上颌窦解剖因素对穿牙槽嵴上颌窦底提升骨增量材料改建影响的研究

doi:10.12337/zgkqzzxzz.2023.04.003

摘要/Abstract

摘要： 目的评估上颌窦解剖因素（窦腔宽度、窦腔角度和窦底形态）对穿牙槽嵴上颌窦底提升骨增量材料改建的影响。方法纳入23名患者共36个种植位点,分析术后6个月和术后即刻种植体根端骨高度和种植体周围骨密度变化,评估上颌窦解剖因素对上颌窦内骨增量材料改建的影响。结果窦腔宽度、窦腔角度和窦底形态（突入角度）与种植体根端骨高度变化存在正相关,P<0.01。窦底形态（突入角度）与种植体周围骨密度变化存在负相关,P<0.05。剩余垂直骨高度（residual bone height,RBH）与骨增量材料改建不具有统计学显著性,不同颊腭侧骨壁接触数对骨增量材料改建的影响不具有统计学显著性。结论上颌窦解剖因素与上颌窦内骨增量材料改建存在相关性,术前应仔细评估上颌窦的解剖形态。

关键词: 穿牙槽嵴上颌窦底提升, 上颌窦解剖结构, 骨改建

Abstract: Objective To evaluate the effects of anatomical factors (sinus cavity width, sinus cavity angle, and sinus floor morphology) on the reconstruction of bone graft materials for transalveolar technique for sinus floor elevation. Methods A total of 36 implant sites in 23 patients were included to analyze the changes in bone height and bone density at 6 months and immediately after surgery, and to evaluate the effect of anatomical factors of maxillary sinus on bone graft material modification in the maxillary sinus. Results The sinus cavity width, sinus cavity angle, and sinus floor morphology (intruding angle) were significantly positively correlated with bone height changes, P<0.01. Sinus floor morphology (intruding angle) was negatively correlated with changes in bone density around the implant, P<0.05. There was no significant correlation between RBH and bone graft material reconstruction, and different contact numbers of the bone walls had no significant effect on bone graft material reconstruction. Conclusion There was a correlation between the anatomical factors of the maxillary sinus and the reconstruction of bone graft materials in the maxillary sinus, and the anatomical morphology of the maxillary sinus should be carefully evaluated before surgery.

Key words: Transalveolar technique for sinus floor elevation, Anatomy of the maxillary sinus, Bone remodeling

余正荣,郭水根,杨晶晶,等. 上颌窦解剖因素对穿牙槽嵴上颌窦底提升骨增量材料改建影响的研究[J]. 中国口腔种植学杂志, 2023, 28(2): 82-89. DOI: 10.12337/zgkqzzxzz.2023.04.003

Yu Zhengrong, Guo Shuigen, Yang Jingjing, Mao Weihua, Wei Hongwu. Influence of anatomical factors of maxillary sinus on the remodeling of bone graft materials for maxillary sinus floor lift[J].Chinese Journal of Oral Implantology, 2023, 28(2): 82-89.DOI: 10.12337/zgkqzzxzz.2023.04.003.

