Department of Implant Dentistry, Showa University School of Dentistry, 2-1-1, Kita-Senzoku, Ota-ku, 145-8515, Tokyo, Japan.
Tokyo Medical and Dental University Dental Hospital, Tokyo Medical and Dental University, Tokyo, Japan.
Int J Implant Dent. 2021 Mar 2;7(1):16. doi: 10.1186/s40729-021-00298-y.
During implant treatment in the maxillary molar area, maxillary sinus floor augmentation is often performed to ameliorate the reduced alveolar bone height attributable to bone remodeling and pneumatization-induced expansion of the maxillary sinus. However, this augmentation may cause complications such as misplaced implants, artery damage, and maxillary sinus mucosal perforation; infections like maxillary sinusitis; and postsurgical complications such as bone graft leakage and postoperative nasal hemorrhaging. To reduce the complications during maxillary sinus floor augmentation and postoperative infections, we performed retrospective investigations of various systemic and local factors that influence pre-operative sinus mucosal thickness (SMT) by using cone-beam computed tomography (CBCT). Subjects included patients who underwent maxillary sinus floor augmentation in an edentulous maxillary molar area with a lateral approach. Pre-operative SMT, existing bone mass, and nasal septum deviation were measured using CBCT images. Relationships between SMT and the following influencing factors were investigated: (1) age, (2) sex, (3) systemic disease, (4) smoking, (5) period after tooth extraction, (6) reason for tooth extraction, (7) residual alveolar bone height (RBH), (8) sinus septa, and (9) nasal septum deviation. Correlations were also investigated for age and RBH (p < 0.05).
We assessed 35 patients (40 sinuses; 11 male, 24 female). The average patient age was 58.90 ± 9.0 years (males, 57.9 ± 7.7 years; females, 59.9 ± 9.4 years; age range, 41-79 years). The average SMT was 1.09 ± 1.30 mm, incidence of SMT > 2 mm was 25.0%, incidence of SMT < 0.8 mm was 50.0%, and the average RBH was 2.14 ± 1.02 mm. The factors that influenced SMT included sex (p = 0.0078), period after tooth extraction (p = 0.0075), reason for tooth extraction (p = 0.020), sinus septa (p = 0.0076), and nasal septum deviation (p = 0.038).
Factors associated with higher SMT included male sex, interval following tooth extraction < 6 months, periapical lesions, sinus septa, and nasal septum deviation. Factors associated with SMT > 2 mm were sex and reason for tooth extraction, while factors associated with SMT < 0.8 mm were time following tooth extraction and nasal septum deviation. Despite the limitations of this study, these preoperative evaluations may be of utmost importance for safely conducting maxillary sinus floor augmentation.
在进行上颌磨牙区种植体治疗时，常进行上颌窦底提升术以改善因骨重塑和上颌窦气化扩张导致的牙槽骨高度降低。然而，这种提升术可能会导致诸如种植体位置不当、动脉损伤和上颌窦黏膜穿孔等并发症；还可能引发上颌窦炎等感染；以及术后并发症，如骨移植渗漏和术后鼻出血。为了降低上颌窦底提升术和术后感染的并发症风险，我们通过锥形束计算机断层扫描（CBCT）对影响术前窦黏膜厚度（SMT）的各种全身和局部因素进行了回顾性研究。研究对象包括接受经外侧入路在上颌无牙磨牙区进行上颌窦底提升术的患者。使用 CBCT 图像测量术前 SMT、现有骨量和鼻中隔偏曲。研究了 SMT 与以下影响因素之间的关系：（1）年龄，（2）性别，（3）系统性疾病，（4）吸烟，（5）拔牙后时间，（6）拔牙原因，（7）剩余牙槽骨高度（RBH），（8）窦间隔，和（9）鼻中隔偏曲。还对年龄和 RBH 进行了相关性分析（p<0.05）。
我们评估了 35 名患者（40 个窦腔；11 名男性，24 名女性）。患者平均年龄为 58.90±9.0 岁（男性，57.9±7.7 岁；女性，59.9±9.4 岁；年龄范围 41-79 岁）。平均 SMT 为 1.09±1.30mm，SMT>2mm 的发生率为 25.0%，SMT<0.8mm 的发生率为 50.0%，平均 RBH 为 2.14±1.02mm。影响 SMT 的因素包括性别（p=0.0078）、拔牙后时间（p=0.0075）、拔牙原因（p=0.020）、窦间隔（p=0.0076）和鼻中隔偏曲（p=0.038）。
与较高 SMT 相关的因素包括男性、拔牙后时间<6 个月、根尖病变、窦间隔和鼻中隔偏曲。SMT>2mm 的相关因素为性别和拔牙原因，而 SMT<0.8mm 的相关因素为拔牙后时间和鼻中隔偏曲。尽管本研究存在局限性，但这些术前评估对于安全进行上颌窦底提升术可能至关重要。
