盘钻法上颌窦内提升牙种植术的10年临床效果回顾分析

doi:10.19439/j.sjos.2024.01.011

摘要/Abstract

摘要： 目的: 分析盘钻法上颌窦内提升牙种植术术后10年种植体周围骨改建情况,并探讨不同因素对种植体存留率的影响。方法: 收集青岛大学附属医院口腔种植科2008年1月—2011年12月间,应用盘钻法行上颌窦内提升同期牙种植术患者的临床及影像学资料。应用全景片和CBCT测量不同时期种植体周围的骨量变化,利用SPSS 26.0软件包中的Kaplan-Meier 法和 Log-rank 检验法分析不同因素对种植体存留率的影响。结果: 共纳入98例患者,合计128颗种植体。随访0~168个月,随访过程中,7颗种植体失败,其余均形成良好的骨结合并行使功能,10年累积存留率达94.53%。获得完整影像学数据的75个种植位点中,术后10年种植体尖端成骨高度（0.29±0.15） mm,窦内成骨高度为（2.74±0.66） mm。Kaplan-Meier 法和 Log-rank 检验法分析表明,初始骨高度、提升骨高度、黏膜穿孔、种植体长度、植入扭力、吸烟、糖尿病、牙周炎等8个因素对种植体存留率有显著影响。结论: 盘钻法上颌窦内提升牙种植术是解决上颌后牙区垂直骨缺损的一种可靠、稳定的骨增量手术,10年累计存留率不低于94%。初始骨高度、提升骨高度、黏膜穿孔、种植体长度、植入扭力、吸烟、糖尿病、牙周炎等是影响种植体长期存留率的重要因素。

关键词: 牙种植, 盘钻法, 上颌窦内提升术, 存留率

Abstract: PURPOSE: To analyze the bone remodeling around the implant 10 years after disk-up sinus reamer(DSR)-based internal sinus floor elevation with implantation and to investigate the influence of different factors on implant retention. METHODS: The clinical and imaging data of patients undergoing DSR-based sinus floor elevation with simultaneous implantation were collected from the Department of Dental Implantology, Affiliated Hospital of Qingdao University from January 2008 to December 2011. Panoramic film and CBCT were used to measure the changes of bone mass around implant in different periods. Kaplan-Meier and Log-rank tests were used to analyze the effects of different factors on implant retention with SPSS 26.0 software package. RESULTS: The study included 98 patients with a total of 128 implants. During the follow-up of 0-168 months, 7 implants failed, and the remaining formed good osseointegration and functioned, with a 10-year cumulative retention rate of 94.53%. The height of bone formation was (0.29±0.15) mm at the top and (2.74±0.66) mm in the sinus of 75 implant sites with complete imaging data obtained ten years after surgery. Kaplan-Meier and Log-rank tests showed that 8 factors including initial bone height, elevated bone height, mucosal perforation, implant length, implant torsion, diabetes, smoking and periodontitis had significant effects on implant retention. CONCLUSIONS: The DSR-based internal sinus floor elevation with implantation is a reliable and stable bone augmentation operation for vertical bone defect in maxillary posterior region, with a 10-year cumulative retention rate of no less than 94%. Initial bone height, elevated bone height, mucosal perforation, implant length, implant torsion, diabetes, smoking and periodontitis are the important factors affecting the long-term retention rate of implants.

Key words: Dental implant, Disk-up sinus reamer, Internal sinus floor elevation, Retention rate

中图分类号:

R782.1

张凯悦, 韩泽禹, 姜帅, 徐昊, 李凡, 赵保东. 盘钻法上颌窦内提升牙种植术的10年临床效果回顾分析[J]. 上海口腔医学, 2024, 33(1): 64-70.

ZHANG Kai-yue, HAN Ze-yu, JIANG Shuai, XU Hao, LI Fan, ZHAO Bao-dong. Review of clinical effects of disk-up sinus reamer(DSR)-based internal sinus floor elevation with implantation in 10 years[J]. Shanghai Journal of Stomatology, 2024, 33(1): 64-70.

