上颌后牙区不同剩余骨高度行经牙槽嵴顶提升术同期植入种植体的临床效果研究

Clinical effect of transalveolar maxillary sinus floor elevation and simultaneous implant implantation with different residual bone height in maxillary posterior region

目的探讨上颌窦底不同剩余骨高度(residual bone hight,RBH)行经牙槽嵴顶上颌窦底提升术同期植入种植体以及术中应用浓缩生长因子(concentrated growth factors,CGF)的临床应用效果。方法纳入我院2014年1月至2017年12月上颌后牙区牙槽骨剩余骨高度不足患者38例,根据不同的RBH以及术中是否应用CGF将38例患者分为四组。A组:3 mm≤RBH<5 mm,经牙槽嵴顶上颌窦底提升术后同期植入种植体7例。B组:3 mm≤RBH<5 mm,经牙槽嵴顶上颌窦底提升术+CGF后同期植入种植体9例。C组:5 mm≤RBH<8 mm,经牙槽嵴顶上颌窦底提升术后同期植入种植体12例。D组:5 mm≤RBH<8 mm,经牙槽嵴顶上颌窦底提升术+CGF后同期植入种植体10例。种植术后即刻、6个月、12个月、24个月时复查CBCT检查种植体颈缘骨水平变化,窦底提升后骨高度变化,种植体骨结合及新骨形成的情况,有无种植体周围炎,种植体及修复体的稳定性,种植义齿的并发症。结果38例病例无上颌窦炎症反应及上颌窦黏膜穿孔,种植体骨结合良好,永久修复后种植体及修复体稳定,术后一年种植体颈缘骨水平稳定。A、B组间,C、D组间种植体稳定系数(ISQ)的平均值在术后4个月和6个月差异有统计学意义(P<0.05)。A、B组间,C、D组间在术后以及随访的24个月内的上颌窦底骨提升量差异均有统计学意义(P<0.05),且应用CGF组窦底骨提升量分别高于A组、C组。结论在3 mm≤RBH<8 mm时,经牙槽嵴顶上颌窦底提升术同期种植后可获得良好的骨结合,在术中应用CGF可促进上颌窦内提升同期种植后新骨形成,加快骨结合,有效增加窦底骨高度,增强种植体稳定性。

Objective To investigate the clinical effect of transalveolar maxillary sinus floor elevation and simultaneous implant implantation with different residual bone height(RBH)in maxillary posterior region using concentrated growth factors(CGF).Methods From January 2014 to December 2017,38 patients with insufficient height of residual alveolar bone in maxillary posterior region were included and divided into four groups according to different RBH and whether CGF was used during operation.Group A:3 mm≤RBH<5 mm,7 cases were implanted with implants after maxillary sinus elevation.Group B:3 mm≤RBH<5 mm,9 cases were implanted with implants after maxillary sinus elevation+CGF.Group C:5 mm≤RBH<8 mm,12 cases were implanted with implants after maxillary sinus elevation.Group D:5 mm≤RBH<8 mm,10 cases were implanted with implants after maxillary sinus elevation+CGF.CBCT was reexamined immediately after implantation,6 months,12 months and 24 months after implantation to check changes of bone level of implant neck margin,bone height after sinus floor elevation,osseointegration and new bone formation of implant,peri implant inflammation,stability of implant and prosthesis,and complications of implant denture.Results There was no inflammatory reaction or perforation of maxillary sinus mucosa in 38 cases.The implant bone union was good.The implant and prosthesis were stable after permanent restoration,and the level of implant neck bone was stable one year after operation.There were significant differences in ISQ between group A and group B,group C and group D at 4 and 6 months after operation(P<0.05).There was significant difference in the amount of maxillary sinus floor bone lifting between group A and group B,group C and group D during postoperative and 24 months of follow-up(P<0.05),and the amount of maxillary sinus floor bone lifting in group B and group D was higher than that in group A and group C respectively.Conclusion When 3 mm≤RBH<8 mm,good osseointegration can be obtained after maxillary sinus lifting and simultaneous implantation.The application of CGF during operation can promote the formation of new bone,accelerate osseointegration,effectively increase the height of sinus floor bone and enhance the stability of implant.