| Transcrestal sinus floor elevation using osteotome technology effectively solves the problems of the the lost of teeth in the posterior maxillary with lack of vertical bone mass.This technology has the advantages of less surgery time,less trauma,the patient recovered faster.However,the surgical sensitivity is high due to the lack of direct visual during the surgery.And the long-term postoperative osteogenic effect of individual differences exist.In this study,patients with missing posterior teeth from our department were used as a sample source.using a prospective cohort study designed to evaluate the long-term effects of the surgery through clinical follow-up,including implant cumulative survival rate,the status of peri-implant soft tissue and marginal bone loss.At the same time,through radiographic results to analysis the long-term effects of the endo-sinus bone remolding and the stability of the new bone.Long-term change of maxillary sinus mucosa and its tolerance to the surgery were also observed at the same time,in order to provide some reference for future clinical work.Part Ⅰ: 3-year clinical outcomes of transcrestal sinus floor elevation with simultaneous placement of dental implants.Objective: The 3-year clinical follow-up outcomes was used to evaluate the long-term effect of the surgery,including implant survival rate,the status of peri-implant soft tissue and marginal bone loss.Material and Methods: A total of 100 clinical patients(126 implants)were included in this study,which were included in our prophase study from January 2012 to August 2015 in our department.In the previous study,only one implant in this group failed due to infection during the healing period,and the early success rate of the implant was 99.2%.The ISR after loaded at the first year of follow-up was 99.2%.In the present study,3-year clinical outcomes were performed in this group of patients to record the peri-implant soft tissue parameters including ISR,implant cumulative success rate,m SBI,m PLI and PD was measured at six locations.Using digital dental film to measure and calculate the MBL.All clinical data were analyzed by SPSS 23.0 software.Results: In this study,84 patients(103 implants)with loading for three years and completed follow-up were included.The mean age was 50.05±12(22-80)years.At three years of follow-up,the ISR of 84 patients(103 implants)was 100%.Except for one implant,severe marginal bone loss was found at the third year of follow-up.Other patients achieved good long-term results with a cumulative success rate of 98.81%.The average MBL of 103 implants at first year follow-up was 0.48±0.81 mm,and at 3-year follow-up was 0.93±0.53 mm.During the 3-year follow-up the mean m SBI was 0.49±0.62,the mean m PLI was 0.41±0.58,PD(mesial-buccal was 3.98±1.10mm;buccal was 3.11±0.95mm;distal-buccal was 3.58±0.90mm;mesial-lingual was 4.09±1.10mm;lingual was 3.50±1.20mm;distal-lingual was 3.78±1.00mm).According to the experimental design,at implant level,the prevalence of Peri-implant mucositis was 41.75%,and the prevalence of peri-implantitis was 0.97%.Conclusions: The long-term effect of transcrestal SFE was safe and reliable.Most patients have healthy peri-implant soft tissue and the MBL within the normal range.Part Ⅱ: Long-term outcomes of transcrestal sinus floor elevation on endo-sinus bone formation and its stability.Objective: Through the radiographic results to observe the stability of the endo-sinus new bone,to evaluate the effect of endo-sinus bone formation,try to analyze the factors that affect the bone formation.Material and Methods: The data was the same as that in Part I.In the previous study,RBH(7.18±1.20mm)before surgery and IPL(2.89±0.91mm)after surgery were obtained.In this study,3-year of radiographic results were used to calculate and analyze the ABH and the bone resorption rate by Mimics and Digimizer software.The situation of the bone around implant apex were observed,The new bone is not completely wrapped around the apex of the implant as partial osteogenesis,and the apex of the implant is completely wrapped around the new bone as complete osteogenesis.All clinical data were statistically analyzed with SPSS23.0 software.Results: After loaded for one year,the average of endo-sinus bone height was 3.48±1.05 mm.After loaded for 3 years,The average of endo-sinus bone height was 2.75 ± 1.44 mm,the endo-sinus new bone resorption rate was 20.98%.At one year follow-up,of the 103 implants,74 implants were completely osteogenica while at 3-year follow-up,there were 65 implants completely osteogenic.At the 1-year follow-up,the mean ABH was 1.34±0.87 mm.At 3-year follow-up,the mean ABH was 0.81±1.36 mm.The mean ABH decreased by 0.53±1.05 mm.Conclusions: This technique achieved good long-term endo-sinus bone formation.The new bone on the implant apex slightly absorbed,but the overall stability is good.Part Ⅲ: Long-term outcomes of transcrestal sinus floor elevation on maxillary sinus mucosaObjective: The quantitative and qualitative changes of the maxillary sinus mucosa after surgery were observed by radiographic results to evaluate the long-term effect of the technology on the maxillary sinus mucosa.Analyze the long-term tolerance of patients with maxillary sinus pseudocyst without removing the cyst.Material and Methods: The data was the same as that in Part I.In the previous study,we found pre-surgery,of the 88 sides of sinus,the normal MT group are 62 sides of sinus,flat MT group are 11 sides of sinus,the pseudocyst group are 15 sides of sinus.In this experiment,3 years of radiographic examination were carried out.The MT was measured by Mimics software based on the previous experimental design,and the prognosis of maxillary sinus pseudocyst was observed.Compared with the pre-surgery results,the long-term effect of the operation on the mucosa of the maxillary sinus was analyzed.Results: In this experiment,88 sides of the sinus(103 implants)were followed up three years after surgery.67 cases in the normal MT group(Group A),11 in the flat MT group(Group B)and 10 in the cyst group(Group C).In Group A,2 cases had mucosal thickening and MT>2mm;In Group B,5 cases had mucosal thickness and MT≤2mm;In Group C,5 cases of cyst disappeared(3 cases became Group B,2 cases recovered to Group A.Except patients with pseudocysts before and after surgery,the remaining 85 sides of sinus with mean MT before surgery was 1.51±0.66 mm.At 3-year follow-up,the mean MT was 1.20±0.6mm.The difference is statistically significant(P<0.05).Conclusions: In this group of patients,the maxillary sinus mucosa condition is generally stable after surgery,which can tolerate the operation and has good long-term outcome.The maxillary sinus pseudocyst has good prognosis. |
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