胶原蛋白海绵在穿牙槽嵴上颌窦底提升中应用效果的研究

doi:10.12337/zgkqzzxzz.2022.06.004

摘要/Abstract

摘要： 目的验证胶原蛋白海绵在穿牙槽嵴上颌窦底提升中应用的临床效果,通过CBCT及Mimics软件测量分析术后短期内成骨效果,并分析上颌窦内成骨的影响因素。方法选择自2019年12月至2021年12月于大连医科大学附属第一医院口腔科就诊均采用磨除法进行穿牙槽嵴上颌窦底提升的14例患者（24个种植位点）,由胶原蛋白海绵和种植体共同维持上颌窦底提升空间,记录术中上颌窦底黏骨膜穿孔情况。术后即刻及术后6个月拍摄CBCT并测量上颌窦底提升高度（lifting length,LH）、种植体突入上颌窦腔内的长度（protruded length,PL）,术后6个月测量上颌窦内新增骨高度（new bone height,NBH)。将CBCT数据导入Mimics软件,建模配准计算出上颌窦内新增骨体积及高度,对成骨影响因素进行单因素方差分析和逐步多元线性回归分析。结果植入的24颗种植体短期留存率为100%,3个种植位点在预备种植窝洞时出现了上颌窦底黏骨膜穿孔,穿孔率为12.5%,但在填塞胶原蛋白海绵和植入种植体的过程中无穿孔,所有种植体在术后6个月的放射线检查中均取得良好的骨结合并成功负荷;术后6个月上颌窦腔内平均新增骨高度为（3.09±0.99）mm,上颌窦内新生骨体积平均为（320.24±85.79）mm³;经Pearson相关性分析,LH、PL及NBH与新生骨体积存在线性相关关系（P<0.05）,单因素方差分析上颌窦底形态组间比较,差异具有统计学意义（P<0.01）,新生骨体积圆形组高于卵圆形组和尖圆形组（P<0.05）。上颌窦底形态、性别及PL纳入多元线性回归模型,决定系数为0.753。结论胶原蛋白海绵作为穿牙槽嵴上颌窦底提升不植骨技术的术中充填材料,术中操控性较好,同时可以与种植体共同维持上颌窦腔内成骨空间,形成一定体积的新生骨。此外,LH、性别、PL及上颌窦底形态可能是上颌窦腔内新生骨形成的影响因素。

关键词: 穿牙槽嵴上颌窦底提升, 胶原蛋白海绵, 骨增量, 骨体积

Abstract: Objective To measure the changes in bone height and bone volume in the transcrestal sinus floor elevation using absorbable collagen sponge by cone beam computed tomography (CBCT) and three-dimensional measurement by mimics, and to analyze the factors affecting bone formation in the sinus. Methods A total of 14 patients (24 implant sites) were selected from December 2019 to December 2021 in the Department of Stomatology, The First Affiliated Hospital of Dalian Medical University. All patients underwent transcrestal sinus floor elevation using only the absorbable collagen sponge by grinding method, and the lifting space of the sinus floor was maintained by collagen sponge and implant. The perforation of the sinus floor mucosa was recorded during the operation. The height of new bone was measured by CBCT before and 6 months after the operation. Immediately and 6 months after surgery, the protruding length (PL) and lifting length (LH) of the maxillary sinus floor were examined by CBCT. New bone height (NBH) was measured 6 months after the operation. The CBCT image data were imported into Mimics Research software. Mimics software was used for modeling and registration, and Boolean arithmetic was used to calculate the new bone volume in the maxillary sinus. The factors affecting osteogenesis were analyzed by one-way ANOVA and stepwise multiple linear regression, and the regression simulation prediction equation was established. Results A total of 24 implants were implanted and the short-term retention rate was 100%. The mucoperiosteum of the maxillary sinus floor was perforated at three sites during the preparation of the implant socket, and the perforation rate was 12.5%. There was no perforation in the process of collagen sponge filling and implant implantation. And all implants achieved good osseointegration on imaging 6 months after surgery and successfully loaded. The average new bone height in the sinus was（3.09±0.99）mm and the volume of new bone in the sinus is （320.24±85.79）mm³ 6 months after the operation. According to Pearson correlation analysis, there was a linear correlation between LH, PL, and NBH and new bone volume (P<0.05), one-way ANOVA showed statistically significant difference between sinus floor morphology groups (P<0.01), and new bone volume in the round group was higher than that in the oval and pointy round groups (P<0.05). Sinus floor morphology, gender, and PL were included in the multiple linear regression model, with a determination coefficient of 0.753. Conclusion Collagen Sponge, as the filling material for transcrestal sinus floor elevation without grafting technique, has good operation performance and can maintain the osteogenic space in the sinus cavity together with the implant to form new bone of a certain volume. In addition, the new bone formation may be related to LH, gender, PL, and sinus floor morphology.

Key words: Transcrestal sinus floor elevation, Collagen sponge, Bone increment, Bone volume

邓磊,程熠,赵楠,等. 胶原蛋白海绵在穿牙槽嵴上颌窦底提升中应用效果的研究[J]. 中国口腔种植学杂志, 2022, 27(3): 147-155. DOI: 10.12337/zgkqzzxzz.2022.06.004

Deng Lei, Cheng Yi, Zhao Nan, Chen Gang, Huang Haitao. Implant placement with transcrestal sinus floor elevation using absorbable collagen sponge: an analysis of 6-month images using CBCT and mimics software[J].Chinese Journal of Oral Implantology, 2022, 27(3): 147-155.DOI: 10.12337/zgkqzzxzz.2022.06.004.

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