上颌磨牙区新鲜拔牙创骨质条件不良的即刻种植

目的探讨在上颌磨牙区上颌窦底骨质菲薄的拔牙创，开展即刻种植的可行性。方法收集上颌磨牙区上颌窦底骨质间隔菲薄的拔牙病例，实施同期上颌窦底内提升并即刻种植，观察植体初期稳定性的形式及效果，观察伤口生长及植体愈合情况，观察上颌窦的变化情况。术后六个月制作并佩戴种植牙冠，观察咀嚼功能恢复情况，MCT观察牙槽骨质生长情况并测试比较手术前后牙槽骨的变化。结果共收集32例上颌窦底骨质薄弱的上颌磨牙区拔牙病例实施即刻种植，平均年龄59.8岁。植体长度8.5~10 mm，直径4.5~5.5 mm。植体的最小就位扭力仅依靠手指就位能够维持静立不动，最大就位扭力达到30 Ncm。术后过程平稳，无植体松动失败。术后6月，上颌窦未见异常表现，完成种植牙冠制作佩戴，恢复咀嚼功能良好。随访时间12~96月，成功率100%。治疗前后，颊、腭及近、远中牙槽嵴高度变化差值分别为0.8069±0.6253（t=1.2904, P>0.1）、0.5275±0.3331（t=1.5836, P>0.05）、0.5416±0.4048（t=1.3379, P>0.05）、0.5172±0.3874（t=1.3351, P>0.05）mm，牙槽嵴宽度变化差值为0.5522±0.4381（t=1.2604, P>0.1）mm，术前后牙槽骨尺寸变化差异没有统计学意义（P>0.05）。结论在上颌磨牙区拔牙创骨质条件欠佳、上颌窦底骨质薄弱的情况下实施即刻种植，即可以避免损伤上颌窦底粘膜又能达到良好的种植效果。手术过程简单、创伤小，充分利用了现存牙龈以及牙槽嵴的有利条件，维持了牙槽嵴的形态，避免了延期种植的缺陷和不足。

Immediate implantation following tooth extraction in fresh maxillary molar socket withpoor bone quality

Objective To explore the feasibility of immediate implantation after tooth extraction in the maxillary molar socketwith poor bone quality beneath the sinus. Methods We collected the data from the patients undergoing extraction of maxillarymolars with poor bone quality between the sockets and sinuses. Sinus lifting and immediate implant following the extractionwere performed simultaneously in these cases, and the primary stability of the implants, wound healing, and changes of thesinus were observed. At 6 months after the operations, the crowns were installed on the implants. The masticatory functionwas observed, and the growth of the alveolar bones and their changes after the operations were examined using microcomputedtomography (MCT). Results We analyzed 32 extraction cases with immediate implantation in the maxillary molarsockets with poor bone quality beneath the sinus. The average age of the patients was 59.8 years, and the length and diameterof the implant ranged from 8.5 to 10 mm and from 4.5 to 5.5 mm, respectively. The torque force of the implants varied fromthe minimum (in which cases the implants remained fixed after insertion with fingers) to the maximum of 30 N · cm. Thepostoperative recovery was uneventful in all the cases and no failed or movable implants were found. At 6 months after theoperation, none of the patients showed abnormalities in the sinus, and in all the cases the crowns were successfully installedon the implants with good recovery of the masticatory functions. Follow-up of the patients for 12 to 96 months after theoperation showed successful immediate implantation in all the cases. After the operation, the changes of the mean alveolarridge heights on the buccal, palatal, mesial, and distal sides of the patients were 0.8069±0.6253 mm (t=1.2904, P>0.1), 0.5272±0.3331 mm (t=1.5836, P>0.05), 0.5416±0.4048 mm (t=1.3379, P>0.05), and 0.5172±0.3874 mm (t=1.3351, P>0.05), respectively; thechange of the alveolar ridge width was 0.5522±0.4381 mm (t=1.2604, P>0.1) mm. The dimension of the alveolar bone underwentno significant changes after the operation in these patients. Conclusion Immediate implantation in the maxillary extractionsocket with a poor bone quality can avoid damages to the sinus and achieve good outcomes with such advantages of lesstrauma, full use of the innate gingiva and alveolar ridge, and well preserved morphology of the alveolar ridge as comparedwith delayed implantation.