- 期刊
Management of Membrane Perforation When Implant Placement Along with Osteotome Sinus Augmentation: Case Reports and Literature Review
摘要
After introduction of the sinus grafting technique, implant placement in the resorbed posterior maxillary ridge becomes a valid treatment option. The most common complication during sinus grafting surgery via lateral or transcrestal approach is sinus membrane perforation. Factors that influence membrane perforation include anatomical variation, membrane thickness, residual bone height, previous sinus infection, and surgeon's experience. A literature review and two case reports were conducted to evaluate membrane perforation rate and implant survival with regard to membrane perforation. Perforation rate during sinus lifting is 6.28% with osteotome technique and 6.0-21% with lateral approach. Schneiderian membrane perforation is not an absolute indication for abandoning the procedure, and it remains controversial regarding implant survival. This study consisted two cases of sinus lifting by osteotome technique with simultaneous implant placement, membrane perforation was detected from periapical film in both cases. In the former case simultaneous implant placement was done since dome shaped membrane space retained, and in the latter case the surgical procedure was postponed due to bone graft spread out into sinus cavity. All implants with perforated sinuses were osseointegrated successfully in the observation. Proper diagnosis and management could lead to a favorable treatment outcome.
並列摘要
當上顎後牙區骨脊高度不足，需藉由上顎竇增高術增加骨高度以利缺牙區之重建。不論使用側方開窗式或經骨脊骨鑿式上顎竇增高術，皆為預測性高的術式，於術中最常見之併發症為竇膜穿孔。影響竇膜穿孔的因素包括：解剖性變異、上顎竇膜厚度、剩餘骨高度、鼻竇感染病史、以及手術醫師經驗等。本篇文章回顧上顎竇增高術合併植牙的相關文獻以及利用兩病例，整理竇膜穿孔發生率以及穿孔對人工植牙術的影響。於骨鑿式上顎竇增高術中發生竇膜穿孔的比率為6.28%,，使用側方開窗式發生的比率為6.0-20.1%。維持竇膜完整有其重要性，然而穿孔並非意味手術必須終止，也不一定會影響植體存活率。本文採用之兩病例皆利用經骨脊骨鑿式上顎竇增高術合併植牙，術中發生竇膜穿孔，第一例在根尖片可見骨粉仍能維持於一圓頂空間故同次植牙，第二例根尖片已不見骨粉撐高之圓頂形空間，故等待癒合後再安排植牙。兩病例植體行使正常咬合功能後，皆有穩定之追蹤結果。可見上顎竇增高術術中發生竇膜穿孔，經由適當的診斷及處置仍可達到成功的結果。