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北京大学学报（医学版） ›› 2025, Vol. 57 ›› Issue (5): 967-974. doi: 10.19723/j.issn.1671-167X.2025.05.023

• 论著 • 上一篇    下一篇

穿颧种植体上颌窦段成骨的影像学研究

于子杨1, 郭厚佐1, 蒋析1, 韩玮华2, 林野1,*()   

  1. 1. 北京大学口腔医学院·口腔医院种植科, 国家口腔医学中心, 国家口腔疾病临床医学研究中心, 口腔生物材料和数字诊疗装备国家工程研究中心, 口腔数字医学北京市重点实验室, 北京 100081
    2. 中国医学科学院北京协和医学院, 北京协和医院口腔科, 北京 100730
  • 收稿日期:2023-02-23 出版日期:2025-10-18 发布日期:2025-09-05
  • 通讯作者: 林野
  • 基金资助:
    中央保健科研重点课题(2022—2027); 中央保健科研重点课题(2022ZD18)

Imaging study of osteogenesis in maxillary sinus segment of zygomatic implants

Ziyang YU1, Houzuo GUO1, Xi JIANG1, Weihua HAN2, Ye LIN1,*()   

  1. 1. Department of Implantology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digi-tal Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    2. Department of Stomatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
  • Received:2023-02-23 Online:2025-10-18 Published:2025-09-05
  • Contact: Ye LIN
  • Supported by:
    the National Central Healthcare Research Project(2022—2027); the National Central Healthcare Research Project(2022ZD18)

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摘要： 目的: 使用影像学手段评估穿颧种植体植入1年后上颌窦段的成骨情况, 并探讨患者因素、上颌窦解剖因素和手术因素对成骨效果的影响。方法: 本研究为回顾性研究, 纳入2017年7月至2022年1月于北京大学口腔医院种植科行穿颧种植且种植体穿行上颌窦的患者, 于术前、术后即刻和术后1年拍摄锥形束CT(cone beam CT, CBCT), 测量并计算种植体在上颌窦段的平均成骨高度(average osteogenesis height, AOH), 同时记录剩余牙槽骨高度(residual bone height, RBH)、上颌窦底颊腭向宽度和形态、术中上颌窦黏膜完整性以及患者和种植体基本情况。通过对比解剖条件和手术特征, 分析不同情况下AOH的差异, 并以中位数为阈值将AOH分为两组(明显成骨、不明显成骨), 使用广义线性混合模型评估成骨情况的影响因素。结果: 纳入患者24例, 共植入47枚穿颧种植体。在平均12.1个月的随访期内未见种植体失败, 种植体存留率100%。术后CBCT显示43枚种植体的上颌窦段出现成骨影像, 新骨起自上颌窦底, AOH中位数为3.1 mm(四分位距: 4.0 mm)。上颌窦宽度方面, 纳入患者包含宽型上颌窦31例(66.0%)和窄型上颌窦16例(34.0%); 解剖形态方面, 包含锥形17例(36.2%)、卵圆形20例(42.6%)、方形10例(21.3%)。术前RBH中位数为2.8 mm(四分位距: 2.2 mm)。广义线性混合模型单因素分析显示, 明显成骨率与RBH(OR=2.09, P=0.006)有关, 多因素分析显示RBH(OR=2.55, P=0.022)和锥形上颌窦形态(OR=11.44, P=0.040)与术后明显成骨率有统计学相关性。结论: 穿颧种植体植入1年后上颌窦底有成骨影像, 较大的RBH和锥形上颌窦形态可能是成骨的有利因素。

