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北京大学学报（医学版） ›› 2021, Vol. 53 ›› Issue (1): 95-101. doi: 10.19723/j.issn.1671-167X.2021.01.015

• 论著 • 上一篇    下一篇

经嵴顶上颌窦底提升术后不植骨同期种植的影像研究

李蓬1,Δ(),朴牧子1,胡洪成1,王勇2,赵一姣2,申晓婧2   

  1. 1.北京大学口腔医学院·口腔医院,第二门诊部 国家口腔疾病临床医学研究中心 口腔数字化医疗技术和材料国家工程实验室 口腔数字医学北京市重点实验室,北京 100101
    2.北京大学口腔医学院·口腔医院口腔医学数字化研究中心, 北京 100081
  • 收稿日期:2020-09-23 出版日期:2021-02-18 发布日期:2021-02-07
  • 通讯作者: 李蓬 E-mail:kqlipeng05420533@sina.com

Radiography study on osteotome sinus floor elevation with placed implant simultaneously with no graft augmentation

LI Peng1,Δ(),PIAO Mu-zi1,HU Hong-cheng1,WANG Yong2,ZHAO Yi-jiao2,SHEN Xiao-jing2   

  1. 1. Second Clinical Division, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100101, China
    2. Center of Digital Dentistry, Peking University School and Hospital of Stomatology, Beijing 100081, China
  • Received:2020-09-23 Online:2021-02-18 Published:2021-02-07
  • Contact: Peng LI E-mail:kqlipeng05420533@sina.com

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摘要：

目的: 应用锥形束计算机断层(cone beam computed tomography,CBCT)及三维测量研究经嵴顶上颌窦底提升术不植骨同期植入种植体后窦内骨高度和骨体积的变化,分析影响窦内骨增量的相关因素。方法: 选择2014年1月至2019年12月在北京大学口腔医院第二门诊部就诊的38例牙列缺损患者影像学资料进行回顾性分析,38例患者经牙槽嵴顶上颌窦底提升后不植骨同期植入44 枚种植体。比较分析术前和术后9~68 个月拍摄的CBCT, 测量种植体颊侧、腭侧、近中和远中位点的窦内新增骨高度,通过Mimics软件建模配准,布尔(Boolean)运算计算出上颌窦内新增的骨体积,并且分析影响窦内新增骨高度和新增骨体积的相关因素, 根尖片追踪监测边缘骨吸收情况。结果: 术前上颌窦底平均剩余牙槽骨高度 (residual bone height, RBH)为(3.41±1.23) mm,种植体突入长度(protruded length, PL)为(3.41±1.28) mm, 种植体周围各位点窦内新增骨高度远中为(2.44±1.23) mm、近中为(2.88±1.20) mm、颊侧为(2.83±1.22) mm和腭侧为(2.96±1.16) mm,术后窦内平均新增骨高度为(2.78±1.13) mm,窦内新增骨体积为(122.15±73.27) mm3。多因素分析显示调整性别、年龄、吸烟等因素后,窦内平均新增骨高度与PL和成骨时间呈正相关,与术前RBH呈负相关, 而窦内新增骨体积与PL和成骨时间呈正相关。观察期内种植体成功率100%,平均边缘骨吸收为0(0~1.41) mm。结论: 经嵴顶上颌窦底提升术不植骨同期植入种植体可增加种植体周围窦内骨高度,不植骨亦可以获得窦内一定体积的新骨形成,RBH、PL及成骨时间均是影响窦内成骨量的重要因素。

关键词: 窦底增高术, 牙种植, X线计算机体层摄影术

Abstract:

