants at 9 months after surgery, there was no clinical or radiographic evidence of crestal bone loss around the implants. Histologic examination of bone cores from the grafted sites revealed successful integration and a high degree of cellularity. All patients maintained stable implant prostheses during follow-up. These findings indicate that the single-step procedure is a feasible option for patients with as little as 3 mm of alveolar bone height prior to augmentation grafting, utilizing hydroxyapatite-coated implants and autogenous bone.     

Functional rehabilitation using orthognathic surgery, bone transplants and implants after irradiation of malignancy in early childhood

Functional rehabilitation has been carried out in four young patients by use of orthognathic surgery, bone grafting and implants. All four patients had been successfully treated for malignant tumours in the midface during early childhood by use of full dose irradiation. Retarded growth of the maxilla together with missing root formation of permanent teeth prevented the alveolar process to develop. Bimaxillary osteotomies with inlay bone graft have been made in two cases and maxillary osteotomy le Fort I with interpositional and inlay grafting in two individuals. Implants surgery has been made in a second stage surgery. A total of eighteen implants has been inserted and during five years follow-up two implants have been lost (survival rate 90%). All patients have been successfully rehabilitated with fixed bridge prosthesis.     

Rehabilitation of a patient with cleft lip and palate with an extremely edentulous atrophied posterior maxilla using zygomatic implants: case report.

OBJECTIVE: This case report describes the clinical and surgical management of a patient with a unilateral alveolar cleft and associated extremely atrophied totally edentulous maxilla. METHOD: Two zygomatic implants and four endosseous oral implants were placed under general anesthesia in a compromised maxilla to rehabilitate a 33-year-old patient with cleft lip and palate. The two specially designed zygomatic implants were utilized to avoid the need for bone grafting in the patient. The final prosthetic rehabilitation was an esthetic and functional maxillary overdenture prosthesis supported by implants. RESULTS: Preliminary results have shown how dental prostheses supported by endosseous implants in grafted alveolar cleft are a reliable possibility in the dental rehabilitation of this malformation. CONCLUSION: The use of zygomatic implants may be considered a reliable alternative to more resource-demanding techniques such as bone grafting in patients with cleft palate.     

肿瘤术后颌骨缺损的功能重建

目的：肿瘤术后造成的颌面缺损使患者丧失咀嚼、语言等功能，并导致颜面畸形。采用植骨种植功能颌面建，以提高患者的生存质量。方法：本组64例肿瘤术后颌骨缺损（上颌10例，下颌54例）所用3种方法：（1）下颌骨部分或全部缺损，采用血管化或非血管化骨移植延期（同期）牙种植，完成种植义齿修复；（2）一侧上颌骨缺损，健侧缺牙或无牙，采用健侧牙种植完成赝复修复；（3）双侧上颌骨缺损，采用颧骨种植，通过磁附着固位完成义颌赝复修复。结果：64例所用3种方法均达到恢复外形与功能理想的效果。观察时间最长12年，最短5年，其中6枚种植体未实现骨结合。上颌缺损修复的种植体存留率为97．5％；下颌骨缺损血管化植骨种植为97．1％；非血管化植骨种植为97．7％。结论：上颌骨缺损采用种植赝复修复可行，若颧骨较薄，应先植骨；植骨－种植是下颌骨功能重建理想的方法。血管化植骨种植适用于植骨床血运差的患者；非血管化植骨种植方法简单，易于推广。因缩短了移植骨的离体时间，骨细胞仍有活性，与血管化骨移植效果一致。证实了自体骨植骨块兼有骨形成、骨诱导及骨传导作用。     

自体胫骨骨松质移植提升上颌窦与骨内牙种植

本文通过8例自体胫骨骨松质移植提升上颌窦的成功．认为上颌窦底自体胫骨骨松质移植对于解决上颌后区牙槽嵴萎缩、上颌窭与牙槽嵴接近而又需要进行骨内种植牙的病人提供了一种良好的方法。胫骨近中外上髁作为供骨区有明显的优点，可以获得质量高、数量较多的骨质．骨面与皮肤接近．创口小，并发症少。     

