超声骨刀在上颌窦侧壁开窗提升种植术中的临床应用

目的：评价超声骨刀在上颌窦侧壁开窗提升牙种植术中应用的临床效果。方法：15例上颌后牙缺失患者,术前CBCT检查牙槽嵴顶距上颌窦底的骨量高度为3．0～6．5 mm,采用超声骨刀行上颌窦侧壁开窗提升术并同期植入19颗种植体,术后即刻CBCT观察上颌窦底黏膜、窦内情况及种植体植入情况,术后3天随访观察有无上颌窦黏膜破裂并发症状。结果：15例中无1例出现上颌窦黏膜破裂,术后CBCT检查所有患者上颌窦窦底黏膜提升成功,无上颌窦底黏膜破损者,无患者出现上颌窦内液体渗出堆积。术后3天内随访,均无鼻腔出现血性分泌物或骨粉等异物排出现象。结论：采用超声骨刀行上颌窦侧壁开窗提升牙种植术,可以大大减少种植手术的时间,降低了手术并发症的风险。     

超声骨刀在上颌窦内提升术中的应用

目的:探讨超声骨刀在上颌窦底内提升种植术中应用的效果和技术特点。方法:30名患者共36颗上颌磨牙缺失,牙槽嵴顶至上颌窦底之间的剩余骨高度2～8 mm,以超声骨刀行上颌窦底内提升术,同期或延期植入种植体。结果:24名患者植骨同时植入28枚种植体。6例因剩余牙槽骨高度少于5 mm先行上颌窦提升植骨术,6个月后延期植入8枚种植体。平均上颌窦底提升高度为426 mm(213～540 mm)。36个上颌窦提升位点,仅1例出现上颌窦黏膜穿孔,以Bio-Gide胶原膜修补。术后随访未发现种植体周围阴影或快速骨吸收。所有病例随访3～17个月,未见种植体脱落或松动现象。结论:超声骨刀上颌窦内提升术简单易学,避免了开窗式上颌窦提升术的术后反应,降低了上颌窦黏膜穿孔的机率,值得在临床上推广应用。     

上颌窦底提升术

目前,种植手术已成为一种常规的技术应用于临床,随着种植体设计的改进和植入技术的日趋成熟,成功率不断提高,适应证也不断扩大,但是剩余骨高度不足仍是影响上颌后牙区种植手术的主要因素.临床上多采用上颌窦底提升术,主要包括上颌窦侧壁开窗术和冲压式上颌窦底提升术,这2种术式有效解决了上颌后牙区剩余骨高度不足的问题.本文主要介绍上颌窦的解剖结构、底壁分嵴等情况,以及口腔影像学检查方法的应用;归纳总结上颌窦底提升术的基本原则,上颌窦侧壁开窗提升术的切口设计、手术方法,以及3种改良冲压式上颌窦底提升术的比较,骨挤压器和骨冲顶器的应用,初步探讨植骨材料的选择,辅助上颌窦底提升术的特殊器械(超声骨刀和内镜)的特点,伴发上颌窦囊肿和术后并发症的处理方法.     

压电超声骨刀在23例上颌窦提升术中的应用

目的:总结压电超声骨刀在上颌窦提升开窗手术中的临床应用,探讨其手术特点及术中注意的问题。方法:对符合上颌窦外提升术标准(种植区骨高度为5～8mm)的23例患者(24侧),进行了上颌窦外提升手术,术中应用压电超声骨刀进行上颌窦开窗手术,黏膜提升,填入人工骨粉,同期植入种植体。结果:24侧上颌窦提升手术,其中1侧由于术中操作不当,出现黏膜穿孔,终止手术;其余23侧均成功地进行了上颌窦提升,黏膜穿孔率仅为4.2%,并同期植入种植体48个,愈合期内(手术后10d拆线时)无感染及创口裂开等并发症。结论:应用压电超声骨刀进行上颌窦外提升手术,快捷、安全、可靠。     

