头后仰位骨钻磨除法提升上颌窦底同期种植术

Clinical Study of Maxillary Floor Augmentation by Drilling Crestal Bone Using Osseous Reamer and Implant Placement Simultaneously in Head Extension Position

【目的】为解决传统冲顶法提升上颌窦底易致上颌窦黏膜穿孔及适应证窄这一难题。【方法】自2010年10月至2015年4月,共收集患者37例,均为上颌后牙单牙或多牙缺失,剩余垂直骨高度（RBH）（5.32±2.14）mm。采用头后仰位常规骨钻磨除法提升上颌窦底黏膜,同期种植体植入。【结果】37例共植入种植体55枚,上颌窦底提升高度为（4.11±1.88）mm。其中2-4个位点连续提升7例,上颌窦底倾斜者16例,垂直骨量〈5 mm者11例。仅1例（1个种植位点）发生上颌窦黏膜穿孔,但并未影响种植体植入,穿孔率1.82%。所有病例术后未观察到明显的并发症及不良反应。其中30例（44枚种植体）已完成种植修复,平均追踪（18.21±1.44）个月,追踪期内无上颌窦并发症,种植体留存率100%。【结论】采用头后仰位常规骨钻磨除法行上颌窦底提升及同期种植体植入术创伤小,降低了上颌窦黏膜穿孔的几率,临床操作简单,可同时连续提升2-4个种植位点,对于上颌窦底倾斜、垂直骨量〈5 mm的病例亦适用,手术安全,可重复性好,近期临床效果可靠。

【Objective】 To evaluate a novel technique for elevation of the maxillary sinus floor to minimize sinus membrane perforation which easily occurred in traditional transalveolar technique and enlarge indications. 【Methods】 Between October 2010 and April 2015, a total of 37 patients with 55 posterior maxillary teeth missing were enrolled in this study. The residual bone height（RBH）was（5.32 ± 2.14） mm. Sinus floor augmentation was finished by drilling crestal bone using regular implant instruments in head extension position, and implants were placed simultaneously. 【Results】 55 implants were placed in 37 cases of which 7 cases were two to four consecutive augmentation, 16 tilting sinus and 4 cases with residual bone high less than 5 mm. Mean height of sinus elevation was（4.11 ± 1.88） mm. Membrane perforation occurred in only one site without affecting implant placement and perforation rate was1.82%. Only minor complications were observed postoperatively. 30 cases 44 implants were restored and no implant lost was observed during the（18.21 ± 1.44） month follow-up. 【Conclusions】 Maxillary sinus floor augmentation by drilling crestal bone using regular instruments in head extension position reduced the risk of perforation. The new technique applied to cases of consecutive augmentation,tilting sinus and residual bone high less than 5 mm. It may provide a new option for minimally invasive transcrestal sinus surgery and may represent a safe and predictable method in the atrophic posterior maxilla.