关键词: 牙种植体, 颧骨, 上颌窦, 骨生成

Abstract: Objective: To assess the osteogenesis height in maxillary sinus segment one year after zygomatic implantation by imaging methods, and evaluate the influence of patient factors, maxillary sinus anatomical factors and surgical factors on postoperative osteogenesis height. Methods: This study is a retrospective study, including patients who underwent zygomatic implantation and whose zygomatic implants passed through the maxillary sinus at the Department of Implantology, Peking University School and Hospital of Stomatology from July 2017 to January 2022. Preoperative and postoperative cone beam CT (CBCT)was taken to measure and calculate the average osteogenesis height (AOH) in maxillary sinus segment of the zygomatic implants, then the residual bone height, the width and morphology of the maxillary sinus floor in the buccal and palatal directions were measured. Besides, the integrity of Schneiderian membrane during implant surgery, and the general information of the patients and zygomatic implants were recorded. By comparing anatomical situations and surgical characteristics, the differences of AOH under different conditions were analyzed. Then AOH was divided into two groups (obvious osteogenesis group and non-obvious osteogenesis group) using the median as the threshold, and the influencing factors of osteogenesis were evaluated using mixed effect generalized linear model univariable and multivariable analysis. Results: A total of 47 zygomatic implants were implanted in 24 patients. During the average follow-up period of 12.1 months, there was no implant failure, and the implant survival rate was 100%. Postoperative CBCT showed that 43 zygomatic implants had osteogenic images in the maxillary sinus segment, most of which originated from the floor of the maxillary sinus, and the median AOH was 3.1 mm [interquartile range (IQR): 4.0 mm]. In terms of maxillary sinus width, there were 31 cases (66.0%) of wide type and 16 cases (34.0%) of narrow type. In the aspect of buccal and palatal morphology, 17 cases were taper (36.2%), 20 cases were round (42.6%), and 10 cases were flat (21.3%). The median of residual bone height was 2.8 mm (IQR: 2.2 mm) before operation. Univa-riate analysis of mixed effect generalized linear model showed that postoperative obvious osteogenic rate was related to the residual bone height (OR=2.09, P=0.006). Multivariate analysis showed that the resi-dual bone height (OR=2.55, P=0.022) and the shape of a taper maxillary sinus (OR=11.44, P=0.040) had a significant impact on the postoperative obvious osteogenic rate. Conclusion: The maxillary sinus floor showed osteogenic images 1 year after the zygomatic implantation surgery. Larger residual bone height and the shape of a taper maxillary sinus may be favorable factors for osteogenesis.

Key words: Dental implants, Zygoma, Maxillary sinus, Osteogenesis

中图分类号: 

  • R782.12

图1

Bedrossian提出的上无牙颌分区"

图2

RBH和PBD的测量"

图3

上颌窦颊腭向轮廓"

图4

窦底成骨高度的测量"

表1

患者一般资料(n=24)"

Items Data
Gender, n(%)
  Male 16 (66.7)
  Female 8 (33.3)
Age/years, n(%)
  30- 1 (4.2)
  40- 8 (33.3)
  50- 8 (33.3)
  60-69 7 (29.2)
General condition, n(%)
  Hypertension 6 (25.0)
  Diabetes 2 (8.3)
  Cardiovascular disease 1 (4.2)
Smoking history, n(%) 3 (12.5)

表2

穿颧种植体一般资料(n=47)"

Items Data
Length of zygomatic implants/mm, ${\bar x}$±s 43.78±4.91
Site, n(%)
  Left 24 (51.1)
  Right 23 (48.9)
Survival, n(%)
  No 0 (0.0)
  Yes 47 (100.0)
Schneiderian membrane, n(%)
  Perforated 10 (21.3)
  Non-perforated 37 (78.7)

表3

穿颧种植体的剩余牙槽骨高度"

Items n RBH/mm, median (IQR) P
Gender 0.025
  Male 31 2.40 (1.70)
  Female 16 3.90 (3.93)
Site 0.873
  Left 24 2.60 (2.43)
  Right 23 2.80 (2.20)
Total 47 2.80 (2.20)

图5

穿颧种植体术后1年的AOH"

表4

上颌窦底成骨情况的单因素分析"

Examined variable n Obvious osteogenic rate/% β OR (95%CI) P
Gender
  Male 31 62.5 Reference
  Female 16 41.9 -0.842 0.43 (0.09, 1.52) 0.197
Age 47 48.9 0.038 1.04 (0.96, 1.14) 0.320
Smoker
  No 41 51.2 Reference
  Yes 6 33.3 -0.752 0.47 (0.05, 3.09) 0.426
Diabetes
  No 43 48.8 Reference
  Yes 4 50.0 -0.002 1.00 (0.05, 9.37) 0.998
RBH 47 48.9 0.738 2.09 (1.32, 4.57) 0.006
PBD
  Wide 31 48.4 Reference
  Narrow 16 50.0 0.094 1.10 (0.31, 5.44) 0.886
Morphology
  Round 20 35.0 Reference
  Taper 17 70.6 1.706 5.51 (0.84, 36.0) 0.075
  Flat 10 40.0 0.310 1.36 (0.23, 8.16) 0.734
Perforation
  No 28 57.1 Reference
  Yes 19 36.8 -0.827 0.44 (0.13, 1.48) 0.175
Site
  Left 24 50.0 Reference
  Right 23 47.8 -0.091 0.91 (0.28, 2.95) 0.878

表5

上颌窦底成骨情况的多因素分析"

Examined variables β OR (95%CI) P VIF
Morphology
  Round Reference
  Taper 0.937 11.44 (1.11, 117.4) 0.040 1.128
RBH 2.437 2.55 (1.14, 5.69) 0.022 1.272

图6

1例颧周感染患者手术探查时发现上颌窦底成骨"

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ISSN 1671-167X
CN 11-4691/R
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