Raghoebar G M, Timmenga N M, Reintsema H, Stegenga B, Vissink A
Department of Oral and Maxillofacial Surgery and Maxillofacial Prosthetics, University Hospital Groningen, The Netherlands.
Clin Oral Implants Res. 2001 Jun;12(3):279-86. doi: 10.1034/j.1600-0501.2001.012003279.x.
Insertion of endosseous implants in the atrophic maxilla is often complicated because of lack of supporting bone. Augmentation of the floor of the maxillary sinus with autogenous bone graft has been proven to be a reliable treatment modality, at least in the short term. The long-term clinical and radiographic outcome with regard to the grafts, the implants and satisfaction of the patients with their implant-supported overdenture was studied in 99 patients. The sinus floor was augmented with bone grafts derived from the iliac crest (83 subjects, 162 sinuses, 353 implants), the mandibular symphysis (14, 18, 37), or the maxillary tuberosity (2, 2, 2). Before implant installation, the width and height of the alveolar crest were increased in a first stage procedure in 74 patients, while in the other 25 patients augmentation and implant installation could be performed simultaneously (width and height of the alveolar crest >5 mm). Perforation of the sinus membrane occurred in 47 cases, which did not predispose to the development of sinusitis. Loss of bone particles and sequestration were observed in one (diabetic) patient only, in whom a dehiscence of the oral mucosa occurred. A second augmentation procedure was successful in this patient. Symptoms of transient sinusitis were observed in 3 patients. These symptoms were successfully treated with decongestants and antibiotics. 2 other patients developed a purulent sinusitis which resolved after a nasal antrostomy. In all cases, the bone volume was sufficient for implant insertion. 32 of 392 inserted Brånemark implants (8.2%) were lost during the follow-up. After the healing period of the bone grafts, no sinus pathology was observed. The patients received implant-supported overdentures (72 patients) or fixed bridges (27 patients). Overall, the patients were very satisfied with the prosthetic construction. We conclude that bone grafting of the floor of the maxillary sinus floor with autogenous bone for the insertion of implants is a reliable treatment modality with good long-term results.
由于缺乏支持骨，在上颌骨萎缩患者中植入骨内种植体往往较为复杂。上颌窦底自体骨移植已被证明是一种可靠的治疗方式，至少在短期内如此。我们对99例患者进行了研究，观察了移植骨、种植体的长期临床和影像学结果以及患者对种植体支持式覆盖义齿的满意度。上颌窦底采用取自髂嵴的骨移植（83例患者，162侧窦，353枚种植体）、下颌联合（14例，18侧窦，37枚种植体）或上颌结节（2例，2侧窦，2枚种植体）。在种植体植入前，74例患者在第一阶段手术中增加了牙槽嵴的宽度和高度，而另外25例患者可同时进行上颌窦底增高和种植体植入（牙槽嵴宽度和高度>5mm）。47例发生了上颌窦黏膜穿孔，但未引发鼻窦炎。仅1例（糖尿病）患者观察到骨颗粒丢失和骨片形成，该患者出现了口腔黏膜裂开。该患者再次进行上颌窦底增高手术成功。3例患者出现了短暂性鼻窦炎症状，经减充血剂和抗生素治疗成功。另外2例患者发生了化脓性鼻窦炎，经鼻上颌窦造口术后痊愈。所有病例中，骨量均足以植入种植体。在随访期间，392枚植入的Brånemark种植体中有32枚（8.2%）丢失。在骨移植愈合期后，未观察到上颌窦病变。患者接受了种植体支持式覆盖义齿（72例患者）或固定桥修复（27例患者）。总体而言，患者对修复体非常满意。我们得出结论，上颌窦底自体骨移植用于植入种植体是一种可靠的治疗方式，长期效果良好。
