| Objectives Patients with lost maixllary posterior tooth and received maxillary sinus floor elevation with simultaneous dental implantation were enrolled in this study and sinus mucosa status,residualbone height(RBH),sinus floor elevation height,operation success rate,mucosa perforation rate,as well as implant survival rate were analysed clinically and radiologically.The effect of maxillary sinus lesions,mucosa thickening and sinus pseudocysts,on dental implant restoration in patients received maxillary sinus floor elevation with simultaneous dental implantation were evaluated,to provide some clinical clue for determination of the treatment method for these lesions in these patients.Methods Clinical retrospective study was used in this study and the patients with lost maxillary posterior tooth and received maxillary sinus floor elevation with simultaneous dental implantation in department of Oral Implantology,Bochuang dental hospital from January 2014 to December 2017,were enrolled in this study.Clinical data including patient age,gender,implanting sites and so on were collected.At presurgical stage,corebeam CT(CBCT)examination were performed and sinus mucosa thickness,diameter of pseudocyst as well as RBH,were measured.Sinus floor were elevated either by creastal approach with hydraulic technique or by lateral window opening approach and implantation was performed simultaneously.At postsurgiucal stage,panoramic radiography was examined and mucosa perforation rate,sinus floor elevation height and surgery success rate were evaluated.Follow-up was conducted and the study ended in December 2018.Implant survival rate was calculated and status of soft tissue around dental implants was evaluated.CBCT examination was also used to analyse change of sinus mucosa thickness,sinus floor new bone height and marginal bone loss around dental implants.Results 1 According to inclusion and exclusion criteria,35 patients(37 maxillary sinuses)with lost maxillary posterior tooth and received maxillary sinus floor elevation with simultaneous dental implantation were enrolled in this study.These patients included 14 males and 21 females,the average age of these patients was 47.57±12.25 years old,a total of 54 implants were inserted,and the most common implanting site was maxillary first molar.2 Presurgucal CBCT examination showed that within 35 patients and 37 sinuses,normal sinus mucosa occured in 19 sinuses(51.35%)and mucosa thickness was 0.88±0.24mm(0.50~1.21mm),mucosa thickening was observed in 15 sinuses(40.54%)and mucosa thickness was 4.32 ± 1.91 mm(2.13~9.29mm),and pseudocysts occured in 3sinuses(8.10%)and diameter of cyst was 16.27±3.70mm(12.00~18.45mm).Presurgucal CBCT examination also showed that average RBH within 35 patients and 54 implanting sites was 6.10±1.45 mm,average RBH in sinuses with normal mucosa was 6.40±1.03 mm,in sinuses with mucosa thickening was 6.09±1.67 mm and in sinuses with pseudocyst was3.73±0.69 mm.RBH showed no significant difference between normal mucosa and mucosathickening patients(p>0.05).3 In 37 sinuses mucosa perforation occured in one sinus(1implant)and total mucosa perforation rate was 2.70%.This happened in one patient with normal sinus mucosa and no mucosa perforation occurred in patients with mucosa thickening and sinus pseudocyst.Above results indicated that mucosa thickening do not increase the risk of mucosa perforation during sinus floor elevation operation.Postsurgical panoramic radiograph showed that sinus floor elevation height was 5.08±1.50 mm in total54 implanting sites,and sinus floor elevation height was 4.68±1.16 mm in normal mucosa patients,5.26±1.63 mm in mucosa thickening patients and 7.52±0.92 mm in pseudocysts patients.Three implants lost in two cases during the healing period and the total surgical success rate was 94.5%.One case(2 implnats)suffered acute suppurative periimplantitis and the sinus mucosa was normal(surgical success rate 94.74%),the other case suffered acute suppurative sinusitis and a large pseudocyst(18.45mm)existed in the sinus,which was not removed during sinus floor elevation operation.Above results suggested that mucosa thickening did not affect surgical success rate but large pseudocyst could bring great risk to sinus floor elevation and dental implant surgery(surgical success rate 66.67%).4 During the final follow-up period,35 sinuses and 51 implants were analyzed.CBCT analysis showed that mucosa in 18 sinuses were normal and average mucosa thickness was0.91±0.23 mm,15 sinuses showed thickened mucosa and the mucosa thickness was3.45±1.61 mm.Mucosa thickness showed no significant difference in patients with normal mucosa and mucosa thickening(P>0.05),whereas mucosa thickness significantly decreased in patients with mucosa thickening during follow-up stage when compared with presurgical stage(p<0.05).The pseudocysts in 2 sinuses,which were treated with sinus floor elevation by lateral window opening plus cyst fluid aspiration,disappeared during follow-up and the mucosal thickness recovered to 1.45±0.16 mm.This result suggested that cyst fluid aspiration during sinus floor elevation operation could lead to postsurgical healing of sinus pseudocyst.In 51 implants,the average sinus new bone height was4.56±1.52 mm,while it was 4.14±1.12 mm in normal mucosa patients,4.77±1.68 mm in mucosa thickening patients and 6.97±0.98 mm in sinus pseudocyst patients.Influencing factor analysiss of new bone height showed that gender and age did not affect new bone height in the sinus(P>0.05)and there was no significant difference for new bone height between patients with normal mucosa and mucosa thickening(P>0.05).The result indicated that sinus mucosa thickening did not affect new bone formation after sinus floor elevation operation.At the end of the study,the total implant survival rate of 54 implants was 94.44%,and it was 92.59% in normal mucosa patients,100% in mucosa thickening patients and 66.67% in patients with sinus pseudocyst.Above results suggested that mucosa thickening did not affect final impalnt survival rate,whereas large sinus pseudocyst could bring great risk to final impalnt survival rate.Conclusions 1 Maxillary sinus mucosal thickening had no significant influence on implant survival rate and sinus mucosa perforation rate,and it also did not affect sinus floor new bone formation in patients received maxillary sinus floor elevation with simultaneous dental implantation.2 Large sinus pseudocyst(>18mm)could decrease success rate ofsinus floor elevation operation with simultaneous dental implantation and implant survival rate,and cyst fluid aspiration could promote healing of the lesion and benefit dental implant restoration.Figure 16,Table 13,Reference 73... |
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