Reiser G M, Rabinovitz Z, Bruno J, Damoulis P D, Griffin T J
Tufts University, School of Dental Medicine, Department of Periodontology, Boston, Massachusetts, USA.
Int J Oral Maxillofac Implants. 2001 Nov-Dec;16(6):833-40.
Implant placement in the posterior maxilla often requires elevation of the sinus floor, which can be achieved through either the modified Caldwell-Luc or the crestal osteotome technique. The objectives of this study were to evaluate (a) the resistance to perforation of maxillary sinus membranes obtained from formaldehyde-fixed cadavers in vitro, (b) the frequency and extent of membrane perforations occurring after sinus floor elevation in cadavers using the crestal approach, and (c) the amount of membrane elevation (doming) that can be achieved using the crestal approach. Pretreatment of maxillary sinus membrane tissues with commonly used tissue softeners did not have a statistically significant effect on resistance to perforation. Maxillary sinus membranes were elevated 4 to 8 mm in formaldehyde-fixed cadavers using the osteotome technique; implants were placed. Of the 25 sites that received implants, only 6 showed perforations, as assessed by double-blind investigation after dissection of the lateral wall of the nose, allowing direct examination of the sinus cavity. Perforations were categorized as Class I (< or = 2 mm with exposure of the implant into the sinus cavity and loss of doming); Class II perforations (> or = 2 mm) were associated with proximity of the osteotomy site to the medial wall of the sinus or the presence of septae. These results indicated that the crestal osteotome approach compared favorably to the modified Caldwell-Luc technique as it relates to the frequency of maxillary sinus membrane perforations and the degree of achievable membrane elevation.
在上颌骨后部植入种植体通常需要抬高窦底，这可以通过改良的考德威尔-卢氏手术或嵴顶骨凿技术来实现。本研究的目的是评估：(a) 体外从甲醛固定尸体获取的上颌窦膜的抗穿孔能力；(b) 使用嵴顶入路在尸体中抬高窦底后发生膜穿孔的频率和范围；(c) 使用嵴顶入路可实现的膜抬高（穹顶化）量。用常用的组织软化剂对上颌窦膜组织进行预处理，对其抗穿孔能力没有统计学上的显著影响。使用骨凿技术在甲醛固定的尸体中将上颌窦膜抬高4至8毫米；然后植入种植体。在接受种植体植入的25个部位中，经鼻外侧壁解剖后的双盲调查评估，只有6个部位出现穿孔，从而可以直接检查窦腔。穿孔分为I类（≤2毫米，种植体暴露于窦腔且穹顶化消失）；II类穿孔（≥2毫米）与截骨部位靠近窦内侧壁或存在间隔有关。这些结果表明，就上颌窦膜穿孔的频率和可实现的膜抬高程度而言，嵴顶骨凿入路优于改良的考德威尔-卢氏技术。
