上颌窦黏膜囊肿对牙槽嵴顶入路上颌窦底提升术的影响

The impact of maxillary sinus mucosa cyst on transcrestal sinus floor elevation

目的研究牙槽嵴顶入路上颌窦底提升术后,上颌窦内黏膜囊肿的变化和囊肿区种植体周围的成骨情况,探讨上颌窦黏膜囊肿对牙槽嵴顶入路上颌窦底提升术的影响。方法选取12例上颌后牙缺失骨量不足并患有上颌窦黏膜囊肿的患者,在不摘除窦腔内黏膜囊肿的情况下,经牙槽嵴顶入路提升上颌窦底同期植入种植体14枚。术前测量上颌窦底高度,术后当日测量种植体穿入窦底长度,术后1年测量穿入窦腔内的种植体周围成骨高度,观察黏膜囊肿对种植体周围成骨的影响。采用配对样本t检验对比术前-术后当日及术前-术后6个月黏膜囊肿投影面积变化,评估手术创伤与黏膜囊肿的相互的影响。结果通过牙槽嵴顶入路上颌窦底提升术植入的种植体在含有上颌窦黏膜囊肿的上颌后牙区种植体周围成骨良好,术后6个月时全部14枚种植体形成良好骨结合。术前上颌窦底高度为(5.5±1.4)mm,术中种植体穿入上颌窦长度为(2.9±1.3)mm,上颌窦底厚度平均增加了(1.8±1.0)mm。根据测量结果计算黏膜囊肿投影面积,术前(201.2±184.0)mm2,术后当日(133.6±187.6)mm2,术后6个月(134.5±107.1)mm2。术前-术后6个月的成对差分均值及标准差[(66.6±142.8)mm2]明显增大,说明术后6个月时黏膜囊肿的体积呈现出多样化的表现。术前-术后当日的黏膜囊肿投影面积相比显著减小,差异有统计学意义(t=2.685,P=0.021),术前-术后6个月的黏膜囊肿投影面积差异无统计学意义(t=1.617,P=0.134)。手术短期内会对上颌窦内黏膜囊肿造成一定的创伤,但未对上颌窦黏膜囊肿产生激惹、恶化等不良影响。结论上颌窦内黏膜囊肿的存在不影响牙槽嵴顶入路上颌窦底提升术的实施与种植体周围成骨。

Objective By comparing the changes of mucosa cyst in maxillary sinus and the newly-formed bone around the implant in the cyst area after transcrestal sinus floor elevation surgery to evaluate whether transcrestal sinus floor elevation surgery is impacted by maxillary sinus mucosa cyst.Methods A total of 12 patients who lost upper molar supervened with alveolar bone insufficiency with maxillary sinus mucosa cyst were enrolled among patients.Sinus floor was elevated by transcrestal path and dental implants were placed simultaneously with the cyst untreated.A series of measures were taken to evaluate osteogenesis around the implant beneath mucosa cyst.Paired sample t test was used to compare the projection area changes of mucosa cysts before surgery and the day after surgery as well as six months after surgery in order to evaluate the interaction between surgical trauma and mucosa cysts.Results The bone around implants was formed well in the area where the mucosa cyst was.All the 14 implants got well osteogenesis after six months.The average height of maxillary floor in this study was(5.5±1.4)mm.The average length implants protruded into maxillary sinus was(2.9±1.3)mm.One year after,the thickness of maxillary sinus floor increased(1.8±1.0)mm.Projection area of mucosa cyst was calculated and analyzed based on the measurement.The area mucosa cyst before surgery was(201.2±184.0)mm^2,while the day after surgery was(133.6±187.6)mm^2,and six months after surgery was(134.5±107.1)mm^2.Statistical results showed that paired difference mean and standard deviation between surgery before and the day after was(67.5±87.1)mm^2,and then between surgery before and six months after was(66.6±142.8)mm^2.The standard deviation of paired difference between surgery before and six months after was significantly increased,indicating that the volume of mucosa cysts showed a variety of manifestations in six months after surgery.Projection area data of mucosa cysts were compared with before and the day after surgery by paired sample t test.Statistic results showed that the size of mucosa cyst shrieked significantly the day after surgery(t=2.685,P=0.021).While the data were compared with before surgery and six months after surgery,Statistic results showed that the size of mucosa cyst did not change significantly(t=1.617,P=0.134).Results of the matched t test indicated that sinus lift operation caused trauma to mucosa cyst in the short term.Nevertheless,mucosal cysts were not irritated to deteriorate in the long term.Conclusion The presence of mucosa cyst in maxillary sinus has little effect on the maxillary sinus floor lifting and osteogenesis around implant.