上颌窦腭侧壁扩张提升上颌窦底的临床研究

发布时间：2018-04-18 13:16

本文选题：锥形束CT + 上颌窦腭侧壁扩张　；参考：《安徽医科大学》2017年硕士论文

【摘要】：目的:通过CBCT影像学资料分析成年人上颌磨牙区上颌窦腭侧骨壁最小厚度及上颌磨牙缺失位点牙槽突密度、上颌窦腭侧骨壁密度的变化规律,为临床治疗提供必要的数据。对上颌后牙缺失,种植区骨高度不足且上颌窦腭侧骨壁厚度(Palatal bone thickness,PBT)4mm的病例采用经牙槽嵴顶入路上颌窦腭侧壁挤压、扩张提升上颌窦底的手术方式,不植骨同期植入种植体。随访观察影像学及临床效果,探讨手术方法的可行性,为临床治疗提供参考。资料与方法:第一部分:选取2015年1月~2016年6月在解放军第105医院口腔科行CBCT检查的患者,将符合纳入标准的CBCT影像资料175份纳入统计,共700个测量位点,分析比较上颌磨牙区上颌窦腭侧骨壁厚度、上颌磨牙区牙槽突密度及上颌窦腭侧骨壁密度的变化规律。通过SPSS 17.0软件对获得的数据进行统计分析,采用两独立样本t检验进行比较,以P0.05为差异有统计学意义。第二部分:选取2014年1月~2015年12月,在解放军第105医院口腔科行上颌后牙种植修复的患者共24例,术前获取患者知情同意,并告知手术方式及可能出现的并发症,采用经牙槽嵴顶入路上颌窦腭侧壁扩张提升上颌窦底,不植骨同期植入种植体的手术方式,共植入37颗种植体,平均6个月左右行单冠修复。术后6个月、12个月随访时,通过cbct影像测量种植体根部新骨形成的高度,冠修复后6个月、12个月随访时统计种植体的存留率。结果:第一部分:(1)通过对175份符合条件的影像学资料进行统计分析获得以下结果:男性93例,女性82例,最小年龄26岁,最大年龄96岁,平均年龄57.0岁。共700个测量位点,147个第一磨牙缺失,pbt值为4.438±2.377mm,203个第一磨牙存留,pbt值为4.961±2.143mm,163个第二磨牙缺失,pbt值为3.163±1.891mm,187个第二磨牙存留,pbt值为3.373±1.705mm。第一磨牙缺失位点pbt最大值为10.48mm,最小值为0.81mm;第一磨牙存留位点pbt最大值为10.31mm,最小值为0.87mm;第二磨牙缺失位点pbt最大值为9.21mm,最小值为0.58mm;第二磨牙存留位点pbt最大值为8.64mm,最小值为0.81mm。(2)129个骨密度测量位点,牙槽突密度为372.78±207.49(hounsfield,hu),上颌窦腭侧骨壁密度为516.74±236.60hu。第二部分:术后6个月复诊时,37颗种植体均顺利完成单冠修复,冠修复后12个月复诊时,37颗种植体均能正常行使功能,一年成功率100%。受植区平均牙槽骨高度为(6.7±0.8)mm,上颌窦底提升高度为(4.2±0.6)mm。上颌窦底种植体周围有新骨形成,术后6个月平均成骨2.1mm,术后12个月平均成骨2.3mm。结论:(1)上颌第一磨牙位点的上颌窦腭侧骨壁厚度和上颌第二磨牙位点的上颌窦腭侧骨壁厚度存在显著差异,且第一磨牙位点上颌窦腭侧壁厚度大于第二磨牙位点。(2)上颌第一磨牙存留位点的上颌窦腭侧骨壁厚度大于第一磨牙缺失位点,差异有统计学意义;上颌第二磨牙存留位点和上颌第二磨牙缺失位点的上颌窦腭侧骨壁厚度无显著性差异。(3)上颌磨牙区上颌窦腭侧骨壁密度和牙槽突密度存在显著差异,且上颌窦腭侧骨壁密度大于牙槽突密度。(4)上颌磨牙区骨密度在55岁以后有明显降低,男性的上颌磨牙区牙槽突和上颌窦腭侧骨壁密度均高于女性。(5)上颌后牙区骨量不足时采用上颌窦腭侧壁扩张提升上颌窦底不植骨同期种植的手术方式是可行的,挤压至种植体根部的上颌窦腭侧骨壁具有促进新骨形成的能力。
[Abstract]:Objective: through the CBCT imaging data of adult maxillary sinus maxillary molars palatal bone wall and the minimum thickness of maxillary molar missing sites of alveolar density changes of palatal bone density in maxillary sinus wall, to provide the necessary data for clinical treatment. The maxillary posterior teeth missing, planting area and insufficient bone height in maxillary sinus palatal bone wall thickness (Palatal bone thickness, PBT 4mm) were treated with the alveolar ridge approach of maxillary sinus palatal wall extrusion, extended lift operation of maxillary sinus, without bone graft implantation. Follow-up imaging and the clinical effect and feasibility of operation methods, to provide reference for clinical treatment. Materials and methods: the first part: from January 2015 ~2016 year in June in the 105th Hospital of PLA Department of Stomatology patients performed CBCT, will meet the inclusion criteria of 175 CBCT image data included in the statistics, a total of 700 measuring sites, Comparative analysis of maxillary molars maxillary palatal bone thickness, changes of alveolar density of maxillary molars and maxillary sinus wall palatal bone density. By using SPSS 17 software for statistical analysis of the data obtained, using two independent sample t test to compare with P0.05, the difference was statistically significant. The second part: in January 2014 ~2015 year in December, in the 105th Hospital of PLA Department of stomatology for maxillary posterior implant patients with a total of 24 cases of preoperative patients obtain informed consent, and inform the operation methods and possible complications, the alveolar crest into the maxillary sinus on palatal wall expansion of maxillary sinus lifting, surgery without bone graft implantation the implants were implanted, 37 implants, an average of 6 months for single crowns. 