利用上颌窦底壁骨嵴和骨突进行种植体植入的方法研究  

Research on a method of embedding implants into crista and apophysis of sinus maxillaris

作　　者：孙振宇[1] 刘慧[1] 王道富[1] 陈光[1] 张明睿[1] 冯颉[1] 

机构地区：[1]解放军305医院口腔科,北京100017

出　　处：《解放军医学杂志》2011年第9期928-930,共3页Medical Journal of Chinese People's Liberation Army

基　　金：首都医学发展科研基金(2009-3062)

摘　　要：目的研究并评价将种植体尖端安全准确植入上颌窦底壁骨嵴和骨突内的方法。方法 8例上颌后牙缺失、可用骨高度不足种植义齿修复需要的患者,其中男5例,女3例,年龄46.4±12.8岁,经CT扫描三维重建确定每例患者缺牙间隙上方均伴有上颌窦底壁骨嵴和骨突,并且这些骨嵴和骨突符合基底部宽度大于5mm、近中或远中斜面与上颌窦底壁夹角小于70°的纳入标准。利用快速成型技术制造缺牙区树脂模型,实施模型手术将种植体尖端准确定位在骨嵴和骨突内,制作手术导板,并完成患者口内的种植导航手术。术后即刻CT扫描分析种植体尖端与骨嵴和骨突的关系,观察上颌窦底黏膜是否完整。结果种植体植入位置与模型手术相符,8颗种植体尖端2~5mm部分成功进入上颌窦底壁骨嵴和骨突内,并在骨嵴的近中斜面或远中斜面突破骨皮质,种植体尖端部分一侧位于上颌窦底壁骨嵴内,一侧位于上颌窦腔黏膜下方。种植体初期稳定性好,上颌窦底黏膜完整。结论上颌窦底壁骨嵴和骨突能为上颌后牙缺失骨量不足的患者提供必要的可用骨高度,从而获得足够的种植体稳定性。要将种植体尖端准确安全地植入到骨嵴和骨突内,需要CT扫描三维重建进行骨嵴和骨突的选择及准确定位、模型手术和手术导板制作、导板辅助的种植手术、上颌窦底开孔钻的使用等步骤的严密配合。Objective To study and evaluate the method of embedding implants into crista and apophysis of sinus maxillaris precisely and safely.Methods Eight patients with insufficient alveolar bone height in the posterior maxillary region,including 5 males and 3 females with mean age of 46.4±12.8 years,received dental implant surgery.By using CT scan based on 3D reconstruction analysis,each patient was chosen in accordance with the following criteria： sinus septa and apophysis located over the lost teeth,the width at the base of the septum and apophysis was over 5mm and the included angle between sinus floor and mesial or distal slope of the septum and apophysis was less than 70°.A simulation operation was done on each patient＇s rapid prototyping model and apical part of implants was set into sinus septum and apophysis.After surgical guide was fabricated,osteotomy preparation and implant placement were performed aided by the surgical guide,and then followed by immediate CT scan to thoroughly examine the relative position of implants to septum and apophysis and the integrity of the sinus membrane.Results The position of all the 8 implants was in consistent with that in the rapid prototyped model.Sinus floor was lifted to the mesial or distal surface of the septum or apophysis.One side of the implants＇ apical parts,with the length ranged from 2 to 5mm,was tightly embedded to sinus septum or apophysis,and the other side of the implants was well covered by mucous membrane.The implants were found with good stability after the surgery.No damage or laceration of the sinus mucous membrane was observed.Conclusions Sinus septa and apophysis can provide the necessary height to maintain implant stability when the alveolar bone height is insufficient for the insertion of a dental implant in the posterior region.In order to precisely embed implants into sinus septum and apophysis,the following procedures are required and must strictly coordinate with one another： accurate positioning and measurement of septa and apophysis by us

关 键 词：上颌窦 牙种植 骨嵴 骨突 

分 类 号：R782.12[医药卫生—口腔医学]