上颌牙列缺失伴巨大上颌窦颧种植即刻负荷修复治疗1例

doi:10.12337/zgkqzzxzz.2025.06.005

摘要/Abstract

摘要： 本文通过对1例上颌后牙区牙槽骨重度萎缩伴有巨大气化上颌窦,且修复空间不足的患者实施了颧种植并即刻负荷治疗,即拔除上颌余留牙后,佩戴临时义齿,抬高6 mm咬合高度后,行上颌双侧颧种植+倾斜种植手术,术后第3天完成即刻负荷,术后6个月完成最终修复。本病例通过对患者术前临床资料充分剖析,排除了其他几种手术方案的可行性,最终选择双侧颧种植+倾斜种植方案,较好的修复了患者的缺失上颌牙。通过对其病例分析,总结了该类病例诊治的处理原则和注意事项,为临床医生处置此类种植病例提供了诊治经验。

关键词: 口腔种植, 颧种植, 上颌窦气化, 牙槽骨萎缩

Abstract: In this paper, a patient with severe alveolar bone atrophy in the maxillary posterior region, a giant pneumatized maxillary sinus, and insufficient restoration space underwent zygomatic implantation with immediate loading. Following extraction of the remaining maxillary teeth and occlusal space elevation by 6 mm using a temporary denture, bilateral maxillary zygomatic and inclined implants were placed. Immediate loading was completed 3 days after implant placement, and final restoration was achieved after 6 months. Based on a comprehensive analysis of the patient’s preoperative clinical data, the authors eliminated several alternative surgical approaches and ultimately selected the bilateral zygomatic implantation protocol, which successfully restored the patient's maxillary edentulism. By analyzing this case, the authors synthesized treatment principles and clinical experiences for the diagnosis and management of similar cases, providing valuable insights for addressing comparable implant scenarios.

Key words: Dental implant, Zygomatic implant, Maxillary sinus pneumatization, Alveolar bone atrophy

康仕博,马伊娜,郭爱霞,等. 上颌牙列缺失伴巨大上颌窦颧种植即刻负荷修复治疗1例[J]. 中国口腔种植学杂志, 2025, 30(3): 224-233. DOI: 10.12337/zgkqzzxzz.2025.06.005

Kang Shibo, Ma Yina, Guo Aixia, Gao Peng, Ma Weiping, Cheng Xinghan, Yu Qiong, Zhang Dayong. Immediate loading with zygomatic implants for edentulous maxilla with giant maxillary sinus: a case report[J].Chinese Journal of Oral Implantology, 2025, 30(3): 224-233.DOI: 10.12337/zgkqzzxzz.2025.06.005.

