| Objective:To explore the clinical application effect of absorbable collagen sponge(ACS)to modify osteotome sinus floor elevation in patients with severely insufficient vertical bone mass in the maxillary posterior teeth area,in order to provide more minimally invasive,safe,economical surgical method.Methods:This study is a prospective study.Select patients who were treated in the oral implant center of Qingdao Municipal Hospital from January 2018 to December 2018,and select patients with a residual bone height in the maxillary posterior teeth area within the range of 3～5mm according to the inclusion criteria,and the shape of the maxillary sinus floor is relatively flat as a research object.It is planned to use the absorbable collagen sponge to modify osteotome sinus floor elevation of maxillary sinus and implant implants at the same time and implanted fixed dentures will be repaired about 6 months after the operation.Clinical follow-up observation and cone beam CT(CBCT)were taken on the day of surgery,6 and 12 months after surgery to evaluate the osteogenesis of the sinus floor lifting area,the survival rate of implants and intraoperative and postoperative complications;statistical analysis of clinical data using SPSS 24.0 software.Results:(1)In this study,19 patients were included,including 8 males and 11 females.A total of 23 Straumann bone horizontal implants(length 8mm)were implanted.The preoperative CBCT measured the maxillary posterior tooth area from the sinus floor to the crest.The bone height is 4.09 ± 0.52 mm,of which the maximum is 4.90 mm and the minimum is 3.38 mm.Absorbable collagen sponge was used to improve osteotome sinus floor elevation after six months of the operation.CBCT showed that the maxillary sinus floor was significantly improved.The newly formed sinus floor was basically located above or flat at the top of the implant root,and the shape of the sinus floor is relatively flat and natural,the height of the newly formed maxillary sinus floor to the alveolar crest is 8.63±1.08 mm,which is significantly different from that before surgery(P<0.05).There were no symptoms such as loosening,pain and discomfort from clinical examination of implants.The above results suggest that all implants have formed good osseointegration,and 23 implants have completed the restoration of the upper crown normally.Six months after the restoration was completed(12 months after the operation),the clinical examination found that all the restorations were functioning well.CBCT shows good peri-implant bone integration after 12 months.There was no significant change in sinus floor morphology and osteogenesis height compared with 6 months after surgery(P> 0.05).(2)One of the 19 patients in this study had perforated maxillary sinus mucosa.CBCT examination revealed that collagen sponge material overflowed into the maxillary sinus.The perforation rate was 4.3%.Antibiotic treatment was given after the operation.Follow-up observation showed that there were no obvious symptoms of maxillary sinus infection and adverse reactions.After 3 months of CBCT examination,the materials scattered in the maxillary sinus were completely absorbed,and the osteogenesis in the sinus was basically not affected.The patient has a good prognosis.(3)Survival rate of implants: All implants were followed up for 12 months and no loosening or shedding of implants occurred in 12 months.The patients were satisfied with the repair effect and the survival rate was 100%.Conclusions:In this study,the traditional osteotome sinus floor elevation technique(internal lifting)was improved by using absorbable collagen sponge,broadening the surgical indications for maxillary sinus lifting;increasing the lifting height of maxillary sinus lifting;reducing the difficulty of operation and reducing the risk of sinus floor mucosal damage;and it also obtains good short-term clinical results,thereby providing a relatively minimally invasive,safe and economical treatment plan for patients with insufficient bone mass in the posterior maxillary area who need to undergo lateral wall window maxillary sinus floor lifting for bone augmentation. |