上颌窦底内提升同期植入种植体的临床效果观察

目的:观察单纯上颌窦内提升术同期牙种植修复的临床效果.方法:上颌后牙区牙槽骨严重吸收的36例患者,种植区剩余牙槽骨高度为(5.9±2.1)mm,行单纯上颌窦内提升同期牙种植术,共植入42枚种植体,其中瑞士Straumann种植体22枚、韩国奥齿泰SSⅡ种植体13枚、法国安多健种植体7枚.术后3～4个月,行上部结构修复,同时观察种植体的稳定性和种植体周围骨结合情况.随访期(12.2±3.6)个月.结果:36例患者上颌窦底提升高度(2.83±1.12)mnl,41枚种植体成功负载,种植体稳定,骨结合状况良好,无不良自觉症状.1枚种植体术后5周脱落,脱落2个月后重新种植,成功负载.结论:单纯上颌窦内提升同期牙种植术能有效治疗上颌窦底牙槽骨高度不足的上颌后牙缺失,手术创伤小,操作简便,并发症少,近期效果满意.     

Dental implantation at the maxilla with autologous bone transplantation

In the Department of Maxillofacial and Oral Surgery of County Hospital of Szentes, different types of bone losses of the maxillary alveolar ridge have been treated since 1 March, 1990. The applied surgical procedures were the following: 1. 394 patients were treated with GBR technique and 567 DenTi implants were inserted for these patients. 2. In 47 cases autogenous bone grafts were harvested from mandibular cortica and 78 DenTi implants were placed. Altogether 14 implants were lost; the success rate was 97.81% in the period between 1 March, 1990 and 31 January, 2001. 3. The severely resorbed maxillary alveolar ridge was replaced by rigid autogenous bone graft harvested from the ilium or from tibia. The bone graft was fixed with implants to the recipient surface. This method was applied in 36 cases from 1 February, 1992 until 31 January, 2001. 147 DenTi implants were inserted and 7 of them were lost. The success rate was 97.28%. Our results have indicated that the dental implants had accelerated the remodelling process of the transplanted autogenous bone and the success rate of the simultaneously performed dental implants were comparable to that of the two stage procedures in which dental implants were inserted several weeks following bone grafting. Based on our long-term favourable clinical experience this technique has been proven to be an excellent method for correcting and replacing the lost maxillary alveolar ridges as well as the circumscribed alveolar bony defects.     

上颌窦内提升植骨同期植入Endopore种植体临床评价

目的 评价上颌窦内提升植骨同期植入Endopore种植体临床效果。方法 20例上颌后牙缺失，因牙槽骨高度不足，采用上颌窦内提升植骨，同期植入Endopore种植体28枚。术后6-9个月行种植义齿修复。结果 28枚种植体植入后伤口一期愈合，无上颌窦炎发生，义齿修复后行使咀嚼功能6-36个月，种植体稳定。X线检查植骨改建成新骨并与种植体形成紧密结合。结论 对牙槽骨高度不足的上颌后牙缺失，经上颌窦内提升植骨同期植入Endopore种植体，近期成功率高，方法简便。     

Sinus membrane elevation in combination with placement of blasted implants: a 3-year case report of sinus augmentation without grafting material

Owing to the increasing use of dental implants to restore edentulous conditions, clinicians often face situations where available bone volumes are reduced and need to be augmented before implant placement. This is common in the posterior maxilla, where the presence of the maxillary sinus combined with severe atrophy of the bone crest, owing to long-standing edentulism or pathological conditions, might preclude implant placement. Techniques to augment the sinus floor in combination with several grafting materials are commonly used to restore adequate volumes for implantation. Recent studies have described bone reformation and integration of oxidized implants by simple elevation of the sinus membrane without any grafting material. The aim of this case report is to document the application of the sinus membrane elevation technique in combination with the placement of 3 blasted microthreaded implants in a patient who was clinically and radiographically followed up for 3 years. During the follow-up period, the blasted implants were all stable and intraoral radiographs showed that the bone reformed in contact with the implants and remained stable.     

Resolution of a titanium implant fracture after a recurrent trauma

Abstract – Post‐traumatic complications occasionally lead to tooth loss as well as the need for future implants. However, rehabilitation with endosseous osseointegrated implants does not protect the patient from the risk of suffering a new trauma. Implant fracture and the damage of the hexagon are post‐traumatic complications that guide the clinician to preparing a more intricate treatment plan. The authors present a clinical case of a recurrent trauma of maxillary implant fracture. The treatment plan was to remove the implants followed by autogenous bone grafting to correct the defect. Two titanium implants were replaced, followed by connective tissue graft after allowing complete the healing process of the bone graft to occur. In the postoperative period of 6 months, satisfactory results have been shown as regards soft and hard tissues wound healing.     

