Khorshed Khalid Ali Abd-Elmoneam, Elgamal Mohamed, Haggag Mai Ahmed, ELsyad Moustafa Abdou
Assistant Lecturer, Department of Removable Prosthodontics, Faculty of Dentistry, Mansoura University, Eldakahlia, Egypt.
Associate Professor, Department of Removable Prosthodontics, Faculty of Dentistry, Mansoura University, Eldakahlia, Egypt, and Associate Professor, Department of Removable Prosthodontics, Faculty of Dentistry, Horus University, Damietta, Egypt.
J Prosthet Dent. 2025 Jun;133(6):1503.e1-1503.e8. doi: 10.1016/j.prosdent.2024.01.035. Epub 2024 Mar 20.
Rehabilitation of elderly or medically compromised patients with an atrophied unilateral posterior maxillary ridge by an implant-supported prosthesis may be complicated by maxillary sinus pneumatization with insufficient bone for implant placement.
This short-term clinical trial assessed clinical results of closed sinus lift and fixed prosthesis versus implant-assisted overdentures in the management of participants with atrophied distal extension maxillary ridges.
Forty participants with unilateral atrophying distal extension maxillary ridges were randomly assigned into 2 groups. The CSL group (n=20) participants received fixed prostheses supported by 3 implants following a closed sinus lift. The IOD group (n=20) participants received removable partial overdentures assisted by a single implant that was positioned mesially to the maxillary sinus. The modified plaque index (MPI), modified gingival index (MGI), pocket depth (PD), implant stability (IS), and vertical bone loss (VBL) were measured at prosthesis delivery (T0), and 6 (T6) and 12 months (T12) after delivery. The oral health impact profile (OHIP-14) questionnaire was used to assess oral health-related quality of life (OHRQoL) at T12. Significant differences between observation times were performed using Friedman and Wilcoxon signed-rank tests for MPI and MGI and using repeated measures ANOVA with Bonferroni correction of P values for PD, IS, VBL, and OHIP. Between-group comparison of MPI and MGI the Mann-Whitney test was used, while for PD, IS, VBL, and OHIP comparison was made using independent samples t test (α=.05 for all tests).
The implant survival rates were 100% for both groups. MPI and PD significantly increased with time for both groups. MGI significantly increased with time for the CSL group only (P=.049). The IS significantly decreased with time for the IOD group. VBL increased significantly from T6 to T12 for the CSL (P=.042) and the IOD (P=.002) groups. The CSL group recorded higher MPI, MGI, PD, and IS values than the IOD group (P<.05). The IOD group recorded higher VBL than the CSL group (P<.001). The CSL group scored significantly lower OHIP-14 values (better OHRQoL) than the IOD group for all values (P<.05).
In comparison with implant-assisted partial overdentures, closed sinus lift with fixed prostheses had higher implant stability, reduced bone loss, and higher participant OHRQoL. However, peri-implant soft tissue health was found to be better with implant overdentures.
对于单侧上颌后牙区牙槽嵴萎缩的老年患者或有医学问题的患者，采用种植体支持的修复体进行修复时，上颌窦气化且缺乏足够的种植体植入骨量可能会使修复变得复杂。
本短期临床试验评估了封闭性上颌窦提升联合固定修复体与种植体辅助覆盖义齿在治疗上颌远中延伸区牙槽嵴萎缩患者中的临床效果。
40名单侧上颌远中延伸区牙槽嵴萎缩的参与者被随机分为2组。封闭性上颌窦提升组（CSL组，n = 20）的参与者在进行封闭性上颌窦提升后，接受由3枚种植体支持的固定修复体。种植体辅助覆盖义齿组（IOD组，n = 20）的参与者接受由1枚位于上颌窦近中的种植体辅助的可摘局部覆盖义齿。在修复体戴入时（T0）以及戴入后6个月（T6）和12个月（T12）测量改良菌斑指数（MPI）、改良牙龈指数（MGI）、牙周袋深度（PD）、种植体稳定性（IS）和垂直骨吸收（VBL）。使用口腔健康影响程度量表（OHIP - 14）问卷在T12时评估口腔健康相关生活质量（OHRQoL）。对于MPI和MGI，使用Friedman检验和Wilcoxon符号秩检验来分析观察时间之间的显著差异；对于PD、IS、VBL和OHIP，使用重复测量方差分析并对P值进行Bonferroni校正。对于MPI和MGI的组间比较，使用Mann - Whitney检验；对于PD、IS、VBL和OHIP的组间比较，使用独立样本t检验（所有检验的α = 0.05）。
两组的种植体存留率均为100%。两组的MPI和PD均随时间显著增加。仅CSL组的MGI随时间显著增加（P = 0.049）。IOD组的IS随时间显著降低。CSL组和IOD组的VBL从T6到T12均显著增加（CSL组，P = 0.042；IOD组，P = 0.002）。CSL组的MPI、MGI、PD和IS值均高于IOD组（P < 0.05）。IOD组的VBL高于CSL组（P < 0.001）。在所有数值上，CSL组的OHIP - 14得分显著低于IOD组（OHRQoL更好）（P < 0.05）。
与种植体辅助局部覆盖义齿相比，封闭性上颌窦提升联合固定修复体具有更高的种植体稳定性、更少的骨吸收以及更高的参与者OHRQoL。然而，种植体覆盖义齿的种植体周围软组织健康状况更好。