参考文献

[1] Si MS, Shou YW, Shi YT, et al.Long-term outcomes of osteotome sinus floor elevation without bone grafts: a clinical retrospective study of 4-9 years[J]. Clin Oral Implants Res, 2016, 27(11): 1392-1400.
[2] 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.
[3] Insua A, Monje A, Wang HL, et al.Basis of bone metabolism around dental implants during osseointegration and peri-implant bone loss[J]. J Biomed Mater Res A, 2017, 105(7): 2075-2089.
[4] Bosshardt DD, Chappuis V, Buser D.Osseointegration of titanium, titanium alloy and zirconia dental implants: current knowledge and open questions[J]. Periodontol 2000, 2017, 73(1): 22-40.
[5] Mertens C, Wiens D, Steveling HG, et al.Maxillary sinus-floor elevation with nanoporous biphasic bone graft material for early implant placement[J]. Clin Implant Dent Relat Res, 2014, 16(3): 365-373.
[6] 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.
[7] 王星星, 孙丽娟, 王悦, 等. 冲压法上颌窦底提升术后种植体周围骨改建及影响因素分析[J].实用口腔医学杂志, 2021, 37(1): 45-49.
[8] 黄江琴, 胡常琦, 夏勋, 等. 经牙槽嵴顶上颌窦底提升同期植入短种植体的回顾性研究[J]. 华西口腔医学杂志, 2020, 38(6): 667-671.
[9] 毛玉琳, 赵保东, 徐海洋, 等. 盘钻法和冲顶法提升上颌窦底的临床对比观察[J].泰山医学院学报, 2012, 33(12): 837-840.
[10] Velasco-Ortega E, Sierra-Baztan A, Jiménez-Guerra A, et al.Long-term clinical study of implants placed in maxillary sinus floor augmentation using beta-tricalcium phosphate[J]. Int J Environ Res Public Health, 2021, 18(19): 9975-9989.
[11] Kim DH, Ko MJ, Lee JH, et al.A radiographic evaluation of graft height changes after maxillary sinus augmentation[J]. J Periodontal Implant Sci, 2018, 48(3): 174-181.
[12] Pesce P, Menini M, Canullo L, et al.Radiographic and histomorphometric evaluation of biomaterials used for lateral sinus augmentation: a systematic review on the effect of residual bone height and vertical graft size on new bone formation and graft shrinkage[J]. J Clin Med, 2021,10(21): 4996-5012.
[13] Lee HW, Lin WS, Morton D.A retrospective study of complications associated with 100 consecutive maxillary sinus augmentations via the lateral window approach[J]. Int J Oral Maxillofac Implants, 2013, 28(3): 860-868.
[14] Zhou Y, Shi Y, Si M, et al.The comparative evaluation of transcrestal and lateral sinus floor elevation in sites with residual bone height ≤6 mm: a two-year prospective randomized study[J]. Clin Oral Implants Res, 2021, 32(2): 180-191.
[15] Amam MA, Abdo A, Alnour A, et al.External sinus lifting using calcium sulphate as a bone grafting in an adult male patient: case report[J]. Ann Med Surg (Lond), 2022, 84: 104951.
[16] Kakar A, Sripathi Rao BH, Deshpande N, et al.Osteotome-mediated sinus floor elevation using an in situ hardening biphasic calcium phosphate bone graft substitute compared to xenograft: a randomized controlled clinical trial[J]. Indian J Dent Res, 2021, 32(1): 61-68.
[17] Farina R, Simonelli A, Franceschetti G, et al.Peri-implant tissue conditions following transcrestal and lateral sinus floor elevation: 3-year results of a bi-center, randomized trial[J]. Clin Oral Investig, 2022, 26(5): 3975-3986.
[18] Schleier P, Bierfreund G, Schultze-Mosgau S, et al.Simultaneous dental implant placement and endoscope-guided internal sinus floor elevation: 2-year post-loading outcomes[J]. Clin Oral Implants Res, 2008, 19(11): 1163-1170.
[19] Scarano A, Degidi M, Iezzi G, et al .Maxillary sinus augmentation with different biomaterials: a comparative histologic and histomorphometric study in man[J]. Implant Dent, 2006,15(2):197-207.
[20] Pizzini A, Basma HS, Li P, et al .The impact of anatomic, patient and surgical factors on membrane perforation during lateral wall sinus floor elevation[J]. Clin Oral Implants Res, 2021,32(3): 274-284.
[21] Schwarz L, Schiebel V, Hof M, et al.risk factors of membrane perforation and postoperative complications in sinus floor elevation surgery: review of 407 augmentation procedures[J]. J Oral Maxillofac Surg, 2015, 73(7): 1275-1282.
[22] Díaz-Olivares LA, Cortés-Bretón Brinkmann J, Martínez-Rodríguez N, et al. Management of Schneiderian membrane perforations during maxillary sinus floor augmentation with lateral approach in relation to subsequent implant survival rates: a systematic review and meta-analysis[J]. Int J Implant Dent, 2021,7(1):91-104.