6 months after surgery, 12 months follow-up, formed by CBCT imaging measurement of new bone implant root height, crown 6 Months, 12 months follow-up statistical implant retention rate. Results: the first part: (1) the 175 meet the conditions of the imaging data were analyzed to obtain the following results: 93 cases were male, 82 were female, the minimum age of 26 years, the maximum age of 96 years old, the average age of 57 years. 700 measurement sites, 147 of the first molar, the value of PBT was 4.438 + 2.377mm, 203 first molar retention, PBT = 4.961 + 2.143mm, 163 and second molar, the value of PBT was 3.163 + 1.891mm, 187 and second molar retention, PBT value is 3.373 + 1.705mm. first molar missing sites of PBT maximum for 10.48mm, the minimum value is 0.81mm; the first molar retention sites of PBT maximum value is 10.31mm, the minimum value is 0.87mm; second molar sites of PBT maximum value is 9.21mm, the minimum value is 0.58mm; second molar retention sites of PBT maximum value is 8.64mm, the minimum value is 0.81mm. (2) 129 bone density measurement sites, Alveolar density was 372.78 + 207.49 (Hounsfield, Hu), maxillary palatal bone wall density was 516.74 + 236.60hu. second part: after 6 months, 37 implants were successfully completed single crown, crown after 12 months of follow-up, 37 implants were the normal exercise of power can one year, the success rate of 100%. by planting area average alveolar bone height (6.7 + 0.8) mm, the maxillary sinus lifting height is (4.2 + 0.6) mm. maxillary sinus implant and new bone formation, 6 months after surgery, the average bone 2.1mm, 12 months after surgery, the average bone 2.3mm. conclusion: (1) there was significant difference between the maxillary palatal bone thickness of the maxillary first molar sites maxillary palatal bone thickness and maxillary second molar sites, and the first molar sites of maxillary sinus palatal side wall thickness is larger than second molar sites. (2) the first maxillary molar retention of maxillary sinus wall thickness of palatal bone sites is greater than the first molar missing Lost sites, the difference was statistically significant; maxillary second molar retention maxillary palatal bone thickness in maxillary second molar sites and deletion were no significant difference. (3) there was significant difference between the maxillary molars maxillary palatal bone density and density of alveolar wall, and maxillary palatal bone density is greater than the alveolar wall density. (4) the bone mineral density decreased significantly in the maxillary molar area after 55 years old, male bone density in maxillary molars and alveolar wall of maxillary sinus palatal were higher than those of females. (5) the lack of posterior maxillary bone when maxillary sinus palatal side wall expansion improvement of maxillary sinus surgery bone graft at the end of the same period the implant is feasible, maxillary palatal bone to implant root wall extrusion has the ability to promote the formation of new bone.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R782.1

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