Yang Seung-Min, Kye Seung-Beom
Department of Periodontology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Periodontal Implant Sci. 2014 Apr;44(2):50-6. doi: 10.5051/jpis.2014.44.2.50. Epub 2014 Apr 24.
The aims of this study were to measure the distance of the intraosseous vascular anastomosis in the anterolateral wall of the maxillary sinus from different reference points, and to correlate the location of the intraosseous vascular anastomosis with the tooth position and the residual bone height of the maxilla.
Computed tomography (CT) images were taken from 283 patients undergoing dental implants placement in the posterior maxilla. Three horizontal lines were drawn at the ridge crest, maxillary sinus floor, and the position of the anastomosis. A vertical second line at the center of each tooth was drawn perpendicular to the horizontal lines. The distance from the ridge crest to the maxillary sinus floor and the distance from the maxillary sinus floor to the bony canal were measured from the intersections of the horizontal and vertical lines. The residual alveolar bone height was used to categorize three groups: group 1,<4 mm; group 2, between 4 and 8 mm; and group 3, >8 mm.
The residual bone height values of different tooth positions were significantly different (P=0.0002). The distance from the maxillary sinus floor to the intraosseous vascular anastomosis was significantly different between groups 1 and 3 (P=0.0039). At the molar sites, a moderate negative correlation was found between the residual bone height and the distance from the maxillary sinus floor to the intraosseous anastomosis. The distances of the alveolar ridge crest and the maxillary sinus from the intraosseous vascular anastomosis were not significantly different between sexes.
Within the limitations of this study, sites with a higher residual bone height in the molar regions were at a relatively high risk of artery damage during window osteotomy preparation; therefore, we recommend taking more precautions when using a lateral approach for sinus elevation.
本研究旨在测量上颌窦前外侧壁骨内血管吻合处与不同参考点之间的距离，并将骨内血管吻合处的位置与牙齿位置及上颌骨剩余骨高度相关联。
对283例在上颌后部进行牙种植体植入的患者进行计算机断层扫描（CT）成像。在牙槽嵴顶、上颌窦底和吻合处位置绘制三条水平线。在每颗牙齿的中心绘制一条垂直于水平线的第二条线。从水平和垂直线的交点处测量牙槽嵴顶到上颌窦底的距离以及上颌窦底到骨管的距离。使用剩余牙槽骨高度将患者分为三组：第1组，<4 mm；第2组，4至8 mm；第3组，>8 mm。
不同牙齿位置的剩余骨高度值存在显著差异（P = 0.0002）。第1组和第3组之间上颌窦底到骨内血管吻合处的距离存在显著差异（P = 0.0039）。在磨牙部位，发现剩余骨高度与上颌窦底到骨内吻合处的距离之间存在中度负相关。牙槽嵴顶和上颌窦到骨内血管吻合处的距离在性别之间无显著差异。
在本研究的局限性范围内，磨牙区域剩余骨高度较高的部位在开窗截骨术准备过程中动脉损伤风险相对较高；因此，我们建议在采用外侧入路进行上颌窦提升时采取更多预防措施。
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