Khoury Fouad, Keller Pierre, Keeve Philip L
Int J Oral Maxillofac Implants. 2017 Sep/Oct;32(5):1086-1096. doi: 10.11607/jomi.5832.
To evaluate long-term survival rates and radiographic stability of sinus floor elevations carried out using a two-layer grafting technique.
Records were analyzed for patients treated with sinus floor elevations using a modified technique. Phycogenic hydroxyapatite (Algipore, Dentsply Sirona Implants) and autogenous bone particles harvested from intraoral sites were grafted in two distinct layers after elevation of the sinus mucosae. In this approach, the basal part of the sinus floor is grafted with autogenous bone, while the cranial part is grafted with the phycogenic hydroxyapatite. In some cases, implants were placed simultaneously, such that the entire surface of each implant was covered by autogenous bone particles. A titanium membrane was used to close the sinus window, and the implants were loaded 3 months later. In two-stage approaches, the implants were inserted 3 to 4 months after the grafting and loaded after 3 additional months. Panoramic radiographs were taken after the grafting procedure, after implant insertion, after the prosthetic restoration, and then annually for 10 years. These radiographs were used to measure the height between the implant shoulders and the top of the graft.
Of the 214 sinus floor elevations performed on 129 patients using the bilayering technique, 198 procedures in 118 patients were included in the study (136 one-stage and 62 two-stage). Membrane perforations during surgery occurred in 17.9% of the procedures and were sutured and sealed with fibrin glue. A total of 487 implants were placed in the grafted areas. No severe postoperative complications occurred, but three implants were lost throughout the 10-year follow-up period. A small decrease of vertical height was observed between the grafting surgery and the stage-two surgery (mean: 1.8 mm). After that, no bone height was lost over the 10 years.
The layer grafting technique in combination with sinus floor elevation resulted in radiographically stable vertical bone height for 10 years. This technique enabled early placement and loading of implants in the grafted areas. The survival rate obtained with this procedure is similar to that expected for implants placed in nongrafted areas.
评估采用双层植骨技术进行上颌窦底提升后的长期生存率及影像学稳定性。
分析采用改良技术进行上颌窦底提升治疗的患者记录。将藻源性羟基磷灰石（Algipore，登士柏西诺德种植体）和取自口腔内部位的自体骨颗粒在上颌窦黏膜提升后分两层植入。在该方法中，上颌窦底的基部用自体骨植入，而颅部用藻源性羟基磷灰石植入。在某些情况下，同时植入种植体，使每个种植体的整个表面被自体骨颗粒覆盖。使用钛膜封闭上颌窦窗口，并在3个月后加载种植体。在两阶段方法中，在植骨后3至4个月插入种植体，并在另外3个月后加载。在植骨手术后、种植体植入后、修复修复后以及随后10年每年拍摄全景X线片。这些X线片用于测量种植体肩部与植骨顶部之间的高度。
在129例患者中采用双层技术进行了214次上颌窦底提升，其中118例患者的198次手术纳入研究（136例一期手术和62例二期手术）。手术期间膜穿孔发生在17.9%的手术中，并用纤维蛋白胶缝合和封闭。共在植骨区域植入487枚种植体。未发生严重术后并发症，但在10年随访期间有3枚种植体丢失。在植骨手术和二期手术之间观察到垂直高度有小幅下降（平均：1.8毫米）。此后，10年内骨高度未丢失。
双层植骨技术结合上颌窦底提升在影像学上使垂直骨高度保持稳定达10年。该技术能够在植骨区域早期植入和加载种植体。该手术获得的生存率与非植骨区域植入种植体的预期生存率相似。
