胶原蛋白海绵在上颌窦底提升术中应用效果的回顾性研究

发布时间：2018-05-22 11:52

本文选题：经牙槽嵴顶上颌窦底提升术 + 胶原蛋白海绵　；参考：《山东大学》2017年硕士论文

【摘要】：目的:通过收集18位患者病史资料、治疗相关详细资料及影像学资料,统计经牙槽嵴顶上颌窦底提升术中仅植入胶原蛋白海绵并同期种植技术的存留率及临床效果,为简化手术过程、减轻患者痛苦及经济负担提供一种良好的参考。方法:从2012年12月份至2016年12月份于山东大学口腔医院种植科就诊的病例中,选择经牙槽嵴顶上颌窦底提升术中仅植入胶原海绵并同期种植的病例,共计18例,包含21个牙位。根据2002年Cochran提出的种植体成功标准:①种植体骨结合稳固;②无疼痛及任何主观感觉;③无频繁发作的种植体周围炎;④种植体周围无连续性透射影像;统计其存留率,统计所有术中和术后的并发症,同时追踪观察负载后半年的存留率和临床使用情况。并通过对术后及术后6月CBCT的观测,分别记录术后及术后6月时近远中及植体根部提升高度,及术后6月时植体周围骨结合情况,评价胶原蛋白海绵的成骨效果。使用SPSS软件对测量数据进行统计学分析,P0.05时具有统计学差异。结果:(1)存留率:在观察的18例患者,21个牙位中,所有患者术后均未出现上颌窦黏膜破裂穿孔、感染等临床并发症。18例患者,21个种植体在术后6个月均取得良好的骨结合,存留率为100%,最终修复效果好,病人满意。负载后半年复诊时,18例患者,21个牙位的存留率为100%,21个种植修复体均能行使良好的咀嚼功能,未出现种植体松动、感染,上颌窦穿孔、感染等迹象。(2)数据测量结果:21个牙位的近远中侧牙槽骨剩余高度约为(6.44±2.09)mm,平均值为6.27mm;近中牙槽骨高度为(6.96±2.27)mm,远中牙槽骨高度为(6.09±1.86)mm。骨结合后,种植体近远中侧的新骨生成量约为0.94-7.72mm,平均(2.5±1.59)mm;近中窦底新骨高度为(2.57±1.74)mm,远中为(2.58± 1.39)mm。近远中侧新骨生成量无统计学差异。(3)CBCT观察:在纳入条件的18例患者,21个牙位中,21个种植体突入上颌窦部分,植体根部均可发现形成了新的上颌窦底影像,种植体周围均可见密度均匀连续的高密度影像。结论:在上颌后牙区剩余牙槽骨高度不足时,采用经牙槽嵴顶上颌窦底提升术,在上颌窦内植入胶原蛋白海绵代替骨替代材料,临床上可取得良好的效果,成功率高,且能有效避免上颌窦底黏膜穿孔、上颌窦感染等临床并发症,降低了手术风险,减轻了患者的经济负担,易于患者接受,可在临床上推广应用。
[Abstract]:Objective: to investigate the survival rate and clinical effect of collagen sponge implantation and simultaneous implantation during transalveolar ridge maxillary sinus floor lifting by collecting 18 patients' medical history and imaging data. It provides a good reference for simplifying the operation process and alleviating the pain and economic burden of patients. Methods: from December 2012 to December 2016, only collagen sponge was implanted into the maxillary floor of maxillary sinus in Shandong University Stomatology Hospital from December 2012 to December 2016. A total of 18 cases, including 21 teeth, were selected. According to the successful implant standard proposed by Cochran in 2002, the osseous fixation without pain and any subjective sensation, there was no continuous transmission image around the implant, and the survival rate of the implant was counted. All postoperative and intraoperative complications were recorded, and the retention rate and clinical use of the patients were followed up half a year after loading. The osteogenic effect of collagen sponge was evaluated by observing the CBCT after operation and 6 months after operation, recording the elevation of the proximal distal and the root of the implant and the osseous binding around the implant at 6 months after the operation. There was statistical difference when using SPSS software for statistical analysis of measurement data. Results the survival rate: among 18 patients, 21 teeth were observed, all of them had no clinical complications, such as rupture and perforation of maxillary sinus mucosa, infection and other clinical complications. The 21 implants had good osseous union at 6 months after operation. The survival rate is 100%, the final repair effect is good and the patient is satisfied. The survival rate of 21 teeth was 100, 21 implants could perform good masticatory function without implant loosening, infection, maxillary sinus perforation. Results: the residual height of proximal distal alveolar bone in 21 teeth was about 6.44 卤2.09 mm, the average was 6.27 mm, the height of proximal alveolar bone was 6.96 卤2.27 mm, and the height of distal alveolar bone was 6.09 卤1.86 mm. After bone-binding, the new bone formation of the implants was about 0.94-7.72mm, with an average of 2.5 卤1.59mm, and the height of the new bone near the middle sinus floor was 2.57 卤1.74mm and 2.58 卤1.39mmm. There was no statistical difference in the amount of new bone formation in the proximal distal side. The CBCT observation showed that 21 implants protruded into the maxillary sinus and the root of the implants formed a new image of the maxillary sinus floor in the 18 patients who were included in the condition. High density images with uniform and continuous density can be seen around the implants. Conclusion: when the height of the remaining alveolar bone in the maxillary posterior region is insufficient, the transalveolar ridge top maxillary sinus floor lifting technique and the implantation of collagen sponges into the maxillary sinus to replace the bone substitute material can achieve good clinical results and high success rate. And can effectively avoid the maxillary sinus floor mucosa perforation, maxillary sinus infection and other clinical complications, reduce the risk of surgery, reduce the economic burden of patients, easy to accept, can be used in clinical application.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R782.1

【参考文献】