A technique for inserting endosseous implants in the atrophic maxilla in a single stage procedure.

A technique is described for inserting autogenous iliac bone into the maxillary sinus of the edentulous patient via a fenestration of the anterolateral maxillary wall, maintaining the mucous membrane lining of the sinus intact, and allowing insertion of titanium screw implants into the atrophic maxilla at the same operation. This method avoids a Le Fort I osteotomy approach with its possible attendant complications.     

Rehabilitation of atrophic posterior maxilla with zygomatic implants: review

The objective of this study was to review the published literature to evaluate treatment success with zygomatic implants in patients with atrophic posterior maxilla. Studies from 1987 to 2010 were reviewed. In each study, the following were assessed: indications for treatment, number of patients, number of implants, length and diameter of the implants, surgical technique, prosthetic rehabilitation, success rate, complications, and patient satisfaction. Sixteen studies were included, with a total of 941 zygomatic implants placed in 486 patients. The follow-up periods ranged from 12 to 120 months. Three different surgical techniques were used to place zygomatic implants: intrasinus implants with the classic sinus window technique, the sinus slot technique, and extrasinus zygomatic implants. The most common restoration used was fixed prosthesis, with either delayed loading after 3-6 months (89%-100% success) or immediate loading (96.37%-100% success). The weighted average success rate was 97.05%, and the most frequent complication was maxillary sinusitis. The general level of patient satisfaction was high. Zygomatic implants have a high success rate and constitute a suitable alternative to treat severe posterior maxillary atrophy.     

短种植体在骨高度不足后牙区种植修复的临床短期观察

目的：观察、分析BICON短种植体在后牙区骨高度不足病例种植修复的临床效果。方法：上、下颌后牙区骨高度3-9mm的病例57例,共植入BICON短种植体101枚,长度5.7mm的种植体15枚,长度6mm的种植体20枚,长度8mm的种植体66枚。下颌共植入59枚种植体,上颌共植入42枚种植体,其中上颌窦窦底牙槽骨高度不足的患者行上颌窦底冲击术同期植入种植体和人工植骨材料（天博骨粉）。3-6个月行二期手术,二期术后3-4周完成基台一体化冠永久修复。结果：55例99枚BICON短种植体均获得了良好的骨结合,经12个月的临床观察,种植修复取得了较好的临床效果,X光片及牙科CT检查,种植体颈部骨组织及种植体周围骨组织稳定.上颌2例2枚种植体二期手术时松动脱落,种植成功率98.02%。结论：在后牙区骨高度不足的病例,通过植入BICON短种植体,不仅可以简化植骨术,缩短患者的治疗时间,并且能减少手术风险,使种植体能获得较理想的种植成功率。     

Treating the atrophic posterior maxilla by combining short implants with minimally invasive osteotome procedures.

Edentulous sites in the posterior maxilla are often compromised by reduced bone volume, prohibiting the placement of 10-mm implants without sinus augmentation. The use of shorter implants minimizes the need for more extensive sinus floor elevation, thus reducing treatment duration and morbidity. Two implant designs are presented in combination with localized internal sinus floor elevation to restore the posterior maxilla. This simplified treatment modality can make implant rehabilitation of the atrophic posterior maxilla more accessible and more palatable to even the most reluctant patients and referring doctors.     

The challenge of endosseous implants placed in the posterior partially edentulous maxilla: a clinical report

The survival rate of implants placed in the maxillary molar area in a 2-stage procedure was evaluated. Between 1990 and 1997, 60 consecutive patients (32 females and 28 males, mean age 51 years) received 87 implants to replace missing maxillary molar teeth. Radiographs were evaluated preoperatively for bone quantity (mesiodistal width, potential implant length not compromising the integrity of adjacent vital structures). Second-stage surgery was performed in a mean of 7.9 months postimplantation. The 5-year cumulative implant survival rate and the influence of implant characteristics (type, length, diameter, and coating) on implant failure and complication rates (between the 2 stages of surgery) were evaluated. The total 5-year cumulative survival rate was 95.4% (4 implants were lost). There were a total of 17 "complications" (premature spontaneous implant exposure) in non-failing implants, 11 with high and 6 with flat cover screws, respectively. Implantation in the edentulous maxillary molar area is a predictable procedure with a considerably high survival rate. The type of implant cover screw used can affect the complication rate.     

穿颧骨植体-在无牙上頜的应用

利用穿颧骨植体进行无牙颌修复是非常有效的.众多的文献报告证明了穿颧骨植体的成功率介乎于92%到100%.最新发表的报告更进一步显示出穿颧骨植体在即刻负重方面的可靠性.当然穿颧骨植体也有缺点.上颌窦炎是其中较为严重的问题.我会尝试替大家在穿颧骨植体的文献中找出发生上颌窦炎的原因.也会向大家展示我们能如何避免上颌窦炎的出现.我们自二零零七年中起进行了一项临床研究:在一组共十六人的无牙颌修复研究中,采取了一个新方法去进行穿颧骨植体手术,并且行使了即刻负重方案.这十六人被追踪了十到三十个月,所有三十七根穿颧骨植体都没有失败,也没有任何人发生上颌窭炎.在追踪的过程中,还发现了植体周围有新骨形成.在此交流会议上我会向大家报告这研究的早期结果.     

Maxillary sinus reconstruction with calvarium bone grafts and endosseous implants.

