Reinert S, König S, Eufinger H, Bremerich A
Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Tübingen.
Mund Kiefer Gesichtschir. 1999 May;3 Suppl 1:S30-4. doi: 10.1007/PL00014512.
In the severely resorbed maxilla, a 10-year success rate of only 49-74% of implants in combination with autogenous bone grafts has been reported. We developed a modified technique of antral inlay grafting and lateral and vertical onlay grafting of the severely resorbed maxilla for inserting implants to retain dentures. The clinical and radiologic results are presented. In 21 patients with severely resorbed edentulous maxillae, a total of 20 bilateral and one unilateral antral inlay graftings and lateral and vertical onlay graftings were performed after a prosthodontic setup. We opened the maxillary sinus by removing a bony window from the anterolateral wall and, after elevation of the sinus lining, grafted the sinus floor with corticocancellous iliac crest bone grafts. The maxilla was also augmented in the lateral and vertical direction. The bone grafts were fixed by osteosynthesis. After a median of 5 months, a total of 134 implants (Brånemark) were placed and later loaded by prosthodontic rehabilitation. Computed tomography (CT) scans were taken before the grafting procedure, immediately after grafting, after 4 months, and every year thereafter. A total of 94.8% of the implants were successful at the time of the abutment operation. After loading, two additional failures were seen in an average follow-up period of 2.5 years. Most patients were provided with implant-borne dentures. CT scans showed an average initial gain of vertical bone height of 3.7-17.7 mm. One year after grafting, a loss of 1.3 mm or 7% occurred. In the following 2 years, no major atrophy was observed. Statistical analysis showed no correlation between sex, bone height before augmentation, augmented bone height, and resorption of the grafted bone. We observed undisturbed healing and obtained large vertical bone heights, a high success rate, minimal resorption, and fully satisfactory prosthodontic rehabilitation; we can thus recommend our modified technique of reconstruction of the severely resorbed maxilla for routine use.
据报道，在严重吸收的上颌骨中，采用自体骨移植的种植体10年成功率仅为49%-74%。我们开发了一种改良技术，用于严重吸收的上颌骨的上颌窦嵌体植骨以及外侧和垂直贴附植骨，以便植入种植体来固定义齿。现将临床和影像学结果呈现如下。21例严重吸收的无牙上颌骨患者，在进行义齿修复设计后，共进行了20次双侧和1次单侧上颌窦嵌体植骨以及外侧和垂直贴附植骨。我们从前外侧壁去除骨窗打开上颌窦，在掀起窦黏膜后，用皮质松质髂嵴骨移植材料移植到窦底。上颌骨在外侧和垂直方向也进行了增骨。通过骨内固定将骨移植材料固定。中位时间为5个月后，共植入134枚（Branemark）种植体，随后通过义齿修复进行加载。在植骨手术前、植骨后即刻、4个月后以及此后每年进行计算机断层扫描（CT）。在基台手术时，94.8%的种植体成功。加载后，在平均2.5年的随访期内又出现了2例失败病例。大多数患者佩戴了种植体支持的义齿。CT扫描显示垂直骨高度平均初始增加3.7-17.7mm。植骨1年后，骨高度丢失1.3mm或7%。在接下来的2年中，未观察到明显萎缩。统计分析表明，性别、增骨前骨高度、增骨后的骨高度以及移植骨的吸收之间无相关性。我们观察到愈合顺利，获得了较大的垂直骨高度、高成功率、最小吸收以及完全令人满意的义齿修复效果；因此，我们可以推荐我们改良的严重吸收上颌骨重建技术用于常规临床。
