螺旋 CT 仿真内镜对上颌窦底的测量研究

目的:探讨螺旋CT仿真内镜(virtual endoscopy VE)对评估上颌窦内提升前后窦底形态改变的意义。方法:对15例上颌窦内提升患者术前术后采用64排螺旋CT扫描,三维重建后仿真内镜观察上颌窦底形态改变,测量内提升高度及窦底种植体表面覆盖的软硬组织的厚度。结果:15例上颌后牙缺失患者经过螺旋CT仿真内窥镜术前测量,可以清晰地看到上颌窦内呈现不规则锥形结构,影像类似于真实内镜的图像。上颌窦底形态平坦型:9例(60.0%),V形:4例(26.7%),窦底分隔:2例(13.3%),上颌窦底最低点位置:上颌第二前磨牙与上颌第一磨牙间,种植有效牙槽骨高度:5-8mm,平均6.5mm。模拟手术评估后共植入21枚种植体。术后螺旋CT仿真内镜可以清晰地看到上颌窦底内提升后局部隆起的"帐篷状"改变,21枚种植体提升上颌窦底3±1.5mm,窦底种植体表面覆盖的软硬组织的厚度2.5±0.8mm。结论:螺旋CT仿真内镜是一种无创性、可重复操作的检查手段,不仅可以对骨组织进行三维重建,还可以对软组织进行重建,能多角度、全方位地清晰显示上颌窦内提升前后窦底形态结构的改变,对基层综合性医院上颌窦内提升有着重要的临床价值。     

2种手术入路上颌窦底提升同期种植失败原因和并发症分析

目的:探讨经侧壁或牙槽嵴入路上颌窦底提升术对种植体生存率的影响,分析失败原因和并发症.方法:采用回顾性队列研究,分析2000-2015年在合肥市口腔医院口腔颌面外科就诊、由同一名医师完成上颌窦底提升同期种植的患者.主要预测变量是经侧壁入路上颌窦底提升术和经牙槽嵴入路上颌窦底提升术,混杂变量是性别、年龄、吸烟史、糖尿病史...     

基于锥形束CT对上颌窦分隔分布的影像学分析

目的：运用InVivo Dental软件对北京第二炮兵总医院口腔科锥形束CT（CBCT）影像学资料进行回顾性分析,研究2012年7月至2013年10月期间就诊于我院口腔科成人人群中上颌窦底壁分隔与年龄,性别以及缺牙情况的关系,以期为上颌窦底提升术提供解剖学依据和手术指导。方法：选取538例研究对象的上颌窦CBCT影像资料,其中上颌后牙区缺失牙与不缺牙组各269例,分别按照性别、年龄分组。将所有数据导入In-VivoDental软件中,通过三维重建,测量记录上颌底壁分隔的发生率,位置,高度,方向及形态学变化,采用SPSS18．0软件包对数据进行统计学分析。结果：538例研究对象中,89例有窦分隔,发生率16．54％;29例出现多个窦分隔（5．39％）,25例双侧同时出现分隔（4．64％）;在测得的1076个上颌窦中,116个出现窦分隔,发生率为10．78％;男性中年不缺牙组的窦分隔出现率最高;原发性分隔出现率远远超出继发性分隔出现率;窦分隔的发生与性别、年龄及牙缺失无关。窦分隔主要出现在上颌窦中部,占51．720／0;平均高度左侧为（6．17±3．35）mm,右侧为（6．50±4．22）mm,平均长度右侧为（10．87±2．96）mm,左侧为（10．05±4．27）mm。结论：北京第二炮兵总医院口腔科2012年7月至2013年10月期间就诊患者成人人群中,16．54％出现窦分隔;上颌窦分隔出现率与缺失牙,不考虑年龄及性别。     

常州地区人群上颌窦内提升中的窦底骨性分隔的锥形束CT研究

目的:研究常州地区人群上颌窦底骨性分隔的发生率、部位和形态学特点,探讨上颌后牙缺失与骨性分隔的关系,以及对上颌窦内提升手术的指导意义.方法:选择124例研究对象,于术前拍摄锥形束CT(CBCT)并生成相关数据,以NNT软件测量,获取上颌窦底骨分隔的数据,利用SPSS13.0软件包对数据进行统计学分析.结果:124例患者中,42例(33.87％)存在上颌窦骨性分隔;248个上颌窦中,68个存在骨性分隔(27.42％),其中45个骨性分隔出现于上颌窦中部(66.18％),15个出现在后部(22.06％),8个出现在前部(11.76％).窦分隔的发生与性别、年龄及是否缺牙无关.结论;通过CBCT可以观察到上颌窦底骨性分隔的位置、形态,最大限度地预判手术的难易程度,提高上颌窦内提升术的成功率.     

Prevalence of maxillary sinus septa in 1024 subjects with edentulous upper jaws: a retrospective study

Maxillary sinus floor augmentation has been routinely performed to optimize dental implant placement in the posterior maxilla. However, complications during a sinus grafting procedure, such as perforation of the Schneiderian membrane, have been reported. This complication is generally associated with the presence of maxillary septa. Therefore, the aim of this retrospective study was to evaluate the prevalence of maxillary sinus septae in completely edentulous subjects by means of panoramic radiography. A total of 1024 panoramic radiographs were evaluated by 3 calibrated examiners. From these radiographs, 307 maxillary septa were detected in 221 subjects (21.58%); 86 (8.40%) of the subjects showed maxillary septa in both maxillary sinuses. Logistic regression failed to detect any correlation between the presence of maxillary septa, age, and gender (P > .05). Within the limits of the study, the prevalence of maxillary septa in this Brazilian population was shown to be moderate, indicating that dentists must be aware of the presence of this anatomic structure during maxillary sinus elevation grafting.     

