Kübler N R, Will C, Depprich R, Betz T, Reinhart E, Bill J S, Reuther J F
Klinik und Poliklinik für Mund-, Kiefer-, Gesichtschirurgie, Bayerische Julius-Maximilians-Universität Würzburg.
Mund Kiefer Gesichtschir. 1999 May;3 Suppl 1:S53-60. doi: 10.1007/PL00014517.
In 63 patients, 82 elevations of the maxillary sinus were performed. As augmentation, materials autografts from the iliac crest (combined with alveolar ridge augmentations in 16 sinus lifts) were transplanted in 39 cases and osteoinductive, allogeneic bone powder (AAA bone (autolyzed, antigen-extracted, allogeneic bone): n = 8, DFDBA (demineralized freeze-dried bone allograft) and/or Grafton (demineralized bone matrix gel): n = 35) were used in 43 cases. Some 4-6 months after implantation, osteoinductive, allogeneic (demineralized) bone implants showed radio-opaque areas as an equivalent of bone formation. Histological examinations revealed that osteoinductive implants were completely transformed into patients' own bone tissue. The average augmentation height after autograft transplantations was 14 (+/- 3) mm in comparison with 9 (+/- 3) mm after allograft implantations. Histologically as well as radiologically no differences of the bone quality could be determined between the two augmentation materials. Endoscopic controls showed, in both groups, nonirritated mucous membranes. On an average 2 endosseous implants (Bone Lock or ITI-screw implants) were inserted into the augmentated maxillary sinus floors in both groups. No osseointegration was achieved in 4 out of 67 dental implants when bone autografts were used and in 2 out of 74 dental implants of the allogeneic bone group. Patients with bone autografts suffered from postoperative complaints on an average of 19 (+/- 9) days (without consideration of 2 patients with postoperative complaints persisting for more than 90 days). The average postoperative complaints of recipients of allogeneic bone implants continued for 3 (+/- 5) days. The 13 patients who underwent an ambulant sinus lift procedure with allogeneic bone powder were already symptom-free several hours after the operation. Under critical consideration of all investigated parameters, osteoinductive bone implants are preferable to iliac bone autografts for maxillary sinus augmentations in those cases in which no additional alveolar ridge augmentation is required.
对63例患者进行了82次上颌窦提升术。作为增量材料，39例采用了取自髂嵴的自体移植骨（其中16次上颌窦提升术联合牙槽嵴增量），43例使用了骨诱导性同种异体骨粉（AAA骨（自溶、抗原提取的同种异体骨）：n = 8；脱矿冻干骨同种异体移植（DFDBA）和/或骨基质明胶（Grafton）：n = 35）。植入后约4 - 6个月，骨诱导性同种异体（脱矿）骨植入物显示出与骨形成相当的不透射线区域。组织学检查显示，骨诱导性植入物完全转化为患者自身的骨组织。自体移植后的平均增量高度为14（±3）mm，而异体移植后的平均增量高度为9（±3）mm。在组织学和放射学上，两种增量材料的骨质均无差异。内镜检查显示，两组的黏膜均未受刺激。两组均平均在上颌窦增量后的底部分别植入2枚骨内种植体（骨锁或ITI种植体）。使用自体骨移植时，67枚牙种植体中有4枚未实现骨结合；同种异体骨组的74枚牙种植体中有2枚未实现骨结合。接受自体骨移植的患者术后平均不适19（±9）天（未考虑2例术后不适持续超过90天的患者）。接受同种异体骨植入的患者术后不适平均持续3（±5）天。13例接受同种异体骨粉门诊上颌窦提升术的患者术后数小时就已无症状。在对所有研究参数进行审慎考虑后，在不需要额外牙槽嵴增量的情况下，骨诱导性骨植入物在上颌窦增量方面优于髂骨自体移植。
