上颌窦底微创提升的短期临床疗效评价

Short-term clinical evaluation of minimally invasive osteotome sinus augmentation technique with minimal crestal bone

目的通过临床试验评估一种上颌窦底微创提升技术的疗效。方法试验组11例患者的上颌后牙区行上颌窦底微创提升技术并同期植入短种植体14枚。对照组10例患者进行了使用扩孔钻的上颌窦冲顶技术并同期植入短种植体13枚。两组患者术后6个月行暂冠修复,进行咬合训练及软组织塑形,3个月后永久修复。术后定期复诊,检查患者的上颌窦、种植体骨结合情况,并使用锥形束CT(CBCT)测量骨增量水平。结果试验组及对照组均无种植体松动、脱落及上颌窦炎发生,CBCT显示种植体与周围组织形成良好的骨性结合。经2～28个月随访观察,临床效果良好。试验组和对照组平均窦底垂直骨增量分别为5.87和5.45 mm。结论上颌窦底微创提升联合短种植体同期植入是一种创伤小、操作简单、行之有效的上颌后牙区种植外科技术,可用于上颌窦底垂直骨量严重不足,余留牙槽骨高度不足4 mm的病例。

Objective To introduce a minimally invasive technique of osteotome sinus floor elevation（OSFE） combined with simultaneous short implant placement to treat edentulous posterior maxilla subject to severely insufficient bone height and evaluate its clinical effects in a prospective study. Methods All implants were placed following a one-stage protocol（elevating the sinus floor and placing the implant simultaneously）. A total of 14 short implants were placed in the posterior maxilla of 11 patients using trephines. The temporary crowns were fixed six months after the surgery for bite training and soft tissue reformation. The final prostheses were restored three months later. The stability and osseointegration of the implants were clinically evaluated, and the endo-sinus bone gain around the implants was calculated through cone beam computed tomography measurement. Results The mean observation follow-up period was 12 months（with a range of 2 months to 28 months）. The survival rate was 100% during the study period. Each of the implants was clinically stable and was successfully loaded without pain or any subjective sensation. No implant had detectable sinus membrane perforation during the operation. Radiographic results demonstrate that the endo-sinus bone gains of the two groups were 5.87 and 5.45 mm. Conclusion Based on the results of the present study, short implant placement in conjunction with the OSFE could yield predictable clinical results for the edentulous posterior maxillary region with the residual bone height of less than 4 mm. The proposed technique represents a feasible modality for the treatment of severely atrophic posterior maxilla. In addition, from the clinical point of view, the proposed technique may reduce indications for complex invasive procedures, avoid bone material graft, and simplify treatment in the posterior.