上颌窦内提升植骨并同期种植体植入术在牙槽嵴严重萎缩的上颌后牙区临床应用研究

Clinical application of maxillary sinus lifting,bone graft,and simultaneously placement of implants in severely atrophic maxillae

目的评价上颌窦内提升植骨并同期种植体植入术在牙槽嵴严重萎缩的上颌后牙区的临床应用效果和圆柱形种植体在愈合期内的稳定性。方法选择2012年1月至2014年6月于浦城县医院口腔科就诊接受种植修复的上颌后牙区缺牙后牙槽嵴严重萎缩患者21例,均采用上颌窦内提升植骨并同期种植体植入术。术后对所有患者进行随访,记录种植体成功率、共振频率分析数据以及临床检查和影像学测量数据。结果 3年随访时的种植体成功率为96.7%。在种植体植入后即刻、2周、4周、12周的种植体稳定系数(ISQ)值分别为71.1±4.15、69.6±5.01、68.4±4.34、72.8±6.42,各时间点差异无统计学意义。在1年和3年随访时,改良出血指数分别为0.53±0.40和0.61±0.31,改良菌斑指数分别为0.48±0.44和0.52±0.51,探诊深度分别为(3.21±0.67)mm和(3.45±0.71)mm,各指标在两个时间点差异均无统计学意义。边缘骨吸收从1年随访时的(1.16±0.27)mm增加到3年随访时的(1.45±0.39)mm,差异有统计学意义(P<0.05)。种植体根尖骨高度从基线时的(2.05±0.43)mm下降到1年随访时的(1.85±0.75)mm和3年随访时的(1.42±0.69)mm,不同时间点之间差异有统计学意义(P<0.05)。结论在牙槽嵴严重萎缩的上颌后牙区采用上颌窦内提升植骨并同期种植体植入术的效果是可预期的,且圆柱形种植体也可以获得足够的初期稳定性。3年随访时上颌窦内提升后的种植体成功率较高。

Objective To evaluate the clinical effect of maxillary sinus lifting, bone graft, and simultaneously placement of implants in severely atrophic maxillae and the stability of cylindrical implants. Methods Totally 20 patients with 30 Straumann tissue-level implants were included. After osteotome sinus floor elevation and grafting, implants were inserted. Patients were recalled at 1 and 3-years follow-up. Implant success, resonance frequency analysis, clinical and radiographic outcomes were recorded. Results At 3-year examination, the implant success rate was 96.7%. The ISQ value was 71.1±4.15,69.6 ± 5.01,68.4± 4.34 and 72.8±6.42 at implant insertion, 2,4 and 12 weeks after surgery. Modified bleeding index was 0.53 ± 0.40 and 0.61± 0.31 at 1 and 3-year examination. Probing depth was （3.21± 0.67）mm and （3.45 ± 0.71）ram at 1 and 3-year examination. Modified plaque index was 0.48 ± 0.44 and 0.52 ± 0.51 at 1 and 3-year examination. No significant difference was found between two examinations. Marginal bone loss increased from （1.16± 0.27） mm at 1-year follow-up to （ 1.45 ± 0.39） mm at 3-year follow-up, the difference reached statistically significant （P 〈 0.05）. Implant apex height decreased from （2.05 ±0.43）mm at baseline to （1.85±0.75）mm at 1-year and （1.42± 0.69）mm at 3-year follow-up, the difference reached statistically significant （P 〈 0.05）. Conclusion Maxillary sinus lifting, bone graft, and simultaneously placement of implants could be a predicable treatment option in severely atrophic maxilla. In addition, cylindrical implants could achieve enough stability during the healing phrase. High success rate could be achieved in the short term.