Eshoiee Nathan, Aalam Alexandre Amir, Zelig David, Oh Simon, Kar Kian, Bakshalian Neema
Department of Advanced Periodontology, Ostrow School of Dentistry of USC, Los Angeles, California, USA.
Private Practice, USA.
Ann Med Surg (Lond). 2025 Mar 20;87(4):1814-1822. doi: 10.1097/MS9.0000000000003158. eCollection 2025 Apr.
The rehabilitation of the atrophic maxillae with dental implants represents a challenge that can be addressed with zygomatic dental implants and traditional axial implants. In the event of a severely atrophic pre-maxilla, a quad-zygoma approach may be necessary to provide anchorage for the fixed restoration. The proximity of anatomical features can increase the possible morbidity of the quad-zygoma approach and instead, trans-nasal implants may serve as a viable anterior anchorage alternative in the atrophic pre-maxilla region.
A total of 10 patients diagnosed from a class 2B edentulism received a combined treatment with trans-nasal implants paired with a single zygomatic implant were included in this study. Trans-nasal implant marginal bone level changes were evaluated on CBCT (Cone Bean Computed Tomographic) images taken immediately after trans-nasal implant placement and 1 year of follow-up post loading. The reference point for the CBCT measurement of mesial and distal bone loss after 1 year was the horizontal interface between the implant and the abutment. Secondary measurements taken at the 1 year follow up measured the amount of bone available in the sub-nasal, lateral and apical areas of the dental implant in contact with bone.
The retrospective CBCT analysis of 18 trans-nasal implants (size ranging from 22 to 25 mm with an average of 24.1 mm) placed in 10 patients (all 10 patients were female ranging from 38 to 67 years old with an average age of 59.1 years old) shows an average marginal bone loss of 0.70 mm over a time period of 1 year following restorative loading, < 0.0001. While the sub-nasal, lateral and apical engagement shown respectively 5.46, 12.92, and 2.70 mm of radiographical bone contact with the implant.
The marginal bone loss observed in trans-nasal implants 1 year post loading is comparable to the marginal bone loss of conventional implants under similar conditions. The cumulative radiographical bone to implant contact between the subnasal and the apical bone seems to be of a value of 8.16 mm which seems to correspond to the size of a conventional dental implant. Therefore, it is believed that trans-nasal implants can be considered as an acceptable anterior anchorage alternative to the superior/ anterior zygomatic dental implant in the atrophic pre-maxilla region when paired with a single posterior zygomatic implant.
使用牙种植体修复萎缩性上颌骨是一项具有挑战性的工作，可通过颧骨种植体和传统轴向种植体来解决。如果前上颌骨严重萎缩，可能需要采用四颧骨入路为固定修复提供锚固。解剖结构的临近可能会增加四颧骨入路的潜在发病率，相反，经鼻种植体可作为萎缩性前上颌骨区域可行的前锚固替代方案。
本研究纳入了10例诊断为2B类牙列缺失的患者，他们接受了经鼻种植体与单个颧骨种植体联合治疗。在经鼻种植体植入后立即以及加载后1年随访时拍摄的锥形束计算机断层扫描（CBCT）图像上评估经鼻种植体边缘骨水平的变化。1年后CBCT测量近中及远中骨吸收的参考点是种植体与基台之间的水平界面。在1年随访时进行的二次测量测量了与骨接触的牙种植体鼻下、外侧和根尖区域的可用骨量。
对10例患者（所有10例患者均为女性，年龄在38至67岁之间，平均年龄59.1岁）植入的18枚经鼻种植体（尺寸范围为22至25 mm，平均24.1 mm）进行回顾性CBCT分析，结果显示修复加载后1年期间平均边缘骨吸收为0.70 mm，<0.0001。鼻下、外侧和根尖与种植体的接触分别显示出5.46、12.92和2.70 mm的影像学骨接触。
经鼻种植体加载后1年观察到的边缘骨吸收与类似条件下传统种植体的边缘骨吸收相当。鼻下和根尖骨与种植体之间的累积影像学骨接触似乎为8.16 mm，这似乎与传统牙种植体的尺寸相当。因此，人们认为，当与单个后颧骨种植体配对时，经鼻种植体可被视为萎缩性前上颌骨区域中优于/前于颧骨牙种植体的可接受的前锚固替代方案。
