上颌窦底提升术的临床研究

A clinical study of maxillary sinus lift with implants

目的:研究比较上后牙缺失后牙槽嵴高度不足时根据上颌窦底牙槽嵴骨高度不同,选用不同术式和不同充填材料提升上颌窦底,进行种植修复的治疗效果。方法:89例上后牙缺失的患者,其中68例窦底牙槽嵴骨高6-10mm者行闭合冲压上颌窦底提升术,其余21例骨高2-5mm者行开窗植骨上颌窦底提升手术,同期完成一期种植手术86例,二期完成种植手术3例。充填材料有自体颗粒骨、人工骨粉或者自体颗粒骨加人工骨粉。结果:所有患者术后未出现上颌窦炎症,21例行开窗植骨上颌窦底提升手术的患者2例术中窦膜穿孔,以可吸收生物膜修补后同期完成种植手术。平均提升窦底高度5.8mm,59颗种植体有1颗松动失败,其余种植体平均负载23个月,种植体稳定,骨结合状况良好。68例行闭合冲压上颌窦底提升术的患者,平均提升窦底高度4.1mm。植入术中有3例发生可察觉窦膜破孔,3例术后2天内鼻腔少量自发性渗血,其余无明显症状。在121颗种植体中,有2颗种植体失败,119颗种植体平均负载15个月,种植体稳定,未见明显骨吸收。结论:临床上上颌窦底骨高度不足的情况应根据上颌窦底骨高度不同,选用开窗植骨或闭合冲压提升上颌窦底,并根据需提升高度不同选用不同的充填材料,大多数可以同期种植。

Objective:To study the effect of maxillary sinus lift or internal sinus floor elevation with different grafting materials in placement of implants according to different height of alveolar ridges.Methods:All 89 patients suffered the loss of posterior teeth of up jaws.68 cases whose bone height of maxillary sinus floor was between 6-10mm underwent internal sinus floor elevation,and another 21 cases whose bone height between 2-5mm underwent maxillary sinus lift with autogenous bone graft or composite bone graft.86 cases were simultaneously placed implants and 3 cases were delayed for the placement of implants.Results:There were no clinical complaint of maxillary sinusitis for all of cases.21 cases who underwent maxillary sinus lift had the mean increase in height of the implant sites was 5.8mm.Two cases of them had detectable Schneiderian membrane perforation during operation procedure,and the membrane perforations were repaired with absorbable bio-membrane.All 58 implants have loaded for 23 months and were very stable,and showed well osseointegration on X-ray examination.One implant was lost.68 cases who underwent internal sinus floor elevation showed the mean increase in height of the implant sites was 4.1mm.There were 3 cases had detectable Schneiderian membrane perforation during operation procedure,and 2 implants lost in all of 121 implants.The rest implants(119)have loaded for 15 months and were very stable,and showed well osseointegration on X-ray examination.Conclusion:Two sinus lift approaches show desirable clinical results based on different alveolar ridge height of maxillary posterior region in cases.Most of the cases were simultaneously placed implants.