GBR结合穿牙槽嵴上颌窦底提升垂直骨增量1例

doi:10.12337/zgkqzzxzz.2025.10.010

摘要/Abstract

摘要： 当上颌后牙区牙槽嵴重度吸收伴骨凹陷时,临床上需进行复杂骨增量后延期种植。本文报告1例引导骨再生（GBR）结合穿牙槽嵴上颌窦底提升（TSFE）增加垂直向骨增量的病例,应用三维数字化拟合患者术前及术后6个月影像资料,结果显示骨高度从术前不足1.00 mm增加了9.67 mm（其中窦内提升高度为4.41 mm,牙槽嵴顶骨高度增加了5.26 mm,体积增加了934.22 mm³为术前体积的3.4倍）。这一治疗结果表明,GBR结合TSFE可获得理想的垂直骨增量效果,缩短患者就诊周期。

关键词: 引导骨再生, 穿牙槽嵴上颌窦底提升, 垂直骨增量

Abstract: In cases of severe alveolar ridge resorption with concavity in the posterior maxilla, complex bone augmentation followed by delayed implant placement is often required. This article reports a case of vertical bone augmentation using guided bone regeneration (GBR) combined with transalveolar sinus floor elevation (TSFE). Three-dimensional digital analysis was performed to evaluate preoperative and 6-month postoperative imaging data. The results showed that the bone height increased from less than 1 mm preoperatively to 9.67 mm postoperatively, including a 4.41 mm increase in sinus height and a 5.26 mm increase at the alveolar crest. The grafted bone volume reached 934.22 mm³, approximately 3.4 times the original volume. This suggests that GBR combined with TSFE can achieve ideal vertical bone augmentation results and reduce treatment duration. This paper aims to provide clinical insight into bone augmentation strategies for complex posterior maxillary defects.

Key words: Guided bone regeneration (GBR), Transalveolar sinus floor elevation (TSFE), Vertical bone augmentation

于飞,魏士博,张旭,等. GBR结合穿牙槽嵴上颌窦底提升垂直骨增量1例[J]. 中国口腔种植学杂志, 2025, 30(5): 495-501. DOI: 10.12337/zgkqzzxzz.2025.10.010

Yu Fei, Wei Shibo, Zhang Xu, Guo Shuigen, Wei Hongwu, Huang Jiangqin. Vertical bone augmentation using GBR combined with transalveolar sinus floor elevation: a case report[J].Chinese Journal of Oral Implantology, 2025, 30(5): 495-501.DOI: 10.12337/zgkqzzxzz.2025.10.010.

