Wilkert-Walter C, Jänicke S, Spüntrup E, Laurin Th
Klinik für Zahn-, Mund-, Kiefer- und Plastische Gesichtschirurgie, Universitätsklinikum, RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen.
Mund Kiefer Gesichtschir. 2002 Sep;6(5):336-40. doi: 10.1007/s10006-002-0398-z.
Complication rates after sinus floor augmentation of up to 10% are mentioned in literature, often when heterologous bone implants are used. The aim of our retrospective study was to determine the complication rate involving the maxillary sinus of patients treated with autologous spongiosa.
In 46 patients with an absolute maxillary atrophy (61% female, 39% male, mean age 49 years), a sinus floor augmentation, if necessary combined with an onlay bone graft of the iliac crest, was performed. Implants (Brånemark) were placed in a two-stage procedure after 3-6 months. Prior to surgery, a panoramic film was made for diagnosis and treatment planning; in addition, a sinus X-ray was taken when disease of the maxillary sinus was suspected. panoramic radiography was routinely taken after surgery. A clinical and radiological follow-up examination was performed after 6-12 months, and the patients answered a questionnaire. This study also included evaluation of operation reports and case histories. Ultrasound as well as magnetic resonance imaging to prevent radiation exposure were performed additionally.
In spite of perforation of the maxillary sinus mucosa in about 25%, removal of the bone graft due to inflammation was not necessary. A transient sinusitis developed in 2%. The implant loss rate (3 out of 154) may be called small.
Even though alternative heterologous graft materials exist, maxillary sinus floor elevation with autologous bone graft is still a safe option. Changes of the maxillary sinus are detectable in a small percentage, relatively often due to preexisting unrecognized or subclinical diseases of the maxillary sinus. Magnetic resonance imaging is, in spite of the high financial and technical effort required, a serious alternative to computed tomography. The combination of autologous bone graft with calcium phosphate ceramics, platelet-rich plasma, or synthetic bone growth factors should be tested as an alternative treatment method.
文献中提到，上颌窦底提升术后的并发症发生率高达10%，通常是在使用异体骨植入物时出现。我们这项回顾性研究的目的是确定接受自体松质骨治疗的患者上颌窦相关并发症的发生率。
对46例绝对上颌骨萎缩患者（61%为女性，39%为男性，平均年龄49岁）进行上颌窦底提升术，必要时联合髂嵴块状骨移植。3至6个月后分两期植入种植体（诺贝尔）。术前拍摄全景片用于诊断和治疗规划；此外，怀疑上颌窦疾病时拍摄鼻窦X光片。术后常规拍摄全景片。术后6至12个月进行临床和影像学随访检查，患者回答问卷。本研究还包括对手术报告和病历的评估。另外进行超声以及磁共振成像检查以避免辐射暴露。
尽管约25%的患者上颌窦黏膜穿孔，但无需因炎症取出骨移植材料。2%的患者发生了短暂性鼻窦炎。种植体丢失率（154颗中有3颗）可认为较低。
尽管存在其他异体移植材料，但自体骨移植进行上颌窦底提升仍是一种安全的选择。上颌窦的变化在小部分患者中可检测到，相对常见的原因是上颌窦先前存在未被识别的或亚临床疾病。尽管磁共振成像需要高昂的资金和技术投入，但仍是计算机断层扫描的一种重要替代方法。自体骨移植与磷酸钙陶瓷、富血小板血浆或合成骨生长因子联合应用应作为替代治疗方法进行测试。
