上颌后牙区种植修复后的临床疗效观察

发布时间：2018-06-25 19:53

  本文选题：种植修复术 + 上颌窦提升术　； 参考：《南京大学》2017年硕士论文

【摘要】：[目的]上颌后牙区,由于牙齿缺失后牙槽嵴废用性吸收、上颌后牙区松质骨多,皮质骨较其他区域薄以及上颌窦解剖位置的限制,该区域一直是种植予以回避的区域。随着种植技术的发展,上颌窦提升术应运而生,广泛的用以治疗上颌后牙区骨量不足的种植修复,但其长期的临床效果结论不一。本研究评价上颌窦提升术应用于上颌后牙区垂直骨量不足的种植义齿功能负载6-9年的临床疗效。[方法]收集2007-2010年上颌后牙区牙齿缺失后行种植修复术的患者69例,共植入种植体95枚,根据术前剩余牙槽骨高度(Residual Bone Height,RBH)不同分为上颌窦提升术植骨组(A组)29例38枚,上颌窦提升术未植骨组(B组)17例24枚,常规种植组(C组)25例33枚,平均随访85.4个月,通过临床检查,从种植体存留率、种植体周围软组织状态、患者满意度、边缘骨吸收(Marginal Bone Loss,MBL)的方面评估上颌窦提升术的远期临床疗效;通过影像学资料,从植入骨粉变化、上颌窦底位置变化、种植体突入窦腔高度及上颌窦黏膜提升高度与上颌窦底新骨生成相关关系等方面评估上颌窦底成骨效果。[结果]95枚种植体中有2枚在种植术后6个月内脱落,上颌窦提升术6-9年存留率97.9%,不同术式间种植体存留率无统计学差异;三组患者对种植义齿功能负载后的满意度评分为:30.5±4.7分、29.27±5.34分、29.54±5.14分,不同术式间患者满意度评分无统计学差异;术后6-9年随访,种植体周围软组织状态良好,三组间无统计学差异;种植术后6个月,A、B、C三组种植体近远中的边缘骨平均吸收为:0.26±0.43mm、0.35±0.37mm、0.50±0.61mm,结果有统计学差异;术后6-9年随访时,A、B、C三组患者的种植体近远中的边缘骨平均吸收为:1.45±1.20mm、1.47±1.64mm、1.57± 1.51mm,结果有统计学意义,但吸收值均符合Albrektsson等提出的种植体成功率/存留率标准,且不同术式间边缘骨吸收无差异;术后6个月A组上颌窦底位置上升为1.42±2.23mm,术后6-9年A组上颌窦底位置上升为1.95± 1.87 mm,且具有统计学差异,其他两组差异无统计学意义。A组植入骨粉在术后6个月平均剩余64.23%,6-9年剩余6.56%;种植体突入窦内高度与新骨生成的相关性r值为0.533,具有正相关性;上颌窦粘膜提升高度与新骨生成的相关性r值为0.384,具有正相关,但相关性较弱。[结论]对垂直骨量不足的上颌后牙区行种植修复术后6-9年的远期临床疗效良好;功能负载6-9年种植体边缘骨吸收符合Albrektsson等提出的标准,能取得可预期的疗效;植骨组上颌窦底位置上升率较高,所植骨粉大部分被吸收。
[Abstract]:[objective] in the maxillary posterior region, due to the loss of posterior alveolar crest, more cancellous bone, thinner cortical bone and the limitation of anatomic position of maxillary sinus, this area is always the area to be avoided by implant. With the development of implant technology, maxillary sinus lifting has emerged as the times require, which is widely used to repair the bone defects in maxillary posterior teeth, but its long-term clinical effect is not consistent. The purpose of this study was to evaluate the clinical efficacy of maxillary sinus lifting for 6-9 years of functional loading of implant dentures with insufficient vertical bone mass in the maxillary posterior region. [methods] A total of 69 cases (95 implants) with implant repair after maxillary posterior tooth loss were collected from 2007 to 2010. According to the residual bone height (RBH), they were divided into two groups: group A (n = 29) and group A (n = 29). There were 17 cases (24 pieces) in group B without maxillary sinus lifting and 33 pieces in group C (25 cases). The average follow-up was 85.4 months. After clinical examination, the survival rate of implant, the soft tissue condition around implant, and the satisfaction degree of patients were obtained. The long term clinical effect of maxillary sinus lifting was evaluated by marginal bone resorption (MBL). The effect of maxillary sinus floor osteogenesis was evaluated from the relationship between the height of implants and the elevation of maxillary sinus mucosa and the formation of new bone in the floor of maxillary sinus. [results] two of the 95 implants fell off within 6 months after implantation, and the survival rate of maxillary sinus lifting operation was 97.9 years from 6 to 9 years. The scores of satisfaction of the three groups were 30. 5 卤4. 7 and 29. 27 卤5. 34 and 29. 54 卤5. 14, respectively. 6 months after implantation, the average marginal bone resorption of the implants in the three groups was: 0.26 卤0.43 mm / 0.35 卤0.37 mm / 0.50 卤0.61 mm, respectively, and the average absorption of the marginal bone was 1.45 卤1.20 mm / 1.47 卤1.64 mm / 1.57 卤1.51 mm after 6-9 years follow-up. However, the absorptive values were in line with the implant success rate / survival rate standard proposed by Albrektsson et al, and there was no difference in marginal bone resorption among different surgical methods. The position of maxillary sinus floor increased to 1.42 卤2.23 mm in group A 6 months after operation, and 1.95 卤1.87 mm to 1.95 卤1.87 mm in group A 6-9 years after operation. There was no significant difference between the other two groups. The average remaining time of bone powder implantation in group A was 64.23 and 6.56 in 6-9 years after operation, and the correlation between implant height and new bone formation was 0.533, with positive correlation. The correlation between the elevation height of maxillary sinus mucosa and new bone formation was 0.384, which was positive, but the correlation was weak. [conclusion] the long-term clinical effect of implant repair for maxillary posterior teeth with insufficient vertical bone mass is good 6-9 years after implantation, and the marginal bone resorption of implant in 6-9 years of functional load conforms to the standard proposed by Albrektsson, and can obtain the expected curative effect. In the bone graft group, the ascending rate of the maxillary sinus floor was higher, and most of the bone graft powder was absorbed.
【学位授予单位】：南京大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R783.6
，

本文编号：2067288