参考文献

[1] 程浩德. 经牙槽嵴上颌窦底提升术窦底黏膜提升高度及成骨效果评价[J]. 实用口腔医学杂志, 2018, 34(1):121-124. DOI: 10.3969/j.issn.1001-3733.2018.01.027.
Cheng HD.Evaluation of sinus membrane elevation height and osteogenesis after transalveolar sinus floor elevation[J]. J Pract Stomatol, 2018, 34(1): 121-124. DOI: 10.3969/j.issn.1001-3733.2018.01.027.
[2] 张富贵,宿玉成,邱立新,等.牙槽骨缺损骨增量手术方案的专家共识[J].口腔疾病防治,2022,30(4):229-236.DOI: 10.12016/j.issn.2096-1456.2022.04.001.
Zhang FG,Su YC,Qiu LX,et al.Expert consensus on the bone augmentation surgery for alveolar bone defects[J]. J Prev Treat Stomatol Dis,2022,30(4):229-236.DOI: 10.12016/j.issn.2096-1456. 2022.04.001.
[3] Milinkovic I, Cordaro L.Are there specific indications for the different alveolar bone augmentation procedures for implant placement? A systematic review[J]. Int J Oral Maxillofac Surg, 2014, 43(5):606-625. DOI: 10.1016/j.ijom.2013.12.004.
[4] 夏海斌,徐珺怡.上颌窦底内提升同期植入种植体的研究现状[J].中国口腔种植学杂志,2024,29(2):109-117.DOI: 10.12337/zgkqzzxzz.2024.04.004.
Xia HB.Xu JY.Current research status of transalveolar technique for sinus floor elevation with simultaneous placement of dental implants[J]. Chin J Oral Implantol, 2024,29(2):109-117.DOI: 10.12337/ zgkqzzxzz. 2024.04.004.
[5] Ma F, Lin Y, Sun F, et al.The impact of autologous concentrated growth factors on the alveolar ridge preservation after posterior tooth extraction: a prospective, randomized controlled clinical trial[J]. Clin Implant Dent Relat Res, 2021, 23(4):579-592. DOI: 10.1111/cid.13026.
[6] Chrcanovic BR, Albrektsson T, Wennerberg A.Bone quality and quantity and dental implant failure: a systematic review and meta-analysis[J]. Int J Prosthodont, 2017, 30(3):219-237. DOI: 10.11607/ijp.5142.
[7] Elnayef B, Monje A, Gargallo-Albiol J, et al.Vertical ridge augmentation in the atrophic mandible: a systematic review and meta-analysis[J]. Int J Oral Maxillofac Implants, 2017, 32(2):291-312. DOI: 10.11607/jomi.4861.
[8] 刘毅, 李德华. 钛网围栏技术行牙槽嵴水平骨增量的临床研究[J]. 实用口腔医学杂志, 2022, 38(6): 763-767. DOI:10.3969/j.issn.1001-3733.2022.06.014.
Liu Y, Li DH.Clinical study of horizontal bone augmentation of the alveolar ridge using titanium mesh fence technique[J]. J Pract Stomatol , 2022, 38(6): 763-767. DOI: 10.3969/j.issn.1001-3733.2022.06.014.
[9] 于德栋, 张佳园, 吴轶群. 影响3D打印个性化钛网骨增量效果的原因与对策[J]. 口腔疾病防治, 2025, 33(2):89-99. DOI: 10.12016/j.issn.2096-1456.202440359.
Yu DD,Zhang JY,Wu YQ.Factors affecting the bone augmentation outcome of 3D-printed individualized titanium mesh and countermeasures[J]. J Prev Treat Stomatol Dis,2025,33(2):89-99. DOI: 10.12016/j.issn. 2096-1456.202440359.
[10] 谢雨,蔡潇潇.钛网在口腔种植骨增量中的应用研究进展[J].中华口腔医学杂志,2021,56( 4) : 390-395.DOI:10.3760/cma.j.cn112144-20200802-00445.
Xie Y, Cai XX.Research progress on the application of titanium mesh in bone augmentation for dental implantation[J]. Chin J Stomatol, 2021, 56(4): 390-395. DOI:10.3760/cma.j.cn112144- 20200802-00445.
[11] Xie Y, Li S, Zhang T, et al.Titanium mesh for bone augmentation in oral implantology: current application and progress[J]. Int J Oral Sci, 2020, 12(1):37. DOI: 10.1038/s41368-020-00107-z.
[12] 宿玉成, 刘倩, 任斌. 钛网支撑的引导骨再生的专家共识[J]. 中国口腔种植学杂志, 2024, 29(2):95-100. DOI: 10.12337/zgkqzzxzz.2024.04.001.
Su YC,Liu Q,Ren B.Expert consensus on titanium mesh supported guided bone regeneration[J]. Chin J Oral Implantol, 2024, 29(2):95-100.DOI: 10.12337/zgkqzzxzz.2024.04.001.
[13] Buser D, Urban I, Monje A, et al.Guided bone regeneration in implant dentistry: Basic principle, progress over 35 years, and recent research activities[J]. Periodontol 2000, 2023, 93(1):9-25. DOI: 10.1111/prd.12539.
[14] 张玉峰, 王宇蓝. 血浆基质在口腔种植垂直骨增量中的应用[J]. 口腔疾病防治, 2022, 30(12):837-843. DOI:10.12016/j.issn. 2096-1456.2022.12.001.
Zhang YF, Wang YL.Application of plasma matrix in vertical bone augmentation for dental implantation[J]. J Prev Treat Stomatol Dis, 2022, 30(12): 837-843. DOI:10.12016/j.issn. 2096-1456.2022.12.001.