超声骨刀在口腔种植中应用效果的初步探讨

【摘要】 目的 本研究通过观察、比较超声骨刀和传统球钻在Onlay植骨、上颌窦提升、骨劈开等手术中的临床应用效果,探讨超声骨刀在种植手术中的优越性及操作要点。方法 2006—2012年在常州市口腔医院种植科就诊,需要进行植骨手术的78例患者,总计80个术区,分别使用超声骨刀和传统球钻在Onlay植骨、上颌窦提升、骨劈开等手术中进行切骨操作;超声骨刀组42例,传统球钻组38例。分别于术后6 h、24 h、3 d进行复查,采用 VAS记录术后疼痛水平,利用SPSS11.5统计软件将临床数据采用等级资料秩和检验进行统计学分析。结果 超声骨刀组在术后6 h VAS均值为（3.98±2.16）、24 h VAS均值（2.35±1.86）,传统球钻组在术后6 h VAS均值为（4.79±1.95）、24 h VAS均值（3.21±1.76）,术后6小时、术后24小时两组间疼痛反应差异有统计学意义（p＜0.05）。结论 与传统球钻相比,采用超声骨刀进行种植植骨手术可以降低植骨术后短期疼痛发生率。     

上颔窦超声骨刀法提升术同期植入种植体

目的：用超声骨刀行上颌窦开窗提升窦底黏膜，同期植入牙种植体的方法与疗效。方法：24例上后牙牙槽骨高度4～7mm的牙缺失者行开窗上颌窦提升术，同期植入植体。结论：超声骨刀提升上颌窦手术创伤小，术后反应轻．保证了手术的成功，减少了术后鼻腔反应，有效地保护了窦底黏膜．它是一种安全可靠的新方法。     

口腔外科新利器-赛特力公司超声骨刀

超声领域领先制造商-法国赛特力公司于2005年推出了用于口腔外科的超声设备:PiezotomeTM超声骨刀。超声骨刀主要用于骨切开术、骨整形术、骨嵴扩张、韧带切开术、上颌窦提升等棘手的精细手术。使用PiezotomeTM超声骨刀,可以毫不费力地进行精细的切割手术且不会损伤软组织。术后疼痛轻微,愈合迅速,而且不用十分费力,     

鼻内窥镜下经上颌窦入路取出牙齿断根的临床观察

目的：探讨误入上颌窦内的牙根,经上颌窦前壁开窗辅助鼻内窥镜取出拔牙断根的临床疗效。方法：对在拔牙过程中造成断根误入上颌窦的6例患者中的6个断根,经口内切口上颌窦前壁开窗,辅以鼻窦内窥镜直视下取出断根。结果：6例患者6个误入上颌窦的断根通过冲洗或夹取均快速、完整取出,该手术方法视野开阔、清晰,组织损伤小,创口愈合良好,术后无不良反应发生。结论：采用经上颌窦前壁开窗辅助鼻内窥镜直视下取出误入上颌窦内的断根手术式可以方便、快捷地取出断根,手术时间短、创伤小。     

口腔外科新利器-赛特力公司超声骨刀

注册证号:国食药监械(进)字2007第2230109号超声领域领先制造商-法国赛特力公司于2005年推出了用于口腔外科的超声设备:PiezotomeTM超声骨刀。超声骨刀主要用于骨切开术、骨整形术、骨嵴扩张、韧带切开术、上颌窦提升等棘手的精细手术。使用PiezotomeTM超声骨刀,可以毫不费力地进行精细的切割手术且不会损伤软组织。术后疼痛轻微,愈合迅速,而且不用十     

超声骨刀在上颌窦底外提升术中的临床应用观察

目的：探讨超声骨刀在开窗式上颌窦底外提升术中应用的临床效果及安全性。方法：对29名患者30侧行上颌窦底开窗式外提升术,用超声骨刀开窗,植入种植体共53枚（同期植入47枚,延期植入6枚）,6～8月后完成上部修复。修复后3、6及12个月复查。结果：术前平均剩余牙槽突高度为4．46 mm,术后平均提升高度为7．34 mm,植入53枚植体,没有发生黏膜穿孔。术后随访3～18个月没有发生种植体周围炎、种植体周围黏膜炎及种植体松动脱落。X线片显示种植体周围骨结合良好。种植体存留率及手术成功率均为100％。结论：超声骨刀在上颌窦底开窗式外提升术中安全可靠。     

