经牙槽嵴顶二次提升术在上颌后牙区骨高度严重不足患者中的临床应用研究  

Application of two-stage crestal approach sinus elevation in severe atrophic posterior maxilla

作　　者：林曦 周震 李少冰 高岩 李世轶 朱培君 徐淑兰 Lin Xi;Zhou Zhen;Li Shaobing;Gao Yan;Li Shiyi;Zhu Peijun;Xu Shulan(Department of Implant Center,Stomatological Hospital,Southern Medical University,Guangzhou 510280,China)

机构地区：[1]南方医科大学口腔医院种植中心,广州510280

出　　处：《中华口腔医学杂志》2020年第11期871-877,共7页Chinese Journal of Stomatology

基　　金：国家自然科学基金(81801008);南方医科大学口腔医院科研培育计划(PY2019025);南方医科大学口腔医院临床新技术项目(2018006)。

摘　　要：目的分析经牙槽嵴顶二次提升术在上颌后牙区骨高度严重不足患者中的临床应用情况,为临床提供参考。方法收集2016年5月至2018年5月于南方医科大学口腔医院种植中心就诊的上颌后牙区单牙或多牙缺失患者25例,男性13例,女性12例,年龄32~49岁,牙槽嵴垂直骨高度1.5~3.0 mm,可用骨宽度≥6.0 mm,无急慢性上颌窦病变,提升区域无上颌窦纵隔。采用经牙槽嵴顶二次提升术共植入种植体33枚,种植体植入术后6个月行永久修复。根据上颌窦颊腭径宽度(sinus width,SW)将33个植入位点分为宽上颌窦组(16个,SW>15 mm)、中上颌窦组(12个,SW≥12 mm且≤15 mm)、窄上颌窦组(5个,SW<12 mm)。记录3组种植体存留率、种植体植入时稳定性系数、两次术后即刻垂直骨高度,术后半年、修复后1年窦底骨高度变化,修复后1年种植体边缘骨吸收。结果最终纳入23例患者,男性12例,女性11例,年龄(41.2±7.6)岁。33枚种植体愈合期及修复后1年存留率为100%(33/33)。宽上颌窦组植入时初期稳定性系数(50.81±2.69)显著小于中上颌窦组(60.58±2.54)和窄上颌窦组(63.12±3.58)(P<0.05);宽上颌窦组第1次术后即刻垂直骨高度[(7.99±1.13)mm]显著低于中上颌窦组[(8.95±0.81)mm]和窄上颌窦组[(9.18±0.90)mm](P<0.05);宽上颌窦组第2次术后即刻垂直骨高度[(11.46±0.88)mm]显著低于中上颌窦组[(12.77±0.49)mm]和窄上颌窦组[(12.57±0.55)mm](P<0.05)。宽上颌窦组修复后1年边缘骨吸收量[(0.91±0.05)mm]显著大于中上颌窦组[(0.79±0.10)mm]及窄上颌窦组[(0.74±0.07)mm](P<0.05);修复后1年3组窦底骨高度变化差异无统计学意义(P>0.05)。结论对中和窄颊腭径上颌窦应用经牙槽嵴顶二次提升术可解决上颌后牙区骨高度严重不足问题,其近远期临床效果需要进一步观察。Objective To investigate the feasibility of two-stage crestal approach sinus elevation in severe atrophic maxilla.Methods A total of 25 patients(male:13 cases,female:12 cases)who attended Department of Implant Center,Stomatological Hospital,Southern Medical University from May 2016 to May 2018 were included in this study.The age of the patients was 32-49 years old.The inclusion criteria were:single or multiple tooth loss in posterior maxilla with residual bone height ranged from 1.5 to 3.0 mm and vertical bone width≥6 mm,no pathological changes or septum were detected in the sinus.The elevated sides were divided into three groups according to different buccal-palatal sinus width(SW):wide(16 case,SW>15 mm),normal(12 case,12 mm≤SW≤15 mm),narrow(5 case,SW<12 mm).Finally,23 patients with 33 implants were placed by the two-stage crestal approach for sinus elevation.Six months after implant placement,final restorations were delivered.Implant survival rate,implant stability quotient(ISQ),immediate vertical bone height(VBH)after surgeries,changes of sinus elevation height(cSEH),marginal bone loss(MBL)at 1 year follow-up were examined.Results Twenty-three patients were finally included in the study,including 12 males and 11 females,aged(41.2±7.6)years old.All implants healed uneventfully.ISQ(wide:50.81±2.69;normal:60.58±2.54;narrow:63.12±3.58),immediate VBH after 1st surgery[wide:(7.99±1.13)mm;normal:(8.95±0.81)mm;narrow:(9.18±0.90)mm]and 2nd surgery[wide:(11.46±0.88)mm;normal:(12.77±0.49)mm;narrow:(12.57±0.55)mm],cSEH six months after 1st[wide:(3.87±0.43)mm;normal:(2.01±0.65)mm;narrow:(1.49±0.33)mm]and 2nd[wide:(1.16±0.29)mm;normal:(1.04±0.33)mm;narrow:(0.97±0.41)mm]surgery,MBL[wide:(0.91±0.05)mm;normal:(0.79±0.10)mm;narrow:(0.74±0.07)mm]were significantly different among three groups(P<0.05).In all the three groups,cSEH was barely detected at 1-year follow-up(P>0.05).Conclusions Two-stage crestal approach for sinus elevation might be an alternative protocol in severe atrophic posterior maxilla,e

关 键 词：牙种植体 上颌窦内提升术 骨增量 骨整合 

分 类 号：R783.6[医药卫生—口腔医学]