经牙槽嵴顶上颌窦底二次提升术可改善上颌后牙区骨高度严重不足
|
摘要
目的评价上颌后牙区骨高度严重不足即上颌窦底剩余牙槽嵴垂直骨高度(RBH)≥1 mm且≤3 mm时行经牙槽嵴顶上颌窦底二次提升术的长期临床效果。方法选取南方医科大学口腔医院种植中心2012年3月～2014年12月就诊的上颌后牙缺失拟行上颌窦提升种植修复的患者78例,符合RBH≥1 mm且≤3 mm,牙槽嵴宽度≥5 mm,采用经嵴顶二次提升法,共植入种植体148枚,术后6个月行上部结构修复,随访1～5年,行临床及影像学检查,评价患者满意度、种植体稳定性、种植体存留率、软组织情况、窦底骨高度变化及种植体周边缘骨吸收情况。结果术中发生3例上颌窦底黏膜破裂,穿孔率为3.85%(3/78)。23例(30.67%)存在轻微疼痛,52例(69.33%)无头痛发热,无明显疼痛及肿胀反应。种植体稳定性系数ISQ值术后即刻和术后半年分别为58.39±1.39,81.88±1.22,两组差异有统计学意义(P<0.05)。随访率100%,愈合期及随访过程中无一种植体脱落,种植体存留率为100%。比较随访时间1年和5年的种植体周探诊深度,改良龈沟出血指数,差异均无统计学意义(P>0.05)。平均上颌窦底提升高度及种植体周边缘骨吸收术后1年和术后5年差异均有统计学意义(P<0.05)。结论与侧壁开窗式上颌窦提升术相比,经牙槽嵴顶上颌窦底二次提升术植骨手术创伤小、患者不适感明显减轻,有效解决上颌后部牙槽骨高度严重不足的问题并取得良好的长期临床效果。
Objective To evaluate the long-term clinical outcomes of two-stage closed sinus lift for the maxillary sinus with residual bone height(RBH) of 1-3 mm in the posterior maxillary. Methods Seventy-eight patients with maxillary posterior tooth loss(1 mm≤RBH≤3 mm and alveolar ridge width≥5 mm) were treated with two-stage closed sinus lift at the Dental Implantation Center of our hospital between March, 2012 and December, 2014. Coral hydroxyapatite powder and 148 implants were implanted. The superstructure was fixed within 6 months after the operation and the patients were followed up for 1-5 years for assessing the patients' satisfaction, postoperative response, stability and survival rates of the implant, soft tissue condition, bone height of maxillary sinus floor elevation and the marginal bone loss. Results Perforation of the maxillary sinus floor occurred in 3(3.85%) of the cases. Twenty-three(30.67%) patients complained of mild pain, and 52(69.33%) did not experience headache or fever or reported obvious pain or swelling after the operation. The overall response to the operation was favorable. The ISQ value was 58.39 ± 1.39 immediately after the operation, and increased significantly to 81.88 ± 1.22 at 6 months(P<0.05). During the healing period and the follow-up, none of the implants fell off, and the implant survival rate was100%. The peri-implant probing depth and modified sulcus bleeding index at 1 year after sinus lifting were similar to those at 5 years after the operation(P>0.05), but the sinus floor elevation and marginal bone resorption at the two time points differed significantly(P<0.05). Conclusion Compared with lateral wall lifting, two-stage close lifting of the maxillary sinus floor is associated with less trauma and less discomfort, and effectively solves the problem of severe alveolar bone height deficiency in the maxillary posterior region to achieve favorable long-term clinical outcomes.
Objective To evaluate the long-term clinical outcomes of two-stage closed sinus lift for the maxillary sinus with residual bone height(RBH) of 1-3 mm in the posterior maxillary. Methods Seventy-eight patients with maxillary posterior tooth loss(1 mm≤RBH≤3 mm and alveolar ridge width≥5 mm) were treated with two-stage closed sinus lift at the Dental Implantation Center of our hospital between March, 2012 and December, 2014. Coral hydroxyapatite powder and 148 implants were implanted. The superstructure was fixed within 6 months after the operation and the patients were followed up for 1-5 years for assessing the patients' satisfaction, postoperative response, stability and survival rates of the implant, soft tissue condition, bone height of maxillary sinus floor elevation and the marginal bone loss. Results Perforation of the maxillary sinus floor occurred in 3(3.85%) of the cases. Twenty-three(30.67%) patients complained of mild pain, and 52(69.33%) did not experience headache or fever or reported obvious pain or swelling after the operation. The overall response to the operation was favorable. The ISQ value was 58.39 ± 1.39 immediately after the operation, and increased significantly to 81.88 ± 1.22 at 6 months(P<0.05). During the healing period and the follow-up, none of the implants fell off, and the implant survival rate was100%. The peri-implant probing depth and modified sulcus bleeding index at 1 year after sinus lifting were similar to those at 5 years after the operation(P>0.05), but the sinus floor elevation and marginal bone resorption at the two time points differed significantly(P<0.05). Conclusion Compared with lateral wall lifting, two-stage close lifting of the maxillary sinus floor is associated with less trauma and less discomfort, and effectively solves the problem of severe alveolar bone height deficiency in the maxillary posterior region to achieve favorable long-term clinical outcomes.
