冲顶式上颌窦提升的临床评价及相关问题探讨

The clinical evaluation on maxillary sinus elevation with simultaneous implantation with osteotome and discussion of relevant questions

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24h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。

Purpose:It was the aim of the present study to clinically evaluate the therapeutic effect and relevant influence factors of maxillary sinus floor elevation with simultaneous placement of implants from the top of alveolar ridge.Methods:25 patients underwent maxillary sinus floor elevation with simultaneous placement of implants from the top of alveolar ridge using autogenous and xenogenic bone meal.51 implants were inserted and restored.The follow-up time after operation was 1-3 years.Results:All the patients with 4-8.9mm height of residual bone in the posterior maxilla underwent sinus floor elevation with simultaneously implant placement.With this procedure,the gain of sinus elevation ranged from 2 mm to 6 mm,the average augmentation being 3.98mm.The implant lengths ranged from 8 to 13mm.The average of lengths is 11.5mm.No sinus complication was observed during the follow-up period.There were a total of 3 failure due to failed to osseointergration before second-step prosthesis.After extracting loosening implants,two of them were implanted again and X-ray showed well osseointergration.All the patients had finished fixed partial prosthesis in 6-18 months postoperatively.There were no implant or prosthesis loose or lost during the follow-up term.Conclusion:Compared with lateral window tenique,the osteotomes sinus floor elevation technique allows for shorter post-treatment waiting times,provides a less invasive approach,avoids a second surgical sites,and reduces operation time,cost and inconvenience of patients.And so it can be used predictably for implant placement at sites with moderate vertical deficiencies in the posterior maxilla.