de Almeida Ferreira Carlos Eduardo, Martinelli Carolina Borges, Novaes Arthur Belém, Pignaton Túlio Bonna, Guignone Camila Coser, Gonçalves de Almeida Adriana Luísa, Saba-Chujfi Eduardo
Int J Oral Maxillofac Implants. 2017 Mar/Apr;32(2):401-407. doi: 10.11607/jomi.4419.
The aim of this retrospective study was to evaluate implant survival rates (ISRs) for implants placed in grafted sinuses where a membrane perforation occurred during augmentation using exclusively anorganic bovine bone (ABB) by means of clinical and radiographic examinations. Histologic information of five biopsy specimens taken from large membrane perforations is also presented.
Consecutive patients who underwent sinus augmentation procedures at a private practice Dental Institute between 2004 and 2013 were collected from a computer database. The following profiles were selected for data analysis: computed tomography prior to treatment; perforated membrane information according to size: not perforated, small (≤ 5 mm), medium (> 5 and < 10 mm), or large (≥ 10 mm); sinuses grafted exclusively with ABB and lateral window covered with a collagen membrane (CM); and implant survival after at least 2 years of functional loading placed in augmented sinuses. Implants were considered survivals in the absence of infection, mobility, or pain.
The sample in this retrospective study comprised 531 patients; 214 required bilateral sinus augmentation, and 317 required unilateral sinus augmentation (total = 745 sinuses). A total of 1,588 implants were placed. From 745 augmented sinuses, 237 (31.8%; 523 implants) were perforated during the procedure. Among these, 48 perforations were large (20.2%; 107 implants), 67 (28.3%; 150 implants) were medium, and 122 were small (51.5%; 266 implants). Of 523 implants placed in perforated sinuses, 15 were lost (ISR = 97.1%). Comparison of the ISRs for small (97.7%), medium (97.3%), and large (95.3%) perforations with 1,065 implants placed in nonperforated sinuses (ISR = 97.7%) was not statistically significant. The histomorphometric analysis of the five biopsy specimens showed 24.52% ± 6.99% of new bone, 24.32% ± 6.42% of marrow space, and 51.2% ± 3.75% of the remaining ABB.
The difference in ISR for implants placed in perforated and nonperforated sinuses was not statistically significant. Within the limits of the histologic data, histomorphometric results with 24.52% ± 6.99% of new bone formation in sinuses with large perforations showed similar bone formation compatible with nonperforated sinuses described in the literature. The authors attributed the high ISR shown in perforated sinuses in this study to the proper management of the perforations.
本回顾性研究旨在通过临床和影像学检查，评估在仅使用无机牛骨（ABB）进行上颌窦植骨增容过程中发生膜穿孔的情况下，种植体的存留率（ISR）。还展示了从大的膜穿孔处获取的5个活检标本的组织学信息。
从计算机数据库中收集2004年至2013年在一家私立牙科研究所接受上颌窦增容手术的连续患者。选择以下资料进行数据分析：治疗前的计算机断层扫描；根据穿孔大小的穿孔膜信息：未穿孔、小（≤5mm）、中（>5且<10mm）或大（≥10mm）；仅用ABB植骨且外侧窗口覆盖胶原膜（CM）的上颌窦；以及在增容后的上颌窦中至少进行2年功能负载后的种植体存留情况。种植体在无感染、松动或疼痛的情况下被视为存留。
本回顾性研究的样本包括531例患者；214例需要双侧上颌窦增容，317例需要单侧上颌窦增容（总计745个上颌窦）。共植入1588颗种植体。在745个增容的上颌窦中，237个（31.8%；523颗种植体）在手术过程中发生穿孔。其中，48个穿孔为大穿孔（20.2%；107颗种植体），67个（28.3%；150颗种植体）为中穿孔，122个为小穿孔（51.5%；266颗种植体）。在穿孔的上颌窦中植入的523颗种植体中，15颗丢失（ISR = 97.1%）。将小穿孔（97.7%）、中穿孔（97.3%）和大穿孔（95.3%）的ISR与在未穿孔的上颌窦中植入的1065颗种植体的ISR（97.7%）进行比较，差异无统计学意义。对5个活检标本进行的组织形态计量学分析显示，新骨占24.52%±6.99%，骨髓腔占24.32%±6.42%，剩余的ABB占51.2%±3.75%。
穿孔和未穿孔的上颌窦中种植体的ISR差异无统计学意义。在组织学数据的范围内，大穿孔的上颌窦中形成24.52%±6.99%新骨的组织形态计量学结果显示出与文献中描述的未穿孔上颌窦相似的骨形成情况。作者将本研究中穿孔的上颌窦中显示的高ISR归因于对穿孔的妥善处理。