引文
[1] Pommer B, Hof M, F?dler A, et al. Primary implant stability in the atrophic sinus floor of human cadaver maxillae:impact of residual ridge height, bone density, and implant diameter[J]. Clin Oral Implants Res, 2014, 25(2):e109-13.
[2]Zhao X, Gao W, Liu F. Clinical evaluation of modified transalveolar sinus floor elevation and osteotome sinus floor elevation in posterior maxillae:study protocol for a randomized controlled trial[J]. Trials, 2018, 19(1):489.
[3] Tan WC, Lang NP, Zwahlen M, et al. A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation. Part II:transalveolar technique[J]. J Clin Periodontol, 2008, 35(8 Suppl):241-54.
[4]满毅.经牙槽嵴顶上颌窦底提升术的应用研究进展[J].口腔疾病防治, 2018, 26(8):477-83.
[5] Gatti F, Gatti C, Tallarico M, et al. Maxillary sinus membrane elevation using a special drilling system and hydraulic pressure:a 2-Year prospective cohort study[J]. Int J Periodontics Restorative Dent, 2018, 38(4):593-9.
[6] Krasny K, Krasny M, Kaminski A. Two-stage closed sinus lift:a new surgical technique for maxillary sinus floor augmentation[J].Cell Tissue Bank, 2015, 16(4):579-85.
[7] Buser D, Mericske-Stern R, Bernard JP, et al. Long-term evaluation of non-submerged ITI implants. Part 1:8-year Life table analysis of a prospective multi-center study with 2359 implants[J]. Clin Oral Implants Res, 1997, 8(3):161-72.
[8] Cochran DL, Buser D, Ten Bruggenkate CM, et al. The use of reduced healing times on ITI(R)implants with a sandblasted and acid-etched(SLA)surface:Early results from clinical trials on ITI(R)SLA implants[J]. Clin Oral Implants Res, 2002, 13(2):144-53.
[9] Krasny K, Krasny M, Kaminski A. Two-stage closed sinus lift:a new surgical technique for maxillary sinus floor augmentation[J].Cell Tissue Bank, 2015, 16(4):579-85.
[10]耿威,林潇,李晓光,等.下颌后牙区SLActive种植体3周早期负荷修复1年随访的临床观察[J].口腔医学研究, 2015, 23(5):475-8.
[11]Corbella S, Taschieri S, Del Fabbro M. Long-term outcomes for the treatment of atrophic posterior maxilla:a systematic review of literature[J]. Clin Implant Dent Relat Res, 2015, 17(1):120-32.
[12]周磊,岳新新. All-on-Four技术在口腔种植领域中的应用进展[J].口腔疾病防治, 2017, 25(1):1-7.
[13]Nedir R, Nurdin N, Khoury P, et al. Osteotome sinus floor elevation with and without grafting material in the severely atrophic maxilla.A 1-year prospective randomized controlled study[J]. Clin Oral Implants Res, 2013, 24(11):1257-64.
[14]Yilmaz HG, Tozum TF. Are gingival phenotype, residual ridge height,and membrane thickness critical for the perforation of maxillary sinus[J]. J Periodontol, 2012, 83(4):420-5.
[15]Tavelli L, Borgonovo AE, Ravida AA, et al. Analysis of forces applied during transalveolar sinus lift:a preliminary clinical study[J]. Implant Dent, 2018, 27(6):630-7.
[16]Cardoso CL, Curra C, Santos PL, et al. Current considerations on bone substitutes in maxillary sinus lifting[J]. Revista Clínica de Periodoncia, Implantología Y Rehabilitación Oral, 2016, 9(2):102-7.
[17]Janner SF, Caversaccio MD, Dubach PA, et al. Characteristics and dimensions of the Schneiderian membrane:a radiographic analysis using cone beam computed tomography in patients referred for dental implant surgery in the posterior maxilla[J]. Clin Oral Implants Res, 2011, 22(12):1446-53.