上颌窦底提升同期植入种植体过程中超声骨刀和植骨量的作用

目的:评价应用超声骨刀进行上颌窦底开放式外提升同期植入种植体,以及不同植骨量对种植效果的影响。方法:对21例上颌后牙槽骨高度不足患者随机分成两组,应用超声骨刀进行上颌窦底开放式外提升同期植入种植体,将A组11例患者进行全量骨粉植入,B组10例患者进行半量骨粉植入,6-12个月后检查种植体的稳定性和骨愈合情况。结果:A、B两组25颗种植体与周围组织均形成良好的骨性结合,无上颌窦炎发生,两组间无显著差异。结论:应用超声骨刀行上颌窦底提升术可精确地完成手术,术中半量或全量植骨均能达到较好的临床效果。     

Atrophic ridge augmentation using intra-oral onlay bone grafts--expanding the limits

Placement of an endosseous implant requires sufficient bone volume for complete bone coverage. There is a growing use of intraoral block bone grafts from intraoral sources. The use of bone from the mandibular symphysis, retromolar area, mandibular ramus, and the maxillary tuberosity can serve as a good treatment alternative for alveolar ridge augmentation with a high success rate for long span augmentation, up to complete jaw augmentation or extensive bone reconstruction. The intraoral block bone graft procedure can be combined with other surgical procedures, such as sinus lift elevation or nasal floor elevation.     

Use of piezosurgery device in management of surgical dental implant complication: a case report

An implant displacement into the maxillary sinus could be a complication of implant surgery in the upper jaw. In such cases, implant removal is needed to avoid the occurrence of sinus pathologies. Piezosurgery techniques could assure safer management of such complications because of clear surgical visibility and a selective ability to cut. The aim of this report is to present a case of an implant-related oral surgery complication that was resolved by means of a piezosurgery technique.     

A 9–14 year follow-up of onlay bone grafting in the atrophic maxilla

Treatment of the atrophic edentulous maxilla is challenging especially when bone graft procedures are necessary. In this study an onlay bone graft, a saddle or veneer, with or without maxillary sinus floor inlay graft, harvested from the anterior iliac crest, in combination with implants was used in the reconstruction of patients with extreme atrophy in their maxillae. The aim was to investigate treatment outcome, and the impact of gender and smoking, in 44 patients in a prospective, long-term, follow-up study concerning implant survival rate and marginal bone loss adjacent to the surfaces of the implant.Mean follow-up time was 11 years. Of 334 inserted Brånemark implants, with machined surface, 27 failed. Estimated implant survival rate was 90%. Marginal bone loss was 1.8 mm 1 year after implant surgery; 2.3 mm after 5 years; and 2.4 mm after 10 years. There was a significant difference between genders in implant survival. Marginal bone loss differed significantly between smokers and non-smokers up to the 5-year examination and between genders after the 4-year examination. The onlay bone graft, with or without a maxillary inlay graft, results in high implant survival rate, good oral function and stabilised marginal bone. All patients are still wearing their original fixed bridges.     

改良型富血小板纤维蛋白在上颌窦底提升术中成骨效果的临床研究

目的    探讨改良型富血小板纤维蛋白（advanced platelet-rich fibrin,A-PRF）作为骨移植材料在经牙槽嵴顶上颌窦底提升术中的骨再生效果。方法    选择2017年9月至2019年12月于大连医科大学附属口腔医院种植科拟行经牙槽嵴顶上颌窦底提升术同期行上颌后牙区种植的患者45例,共植入50枚种植体。随机分为3组：A-PRF组;A-PRF混合自体骨屑组;不使用骨移植材料组。每组15例,术后3个月及1年评估患者术后疼痛程度及种植体稳定性,再通过锥形束CT（cone beam CT,CBCT）观察上颌窦底种植体周围新生骨的高度变化,分析提升种植区域骨再生重建的效果。结果    3例A-PRF组、10例A-PRF混合自体骨屑组及3例不使用骨移植材料组的患者疼痛等级为1级,未出现2级和3级疼痛患者;术后即刻和术后3个月的种植体稳定系数（implant stability quotient,ISQ）,3组间差异均无统计学意义（均P > 0.05）;术后1年种植体近远中新生骨高度变化值,A-PRF混合自体骨屑组高于A-PRF组,A-PRF组高于不使用骨移植材料组,差异均具有统计学意义（均P < 0.05）。结论    A-PRF膜联合自体骨屑在经牙槽嵴顶上颌窦底提升术中的骨再生效果最好,但单纯使用A-PRF膜也可以获得足够的骨量,且患者术后反应轻微。     

