A comparison of two techniques to augment maxillary sinuses using the lateral window approach: rigid synthetic resorbable barriers versus anorganic bovine bone. Five-month post-loading clinical and histological results of a pilot randomised controlled clinical trial.
A comparison of two techniques to augment maxillary sinuses using the lateral window approach: rigid synthetic resorbable barriers versus anorganic bovine bone. Five-month post-loading clinical and histological results of a pilot randomised controlled clinical trial.
复制标题
使用侧窗方法增强上颌窦的两种技术的比较：刚性合成可吸收屏障与无机牛骨。
DOI：
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发表时间：
2009
影响因子：
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通讯作者：
M. Esposito
中科院分区：
文献类型：
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作者：
P. Felice;A. Scarano;R. Pistilli;L. Checchi;M. Piattelli;G. Pellegrino;M. Esposito
目的
目的：比较两种不同的上颌窦扩大技术的疗效：硬质人工可吸收屏障(INION)和颗粒状无机牛骨(Bio-Oss)。
材料和方法
10例部分无牙颌患者，双侧剩余骨高度1~5 mm，上颌窦下方至少5 mm宽，根据CT扫描测量，随机接受两种不同的两阶段鼻窦提升手术，采用侧窗入路。一侧通过放置无任何骨替代材料的可吸收刚性阴离子屏障来提升鼻窦衬里，而对侧则松散地填充100%颗粒状Bio-Oss。术后6个月，每侧植入2~3颗种植体，埋入4个月。植入物上装有临时的丙烯酸假体，4个月后更换为最终的螺丝固位金属陶瓷假体。结果衡量标准是：完成隆起手术所需的时间、CT扫描的骨增量、组织形态计量学、任何并发症、种植体和假体失败，以及临床医生和患者的偏好由盲法结果评估者评估。所有患者均于术后5个月随访。
结果
无一例患者退出。完成增强手术的时间没有显著差异(Inion为19.8分钟，Bio-Oss为20.5分钟)。6个月后，两种干预方法均获得了高度统计学意义的骨量(Inion组为14.4 mm，Bio-Oss组为14.1 mm)，两种方法之间没有显著差异。在组织学上，Bio-Oss处理的部位有更多的新骨形成(36.1%比24.2%)，差异有高度统计学意义(P=0.002)。两组之间的并发症没有差异(在Inion治疗部位有2个上颌衬里穿孔，而在Bio-Oss部位有1个)，然而，在一个在Inion部位发生穿孔的患者中，在种植时，三分之二的鼻窦被软组织填满，该部位被Bio-Oss成功地收回。没有植入物失败。临床医生更喜欢Bio-Oss，因为它更容易操作。患者在术后1个月和交付最终假体1个月后的偏好没有统计学差异：8名患者没有偏好，2名患者倾向于Bio-Oss治疗侧。
结论
虽然不需要植骨来增加萎缩的上颌窦，因为它足够用坚硬的屏障保持空间，但骨组织学更成熟，在临床上使用Bio-Oss似乎更困难。此外，人们认为，用骨替代物填充鼻窦比放置刚性屏障以维持空间更简单。
PURPOSE
To compare the efficacy of two different techniques to augment maxillary sinuses using a lateral window approach: rigid synthetic resorbable barriers (Inion) versus granular anorganic bovine bone (Bio-Oss).
MATERIALS AND METHODS
Ten partially edentulous patients having bilaterally 1 to 5 mm of residual bone height and at least 5 mm bone width below the maxillary sinuses, as measured on computed tomography (CT) scans, were randomised to receive two different 2-stage sinus lift procedures using the lateral window approach. In one side, the sinus lining was raised by placing a resorbable rigid Inion barrier without any bone substitute whereas the contralateral side was loosely packed with 100% granular Bio-Oss. After 6 months, 2 to 3 implants were inserted at each side and submerged for 4 months. Implants were loaded with provisional acrylic prostheses and replaced after 4 months, by definitive screwretained metal-ceramic prostheses. Outcome measures were: time necessary to complete the augmentation procedure, bone gain on CT scans, histomorphometry, any complication, implant and prosthetic failures, and clinician and patient preference assessed by a blinded outcome assessor. All patients were followed up to 5 months after loading.
RESULTS
No patient dropped out. There was no significant difference in time to complete the augmentation procedure (19.8 minutes for Inion versus 20.5 for Bio-Oss). After 6 months, both interventions gained bone in a highly statistically significant way (14.4 mm for Inion versus 14.1 mm for Bio- Oss) with no significant differences between the procedures. Histologically, more new bone formed at Bio-Oss treated sites (36.1% versus 24.2%), the difference being highly statistically significant (P = 0.002). There were no differences in complications between groups (2 perforations of the maxillary lining at Inion treated sites versus 1 at a Bio-Oss site), however, in one of the patients where a perforation occurred at the Inion site, at implant placement, the sinus was two-thirds filled with soft tissue and the site was successfully retreated with Bio-Oss. No implant failed. The clinician preferred Bio-Oss because it was simpler to handle. There were no statistically significant differences in patient preference 1 month after surgery and 1 month after delivery of definitive prostheses: 8 patients had no preference while 2 preferred the Bio-Oss treated side.
CONCLUSIONS
Although bone grafting is not needed to augment atrophic maxillary sinuses since it is sufficient to keep space with a rigid barrier, bone was histologically more mature and appeared to be clinically harder when using Bio-Oss. Moreover, it was judged simpler to fill sinuses with a bone substitute than to position a rigid barrier for maintaining space.