[15] Cortese A, Pantaleo G, Amato M, et al.Platelet-rich fibrin (PRF) in implants dentistry in combination with new bone regenerative flapless technique: evolution of the technique and final results[J]. Open Med (Wars), 2017, 12:24-32. DOI: 10.1515/med-2017-0005.
[16] 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.
[17] 赖红昌,史俊宇.上颌窦提升术[J].口腔疾病防治, 2017,25(1):8-12. DOI:10.12016/j.issn.2096-1456. 2017.01.002.
Lai HC, Shi JY.Sinus floor elevation[J]. J Prev Treat Stomatol Dis, 2017, 25(1): 8-12. DOI:10.12016/j.issn. 2096-1456.2017.01.002.
[18] 张志勇, 宿玉成. 国际口腔种植学会(ITI)第四届共识研讨会共识性论述, 2008[J]. 口腔颌面外科杂志, 2009, 19(1): 49-52.
Zhang ZY, Su YC.Consensus statements of the 4th consensus conference of the International Team for Implantology (ITI), 2008[J]. J Oral Maxillofac Surg, 2009, 19(1): 49-52.
[19] 许舒宇,范震,王佐林.上颌窦底提升术成骨机制与临床术式选择[J].口腔颌面外科杂志,2023,33(2):63-70. DOI:10.3969/j.issn.1005-4979.2023.02.001.
Xu SY, Fan Z, Wang ZL.Osteogenic mechanisms and clinical protocol selection of sinus floor elevation[J]. J Oral Maxillofac Surg , 2023, 33(2): 63-70. DOI:10.3969/j.issn.1005-4979.2023.02. 001.
[20] 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. DOI: 10.3969/j.issn. 1005-4979.2018.01.001.
Fan Z, Wang F, Wang ZL.Transcrestal sinus floor elevation: 5th Academic Consensus of the CSA specialty committee on oral implantology[J]. J Oral Maxillofac Surg , 2018, 28(1): 1-9. DOI:10.3969/j.issn.1005-4979.2018.01.001.
[21] 满毅. 经牙槽嵴顶上颌窦底提升术的应用研究进展[J].口腔疾病防治, 2018, 26(8):477-483. DOI:10.12016/j.issn. 2096-1456.2018.08.001.
Man Y.Research progress on the application of transcrestal sinus floor elevation[J]. J Prev Treat Stomatol Dis, 2018, 26(8): 477-483. DOI:10.12016/j.issn.2096-1456.2018.08.001.
[22] 管翔宇,高益鸣.上颌窦底提升术成骨机制研究进展[J].中国口腔颌面外科杂志,2024,22(2):198-201.DOI:10.19438/j.cjoms.2024.02.015.
Guan XY, Gao YM.Research progress on osteogenic mechanisms of sinus floor elevation[J]. Chin J Oral Maxillofac Surg , 2024, 22(2): 198-201. DOI:10.19438/j.cjoms.2024.02.015.
[23] 徐淑兰,郭泽鸿,宁颖圆,等.种植义齿冠根比与临床并发症[J].口腔疾病防治,2020,28(9):545-550.DOI:10.12016/j.issn.2096-1456.2020.09.001.
Xu SL, Guo ZH, Ning YY, et al.Crown-to-root ratio and clinical complications of implant-supported dentures[J]. J Prev Treat Stomatol Dis, 2020, 28(9): 545-550. DOI:10.12016/j.issn.2096-1456.2020.09.001.
[24] Ueno D, Kurokawa T, Maruo K, et al.Palatal window osteotomy technique improves maxillary sinus augmentation in previously insufficient augmentation case[J]. Int J Implant Dent, 2015, 1(1):19. DOI: 10.1186/s40729-015-0018-y.
[25] Stübinger S, Saldamli B, Seitz O, et al.Palatal versus vestibular piezoelectric window osteotomy for maxillary sinus elevation: a comparative clinical study of two surgical techniques[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2009, 107(5):648-655. DOI: 10.1016/j.tripleo.2008.12.016.
[26] Adawi H, Hengjeerajaras P, Froum SJ, et al.A less-invasive window design for lateral wall maxillary sinus augmentations[J]. Int J Periodont Restorat Dent, 2019, 39(6):855-861. DOI: 10.11607/prd.4206.
[27] Zhen F, Fang W, Jing S, et al.The use of a piezoelectric ultrasonic osteotome for internal sinus elevation: a retrospective analysis of clinical results[J]. Int J Oral Maxillofac Implants, 2012, 27(4):920-926.
[28] 周延民, 秦秋月. 上颌窦三维成骨模式促进上颌窦内成骨的临床意义[J]. 中国口腔种植学杂志, 2023, 28(2):69-76. DOI: 10.12337/zgkqzzxzz.2023.04.001.
Zhou YM,Qin QY.Clinical implications of 3-dimensional osteogenesis model for maxillary sinus to promote osteogenesis in maxillary sinus[J]. Chin J Oral Implantol, 2023, 28(2):69-76. DOI: 10.12337/zgkqzzxzz.2023.04.001.
[29] Johansson LA, Isaksson S, Lindh C, et al.Maxillary sinus floor augmentation and simultaneous implant placement using locally harvested autogenous bone chips and bone debris: a prospective clinical study[J]. J Oral Maxillofac Surg, 2010, 68(4):837-844. DOI: 10.1016/j.joms.2009.07.093.
[30] De Santis E, Lang NP, Ferreira S, et al.Healing at implants installed concurrently to maxillary sinus floor elevation with Bio-Oss(®) or autologous bone grafts. A histo-morphometric study in rabbits[J]. Clin Oral Implants Res, 2017, 28(5):503-511. DOI: 10.1111/clr.12825.