低矮上颌窦底内提升同期种植术植骨与不植骨的临床观察

Clinical study of low maxillary sinus floor elevation and implant placement by osteotome with or without graft materials

目的观察低矮上颌窦行内提升同期植入种植体,使用和不使用植骨材料情况下种植体根尖新骨形成情况及种植体存留率。方法对共60例剩余牙槽骨高度在2~4 mm的患者行上颌窦内提升同期种植术,采用抽签法随机分为实验组和对照组(每组30例)。实验组30例患者使用植骨材料并同期植入30颗种植体;对照组30例患者未使用植骨材料并同期植入30颗种植体,术后2周和3年分别进行锥形束计算机断层扫描(cone beam computed tomography,CBCT)影像学分析上颌窦内种植体周围的骨量情况,并统计术后3年种植体存留状况。结果在手术过程中,实验组1例上颌窦黏膜穿孔,穿孔率为3.3%;对照组未发现上颌窦黏膜穿孔,穿孔率为0%,两者间差异无统计学意义(P>0.05)。术后3年实验组上颌窦内平均新骨形成高度为(4.46±0.98)mm,对照组上颌窦内平均新骨形成高度为(3.36±0.73)mm,两者间差异有统计学意义(P<0.05)。实验组30颗种植体未见松动脱落,3年种植体存留率100%;对照组30颗种植体中1颗在术后2个月时因种植体松动取出,3年种植体存留率96.7%,两者间差异无统计学意义(P>0.05)。结论低矮上颌窦行内提升同期植入种植体,使用植骨材料的种植体周围新骨形成效果比不使用植骨材料者更为理想,但3年后种植体存留率两者间差异无统计学意义。

Objective To observe the endo-sinus bone gain around the apex of implants and the survival rate in low maxillary sinus by osteotome sinus floor elevation and simultaneous implants placement with or without graft materials. Methods Total of 60 low maxillary sinus with residual bone height between 2-4 mm. Patients were randomly assigned into two groups. Trial group： 30 patients received 30 implants by sinus lift technique with graft materials; Control group： 30 patients received 30 implants by sinus lift technique without bone materials,after 2-week and 3-year loading,cone beam computed tomography（ CBCT） was used to measure the endo-sinus bone around the apex of implants and check the survival rate of implants. Results During the operation,1 cases of maxillary sinus mucosa perforation were found in the trial group,the perforation rate was 3. 3%; the perforation rate of the control group was 0%,there was no significant difference between the two groups（ P〉0. 05）. The 3-year CBCT indicated that the trial group mean bone height was（ 4. 46 ± 0. 98） mm,the control group mean bone height was（ 3. 36 ± 0. 73） mm,there was significant difference between the two groups（ P〉0. 05）. There was no implant loose in trial group,implant survival rate was 100%; there was 1 implant loose in control group at 2 month after surgery,implant survival rate was 96. 7%,there was no significant difference between the two groups（ P〉0. 05）. Conclusion The study suggested low maxillary sinus used osteotome sinus floor elevation and simultaneous implants placement with or without bone materials,the new bone formation around the implants with bone graft materials were better than that without bone graft materials,but there was no significant difference between the implant survival rates.