Sinus Lifting with Osteotome Technique in Inadequate Residual Bone Situation-Case Report

在上顎後牙剩餘骨高度不足時使用骨鑿術進行鼻竇墊高－病例報告

鄭偉立(Wei-Li Cheng) ； 王振穎(Chen-Ying Wang) ； 賴向華(Eddie Hsiang-Hua Lai)

《中華民國家庭牙醫學雜誌》 7卷1期 (2012/06) Pp. 48-56

https://doi.org/10.6566/JFD/2012.7(1).48

摘要

人工植牙要達到穩定骨整合的先決條件是要有足夠的殘存骨嵴以提供人工牙根初期的穩定性。在下顎後牙區，下顎神經管和頦孔等是主要影響植體手術解剖構造。而在上顎後牙區，剩餘骨嵴主要受到上顎竇的影響。當剩餘的骨量不足時，在植牙前或植牙手術同時必須進行骨增高術。文獻回顧顯示骨嵴增高術在橫向增高比縱向增高較能穩定達成。不過在上顎後牙區，經由鼻竇墊高的方式，卻能有效的得到縱向增加骨高度。臨床上鼻竇墊高可藉由底部骨鑿術式或側方開窗術式來進行。當病患殘餘的骨量較少時，一般較建議進行側方開窗術並採取兩階段的手術方式進行，因為人工植體較難達到初期穩定性。然而二階段手術方式將增加整個療程時間而且側方開窗的鼻竇墊高術式也比底部骨鑿墊高方式更易造成病患術後的腫疼與不適。本篇病例報告則採用底部骨鑿鼻竇墊高方式在剩餘骨嵴極度不足的上顎後牙區，在臨床上也能達到穩定成功的骨整合。

關鍵字

人工植牙 ； 鼻竇墊高 ； 側方開窗 ； 底部骨鑿

並列摘要

The prerequisite for predictable osseointegration of dental implant is adequate remaining bone to provide initial stability. In mandibular posterior area, the mandibular canal and metal foramen are the limiting anatomic structures for implant placement. In maxillary posterior area, the limiting anatomic structure is the maxillary sinus. In the case of inadequate remaining bone, ridge augmentation procedure should be performed before or simultaneously with implant placement. Literatures showed that horizontal ridge augmentation to increase the bone width is more predictable than vertical ridge augmentation. Fortunately, in the maxillary posterior area, sinus lifting procedure to increase the vertical bone height seems to be more stable than in other areas of the jawbone. There are two surgical techniques for sinus lifting: lateral window technique and osteotome technique. In patients with less remaining bone, lateral window for sinus grafting and two stages approach is recommended because initial implant stability is hard to achieve. However, two stages approach will lengthen the total treatment time and the post-operative discomfort of the patient is more apparent with open window technique compared to osteotome technique. This case report will show the sinus lifting procedure using osteotome technique and implant placement concomitantly even in the compromised remaining bone condition.

並列關鍵字

Sinus lift ； sinus elevation ； osteotome ； lateral window ； dental implant