Sinustech上颌窦底开孔钻在种植中的应用

Clinical application of maxillary sinus lift with sinustech reamer

目的:观察上颌窦底开孔钻在种植上颌窦提升手术的临床应用效果。方法:9例种植修复上颌后牙缺失需要上颌窦提升手术患者,男7例,女2例,平均年龄51.6岁,平均牙槽骨高度7.8mm。通过CT扫描三维重建分析、模型手术分析精确测量种植区域牙槽嵴顶到上颌窦底的距离,计算出种植体与上颌窦底的接触位置,测量种植体这一位置的直径,再通过骨质分类预定好上颌窦底开孔直径,制作种植手术导板进行种植导航手术,先用先锋钻钻至距上颌窦底1mm深度,然后换上选定直径的上颌窦底开孔钻,逐级扩大种植窝洞同时收集开孔钻槽沟上的自体骨屑,最后将种植窝洞预备到术前设计的直径并将上颌窦底皮质骨钻开一定直径大小的圆孔,提升上颌窦粘膜后植入收集到的自体骨或/和人工骨后安放种植体,检查初期稳定性。术后即刻CT检查植入方向、植骨情况、粘膜穿孔情况。结果:上颌窦底开孔后粘膜完整,种植体初期稳定性好;CT检查种植体与骨组织接触紧密,种植体尖端为骨粉和粘膜覆盖包绕,粘膜完整连续无破溃。结论:通过螺旋CT三维重建分析和快速成型模型手术来获得牙槽嵴顶到上颌窦底的精确距离对于用上颌窦底开孔钻在上颌窦底钻出特定直径的孔至关重要,没有骨折的上颌窦底骨质能增强种植体初期稳定性,术中取出自体骨屑可以减少人工骨粉的使用,提升术中粘膜完整无穿孔,方法简便安全,值得推广。

Objective：To introduce and evaluate the use of Sinustech reamer in clinical surgery of maxillary sinus lift.Methods：9 patients,7 men and 2 women,with an average age of 51.6 years and an average alveolar bone height of 7.8 mm in the maxillary posterior region,received sinus lift with the application of Sinustech reamer.Accurate measurement of the distance between top of the alveolar bone and the sinus floor,and calculation of the precise contact positioning between the implant and the sinus floor were achieved by using a CT scan based three-dimensional reconstruction analysis combined with simulating model operations.The diameters of the implant and the hole to which it is to be implanted were decided according to the quality of the alveolar bone in the patient.This was followed by the fabrication of a surgical guide.Osteotomy preparation and implant placement were then performed using the surgical guide aided by surgical navigation instrumentation：after placing stably the surgical guide,a 2.2 mm twist drill was applied to drill the top of alveolar bone,stopping at a distance less than 1 mm from the sinus floor.A Sinustech reamer with proper diameter was used to cut a hole in the sinus floor with a diameter determined in simulating model surgery.At the same time the sinus membrane was lifted,allowing collection and grafting of the autogenous bone debris attached to the reamer blade,with or without the addition of artificial bone powder used for grafting.Finally the implant was introduced and its initial stability checked.This was followed by immediate CT scan to perform a thorough examination on the placement,positioning,depth,angulation,and hex-orientation of the implant,and on the intactness of the sinus membrane.Results：after the sinus floor surgery no damage or laceration of the sinus membrane was observed.The CT scan showed a compatible and tight imbedding of the implant to the alveolar bone tissue,with the root tip of the implant covered by grafted bone powders and intact membranes.Conclusions：establishment of the precise distance from top of the alveolar bone to the sinus floor,using the CT scan based three-dimensional reconstruction analysis and the simulating model operations,is the key for the success of using Sinustech reamer to operate on sinus floor with required diameter.A sinus floor without any fracture is critical for the good stability of the implant.By collecting the autogenous bone debris on sinus reamer blade and grafting them back into the sinus,not only the cost of using artificial bone powder was reduced,but the membrane intactness was also enhanced.The entire procedure was found to be safe,simple and straightforward,demonstrating a good potential for wide introduction and application.