倾斜种植体在上颌后牙区骨量不足患者中的应用

Tilted implants treatment without maxillary sinus grafting in severely resorbed posterior maxilla

目的:探讨倾斜种植体作为一种避免上颌窦植骨的方法,应用于上颌骨后牙区骨量不足患者种植修复的可靠性。方法:2005年1月—2007年12月间,21例患者共27个固定桥修复上颌后牙缺失,分别使用ITI和Br覽nemark 2种种植系统共植入78颗种植体,其中34颗种植体采用倾斜植入,44颗轴向植入。所有患者均为上颌后牙区骨量不足无法直接接受常规种植体植入。种植体植入后常规愈合3个月,除1颗种植体失败外,其余种植体均功能性负载支持固定义齿修复,修复方式为黏结固位和螺丝固位。每例患者均于负载后12、24和36个月接受临床和放射学随访检查。采用SPSS11.0软件包对数据进行统计学处理。结果:上颌有1颗轴向种植体在术后2个月时失败,倾斜种植体无失败。随访时间为36个月。上颌轴向种植体的累积存活率为97.72%,倾斜种植体的累积存活率为100%,修复成功率为100%。随访期间,种植体周围软组织保持稳定,平均探诊深度和附着水平无明显变化。结论:倾斜种植体作为一种上颌骨后牙区骨量不足患者的治疗方法是可靠的,能有效避免植骨手术,并节约治疗时间。

PURPOSE：To evaluate the surgical outcome of tilted implants as an alternative to sinus grafting and the prosthodontic outcome of the bridges on tilted implants in severely resorbed posterior maxilla.METHODS：A total of twenty-one patients were rehabilitated with 27 fixed prostheses supported by 78 Brnemark and ITI System implants between January 2005 and December 2007.Forty-four implants were placed in an axial and 34 in a tilted direction.In these patients,the maxillary bone volumes were insufficient for conventional placement of implants to support a fixed prosthesis.After an average healing period of 3 months,all implants were functionally loaded with cemented bridges or screw retained bridges.Each patient was recalled at 12th,24th and 36th month for clinical and radiographic examinations.SPSS11.0 software package was used for statistical analysis.RESULTS： One of the 44 axial implants was lost 2 months postoperatively.After 3 years,the implant survival rate was 100% for the tilted implants and 97.72% for the axial implants,and the prosthesis survival rate was 100%.The peri-implant soft tissues were stable over time;the mean probing depths and mean attachment levels did not change during the follow-up period.CONCLUSIONS： This study demonstrates that patients with a severely resorbed maxilla can be treated successfully with tilted implant treatment;the use of tilted implants is an effective and safe alternative to maxillary sinus floor augmentation procedure.