上颌窦腭侧壁扩张提升上颌窦底的临床效果研究

目的观察经牙槽嵴顶入路上颌窦腭侧壁扩张提升上颌窦底的临床效果。方法收集24例上颌后牙缺失患者,采用经牙槽嵴顶入路上颌窦腭侧壁扩张提升上颌窦底,不植骨同期植入种植体的手术方式,共植入37颗种植体。在6个月和12个月进行随访,统计种植体的成功率,拍摄CBCT测量种植体根部新骨形成的高度。结果 6个月复诊时,1颗种植体出现松动取出,其余36颗种植体正常行使功能,1年成功率97.3%。受植区平均牙槽骨高度为(6.7±0.8)mm,上颌窦底提升高度为(4.2±0.6)mm。上颌窦底种植体周围有新骨形成,6个月平均成骨2.1 mm,12个月平均成骨2.3 mm。结论上颌后牙区骨量不足时采用上颌窦腭侧壁扩张提升上颌窦底不植骨同期种植的手术方式是可行的,上颌窦黏膜具有潜在的成骨能力。     

上颌窦内提升术中不植骨同期植入种植体的临床效果观察

目的通过临床观察和X线测量,评估上颌窦内提升术中不植骨,同时植入种植体的临床疗效。方法选择17例上颌后牙缺失,同时牙槽嵴顶距上颌窦底高度为4～5 mm的患者,经上颌窦内提升术,不伴植骨,提升高度<5 mm,同期植入种植体,共计21枚。术后拍X线片,并于3个月后复诊,拍摄X线片,临床观察,并行上部修复。结果 17例患者共21枚种植体稳固无松动,患者无明显不适感,未发生上颌窦炎或上颌窦口腔瘘等并发症,术后当天X线片显示上颌窦底平均抬高(3.4±0.5)mm,术后3个月的X线片示上颌窦底黏膜完整,种植体周围骨结合良好,上颌窦底平均抬高(2.9±1.1)mm,所有种植体均可正常负重,种植成功率100%。结论上颌后牙缺失且牙槽嵴高度不足时,可选择上颌窦内提升术,术中不植骨,同期植入种植体,可在保证种植成功的基础上,减少患者费用,缩短治疗时间。     

闭合式上颌窦挤压提升同期人工牙种植修复45例分析

目的：观察使用Summers骨凿或骨挤压器经牙槽嵴顶闭合式抬高上颌窦底、同期植入种植体的临床效果。方法：对41例45侧后牙缺失患者行上颌窦闭合式提升，必要时植自体骨或人工骨，同时植入种植体。结果：45侧上颌窦剩余牙槽骨平均高度为6．8mm(5～9mm)，用骨凿平均提升上颌窦底高度3．5mm(2～6mm)。2侧上颌窦黏膜被钻穿孔，放弃牙种植。其余43侧上颌窦共植入63颗种植体，长度10～15mm。Ⅱ期手术时，5颗种植体松动拔除。追踪12～48个月，修复后1颗种植牙松动拔除，1颗进行性骨吸收，总成功率达88．9％。所有病例均无上颌窦并发症：结论：上颌窦内提升技术较开窗式上颌窦提升创伤小，操作步骤简单，对有适量剩余牙槽骨的上颌窦区种植可以考虑使用；但由于存在窦底黏膜穿孔风险，技术要求高，同时必须有专用的器械，应慎重使用。在严格控制适应证、掌握种植外科技巧的情况下，开展上颌窦内提升技术是可行的，可以取得较高的成功率。     

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。     

胶原骨冲击法上颌窦内提升术的临床研究

背景:经典的上颌窦内提升术(OSAF、BAOSAF)具有较好的治疗效果。但是伴有上颌窦穿孔(10%)、无法预测的植骨量等并发症。多种植骨材料和改良手术方法业已应用ISL。目的:评价应用胶原骨做为上颌窦内提升术提升介质和植骨材料的手术方法,对上颌后牙区剩余骨高度不足患者进行种植手术同期植入胶原骨,探讨其技术要点及临床效果。材料与方法:2007年9月至2009年2月,共完成12例胶原骨Bio-col冲击法上颌窦内提升手术病例。男性5例,女性7例,平均年龄43.4岁(27—58岁),共植入种植体12枚。随访3年以上7例,2年以上5例。平均随访2.6年。评价方法为临床检查、X线检查和共振频率检查(Osstell)。患者上颌后牙区窦底剩余骨高度在5.8—8.0mm(平均6.6mm),提升高度为4.5—10.3mm(平均7.3mm)。术中采用胶原骨Bio-col作为冲击介质辅助提升,并利用胶原骨特性将其置于种植体根部正上方,同期植入种植体并暴露,5个月后完成种植修复。结果:12例中没有上颌窦黏骨膜穿破,术后种植体均获得良好的骨结合并完成种植修复。5个月修复时,共振频率值72—84(平均78)。1年期X线评测,提升高度为2.8—7.6mm(平均5.8mm)观察期内,无种植体脱落,患者对修复效果满意。结论:改良的胶原骨冲击法上颌窦内提升术,有效的降低上颌窦穿孔的风险,并且获得良好的成骨高度。克服既往上颌窦提升后窦底植骨或不植骨,骨高度降低的难题。     

