不同上颌窦提升手术路径对不植骨上颌后牙缺失骨量不足患者的疗效和近远期影响

The short-term and long-term effects of different maxillary sinus lifting surgical paths on patients with bone deficiency and lack of maxillary posterior teeth without bone grafting

目的分析不同上颌窦提升手术路径对不植骨上颌后牙缺失骨量不足患者的近远期影响。方法选择浙江省丽水市人民医院收治的不植骨上颌后牙缺失骨量不足患者136例,随机分为内提升组和外提升组各68例,内提升组采用经牙槽嵴顶提升术联合同期种植治疗,外提升组采用侧壁开窗上颌窦底提升术联合同期种植治疗,比较两组治疗后的手术情况(上颌窦底提升高度、手术时间、种植体直径、种植体长度以及种植体数量)、术后疼痛程度、近期和远期疗效(近期疗效:种植体稳定性及周围骨吸收情况;远期疗效:剩余牙槽骨高度及平均获得骨高度)。结果内提升组手术时间明显短于外提升组,差异有统计学意义(P<0.05);内提升组术后24小时的疼痛程度明显轻于外提升组,差异有统计学意义(P<0.05);内提升组术后12个月的剩余牙槽骨高度以及平均获得骨高度明显高于外提升组,差异有统计学意义(P<0.05);内提升组术后24、36个月的平均获得骨高度明显高于外提升组,差异有统计学意义(P<0.05)。但两组术后随访不同时间的种植体稳定性以及周围骨吸收情况比较,差异无统计学意义(P>0.05)。结论不植骨上颌后牙缺失骨量不足患者中应用经牙槽嵴顶提升术或侧壁开窗上颌窦底提升术均能获得较好的种植体稳定性,但经牙槽嵴顶提升术在减轻手术创伤及疼痛方面更具优势。

Objective To analyze the short-term and long-term effects of different maxillary sinus lifting operation paths on patients with bone deficiency and missing maxillary posterior teeth without bone grafting.Methods 136 patients without bone grafting were randomly divided into internal lifting group and external lifting group,with 68 cases in each group.The internal lifting group was treated with alveolar crest lifting combined with simultaneous implantation,and the external lifting group was treated with lateral fenestration of maxillary sinus floor lifting combined with contract implantation,The operation conditions(maxillary sinus floor lifting height,operation time,implant diameter,implant length and implant number),postoperative pain degree,short-term and long-term efficacy(short-term efficacy:implant stability and surrounding bone absorption;long-term efficacy:residual alveolar bone height and average obtained bone height)were compared between the two groups.Results The operation time in the internal lifting group was significantly shorter than that in the external lifting group(P<0.05);The degree of pain 24 hours after operation in the internal lifting group was significantly lighter than that in the external lifting group(P;The residual alveolar bone height and the average bone height obtained 12 months after operation in the internal lifting group were significantly higher than those in the external lifting group(P<0.05);The average bone height of the internal lifting group at 24 and 36 months after operation was significantly higher than that of the external lifting group(P<0.05).However,there was no significant difference in implant stability and surrounding bone resorption between the two groups at different follow-up times(P>0.05).Conclusion In the patients without bone grafting and with maxillary posterior teeth missing and insufficient bone mass,the application of alveolar crest lifting or maxillary sinus floor lifting with lateral fenestration can obtain better implant stability,but the alveolar crest lifting has more advantages in reducing surgical trauma and pain.