上颌翼板区种植技术的临床应用及操作规范

doi:10.12337/zgkqzzxzz.2021.06.001

中国口腔种植学杂志 ›› 2021, Vol. 26 ›› Issue (3): 143-151.DOI: 10.12337/zgkqzzxzz.2021.06.001

• 专家笔谈 • 下一篇

上颌翼板区种植技术的临床应用及操作规范

浦益萍¹, 高振华², 赵正宜³, 邹多宏¹, 杨驰¹, 张志愿¹

¹上海交通大学医学院附属第九人民医院·口腔医学院口腔外科国家口腔疾病临床医学研究中心上海市口腔医学重点实验室上海市口腔医学研究所中国医学科学院口腔颌面再生医学创新单元 200001;
²鼎植医疗集团,上海 200120;
³安徽医科大学口腔医学院,合肥 230032

收稿日期:2021-03-13 出版日期:2021-06-10 发布日期:2021-07-14
通讯作者: 邹多宏,Email：zouduohongyy@163.com;电话：021-53315989
作者简介:邹多宏教授、研究员、博士研究生导师、博士后合作导师,美国密歇根大学高级访问学者,中华口腔医学会牙及牙槽外科专业委员会副主任委员,上海市口腔医学会口腔种植专委会常务委员; 获上海交通大学医学院“双百人”人才计划、上海市“医苑新星”杰出青年医学人才培养资助计划、安徽省杰出青年基金人才培养计划及安徽省高校优秀人才支持计划; 近5年主持国家级课题2项,以独立通讯作者/共同通讯作者分别在Nat Biomed Eng.、Sci Adv.、Cell Death Differ.、Matter、Adv. Funct. Mater.、ACS Nano.、Biomaterials、Nano Research、Acta Biomater.、Nanoscale、J Dent Res.以及 Stem cells等期刊发表SCI源刊物20篇; 主编专著1部,参编专著6部,申请专利99项(第一申请人),并获得了系列成果转化,研发了专用牙槽骨骨增量装置及特殊口腔种植体与相关手术器械,为我国口腔医疗器械国产化进程起到了一定的推动作用
基金资助:
中国医学科学院医学与健康科技创新工程项目资助(2019-I2M-5-037); 国家自然科学基金(31870969); 上海交通大学医学院“双百人”人才计划 (20191816)

Clinical application of implant technique in the pterygoid plate area-standard operational practice

Pu Yiping¹, Gao Zhenhua², Zhao Zhengyi³, Zou Duohong¹, Yang Chi¹, Zhang Zhiyuan¹

¹Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai 200001, China;
²Dingzhi Doctor Group, Shanghai 200120, China;
³Department of Oral Implant, Stomatologic Hospital & College, Anhui Medical University Key Lab. of Oral Diseases Research of Anhui Province, Hefei 230032, China

Received:2021-03-13 Online:2021-06-10 Published:2021-07-14
Contact: Zou Duohong,Email：zouduohongyy@163.com,Tel:0086-21-53315989
Supported by:
The National Natural Science Foundation of China (31870969); CAMS Innovation Fund for Medical Sciences (CIFMS) (2019-I2M-5-037); Shanghai Municipal Education Commission Two-hundred Talent (20191816)

摘要/Abstract

摘要： 翼板区种植技术是将种植体由牙槽嵴植入位点靠近上颌窦后壁经过上颌结节、腭骨锥突,最终植入蝶骨翼突区的倾斜种植体应用技术。翼板区种植体植入角度为30~50度的倾斜植入式,位于上颌种植修复的最远端,消除了种植修复体远中悬臂,且腭骨锥突及蝶骨翼突联合区以45度倾斜植入,平均可获得8~9 mm的硬质骨支持,初始稳定性良好,为即刻负荷提供了有利条件,临床上常和上颌前牙区及双尖牙区口腔种植体联合应用,即可完成牙槽骨萎缩条件下上颌全牙弓或单侧多颗后牙缺失的即刻种植和即刻修复,在上颌后牙区获得较高的种植体留存率(>90%),同时可避免上颌窦区域的骨增量手术,简化了口腔种植治疗程序,减小了患者创伤,减轻了术后反应和患者疼痛,缩短了疗程,为上颌后牙区骨量不足、不能耐受植骨或骨移植失败患者行即刻负荷提供了新的临床解决方案。但目前广大临床医师对翼板区种植技术的临床应用存在诸多困惑,如种植位点选择,术前评估及种植体长度与角度设计,安全的备洞方式与流程,植入方向控制及风险规避等。鉴于此,作者基于翼板区种植的临床手术流程,撰写了翼板区种植在上颌后牙区骨量及骨质严重不足条件下即刻种植即刻负荷的临床应用操作规范,旨在提供上颌后牙区上颌窦底提升及牙槽骨增高等骨增量之外的解决方案,从而避免骨增量相关复杂手术及其并发症,实现即刻负荷,显著缩短治疗时间,并为广大口腔医师提供参考和依据,对临床推广应用起到积极作用。

关键词: 翼板区种植, 翼板区解剖, 挤压备洞, 即刻负荷, 规范化操作

Abstract: The technique of TPP (T:maxillary tuberosity,P:pterygoid plate,P:palatine) implants has been proposed, that the pillar composed of maxillary tuberosity,the pyramidal process of the palatineand the pterygoid process of the sphenoid in pterygomaxillary region can provide a certain volume of compact bone. Inclined implants of 30-50 degrees are placed in pterygoid region. As it is located in the end of distal part of maxilla, the distal cantilever of the prosthesis is completely eliminated. TPP implants with good initial stability are often applied in combination with the implants in anterior and bicuspid areas to provide favorable conditions for immediate loading. This technique can be applied for immediate implant and immediate restoration of maxillary complete arch or unilateral multiple posterior teeth loss with alveolar bone atrophy. Furthermore,the success rate is high (>90%). Due to avoiding the procedure of bone augmentation approach in maxillary sinus region and simplifying the procedure of implant surgery, it could reduce the trauma of patients, relieve postoperative reaction and pain, shorten the course of treatment and provide a new clinical solution for patients with insufficient bone in maxillary posterior area, especially for the patients who can not undergo bone graft procedure. However, clinicians still face many difficulties achieving effectively clinical application of this technique, including standard surgical protocol, the correct position of the placement site, preoperative evaluation, the design of length and placement angle, the safety procedure of the surgery and implant direction control and risk management, etc. Our team established standard surgical protocol of TPP technique for immediate implant and immediate loading with severe bone deficiency in maxillary posterior area. We sincerely hope that the article will provide a reference and basis for clinicians when applying the technique to avoid complex operation and complications related to bone augmentation, popularize the clinical application of the technique.

Key words: Pterygoid plate implants, Anatomy of pterygoid maxillary, Osteotome preparation, Immediate loading, Standardized surgery

浦益萍,高振华,赵正宜,等. 上颌翼板区种植技术的临床应用及操作规范[J]. 中国口腔种植学杂志, 2021, 26(3): 143-151. DOI: 10.12337/zgkqzzxzz.2021.06.001

Pu Yiping, Gao Zhenhua, Zhao Zhengyi, Zou Duohong, Yang Chi, Zhang Zhiyuan. Clinical application of implant technique in the pterygoid plate area-standard operational practice[J].Chinese Journal of Oral Implantology, 2021, 26(3): 143-151.DOI: 10.12337/zgkqzzxzz.2021.06.001.

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上颌翼板区种植技术的临床应用及操作规范

Clinical application of implant technique in the pterygoid plate area-standard operational practice

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