上颌窦底提升术中Bio—Oss骨代用品成骨效果的初步观察

Maxillary sinus floor augmentation with Bio-Oss as a sole graft： a histoiogic, radiographic and preliminary clinical study

目的评价开窗法上颌窦底提升术中单纯Bio—Oss骨粉作为植骨材料的成骨效果和临床效果。方法9例患者（10侧）接受开窗法上颌窦底提升植骨术，采用单纯Bio—Oss骨粉作为植骨材料。术后5～11个月行延期种植体植入术，共植入Straumann种植体18枚。在种植区以环形钻获取骨组织标本，采用微型CT和组织学分析成骨效果。锥形束CT测量植骨区骨量变化；连续测量种植体稳定系数（implant stability quotient，ISQ）监测骨结合。影像学、微型CT及组织学结果采用t检验分析比较，种植体稳定系数采用双因素方差分析比较。结果9例患者中共获取14个骨组织标本。微型CT和组织学检测分别显示植骨区新骨形成率为（30．60±9．25）％和（25．36±4．20）％。锥形束CT测量显示经骨愈合窦嵴距提升至（13．68±1．95）mm。种植体愈合6个月后，ISQ由种植术后即刻71．94±6．51升至82．56±3．20（P〈0．05）。结论单纯应用Bio—Oss骨粉作为上颌窦底植骨材料能够获得良好的成骨效果。

Objective To evaluate new bone formation and preliminary clinical outcomes following maxillary sinus floor augmentation with Bio-Oss alone. Methods Nine patients were treated with ten maxillary sinus floor augmentations using Bio-Oss alone, and eighteen Straumann implants were placed. After five to eleven-month healing period at implant placement, cylindrical specimens were biopsied from the augmented area. The new bone formation of specimens was analyzed by histology and micro-computed tomography. Cone beam computed tomography （CBCT） scans were performed for measurements of residual erestal bone height under the sinus, the amount of increased height immediate after the augmentation and before implant insertion. To monitor stability changes, resonance frequency analysis was performed and implant stability quotient （ISQ） values were collected at implant placements （baseline ,0 month）, one month, three months and six months after placements. Results All implants were loaded six months after insertion and no failures were recorded. Compared to adjacent native bone, no significant differences of bone volume fraction were found in augmented area （ P 〉 0. 05 ）, together with lower trabecular number （ P 〈 0. 05 ） and trabecular thickness（ P 〈 0. 01 ） as well as higher trabecular separation （ P 〈 0. 01 ） by microradiographic analysis. Histomorphometrically, there was no significant difference in the amount of new bone formation between the adjacent native bone and augmented area （ P 〉 0. 05 ） . CBCT showed a bone height gain of （ 14. 19 ±2. 02 ） mm immediate after augmentation, which stabilized at （ 13.68 ±1.95 ）mm after bone healing period. Mean ISQ value was 71.94 ±6. 51 at baseline, decreased to 70. 19 ±6. 38 at 1 month, and increased to 78.17 ±3.83 at 3 month and 82.56 ±3.20 at 6 month. Conclusions The use of Bio-Oss as the sole graft is reliable and can lead to satisfactory bone formation and clinical outcome.