~8 mm CBCT CBCT 4~5 mm 1 1 CT 2 Bicon Fig 1 Cone beam CT CBCT scans showed the thin cortical bone and the septa in right maxillary sinu

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1 [ ] (, ) [ ] [ ] [ ] R [ ] A [doi] /j.issn Risk factors and strategies of dental implants in the maxillary posterior without sufficient bone available Huang Jiansheng. Dept. of Special Clinic, Guangdong Provincial Stomatological Hospital, South University of Medical Sciences, Guangzhou , China [Abstract] There are two ways to place dental implants in the maxillary posterior without sufficient bone available, one is the maxillary sinus floor bone augmentation technique, the other is to evade maxillary sinus. The maxillary sinus floor bone augmentation technique may result in a series of complication, and reduce obedience of patients for implant surgery. According to principles of the best bone utilization, the evaded maxillary sinus implant technique is more simple, more economic, more predictable, and more shortage of time, compared with the maxillary sinus floor bone augmentation technique, and has certain technological advantages in some special cases. [Key words] maxillary sinus implant complication simplification technique of sinus floor lift osteotome technique Tatum [1] implantology unlimited Boyne Jame 1 Kent Block 1 Caldwell-Luc 2 Summers [2-3] [ ] [ ] [ ] [ ] Tel

2 ~8 mm CBCT CBCT 4~5 mm 1 1 CT 2 Bicon Fig 1 Cone beam CT CBCT scans showed the thin cortical bone and the septa in right maxillary sinus left, and simultaneous placement of two Bicon implants with technique of sinus floor lift, which acquired initial stability depending on the sinus lift abutment right pterygoid implant zygoma option Fig Sinus lift with two windows in order to evade the septa 3 2 Caldwell-Luc 2.3

3 CT Fig 4 Mucous membrane perforation occured during preparing Fig 3 CT axial slice showing the mildew spot which showed increased density and high density blocks in maxillary sinus bone windows left, then, alternative bone window was prepared in the mesio site, and the collagen membrane and gelatin foam were padded into the perforation right ~6 press-fit

4 Fig 6 implant systems 8 8 Radiological examination showed the right sinus mucous membrane perforation was occured, resulted in diffusing with bone substitute up. After 8 months, osseointegrate occurred around implant partly down 7 Fig Radiological examination showed four implants were penetrated in the maxillary sinus, three of four were press-fit CBCT Caldwell-Luc Fig 8 CBCT showed implant was into the maxillary sinus after surgery with osteotome technique left. Mass fester outflowed from the maxillary after Caldwell-Luc technique right 3 2 6~12 6~9 mm 3 mm 6 5~7 mm 4 6~12 9 Lundgren [4]

5 KISS keep it simple and short Fig 9 CBCT 5 mm A 10 mm ITI CBCT B 7 CBCT C CBCT showed lack teeth area had poor bone condition and 5 mm available bone height A. 10 mm ITI implant was inserted with osteotome technique no bone substitute, CBCT showed the mucous membrane was raised camber B. CBCT showed new bone formation occured between implant and maxillary sinus floor after 7 months C 4.1 shorter implant 8 mm 10 [5] Fig 10 2 mm 11 7 mm 5 mm 6 mm Bicon 3 CBCT Right maxillary first molar was missing and inserted a 5 mm 6 mm Bicon implant with osteotome technique with only 2 mm bone height available. CBCT showed the implant osseointegrated tightly on fuction loading after 3 years Fig 11 6 mm 8 mm Bicon 17 CBCT Right maxillary first molar district was inserted a 6 mm 8 mm Bicon implant with osteotome technique of which available bone height was 7 mm. CBCT showed the implants osseointergrated tightly on fuction loading after 17 months

6 6 4.2 华西口腔医学杂志第 30 卷第 1 期 2012 年 2 月 West China Journal of Stomatology Vol 30 No.1 Feb.2012 http // 倾斜种植体 tilted implant 技术近几年来越来越多的临床医生使用倾斜种植体技术与咬合面间倾斜角度大于15 治疗上颌窦底可利用骨高度不足而上颌窦近中和或远中有一定骨组织的病例避免了使用骨增量术植入了更长的种植体合理的倾斜种植体可以获得轴向种植体一样的成功率倾斜种植体可以在上颌窦近中由近中向远中倾斜从而使种植体顶部的位置向远中延伸扩大了修复所需的距离避免或者缩短了修复体悬臂梁的长度图12 13 图 13 放射学检查显示双侧上颌窦底可利用骨高度严重不足末端种植体采用倾斜技术末端种植体与近中种植体采用了悬臂梁联合修复 Fig 13 Radiological examination showed insufficient available bone height in the bilateral maxillary sinus. Terminal implant were used the tilted implant technique, combined from the mesio-implant for fixed denture with cantilever 倾斜种植体也可植入上颌窦远中通常是上颌结节该位置骨质比较疏松黏膜又比较厚可以选择有一定自攻能力的种植体且应制备大角度的基台图 12 功能负载3年后放射学检查显示左侧紧贴上颌窦近中的 Fig 12 最好采用在植入种植体同期接入愈合基台的开放式倾斜种植体未出现骨吸收末端种植体与近中种植体愈合方式必要时给予渐进式负重此外很多时候采用悬臂梁和短牙弓技术联合修复上部修复结构可能需要延伸至第三磨牙图14 有时 After 3 years function loading, radiological examination 也可联合有颊腭向角度的种植体图15 后牙区倾 showed no bone lost in left tilted implant which ap - 斜种植体原则上需要多颗种植体联合修复联合修复 pressed maxillary sinus. The terminal and mesio implant combined for fixed dentures with cantilever and shortened dental arch technique 受益于两个种植体间的刚性连接可抵消部分侧向力降低种植体周围骨应力更有利于种植体稳定从A到E依次为病例1到病例5 图 14 5个病例均在上颌窦近远中采用了倾斜种植体技术并都采用了2颗以上种植体联合修复其中病例2和5修复了第三磨牙病例5 为上颌窦口鼻腔瘘修补术后患者放射学检查清晰显示上颌窦底骨缺损 Fig 14 Tilted implant technique was used in mesio or desio of the maxillary sinus in five cases, each one was used more than two unites fixed denture. In case 2 and 5, the third molar was restored. Radiological examination showed the bone defect of the maxillary sinus floor in case 5 that was the patient suffered the mouth of the maxillary sinus nasal fistula suture