Objective: To investigate the change of endo-sinus bone height and bone volume in osteotome sinus floor elevation (OSFE) without bone graft but placing implants simultaneously by using cone beam computed tomography (CBCT) and three dimensional analysis, and to find the impacting factors on endo-sinus bone augmentation.Methods: OSFE was performed in 38 edentulous patients with missing teeth at posterior maxillary region, and 44 implants were placed and referred for OSFE using no graft materials. CBCT was performed pre-surgery and 9-68 months post-surgery when the patients encountered another implant surgery. The gained bone height at mesial, distal, buccal and palatal sites around the implant in sinus were measured, volumetric measurements of the endo-sinus gained bone volume (ESGBV) in the elevated region were calculated by Mimics software. Univariate analysis and multiple linear regression were performed to investigate the impacting factors on the gained bone height and ESGBV. Marginal bone loss was recorded according to the periapical radiography after implant restoration.Results: The mean residual bone height (RBH) pre-surgery was (3.41±1.23) mm, the mean protruded length (PL) into sinus of implant post-surgery was (3.41±1.28) mm, the mean endo-sinus gained bone height was (2.44±1.23) mm at distal sites, (2.88±1.20) mm at mesial sites, (2.83±1.22) mm at buccal sites and (2.96±1.16) mm at palatal sites, the mean endo-sinus gained bone height at distal sites was significantly lower than the other three sites (P<0.05). The average endo-sinus gained bone height was (2.78±1.13) mm. The mean ESGBV was (122.15± 73.27) mm3. Univariate analysis showed the more RBH, the less bone height gained in sinus, which existed at buccal, lingual, mesial and distal sites (P<0.001), and the more RBH, the smaller ESGBV gained (P=0.012). The ESGBV was significantly higher in the subjects whose bone generation period was more than 24 months than those whose bone generation period less than 24 months (P=0.034). The more PL, the more bone height and ESGBV gained (P=0.008). Multivariate analysis showed after adjusting factors of gender, age, smoking, width of sinus floor, thickness of sinus membrane pre-surgery, diameter and length of the implant, PL and bone generation period was positively correlated with mean endo-sinus gained bone height and ESGBV, while RBH negatively correlated with mean endo-sinus gained bone height. During the follow-up, the mean marginal bone loss was 0 (0-1.41) mm and all the implants loaded successfully.Conclusion: OSFE without bone graft but with placed implant simultaneously can increase endo-sinus gained bone height and ESGBV. RBH, PL and bone generation period are the significant factors impacting endo-sinus bone augmentation.

Key words: Sinus floor augmentation, Dental implants, X-ray computed tomography

中图分类号: 

  • R783

图1

种植术后即刻X线片(A)和二期手术后X线片(B)"

图2

术前窦底剩余骨高度和窦底宽度测量"

图3

骨嵴顶到种植体根尖区距离(A) 的测量方法"

图4

在术后CBCT冠状面测量窦内颊侧和腭侧位点骨高度(A),在矢状面测量窦内近中和远中位点骨高度(B)"

图5

Mimics软件中测量上颌窦内骨增量体积"

表1

剩余骨高度、成骨时间和种植体突入上颌窦内长度对窦内成骨的影响"

Items BHM/mm BHD/mm BHB/mm BHP/mm ABH/mm ESGBV/mm3
RBH
≤3 mm (n=13) 4.06±0.85 3.62±0.74 4.09±1.06 4.04±1.03 3.95±0.78 162.55±62.28
3-5 mm (n=27) 2.66±0.59 2.17±0.74 2.56±0.51 2.77±0.55 2.54±0.50 88.10(10.47-234.06)*
≥5 mm (n=4) 0.25(-0.2-1.73)* 0.70(-1.75-2.24)* 0.35(0.2-1.54)* 0.52(0.17-1.83)* 0.45(-0.38-1.83)* 51.34(6.34-78.48)
P <0.001 <0.001 <0.001 <0.001 <0.001 0.012
T
≤24 months (n=29) 2.75(-0.2-4.35) 2.25±1.28 2.69±1.28 2.75(0.17-5.37) 2.61±1.13 103.82±63.41
>24 months (n=15) 3.23±1.25 2.81±1.07 3.11±1.06 3.25±1.15 3.10±1.09 157.61±80.01
P 0.316 0.185 0.316 0.298 0.23 0.034
PL
≤3 mm (n=15) 2.00(-0.2-2.72)* 1.45(-1.75-2.55)* 2.10(0.2-2.92)* 1.90±0.87 2.08(-0.38-2.54)* 77.37(6.34-214.14)*
3-6 mm (n=29) 3.37(2.32-6.31)* 3.02±0.89 3.35±1.03 3.38(2.42-5.89)* 3.15(2.28-5.68)* 142.87±72.32
P <0.001 <0.001 <0.001 <0.001 <0.001 0.008

表2

影响窦内新增骨高度的多因素分析"

Variables B 95%CI P
PL 0.37 0.05-0.69 0.025
T 0.012 0.003-0.022 0.012
RBH -0.48 -0.81 to -0.15 0.005
Constant 2.91 0.76-5.06 0.009

表3

影响窦内新增骨体积的多因素分析"

