Performance and Risk Assessment of One Step Implant Therapy with Severely Atrophic Posterior Maxillae: A Preliminary Report

背景：本回溯性研究的目的是評估剩餘骨低於五毫米之上顎嚴重吸收以開窗技術與一步驟植體治療的臨床效果與風險。材料與方法：本研究病例來自臺北慈濟綜合醫院。所有病例皆接受開窗技術與一步驟植體治療。上顎植牙部位吸收依剩餘骨量分類：A（4 ~ 5 mm）和B（＜ 4 mm）。34位患者接受41個鼻竇骨增生手術，共植入70顆兩階段式植體。植牙術後直接鎖上癒合帽以避免二次手術。最後以廣義估計方程（GEE）進行單變量與多變量分析與植體邊緣骨喪失與植體失敗相關的風險因子。結果：77%（54）植牙部位剩餘骨量屬分類B（＜ 4 mm remaining bone），23%屬分類A。所有植體邊緣骨喪失皆低於2 mm。一顆植體失敗，後來成功重植並製作義齒。植體五年生存率與成功率分別是98.4%與97.1%。單變量分析發現抽菸（p=0.015）、鼻竇模穿孔（p=0.058）與粗植體（p=0.045）較常見早期邊緣骨吸收。多變量分析顯示抽菸（p=0.028）與粗植體（p ＜ 0.05）較常見早期邊緣骨吸收。結論：本臨床初步研究發現在慎選病例時，以開窗技術與一步驟植體治療上顎嚴重吸收有很高的可預測性。抽菸、鼻竇模穿孔與粗植體較常見邊緣骨吸收。未來建議針對此技術進行較大樣本與長期之觀察。

關鍵字

一步驟；植體治療；鼻竇增生；上顎嚴重吸收

並列摘要

Background: The purpose of this retrospective study was to assess the efficacy of and risk factors associated with performing a one-step, non-submerged, open window surgical technique that allows simultaneous implant placement in sites with ≤ 5 mm of residual bone. Materials and methods: Clinical data were obtained from Periodontic Department at Buddist Tzu Chi General Hospital, Taipei. The dataset included all consecutively placed implants in the maxillary sinus using an open window technique. Remaining bone height at implant sites was classified into A (4 ~ 5 mm), and B (＜ 4 mm). In total, 34 patients and 41 sinuses received 70 two-piece implants to support both multiple and single tooth reconstruction. Healing abutments were simultaneously inserted at the time of fixture placement. The generalized estimating equation method for univariable and multivariable analysis was performed to assess possible risk factors associated with marginal bone loss and implant failure. Results: Among the patients, 77% (54) of the implant sites were class B and 23% were class A. No implant had marginal bone loss that was ＞ 2 mm. One implant was lost and was restored successfully. The overall implant survival and success rates over 5 years were 98.4% and 97.1% respectively. Univariable analysis indicated that implants with a wide diameter (p=0.045), implants where a perforation of the sinus membrane occurs (p=0.058), and implants in patients who smoked (p=0.015) seemed to be associated with early bone loss. Multivariable analyses showed that smoking (p=0.028) and 5 mm wide implants (p ＜ 0.05) were more likely to show early bone loss. Conclusions: The present clinical study shows that with careful case selection single-stage implant placement in maxillary sinus using an open window technique is predictable. Smoking, sinus perforation, and wide implants are more likely to show early bone loss. Further long-term evaluation with a larger sample is needed.

並列關鍵字

one-stage ； implant therapy ； sinus augmentation ； atrophic maxilla

國際替代計量

Performance and Risk Assessment of One Step Implant Therapy with Severely Atrophic Posterior Maxillae: A Preliminary Report

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