评价改良上颌窦内提升术同期种植在上颌后牙区严重牙槽嵴萎缩病例中的临床应用效果。

选择2018年1月至2019年6月就诊于东莞健力口腔医院种植中心上颌后牙缺失拟行上颌窦提升术同期种植（剩余骨高度为2~3 mm）的患者50例。将纳入的50例患者进行编号，以随机数字表法随机抽取25例为实验组，其余25例为对照组。实验组使用改良上颌窦内提升术，对照组使用上颌窦侧壁开窗技术，对两组患者进行上颌窦提升术同期植入种植体，术后9~12个月进行二期手术及种植修复，戴牙12个月后随访，采集手术过程中及永久修复12个月后的锥形束CT（CBCT）数据。使用SPSS 20.0软件对种植体存留率、上颌窦底提升高度和穿孔率等计量资料来进行相应的统计分析，采用配对t检验进行比较，以P<0.05认为差异有统计学意义。

所有50例患者随访率100%，65枚种植体均无松动或者脱落，留存率100%。实验组和对照组术前剩余骨高度分别为（2.94 ± 0.31）和（3.06 ± 0.32）mm，差异无统计学意义（t = -1.395，P = 0.168）。实验组和对照组术后即刻提升高度分别为（10.90 ± 1.78）和（12.01 ± 1.88）mm，差异有统计学意义（t = 5.298，P<0.001）。实验组和对照组术后9个月提升高度分别为（10.14 ± 1.33）和（11.40 ± 1.38）mm，差异有统计学意义（t = 3.786，P<0.001）。实验组和对照组修复完成后12个月提升高度分别为（10.01 ± 1.22）和（11.18 ± 1.26）mm，差异有统计学意义（t = 2.474，P<0.001）。术后实验组采用改良上颌窦内提升术同期植入种植体31枚，涉及上颌窦25个，术中未发现上颌窦黏膜穿孔，但有1例患者术后第2天出现了术侧鼻腔出血的情况，7 d拆线时出血情况停止，3个月复查时拍CBCT，未见上颌窦内异常液平面。对照组采用外提升术同期植入种植体34枚，涉及上颌窦25个，其中3例术中开窗时发生窦黏膜穿孔，通过使用胶原膜进行修补，术后未出现任何不良反应。术后统计实验组黏膜穿孔率4%，远低于对照组外提升黏膜穿孔率（12%）。

改良上颌窦内提升术在上颌后牙区余留骨高度为2~3 mm的临床应用过程中，可获得较理想的上颌窦提升效果，术后窦膜穿孔等并发症发生率低，短期种植效果满意。

To evaluate the clinical outcome of the modified transcrestal around detached sinus floor elevation technique and simultaneous implantation in severe atrophic alveolar ridge of maxillary posterior region.

A total of 50 patients (65 implant sites) underwent transcrestal around detached sinus floor elevation technique with bone grafting were included in this study in Jianli Stomatological Hospital of Dongguan from October 2017 to October 2019. These patients were randomly divided into two groups with 25 in each. The experimental group was treated with the modified transcrestal around detached sinus floor elevation technique while lateral window technique was used in the control group. A total of 65 implants were placed simultaneously with sinus floor elevation. The second stage operation and implant restoration were performed nine months later. The patients were followed up 12 months after final restoration. Data of CBCT in the process of implantation were collected.

Both the follow-up rate of the patients and the survival rate of implants were 100%. The residual bone height in the posterior maxilla of the experimental and control groups were (2.94 ± 0.31) mm and (3.06 ± 0.32) mm, respectively, where there was no significant difference (t = -1.395, P = 0.168) . The post-op height in the posterior maxilla of the control and experimental group were (10.90 ± 1.78) and (12.01 ± 1.88) mm, respectively, where there was significant difference (t = 5.298, P<0.001) . This height was found to be (10.14 ± 1.33) and (11.40 ± 1.38) mm, respectively, after nine months, where there was significant difference (t = 3.786, P<0.001) . Further, this height changed into (10.01 ± 1.22) and (11.18 ± 1.26) mm, respectively, where there was significant difference (t = 2.474, P<0.001) . In this study, a total of 31 implants were implanted in the experimental group for 25 maxillary sinuses. No perforation of maxillary sinus mucosa was found during the operation, but one patient had bleeding in the nasal cavity on the second day after operation. After active anti-inflammatory treatment, the bleeding stopped and then the suture was removed on the 7th day. CBCT was taken at the re-examination of three months, and no abnormal fluid in the maxillary sinus was found. In the control group, a total of 34 implants were implanted at the same time, involving 25 maxillary sinuses. Among them, three cases had sinus mucosal perforation during fenestration. The perforation lesion was covered with collagen membrane, and there were no adverse reactions after operation. The mucosal perforation rate in the experimental group was 4%, which was much lower than that of the control group (12%) .

The modified maxillary sinus elevation and simultaneous implantation can achieve a better effect in the cases with severe alveolar ridge atrophy in the posterior maxillary area. The complications such as perforation of the sinus membrane are low and the short-term implant effect is satisfactory.