参考文献

[1] Nandra A, Dattani S, Aminian A.The biomechanical principles of restoring a dentition with dental implants:a general dental practitioner's perspective[J]. Prim Dent J, 2024, 13(3):73-80. DOI: 10.1177/20501684241280123.
[2] Brånemark PI.Surgery and fixture installation: zygomaticus fixture clinical procedures[M]. Gothenburg, Sweden: Nobel Biocare AB, 1998.
[3] Aparicio C, Ouazzani W, Hatano N.The use of zygomatic implants for prosthetic rehabilitation of the severely resorbed maxilla[J]. Periodontol 2000, 2008, 47:162-171. DOI: 10.1111/j.1600-0757.2008.00259.x.
[4] Costa EF, Penteado MM, Maior BS.Comparative analysis of biomechanical response between zygomatic implant and Facco technique through the three-dimensional finite element method[J]. J Clin Exp Dent, 2023, 15(2):e96-e101. DOI: 10.4317/jced.59885.
[5] Bedrossian E, Sullivan RM, Fortin Y, et al.Fixed-prosthetic implant restoration of the edentulous maxilla: a systematic pretreatment evaluation method[J]. J Oral Maxillofac Surg, 2008, 66(1):112-122. DOI: 10.1016/j.joms.2007.06.687.
[6] Zheng X, Huang L, Huang S, et al.Influence of anatomical factors related to maxillary sinus on outcomes of transcrestal sinus floor elevation[J]. J Dent Sci, 2022, 17(1):438-443. DOI: 10.1016/j.jds.2021.07.023.
[7] Chiapasco M, Zaniboni M.Clinical outcomes of GBR procedures to correct peri-implant dehiscences and fenestrations: a systematic review[J]. Clin Oral Implants Res, 2009, 20(Suppl 4):113-123. DOI: 10.1111/j.1600-0501.2009.01781.x.
[8] 李德华. 引导骨再生理论和技术[J]. 实用口腔医学杂志, 2004,20(4):507-509.DOI:10.3969/j.issn.1001-3733.2004.04.047.
Li DH.Guided bone regeneration theory and technology[J]. J Pract Stomatol, 2004,20(4):507-509. DOI:10.3969/j.issn.1001-3733.2004.04.047.
[9] Wang HL, Boyapati L."PASS" principles for predictable bone regeneration[J]. Implant Dent, 2006, 15(1):8-17. DOI: 10.1097/01.id.0000204762.39826.0f.
[10] Summers RB. A new concept in maxillary implant surgery: the osteotome technique[J]. Compendium, 1994, 15(2):152, 154-156, 158 passim; quiz 162.
[11] Tatum H Jr.Maxillary and sinus implant reconstructions[J]. Dent Clin North Am, 1986, 30(2):207-229.
[12] Chen S, Buser D, Wismeijer D. ITI Treatment Guide.Volume 7[M]. 宿玉成译:口腔种植的牙槽嵴骨增量程序:分阶段方案. 沈阳: 辽宁科学技术出版社, 2016.
Chen S, Buser D, Wismeijer D. ITI Treatment Guide.Volume 7[M]. Su YC,trans: Ridge augmentation procedures in implant patients: a staged approach. Shenyang: Liaoning Science and Technology Publishing House, 2016.
[13] Jang HY, Kim HC, Lee SC, et al.Choice of graft material in relation to maxillary sinus width in internal sinus floor augmentation[J]. J Oral Maxillofac Surg, 2010, 68(8):1859-1868. DOI: 10.1016/j.joms.2009.09.093.
[14] 郑小菲, 莫安春, 朱娟芳,等. 上颌窦解剖因素对经牙槽嵴顶上颌窦底提升术成骨效果的影响[J]. 华西口腔医学杂志, 2020, 38(6):652-656. DOI: 10.7518/hxkq.2020.06.008.
Zheng XF, Mo AC, Zhu JF et al. Effect of anatomical parameters of maxillary sinus on the outcomes of transcrestal sinus lift[J]. West Chin J Stomatol, 2020, 38(6):652-656. DOI: 10.7518/hxkq.2020.06.008.
[15] 朱秋艳, 吴道敏, 鲍济波, 等. 上颌窦宽度与角度对上颌窦底提升术后成骨效果的影响[J]. 国际口腔医学杂志, 2023, 50(2):159-165. DOI: 10.7518/gjkq.2023037.
Zhu QY, Wu DM, Bao JB, et al.Research progress on the influence of bucco-palatal sinus width and angle on sinus augmentation[J]. Int J Stomatol, 2023, 50(2):159-165. DOI: 10.7518/gjkq.2023037.
[16] Oh S, Zelig D, Aalam AA, et al.Case report: utilization of Z-point fixture "trans-nasal" implants[J]. Ann Med Surg (Lond), 2023, 85(5):1959-1965. DOI: 10.1097/MS9.0000000000000520.
[17] Yalçın M, Can S, Akbaş M, et al.Retrospective analysis of zygomatic implants for maxillary prosthetic rehabilitation[J]. Int J Oral Maxillofac Implants, 2020, 35(4):750-756. DOI: 10.11607/jomi.8196.
[18] Menchini-Fabris GB, Toti P, Tommaso G, et al.Immediate full-arch restorations supported by conventional implants plus uni- or bilateral zygomatic implants: a three to five years retrospective radiologic and clinical comparison[J]. Int J Periodontics Restorative Dent, 2025, 0(0):1-29. DOI: 10.11607/prd.7114.
[19] He SM, Yu K, Wang HW, et al.The feasibility of zygomatic implant quad approach in patients with tooth agenesis:a radiographic analysis[J]. Shanghai Kou Qiang Yi Xue, 2021, 30(2):196-200.
[20] Agliardi EL, Panigatti S, Romeo D, et al.Clinical outcomes and biological and mechanical complications of immediate fixed prostheses supported by zygomatic implants:a retrospective analysis from a prospective clinical study with up to 11 years of follow-up[J]. Clin Implant Dent Relat Res, 2021, 23(4):612-624. DOI: 10.1111/cid.13017.
