上颌窦外提升中黏膜穿孔成因与修复后的种植

摘要

BACKGROUND: Mucosal perforation is the most common complication in open maxilary sinus lift, which limits the clinical application of dental implantation. Clinical effects of precise operation in open maxilary sinus lift with dental implant for mucosal perforation. OBJECTIVE:To analyze the cause of mucosal perforation in maxilary sinus lift with dental implant and to observe the effect of dental implantation after perforation closure. METHODS:Twenty-nine cases underwent open maxilary sinus lift (39 implants). Mucosal perforation was repaired by absorbable biofilms, and coraline hydroxyapatite was used as a bone graft material in open maxilary sinus lift. RESULTS AND CONCLUSION:Eight of 29 cases (20.5%) developed mucosal perforation, among which, 5 were repaired and implanted instantly, and the other 3 cases underwent sinus lifting and delayed dental implantation. No infection occurred, and only one case appeared to have implant shedding. Al the 29 cases (39 dental implants) completed the restoration, and no implant loosening and pain occurred. These findings indicate that mucosal perforation in maxilary sinus lift is mainly related to the mucosal condition of the sinus floor, choice of operating instruments and surgeon’s operating skil. Based on the proper mucosal repair and appropriate selection of dental implants, open maxilary sinus lift with instant or delayed dental implantation can both achieve satisfactory effects.%背景：有研究表明上颌窦黏膜穿孔是上颌窦外提升最常见的并发症，限制了种植手术的临床应用，但在上颌窦破坏后需做种植的患者植入种植体后的临床效果至今少有报道。　　目的：分析导致上颌窦外提升中窦底黏膜穿孔的原因，观察黏膜穿孔封闭后完成种植的效果。　　方法：收集行上颌窦外提升术治疗的患者29例，共植入种植体39颗。若发生穿孔，修补或封闭穿孔用可吸收生物膜，植骨材料为羟基磷灰石生物陶瓷骨粉。　　结果与结论：在29例共39颗种植体进行上颌窦外提升时8例(20.5%)发生窦底黏膜破损，其中5例行穿孔修补后同期完成植骨；另外3例穿孔加大修补后植骨，延期行口腔种植；所有病例未发生感染，1例(2.6%)发生植体脱落；39例均已完成后期修复，种植体无松动，无疼痛。结果证实，在上颌窦外提升术中导致上颌窦底黏膜穿孔的主要成因在于窦底的黏膜状况、提升工具的选择以及术者的操作，如果黏膜修复得当以及选择合适的种植体，同期或延期种植均可获得良好效果。