無翻瓣上顎竇增高術與大臼齒單顆植牙手術：病例報告

Flapless Sinus Floor Augmentation and Single Molar Implant Surgery: Cases Report

許仁信(Jen-Hsin Hsu) ； 李協泰(Lestario Lee) ； 盧俊泰(Jun-Tai Lu)

《中華民國牙周病醫學會雜誌》 11卷3期 (2006/09) Pp. 203-217

摘要

許多上顎竇骨移植技巧的創新與進展，有效改善受植區骨組織的限制。本文提出以無翻瓣方式合併上顎竇增高術與單顆植牙手術，運用在後臼齒單顆缺牙合併剩餘齒槽骨高度不足時。並提出一分類，以描述此一新的上顎竇增高術的策略與適應症。所有個案都由植牙位置軟組織洞口，不經翻瓣將通道盡頭的上顎竇膜做環繞式預先側方剝離，作上顎竇提昇術並同時放入植體。藉由減少施予上顎竇膜的壓力，其上顎竇重建體積量較不受限制。共連續五位患者經此上顎竇增高術合併ITI植體單顆植牙手術，並於補綴物完成後至少6個月以上的追蹤時間。患者術後無明顯疼痛、不適與腫脹現象。在術後追蹤X光檢查，沒有病理發現，可見上顎竇提昇空間骨移植材持續的骨轉化現象。我們提出只要有充分的術前軟硬組織評估與適當的手術技巧，臨床個案在達到初期穩定度時，適合採用無翻瓣方式合併上顎竇增高術與單顆植牙手術。而臨床個案在4mm以下剩餘齒槽骨高度時（即RBH type A），積極的作法在善用鑽孔技巧與選擇適當植體下，仍可合併植體放置。但受限於本文有限病例，且仍須更長時間追蹤此類個案，來確定這方法的結果。

關鍵字

無翻瓣手術 ； 上顎竇增高術 ； 單顆植體 ； 大臼齒

並列摘要

Advances in bone grafting surgical techniques give the clinician several available options to treat the anatomical restrictions of the posterior maxilla. This cases report presents a flapless method of the combination of sinus floor augmentation and single molar implant surgery in a deficient residual bone height (RBH). Besides this original technique, a sinus floor augmentation classification was proposed in an attempt to describe the strategy and indications. Using the in advance lateral dissection of the sinus membrane at the periphery of the elevated area, bone grafting and simultaneous implant placement are performed through the osteotomy site without raising a flap. It is possible to gain a greater sinus elevation because the stress applied to the sinus mucosa is reduced. In 5 consecutive cases, 5 implants of the ITIs Dental Implant System were placed subjacent to the sinus floor, and 5 single implant prosthesis were with an at least 6-month follow-up after delivery. Healing in all cases was uneventful, Postoperative pain, discomfort and swelling were minimal. Postoperative radiograph revealed no pathologic findings and grafted area underwent continuously remodeling. The results of this report demonstrate that flapless sins augmentation with simultaneous single implant placement could be applied to treat the single gap maxilla in patients with deficient RBH when appropriate primary stability can be achieved, and when careful case planning and surgical technique are used. This procedure is also indicated when RBH less than 4 mm (RBH type A). Within the limited cases, more follow-up time needs to be done on a larger group of individuals to verify the observations made in this cases report.

並列關鍵字

flapless surgery ； sinus floor augmentation ； single implant ； molars