骨挤压器在不开窗上颌窦底提升后种植术中的应用

目的:介绍采用骨挤压器从牙槽嵴顶入路提升上颌窦底后植入种植体,观察该方法窦底提升后种植的临床效果.方法:术前在曲面断层片和种植区牙片上测量牙槽嵴顶到上颌窦底的距离,对40例经测量后预计种植体植入后将超出上颌窦底,但超出窦底距离不多于4mm的接受种植术患者,自牙槽嵴顶制备种植体洞型,在距离上颌窦底约1毫米时停止,换用固定了止停器的骨挤压器轻力敲击加压,穿破上颌窦底骨壁,在不损伤窦底粘膜的情况下植入种植体。结果:用此方法植入的种植体共59枚,种植体初期稳定性良好。术后X光片测量显示,种植体超出上颌窦底最大距离4.5毫米,平均超出2.3毫米。种植后3-6个月进行上部修复。共三枚种植体二期修复前没有骨结合取出,一枚种植体修复后一年半种植体松动拔除。其余种植体观察6个月-4.5年骨结合良好。结论:本方法能有效提高窦底距离1-4毫米,不需要从颊侧开窗进行上颌窦底提升手术,具有创伤小,方法简单可靠的特点,患者易于接受。

The Use of Osteotomes for Sinus Floor Elevation without Door Open from Maxillary Sinus Wall at the Time of Implant Placement

Objective: Introduce the use of osteotomes to elevate the sinus floor from alveolar ridge at the time of implant placement .Observe the clinical effect after implant.Method: There are 40 patients between 22 and 68 years old using osteotomes to lift the sinus floor before implant placement . All these patients are taken X-ray before the surgical procedure. A tomogram obtained with a 5mm diameter steel ball in place that there was insufficient bone height to place implant. The vertical bone height between the residual crest and the sinusal membrane for primary stability must more than 5mm, but no enough to place 8-13mm long implant. Prepare the implant hole with pilot drill ,along with direction indicators and the depth of measurement result of X-ray. According to the calculate result , stop the pilot drill when there is still about 1mm distance to the sinus floor. Take another X-ray immediately when near the sinus floor , make sure that the distance from the tip of hole to the sinus floor is up to 1mm. Change different drills to enlarge the hole until the needed diameter . Using osteotome to punch the sinus bone floor and put the implant inside the hole.Result: There are 59 implants were placed in maxillary sinus area. All the implants get good primary stability .The length of implant is from 8mm to 13mm. X-ray after implant show that the large distance of implant over the sinus floor is 4.5mm ,the average height of 59 implants is 2.3mm.Crowns were fixed after 3-6 months later .There were a total of 4 failures : 3 implants failed to integrate before 2 stage ,1 implant was lost within the first 18 months of loading. Others follow -up for 6 to 54 months.Conclusion: The osteotomes sinus floor elevation technique may be used successfully for the placement of different implants .It allows for shorter post-treatment waiting times and provides a less invasive approach compared to other methods. This method also avoids a second surgical sites , and reduces operation time ,cost and inconvenience to the patient.