Hao Xin-He, Ye Hu, Zhai Qin-Kai
Department of Oral and Maxillofacial Surgery, Hefei Stomatology Hospital. Hefei 230001, Anhui Province, China. E-mail:
Shanghai Kou Qiang Yi Xue. 2021 Apr;30(2):214-218.
To investigate the 5-year survival and complication rates of implants placed in grafted sinuses with different surgical approaches and analyze the causes for failure.
This study retrospectively observed the prognosis of patients who underwent maxillary sinus augmentation by means of lateral window technique(LWT) or transalveolar osteotomy technique (TOT) and simultaneously installed implants performed, in Hefei Stomatological Hospital. The primary predictor variables were surgical approaches, including LWT and TOT. The primary outcome measurement was the 5-year implant survival rate, complication rates and failure causes. Potential confounders included diabetes, age at surgery, gender, smoking habit, oral hygiene, tooth position, length and diameter of implants and type of prosthesis. Chi-square test and logistic regression analysis were performed with SPSS 21.0 software package.
Fifty-nine patients (31 males and 28 females), installed with 93 implants, with a mean age of (61.3±10.1) years old, were enrolled. Over (5±1.2) years of follow-up, five implants failed, with a total survival rate of 94.6%. In detail, there were 3 failed implants in the LWT group and 2 failed implants in the TOT group, for a survival rate of 85.7% and 97.2%, respectively. Chi-square test showed that smoking habit (P=0.010), oral hygiene(P=0.037) as well as operative approach(P=0.040) were significantly associated with the final survival rates, multivariate logistic regression analysis displayed that smoking habit (OR=0.030, 95%CI: 0.002-0.493, P=0.014) was still associated with the finial survival rates. Surgical approach(P=0.025) was markedly related to causes for the failed implants. Of which, three (100%) failed implants in the LWT group was due to poor osseointegration and implant mobility 3 months after sinus augmentation, and 2(100%) in the TOT group was because of persistent peri-implantitis and loss of the graft or alveolar bone 4 years after sinus augmentation. Smoking habit was also significantly relevant to complication rates(P=0.014), and the occurrence incidence of controllable peri-implantitis in patient having a smoking habit was relatively higher, accounting for 6.8%(6/88), compared with patients without smoking habit. Significant relationship between surgical approaches and implant complications was not observed(P=0.051).
Different surgical approaches for maxillary sinus augmentation do not significantly correlate with implant survival rates and implant complications. However, surgical approach is markedly related to the causes of failed implants. Smoking will lead to a decreased implant survival rate and controllable peri-implantitis.
探讨采用不同手术方法植入种植体于移植后的上颌窦中的5年生存率和并发症发生率，并分析失败原因。
本研究回顾性观察了在合肥口腔医院接受上颌窦外提升术（LWT）或经牙槽骨截骨术（TOT）进行上颌窦增量并同期植入种植体的患者的预后情况。主要预测变量为手术方法，包括LWT和TOT。主要观察指标为5年种植体生存率、并发症发生率及失败原因。潜在混杂因素包括糖尿病、手术年龄、性别、吸烟习惯、口腔卫生、牙位、种植体长度和直径以及修复体类型。使用SPSS 21.0软件包进行卡方检验和逻辑回归分析。
纳入59例患者（男31例，女28例），共植入93枚种植体，平均年龄（61.3±10.1）岁。经过（5±1.2）年的随访，有5枚种植体失败，总生存率为94.6%。具体而言，LWT组有3枚种植体失败，TOT组有2枚种植体失败，生存率分别为85.7%和97.2%。卡方检验显示，吸烟习惯（P=0.010）、口腔卫生（P=0.037）以及手术方法（P=0.040）与最终生存率显著相关，多因素逻辑回归分析显示吸烟习惯（OR=0.030，95%CI：0.002 - 0.493，P=0.014）仍与最终生存率相关。手术方法（P=0.025）与种植体失败原因显著相关。其中，LWT组3枚（100%）失败种植体是由于上颌窦增量术后3个月骨结合不良和种植体松动，TOT组2枚（100%）是由于上颌窦增量术后4年持续性种植体周围炎以及移植骨或牙槽骨丧失。吸烟习惯也与并发症发生率显著相关（P=0.014），有吸烟习惯患者可控性种植体周围炎的发生率相对较高，占6.8%（6/88），而无吸烟习惯患者则无此情况。未观察到手术方法与种植体并发症之间存在显著关系（P=0.051）。
上颌窦增量的不同手术方法与种植体生存率和种植体并发症无显著相关性。然而，手术方法与种植体失败原因显著相关。吸烟会导致种植体生存率降低以及可控性种植体周围炎。
