钛网连接固定种植体增强初期稳定性的临床应用

Clinical application of titanium mesh with fixed dental implant increases initial-stage stability

背景:上颌后牙缺失后,部分病例出现上颌窦底剩余牙槽骨骨高度极端不足,如何做到简单、快捷、有效的进行种植修复是正在努力探索的课题,通过钛板或钛网固定种植体获得足够的初期稳定性,缩短治疗周期同时提高成功率是目前探索的方向之一。目的:探讨在上颌窦底剩余骨量极端不足(1～3mm)时,上颌窦外提升同期牙种植术中应用钛网连接固定种植体增强种植体初期稳定性的可行性。方法:24例上颌后牙缺失患者,上颌窦底剩余牙槽骨量1～3mm,进行上颌窦外提升术植骨,同期植入Straumann种植体63颗,术中采用钛网辅助增加种植体初期稳定性,术后6个月上部结构修复,随访30个月。结果与结论:术中种植体扭力均达到10N·cm以上,与未连接钛网前术中种植体扭力值比较,差异有显著性意义(P<0.05);6个月后种植体ISQ值为69.78±4.78;负载24个月时种植体末端骨厚度(2.53±0.36)mm,与刚植入时比较差异无显著性意义(P>0.05);种植体边缘骨吸收(1.07±0.40)mm;术中未发生上颌窦黏膜破裂,观察期内种植体稳固,种植体周围组织健康,没有脱落现象,上部结构修复后咀嚼功能恢复满意;X射线检查种植体与骨结合紧密,种植体周围未见骨低密度影,无上颌窦炎症影像;2例在上部结构修复完成后失访。结果表明上颌后牙缺失2个以上牙位,上颌窦底剩余骨高度在极度不足(1～3mm)情况下,尽可能采用大直径的Straumann黏膜水平即刻种植体,同时采用钛网辅助增加初期稳定性,可以进行上颌窦外提升同期牙种植,获得理想的近期临床效果。

BACKGROUND：After maxillary posterior tooth missing,height of the remaining alveolar bone at the bottum of maxillary sinus occurred shortage displayed in some cases.How to do a simple,quick and effective restoration is the subject of exploration which dentists work hard to achieve.Shorter treatment cycles and increase of the success rate by titanium plate or titanium mesh fixed dental implant to obtain enough initial stage stability in operation is under exploration.OBJECTIVE：To investigate feasibility of applying titanium plate or titanium mesh fixed dental implant to increase the initial stage stability in the sinus surgery at the same time dental implantation to solve extreme shortage of bone height at the bottom of the maxillary sinus（1-3 mm）.METHODS：Twenty-four cases of maxillary posterior tooth loss,with remaining maxillary alveolar bone at the bottom of maxillary sinus about 1-3 mm,underwent bone graft surgery outside the maxillary sinus,63 Straumann implants were embedded at the same time.Titanium meshes were applied to increase the initial stage stability in operation.Upper structure was restored 6 months after operation.Follow-up remained 30 months.RESULTS AND CONCLUSION：Torque of implants have reached more than 10 N·cm in operation.Compared with those implants without connection titanium meshes,the difference of torque values was statistically significant（P 0.05）;implant ISQ value was 69.78±4.78 after 6 months;the thickness of implant end bone was（2.53±0.36） mm after loading for 24 months,compared with the values during just implantation,there was no significant difference（P 0.05）;implant marginal bone resorption was（1.07±0.40） mm;none of these cases exhibited rupture of maxillary sinus mucosa in operation.Implants were stable during observation period,its surrounding tissues were healthy without any loss.The patients were satisfactory for masticatory function after upper structure restoration.X-ray examination showed bone and grafts linked closely together,without peri-implant bone density shadow or maxillary sinus inflammation images.Two cases were lost in follow-ups after upper structure restoration.Results demonstrated that when patients have two or more maxillary posterior teeth missed and under extreme shortage（1-3 mm） of bone height at the bottom of the maxillary sinus,it is recommended to apply large-diameter Straumann mucosa immediate implant,at the same time,utilizing titanium meshes as an assist to achieve the initial stability of implants.Sinus surgery complying with dental implantation could obtain ideal short-term clinical results.