经牙槽嵴顶上颌窦底提升术中骨替代材料应用的临床疗效观察

Comparison between Bone Substitute Materials in Transcrestal Sinus Floor Elevation

目的：对比经牙槽嵴进顶行上颌窦底提升术时使用或不使用骨替代材料的临床效果及义齿功能的使用情况。方法：2013-01—2014-09期间,于同济大学附属口腔医院种植科行经牙槽嵴顶上颌窦底提升术,并同期植入种植体的患者共57例、73枚种植体。其中23例、34枚种植体在上颌窦底提升术的同时使用骨替代材料。34例、39枚种植体在经上颌窦底提升术的同时未使用骨的替代材料。分别在术后3、10 d,义齿负载后6~18个月进行随访。通过临床观察和CBCT影像学检查对患者种植术后软硬组织进行评估,采用视觉测量尺（visual analog scale,VAS）获得患者满意度。结果：经牙槽嵴顶提升同期植入骨替代材料的研究组可用骨高度为2.01~7.53 mm,平均值（5.62±1.61）mm,平均提升高度为（7.30±1.95）mm;未植入骨替代材料的研究组可用骨高度为3.98~9.24 mm,平均值（6.29±1.47mm）,平均提升高度为（3.33±1.27）mm。术后经植入骨替代材料的25名患者中,8例患者出现软组织红肿,占34.78%;未植入骨替代材料的34名患者中仅3例患者出现术区软组织红肿,占17.65%。两组患者均无面部肿胀、术区软组织红肿及愈合不良等情况。未植入骨替代材料组患者的满意度度平均值为7.29,较同期植入骨替代材料组患者的满意度5.61相比更高。义齿负载6个月以上,两组的种植义齿周围软组织探诊深度值以及种植体周骨组织吸收量的差异比较,均无统计学意义（P〉0.05）。结论：经牙槽嵴顶行上颌窦底提升术时,无论是否使用骨替代材料,在影像学检查中上颌窦内均可见新骨形成。与使用骨替代材料相比,经牙槽嵴顶行上颌窦底提升术时不使用骨替代材料,患者的术后反应小,患者的主观满意度更高。

Objective： To compare the clinical effects and denture functions about the transcrestal sinus floor elevation with or without bone substitute materials. Methods： 57 patients from January 2013 to September 2014 were enrolled in this retrospective study. According to different surgical methods, the patients were divided into two groups： normal group A （23 patients and a total of 34 implants） of the transcrestal sinus floor elevation with using bone substitute materials; improved group B （34 patients and a total of 39 implants） of the transcrestal sinus floor elevation without using bone substitute material. The follow-up were carried out at 3 d and 10 d after the surgery and 6-18 months after the denture loading. Clinical observation and CBCT examination were performed to detection the hard and soft tissue. The satisfaction of patients were gained by Visual Analog Scale （VAS）. Results： In normal group A, the average residual bone height was （5.62±1.61） mm （ranged 2.01-7.53 ram）, and the average sinus floor lift height was 7.30±1.95 mm. In improved group B, the average sinus floor lift height was （6.29±1.47） mm, the average residual bone height was （3.33±1.27） mm. 8 patients （34.78%） showed soft tissue swelling in normal group, while only 3 patients （17.65%） swelling in improved group. VAS of patients in normal group was 7.29 as compared to improved group patients （5.61）. After denture loading of 6 months, the comparison of diagnosis depth of the peri-implant soft tissue and bone absorption of peri-implant have no statistical significance （P〉0.05） between the two groups. Conclusion： Using the transerestal sinus floor elevation, we can effectively see the forming of new bone in the maxillary sinus by image examination. During the transerestal sinus floor elevation, patients without using bone substitute materials （improved group） seems have less postoperative inflammation and higher satisfaction than those who using bone substitute material （normal group）.