用盘钻经牙槽嵴提升上颌窦底手术的临床效果观察

目的 观察并评估应用盘钻行经牙槽嵴上颌窦底提升同期种植体植入术的临床效果.方法 上颌后牙缺失患者37例,种植区剩余牙槽骨高度为3～8 mm,平均(5.61±1.61) mm,应用盘钻行上颌窦底提升,同期植入种植体51枚,评估手术安全性及舒适度.术后3～6个月行上部结构修复,随访3～24 个月,观察种植体稳定性、骨结合及种植体周围骨量变化情况.结果 本组术中提升上颌窦底高度2～8 mm,平均(4.75±1.55) mm;所有病例均未发生上颌窦黏膜穿孔,患者主观感觉良好,痛苦指数为(2.22±0.98).随访期内,所有病例均未出现上颌窦感染等并发症,骨结合良好,种植体及修复体无松动、脱落,留存率100%.种植体根方骨量于术后6个月趋于稳定,术后1年颈部骨吸收(1.20±0.72) mm.结论 应用盘钻行经牙槽嵴上颌窦底提升同期种植体植入术,近期效果满意.

Abstract：

Objective To evaluate the clinical effect of the disk-up sinus reamer (DSR) applied to transcrestal maxillary sinus floor elevation with simultaneous placement of implants. Methods Thirty-seven patients underwent transcrestal maxillary sinus floor elevation with fifty-one implants placed simultaneously using the DSR. The residual bone height(RBH) was 3 to 8 mm, (5.61±1.61) mm on average. The safety of this technique and the pain index during the operation was evaluated. The final prostheses were restored in 3-6 months postoperatively. The follow-up period was 3 to 24 months. The stability and osseointegration of the implants were clinically evaluated, and the endo-sinus bone gain around the implants were measured. Results The elevation height ranged from 2 to 8 mm, with an average of (4.75±1.55) mm. There was no detectable sinus membrane perforation, no serious suffering or uncomfortable subjective sensation in any patients during operation with a pain index of (2.22±0.98). During the follow-up period, no sinus complication was observed. Favorable osseointegration was obtained. There were no implants or prostheses which were loose or lost. The survival rate was 100%. The radiographic results demonstrated that the endo-sinus bone gain tended to reach stabilization after 6 months and the marginal bone loss was(1.20±0.72) mm after 12 months. Conclusions Transcrestal maxillary sinus floor elevation with simultaneous implant placement by DSR is a safe, invasive and handy technique, with higher elevation height,fewer clinical complications and less pain. It shows satisfactory clinical results in short term and a long-term observation is still needed.     

不植骨上颌窦内提升术种植的临床疗效观察

目的 评价不植骨上颌窦内提升术在剩余牙槽骨高度为（RBH）3-8mm的患者种植修复中应用的临床效果。方法 对上颌后牙缺失,接受上颌窦内提升术,同期植入种植体但未进行植骨的10例患者进行回顾调查研究,这些病例术前的RBH范围均处于3~8 mm范围内。参照Cochran提出的种植体成功标准进行临床随访。通过影像资料测量术前种植体近远中位置RBH,并与术后1年相同位置进行对比,分析骨量变化。结果 10例病例的种植体均存留,根据标准评价1年种植成功率100%。病例术前RBH处于3.0-7.2mm之间,术后1年种植体边缘骨高度为3.6-9.2 mm,两者比较存在统计差异（P＜0.05）,种植区骨变化量（1.1±0.5）mm。结论 上颌窦内提升术在不植骨的条件下对于RBH 3-8mm的患者具有较好的短期临床效果。     

122例外侧壁开窗式上颌窦底提升术相关并发症的研究

目的 研究并讨论外侧壁开窗式上颌窦底提升术相关的并发症以及建议的治疗方法。方法 122例上后牙缺失并且骨量不足的患者于2010年8月1日至2013年7月15日接受了外侧壁开窗式上颌窦底提升手术,均已完成上部修复。测量记录术前剩余牙槽骨高度。记录所有术中或术后并发症,比如过量出血、上颌窦底黏膜穿孔、感染、创口裂开、急性上颌窦炎、移植骨吸收,以及统计种植体存留率。结果 术中8例发生窦底黏膜穿孔,术后3例当晚少量鼻出血,术后1～2周3例伤口裂开,术后2周1例急性上颌窦炎伴化脓性感染;术后6个月内,有6例患者的移植骨出现部分吸收,6颗种植体发生松动或自行脱落。结论 外侧壁开窗式上颌窦底提升术相关的并发症有黏膜穿孔、感染、创口裂开、移植骨吸收以及种植体松动、脱落,可通过术前周密检查、术中控制手术操作、修补穿孔黏膜、术后适当加大抗生素剂量、缝合裂开创口并配合使用漱口水及系统性抗生素治疗等方法预防及治疗相关并发症。     

经牙槽嵴顶上颌窦底提升术植骨与否的研究进展

上颌后牙区常因骨量不足而成为种植的难点区域,常用的解决办法为上颌窦侧壁开窗窦底提升术和经牙槽嵴顶上颌窦底提升术。经牙槽嵴顶上颌窦底提升术因为手术操作简单、创伤小、愈合时间短、术后不适感少等优点逐步得到广泛应用。该技术早期应用常伴有同期植骨,但由于骨替代材料存在感染、低吸收率及引发上颌窦再气化等风险,近些年来临床上开始主张经牙槽嵴顶上颌窦底提升时不再植骨。目前对经牙槽嵴顶上颌窦底提升术中植骨与不植骨的愈合状况和临床疗效等方面都有较多的研究报道。本文就经牙槽嵴顶上颌窦底提升术是否需要同期植骨的研究进展做如下综述。     

