侧壁开窗上颌窦底提升愈合早期种植的可行性分析：一项前瞻性临床对照研究

doi:10.12337/zgkqzzxzz.2024.12.010

摘要/Abstract

摘要： 目的通过评价侧壁开窗上颌窦底提升（lateral window technique for sinus floor elevation）愈合早期的成骨效果和种植体留存率,探索侧壁开窗上颌窦底提升愈合早期种植的可行性。方法招募上颌后牙缺失、牙槽骨严重萎缩（剩余骨高度≤4 mm）需行侧壁开窗上颌窦底提升和延期种植的患者,采用无机去蛋白牛骨矿物质（deproteinized bovine bone mineral,DBBM）骨粉作为骨增量材料。将患者按愈合时间分为4~5个月组、6~7个月组、8~9个月组和10个月及以上组,二期种植时于种植位点获取骨组织样本。主要评价指标为骨组织样本的新生骨比例（VB%）,次要评价指标为种植体1年留存率。结果 2017年9月至2020年12月期间,共纳入146例行侧壁开窗上颌窦底提升、延期种植的患者（160侧上颌窦）,植入275颗种植体,获得完整骨样本95例。2例患者的3颗种植体（均为4~5个月组）发生早期失败,种植体总体留存率为98.91%（272/275）,其中4~5个月组种植体留存率为95.31%（61/64）,低于其他组种植体留存率（100.00%）,但差异无统计学意义（P=0.18）。组织学结果显示：随着愈合时间的延长,新骨生成率缓慢增加,10个月及以上组较4~5个月组差异存在统计学意义（P=0.02）,但剩余DBBM材料及非矿化组织百分比随愈合时间增长变化无统计差异（P=0.23,P=0.81）。结论随着愈合时间的延长,新生骨比例缓慢增加。术后4~9个月新骨形成无明显差异,直至10个月后才较4~5个月组增长具有统计学意义。这表明,侧壁开窗上颌窦底提升后4~9个月拟种植位点具有相似的骨质条件,而4个月植入可大幅缩短治疗周期。

关键词: 侧壁开窗上颌窦底提升, 愈合早期, 成骨效果, 种植体留存

Abstract: Objective To explore the feasibility of implant placement during the early healing phase following the lateral window technique for sinus floor elevation (LSFE) by evaluating the osteogenesis effects and implant survival rates. Methods Patients with posterior maxillary edentulism and severe alveolar bone atrophy (VBH≤4 mm) requiring LSFE and delayed implant placement were recruited. LSFE was performed using deproteinized bovine bone mineral (DBBM) as the sole graft material. Patients were divided into four groups based on healing duration: 4~5 months, 6~7 months, 8~9 months, and ≥10 months. Bone biopsies were obtained from implant sites during the second-stage surgery. The primary outcome was the percentage of vital bone (VB%) in bone biopsies, and the secondary outcome was the 1-year implant survival rate. Results From September 2017 to December 2020, 146 patients (160 maxillary sinuses) underwent LSFE and delayed implantation, with 275 implants placed. Ninety-five complete bone biopsies were obtained. Three implants failed in two patients (all in the 4~5 months group), resulting in a cumulative implant survival rate of 98.91% (272/275). The implant survival rate in the 4~5 months group was 95.31% (61/64), which was lower than that of other groups (100%), but the difference was not statistically significant (P=0.18). Histomorphometric analysis showed that the proportion of vital bone increased slowly with longer healing durations, with a statistical difference observed between the ≥10 months group and the 4~5 months group (P=0.02). However, no statistical differences in the percentages of residual DBBM or non-mineralized tissue were found among the groups (P=0.23, P=0.81). Conclusion With prolonged healing time, the proportion of vital bone increased slowly. No significant differences were found in new bone formation between 4 to 9 months after LSFE, while a statistically significant increase was noted at ≥10 months compared to the 4~5 months group. These findings suggest that implant placement at 4~9 months post-LSFE provides comparable bone quality, with implantation at 4 months offering the benefit of a shorter treatment duration.

Key words: Lateral window technique for sinus floor elevation, Early healing phase, Osteogenesis effect, Implant survival

周文洁,吴轶群. 侧壁开窗上颌窦底提升愈合早期种植的可行性分析：一项前瞻性临床对照研究[J]. 中国口腔种植学杂志, 2025, 29(6): 524-530. DOI: 10.12337/zgkqzzxzz.2024.12.010

Zhou Wenjie, Wu Yiqun. Feasibility of implant placement during the early healing phase following lateral window technique for sinus floor elevation: a prospective controlled clinical trial[J].Chinese Journal of Oral Implantology, 2025, 29(6): 524-530.DOI: 10.12337/zgkqzzxzz.2024.12.010.

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