Ankylos种植系统在上颌窦外提升术同期牙种植中的应用

目的:对Ankylos种植系统在上颌窦提升术同期牙种植中的临床效果进行评价。方法:收集2008年1月至2010年1月期间,对46例上颌后牙区牙齿缺失要求种植的患者,于58侧上颌窦行外提升术,同期植入Ankylos种植体142枚,修复后随访观察1～3年。结果:观察期内142颗种植体,均无松动或脱落,曲面断层片检查种植体周围未见明显骨吸收阴影。结论:Ankylos种植系统应用于上颌窦提升术同期牙种植可获得满意的临床效果。     

Spontaneous Bone Formation in the Maxillary Sinus after Removal of a Cyst: Coincidence or Consequence?

Background: Maxillary sinus floor‐augmentation techniques are frequently used to increase the bone volume in the posterior edentulous maxilla to enable placement and integration of titanium implants. Purpose: The purpose of this report is to document an unexpected healing pattern after maxillary sinus surgery and to discuss the implications for future bone‐augmentation techniques. Materials and Methods: In a patient referred for sinus augmentation, an intrasinus mucosal cyst was removed 3 months prior to the planned augmentation procedure. A replaceable bone window was prepared in the lateral aspect of the sinus wall. The cyst was removed, the ruptured mucosa was sutured, and the bone window was replaced, resulting in a secluded space in the sinus. Results: After 3 months of healing, the space between the replaced bony window and the lifted sinus membrane was filled with newly formed bone. The surgical technique was repeated in a second patient and resulted in a similar bone reformation pattern. Conclusion: Surgical trauma and the creation of a secluded space between the bone surfaces and the sinus mucosa result in spontaneous bone formation in the maxillary sinus. The surgical approach described may be used to achieve bone reformation to enable placement of dental implants without the addition of any grafting material.     

植骨与否对上颌窦底内提升同期种植术临床疗效的影响

目的: 探讨上颌窦底内提升后植骨与不植骨术后6个月上颌窦成骨效果及种植体稳定性的差异。方法: 选择2019年12月—2021年12月于丽水市人民医院行上颌窦底内提升及同期种植的患者150例,按植骨与否分为A组（上颌窦底内提升+植骨）与B组（上颌窦底内提升+不植骨）,测量分析患者术前、术后CBCT资料及种植体稳定性,比较2组患者临床疗效是否存在差异。采用SPSS 25.0软件包对数据进行统计学分析。结果: 共植入199颗种植体。术后1年,A组种植体存留率为97.6%,B组为95.7%,2组之间无显著差异（P>0.05）。术前剩余牙槽骨高度（residual bone height,RBH）及灰度值（HU）在A组与B组之间无显著差异（P>0.05）,术后6个月上颌窦内成骨高度（sinus bone gain,SBG）及HU在2组之间无显著差异（P>0.05）。术后即刻及术后6个月的ISQ值2组之间无显著差异（P>0.05）。结论: 在RBH为3~8 mm且计划提升高度为3~4 mm的病例中,植骨与否在上颌窦底内提升术同期种植患者中对种植体的存留率及稳定性影响不大。     

Maxillary sinus augmentation

Attention to the principles of bone grafting, bone healing, and maxillary sinus physiology as well as anatomy is critical to the successful placement of dental implants in the posterior maxilla. The integration of these principles must take into account the restorative dental requirements and the patient's autonomy in guiding implant reconstruction. As in so many clinical disciplines, additional research is needed to provide better guidance for clinicians. Despite some gaps in our knowledge, however, sinus augmentation procedures have proven to be safe and effective and have permitted the placement of implants in sites that would have otherwise been impossible to treat. This article summarizes techniques and technologies related to maxillary sinus augmentation.     

上颌后牙游离端应用倾斜种植的研究进展

上颌后牙区垂直骨量不足是临床上常见的一种情况,目前针对上颌后牙区骨量不足,临床上主要通过上颌窦底提升进行植骨的方法解决。近年来出现的倾斜种植,相对于传统轴向种植,可以避免植骨,减少并发症,缩短治疗周期,降低患者的治疗成本,在临床逐渐得到推广。本文就上颌后牙游离端倾斜种植的概念、生物力学和临床评价及数字化趋势等作一综述。