本文選題：種植修復(fù)術(shù) + 上頜竇提升術(shù)�。� 參考：《南京大學(xué)》2017年碩士論文

【摘要】：[目的]上頜后牙區(qū),由于牙齒缺失后牙槽嵴廢用性吸收、上頜后牙區(qū)松質(zhì)骨多,皮質(zhì)骨較其他區(qū)域薄以及上頜竇解剖位置的限制,該區(qū)域一直是種植予以回避的區(qū)域。隨著種植技術(shù)的發(fā)展,上頜竇提升術(shù)應(yīng)運而生,廣泛的用以治療上頜后牙區(qū)骨量不足的種植修復(fù),但其長期的臨床效果結(jié)論不一。本研究評價上頜竇提升術(shù)應(yīng)用于上頜后牙區(qū)垂直骨量不足的種植義齒功能負(fù)載6-9年的臨床療效。[方法]收集2007-2010年上頜后牙區(qū)牙齒缺失后行種植修復(fù)術(shù)的患者69例,共植入種植體95枚,根據(jù)術(shù)前剩余牙槽骨高度(Residual Bone Height,RBH)不同分為上頜竇提升術(shù)植骨組(A組)29例38枚,上頜竇提升術(shù)未植骨組(B組)17例24枚,常規(guī)種植組(C組)25例33枚,平均隨訪85.4個月,通過臨床檢查,從種植體存留率、種植體周圍軟組織狀態(tài)、患者滿意度、邊緣骨吸收(Marginal Bone Loss,MBL)的方面評估上頜竇提升術(shù)的遠(yuǎn)期臨床療效;通過影像學(xué)資料,從植入骨粉變化、上頜竇底位置變化、種植體突入竇腔高度及上頜竇黏膜提升高度與上頜竇底新骨生成相關(guān)關(guān)系等方面評估上頜竇底成骨效果。[結(jié)果]95枚種植體中有2枚在種植術(shù)后6個月內(nèi)脫落,上頜竇提升術(shù)6-9年存留率97.9%,不同術(shù)式間種植體存留率無統(tǒng)計學(xué)差異;三組患者對種植義齒功能負(fù)載后的滿意度評分為:30.5±4.7分、29.27±5.34分、29.54±5.14分,不同術(shù)式間患者滿意度評分無統(tǒng)計學(xué)差異;術(shù)后6-9年隨訪,種植體周圍軟組織狀態(tài)良好,三組間無統(tǒng)計學(xué)差異;種植術(shù)后6個月,A、B、C三組種植體近遠(yuǎn)中的邊緣骨平均吸收為:0.26±0.43mm、0.35±0.37mm、0.50±0.61mm,結(jié)果有統(tǒng)計學(xué)差異;術(shù)后6-9年隨訪時,A、B、C三組患者的種植體近遠(yuǎn)中的邊緣骨平均吸收為:1.45±1.20mm、1.47±1.64mm、1.57± 1.51mm,結(jié)果有統(tǒng)計學(xué)意義,但吸收值均符合Albrektsson等提出的種植體成功率/存留率標(biāo)準(zhǔn),且不同術(shù)式間邊緣骨吸收無差異;術(shù)后6個月A組上頜竇底位置上升為1.42±2.23mm,術(shù)后6-9年A組上頜竇底位置上升為1.95± 1.87 mm,且具有統(tǒng)計學(xué)差異,其他兩組差異無統(tǒng)計學(xué)意義。A組植入骨粉在術(shù)后6個月平均剩余64.23%,6-9年剩余6.56%;種植體突入竇內(nèi)高度與新骨生成的相關(guān)性r值為0.533,具有正相關(guān)性;上頜竇粘膜提升高度與新骨生成的相關(guān)性r值為0.384,具有正相關(guān),但相關(guān)性較弱。[結(jié)論]對垂直骨量不足的上頜后牙區(qū)行種植修復(fù)術(shù)后6-9年的遠(yuǎn)期臨床療效良好;功能負(fù)載6-9年種植體邊緣骨吸收符合Albrektsson等提出的標(biāo)準(zhǔn),能取得可預(yù)期的療效;植骨組上頜竇底位置上升率較高,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 鹵4. 7 and 29. 27 鹵5. 34 and 29. 54 鹵5. 14, respectively. 6 months after implantation, the average marginal bone resorption of the implants in the three groups was: 0.26 鹵0.43 mm / 0.35 鹵0.37 mm / 0.50 鹵0.61 mm, respectively, and the average absorption of the marginal bone was 1.45 鹵1.20 mm / 1.47 鹵1.64 mm / 1.57 鹵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 鹵2.23 mm in group A 6 months after operation, and 1.95 鹵1.87 mm to 1.95 鹵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.
【學(xué)位授予單位】：南京大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R783.6
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本文編號：2067288