原位取骨上颌窦内提升同期牙种植在严重上颌骨萎缩病例中的应用

目的:评价上颌窦内提升同期牙种植术在上颌牙槽骨高度严重不足的临床应用.方法:对20例上颌窦底牙槽骨剩余高度4.0-7.0mm(平均高度5.4mm)的牙缺失患者采用空心环柱形切骨锯在种植区切骨、取骨,用骨挤压器对上颌窦底提升后,将圆柱状骨芯研磨成颗粒后,将自体骨颗粒或混合羟基磷灰石的颗粒植入上颌窦底,再置入种植体,术后1、3.6、12、18、24个月后复查.结果:共28枚Replace种植体植入,其中窦底提升3-6mm后(平均4.6mm)植入27枚,上颌窦穿孔后同期植入种植体1枚,全部一期愈合,术后3月X线片显示种植体与新骨形成紧密的骨性结合,术后3-6月完成种植修复,效果理想.术后24个月留存率100%.结论:上颌牙槽骨高度严重不足的病例中采用上颌窦内提升,结合原位取骨、植骨,同期牙种植的方法能有效解决骨量严重不足时牙种植问题.     

冲顶式上颌窦提升的临床评价及相关问题探讨

目的:评价经牙槽嵴顶入路行冲顶式上颌窦提升同期植入牙种植体的临床疗效及相关影响因素.方法:25例上颌后牙缺失的患者接受冲顶式上颌窦提升术同期植骨并植入牙种植体,共植入种植体51颗,采用自体骨和人工骨的混合骨粉作为植骨材料,术后随访1-3年.结果:原牙槽嵴高度为4-8.9mm,术后提升上颌窦底高度2～6mm,平均提升高度3.98mm.种植体长度在8-13mm之间,平均11.5mm.有一例术后24 h有轻微鼻腔出血,所有病例均未发生上颌窦穿孔.三颗种植体在二期修复前松动,拔除后有两颗重新植入获得良好的骨整合效果.所有病例均在术后6-18个月行固定义齿修复,在随访期内未发现种植体或上部结构松动.结论:冲顶式上颌窦底提升同期牙种植体植入术较开窗式上颌窦提升创伤小,操作步骤简单,避免了二次手术,节约了患者的时间和费用,可以广泛应用于垂直骨量相对不足的上颌后牙区.     

上颌窦内外侧宽度对不植骨上颌窦内提升的成骨影响

目的:评估上颌窦内外侧宽度对不植骨的上颌窦内提升成骨效果的影响.方法:回顾性地分析48例不植骨的骨凿法上颌窦内提升术并同期植入种植体的患者,植入种植体52枚,在术前、术后即刻、术后6个月三个时间点拍摄的锥束状CT进行评估及数据分析,分析新骨生成与上颌窦内外侧径的关系.结果:患者的平均上颌窦宽度为(16.07±4.17)mm,平均剩余骨高度为(6.42±1.17)mm,术中平均提升高度为(4.34±0.93)mm,术后6个月平均新骨生成量为(1.06±0.57)mm,新骨生成与上颌窦宽度呈负相关(P<0.01).结论:在上颌窦内提升不植骨的术式中,上颌窦内外侧径会影响最终窦内成骨的高度,较小的上颌窦宽度有利新骨的生成.     

上颌窦内外侧宽度对不植骨上颌窦内提升的成骨影响

目的:评估上颌窦内外侧宽度对不植骨的上颌窦内提升成骨效果的影响.方法:回顾性地分析48例不植骨的骨凿法上颌窦内提升术并同期植入种植体的患者,植入种植体52枚,在术前、术后即刻、术后6个月三个时间点拍摄的锥束状CT进行评估及数据分析,分析新骨生成与上颌窦内外侧径的关系.结果:患者的平均上颌窦宽度为(16.07±4.17)mm,平均剩余骨高度为(6.42±1.17)mm,术中平均提升高度为(4.34±0.93)mm,术后6个月平均新骨生成量为(1.06±0.57)mm,新骨生成与上颌窦宽度呈负相关(P<0.01).结论:在上颌窦内提升不植骨的术式中,上颌窦内外侧径会影响最终窦内成骨的高度,较小的上颌窦宽度有利新骨的生成.     

