吸烟对上颌窦底植骨种植修复术短期疗效的影响

Short-term effects of smoking on clinical efficacy of maxillary sinus augmentation with dental implant

目的:探讨吸烟对上颌窦底植骨种植修复术短期临床疗效的影响。方法:对因上颌后牙区牙齿缺失行种植修复术的981例患者(置入种植体1 911枚)进行随访,从其中行上颌窦底植骨种植修复术的患者中筛选出完全符合入组条件且获有效回访者28例(置入种植体71枚)进行分析,根据患者有无吸烟习惯将其分为吸烟组14例(置入种植体27枚)和非吸烟组14例(置入种植体44枚),平均随访时间为(16±11)个月。比较两组间种植体存留率、边缘骨吸收以及植入窦底的骨粉在术后当日(T1)、术后6个月(T2)和功能负载后随访期(T3)的变化。结果:随访的981例患者中,行上颌窦底植骨种植修复术的吸烟患者种植体存留率(91.0%)明显低于不吸烟者(98.3%),差异有统计学意义(P <0.05)。获有效回访的行上颌窦底植骨种植修复术的28例患者在观察期内无种植体脱落。与T1期比较,T2期吸烟组和非吸烟组种植体的边缘骨在颊侧、腭侧、近中和远中均表现为吸收(P <0.05),但两组之间的边缘骨吸收在4个方向上差异均无统计学意义。与T1期比较,T3期两组种植体的边缘骨在颊侧、腭侧、近中和远中均表现为吸收(P <0.05),且腭侧边缘骨吸收吸烟组[(-0.78±0.91) mm]比非吸烟组[(-0.34±0.59) mm]明显(P <0.05),颊侧、近中、远中边缘骨吸收在两组间无显著性差异。与T1期比较,T2、T3期吸烟组、非吸烟组上颌窦底植入的骨粉均有吸收(P <0.05),但两组间骨粉吸收差异无统计学意义。吸烟组与非吸烟组植入窦底骨粉的密度在T2期有增加,而在T3期则出现下降趋势,但较之T1期仍表现为密度升高,两组间差异无统计学意义。结论:上颌窦底植骨种植修复术后短期功能负载的患者中,吸烟组种植体的存留率明显低于不吸烟组,且与烟雾接触面积大的腭侧边缘骨吸收比不吸烟组的腭侧明显,一定程度上反映出吸烟是上颌窦底植骨种植修复术的危险因素,可能与术后种植体的存留率降低、边缘骨吸收增加相关。

Objective:To evaluate the short-term clinical effects of smoking on maxillary sinus augmentation with dental implant.Methods:Nine hundred and eighty-one patients(1 911 implants)who were treated with dental implantation for maxillary posterior tooth loss were followed up.Among them,28 patients(71 implants)who were treated with maxillary sinus augmentation and followed-up effectively were analyzed and divided into two groups according to smoking condition:the smoking group(14 patients treated with 27 implants)and the non-smoking group(14 patients treated with 44 implants).The average follow-up time was(16±11)months.The survival rate of implants,marginal bone loss(MBL)and the changes of bone substitutes in sinus floor of the two groups were recorded and compared at the day of surgery(T 1),6 months(T 2),and follow-up after functional loading(T 3).Results:Among the 981 patients,the implant survival rate in the smoking group(91.9%)treated with maxillary sinus augmentation was statistically significantly lower than that of non-smoking the group(99%)(P<0.05).Twenty-eight patients who were treated with maxillary sinus augmentation and followed-up effectively were found no loss of implants during the observation period.Compared with T 1,MBL of the both groups showed reduction in the buccal and palatal side,mesial and distal side at T 2(all P<0.05).But there was no statistically significant difference in MBL of 4 directions between the two groups.At T 3,MBL of the both groups showed significant reduction in the buccal and palatal side,mesial and distal side compared with baseline(T 1).MBL in palatal side of smoking group[(-0.78±0.91)mm]was more obviously than that of non-smoking group[(-0.34±0.59)mm](P<0.05).And MBL in buccal,mesial and distal side of the both groups showed no statistical difference.Compared with T 1,the obvious bone substitutes absorption of the maxillary sinus was found in the both groups at T 2 and T 3(all P<0.05),with no statistical difference between the two groups.In the both groups,the density of bone powder implanted into sinus floor increased at T 2,and decreased at T 3,which was still higher compared to baseline(T 1).Conclusions:In the patients with short-term functional load after maxillary sinus augmentation with dental implant,the survival rate of implant in the smoking group is significantly lower than that in the non-smoking group.And the MBL of palatal side largely exposed to smoke in smoking group is more obvious compared with non-smoking group.To some extent,smoking is a risk factor for maxillary sinus augmentation with dental implant,which may be closely related to the decrease of implant survival rate and the increase of marginal bone loss.