Lie Nynke, Merten Hans-Albert, Meyns Joeri, Lethaus Bernd, Wiltfang Jörg, Kessler Peter
Department of Cranio-Maxillofacial Surgery (Head: Prof. P. Kessler), Maastricht Univesity Medical Center, Maastricht, The Netherlands.
Department of Orthodontics, Hannover Medical School, Hannover, Germany.
J Craniomaxillofac Surg. 2015 Oct;43(8):1670-7. doi: 10.1016/j.jcms.2015.07.011. Epub 2015 Jul 27.
Sinus floor elevation via the lateral window approach represents a reliable technique for bone augmentation in the atrophic posterior maxilla. It is known that sinus membrane elevation leads to new bone formation. This prospective clinical study compared a specific technique in sinus membrane elevation with a conventional sinus floor augmentation (xenogenous/autogenous bone) in a human split mouth model.
Five edentulous patients with highly atrophic posterior maxillae were included in this study. On one maxillary side a degradable PDLLA-membrane was placed to create a space underneath the sinus membrane. Contralateral a mixture of autogenous and xenogenous bone was used for sinus floor augmentation. A two-stage procedure was carried out. The following variables were assessed: bone regeneration on cone-beam computed tomography (cone-beam CT), implant success, prosthetic comfort and patient satisfaction. Bone biopsies were taken with simultaneous implant placement. The samples were histologically analyzed.
Cone-beam CTs revealed new bone formation on both sides. Thirty implants were placed, 15 in the augmented region and 15 in the non-augmented side. Thirty bone biopsies were taken and evaluated. Vital new bone was detected on the experimental side (osteoinductivity). On the conventional side a mixture of autogenous and residual bone substitute material was seen (osteoconductivity). Implant survival was 100% so far. Patient's satisfaction was high and prosthetic complications were not encountered.
As it provides the highest rate of bone formation, autogenous bone in combination with bone substitute material can be considered as a very reliable standard procedure in sinus floor augmentation. The specific sinus membrane elevation technique as presented here showed satisfying results and might be a suitable alternative for maxillary sinus augmentation.
经外侧窗口入路进行上颌窦底提升术是一种用于萎缩性上颌后牙区骨增量的可靠技术。已知上颌窦膜提升可导致新骨形成。本前瞻性临床研究在人体双侧对照模型中，将一种特定的上颌窦膜提升技术与传统的上颌窦底提升术（异种骨/自体骨）进行了比较。
本研究纳入了5例上颌后牙区高度萎缩的无牙颌患者。在一侧上颌，放置可降解的聚-DL-乳酸（PDLLA）膜以在上颌窦膜下方形成空间。对侧则使用自体骨和异种骨的混合物进行上颌窦底提升。采用两阶段手术。评估以下变量：锥形束计算机断层扫描（CBCT）上的骨再生情况、种植体成功率、修复舒适度和患者满意度。在同期植入种植体时进行骨活检。对样本进行组织学分析。
CBCT显示两侧均有新骨形成。共植入30枚种植体，15枚植入骨增量区，15枚植入未进行骨增量的一侧。共采集并评估了30份骨活检样本。在实验侧检测到有活力的新骨（骨诱导性）。在传统侧可见自体骨和残余骨替代材料的混合物（骨传导性）。迄今为止，种植体存活率为100%。患者满意度高，未出现修复并发症。
由于自体骨与骨替代材料结合能提供最高的骨形成率，可被视为上颌窦底提升术中一种非常可靠的标准术式。本文介绍的特定上颌窦膜提升技术显示出令人满意的结果，可能是上颌窦提升的一种合适替代方法。
