Esposito Marco, Piattelli Maurizio, Pistilli Roberto, Pellegrino Gerardo, Felice Pietro
Department of Biomaterials, The Sahlgrenska Academy at Göteborg University, Sweden.
Eur J Oral Implantol. 2010 Winter;3(4):297-305.
To compare the efficacy of two different techniques for maintaining the space beneath a maxillary lining lifted using a lateral window approach: rigid synthetic resorbable barriers versus granular anorganic bovine bone.
Ten partially edentulous patients having bilaterally 1 to 5 mm of residual bone height and at least 5 mm bone width below the maxillary sinuses, were randomised in a split-mouth study design, to receive a rigid Inion GTR Biodegradable Membrane System barrier without any graft on one side and 100% loosely packed granular Bio-Oss on the contralateral side following a lateral window, two-stage, sinus lift procedure. After 6 months, two or three implants were inserted at each side and submerged for 4 months. Implants were loaded with provisional acrylic prostheses and replaced, after 4 months, by definitive metal-ceramic prostheses cemented with provisional cement. Outcome measures were implant and prosthetic failures, any complication and peri-implant marginal bone level changes assessed by a blinded outcome assessor. All patients were followed up to 1 year after loading.
One patient dropped out after implant placement. One distal implant failed at the Inion side just before delivery of the definitive prosthesis, which was cut and maintained as a single crown. Four complications occurred in three patients at Inion sites (two sinus lining perforations, one fracture of the ceramic cusp of the definitive prosthesis, one iatrogenic peri-implantitis) versus two complications at Bio-Oss sites (one sinus lining perforation and one iatrogenic peri-implantitis). There were no differences for failures or complications between groups; however, in one of the patients where a perforation occurred at the Inion site, at implant placement, the sinus was filled two-thirds with soft tissue and the site was retreated with Bio-Oss. There were no statistically significant differences in bone loss between groups. One year after loading, Inion sides lost an average of 1.5 mm of periimplant bone and Bio-Oss sides about 1.7 mm.
A bone graft may not be needed to augment atrophic maxillary sinuses since it is sufficient to keep space with a rigid barrier; however, it may be simpler to fill sinuses with a bone substitute than positioning a rigid barrier to maintain space.
比较两种不同技术在上颌窦侧壁开窗提升术后维持上颌窦底提升间隙的效果：刚性合成可吸收屏障与颗粒状无机牛骨。
10例双侧剩余骨高度为1至5mm且上颌窦下方骨宽度至少为5mm的部分牙列缺损患者，采用分口研究设计进行随机分组，一侧接受不植骨的刚性Inion GTR生物可降解膜系统屏障，另一侧在侧壁开窗、两阶段上颌窦提升术后接受100%松散填充的颗粒状Bio-Oss骨粉。6个月后，两侧各植入2至3枚种植体并埋入4个月。种植体加载临时丙烯酸修复体，4个月后更换为用临时粘固剂粘固的最终金属烤瓷修复体。观察指标包括种植体及修复体失败情况、任何并发症以及由盲法观察评估者评估的种植体周围边缘骨水平变化。所有患者在加载后随访1年。
1例患者在种植体植入后退出研究。在最终修复体交付前，Inion侧1枚远中种植体失败，该修复体被切割并保留为单冠修复。Inion侧3例患者出现4种并发症（2例上颌窦黏膜穿孔、1例最终修复体陶瓷牙尖折断、1例医源性种植体周围炎），Bio-Oss侧2例患者出现2种并发症（1例上颌窦黏膜穿孔和1例医源性种植体周围炎）。两组在失败或并发症方面无差异；然而，在Inion侧发生穿孔的1例患者中，种植体植入时上颌窦三分之二被软组织填充，并再次用Bio-Oss骨粉处理该部位。两组之间的骨吸收无统计学显著差异。加载1年后，Inion侧种植体周围骨平均吸收1.5mm，Bio-Oss侧约为1.7mm。
对于萎缩性上颌窦，可能无需植骨来增加骨量，因为使用刚性屏障保持间隙就足够了；然而，用骨替代物填充上颌窦可能比放置刚性屏障来维持间隙更简单。