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。     

A retrospective analysis of maxillary sinus septa on reformatted computerised tomography scans

Objectives: This study analysed 200 consecutive computerised tomography (CT) scans, reformatted with specialised software for the identification of maxillary sinus septa. All patients were routine implant patients who had undergone CT scans for dental implant planning.
Materials and methods: The data of two hundred consecutive patients (400 maxillary sinuses) who had been sent for CT scan, were reformatted with CT software. The group consisted of 115 edentulous and 85 dentate (below sinuses) patients. Septa were identified using three-dimensional (3D) reconstruction and panoramic views. No septa were included unless they were clearly visible on the 3D reconstruction. The prevalence, height and number of septa were analysed for both groups of patients.
Results: The prevalence of sinus septa was found to be 69% (138 patients), with a significant number of these patients showing multiple septa (89/138). The mean age of the patients was 54 (±14). The prevalence of edentulous patients with septa (71%) was not statistically different from the dentate patients (66%) ( P =0.7).
Discussion: This study found a higher prevalence of patients with maxillary sinus septa than what has been reported previously. This may be due to the exact nature of the CT software and the ease of use of the 3D reconstruction for identification of septa. Another explanation could be that all septa that were visible on the 3D reconstruction were included and there was no minimum cut-off height. No significant differences were found between edentulous and dentate patients.     

上颌窦提升术中上颌窦解剖生理及病理的 CBCT 探讨

目的:探讨上颌窦生理及病理性CBCT影像表现,为上颌窦提升术解剖定位和操作入路提供参考依据。方法:收集涉及上颌窦的CBCT资料,分析上颌窦解剖特征及病变。结果:1.上颌窦解剖结构位置及其比邻关系复杂;2.影响上颌窦提升术的解剖因素有生理及病理性两种:生理性如上颌窦内的分隔,上颌窦外侧壁的厚度,窦壁上存在的血管影像的粗细,病理性如窦腔内黏膜的增厚,上颌窦内的黏液囊肿,上颌窦内的大量积液等等。结论:CBCT能够准确地显示完整的上颌窦影像,利用CBCT确定解剖定位标志,确定上颌窦提升手术路径和方式,更符合安全、准确、微创的口腔种植理念。     

江苏汉族人群上颌窦间隔解剖结构的锥形束CT研究

目的:通过拍摄锥形束CT(CBCT)结合Simplant软件,研究江苏地区汉族人群中上颌窦窦间隔的解剖学变化,为上颌窦底提升术提供解剖学依据和手术指导。方法:选取424例研究对象的上颌窦CBCT影像资料,将获取的Dicom文件数据导入到Simplant软件中,通过三维重建,测量分析上颌窦间隔的发生、位置、高度、方向及形态学变化,采用SPSS17.0软件包对数据进行统计学分析。结果:424例研究对象中,190例有上颌窦间隔,发生率为44.81%;90例出现多个窦间隔(21.23%);87例双侧上颌窦同时出现窦间隔(20.52%);在所测的848个上颌窦中,277个出现窦间隔,发生率为32.67%;窦间隔的发生与性别、年龄及牙缺失无关。窦间隔主要出现在上颌窦中部,占59.94%;平均高度右侧(5.90±3.65)mm,左侧(5.54±2.87)mm;平均长度右侧(8.15±2.40)mm,左侧(7.88±2.73)mm。结论:江苏汉族人群中,44.81%出现上颌窦间隔;CBCT能全面而准确定量分析上颌窦窦间隔的解剖结构,为上颌窦底提升术提供解剖学依据,对手术操作具有指导意义。     

Radioanatomic study of maxillary sinus palatal process pneumatization

Oral Radiology - To perform a detailed analysis of palatal process pneumatization (PPP) on cone beam computed tomography (CBCT) images. This study consisted of 376 maxillary sinuses of 188 patients...     

Retreatment of multiple failing maxillary implants after full arch rehabilitation: a retrospective,observational cohort study

The aim of this study was to assess implant retreatment in a group of patients whose maxillary implants were all failing after full arch rehabilitation. Treatment involved implant removal, augmentation, and placement of an overdenture supported by four to six implants. All consecutive patients referred between 2008 and 2018, following multiple late implant failures in the rehabilitated maxilla, were included in the study. Seventy implants in 15 patients were evaluated at 3.3 ± 2.5 years (range 1.1–8.6 years) after loading. Implant survival, complications, clinical parameters, marginal bone loss, and patient-related outcome measures were recorded at the time of evaluation. Overall implant survival was 95.7%. Three implant failures occurred within the first year of function. Marginal bone loss was 0.32 ± 0.46 mm; pocket probing depth was 4.55 ± 1.59 mm. Plaque, calculus, inflammation, and bleeding were hardly seen (median index score 0). Patients scored their satisfaction with their overdentures as high (mean overall score 8.7 ± 1.2, maximum 10). Chewing soft and tough food was scored as ‘good’ and hard food as ‘moderate’. The mean Oral Health Impact Profile score was 29.5 ± 33.3. It can be concluded that the replacement of multiple failing implants in an edentulous maxilla after bone augmentation is a safe and predictable treatment procedure when applied as an implant-supported overdenture.