Variables B 95%CI P
PL 30.20 16.30-44.10 0.001
T 1.86 0.36-3.37 0.016
Constant -21.83 -78.92-35.26 0.444
[1] Fok MR, Pelekos G, Tonetti MS. Feasibility and needs for simultaneous or staged bone augmentation to place prosthetically guided dental implants after extraction or exfoliation of first molars due to severe periodontitis[J]. J Clin Periodontol, 2020,47(10):1237-1247.
doi: 10.1111/jcpe.13344 pmid: 32652610
[2] 范震, 王方, 王佐林. 经牙槽嵴顶上颌窦底提升术: 中华口腔医学会第五届口腔种植专业委员会学术共识[J]. 口腔颌面外科杂志, 2018,28(1):1-9.
[3] Chen TW, Chang HS, Leung KW, et al. Implant placement immediately after the lateral approach of the trap door window procedure to create a maxillary sinus lift without bone grafting: a 2-year retrospective evaluation of 47 implants in 33 patients[J]. J Oral Maxillofac Surg, 2007,65(11):2324-2328.
doi: 10.1016/j.joms.2007.06.649 pmid: 17954333
[4] Pjetursson BE, Lang NP. Sinus floor elevation utilizing the transalveolar approach[J]. Periodontol 2000, 2014,66(1):59-71.
doi: 10.1111/prd.12043 pmid: 25123761
[5] Chen S, Buser D, Wismeijer D, 等. 宿玉成译.国际口腔种植学会(ITI)口腔种植临床指南. 第5卷,上颌窦底提升的临床程序[M]. 北京: 人民军医出版社, 2012: 53.
[6] Boyne PJ. Analysis of performance of root-form endosseous implants placed in the maxillary sinus[J]. J Long Term Eff Med Implants, 1993,3(2):143-159.
pmid: 10146541
[7] Starch-Jensen T, Schou S. Maxillary sinus membrane elevation with simultaneous installation of implants without the use of a graft material: a systematic review[J]. Implant Dent, 2017,26(4):621-633.
doi: 10.1097/ID.0000000000000617 pmid: 28639983
[8] Parra M, Atala-Acevedo C, Fariña R, et al. Graftless maxillary sinus lift using lateral window approach: a systematic review[J]. Implant Dent, 2018,27(1):111-118.
doi: 10.1097/ID.0000000000000695 pmid: 29210825
[9] Pinchasov G, Juodzbalys G. Graft-free sinus augmentation procedure: a literature review[J/OL]. J Oral Maxillofac Res, 2014,5(1): e1[2020-08-01]. http://www.ejomr.org/JOMR/archives/2014/1/e1/v5n1e1ht.pdf, 2014-03-08.
[10] Starch-Jensen T, Aludden H, Hallman M, et al. A systematic review and meta-analysis of long-term studies (five or more years) assessing maxillary sinus floor augmentation[J]. Int J Oral Maxillofac Surg, 2018,47(1):103-116.
[11] Markovic A, Mišic T, Calvo-Guirado JL, et al. Two-center prospective, randomized, clinical, and radiographic study comparing osteotome sinus floor elevation with or without bone graft and simultaneous implant placement[J]. Clin Implant Dent Relat Res, 2016,18(5):873-882.
doi: 10.1111/cid.12373 pmid: 26315564
[12] Scala A, Botticelli D, Faeda RS, et al. Lack of influence of the Schneiderian membrane in forming new bone apical to implants simultaneously installed with sinus floor elevation: an experimental study in monkeys[J]. Clin Oral Implants Res, 2012,23(2):175-181.
doi: 10.1111/j.1600-0501.2011.02227.x pmid: 21668505
[13] Srouji S, Kizhner T, Ben David D, et al. The Schneiderian membrane contains osteoprogenitor cells: in vivo and in vitro study[J]. Calcif Tissue Int, 2009,84(2):138-145.
doi: 10.1007/s00223-008-9202-x pmid: 19067018
[14] Palma VC, Magro-Filho O, de Oliveria JA, et al. Bone reformation and implant integration following maxillary sinus membrane elevation: an experimental study in primates[J]. Clin Implant Dent Relat Res, 2006,8(1):11-24.
doi: 10.2310/j.6480.2005.00026.x pmid: 16681489
[15] Duan DH, Fu JH, Qi W, et al. Graft-free maxillary sinus floor elevation: a systematic review and meta-analysis[J]. J Periodontol, 2017,88(6):550-564.
doi: 10.1902/jop.2017.160665 pmid: 28168901
[16] 唐德争, 马攀, 刘长营, 等. 低矮上颌窦底内提升同期种植术植骨与不植骨的临床观察[J]. 首都医科大学学报, 2018,39(1):98-102.
[17] Cricchio G, Sennerby L, Lundgren S. Sinus bone formation and implant survival after sinus membrane elevation and implant placement: a 1- to 6-year follow-up study[J]. Clin Oral Implants Res, 2011,22(10):1200-1212.
doi: 10.1111/j.1600-0501.2010.02096.x pmid: 21906186
[18] Suk-Arj P, Wongchuensoontorn C, Taebunpakul P. Evaluation of bone formation following the osteotome sinus floor elevation technique without grafting using cone beam computed tomography: a preliminary study[J]. Int J Implant Dent, 2019,5(1):27.
