Radiography Analysis Of Collagen Sponge In The Osteogenesis Of The Sinus Floor Elevation

ObjectiveThrough clinical observation and imaging analysis,the implant survival rate and the endo-sinus bone gain were calculated,and the feasibility of using collagen sponge replacing bone graft material in the sinus floor elevation was explored.Surgical methods included lateral window sinus floor elevation with delayed implantation and osteotome sinus floor elevation with simultaneous implantation only using collagen sponge.Materials and MethodsFrom 2018 to 2019,in the Dept.of Implantology,School&Hospital of Stomatology,Shandong University,three patients including 6 implantation sites who received lateral window sinus floor elevation with delayed implantation were selected,and 40 patients including 44 implantation sites were received osteotome sinus floor elevation with simultaneous implantation.Collagen sponge was placed at the elevation site during the operation.After 6 months,a core biopsy was removed for histological evaluation from patient who received lateral window sinus floor elevation.The biopsy site was then further prepared for osteotome sinus floor elevation with simultaneous implantation in the same location.Clinical data of patients and CBCT at preoperative and 6 months after surgery were collected.Implant survival rate was evaluated according to Cochran’s retention criteria.According to CBCT,the residual bone height,the implant protrusion length and the endo-sinus bone gain were measured to evaluate the effect of collagen sponge on osteogenesis by Mimics software.Use SPSS 26.0 for data statistical analysis.The datas were tested for normality.Continuous variables conforming to the normal distribution were described by the mean ± standard deviation.The independent sample t test was used for statistical analysis on the difference test of grouped data,pearson correlation analysis was carried out for continuous variables and spearman correlation analysis was carried out for sub-type variable data.Finally,linear regression equation was established to study the correlation between factors.In the study of lateral window sinus floor elevation with delayed implantation,the difference of alveolar bone height before and after elevation was tested by independent sample t test for statistical analysis.P<0.05 indicates statistical significance.Results1.Clinical observation:Three patients including 6 implantation sites who received lateral window sinus floor elevation with delayed implantation and 40 patients including 44 implantation sites who received osteotome sinus floor elevation with simultaneous implantation all achieved good osteogenesis after surgery and were repaired as scheduled.At 1 year follow-up,there was no implant loosening or failing,and the implant survival rate was 100%.2.Measurement of imaging indicators ①In the study of lateral window sinus floor elevation,the residual bone height was(2.21 ± 1.17)mm,the maximum was 2.94mm and the minimum was 0.85mm.Postoperative bone height was(6.37±1.11)mm,the maximum was 7.11mm and the minimum was 5.10mm.The endo-sinus bone gain was(4.17±0.18)mm,the maximum was 4.29mm and the minimum was 3.97mm.②In the study of osteotome sinus floor elevation,the residual bone height was(5.85±1.26)mm,the maximum was 7.96mm and the minimum was 3.31mm.The implant protrusion length was(4.00±1.20)mm,the maximum was 6.54mm and the minimum was 1.43mm.The endo-sinus bone gain was(4.12±1.12)mm,the maximum was 6.37mm and the minimum was 2.22mm.The endo-sinus bone gain was not significantly correlated to residual bone height(P>0.05).The implant protrusion length was significantly correlated to the endo-sinus bone gain(P<0.01).Compared with normal schneiderian membrane group,the mucosal cyst of maxillary sinus group had no significant difference in endo-sinus bone gain(P>0.05).3.Histological evaluation showed that all the biopsy samples were red stained bone tissue,and the nucleus was blue stained,without inflammatory cells and soft tissue cells and achieved good osteogenesisConclusion1.During lateral window sinus floor elevation with delayed implantation,only using collagen sponge has a good osteogenesis,which greatly reduced the difficulty of subsequent treatment.2.During the osteotome sinus floor elevation with simultaneous implantation,collagen sponge is used to replace the bone grafting material,and the endo-sinus bone gain is greater than the implant protrusion length,which could effectively avoid the situation that the implant in the apical area don’t have bone tissue support.3.The maxillary sinus mucosa cyst and retention cyst are not treated during the osteotome sinus floor elevation,and they have no effect on osteogenesis.Using collagen sponge replacing bone graft material in the sinus floor elevation can reduce the risk of surgery and the economic burden of patients,and achieve good osteogenesis,which provides a new idea for the selection for the sinus floor elevation.The long-term effect still needs further follow-up observation.