Ferri Joël, Dujoncquoy Jean-Pascal, Carneiro José Mario, Raoul Gwénael
Maxillo-Facial Department at Lille 2 University, Lille, France.
Head Face Med. 2008 Dec 16;4:31. doi: 10.1186/1746-160X-4-31.
The purpose of the present study was to evaluate different types of maxillary pre-prosthetic surgery using autogenous bone graft and suggest a guideline for maxillary reconstruction to place implant.
181 patients (125 females and 56 males), age range from 16 to 76 years old, were operated at the Maxillo-Facial Service of the Lille's 2 Universitary Hospital Center (Chairman Pr Joël Ferri). Different techniques were used, but always with autogenous bone grafting. 21 patients underwent a Lefort 1 procedure, 139 underwent sinus graft with or without vestibular onlay graft and 21 underwent onlay graft. This surgical procedure was made to allow the insertion of 685 implants.
The patients were evaluated by clinical and radiological assessment. In the cases of Lefort 1, the rate of successful osteointegration was higher when the implants were placed in the second part of a two stages procedure: 92%, against 81% for one stage. In cases of sinus lift procedure, the rate of implant success was 98%. The infection rate was 3.5%. There was no significant resorption and the type of prosthesis used was a denture retained by a bar or fixed bridge. In cases of onlay graft, the implant insertion success was 97% and there was no infection. The amount of resorption was more significant in the pre-maxilla than in the other areas and the type of prosthesis used was fixed dentures.
These observations demonstrate that: the aetiology of the bone defect indicate the type and number of the surgical procedures to re-established good jaws relationship and give the bone conditions to implant insertion successful.
A guideline for surgical decision in the maxillary reconstruction for oral rehabilitation by implants may help to prevent failures of osseous resorption disorders and to foresee the investment of the bone in quality and necessary quantity.
本研究的目的是评估使用自体骨移植的不同类型上颌修复前手术，并提出上颌种植修复重建的指导原则。
181例患者（125例女性和56例男性），年龄在16至76岁之间，在里尔第二大学医院中心颌面外科（主任乔埃尔·费里教授）接受手术。采用了不同的技术，但均采用自体骨移植。21例患者接受了勒福Ⅰ型截骨术，139例患者接受了上颌窦提升术（有或无前庭植骨），21例患者接受了植骨术。进行这些手术是为了植入685颗种植体。
通过临床和影像学评估对患者进行评价。在勒福Ⅰ型截骨术的病例中，种植体分两期植入时，二期植入时骨结合成功率较高：为92%，一期植入时为81%。在上颌窦提升术的病例中，种植体成功率为98%。感染率为3.5%。无明显吸收，所使用的修复体类型为杆卡式义齿或固定桥。在植骨术的病例中，种植体植入成功率为97%，无感染。前牙区的吸收量比其他区域更显著，所使用的修复体类型为固定义齿。
这些观察结果表明：骨缺损的病因决定了重建良好颌骨关系并为种植体成功植入提供骨条件所需的手术类型和数量。
上颌种植修复重建手术决策的指导原则可能有助于预防骨吸收障碍的失败，并预见在质量和必要数量方面的骨投入。