doi: 10.1186/s40729-019-0181-7 pmid: 31367919
[19] Balleri P, Veltri M, Nuti N, et al. Implant placement in combination with sinus membrane elevation without biomaterials: a 1-year study on 15 patients[J]. Clin Implant Dent Relat Res, 2012,14(5):682-689.
doi: 10.1111/j.1708-8208.2010.00318.x pmid: 21176096
[20] Sonoda T, Harada T, Yamamichi N, et al. Association between bone graft volume and maxillary sinus membrane elevation height[J]. Int J Oral Maxillofac Implants, 2017,32(4):735-740.
doi: 10.11607/jomi.5290 pmid: 28231348
[21] Frost HM. A 2003 update of bone physiology and Wolff’s Law for clinicians[J]. Angle Orthod, 2004,74(1):3-15.
doi: 10.1043/0003-3219(2004)074<0003:AUOBPA>2.0.CO;2 pmid: 15038485
[22] Nedir R, Nurdin N, Szmukler-Moncler S, et al. Placement of tapered implants using an osteotome sinus floor elevation technique without bone grafting: 1-year results[J]. Int J Oral Maxillofac Implants, 2009,24(4):727-733.
pmid: 19885415
[23] Nedir R, Nurdin N, Khoury P, et al. Short implants placed with or without grafting in atrophic sinuses: the 3-year results of a prospective randomized controlled study[J]. Clin Implant Dent Relat Res, 2016,18(1):10-18.
doi: 10.1111/cid.12279 pmid: 25622803
[24] Nedir R, Nurdin N, Abi Najm S, et al. Short implants placed with or without grafting into atrophic sinuses: the 5-year results of a prospective randomized controlled study[J]. Clin Oral Implants Res, 2017,28(7):877-886.
doi: 10.1111/clr.12893 pmid: 27296955
[25] Nedir R, Nurdin N, Vazquez L, et al. Osteotome sinus floor elevation without grafting: a 10-year prospective study[J]. Clin Implant Dent Relat Res, 2016,18(3):609-617.
doi: 10.1111/cid.12331 pmid: 25786548
[26] Temmerman A, Van Dessel J, Cortellini S, et al. Volumetric changes of grafted volumes and the Schneiderian membrane after transcrestal and lateral sinus floor elevation procedures: a clinical, pilot study[J]. J Clin Periodontol, 2017,44(6):660-671.
doi: 10.1111/jcpe.12728 pmid: 28382627
[27] Arasawa M, Oda Y, Kobayashi T, et al. Evaluation of bone volume changes after sinus floor augmentation with autogenous bone grafts[J]. Int J Oral Maxillofac Surg, 2012,41(7):853-857.
doi: 10.1016/j.ijom.2012.01.020 pmid: 22551647
[28] Klein GG, Curvello VP, Dutra RA, et al. Bone volume changes after sinus floor augmentation with heterogenous graft[J]. Int J Oral Maxillofac Implants, 2016,31(3):665-671.
doi: 10.11607/jomi.3948 pmid: 27183076
[29] Alayan J, Ivanovski S. A prospective controlled trial comparing xenograft/autogenous bone and collagen-stabilized xenograft for maxillary sinus augmentation-complications, patient-reported outcomes and volumetric analysis[J]. Clin Oral Implants Res, 2018,29(2):248-262.
pmid: 29231263
[30] Xavier SP, Silva ER, Kahn A, et al. Maxillary sinus grafting with autograft versus fresh-frozen allograft: a split-mouth evaluation of bone volume dynamics[J]. Int J Oral Maxillofac Implants, 2015,30(5):1137-1142.
doi: 10.11607/jomi.3924 pmid: 26394351
[31] Sbordone C, Toti P, Guidetti F, et al. Volume changes of autogenous bone after sinus lifting and grafting procedures: a 6-year computerized tomographic follow-up[J]. J Craniomaxillofac Surg, 2013,41(3):235-241.
doi: 10.1016/j.jcms.2012.09.007 pmid: 23084768
[32] Lin IC, Gonzalez AM, Chang HJ, et al. A 5-year follow-up of 80 implants in 44 patients placed immediately after the lateral trap-door window procedure to accomplish maxillary sinus elevation without bone grafting[J]. Int J Oral Maxillofac Implants, 2011,26(5):1079-1086.
pmid: 22010092
[33] Kühl S, Payer M, Kirmeier R, et al. The influence of particulated autogenous bone on the early volume stability of maxillary sinus grafts with biphasic calcium phosphate: a randomized clinical trial[J]. Clin Implant Dent Relat Res, 2015,17(1):173-178.
doi: 10.1111/cid.12086 pmid: 23714235
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