上颌后牙区种植修复后6～9年临床疗效观察

A 6 ~ 9 years retrospective clinical study of implant in sinus-lifted maxillary bone

目的:评价上颌窦提升术应用于上颌后牙区垂直骨量不足的种植义齿功能负载6~9年的临床疗效。方法:收集2007~2010年上颌后牙区牙齿缺失行种植义齿修复患者69例,共植入种植体95枚,根据术前剩余牙槽骨高度(RBH)不同分为上颌窦提升术植骨组(A组)27例38枚,上颌窦提升术未植骨组(B组)17例24枚,常规种植组(C组)25例33枚,平均随访85.4个月,评估种植体存留率、种植体周围软组织状态、患者满意度、边缘骨吸收(MBL)、植入骨粉变化、上颌窦底位置变化等指标。结果:95枚种植体中有2枚在术后6个月脱落,存留率97.9%;三组患者对种植修复满意度评分为:(30.5±4.7)分、(29.27±5.34)分、(29.54±5.14)分,不同术式间满意度无差异;术后6~9年随访,种植体周围软组织状态良好,三组间无统计学差异;术后6个月,A、B、C三组种植体近远中边缘骨平均吸收为:(0.26±0.43)mm、(0.35±0.37)mm、(0.50±0.61)mm,结果有统计学差异;术后6~9年随访时,A、B、C三组种植体近远中边缘骨平均吸收为:(1.45±1.20)mm、(1.47±1.64)mm、(1.57±1.51)mm,结果有统计学意义,不同术式间边缘骨吸收无差异;术后A组上颌窦底位置上升,术后6个月为(1.42±2.23)mm,术后6~9年为(1.95±1.87)mm,且有统计学差异,其他两组差异无统计学意义。A组植入骨粉在术后6个月平均剩余64.23%,6~9年剩余6.56%。结论:对垂直骨量不足的上颌后牙区种植修复术后6-9年的远期临床疗效良好,上颌窦底位置上升率较高,所植骨粉大部分被吸收。

Objective： To evaluate the clinical effect of dental implantation in patients who missed at least one maxillary posterior tooth with insufficient maxillary bone volume over a time period of 6-9 years.Methods： In this study,69 patients suffered from maxillary posterior teeth loss were enrolled,with 95 dental implants inserted from2007 to 2010.For group A,27 patients were placed 38 implants via maxillary sinus floor lift with bone grafts technique.For group B,17 patients were placed 24 implants via maxillary sinus floor lift without bone grafts technique.For group C,25 patients were placed 33 implants positioned in native areas beneath the sinus.All patients were followed up for 72 to 108 months after surgery.The aspects of implant survival rate,peri-implant soft tissues status,patients＇ satisfaction degree,marginal bone loss,bone substitutes volume and maxillary sinus floor level were evaluated.Results： The total implant survival rate showed 97.9% with 2 implants failed in 6 months after surgery.There was no difference of patients＇ satisfaction degree among group A,group B and group C.Similarly,no difference of peri-implant soft tissues was found,which kept in good condition at 6 - 9 years after surgery.MBL was discovered with significant difference between 6 months and 6 - 9 years in the three groups and was not associated with types of surgery.Large parts of maxillary sinus floor were risen for group A.We found that the volume of graft materials remained 64.23% at 6 months and 6.56% at 6 - 9 years after surgery.Conclusion： The results suggest that implants in sinus-lifted maxillary bone achieve good clinical effect during the 6 - 9 years follow-up.The rate of rising maxillary sinus floor is increased after bone graft but bone substitutes are absorbed at a high proportion.