Kiyokawa Kensuke, Rikimaru Hideaki, Kiyokawa Munekatsu, Fukaya Hajime, Sakaguchi Shinji
From the *Department of Plastic and Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine; †Kiyokawa Dental and Oral Surgery Clinic; and ‡Sakaguchi Ear Nose and Throat Clinic.
J Craniofac Surg. 2013 Sep;24(5):1599-602. doi: 10.1097/SCS.0b013e3182a20fd5.
We have developed a regenerative medicine therapy for the alveolar bone and endoscopic surgery for maxillary sinus lift without bone grafts, in patients experiencing severe periodontal disease with significant absorption of the maxillary alveolar bone, in which more than 10 mm of bone thickness in the maxillary bone was attained, with satisfactory results. The objective of this study was to examine the treatment outcomes of implants that were performed after these therapies.
The participants were 36 patients with severe periodontal disease, who cannot be cured with any other treatments except the extirpation of all teeth. The 36 patients are all patients who underwent regenerative treatment of the alveolar bone through tooth replantation and transplantation of the iliac cancellous bone (the bone marrow) as well as endoscopic surgery for maxillary sinus lift from May 2003 to July 2007 in our clinic. A total of 120 implants were placed in these patients when the replanted teeth fell out because of root resorption, and the success rate was examined.
The success rates of the implants were 16 of 33 (48%) in the group when surveyed less than 2 years after the surgery and 84 of 87 (96.5%) in the group when surveyed more than 2 years after the surgery. A statistically significant difference was found between the 2 groups (Chi-squared test, P < 0.001).
It was believed that it takes approximately 2 years for the bones in the maxillary sinus floor, augmented through endoscopic surgery for maxillary sinus lift, to attain the thickness and hardness required for implant placement. Therefore, although the implant treatment should be performed later than 2 years after surgery, chewing is possible during this period, with the replanted teeth that were used for regenerative treatment of the alveolar bone. It is believed that this is an extremely effective treatment method to improve the patients' quality of life.
我们已研发出一种针对牙槽骨的再生医学疗法以及无需植骨的上颌窦提升内镜手术，用于患有严重牙周病且上颌牙槽骨大量吸收的患者，这些患者在上颌骨中实现了超过10毫米的骨厚度，效果令人满意。本研究的目的是检验这些治疗后进行种植体植入的治疗效果。
参与者为36例患有严重牙周病的患者，除拔除所有牙齿外，其他任何治疗方法均无法治愈。这36例患者均为2003年5月至2007年7月在我们诊所接受了通过牙齿再植和髂骨松质骨（骨髓）移植进行牙槽骨再生治疗以及上颌窦提升内镜手术的患者。当再植牙因牙根吸收脱落时，在这些患者中共植入了120颗种植体，并检测成功率。
术后不到2年进行调查时，种植体成功率在该组中为33颗中的16颗（48%）；术后超过2年进行调查时，该组成功率为87颗中的84颗（96.5%）。两组之间存在统计学显著差异（卡方检验，P<0.001）。
据信，通过上颌窦提升内镜手术增厚的上颌窦底骨需要大约2年时间才能达到植入种植体所需的厚度和硬度。因此，尽管种植体治疗应在术后2年以后进行，但在此期间可以使用用于牙槽骨再生治疗的再植牙进行咀嚼。据信这是一种改善患者生活质量的极其有效的治疗方法。
