Manekar Varsha Sunil
Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Nagpur, Maharashtra, India.
Natl J Maxillofac Surg. 2020 Jul-Dec;11(2):213-218. doi: 10.4103/njms.NJMS_38_19. Epub 2020 Dec 16.
The posterior maxilla is always a challenge for dental implant restoration. The presence of maxillary sinus and reduced subantral bone height are the limitations for implant insertion. The need of the hour is to make the surgical procedures simple, minimally invasive, andpredictable. Can we perform the sinus lift and simultaneous implant insertion by minimally invasive,simple, cost-effective, and less time-consuming technique? With this in consideration, the author carriedout this study for graftless crestal hydraulic sinus lift (CHSL) and simultaneous implant insertion in partially edentulous posterior maxilla for 26 implants. The aim is to evaluate the clinical and radiological success of graftless CHSL with simultaneous implant insertion.
The sample size was 17 patients and 26 implants were inserted. The clinical as well as radiological follow-up was done for 1 year. The outcome variables were the gain in bone height and implant survival.
Mean Bone height Gain is 5.6 mm; Mean torque used 32 nm, Mean age of the patient was 53 years. The literature shows a success of graftless lateral and osteotome-mediated sinus lift. The concept is the blood filling the gap around the implant in tented sinus lining can eventually result in the ossification to form bone. Until now, no study has demonstrated the bone formation in the peri-implant area of CHSL with simultaneous implant insertion. CHSL, a minimally invasive sinus lift surgery is very encouraging, easy to master, and predictive. The simultaneous implant insertion acts to retain the elevated sinus lining by tenting. It also reduces treatment time. After a sinus lifting procedure, the compartment around the implants under the sinus mucosal lining in the sinus floor is filled with a blood clot from surrounding bleeding. Blood clot can be considered autologous osteogenic graft material, to which osteoprogenitors can migrate, differentiate, and regenerate bone.
The graftless CHSL is predictable and safe for the sinus lift. The gain of up to 5-6 mm of subantral bone is possible.
上颌后牙区的牙种植修复一直是一项挑战。上颌窦的存在以及窦下骨高度降低是种植体植入的限制因素。当前迫切需要使手术操作简单、微创且可预测。我们能否通过微创、简单、经济高效且耗时少的技术来进行上颌窦提升术并同时植入种植体？考虑到这一点，作者开展了本研究，对26颗种植体采用无植骨嵴顶液压上颌窦提升术（CHSL）并同时植入种植体，用于部分缺牙的上颌后牙区。目的是评估无植骨CHSL并同时植入种植体的临床和影像学成功率。
样本量为17例患者，共植入26颗种植体。进行了为期1年的临床及影像学随访。观察变量为骨高度增加量和种植体存活率。
平均骨高度增加5.6毫米；平均使用扭矩32牛米，患者平均年龄53岁。文献表明无植骨外侧和骨凿介导的上颌窦提升术取得了成功。其概念是，充满帐篷状窦黏膜内种植体周围间隙的血液最终可导致骨化形成骨组织。到目前为止，尚无研究证明同时植入种植体的CHSL种植体周围区域有骨形成。CHSL作为一种微创上颌窦提升手术，非常令人鼓舞，易于掌握且可预测。同时植入种植体可通过帐篷状结构保持提升的窦黏膜。它还可缩短治疗时间。上颌窦提升术后，上颌窦底窦黏膜下种植体周围的腔隙会充满周围出血形成的血凝块。血凝块可被视为自体成骨移植材料，骨祖细胞可迁移至此，分化并再生骨组织。
无植骨CHSL用于上颌窦提升术是可预测且安全的。窦下骨可增加5至6毫米。