植骨在上颌窦内提升术同期种植修复中的效果评价

目的探讨上颌窦内提升术并同期种植患者术中植骨的必要性。方法对就诊于我院的30例患者共36颗种植体,随机分为对照组(不植骨)和实验组(植骨),均采用内提升术和同期种植体植入。评价2年后的种植体存留率和种植体周围骨增加情况。结果对照组和实验组2年后的种植体存留率分别为89.5%和88.9%;两组上颌窦内种植体周围骨高度分别增加(2.5±0.7)mm和(2.8±0.8)mm,两组指标均没有统计学差异。结论是否植骨对上颌窦内提升同期种植的远期效果影响很小。     

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。     

应用OSFE技术行上颌窦底黏膜提升同期种植的临床观察

目的:探讨不植骨的骨凿上颌窦底提升技术(OSFE)在牙槽嵴重度萎缩(当RBH<8 mm)的上颌后牙区种植方案中应用的可能性。方法:收集既往于本院施行不植骨骨凿上颌窦底提升技术的病例资料,观察上颌窦底黏膜提升术后同期种植体植入后的临床疗效。结果:观察期内通过OSFE技术在34位患者植入种植体42颗。术前X线片测量的平均余留牙槽嵴高度(RBH)7.41 mm,新骨平均生成高度为2.22 mm,现窦底提升区域有新骨形成的比例为92.3%。种植体植入术后随访观察3～39个月,种植牙成功率100%。结论:使用OSFE技术行上颌窦底黏膜提升不植骨的术式可取得较好的临床效果。     

Sinus floor elevation utilizing the transalveolar approach

A transalveolar approach for sinus floor elevation with subsequent placement of dental implants was first suggested by Tatum in 1986. In 1994, Summers described a different transalveolar approach using a set of tapered osteotomes with increasing diameters. The transalveolar approach of sinus floor elevation, also referred to as ‘osteotome sinus floor elevation’, the ‘Summers technique’ or the ‘Crestal approach’, may be considered as being more conservative and less invasive than the conventional lateral window approach. This is reflected by the fact that more than nine out of 10 patients who experienced the surgical procedure would be willing to undergo it again. The main indication for transalveolar sinus floor elevation is reduced residual bone height, which does not allow standard implant placement. Contraindications for transalveolar sinus floor elevation may be intra‐oral, local or medical. The surgical approach utilized over the last two decades is the technique described by Summers, with or without minor modifications. The surgical care after implant placement using the osteotome technique is similar to the surgical care after standard implant placement. The patients are usually advised to take antibiotic prophylaxis and to utilize antiseptic rinses. The main complications reported after performing a transalveolar sinus floor elevation were perforation of the Schneiderian membrane in 3.8% of patients and postoperative infections in 0.8% of patients. Other complications reported were postoperative hemorrhage, nasal bleeding, blocked nose, hematomas and benign paroxysmal positional vertigo. Whether it is necessary to use grafting material to maintain space for new bone formation after elevating the sinus membrane utilizing the osteotome technique is still controversial. Positive outcomes have been reported with and without using grafting material. A prospective study, evaluating both approaches, concluded that significantly more bone gain was seen when grafting material was used (4.1 mm mean bone gain compared with 1.7 mm when no grafting material was utilized). In a systematic review, including 19 studies reporting on 4388 implants inserted using the transalveolar sinus floor elevation technique, the 3‐year implant survival rate was 92.8% (95% confidence interval: 87.4–96.0%). Furthermore, a subject‐based analysis of the same material revealed an annual failure rate of 3.7%. Hence, one in 10 subjects experienced implant loss over 3 years. Several of the included studies demonstrated that transalveolar sinus floor elevation was most predictable when the residual alveolar bone height was ≥ 5 mm and the sinus floor anatomy was relatively flat.     

Osteotome Sinus Floor Elevation without Bone Grafts – A 3‐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. In 1994, a less‐invasive technique using osteotomes was suggested by Summers. 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. Two implants in edentulous patients were lost at the 1‐year follow‐up, and one more at the 3‐year examination. The remaining 50 implants inserted were in function, giving a 3‐year cumulative survival rate of 94%. Implants used in single‐tooth replacements and in partially edentulous cases had a 100% survival rate. The 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. At the final examination after 3 years, the mean bone level was situated 0.6 ± 0.09 mm below the reference point, indicating a nonsignificant change between 1 year and 3 years. 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.     

