Zitzmann N U, Schärer P
Department of Fixed and Removable Prosthodontics, University of Basel, Switzerland.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Jan;85(1):8-17. doi: 10.1016/s1079-2104(98)90391-2.
The purpose of this study was to compare three different methods for sinus elevation: (1) the lateral antrostomy as a two-step procedure, (2) the lateral antrostomy as a one-step procedure, and (3) the osteotome technique with a crestal approach. Indication criteria were defined, based on the residual bone height measured from computed tomography scans, for the sake of applying the appropriate technique.
In 30 patients designated for implant treatment in the resorbed posterior maxilla, 79 implants were placed in combination with a bone-grafting material for sinus augmentation. The final bone heights were measured from panoramic radiographs or post-operative computed tomography scans.
The success rate for the osteotome technique was 95% during the 30-month study period; no failures occurred in any site treated with a lateral antrostomy. The gain in bone height was comparable for the one-step (median = 10 mm) and two-step (median = 12.7 mm) lateral antrostomies. These sites exhibited a significantly greater increase in bone height (p < 0.001) than did the sites in which the osteotome technique was applied (mean = 3.5 mm). The histologic sections showed both bone apposition in intimate contact with the bone-grafting material particles and initial signs of its remodeling.
The results indicate that the osteotome technique can be recommended when more than 6 mm of residual bone height is present and an increase of about 3 to 4 mm is expected. In cases of more advanced resorption a one-step or two-step lateral antrostomy has to be performed.
本研究旨在比较三种不同的上颌窦提升方法：（1）作为两步法的外侧上颌窦开窗术；（2）作为一步法的外侧上颌窦开窗术；（3）采用嵴顶入路的骨凿技术。基于计算机断层扫描测量的剩余骨高度定义了适应症标准，以便应用合适的技术。
在30例计划于上颌后牙区行种植治疗的患者中，共植入79枚种植体，并联合使用骨移植材料进行上颌窦增高术。通过全景X线片或术后计算机断层扫描测量最终的骨高度。
在30个月的研究期间，骨凿技术的成功率为95%；采用外侧上颌窦开窗术治疗的任何部位均未出现失败病例。一步法（中位数 = 10 mm）和两步法（中位数 = 12.7 mm）外侧上颌窦开窗术的骨高度增加相当。这些部位的骨高度增加显著大于采用骨凿技术的部位（平均值 = 3.5 mm）（p < 0.001）。组织学切片显示骨与骨移植材料颗粒紧密接触并有骨附着，以及其重塑的初始迹象。
结果表明，当剩余骨高度超过6 mm且预期增加约3至4 mm时，可推荐使用骨凿技术。在吸收更严重的情况下，必须进行一步法或两步法外侧上颌窦开窗术。
