盘钻法和冲顶法提升上颌窦底的临床对比观察

The clinical comparison of maxillary sinus floor elevation by the Disk-up Sinus Reamer(DSR) and bone condensers

目的比较盘钻法和冲顶法行上颌窦底提升并同期植入种植体的临床疗效。方法上颌后牙缺失患者58例,种植区剩余牙槽嵴高度不足,且需要行上颌窦提升,按照随机分组原则将其分为A、B两组,每组29例。A组采用盘钻法,同期植入种植体47枚,B组采用冲顶法,同期植入种植体51枚。术后即刻评估种植体稳定度及患者舒适度,术后3～6个月行上部结构修复,术后3～24个月随访观察种植体稳定性、骨结合及种植体周围骨量变化情况。结果 A组术中提升上颌窦底高度为3～8mm,平均(4.87±1.38)mm,患者主观感觉良好,痛苦指数平均为(1.86±0.88)。B组术中提升上颌窦底高度为3-7mm,平均(4.63±1.17)mm,患者主观感觉较差,痛苦指数平均为(3.97±1.57)。A、B两组术后3、6、12个月骨吸收高度有差异。术中所有病例均未发生上颌窦黏膜穿孔。随访期间,所有病例均未出现种植体松动、脱落及上颌窦炎发生,X线检查示:种植体与周围组织均形成良好的骨性结合。结论盘钻法和冲顶法行上颌窦底提升术并同期植入种植体均取得较好的近期临床效果,其中盘钻法术中痛苦指数较小,术后骨吸收量较少,具有明显的临床优越性。

Objective：To compare the clinical effect of maxillary sinus floor elevation by the Disk-up Sinus Reamer（DSR） and bone condensers with simultaneous placement of implants.Methods：58 patients underwent maxillary sinus floor elevation.According to the principle of random group which is divided into two groups,the Disk-up Sinus Reamer（DSR）for group A with 47 implants were inserted,the bone condensers for group B with 51 implants were inserted.The safety of the technique and the pain index during the operation was evaluated.The final prostheses were restored in 3-6 months postoperatively.The follow-up period was 3 to 24 months.The stability and osseointegration of the implants were clinically evaluated,and the endo-sinus bone gain around the implants were measured.Results：Group A of the elevation height ranged from 3 to 8 mm,with an average of（4.87±1.38）mm,no serious suffering or uncomfortable subjective sensation in any patients during operation with a pain index of（1.86±0.88）.group B of the elevation height ranged from 3 to 7 mm,with an average of（4.63±1.17）mm,serious suffering or uncomfortable subjective sensation in some patients during operation with a pain index of（3.97±1.57）.the height of bone loss was different between the group of A and B.During the follow-up period,no sinus complication was observed.X-ray showed good osseointegration.There were no implants or prostheses which were loose or lost.Conclusion：With DSR and bone condensers,maxillary sinus floor elevation with simultaneous placement of implants show satisfactory clinical results in short term,the technique by the DSR with higher elevation height,fewer clinical complications and less pain.