[18]Trombelli L, Franceschetti G, Trisi PA. Incremental, transcrestal sinus floor elevation with a minimally invasive technique in the rehabilitation of severe maxillary atrophy. clinical and histological findings from a Proof-of-Concept case series[J]. J Oral Maxillofac Surg, 2015, 73(5):861-88.
[19]赖红昌,史俊宇.上颌窦提升术[J].口腔疾病防治, 2017, 25(1):8-12.
[20]Lee CT, Tran D, Jeng MD, et al. Survival rates of hybrid rough surface implants and their alveolar bone level alterations[J]. J Periodontol, 2018, 89(12):1390-9.
[21]Pjetursson BE, Lang NP. Sinus floor elevation utilizing the transalveolar approach[J]. Periodontol 2000, 2014, 66(1):59-71.
[22]Si MS, Shou YW, Shi YT, et al. Long-term outcomes of osteotome sinus floor elevation without bone grafts:a clinical retrospective study of 4-9 years[J]. Clin Oral Implants Res, 2016, 27(11):1392-400.
[23]Bassi A, Pioto R, Faverani LP, et al. Maxillary sinus lift without grafting, and simultaneous implant placement:a prospective clinical study with a 51-month follow-up[J]. Int J Oral Maxillofac Surg, 2015, 44(7):902-7.
[24]Del Fabbro M, Wallace SS, Testori T. Long-Term implant survival in the grafted maxillary sinus:a systematic review[J]. International Journal of Periodontics&Restorative Dentistry, 2013, 33(6):773.
[25]Stefanski S, Svensson B, Thor A. Implant survival following sinus membrane elevation without grafting and immediate implant installation with a one-stage technique:an up-to-40-month evaluation[J]. Clin Oral Implants Res, 2017, 28(11):1354-9.
[26]Menini M, Setti P, Pera P, et al. Peri-implant Tissue Health and Bone Resorption in Patients with Immediately Loaded, ImplantSupported, Full-Arch Prostheses[J]. International Journal of Prosthodontics, 2018, 31(4):327-33.
[27]Monje A, Blasi G. Significance of keratinized mucosa/gingiva on peri-implant and adjacent periodontal conditions in erratic maintenance compliers[J]. J Periodontol, 2018 Nov 21. doi:10.1002/JPER.18-0471.[Epub ahead of print]
[28]Ng KT, Fan M, Leung MC, et al. Peri-implant inflammation and marginal bone level changes around dental implants in relation to proximity with and bone level of adjacent teeth[J]. Aust Dent J,2018, 63(4):467-77.
[29]Barbato L, Baldi N, Gonnelli A, et al. Association of smoking habits and height of residual bone on implant survival and success rate in lateral sinus lift:a retrospective study[J]. J Oral Implantol, 2018, 44(6):432-8.
[2]Zhao X, Gao W, Liu F. Clinical evaluation of modified transalveolar sinus floor elevation and osteotome sinus floor elevation in posterior maxillae:study protocol for a randomized controlled trial[J]. Trials, 2018, 19(1):489.
[3] Tan WC, Lang NP, Zwahlen M, et al. A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation. Part II:transalveolar technique[J]. J Clin Periodontol, 2008, 35(8 Suppl):241-54.
[4]满毅.经牙槽嵴顶上颌窦底提升术的应用研究进展[J].口腔疾病防治, 2018, 26(8):477-83.
[5] Gatti F, Gatti C, Tallarico M, et al. Maxillary sinus membrane elevation using a special drilling system and hydraulic pressure:a 2-Year prospective cohort study[J]. Int J Periodontics Restorative Dent, 2018, 38(4):593-9.
[6] Krasny K, Krasny M, Kaminski A. Two-stage closed sinus lift:a new surgical technique for maxillary sinus floor augmentation[J].Cell Tissue Bank, 2015, 16(4):579-85.
[7] Buser D, Mericske-Stern R, Bernard JP, et al. Long-term evaluation of non-submerged ITI implants. Part 1:8-year Life table analysis of a prospective multi-center study with 2359 implants[J]. Clin Oral Implants Res, 1997, 8(3):161-72.
[8] Cochran DL, Buser D, Ten Bruggenkate CM, et al. The use of reduced healing times on ITI(R)implants with a sandblasted and acid-etched(SLA)surface:Early results from clinical trials on ITI(R)SLA implants[J]. Clin Oral Implants Res, 2002, 13(2):144-53.
[9] Krasny K, Krasny M, Kaminski A. Two-stage closed sinus lift:a new surgical technique for maxillary sinus floor augmentation[J].Cell Tissue Bank, 2015, 16(4):579-85.
