闭合式上颌窦底提升术同期种植体植入临床应用分析

目的探讨采用闭合式上颌窦提升术进行上颌窦底提升及同期种植体植入的效果及技术特点。方法对56例患者共64枚种植体应用骨挤压技术经牙槽嵴顶入路行闭合式上颌窦底提升术及同期种植体植入术。观察方法为临床检查和X线片检查。结果全部患者均在术后6个月完成义齿修复。随访时间8个月-5年,平均19.4个月,发现有3例鼻腔出血;义齿修复后种植体无松动及脱落。术后X线片检查种植区窦底高度平均提升(3.85±0.12)mm,种植体周围无阴影,形成良好的骨结合。结论闭合式上颌窦底提升术较传统的开放式上颌窦提升术简化了手术步骤,缩短了手术时间,减轻了患者术后反应,是一种简单有效的窦底提升技术。     

Dental implants placement in conjunction with osteotome sinus floor elevation: a 12-year life-table analysis from a prospective study on 588 ITI implants

OBJECTIVES: The purpose of this prospective study was to evaluate the clinical success of placing ITI dental implants in the posterior maxilla using the osteotome technique. MATERIAL AND METHODS: All implants were placed following a one-stage protocol (elevating the sinus floor and placing the implant at the same time). Five hundred and eighty-eight implants were placed in 323 consecutive patients with a residual vertical height of bone under the sinus ranging from 6 to 9 mm. The mean observation follow-up period was 59.7 months (with a range of 12-144 months). This prospective study not only calculated the 12-year cumulative survival and success rates for 588 implants by life-table analysis but also the cumulative success rates for implant subgroups divided per implant length and the percentage of sinus membrane perforation were evaluated. RESULTS: The 12-year cumulative survival and success rates were 94.8% and 90.8%, respectively. The analysis of implant subgroups showed slightly more favourable cumulative success rates for 12 mm long implants (93.4%) compared with 10 and 8 mm long implants (90.5% and 88.9%, respectively). During the study period, only 13 perforations of the Schneiderian membrane were detected with a perforation rate of 2.2% (13 perforations/601 treated sites). Ten perforations out of 13 were caused during the first half of the study period and of these, seven were detected during the first 3 years of this prospective study. CONCLUSION: Based on the results and within the limits of the present study, it can be concluded that ITI implant placement in conjunction with osteotome sinus floor elevation represents a safe modality of treating the posterior maxilla in areas with reduced bone height subjacent to the sinus as survival and success rates were maintained above 90% for a mean observation period of approximately 60 months. Shorter implants (8 mm implants) did not significantly fail more than longer ones (10 and 12 mm implants): the differences were small compared with the number of events; hence, no statistical conclusion could be drawn. But, from the clinical point of view, the predictable use of short implants in conjunction with osteotome sinus floor elevation may reduce the indication for complex invasive procedures like sinus lift and bone grafting procedures.     

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。     

Sinus bone formation and implant survival after sinus membrane elevation and implant placement: a 1- to 6-year follow-up study

Objectives: To investigate the long‐term clinical and radiographic results of the maxillary sinus membrane elevation technique where implants were inserted in a void space created by the elevation of the sinus membrane without adding any graft material. Materials and methods: A total of 84 patients were subjected to 96 membrane elevation procedures and simultaneous placement of 239 implants. Changes of intra‐sinus and marginal bone height in relation to the implants were measured in intraoral radiographs taken at insertion, after 6 months of healing, after 6 months of loading and then annually. Computerized tomography was performed pre‐surgically and 6 months post‐surgically. Resonance Frequency Analyses measurements were performed at the time of implants placement, at abutment connection and after 6 months of loading. The implant follow‐up period ranged from a minimum of one to a maximum of 6 years after implants loading. Results: All implants were stable after 6 months of healing. A total of three implants were lost during the follow‐up period giving a survival rate of 98.7%. Radiography demonstrated on average 5.3±2.1 mm of intra‐sinus new bone formation after 6 months of healing. RFA measurements showed adequate primary stability (implant stability quotient 67.4±6.1) and small changes over time. Conclusion: Maxillary sinus membrane elevation and simultaneous placement of implants without the use of bone grafts or bone substitutes result in predictable bone formation with a high implant survival rate of 98.7% during a follow‐up period of up to 6 years. The intra‐sinus bone formation remained stable in the long‐term follow‐up. It is suggested that the secluded compartment allowed for bone formation according to the principle of guided tissue regeneration. The high implant survival rate of 98.7% indicated that the implants sufficiently supported the fixed bridges throughout the study period. This technique reduces the risks for morbidity related to harvesting of bone grafts and eliminates the costs of grafting materials. To cite this article:
Cricchio G, Sennerby L, Lundgren S. Sinus bone formation and implant survival after sinus membrane elevation and implant placement: a 1‐ to 6‐year follow‐up study.
Clin. Oral Impl. Res. 22 , 2011; 1200–1212.
doi: 10.1111/j.1600‐0501.2010.02096.x     