PURPOSE: The objectives of this study were 1) to evaluate the survival rate for implants placed in maxillary sinuses augmented with autogenous calvarium bone graft and 2) to evaluate the feasibility, complications, and morbidity of this technique as well as patient satisfaction. PATIENTS AND METHODS: Seventy-nine maxillary sinuses in 58 patients were reconstructed with calvarium grafts between 1992 and 2002 with more than 1 year of prosthetic loading. Two hundred twenty-three implants were placed 3 to 11 months after grafting. Bone levels were measured preoperatively after grafting and 1 year after prosthetic loading. RESULTS: Successful healing was observed in 77 sinuses (97.4%), and 2 patients (2.6%) showed dehiscence and graft loss. All implants integrated; 211 (94.6%) were used for fixed restorations and 12 implants (5.4%) were used in 2 patients for overdentures (6 implants each). The fixed prosthesis survival rate was 100% after 1 year of loading and remained successful in all cases during the follow-up. At the second stage of surgery, crestal bone loss was measured with a caliper. No crestal bone loss was observed in 210 implants (94%). However, in 13 implants (6%), a crestal bone loss between 1.5 and 2.5 mm was observed, but no further bone loss occurred during the follow-up, as shown on panoramic radiography. Panoramic radiograph measurements showed a total bone height (alveolar bone plus grafted bone) of more than 15 mm in all sinuses and of more than 20 mm in 25 sinuses (32.4%) with a mean of 18 mm. Bone levels were maintained during the follow-up. CONCLUSIONS: 1) Calvarium provides graft material of excellent quality and quantity. 2) Satisfactory results can be obtained with implants placed after sinus augmentation with calvarium bone graft as shown in this study with no implant failure. Bone levels, implants, and bridge survival were maintained during the follow-up.     

上颌窦开窗植骨种植修复的远期效果评价

目的:探讨上颌窦开窗植骨种植修复在上颌后牙区骨量不足患者中的临床应用效果。方法:2002年1月—2006年11月,使用上颌窦开窗植骨种植修复上颌后牙缺失40例,其中3例行双侧手术。男29例,女11例,平均年龄51.4岁(28～66岁)。共植入84颗种植体。采用埋入式愈合方式。种植体平均愈合11.8个月(8～19个月)后行永久修复。随访期为62.3个月(47～84个月)。结果:植入的84颗种植体在愈合和随访期内均未发生松动脱落,留存率达100%。4侧上颌窦黏膜在手术过程中发生穿破,但未发生上颌窦炎等并发症。随访期X线片显示种植体颈部骨吸收平均值为(0.63±0.33)mm。结论:上颌窦开窗植骨种植修复技术安全可行,是解决上颌后牙区骨高度不足区种植修复难题的有效方法。     

Augmentation of the atrophic maxilla with interpositional autogenous bone grafts

Extreme ridge atrophy is a significant problem when it occurs in the maxilla, since inadequate denture function, as well as poor facial aesthetics, commonly result. Use of the Le Fort I osteotomy of the maxilla with interpositional iliac cortico-cancellous bone grafts is a predictable method of ridge augmentation in severe cases. In our experience, secondary vestibuloplasty has not been necessary prior to construction of new prostheses. Patient satisfaction has been excellent.     

A new method of inserting endosseous implants in totally atrophic maxillae

A new method is described (Sailer, 1988) whereby endosseous implants are inserted in the totally atrophic maxilla, the intermaxillary relationship and vertical dimension corrected and a vestibuloplasty performed during one surgical procedure. The method can also be used to treat minor degrees of maxillary alveolar atrophy. The procedure enables 20 mm-long Titanium screws to be used in totally atrophic maxillae. The following surgical procedures are carried out during one operation: A Le Fort I osteotomy, removal of the mucous membrane of the sinus floor, obturation of the denuded maxillary sinus floor by autologous bone grafts from the iliac crest, simultaneous insertion of Titanium screws, fixation of the down-fractured maxilla by miniplates, and a modified submucous vestibuloplasty. Intermaxillary relationship and vertical dimension can be normalized, and the aesthetic results are excellent. To date 35 implants of which none has been lost, have been placed in 5 patients.     

严重骨量不足的上颌窦底提升同期种植体植入

牙种植患者上颌或下颌牙槽嵴足够的骨量是施行牙种植修复的前提,但上颌牙缺失后常出现上颌窦腔的扩大气化,导致牙槽嵴高度不足。这常需要进行上颌窦底提升手术以恢复植牙所需的骨高度。常规的治疗方案中,在牙槽嵴剩余骨量小于3mm时,需先进行骨增量手术,待新骨生成后,再作二期种植体植入手术。这种治疗方案由于需两次手术,增加病员的负担及复诊次数,需要较长的治疗疗程。     

Predictability of simultaneous implant placement in the severely atrophic posterior maxilla: A 9-year longitudinal experience study of 2132 implants placed into 731 human sinus grafts

PURPOSE: One-stage implant placement in the grafted maxillary sinus has traditionally been limited to patients with at least 5 mm of residual bone to ensure complete implant stabilization. The aim of this prospective study was to determine the long-term survival rates of implants with roughened surfaces placed immediately into maxillary sinus grafts in patients with 1 to 5 mm of residual bone. MATERIALS AND METHODS: A total of 2132 microtextured screw-type (n=1374) or hydroxyapatite-coated cylinder-type (n=758) implants were immediately placed into the grafted sinuses of 731 patients. The implants were restored and monitored for up to 9 years of clinical follow-up. RESULTS: Cumulative survival at 9 years was 97.9% (n=2091 implants); 20.4% of the implants were placed in 1 to 2 mm of residual bone. Discussion: Initial implant stability and parallelism were achieved through a combination of meticulous condensation of the particulate bone graft material around the implants, the frictional interface of the roughened implant surfaces and the host tissues, and selection of an appropriate graft material. CONCLUSIONS: Simultaneous implant placement into sinus floor grafts can be a predictable treatment option for patients with at least 1 to 2 mm of vertical residual bone height when careful case planning and meticulous surgical techniques are used.