上颌窦底冲压提升法种植修复122例缺牙的临床观察

Evaluation of clinical results on osteotome sinus floor elevation and dental implant placement (122 cases report)

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。

Objective To evaluate the clinical results of osteotome sinus floor elevation technique in the posterior maxillary region. Methods A total of 122 patients underwent osteotome sinus floor elevation from July 1998 to July 20（0, Forty-eight cases were male and 74 were female, The mean age was 46. 5 years （between 20 and 69）. A total of 157 implants were placed and restored, The mean follow-up time was 29. 7 months （between14 and 84 months）. Clinical examination and radiographs were conducted. All the patients with 8-11 mm height of residual bone in the posterior maxilla underwent sinus floor elevation and implant placement using osteotome without any bone grafts simultaneously. The elevation height was 2-5 mm. Healing abutments were connected at the same time of implant placement with insertion torque over 0. 25 N · m and the final prostheses were restored after 3-4 months. Implants were submerged if the insertion torque was less than 0. 25 N ·m. Second-stage operation was conducted 3-4 months later and the implants were restored afterwards. Results Sinus membrane perforation was observed in 12 cases, no sinus complication was observed during the follow-up. All of the 157 implants gained osteointegration and were restored. No implant lost was observed during the follow-up. All the patients were satisfied with the final prostheses. Conclusions Osteotome sinus floor elevation without any bone graft was a predictable and safe technique. It could be used in the maxillary posterior area implant placement with residual bone volume of 8-11 rnm.