参考文献

[1] Pjetursson BE, Lang NP.Sinus floor elevation utilizing the transalveolar approach[J]. Periodontol 2000, 2014,66(1):59-71. DOI: 10.1111/prd.12043.
[2] Boyne PJ, James RA.Grafting of the maxillary sinus floor with autogenous marrow and bone[J]. J Oral Surg, 1980,38(8):613-616.
[3] Tatum H Jr.Maxillary and sinus implant reconstructions[J]. Dent Clin North Am, 1986,30(2):207-229.
[4] Summers RB. A new concept in maxillary implant surgery: the osteotome technique[J]. Compendium, 1994,15(2):152, 154-156, 158 passim; quiz 162.
[5] Summers RB. The osteotome technique: Part 3--less invasive methods of elevating the sinus floor[J]. Compendium, 1994,15(6):698, 700, 702-704 passim; quiz 710.
[6] Chan HL, Wang HL.Sinus pathology and anatomy in relation to complications in lateral window sinus augmentation[J]. Implant Dent, 2011,20(6):406-412. DOI: 10.1097/ID.0b013e3182341f79.
[7] Stacchi C, Lombardi T, Ottonelli R, et al.New bone formation after transcrestal sinus floor elevation was influenced by sinus cavity dimensions: a prospective histologic and histomorphometric study[J]. Clin Oral Implants Res, 2018,29(5):465-479. DOI: 10.1111/clr.13144.
[8] 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.
[9] 王倩, 李丹, 唐志辉. 上颌窦底内提升术同期种植窦内成骨的临床效果[J].北京大学学报(医学版),2019, 51(5):925-930. DOI: 10.19723/j.issn.1671-167X.2019.05.022.
[10] Avila G, Wang HL, Galindo-Moreno P, et al.The influence of the bucco-palatal distance on sinus augmentation outcomes[J]. J Periodontol, 2010,81(7):1041-1050. DOI: 10.1902/jop.2010.090686.
[11] 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.
[12] Chen HH, Lin YC, Lee SY, et al.Influence of sinus floor configuration on grafted bone remodeling after osteotome sinus floor elevation[J]. J Periodontol, 2017,88(1):10-16. DOI: 10.1902/jop.2016.160337.
[13] 杨大维, 肖静宜, 张鹏, 等. 植骨和种植体突入长度对经牙槽嵴上颌窦底提升骨改建影响的回顾性研究[J].华西口腔医学杂志,2021,39(5):570-575. DOI: 10.7518/hxkq.2021.05.012.
[14] Kim SM, Park JW, Suh JY, et al.Bone-added osteotome technique versus lateral approach for sinus floor elevation: a comparative radiographic study[J]. Implant Dent, 2011,20(6):465-470. DOI: 10.1097/ID.0b013e31823545b2.
[15] Nishida T, Takenouchi Y, Mori K, et al.Remodeling of autogenous bone grafts after osteotome sinus floor elevation assessed by limited cone beam computed tomography[J]. Int J Dent, 2013,2013:931708. DOI: 10.1155/2013/931708.
[16] Kim YK, Kim SG, Kim BS, et al.Resorption of bone graft after maxillary sinus grafting and simultaneous implant placement[J]. J Korean Assoc Oral Maxillofac Surg, 2014,40(3):117-122. DOI: 10.5125/jkaoms.2014.40.3.117.
[17] Hatano N, Shimizu Y, Ooya K.A clinical long-term radiographic evaluation of graft height changes after maxillary sinus floor augmentation with a 2:1 autogenous bone/xenograft mixture and simultaneous placement of dental implants[J]. Clin Oral Implants Res, 2004,15(3):339-345. DOI: 10.1111/j.1600-0501.2004.00996.x.
[18] Schultze-Mosgau S, Keweloh M, Wiltfang J, et al.Histomorphometric and densitometric changes in bone volume and structure after avascular bone grafting in the extremely atrophic maxilla[J]. Br J Oral Maxillofac Surg, 2001,39(6):439-447. DOI: 10.1054/bjom.2001.0617.
[19] Todisco M, Trisi P.Bone mineral density and bone histomorphometry are statistically related[J]. Int J Oral Maxillofac Implants, 2005,20(6):898-904.
[20] Soardi CM, Zaffe D, Motroni A, et al.Quantitative comparison of cone beam computed tomography and microradiography in the evaluation of bone density after maxillary sinus augmentation: a preliminary study[J]. Clin Implant Dent Relat Res, 2014,16(4):557-564. DOI: 10.1111/cid.12016.
[21] Zheng X, Teng M, Zhou F, et al.Influence of maxillary sinus width on transcrestal sinus augmentation outcomes: radiographic evaluation based on cone beam CT[J]. Clin Implant Dent Relat Res, 2016,18(2):292-300. DOI: 10.1111/cid.12298.
