2种手术入路上颌窦底提升同期种植失败原因和并发症分析  

The relationships between different surgical approaches for maxillary sinus augmentation and implant failure and complications: a retrospective cohort study

作　　者：郝新河[1] 叶虎[1] 翟沁凯[1] HAO Xin-he;YE hu;ZHAI Qin-kai(Department of Oral and Maxillofacial Surgery,Hefei Stomatology Hospital,Hefei 230001,Anhui Province,China)

机构地区：[1]合肥市口腔医院,安徽医科大学合肥口腔临床学院口腔颌面外科,安徽合肥230001

出　　处：《上海口腔医学》2021年第2期214-218,共5页Shanghai Journal of Stomatology

基　　金：安徽省重点研究与开发计划项目(201904a07020023);合肥市卫计委应用医学研究项目(hwk2018zc009);合肥市自主创新政策“借转补”资金项目(J2019Y03)。

摘　　要：目的:探讨经侧壁或牙槽嵴入路上颌窦底提升术对种植体生存率的影响,分析失败原因和并发症。方法 :采用回顾性队列研究,分析2000—2015年在合肥市口腔医院口腔颌面外科就诊、由同一名医师完成上颌窦底提升同期种植的患者。主要预测变量是经侧壁入路上颌窦底提升术和经牙槽嵴入路上颌窦底提升术,混杂变量是性别、年龄、吸烟史、糖尿病史、口腔卫生状况、牙位、种植体长度和直径、修复类型。结果变量为种植体存活率、失败原因和并发症。采用SPSS 21.0软件包对数据进行统计学分析。结果:59例患者进入研究对列,男31例(52.5%),女28例(47.5%),平均年龄(61.3±10.1)岁。随访(5.6±1.2)年,5颗种植体失败,成功率为88/93(94.6%)。经侧壁入路上颌窦底提升术种植牙失败3颗,成功率为18/21 (85.7%);经牙槽嵴入路上颌窦底提升术种植牙失败2颗,成功率为70/72(97.2%)。单因素分析显示,吸烟史(χ^(2)=6.662,P=0.010)、口腔卫生状况(χ^(2)=4.352,P=0.037)以及手术入路(χ^(2)=4.232,P=0.040)与种植体存活率相关;多因素回归分析显示,仅有吸烟史(OR=0.030,95CI:0.002~0.493,P=0.014)与种植体存活率相关;手术入路(χ^(2)=5.000;P=0.025)与种植体失败原因相关,侧壁入路3颗(100%)种植体失败的原因是(3个月时)松动、骨愈合不良,而牙槽嵴入路2颗(100%)种植体失败的原因是(4年后)种植体周围反复感染、大量骨质丢失。吸烟史和种植体并发症显著相关(χ^(2)=12.433,P=0.014),吸烟患者发生种植体周围炎的比例显著较高(6/88,6.8%)。手术入路和种植体并发症之间无显著相关性(χ^(2)=9.453,P=0.051)。结论:尽管不同手术入路上颌窦底提升术对种植体存活率和术后并发症无显著影响,但手术入路与种植体失败原因相关。吸烟会导致种植体周围炎,降低种植体存活率。PURPOSE: To investigate the 5-year survival and complication rates of implants placed in grafted sinuses with different surgical approaches and analyze the causes for failure. METHODS: This study retrospectively observed the prognosis of patients who underwent maxillary sinus augmentation by means of lateral window technique(LWT) or transalveolar osteotomy technique(TOT) and simultaneously installed implants performed, in Hefei Stomatological Hospital.The primary predictor variables were surgical approaches, including LWT and TOT. The primary outcome measurement was the 5-year implant survival rate, complication rates and failure causes. Potential confounders included diabetes, age at surgery, gender, smoking habit, oral hygiene, tooth position, length and diameter of implants and type of prosthesis. Chisquare test and logistic regression analysis were performed with SPSS 21.0 software package. RESULTS: Fifty-nine patients(31 males and 28 females), installed with 93 implants, with a mean age of(61.3±10.1) years old, were enrolled. Over(5±1.2) years of follow-up, five implants failed, with a total survival rate of 94.6%. In detail, there were 3 failed implants in the LWT group and 2 failed implants in the TOT group, for a survival rate of 85.7% and 97.2%, respectively. Chi-square test showed that smoking habit(χ^(2)=6.662, P=0.010), oral hygiene(χ^(2)=4.352, P=0.037) as well as operative approach(χ^(2)=4.232, P=0.040) were significantly associated with the final survival rates, multivariate logistic regression analysis dis-played that smoking habit(OR=0.030, 95%CI: 0.002-0.493, P=0.014) was still associated with the finial survival rates.Surgical approach(χ^(2)=5.000, P=0.025) was markedly related to causes for the failed implants. Of which, three(100%) failed implants in the LWT group was due to poor osseointegration and implant mobility 3 months after sinus augmentation, and2(100%) in the TOT group was because of persistent peri-implantitis and loss of the graft or alveolar bone 4 years after sinus augment

关 键 词：上颌窦底提升术 经侧壁上颌窦底提升术 经牙槽嵴上颌窦底提升术 

分 类 号：R782.1[医药卫生—口腔医学]