牙保存相关上颌窦底提升术的生物学基础  

Biologic bases of nature tooth-related maxillary sinus floor elevation

作　　者：黄定明[1] 张岚[1] 满毅[2] Huang Dingming;Zhang Lan;Man Yi(State Key Laboratory of Oral Diseases&National Clinical Research Center for Oral Diseases&Dept.of Cariology and Endodontics,West China Hospital of Stomatology,Sichuan University,Chengdu 610041,China;State Key Laboratory of Oral Diseases&National Clinical Research Center for Oral Diseases&Dept.of Implantology,West China Hospital of Stomatology,Sichuan University,Chengdu 610041,China)

机构地区：[1]口腔疾病研究国家重点实验室、国家口腔疾病临床医学研究中心、四川大学华西口腔医院牙体牙髓病科,成都610041 [2]口腔疾病研究国家重点实验室、国家口腔疾病临床医学研究中心、四川大学华西口腔医院种植科,成都610041

出　　处：《国际口腔医学杂志》2023年第3期251-262,共12页International Journal of Stomatology

基　　金：四川省科技厅重点研发项目(2021YFS0030,2021YFS0031);四川大学华西口腔医院探索与研发项目(LCYJ2019-19,LCYJ2019-6);成都市重大科技应用示范项目(2021-YF09-00078-SN)。

摘　　要：上颌后牙缺失需行种植修复时,如果骨量不足,临床上常规采取上颌窦底提升术进行骨增量,以满足种植体初期稳定性的要求。上颌后牙的根管系统非常复杂,出现牙髓根尖周疾病时,根管治疗有可能无法彻底控制根管内感染,治疗后仍可能再度发生慢性根尖周病变。上颌牙、牙槽骨、上颌窦解剖位置及其功能关系紧密,笔者将其命名为“上颌牙-牙槽骨-上颌窦复合体”。当上颌后牙发生慢性根尖周病变时,牙根进入上颌窦内或者病变扩散至上颌窦可形成牙源性上颌窦炎。采用显微根尖手术治疗这类患牙时,常通过上颌窦底提升术建立手术入路。笔者将这种为治疗牙源性上颌窦炎并保存疑难根尖周病患牙而采取的显微根尖手术联合上颌窦底提升术命名为“牙保存相关上颌窦底提升术”。该技术与牙种植相关上颌窦底提升术不同,是一种全新的治疗术式。本文通过文献回顾分析,结合临床开展该技术的经验和认识,从解剖学、病因学和病理学三方面阐述了该技术的生物学基础:上颌牙-牙槽骨-上颌窦复合体是该技术的解剖学基础,牙源性感染引起上颌窦疾病是其病因学基础,根尖周术区和上颌窦黏骨膜的感染性炎症反应是其病理学基础。本文详细解析上述三方面生物学基础,为牙保存相关上颌窦底提升术临床术式的设计、诊治流程的规范和诊疗路径的建立提供了理论依据。When missing maxillary posterior teeth require implantation,adopting maxillary sinus floor elevation routinely provides bone augmentation to meet the initial stability of the implant due to insufficient bone volume.It is very difficult to eliminate the infection completely from the complex root canal system of maxillary posterior teeth by root canal treatment,which results in the chronic apical periodontitis after treatment.The close anatomy relationship among the maxillary posterior teeth,maxillary bone and sinus,termed as maxillary tooth-alveolar-process-sinus complex,makes it easy for the infection to spread into the maxillary sinus.When endodontic microsurgery is needed,the surgical access is often established through maxillary sinus floor elevation, which is named as tooth-related maxillary sinus floor elevation. It is necessary to put forwardthe tooth-related maxillary sinus floor elevation as it is different biologic basis from the traditional dental implantation-related maxillary sinus floor elevation in anatomy, etiology and pathology.

关 键 词：上颌牙-牙槽骨-上颌窦复合体 上颌窦底提升术 牙源性上颌窦炎 感染 炎症反应 

分 类 号：R78[医药卫生—口腔医学]