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.     

Osteotome sinus floor elevation without grafting material: a 1-year prospective pilot study with ITI implants

OBJECTIVE: The aim of the present pilot study was to evaluate: (1) the predictability of an osteotome sinus floor elevation procedure with ITI-SLA implants without placing a bone grafting material, and (2) the possibility to gain bone height without filling the created space with a bone grafting material. MATERIAL AND METHODS: Seventeen patients received 25 implants protruding in the sinus. Most implants (21/25) were 10 mm long, eight were inserted in type 2 bone, 12 in type 3 and five in type 4 bone. At implant placement, the mean residual bone height (RBH) under the maxillary sinus was 5.4+/-2.3 mm; it was 5.7+/-2.6 mm on the mesial side and 5.1+/-1.9 mm on the distal side. Nineteen implants had less than 6 mm of bone on at least one side and six implants had less than 6 mm on both sides. A healing period of 3-4 months was allowed before abutment tightening at 35 Ncm. The percentage of stable implants at abutment tightening and at the 1-year control was calculated. The endo-sinus bone gain and the crestal bone loss (CBL) at the mesial and distal sides were measured. RESULTS: Abutments were tightened after 3.1+/-0.4 months. All implants but one (96%) resisted the applied 35 Ncm torque. At the 1-year control, all implants were clinically stable and supported the definitive prosthesis. All showed endo-sinus bone gain; the mean gain was 2.5+/-1.2 mm. The mean CBL was 1.2+/-0.7 mm. Endo-sinus bone gain and RBH showed a strong negative correlation (r=-0.78 on the mesial side and -0.80 on the distal side). A good correlation (r=0.73) was found between implant penetration in the sinus and endo-sinus bone gain. CONCLUSION: Elevation of the sinus membrane alone without addition of bone grafting material can lead to bone formation beyond the original limits of the sinus floor. Despite a limited RBH at implant placement, a healing period of 3 months was sufficient to resist a torque of 35 N cm and to lead to a predictable implant function at the 1-year control.     

Resonance frequency analysis of stability on ITI implants with osteotome sinus floor elevation technique without grafting: a 5-month prospective study

Objective: The aim of the present study was to (1) monitor the stability changes of ITI implants placed in atrophic posterior maxillary ridges with osteotome sinus floor elevation (OSFE) without grafting during the first 5 months of healing utilizing resonance frequency analysis (RFA) and (2) determine the factors that affect the implant stability quotient (ISQ) at placement and healings. Material and methods: Forty‐two ITI implants were placed in the posterior maxilla in 32 patients with OSFE without bone grafting. The residual vertical bone height ranged from 4 to 8 mm (average 6.36 mm). Bone type was classified into one to four groups according to the Lekholm and Zarb index. ISQ was tested on the day of surgery and consecutively at 2, 4, 6, 8, 12, 16, and 20 weeks by RFA. Results: The 40 osseointegrated implants represented a survival rate of 95.2%. All the 40 implants achieved good primary stability and reached a comparably high stability at 16 weeks postoperation with a dip between 2 and 6 weeks in the stability curve. There was no significant difference of ISQ between type3 and type4 bone at implant placement and follow‐up. The mean ISQ and its changing pattern did not demonstrate a statistically significant difference according to the pretreatment vertical bone height and implant length. Conclusions: The findings of this study indicated that uneventful osseointegration may be predictable applying OSFE alone with no grafting in atrophic posterior maxilla. Residual bone height (RBH), implant length, and bone type did not seem to affect the implant stability in this clinical situation.     

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.     

