Department of Oral and Maxillofacial Surgery, San Camillo Hospital, Rome, Italy.
Private Practice, Via Nizza, 46, Rome 00198, Italy.
J Dent. 2022 Jun;121:104137. doi: 10.1016/j.jdent.2022.104137. Epub 2022 Apr 21.
In the posterior maxilla, due to the presence of maxillary sinus, residual bone height lower than 3mm is a critical factor that can affect implant stability and survival. The use of guided surgery may facilitate the surgical procedures and the implant insertion in case of severely resorbed maxillae. Moreover, it may have beneficial effects on the long-term survival and success of implant-supported restorations. This study aimed to evaluate implant supported restorations on severely resorbed maxilla (<3 mm) after sinus lift with collagenated xenograft and guided surgery.
Forty-three patients with need for implant rehabilitation and residual bone height between 1 and 3 mm were recruited. Surgical and prosthetical aspects were planned following digital approach with the use of Realguide 5.0 (3diemme, Varese, Italy). Lateral window sinus lift was performed and implants were placed simultaneously to the augmentation procedure with a tooth-supported pilot drill surgical template. A pre-hydrated collagenated porcine bone matrix was adopted as regenerative material. Computer-aided-design/computer-aided-manufacturing (CAD/CAM) restorations were delivered after six months of healing. Milled titanium chamfer abutments with CAD/CAM crowns were used. Bone height at implant site level was measured using an image software analysis applied to the pre- and post-surgical radiographs and at the follow-up. Biological and technical complications were recorded during all the follow-up periods.
Fifty-four sinus were treated. After a mean follow-up time of 5.11 years (SD: 2.47), no implants were lost nor showed signs of disease. The mean pristine bone height was 2.07 mm (SD: 075). At the final evaluation the augmented sinus height was 12.83 mm (SD: 1.23). Two cases experienced minor perforation of the membrane, while five patients developed minimal post-operative complications, completely resolved with pharmacologic therapy. No mid-term biological complications were experienced by the patients. No cases experienced peri-implant mucositis and peri-implantitis during the whole follow-up period. Four patients (7.4%) faced an unscrewing of the prosthesis.
The present study showed the efficacy in the mid-term of the digital planning and the guided surgery in restoring severely resorbed posterior maxilla with dental implants.
This paper underlines the high potential of the digital approach in the mid-term to implant rehabilitation of severely resorbed maxilla simultaneously with sinus lift.
在上颌后区，由于上颌窦的存在，剩余骨高度低于 3mm 是影响种植体稳定性和存活率的关键因素。引导式手术的应用可以简化手术过程，并有利于在严重吸收的上颌骨中植入种植体。此外，它可能对种植体支持修复体的长期存活和成功产生有益影响。本研究旨在评估在窦底提升后使用胶原化异种移植物和引导式手术治疗严重吸收的上颌骨（<3mm）的种植体支持修复体。
招募了 43 名需要种植体修复且剩余骨高度在 1 至 3mm 之间的患者。采用 Realguide 5.0（3diemme，瓦雷泽，意大利）进行数字化方法进行手术和修复设计。进行了侧壁开窗窦底提升，并同时在增强过程中使用带牙支持的导板手术模板放置种植体。采用预水合胶原化猪骨基质作为再生材料。在愈合 6 个月后进行计算机辅助设计/计算机辅助制造（CAD/CAM）修复。使用铣削钛角接基台和 CAD/CAM 冠。使用图像软件分析在上颌窦提升术前和术后的放射片中测量种植体部位的骨高度，并在随访时进行测量。在整个随访期间记录生物和技术并发症。
共治疗了 54 个上颌窦。经过 5.11 年（SD：2.47）的平均随访时间，没有种植体丢失或出现疾病迹象。原始骨高度的平均值为 2.07mm（SD：075）。在最终评估时，增强后的窦腔高度为 12.83mm（SD：1.23）。有 2 例发生膜轻微穿孔，5 例患者发生轻微术后并发症，经药物治疗完全缓解。患者未发生中期生物并发症。整个随访期间，无种植体周围黏膜炎和种植体周围炎病例。有 4 名患者（7.4%）出现修复体旋出。
本研究表明，数字化规划和引导式手术在中短期治疗严重吸收的上颌后区种植体方面具有较高的疗效。
本文强调了数字化方法在中短期对严重吸收的上颌骨进行种植体修复并同时进行窦底提升的潜力。
