冲压式上颌窦底提升术同期种植临床分析

A clinical study of osteotome sinus floor elevation combined with simultaneous placement of implants

目的:探讨上颌后牙区采用冲压式上颌窦底提升术植骨与不植骨同期种植的效果。方法:2001年1月—2007年12月,共完成冲压式上颌窦底提升种植修复病例91例,男35例,女56例,随机分为2组,植骨组47例,植入57颗种植体;不植骨组44例,植入种植体51颗,共植入108颗种植体。上颌窦底剩余牙槽骨高度为5～11mm,提升幅度为2～6mm。平均随访56.8个月。35例患者(41颗种植体)于后期随访中行锥形束CT(CBCT)和根尖片,观察种植体新骨形成量和种植体突出窦底高度,应用SPSS17.0软件包对数据进行方差分析和t检验。结果:植骨组7颗种植体脱落,存留率为87.7%;不植骨组3颗种植体脱落,存留率为94.1%。CBCT扫描显示,提升幅度为2～4mm时,植骨组新骨形成高度为(2.7±1.3)mm,不植骨组为(2.4±1.5)mm,2组间无统计学差异;提升幅度为4～6mm时,植骨组新骨形成高度为(3.5±1.3)mm,不植骨组为(1.3±0.4)mm,植骨组比不植骨组新骨形成高度显著增加。结论:在上颌后牙缺失区采用冲压式上颌窦底提升、不植骨同期种植是安全可行的,植骨材料对于促进新骨形成并非必须,然而提升幅度较大时,植骨能获得更多的骨量。

PURPOSE： To evaluate the clinical effect of osteotome sinus floor elevation（OSFE） with or without bone grafting combined with simultaneous implant placement in the treatment of edentulous posterior maxilla.METHODS： A total of 108 implants were placed in 91 patients who underwent OSFE from January 2001 to December 2007.35 were male and 56 were female.The mean age was 44.6 years（between 21 and 60）.57 implants（47 patients） were divided into grafting group with Bio-Oss as a grafting material while 51 implants（44 patients） were divided into non-grafting group without grafting material.The residual bone height（RBH） was 5-11mm,and the elevation height was 2-6mm.The mean follow-up time was 56.8 months.Clinical examination and radiographs were conducted.Endo-sinus bone gain and implant length protruding into the sinus were measured on periapical radiographs and cone beam CT（CBCT） scanning among 35 cases（41 implants） during follow-up,analysis of variance and Student＇s t test were used to analyze the data with SPSS17.0 software package.RESULTS： Seven implants failed in grafting group,and 3 implants failed in non-grafting group,the overall 3-year survival rate was 87.7% and 94.1%,respectively.When sinus floor was raised by 2-4mm,the mean bone gain was（2.7±1.3）mm for the grafting group and（2.4±1.5）mm for non-grafting group.The difference in bone gain between the two groups was not significant.However,the bone gain for grafting group was significantly more（3.5±1.3）mm compared with non-grafting group（1.3±0.4mm） when raised by 4-6mm.CONCLUSIONS： It was predictable and safe when placing implant in the edentulous posterior maxilla after OSFE without grafting material.Grafting material is not necessary to promote osteogenesis beneath the membrane,however,it may gain more bone around implant endo-sinus when utilizing grafting material.