One-stage maxillary sinus elevation using a bone core containing a preosseointegrated implant from the mandibular symphysis

This report presents a novel surgical approach of a one-stage maxillary sinus elevation using a bone core containing a preosseointegrated implant harvested from the mandibular symphysis. As a result, the elevation of the floor of the maxillary sinus and the placement of the implant were achieved at the same time, and the required healing time was significantly reduced. Three months after placement of the implant in the symphysis, a bone core containing the implant was retrieved using a trephine. The bone core was placed in the resorbed posterior maxillary ridge, thereby elevating the maxillary sinus floor. The bone core containing the implant was allowed to heal for 5 months, after which the implant was restored and followed up for 30 months. This technique represents a surgical modification intended to avoid the conventional two-step sinus elevation surgery in which the surgical procedure of graft placement is followed by surgical implant placement. This approach requires significantly reduced healing time and provides an increased bone quality around the implant, which is of clinical importance, particularly in the posterior maxilla.     

Maxillary sinus floor elevation combined with a vertical onlay graft

We performed maxillary sinus floor elevation combined with a vertical onlay graft for a total of 11 sides of nine patients (1 woman and 8 men) in our Hospital. On CT, the preoperative minimum alveolar bone thickness with a mean of 1.8 mm was improved to 15.3 mm within a month after this surgery. A total of 20 dental implants were placed and there was only one failed implant. With the average follow-up of 15.6 months, an average of 3.4 mm of bone absorption was found in the site of the maxillary sinus and 1.1 mm in the site of the onlay graft. The crown-implant ratio in all cases was within the permissible range. Consequently, this bone augmentation surgery was considered to be useful.     

球囊上颌窦提升术的临床应用

目的：研究球囊在上颌窦提升术中的临床应用。方法：收集2008-2009年内蒙古北方医院口腔科就诊的上颌后牙区骨量不足,行上颌窦内提升的病例共40位患者,45侧上颌窦共70颗磨牙缺失,所有病例均不吸烟,种植区骨质无感染,无牙周疾患,排除上颌窦炎症。上颌窦底垂直剩余牙槽骨高度3-8mm,平均高度6mm,年龄28-65岁,其中男18例,女22例,通过球囊提升上颌窦。结果：平均提升上颌窦底高度4mm,取得满意临床效果。结论：在严格控制适应证及掌握外科技巧的情况下开展球囊上颌窦内提升技术是可行的,可以取得较高的成功率。     

Autogenous mandibular bone grafts and osseointegrated implants for reconstruction of the severely atrophied maxilla: a preliminary report

The purpose of this study is to present results obtained with a new procedure for reconstruction of the severely atrophied maxillary alveolar ridge that involves the use of intramembranous corticocancellous bone grafts obtained from the mandibular symphysis fixed to the residual bone by endosseous implants. A total of 107 implants were installed in grafted regions in 26 patients. The follow-up period ranged from 6 to 32 months, with a mean of 16 months. In partially edentulous patients the bone grafts were fixed with implants to the residual bone as 1) onlay graft to the alveolar ridge (8 implants in 4 patients); 2) grafts to the nasal and/or sinus floor after a transoral exposure and elevation of the mucosa of the maxillary sinus and/or the nasal mucosa (33 implants in 11 patients); or 3) a combination of these two (5 implants in 2 patients). In totally edentulous patients, implants and grafts were used as a combination of grafting to both the alveolar ridge and nasal and/or sinus floor sites (61 implants in 9 patients). One hundred of 107 implants showed normal clinical and radiologic healing, whereas 7 implants in 4 patients (6.5%) were lost prior to loading. Seventeen patients have had the implants and bone grafts loaded by a prosthodontic reconstruction from 6 to 26 months (mean, 14 months) without loss of any implants. Postoperative marginal resorption of the onlay bone graft of less than 15% was observed. These findings suggest, that the previously observed rapid resorption of endochondral iliac crest onlay bone grafts and the number of lost implants can be significantly reduced if bone from the mandibular symphysis firmly anchored with titanium implants is used.