7 CBCT Fig 15 Because of maxillary sinus inflammation and polyp, implants were inserted in tilted left. CBCT three-reconstruction showed maxilla terminal implant titled to distal, middle implant tilted to distal and palate right Orthopantomogram left and CBCT right showed no suf- ficient bone height available in right maxillary sinus, implant was inserted in tilted towards buccal, no bone loss was showed CBCT Fig 16 The implant has been on function loading in four years Orthopantomogram up and CBCT down showed no sufficient bone height available in right maxillary sinus, implant was inserted in tilted towards palate, no bone loss was showed ~22 17 Fig CBCT 16 The implant has been on function loading in eleven month. 2 CT 3 35 mm [6]

8 Fig 18 2 ITI 2 On account of insufficient available bone height in the right maxillary sinus posterior, two ITI implants were inserted immediately after removing teeth, bridge porcelainfused-to-metal with cantilever was used. Orthopantomogram showed the condition after two years restoration 21 Fig 21 4 Bego Locater On account of insufficient available bone height in the maxillary posterior, four Bego implants were inserted in the mesio axial site of maxillary sinus up, with Locater attachment overdenture to restoration down 19 Fig mm ITI Three ITI implants were inserted in insufficient bone height with 12, 10, 6 mm length fixture. A bridge with cantilever was used to restore upper structure 20 Fig 20 4 Br 覽 nemark On account of insufficient available bone height in bilateral maxillary posterior, four Br 覽 nemark implants were inserted in the mesio axial site of maxillary sinus up, with bar clip attachment overdenture to restoration down 22 4 Bego 2 ERA Fig 22 On account of insufficient available bone height in the maxillary posterior, four Bego implants were inserted in maxillary canine and first premolar up, and a improved bar clip structure was used with two gold alloys clips in the anterior teeth site and two ERA attachments in the terminal down 4.5 shortened dental arch 12 23

9 occlusal unit OU 1 1 OU 1 2 OU 1981 Arnd kayser functio- nally oriented approach 3~5 OU [7] 158. Dent, 1998, [4] Lundgren S, Cricchio G, Palma VC, et al. Sinus membrane elevation and simultaneous insertion of dental implants A new surgical technique in maxillary sinus floor augmentation[j]. Periodontol 2000, 2008, [5] Gentile MA, Chuang SK, Dodson TB. Survival estimates and risk factors for failure with mm implants[j]. Int J Oral Maxillofac Implants, 2005, [6] Bevilacqua M, Tealdo T, Menini M, et al. The influence of canti- 23 lever length and implant inclination on stress distribution in maxillary 6 implant-supported fixed dentures[j]. J Prosthet Dent, 2011, 105 Fig 23 Insufficient available bone height was in the maxillary posterior, six implants were inserted. Prosthetic technique combined from titled implant, cantilever and shortened dental arch [7] Nassani MZ, Devlin H, Tarakji B, et al. A survey of dentists practice in the restoration of the shortened dental arch[j]. Med Oral Patol Oral Cir Bucal, 2010, 15 1 e85-e89. [ ] [1] Tatum H Jr. Maxillary and sinus implant reconstructions[j]. Dent Clin North Am, 1986, [2] Summers RB. A new concept in maxillary implant surgery The osteotome technique[j]. Compendium, 1994, , , [3] Summers RB. Sinus floor elevation with osteotomes[j]. J Esthet!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! N-Cements Multilink Speed N-Cements N-Cements Variolink N - Syntac Variolink N Multilink N / Monobond-S / Metal/Zirconia Primer Multilink Speed MDP Multilink Speed Multilink Speed

國家圖書館典藏電子全文

國家圖書館典藏電子全文 (Index) (Chinese abstract) (English abstract) (Figure index) (Basic information) (Chief complain) (History) (a) (present illness) (b) (past medical history) (c) (past dental history) (Clinical examination)