Mattar Hebatallah, Nasr Tamer A, Keraa Khaled M, El Sholkamy Mohammed
Int J Oral Maxillofac Implants. 2025 Jun 24;0(0):1-40. doi: 10.11607/jomi.11253.
This study aimed to evaluate clinical, radiographic, patient-centered, and patient- reported outcomes of dental implants placed with maxillary sinus bone augmentation using two different sinus floor elevation techniques in reduced residual bone height of four to seven millimeters.
Thirty implants were placed in conjunction with raising thirty maxillary sinuses in seventeen patients with residual bone heights of four to seven millimeters determined to be primarily due to sinus pneumatization rather than post-extraction resorption, as evidenced by the pre-operative CBCT analysis and comparison to neighboring alveolar bone level heights, with either crestal (indirect/osteotome) or open (direct/lateral window) sinus augmentation using allograft material. Patients were randomly assigned to the test group (crestal technique) or the control group (open technique). A 12-month follow-up assessed dental implant stability through Resonance Frequency Analysis (RFA) and monitored plaque, bleeding indices, and peri-implant probing depths. Changes in vertical, crestal, and buccal bone around the implants were examined after surgery, at six and at 12 months using low-dose Cone Beam Computed Tomography (CBCT) with a fusion module. Additionally, relative radiographic bone density was evaluated utilizing specialized software at six, nine and 12 months. Finally, the patient-centered outcome of edema was objectively measured as well as subjectively reported by the patient.
After 12 months of follow-up, no significant differences were observed between the groups regarding radiographic parameters. There were no statistically significant differences in ISQ scores or implant success/failure rates (p>0.05). Clinically, the test (crestal) group exhibited a lower bleeding index (BI) (p=0.027) and more favorable edema outcome scores, measured by both patient-centered and patient-reported methods, compared to the control group (p=0.016 and 0.003, respectively).
The crestal sinus lifting technique using osteotomes, performed simultaneously with implant placement and allogenic bone grafting, shows only superior clinical outcomes of BI, radiographic outcomes of buccal bone changes, and patient-centered and reported outcomes of edema compared to the open sinus lifting technique. Therefore, the findings suggest that, while the crestal approach demonstrates certain advantages, both techniques can be considered for managing crestal bone heights ranging from four to seven millimeters, providing surgeons with two viable options for dealing with such reduced bone heights. This clinical trial was registered on ClinicalTrials.gov (ID: NCT06265467).
The technique of choice where the maxillary sinus had pneumatized, especially in areas where the residual bone height ranges from four to seven millimeters, is debatable. Our study presents crestal sinus versus open sinus augmentation as a less invasive alternative that may provide similar results.
本研究旨在评估在剩余骨高度为4至7毫米的情况下，使用两种不同的上颌窦底提升技术进行上颌窦骨增量植入牙种植体的临床、影像学、以患者为中心和患者报告的结果。
在17例剩余骨高度为4至7毫米的患者中，植入30颗种植体并同期提升30个上颌窦。术前CBCT分析并与相邻牙槽骨水平高度比较表明，骨高度降低主要是由于上颌窦气化而非拔牙后吸收。采用同种异体材料，通过嵴顶（间接/骨凿）或开放（直接/侧窗）上颌窦增量技术进行操作。患者被随机分配到试验组（嵴顶技术）或对照组（开放技术）。12个月的随访通过共振频率分析（RFA）评估牙种植体稳定性，并监测菌斑、出血指数和种植体周围探诊深度。术后6个月和12个月，使用带有融合模块的低剂量锥形束计算机断层扫描（CBCT）检查种植体周围垂直、嵴顶和颊侧骨的变化。此外，在6个月、9个月和12个月时，利用专门软件评估相对影像学骨密度。最后，客观测量并由患者主观报告以患者为中心的水肿结果。
随访12个月后，两组在影像学参数方面未观察到显著差异。种植体稳定性商数（ISQ）评分或种植体成功/失败率无统计学显著差异（p>0.05）。临床上，试验组（嵴顶技术）的出血指数（BI）较低（p=0.027），与对照组相比，通过以患者为中心和患者报告的方法测量的水肿结果评分更优（分别为p=0.016和0.003）。
与开放上颌窦提升技术相比，使用骨凿的嵴顶上颌窦提升技术在植入种植体和异体骨移植的同时进行，仅在BI的临床结果、颊侧骨变化的影像学结果以及以患者为中心和报告的水肿结果方面表现更优。因此，研究结果表明，虽然嵴顶入路显示出某些优势，但对于处理4至7毫米的嵴顶骨高度，两种技术均可考虑，为外科医生提供了两种可行的选择来应对这种降低的骨高度。本临床试验已在ClinicalTrials.gov上注册（ID：NCT06265467）。
上颌窦气化时的技术选择，尤其是在剩余骨高度为4至7毫米的区域，存在争议。我们的研究提出嵴顶上颌窦与开放上颌窦增量术作为一种侵入性较小的替代方法，可能提供相似的结果。
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