自体骨与牛骨矿物质联合自体骨屑用于两阶段上颌窦底提升术后骨尺寸稳定性分析：一项为期1年的多中心双盲随机对照试验结果

Analysis of bone dimensional stability after two-stage maxillary sinus floor augmentation with autogenous bone versus bovine bone mineral combined with autogenous bone chips: results from a 1-year multicenter split-mouth randomized controlled trial.

作者信息

Reis Isabella Neme Ribeiro Dos, Jue Anouck, Wolvius Eppo, Pijpe Justin, Spin-Neto Rubens, Jung Ronald Ernest, Naenni Nadja, Strauss Franz J, Jonker Brend

机构信息

Department of Stomatology, Division of Periodontology, School of Dentistry, University of São Paulo, Av. Prof. Lineu Prestes, 2227, Cidade Universitária, São Paulo, SP 05508-000, Brazil; Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Plattenstrasse 11 8032 Zürich, Switzerland.

Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 40 3015 GD Rotterdam, Netherlands.

出版信息

J Dent. 2025 Sep;160:105889. doi: 10.1016/j.jdent.2025.105889. Epub 2025 Jun 6.

DOI:10.1016/j.jdent.2025.105889

PMID:40484308

Abstract

OBJECTIVE

To compare the dimensional stability of augmented bone following maxillary sinus floor augmentation (MSFA) using autogenous bone (AB) alone or bovine bone mineral combined with locally harvested AB chips (BBM), one year after implant loading.

MATERIAL AND METHODS

A secondary analysis of a split-mouth, multicenter randomized controlled trial was conducted among 20 patients (40 implants). CBCT/CTs were used to measure bone height (buccal and palatal aspects) and bone area at the implant center at two time points: before implant placement (4-6 months post-MSFA, T1) and 12 months post-implant loading (T2). Residual bone height and sinus width at 1, 5, and 10 mm from the crest were also recorded. Linear regression models with generalized estimating equations were used to assess the influence of graft material (AB and BBM), initial graft dimensions and sinus width on dimensional changes.

RESULTS

Adjusted regression models showed that AB-treated sites experienced significantly greater reductions in graft height (mean difference at buccal sites: -1.76 mm [95 % CI, -0.86 to -2.65]; p-value = <0.001); mean difference at palatal sites: -1.82 mm [95 % CI -0.75 to -2.88]; p = 0.001; and bone area (mean difference -17.80 mm² [95 % CI -6.61 to -28.99]; p = 0.002) compared to BBM. Greater initial graft height and area were associated with reduced dimensional changes (p < 0.001) especially when using BBM. Sinus width, measured 10 mm from the crest, was modestly but significantly associated with changes in bone height (p = 0.020), but not with changes in bone area (p = 0.147).

CONCLUSION

MSFA using BBM combined with autogenous bone chips resulted in greater dimensional stability compared to AB alone.

CLINICAL IMPLICATIONS

BBM combined with autogenous bone chips better preserved graft dimensions than AB alone.

摘要

目的

比较在上颌窦底提升术（MSFA）后单独使用自体骨（AB）或牛骨矿物质联合局部采集的AB骨屑（BBM）进行植骨，种植体植入一年后增强骨的尺寸稳定性。

材料与方法

对一项20例患者（40颗种植体）的分口、多中心随机对照试验进行二次分析。在两个时间点使用CBCT/CT测量种植体中心处的骨高度（颊侧和腭侧）及骨面积：种植体植入前（MSFA后4 - 6个月，T1）和种植体植入后12个月（T2）。还记录了距牙槽嵴顶1、5和10 mm处的剩余骨高度和窦宽度。采用带有广义估计方程的线性回归模型评估移植材料（AB和BBM）、初始移植尺寸和窦宽度对尺寸变化的影响。

结果

调整后的回归模型显示，与BBM相比，AB处理的部位在植骨高度上有显著更大的降低（颊侧部位平均差异：-1.76 mm [95% CI，-0.86至-2.65]；p值 = <0.001）；腭侧部位平均差异：-1.82 mm [95% CI -0.75至-2.88]；p = 0.001；以及骨面积（平均差异-17.80 mm² [95% CI -6.61至-28.99]；p = 0.002）。更大的初始植骨高度和面积与尺寸变化减小相关（p < 0.001），尤其是使用BBM时。距牙槽嵴顶10 mm处测量的窦宽度与骨高度变化有适度但显著的相关性（p = 0.020），但与骨面积变化无关（p = 0.147）。