上颌骨结构变化对老年人种植修复的影响

The influence of maxillary structural changes on the dental implant of elderly patients

老年患者牙齿缺失后常因牙槽骨吸收造成传统义齿固位困难,种植修复可有效解决该问题,但口腔局部解剖结构的改变使老年人的人工种植牙表现出其独有的特点。就上颌而言,一方面上颌牙槽突、上颌结节、牙槽骨壁等部位随着牙齿缺失及其他局部或全身因素的影响会发生不同程度的萎缩和吸收,种植体与牙槽突长轴、鼻腔、上颌窦的位置关系变得更加复杂,加大了种植治疗的难度;而另一方面尖牙支柱、颧骨区等特殊结构或部位的骨质虽然也发生了萎缩和吸收,但这些结构的解剖特点决定了其可以作为种植体的植入位点,从而使牙槽骨严重萎缩老年患者的种植修复成为可能。充分认识老年人失牙后口腔颌面解剖结构的变化特点,不仅可以最大限度的避免种植并发症的发生,还可以扩大牙槽骨严重萎缩老年无牙颌患者的种植适应证,造福广大老年患者。本文针对我们在临床应用上颌牙槽突、上前牙牙长轴、牙槽骨壁、鼻腔、上颌窦、尖牙支柱、颧骨及上颌结节的解剖特点及增龄性变化完成不同类型人工种植修复的实际情况,结合文献,对这些解剖结构变化与种植的关系进行论述,探讨其作为老年患者种植基础的条件及可行性,供同行参考。

After tooth loss in elderly patients, traditional denture retention is difficult due to the absorption of alveolar bone. And dental implant is an effective method to solve this problem. However, the changes of local oral anatomy make the dental implants of elderly patients show its unique characteristics. In the maxilla, alveolar process, maxillary tuberosity and alveolar bone wall are atrophic and absorbed in varying degrees due to the loss of teeth and other local or systemic factors. The position relationship between the implant and the long axis of alveolar process, the nasal cavity and the maxillary sinus is more complicated. All of these increased the difficulty of planting treatment. On the other hand, the bone of some special anatomical structures such as canine buttress and zygomatic areas have also been atrophied and absorbed.However, the anatomical characteristics of these sites determine that they can be used as implantation sites for implants.And it is possible to restore the dental implant in elderly patients with severe alveolar bone atrophy. It is fully recognized that the changes of oral and maxillofacial anatomical structure of old people after tooth loss not only can avoid the occurrence of complications in maximum, but also expand the implant indications of elderly patients with edentulous jaws.And it is a gospel for elderly patients with severe alveolar bone atrophy. In this paper, we summarized the relationship between the anatomical characteristics and age-related changes of maxillary alveolar process, upper anterior teeth axis,alveolar bone wall, nasal cavity, maxillary sinus, canine buttress, zygomatic bone, maxillary tuberosity and the dental implant based on the actual situation of different types of artificial implant prosthesis, which we have completed in clinical practice and relevant literature in recent years to explore the condition and feasibility of elderly patients＇ dental implant basis, for peer reference.