Int J Oral Implantol (Berl). 2024 Mar 19;17(1):89-100.
To establish consensus-driven guidelines that could support the clinical decision-making process for implant-supported rehabilitation of the posterior atrophic maxilla and ultimately improve long-term treatment outcomes and patient satisfaction.
A total of 33 participants were enrolled (18 active members of the Italian Academy of Osseointegration and 15 international experts). Based on the available evidence, the development group discussed and proposed an initial list of 20 statements, which were later evalu-ated by all participants. After the forms were completed, the responses were sent for blinded ana-lysis. In most cases, when a consensus was not reached, the statements were rephrased and sent to the participants for another round of evaluation. Three rounds were planned.
After the first round of voting, participants came close to reaching a consensus on six statements, but no consensus was achieved for the other fourteen. Following this, nineteen statements were rephrased and sent to participants again for the second round of voting, after which a consensus was reached for six statements and almost reached for three statements, but no consensus was achieved for the other ten. All 13 statements upon which no consensus was reached were rephrased and included in the third round. After this round, a consensus was achieved for an additional nine statements and almost achieved for three statements, but no consensus was reached for the remaining statement.
This Delphi consensus highlights the importance of accurate preoperative planning, taking into consideration the maxillomandibular relationship to meet the functional and aesthetic requirements of the final restoration. Emphasis is placed on the role played by the sinus bony walls and floor in providing essential elements for bone formation, and on evaluation of bucco-palatal sinus width for choosing between lateral and transcrestal sinus floor elevation. Tilted and trans-sinus implants are considered viable options, whereas caution is advised when placing pterygoid implants. Zygomatic implants are seen as a potential option in specific cases, such as for completely edentulous elderly or oncological patients, for whom conventional alternatives are unsuitable.
建立以共识为导向的指南，以支持种植体支持的后萎缩上颌骨修复的临床决策过程，最终改善长期治疗效果和患者满意度。
共纳入 33 名参与者（意大利骨整合学会的 18 名积极成员和 15 名国际专家）。根据现有证据，研究小组讨论并提出了最初的 20 条陈述，然后由所有参与者进行评估。完成表格后，将回复发送进行盲法分析。在大多数情况下，当未达成共识时，对陈述进行重新措辞并发送给参与者进行另一轮评估。计划进行三轮。
第一轮投票后，参与者就 6 项陈述接近达成共识，但对其他 14 项陈述未达成共识。在此之后，19 项陈述重新措辞并再次发送给参与者进行第二轮投票，随后有 6 项陈述达成共识，有 3 项陈述几乎达成共识，但对其他 10 项陈述未达成共识。对未达成共识的所有 13 项陈述进行重新措辞并纳入第三轮。在这一轮之后，对另外 9 项陈述达成共识，对 3 项陈述几乎达成共识，但对其余 1 项陈述未达成共识。
这项德尔菲共识强调了准确术前规划的重要性，需要考虑上下颌骨关系，以满足最终修复的功能和美学要求。强调鼻窦骨壁和底在提供骨形成必需元素方面的作用，并评估颊-窦宽度，以选择侧向或经牙槽嵴窦底提升。倾斜和经窦种植体被认为是可行的选择，而在放置翼状突种植体时则需要谨慎。在特定情况下，如完全无牙的老年或肿瘤患者，经颧骨种植体可作为潜在选择，而对于不适合传统替代方案的患者则应谨慎使用。
