| Objective Quantitative assessment of the osteogenic effect of new bone in the maxillary sinus was based on the image gray threshold segmentation technique.By comparing the clinical effect of the lateral sinus floor elevation with the annular bone block embedded in sinus floor elevation,the advantages and disadvantages of the two surgical methods were assessed.Methods Cases of the Center of Oral Implantology of the Affiliated Hospital of Stomatology of Anhui Medical University,who accepts annular bone block embedded in sinus floor elevation or lateral sinus floor elevation during October 2020 to October2022 were selected.We selected the patients with the residual bone height（RBH）of3-5 mm in the maxillary posterior tooth area as the research object,and divided them into bone block embedded group and lateral fenestration group.The postoperative pain index,maxillary sinus mucosal perforation rate,survival rate of implant,and postoperative bone formation were compared by clinical examination and image of CBCT.Trabecular bone parameters were analyzed quantitatively by CTAn image analysis software（CTAnalyser,Sky Scan,Antwerp,Belgium）to assess the osteogenic effect of the new bone in the maxillary sinus.The parameters included bone volume/total volume（BV/TV）,trabecular number（Tb.N）,trabecular thickness（Tb.Th）and trabecular spacing（Tb.Sp）etc.Multiple linear regression was used to evaluate the effects of two surgical methods on trabecular parameters and postoperative bone mass.Results A total of 24 patients were included in the study,with 24 implants and 12implants in each group.There was no significant difference between bone block embedded group and lateral fenestration group in gender（P=0.680）,age（t=-1.197,P=0.246）,periodontitis（P=1.000）and smoking history（P=1.000）,the two groups were comparable.There were no statistical differences in RBH,sinus membrane thickness（SMT）,sinus width（SW）,and implant diameter（P>0.05）.In terms of length of implants and healing time,the bone block embedded group had shorter length of implants（P=0.009）and shorter healing time（t=-2.465,P=0.022）than those in the lateral fenestration group.The postoperative pain index of the bone block embedded group（2.92±0.79 vs 6.00±0.85,P<0.05）was lower than that in the lateral fenestration group.Meanwhile,mucosal perforation was not found in the bone block embedded group,but two cases in the lateral fenestration group were found mucosal perforation during the operation with the perforation rate of 16.67%.The rate of perforation in the two groups was no significant difference（P>0.05）.During the follow-up,no implant shedding was observed,and survival rate of implant in both groups was 100%.The results of CBCT measurement showed that postoperative bone height（7.14±1.91 mm vs 10.75±2.24 mm,P<0.05）and new bone height（3.14±1.83 mm vs 6.96±2.42 mm,P<0.001）in the bone block embedded group were lower than those in the lateral fenestration group.The results of multiple linear regression showed the statistically significant differences between the two groups in the postoperative bone height and the new bone height（t=2.393,P<0.05）.Quantitative analyse of trabecular bone parameters of new bone in the maxillary sinus were performed by CTAn software.The BV/TV（69.60±9.28%vs 32.47±4.99%,P<0.001）,Tb.Th（3.30±0.25 pixel vs 2.00±0.00 pixel,P<0.001）and Tb.N(0.21±0.02pixel-1vs 0.16±0.24 pixel-1,P<0.001)in the bone block embedded group were higher than those in the lateral fenestration group;Tb.Sp（2.00±0.00 pixel vs 2.69±0.58 pixel,P<0.05）in the bone block embedded group was lower than that in the lateral fenestration group.The results of multiple linear regression showed the statistically significant differences between the two groups in BV/TV,Tb.Th,Tb.N and Tb.Sp.Conclusion Compared with the lateral sinus floor elevation,the postoperative bone mass of the annular bone block embedded in sinus floor elevation is less,but the new bone is relatively mature.The two surgical methods have advantages and disadvantages in the quality and quantity of osteogenesis.The annular bone block embedded in sinus floor elevation has shorter healing time,simple operation,less trauma and no need for bone grafting.It is a relatively minimally invasive,simple and economical surgical method and has certain clinical promotion value. |
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