[22] Stacchi C, Lombardi T, Ottonelli R, et al.New bone formation after transcrestal sinus floor elevation was influenced by sinus cavity dimensions: a prospective histologic and histomorphometric study[J]. Clin Oral Implants Res, 2018,29(5):465-479. DOI: 10.1111/clr.13144.
[23] Cheng X, Hu X, Wan S, et al.Influence of lateral-mdial sinus width on no-grafting inlay osteotome sinus augmentation outcomes[J]. J Oral Maxillofac Surg, 2017,75(8):1644-1655. DOI: 10.1016/j.joms.2017.03.010.
[24] Soardi CM, Spinato S, Zaffe D, et al.Atrophic maxillary floor augmentation by mineralized human bone allograft in sinuses of different size: an histologic and histomorphometric analysis[J]. Clin Oral Implants Res, 2011,22(5):560-566. DOI: 10.1111/j.1600-0501.2010.02034.x.
[25] Velloso GR, Vidigal GM Jr, de Freitas MM, et al. Tridimensional analysis of maxillary sinus anatomy related to sinus lift procedure[J]. Implant Dent, 2006,15(2):192-196. DOI: 10.1097/01.id.0000223233.29454.77.
[26] Cho SC, Wallace SS, Froum SJ, et al.Influence of anatomy on Schneiderian membrane perforations during sinus elevation surgery: three-dimensional analysis[J]. Pract Proced Aesthet Dent, 2001,13(2):160-163.
[27] Niu L, Wang J, Yu H, et al.New classification of maxillary sinus contours and its relation to sinus floor elevation surgery[J]. Clin Implant Dent Relat Res, 2018,20(4):493-500. DOI: 10.1111/cid.12606.
[28] French D, Nadji N, Liu SX, et al.Trifactorial classification system for osteotome sinus floor elevation based on an observational retrospective analysis of 926 implants followed up to 10 years[J]. Quintessence Int, 2015,46(6):523-530. DOI: 10.3290/j.qi.a33935.
[29] 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.
[30] Lundgren S, Andersson S, Gualini F, et al.Bone reformation with sinus membrane elevation: a new surgical technique for maxillary sinus floor augmentation[J]. Clin Implant Dent Relat Res, 2004,6(3):165-173.
[31] Rosano G, Taschieri S, Gaudy JF, et al.Maxillary sinus vascular anatomy and its relation to sinus lift surgery[J]. Clin Oral Implants Res, 2011,22(7):711-715. DOI: 10.1111/j.1600-0501.2010.02045.x.
[32] Rosano G, Taschieri S, Gaudy JF, et al.Maxillary sinus vascularization: a cadaveric study[J]. J Craniofac Surg, 2009,20(3):940-943. DOI: 10.1097/SCS.0b013e3181a2d77f.
[33] Jensen OT, Shulman LB, Block MS, et al. Report of the sinus consensus conference of1996[J]. Int J Oral Maxillofac Implants, 1998,13 Suppl:11-45.
[34] Fan T, Li Y, Deng WW, et al.Short implants (5 to 8 mm) versus longer implants (>8 mm) with sinus lifting in atrophic posterior maxilla: a meta-analysis of RCTs[J]. Clin Implant Dent Relat Res, 2017,19(1):207-215. DOI: 10.1111/cid.12432.
[35] Marković A, Mišić T, Calvo-Guirado JL, et al.Two-center prospective, randomized, clinical, and radiographic study comparing osteotome sinus floor elevation with or without bone graft and simultaneous implant placement[J]. Clin Implant Dent Relat Res, 2016,18(5):873-882. DOI: 10.1111/cid.12373.
[36] Rasmusson L, Meredith N, Sennerby L.Measurements of stability changes of titanium implants with exposed threads subjected to barrier membrane induced bone augmentation. An experimental study in the rabbit tibia[J]. Clinical oral implants research, 1997, 8(4): 316-322.DOI:10.1034/j.1600-0501.1997.080410.x
[37] Si MS, Zhuang LF, Gu YX, et al.Osteotome sinus floor elevation with or without grafting: a 3-year randomized controlled clinical trial[J]. J Clin Periodontol, 2013,40(4):396-403. DOI: 10.1111/jcpe.12066.
[38] Yang J, Xia T, Fang J, et al.Radiological changes associated with new bone formation following osteotome sinus floor elevation (OSFE): a retrospective study of 40 patients with 18-month follow-up[J]. Med Sci Monit, 2018,24:4641-4648. DOI: 10.12659/MSM.910739.
[39] 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.