[23] Li F, Wang YH, Wang DS, et al.Effect of DSR-based internal sinus floor elevation with implantation on atrophic maxilla[J]. Int J Clin Exp Med, 2018,11(1): 99-108.
[24] 李凡,赵保东,滕敏华,等.盘钻法行上颌窦内提升牙种植术的长期临床效果评价[J].青岛大学医学院学报, 2016, 52(4): 382-385.
[25] Anitua E, Piñas L, Orive G.Retrospective study of short and extra-short implants placed in posterior regions: influence of crown-to-implant ratio on marginal bone loss[J]. Clin Implant Dent Relat Res, 2015, 17(1): 102-110.
[26] Carosi P, Lorenzi C, Lio F, et al.Short implants (≤6 mm) as an alternative treatment option to maxillary sinus lift[J]. Int J Oral Maxillofac Surg, 2021, 50(11): 1502-1510.
[27] Jung RE, Al-Nawas B, Araujo M, et al.Group 1 ITI consensus report: the influence of implant length and design and medications on clinical and patient-reported outcomes[J]. Clin Oral Implants Res, 2018, 29(Suppl 16): 69-77.
[28] Abdel-Halim M, Issa D, Chrcanovic BR.The impact of dental implant length on failure rates: a systematic review and meta-analysis[J]. Materials (Basel), 2021, 14(14): 3972.
[29] Anitua E, Alkhraist MH, Pi?as L,et al. Implant survival and crestal bone loss around extra-short implants supporting a fixed denture: the effect of crown height space, crown-to-implant ratio, and offset placement of the prosthesis[J]. Int J Oral Maxillofac Implants, 2014, 29(3): 682-689.
[30] Verri FR, Batista VE, Santiago JF Jr, et al.Effect of crown-to-implant ratio on peri-implant stress: a finite element analysis[J]. Mater Sci Eng C Mater Biol Appl, 2014,45: 234-240.
[31] Ramos Verri F, Santiago Junior JF, de Faria Almeida DA, et al. Biomechanical influence of crown-to-implant ratio on stress distribution over internal hexagon short implant: 3-D finite element analysis with statistical test[J]. J Biomech, 2015, 48(1): 138-145.
[32] Telleman G, Raghoebar GM, Vissink A, et al.A systematic review of the prognosis of short (<10 mm) dental implants placed in the partially edentulous patient[J].J Clin Periodontol, 2011, 38(7): 667-676.
[33] 于惠, 柳忠豪, 许胜. 不同植入扭矩对牙种植体-骨结合影响的动物实验研究[J].实用口腔医学杂志, 2018, 34(6): 748-752.
[34] 王柏翔, 孟维艳, 周延民, 等.不同种植系统对种植体周组织影响的对比研究[J].口腔医学研究, 2014, 30(6): 540-543 547.
[35] Binon PP.Implants and components: entering the new millennium[J]. Int J Oral Maxillofac Implants, 2000, 15(1): 76-94.
[36] Oshida Y.Bioscience and bioengineering of titanium materials[M]. Amsterdam: Elsevier, 2007: 406-411.
[37] Oshida Y, Tuna EB, Aktören O, et al.Dental implant systems[J]. Int J Mol Sci, 2010,11(4): 1580-1678.
[38] Naseri R, Yaghini J, Feizi A.Levels of smoking and dental implants failure: a systematic review and meta-analysis[J].J Clin Periodontol, 2020, 47(4): 518-528.
[39] Tamez J, Zilli FN, LA Fandiño, et al.Factors related to the success or failure of dental implants placed in the specialty prosthodontics and implantology at Universidad of La Salle Bajio[J]. Revista Española de Cirugía Oral y Maxilofacial,2017,39(2): 63-71.
[40] Al Zahrani S, Al Mutairi AA.Crestal bone loss around submerged and non-submerged dental implants in individuals with type-2 diabetes mellitus: a 7-year prospective clinical study[J]. Med Princ Pract, 2019, 28(1): 75-81.
[41] Chambrone L, Palma LF.Current status of dental implants survival and peri-implant bone loss in patients with uncontrolled type-2 diabetes mellitus[J]. Curr Opin Endocrinol Diabetes Obes, 2019, 26(4): 219-222.
[42] Krennmair S, Hunger S, Forstner T, et al.Implant health and factors affecting peri-implant marginal bone alteration for implants placed in staged maxillary sinus augmentation: a 5-year prospective study[J]. Clin Implant Dent Relat Res, 2019, 21(1): 32-41.
[43] Smith MM, Knight ET, Al-Harthi L, et al.Chronic periodontitis and implant dentistry[J]. Periodontol 2000, 2017, 74(1): 63-73.
[44] Barone A, Orlando B, Tonelli P, et al.Survival rate for implants placed in the posterior maxilla with and without sinus augmentation: a comparative cohort study[J]. J Periodontol, 2011,82(2): 219-226.