闭合式上颌窦挤压提升同期人工牙种植修复45例分析

目的：观察使用Summers骨凿或骨挤压器经牙槽嵴顶闭合式抬高上颌窦底、同期植入种植体的临床效果。方法：对41例45侧后牙缺失患者行上颌窦闭合式提升，必要时植自体骨或人工骨，同时植入种植体。结果：45侧上颌窦剩余牙槽骨平均高度为6．8mm(5～9mm)，用骨凿平均提升上颌窦底高度3．5mm(2～6mm)。2侧上颌窦黏膜被钻穿孔，放弃牙种植。其余43侧上颌窦共植入63颗种植体，长度10～15mm。Ⅱ期手术时，5颗种植体松动拔除。追踪12～48个月，修复后1颗种植牙松动拔除，1颗进行性骨吸收，总成功率达88．9％。所有病例均无上颌窦并发症：结论：上颌窦内提升技术较开窗式上颌窦提升创伤小，操作步骤简单，对有适量剩余牙槽骨的上颌窦区种植可以考虑使用；但由于存在窦底黏膜穿孔风险，技术要求高，同时必须有专用的器械，应慎重使用。在严格控制适应证、掌握种植外科技巧的情况下，开展上颌窦内提升技术是可行的，可以取得较高的成功率。

An internal sinus floor elevation through a coronal approach with simultaneous implant placement:Report of 45 cases

PURPOSE: The aim of this study was to evaluate the effectiveness of maxillary sinus floor lifting through a coronal approach for immediate implantation. METHODS: From 2000 to 2003, internal sinus floor elevation (ISFE) was carried out in 45 sites using Summers' osteotome or bone condenser. As augmentation material, Bio-Oss or autogenous bone grafts were used,with simultaneous placement of implants. RESULTS: The residual vertical bone height in the posterior maxilla ranged from 5 to 9 mm (average 6.8 mm). The implant lengths ranged from 10 to 15 mm . The mean height increase of the implant sites using Summers' osteotome techniques was 3.5 mm (range from 2 to 6 mm). However, perforation occurred in 2 cases, and the following dental implantation was abandoned. 63 implants were placed. At stage 2 surgery, 5 implants were removed because of mobility. 1 implant was lost within the first 18 months of loading. 1 implant demonstrated progressive bone loss. The overall survival rate was 88.9%. No clinical complications of the maxillary sinus area were noted during a follow-up period of 12 to 48 months . CONCLUSION: With the ISFE, perforations of the sinus membrane can be visualized; however, they can not be avoided. Although this technique is less invasive than the lateral window technique, it can not be recommended as a standard procedure in the posterior maxilla. ISFE procedures greatly simplifies the management process and can be used predictably for implant placement at sites with moderate vertical deficiencies in the posterior maxilla.