上颌后牙骨量严重不足行上颌窦内提升术同期种植的临床效果分析

摘要

目的：观察上颌后牙骨量严重不足即上颌窦底剩余牙槽骨高度（ RBH）＜5 mm行上颌窦内提升术同期植入种植体的临床效果。方法回顾性分析烟台市口腔医院种植中心2012年1月—2013年1月间收治的上颌后牙骨量严重不足（ RBH＜5 mm）行上颌窦内提升术同期种植的病例15例，共植入28颗瑞士Straumann种植体。术后8个月行上部结构修复，通过视觉评估法（ visual analogue scale，VAS）分析患者术后反应及满意度，同时对种植体留存率，骨结合及边缘骨吸收情况进行观察。结果 VAS显示11例患者（73．3％）无明显疼痛及肿胀反应，无头痛、发热、鼻出血等症状，未影响日常生活；4例患者（27．7％）表现轻微疼痛。10例患者（66．7％）表示可接受此次治疗的费用，4例患者（26．7％）认为此次治疗费用偏高，1例患者（6．7％）表示不能接受此次治疗的费用。13例患者（86．7％）表示如需再次进行此种治疗愿意接受，2例患者（13．3％）表示拒绝，患者总体表现对此种治疗方式满意度较高。8个月后CBCT显示种植体周围可见新骨形成，达到良好骨结合状态，上部结构修复1年后，28颗种植体无一脱落，留存率为100％，影像学检查见种植体平均边缘骨吸收（1．2±0．5） mm。在本研究中，15例患者平均RBH为（3．5±1．2）mm，平均上颌窦提升高度为（6．3±1．2）mm。结论上颌后牙区骨量严重不足（RBH＜5 mm）行上颌窦内提升技术同期植入种植体亦可取得较好的临床效果，但此类病例为高度复杂病例，术前需要完善的检查，术中需经验丰富的临床医生细致操作，术后应用抗生素预防感染。%Objective To observe the clinical effects of implant-supported rehabilitations with transalveolar technique and simultaneous implant placement on limited alveolar bone of posterior maxilla ( RBH<5 mm) .Methods Fifteen patients, who had a limited alveolar bone of posterior maxilla ( RBH<5 mm) and received simultaneous implant placement between January 2012 and January 2013 in the Dental Implantation Centre of Yantai Stomtaological Hospiatal, were retrospectively analyzed. Crown was restored 8 months after surgery.Patients'satisfaction and postoperative reaction were analyzed by Visual Analogue Scale (VAS).Survival rates of the implant, osseointegration and loss of margin bone were also studied.Results VAS indica-ted 11 patients (73.3%) had no significant pain,swelling,fever or nose bleeding and the therapy did not affect daily life.4 patients (27.7%) had mild pain.10 patients (66.7%) considered the cost of implant therapy acceptable, while 4 patients (26.7%) thought the cost was expensive and 1 patient could not accept the cost of implant therapy.13 patients (86.7%) indicated willingness to receive treatment again if needed, while 2 patients (13.3%) refused.After 8 months treatment, CBCT indicated formation of new bone around the implant and had good ossointegration.One year after crown restored, there was no implant loss with an implant survival rate of 100%.X-rays indicated margin bone loss (1.2 ±0.5) mm.In the current study, the average RBH in 15 patients was (3.5 ±1.2) mm and the average floor elevation of maxillary sinus was (6.3 ±1.2)mm.Conclusion There is a good clinical effects of implant-supported rehabilitations with transalveolar technique and simultaneous implant placement on limited alveolar bone of posterior maxilla ( RBH<5 mm) .Because such cases are highly complex, complete preoperative examination, an experienced clinical doctor, carefully operation, postoper-ative antibiotics are important.