上颌窦底冲压提升法种植修复122例缺牙的临床观察

目的探讨上颌窦底冲压提升技术在上颌后牙区种植修复中的应用效果和技术特点。方法1998年7月至2004年7月,共完成122例上颌窦底冲压提升种植修复病例。男性48例,女性74例,平均年龄46·5岁(20~69岁),共植入157枚种植体。随访5年以上21例,3年以上41例,2年以上27例,1年以上33例,平均随访29·7个月。观察方法为临床检查和X线检查。患者均因上颌后牙种植区牙槽嵴顶至上颌窦底之间的剩余骨高度在8~11mm,无法植入足够长度的种植体,因而采用上颌窦底冲压法局部提升上颌窦底骨板及黏骨膜,提升幅度为2~5mm。术中未使用任何骨移植材料,同期植入种植体。若种植体植入时的扭力>0·25N·m,则行一段式种植体直接安装愈合基台,3~4个月后进行种植义齿修复;若种植体植入时的扭力<0·25N·m,则采取埋入式种植技术,3~4个月后再行Ⅱ期种植体暴露手术及修复。结果122例中有12例上颌窦黏骨膜穿破,但在观察期内未发生上颌窦炎等并发症。157枚种植体均获得良好的骨结合并已完成种植修复,至2005年10月为止,无种植体脱落,患者对修复效果满意。结论上颌窦底冲压提升种植修复技术安全、简便、易行;手术创伤小,可在上颌后牙区种植修复病例中选用。     

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.     

冲压式上颌窦底提升术同期种植临床分析

目的:探讨上颌后牙区采用冲压式上颌窦底提升术植骨与不植骨同期种植的效果。方法:2001年1月—2007年12月,共完成冲压式上颌窦底提升种植修复病例91例,男35例,女56例,随机分为2组,植骨组47例,植入57颗种植体;不植骨组44例,植入种植体51颗,共植入108颗种植体。上颌窦底剩余牙槽骨高度为5～11mm,提升幅度为2～6mm。平均随访56.8个月。35例患者(41颗种植体)于后期随访中行锥形束CT(CBCT)和根尖片,观察种植体新骨形成量和种植体突出窦底高度,应用SPSS17.0软件包对数据进行方差分析和t检验。结果:植骨组7颗种植体脱落,存留率为87.7%;不植骨组3颗种植体脱落,存留率为94.1%。CBCT扫描显示,提升幅度为2～4mm时,植骨组新骨形成高度为(2.7±1.3)mm,不植骨组为(2.4±1.5)mm,2组间无统计学差异;提升幅度为4～6mm时,植骨组新骨形成高度为(3.5±1.3)mm,不植骨组为(1.3±0.4)mm,植骨组比不植骨组新骨形成高度显著增加。结论:在上颌后牙缺失区采用冲压式上颌窦底提升、不植骨同期种植是安全可行的,植骨材料对于促进新骨形成并非必须,然而提升幅度较大时,植骨能获得更多的骨量。     

Transalveolar maxillary sinus floor elevation using osteotomes with or without grafting material. Part II: radiographic tissue remodeling

Objectives: To evaluate the pattern of tissue remodeling after maxillary sinus floor elevation using the transalveolar osteotome technique with or without utilizing grafting materials.
Methods: During the period of 2000–2005, 252 Straumann^® dental implants were inserted using the transalveolar sinus floor elevation technique in a group of 181 patients. For 88 or 35% of those implants, deproteinized bovine bone mineral with a particle size of 0.25–1 mm was used as the grafting material, but for the remaining 164 implants, no grafting material was utilized. Periapical radiographs were obtained with a paralleling technique and digitized. Two investigators, who were blinded to whether grafting material was used or not, subsequently evaluated the pattern of tissue remodeling.
Results: The mean residual bone height was 7.5 mm (SD 2.2 mm), ranging from 2 to 12.7 mm. The mean residual bone height for implants placed with grafting material (6.4 mm) was significantly less compared with the implants installed without grafting material (8.1 mm). The implants penetrated on average 3.1 mm (SD 1.7 mm) into the sinus cavity. The measured mean radiographic bone gain using the transalveolar technique without grafting material was significantly less, 1.7 mm (SD 2 mm) compared with a mean bone gain of 4.1 mm (SD 2.4 mm), when grafting material was used. Furthermore, the probability of gaining 2 mm or more of new bone was 39.1% when no grafting material was used. The probability increased to 77.9% when the implants were installed with grafting material.
Conclusion: When the transalveolar sinus floor elevation was performed without utilizing grafting material, only a moderate gain of new bone could be detected mesial and distal to the implants. On the other hand, when grafting material was used, a substantial gain of new bone was usually seen on the radiographs.     

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.