Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein - UKSH, Kiel, Germany.
Private practice, München, Germany.
Clin Oral Implants Res. 2022 Apr;33(4):451-460. doi: 10.1111/clr.13905. Epub 2022 Feb 25.
The objective of this study was to evaluate a modified Le Fort I interpositional grafting followed by dental implants for the rehabilitation of edentulous atrophied maxillae (Cawood classes IV and V). The surgical modification was a bilateral sinus floor augmentation prior to the osteotomy. This generated a closed recipient bed which allowed the use of particulated bone grafts (xenogenic bone mineral) and a reduced amount of autologous iliac bone grafts.
A total of 106 patients with maxillary interpositional bone grafts were included in this retrospective analysis between 2006 and 2020. The panoramic radiographs and lateral cephalograms were analyzed to assess the gain and stability of the maxillary bone and the peri-implant bone loss. In addition, the observational period of up to 14 years implant survival and success was evaluated.
A stable vertical bone height with mean 0.63 ± 1.41 mm resorption over 5 years after implant loading was observed. A mean of 0.20 ± 0.37 mm marginal bone loss was noted after 5 years. The implant survival was 96.4% after 5 years and implant success can be rated 91.7% in a mean follow-up period of 93 months and 168 months maximal observation time. Perioperative complications included sinus membrane perforation (59.43%), wound healing disturbances (25.47%), and transient primary complications (13.78%). All receded apart from two subtotal graft losses (1.8%).
The modified Le Fort I osteotomy with interpositional bone grafts is a predictable procedure in terms of bone and implant stability. Patients with atrophic maxillae who are fit for surgery should be informed about risks and benefits of this treatment alternative.
本研究旨在评估改良的 Le Fort I 骨间移植联合牙种植体修复牙槽骨萎缩的无牙上颌骨（Cawood 分类 IV 和 V）。手术改良为在截骨术前进行双侧鼻窦底提升。这产生了一个封闭的受植床，允许使用颗粒状骨移植物（异种骨矿物质）和减少的自体髂骨移植物。
对 2006 年至 2020 年间的 106 例上颌骨间位骨移植患者进行回顾性分析。通过分析曲面断层片和侧位头颅侧位片，评估上颌骨的增加和稳定性以及种植体周围骨的丢失。此外，还评估了长达 14 年的种植体存活率和成功率。
在种植体负荷后 5 年内观察到稳定的垂直骨高度，平均吸收 0.63±1.41mm。5 年后，平均边缘骨丢失 0.20±0.37mm。5 年后种植体存活率为 96.4%，在平均 93 个月和最大观察时间 168 个月的随访期内，种植体成功率可评定为 91.7%。围手术期并发症包括窦膜穿孔（59.43%）、伤口愈合障碍（25.47%）和短暂的原发性并发症（13.78%）。所有患者均愈合，除了两例部分骨移植失败（1.8%）。
改良的 Le Fort I 截骨术联合骨间移植在骨和种植体稳定性方面是一种可预测的方法。对于适合手术的牙槽骨萎缩患者，应告知其这种治疗选择的风险和益处。