[21] Polido WD, Machado-Fernandez A, Lin WS, et al.Indications for zygomatic implants: a systematic review[J]. Int J Implant Dent, 2023, 9(1):17. DOI: 10.1186/s40729-023-00480-4.
[22] Deng H, Wang J, Liu L, et al. Feasibility and accuracy of a task-autonomous robot for zygomatic implant placement[J]. J Prosthet Dent, 2023:S0022-3913(23)00710-00712 [pii]. DOI: 10.1016/j.prosdent.2023.10.029.
[23] Aparicio C, López-Piriz R, Albrektsson T.ORIS criteria of success for the zygoma-related rehabilitation: the (eRvisited) zygoma success code[J]. Int J Oral Maxillofac Implants, 2020, 35(2):366-378. DOI: 10.11607/jomi.7488.
[24] Shi P, Zhou W, Dong J, et al.Scaffolds of bioactive glass (Bioglass®) combined with recombinant human bone morphogenetic protein -9 (rhBMP-9) for tooth extraction site preservation[J]. Heliyon, 2022, 8(1):e08796. DOI: 10.1016/j.heliyon.2022.e08796.
[25] Luong DC, Lanh LD, Thuy VL, et al.Optimizing pterygoid implant placement without sinus intrusion in edentulous vietnamese patients: a comprehensive tomographic analysis and cross-sectional study[J]. J Clin Exp Dent, 2024, 16(11):e1371-e1378. DOI: 10.4317/jced.61787.
[26] Grün P, Bandura P, Schneider B, et al.Radiographic feature changes in an antral pseudocyst that existed prior to sinus floor augmentation and dental implant placement, 15 years after initial detection - a case report[J]. Int J Surg Case Rep, 2023, 110:108653. DOI: 10.1016/j.ijscr.2023.108653.
[27] Carelli S, Passaretti A, Petroni G, et al.Five years follow-up of short implants placed in atrophic maxilla with simultaneous sinus floor transcrestal elevation[J]. Acta Stomatol Croat, 2021, 55(2):177-185. DOI: 10.15644/asc55/2/7.
[28] Zhang J, Hou H, Chen P, et al.Mechanical and modal analysis of different implant strategies for loss of three teeth with bone atrophy in the maxillary posterior region[J]. Comput Methods Biomech Biomed Engin, 2024:1-10. DOI: 10.1080/10255842.2024.2358363.
[29] Acar G, Ari I, Tosun E.Biomechanical evaluation of implant options for unilateral maxillary defects: a finite element analysis[J]. BMC Oral Health, 2024, 24(1):1338. DOI: 10.1186/s12903-024-05100-0.
[30] 张志勇, 吴轶群. 颧种植体在口腔功能重建中的应用-10年回顾[J]. 中国口腔种植学杂志, 2013, 18(2):64. DOI: 10.3969/j.issn.1007-3957.2013.02.021.
Zhang ZY, Wu YQ.Application of zygomatic implants in oral functional reconstruction - a 10-year review[J]. Chin J Oral Implantol, 2013, 18(2):64. DOI: 10.3969/j.issn.1007-3957.2013.02.021.
[31] Maló P, de Araújo Nobre M, Lopes A, et al. Extramaxillary surgical technique: clinical outcome of 352 patients rehabilitated with 747 zygomatic implants with a follow-up between 6 months and 7 years[J]. Clin Implant Dent Relat Res, 2015, 17(Suppl 1):e153-e162. DOI: 10.1111/cid.12147.
[32] Davó R, Pons O.Prostheses supported by four immediately loaded zygomatic implants: a 3-year prospective study[J]. Eur J Oral Implantol, 2013, 6(3):263-269.
[33] Ferrigno N, Laureti M, Alrmali A, et al.Comparative clinical outcomes of two different zygomatic implant protocols for the rehabilitation of severely atrophic maxillae: a retrospective analysis[J]. Int J Periodontics Restorative Dent, 2025, 0(0):1-23. DOI: 10.11607/prd.7493.
[34] Morris GA, Steinberg MJ, Drago C.Full arch immediate occlusal loading using site specific implants: a clinical series of 10 patients (13 arches)[J]. J Prosthodont, 2023, 32(3):204-213. DOI: 10.1111/jopr.13620.
[35] Peñarrocha M, García B, Martí E, et al.Rehabilitation of severely atrophic maxillae with fixed implant-supported prostheses using zygomatic implants placed using the sinus slot technique: clinical report on a series of 21 patients[J]. Int J Oral Maxillofac Implants, 2007, 22(4):645-650.
[36] de Moraes EJ. The buccal fat pad flap: an option to prevent and treat complications regarding complex zygomatic implant surgery. Preliminary report[J]. Int J Oral Maxillofac Implants, 2012, 27(4):905-910.
[37] Muñoz R, Gajos G, Bladimir J, et al.Protocol for mandibular reconstruction with zygomatic implants (zygomatic mandibular implant)[J]. Oral Maxillofac Surg, 2018, 22(1):39-44. DOI: 10.1007/s10006-017-0664-8.
[38] Migliorança RM, Coppedê A, Dias Rezende RC, et al.Restoration of the edentulous maxilla using extrasinus zygomatic implants combined with anterior conventional implants: a retrospective study[J]. Int J Oral Maxillofac Implants, 2011, 26(3):665-672.