Transcrestal sinus floor elevation: a retrospective study of 46 patients up to 16 years

Background: The aim of this study was to evaluate the clinical outcomes and radiographic data of transcrestal sinus floor elevation (TSFE) of residual alveolar bone ≤3 mm. Methods: Forty‐six patients, edentulous in one or both maxillary posterior segments, were enrolled in this study. The residual alveolar ridge was measured. TSFE without bone grafting was performed. Three months after the first surgery procedure, 66 implants were placed without grafting material. 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 10.43 ± 5.01 years (ranged from 5 to 16 years), a survival rate of 95.45% was reported. Mean bone levels at implant placement were 7.12 ± 0.90 mm and, after 1 year, were 13.28 ± 1.23 mm. They were stable over time, reporting an up to 16 years' value of 13.07 ± 2.63 mm. Conclusions: The results of this retrospective clinical study confirmed the reliability of the TSFE procedure and the maintenance of bone levels without grafting procedures over time.     

侧壁开窗上颌窦底提升术后垂直向骨增量的观察研究

目的通过观察侧壁开窗上颌窦底提升术后垂直向骨增量的变化情况,研究其相关的影响因素。方法收集上颌后牙区牙列缺损行侧壁开窗上颌窦底提升术分期种植患者资料,对纳入病例的术前剩余牙槽骨高度(residual bone height,RBH)、术后当日垂直向骨高度、术后6个月垂直向骨高度及垂直向骨增量的变化情况进行观察。结果术后6个月较术后当日垂直向骨高度有显著性降低,降低量为0.56±0.25mm;上颌窦底黏膜厚度的术后6个月较术后当日垂直向骨增量的变化量无明显差异;在不同剩余牙槽骨高度情况下,术后6个月较术后当日垂直向骨增量的变化量有统计学差异,RBH大于5mm的患者相对RBH小于5mm的患者垂直向骨增量的降低值显著增加;上颌窦宽度与术后6个月较术后当日垂直向骨增量的降低值呈正相关。结论侧壁开窗上颌窦底提升术后6个月较术后当日存在垂直向骨增量的降低现象;剩余牙槽骨高度大于5mm时垂直向骨增量的降低值显著增加;上颌窦宽度与垂直向骨增量的降低值呈正相关。     

上颌窦冲顶提升术同期种植体植入的临床研究

目的 研究上颌窦冲顶提升术不植骨同期植入种植体的临床效果及种植特点。方法 43例患者,牙槽嵴顶距窦底骨高度为5～10mm。经上颌窦冲顶提升术不植骨植入56颗ITI种植体。结果 术后X片显示上颌窦底抬高(2.50±1.70)mm。所有患者未发生上颌窦炎的并发症,种植体稳固,X线片显示骨结合良好。所有种植体术后3～4个月均完成种植修复,可正常负重;种植体存留率100%。结论 在选择好适应证及良好的手术操作配合下,上颌窦冲顶提升术不植骨同期植入种植体可以获得很好的种植成功率。     

Osteotome sinus floor elevation and simultaneous placement of implants--a 1-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, although less invasive techniques with osteotomes have been used since 1994. 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. At the 1‐year follow‐up, two implants had been lost, both in edentulous patients. The remaining 51 implants inserted were in function, giving a 1‐year cumulative survival rate of 96%. Implants used in single‐tooth replacements and in partially edentulous cases had a 100% survival rate. The mean 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. 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.     

上颌窦侧壁开窗提升术术后5年以上的临床病例分析

目的:统计上颌窦侧壁开窗提升术术后5-9年种植体存留率,观察种植体根尖骨改建情况。方法:回访行上颌窦侧壁开窗提升术5年以上107颗种植体,通过CBCT测量种植体根尖新骨形成情况。结果:种植体存留率为96.3%。对28例患者(35颗种植体)进行CBCT分析,发现20颗种植体埋于新上颌窦底下,15颗种植体突出新上颌窦底。结论:上颌窦侧壁开窗提升术的种植体5年以上存留率在90%以上。上颌窦侧壁开窗提升术可获得理想的长期稳定提升效果。     

非翻瓣不植骨上颌窦内提升法种植义齿的临床研究

目的:研究在上颌骨骨量不足情况下,采用非翻瓣不植骨法行上颌窦内提升的种植义齿临床效果.方法:收集2013年12月～2014年12月期间,在剩余牙槽骨高度(residual bone high,RBH)不足情况下,完成的30例不翻瓣不植骨的上颌窦内提升种植术病例.随访6～12个月,平均(9.8±1.6)个月.全部病例均在术后6个月内完成上部义齿修复.观察术后种植体的稳定性、种植体周围软组织状况及种植体周围骨结合及骨量改变的情况.结果:30枚种植体中有2枚术中发现上颌窦粘膜穿通,同期放入生物膜,观察期内未出现上颌窦内炎症等并发症;在观察期内30枚种植体成功率100％.术后6个月上颌窦底种植体周围骨质增加高度平均(2.8±0.6) mm,种植体边缘骨吸收(1.3±0.4) mm.结论:在上颌骨牙槽突高度不足的情况下,非翻瓣不植骨法上颌窦内提升术是一种安全,有效的种植术式.