[10]耿威,林潇,李晓光,等.下颌后牙区SLActive种植体3周早期负荷修复1年随访的临床观察[J].口腔医学研究, 2015, 23(5):475-8.
[11]Corbella S, Taschieri S, Del Fabbro M. Long-term outcomes for the treatment of atrophic posterior maxilla:a systematic review of literature[J]. Clin Implant Dent Relat Res, 2015, 17(1):120-32.
[12]周磊,岳新新. All-on-Four技术在口腔种植领域中的应用进展[J].口腔疾病防治, 2017, 25(1):1-7.
[13]Nedir R, Nurdin N, Khoury P, et al. Osteotome sinus floor elevation with and without grafting material in the severely atrophic maxilla.A 1-year prospective randomized controlled study[J]. Clin Oral Implants Res, 2013, 24(11):1257-64.
[14]Yilmaz HG, Tozum TF. Are gingival phenotype, residual ridge height,and membrane thickness critical for the perforation of maxillary sinus[J]. J Periodontol, 2012, 83(4):420-5.
[15]Tavelli L, Borgonovo AE, Ravida AA, et al. Analysis of forces applied during transalveolar sinus lift:a preliminary clinical study[J]. Implant Dent, 2018, 27(6):630-7.
[16]Cardoso CL, Curra C, Santos PL, et al. Current considerations on bone substitutes in maxillary sinus lifting[J]. Revista Clínica de Periodoncia, Implantología Y Rehabilitación Oral, 2016, 9(2):102-7.
[17]Janner SF, Caversaccio MD, Dubach PA, et al. Characteristics and dimensions of the Schneiderian membrane:a radiographic analysis using cone beam computed tomography in patients referred for dental implant surgery in the posterior maxilla[J]. Clin Oral Implants Res, 2011, 22(12):1446-53.
[18]Trombelli L, Franceschetti G, Trisi PA. Incremental, transcrestal sinus floor elevation with a minimally invasive technique in the rehabilitation of severe maxillary atrophy. clinical and histological findings from a Proof-of-Concept case series[J]. J Oral Maxillofac Surg, 2015, 73(5):861-88.
[19]赖红昌,史俊宇.上颌窦提升术[J].口腔疾病防治, 2017, 25(1):8-12.
[20]Lee CT, Tran D, Jeng MD, et al. Survival rates of hybrid rough surface implants and their alveolar bone level alterations[J]. J Periodontol, 2018, 89(12):1390-9.
[21]Pjetursson BE, Lang NP. Sinus floor elevation utilizing the transalveolar approach[J]. Periodontol 2000, 2014, 66(1):59-71.
[22]Si MS, Shou YW, Shi YT, et al. Long-term outcomes of osteotome sinus floor elevation without bone grafts:a clinical retrospective study of 4-9 years[J]. Clin Oral Implants Res, 2016, 27(11):1392-400.
[23]Bassi A, Pioto R, Faverani LP, et al. Maxillary sinus lift without grafting, and simultaneous implant placement:a prospective clinical study with a 51-month follow-up[J]. Int J Oral Maxillofac Surg, 2015, 44(7):902-7.
[24]Del Fabbro M, Wallace SS, Testori T. Long-Term implant survival in the grafted maxillary sinus:a systematic review[J]. International Journal of Periodontics&Restorative Dentistry, 2013, 33(6):773.
[25]Stefanski S, Svensson B, Thor A. Implant survival following sinus membrane elevation without grafting and immediate implant installation with a one-stage technique:an up-to-40-month evaluation[J]. Clin Oral Implants Res, 2017, 28(11):1354-9.
[26]Menini M, Setti P, Pera P, et al. Peri-implant Tissue Health and Bone Resorption in Patients with Immediately Loaded, ImplantSupported, Full-Arch Prostheses[J]. International Journal of Prosthodontics, 2018, 31(4):327-33.
[27]Monje A, Blasi G. Significance of keratinized mucosa/gingiva on peri-implant and adjacent periodontal conditions in erratic maintenance compliers[J]. J Periodontol, 2018 Nov 21. doi:10.1002/JPER.18-0471.[Epub ahead of print]
[28]Ng KT, Fan M, Leung MC, et al. Peri-implant inflammation and marginal bone level changes around dental implants in relation to proximity with and bone level of adjacent teeth[J]. Aust Dent J,2018, 63(4):467-77.
[29]Barbato L, Baldi N, Gonnelli A, et al. Association of smoking habits and height of residual bone on implant survival and success rate in lateral sinus lift:a retrospective study[J]. J Oral Implantol, 2018, 44(6):432-8.