Mertens Christian, Wiens Daniel, Steveling Helmut G, Sander Anja, Freier Kolja
Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany.
Clin Implant Dent Relat Res. 2014 Jun;16(3):365-73. doi: 10.1111/j.1708-8208.2012.00484.x. Epub 2012 Aug 15.
Insufficient bone height in the posterior maxilla is caused by bone atrophy after tooth extraction and continued pneumatization of the maxillary sinus. To allow for implant placement in this area, external sinus-floor elevations are performed. For this indication, the application of various bone graft materials can be a reliable alternative to autologous bone.
The aim of this study was to analyze a nanoporous bone graft material under the condition of early implant treatment in sinus floor elevations.
Sixty-six patients received 94 individual external sinus-floor elevations as a precondition for implant surgery. As grafting material, a synthetic, nanoporous bone graft material consisting of a mixture of nano-hydroxyapatite and nano-β-tricalciumphosphate crystals, combined with blood from the defect side, was used. Depending on the remaining vertical bone height, implant placement was performed either simultaneously with bone augmentation or consecutively in a delayed approach. After a 4-month healing period, the patients received 218 implants and were followed up clinically, radiographically, and histologically. To quantify the bone situation at implant placement, immunohistochemical analysis using tenascin-C was performed.
We achieved an average vertical bone increase of 8.28 mm (SD, 2.59) for the one-stage approach and 10.99 mm (SD, 1.73) for the two-stage approach after sinus-floor elevation. The augmented areas showed mean resorption rates of 10.32% (one stage) and 10.82% (two stages) of vertical graft during the observation period. Immunohistochemical analysis after 4 months of healing showed high tenascin activity, indicating bone growth. Good primary stability was achieved during implant placement. Mean peri-implant marginal bone loss was 0.45 mm (SD, 0.31).
After a mean observation time of 21.45 months, the biomaterial showed good osseointegration and bone stability radiographically. Adding to this the positive histological and immunohistochemical findings, we conclude that, after a relatively short 4-month healing period, the biomaterial showed predictable results.
上颌后牙区骨高度不足是由拔牙后骨吸收和上颌窦持续气化引起的。为了在该区域植入种植体，需进行外提升上颌窦底。针对这一适应症，应用各种骨移植材料可成为自体骨的可靠替代方案。
本研究旨在分析一种纳米多孔骨移植材料在早期种植治疗上颌窦底提升情况下的效果。
66例患者接受了94次个体上颌窦底外提升术，作为种植手术的前提条件。作为移植材料，使用了一种合成的纳米多孔骨移植材料，其由纳米羟基磷灰石和纳米β - 磷酸三钙晶体混合物组成，并与缺损侧的血液混合。根据剩余垂直骨高度，种植体植入可与骨增量同时进行，或采用延迟方式连续进行。经过4个月的愈合期后，患者接受了218颗种植体植入，并进行了临床、影像学和组织学随访。为了量化种植体植入时的骨情况，使用肌腱蛋白 - C进行了免疫组织化学分析。
上颌窦底提升后，一期手术平均垂直骨增量为8.28毫米（标准差，2.59），二期手术为10.99毫米（标准差，1.73）。在观察期内，植骨区垂直植骨的平均吸收率分别为一期10.32%，二期10.82%。愈合4个月后的免疫组织化学分析显示肌腱蛋白活性高，表明有骨生长。种植体植入时获得了良好的初期稳定性。种植体周围平均边缘骨吸收为0.45毫米（标准差，0.31）。
经过平均21.45个月的观察期，该生物材料在影像学上显示出良好的骨整合和骨稳定性。再加上积极的组织学和免疫组织化学结果，我们得出结论，经过相对较短的4个月愈合期后，该生物材料显示出可预测的结果。