Reamer-mediated transalveolar sinus floor elevation without osteotome and simultaneous implant placement in the maxillary molar area: clinical outcomes of 391 implants in 380 patients

Objectives: Minimally invasive sinus elevation and augmentation using a transalveolar approach can reduce perioperative complications and patient discomfort. A specially designed reamer accomplishes this without the use of an osteotome or a mallet. The objective of this study is to present this technique with relevant clinical cases and patient outcomes. Material and methods: Series of reamers with one cutting and one reaming edge were used to prepare an osteotomy site for posterior maxillary areas. A total of 391 osteotomies were prepared with the reamer in 380 patients, and 373 implants were placed simultaneously. In addition to the procedure's success parameters, levels of intraoperative patient comfort were monitored using a visual analogue scale. Results: The mean height of the residual alveolar process was 5.8 (0.9) mm, whereas mean elevation of the sinus floor was 6.2 (0.4) mm. Eighteen (4.6%) Schneiderian membrane perforations occurred, and the 2‐year survival rate was 95.4%. The success rate was 92.7% in sites with thin sinus floors (<4 mm) and 96.4% in sites with greater bone height (>4 mm). None of the patients experienced any discomfort during the procedure. Conclusions: Within the limits of the present study, it can be concluded that reamer‐mediated transalveolar sinus floor elevation is a reliable method for implant placement in the posterior maxilla, even at sites with ≤4 mm of residual alveolar bone height. This reamer‐mediated procedure is less invasive than traditional osteotomy and can minimize patient discomfort during sinus floor elevation. To cite this article :
Ahn S‐H, Park E‐J, Kim E‐S. Reamer‐mediated transalveolar sinus floor elevation without osteotome and simultaneous implant placement in the maxillary molar area: clinical outcomes of 391 implants in 380 patients.
Clin. Oral Impl. Res. 23 , 2012; 866–872.
doi: 10.1111/j.1600‐0501.2011.02216.x     

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.     

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。     

Osteotome sinus floor elevation technique without grafting material: 3-year results of a prospective pilot study

Objective: In a prospective pilot study, short≤10 mm ITI-SLA implants were placed in the resorbed posterior maxilla by means of an osteotome sinus floor elevation (OSFE) procedure without grafting material. This paper presents 3-year data assessing bone-level changes around implants.
Material and methods: Twenty-five implants were placed in 17 patients to rehabilitate 16 molar and nine premolar sites. The mean residual bone height (RBH) was 5.4 ± 2.3 mm. A healing period of 3–4 months was allowed before abutment tightening. Most implants (21/25) were 10 mm long, and the others were 8 and 6 mm long. At the 3-year control, endo-sinus bone gain, implant length protruding into the sinus and crestal bone loss (CBL) were measured on periapical radiographs.
Results: All implants fulfilled the survival criteria. Despite the absence of grafting material, implants were embedded into newly formed bone tissue. All implants gained endo-sinus bone; the mean gained bone was 3.1 ± 1.5 mm. The residual protrusion length decreased from 4.9 ± 2.1 to 1.8 ± 2.1 mm. CBL was 0.9 ± 0.8 mm.
Conclusions: This study confirms that the OSFE procedure without grafting material is sufficient to create bone beyond the natural limit of the sinus. On the mid-term of 3 years, the technique was found to be predictable in the posterior maxilla when the RBH is limited. Implants gained endo-sinus bone despite the lack of grafting material. Bone gain was still improving over the first-year control. No shrinkage of the augmented area was observed.     

上颌窦内提升术种植修复上颌后牙缺失的临床观察

目的:评价上颌窦内提升术并同期植入种植体在上颌后牙区缺失修复中的应用效果。方法:2008年至2010年共完成上颌窦内提升术并同期植入种植体临床病例20例。男12例,女8例,年龄18-65岁。术前CT示:牙槽嵴顶至上颌窦底距离为5-8mm,行上颌窦内提升术,平均提升上颌窦底高度3.8mm(2-5mm),共植入38枚种植体,种植体植入6个月后完成义齿修复。结果:所有患者术后未出现上颌窦炎症,一例术中窦膜穿孔,将种植窝放入明胶海绵,同期植入种植体完成种植手术,术后3天术区疼痛,无其他明显症状。38枚种植体平均负载18个月,种植体稳定,行使功能良好,未见明显骨吸收。结论:对于骨高度不足的患者,行上颌窦内提升术,并同期植入种植体的方法可靠,具有好的疗效,可扩大种植牙的适应症范围。