改良侧壁开窗式上颌窦底提升术治疗上颌后牙区缺牙伴重度骨萎缩患者临床观察

Application of modified lateral window for maxillary sinus floor augmentation

目的:评估改良侧壁开窗式上颌窦底提升术治疗上颌后牙区缺牙伴重度骨萎缩患者的疗效。方法:选择2012年6月至2014年10月于浙江大学医学院附属口腔医院就诊的上颌后牙区缺牙伴重度骨萎缩患者5 5例,均接受改良侧壁开窗式上颌窦底提升术。在上颌窦侧壁开窗操作中,将常规的6～8 mm垂直高度的卵圆形骨窗改良为4～5 mm的沟槽状骨窗,并通过改良骨窗建立的操作通道充分剥离上颌窦底黏膜,于黏膜下方置入适量大颗粒Bio-Oss骨粉。统计种植体存活率,测量骨粉垂直高度、体积并计算其吸收率,记录相关并发症。结果:同期植入86颗种植体,种植体累计存活率为97.67%(基于种植体分析)和96.36%(基于患者分析)。术前剩余骨高度为(4.7±2.6)mm,宽度为(8.4±2.7)mm。术后即刻种植位点骨高度为(16.1±2.5)mm,修复时骨高度为(16.2±2.2)mm,术后1年和2年的骨高度分别为(14.9±2.5)mm和(13.6±2.6)mm。术后即刻骨粉高度为(10.6±2.8)mm,体积为(1569±745)mm^3;术后半年内骨粉高度吸收率为3.79%,体积吸收率为7.87%;术后1年时骨粉高度累计吸收率为6.63%,体积累计吸收率为10.89%;术后2年时骨粉高度累计吸收率为7.58%,体积累计吸收率为15.26%。5例患者术中发生窦底黏膜小穿孔,均使用Bio-Gide胶原膜成功修复。结论:改良侧壁开窗式上颌窦底提升术治疗上颌后牙区缺牙伴重度骨萎缩患者有较高的种植体存活率、良好的骨粉稳定性以及较低的并发症发生率,是一种安全可靠并且创伤较小的种植骨增量手段。

Objective： To evaluate the clinical efficacy of modified lateral window for maxillary sinus floor augmentation （MSFA）. Methods： Fifty-five patients who visited the Stomatology Hospital Affiliated to Zhejiang University School of Medicine between June 2012 and October 2014 were enrolled in the study. Patients underwent MSFA with Bio-Oss grafts based on modified access window. During the operation the vertical height of the bony window was reduced from 6 - 8 mm of conventional oval window to 4 -5 mm of slot-shaped window. The sinus membrane was detached completely via the lateral access and large particle Bio-Oss graft was placed in the sub- mueosal space. The implant survival, graft height, graft volume and resorption rates were measured. Intra-op and post-op complications were recorded. Results： There were 86 implants inserted. The 2 -4 year cumulative survival rates were 97.67% by implant-based analysis and 96.36% by patient-based analysis. The residual bone height was （4.7 ±2.6） mm and bone width was （8.4±2.7） mm. The bone height of implantation site immediately after operation was （ 16. 1 ±2.5 ） mm and it was （ 16.2±2.2） mm at restoration. The bone heights at 1 and 2 years after operation were （ 14.9 ± 2.5） nun and （13.6±2.6） mm, respectively. The graft height was （10.6 ±2.8） mm and the graft volume was （1569±745 ） mm3immediately after operation. The resorption rate of graft height 6 months after operation was 3.79% and that of graft volume was 7.87%. The 1-year accumulative resorption rate of graft height was 6.63% and that of graft volume was 10.89%. The 2-year accumulative resorption rate of graft height was 7.58% and that of graft volume was 15.26%. Small membrane perforation during MSFA was observed in 5 cases and all were successfully repaired by a collagen Bio-Gide membrane. Conclusion： The modified lateral technique obtains high implant survival rate, excellent graft stability and low complication rate at 2 -4 year clinical follow-up, indicating that it is a safe, predictable and minimally invasive surgical method for severe atrophic maxillary posterior dentition.