| Objective:To explore the feasibility of immediate implantation in maxillary molar area and simultaneous lifting and non-embedded healing in maxillary sinus floor,so as to provide experimental basis for immediate implantation in maxillary molar area and simultaneous lifting and non-embedded healing in maxillary sinus floor.Methods:From November 2016 to May 2017,patients with maxillary molar implant prosthesis were selected from the Department of Oral and Maxillofacial Surgery,Affiliated Hospital of Qingdao University.According to the inclusion criteria,patients with maxillary molars losing retention value due to pulp disease,periapical disease or periodontal disease,without contraindication of whole-body and local oral implantation,and with pyramidal bundle CT measuring alveolar ridge to maxillary sinus floor height less than 6 mm and root septum to maxillary sinus height greater than 4 mm were selected.According to the principle of randomized controlled trial grouping,76 patients were randomly divided into experimental group of 38 and control group of 38.In the experimental group,immediate implant and non-implant healing method was used to lift the maxillary sinus floor while in the control group,delayed implant and non-implant healing method were used to lift the maxillary sinus floor three months after extraction.The experimental group and the control group received silicone rubber impressions 6 months after implant implantation and permanent restoration of PFM crowns with individualized abutment.The implant retention rate of the experimental group and the control group at 1 year after permanent repair was counted;the cone-beam CT was taken before,immediately after,6 months after permanent repair and 1 year after permanent repair,and the changes of the width and height of the buccal-hyoid bone of the implant were measured before implantation to 6 months after permanent repair and 6 months after permanent repair to 1 year after permanent repair;the visual analogue score was used to investigate the changes of the width and height of the buccal-hyoid bone of the implant.Subjective satisfaction was calculated.Implant retention rate is the main observation index in this study.Secondary indicators were horizontal and vertical marginal bone loss and patient satisfaction survey.Student T test and Mann-Whitney U test were used to analyze the VAS score.SPSS 19 software is used to process the statistical data.Result:Eight patients were excluded from the study.Four patients in the experimental groupwere unable to continue immediate implantation because of insufficient residual bone after extraction.One patient in the experimental group and two patients in the control group could not complete the follow-up.One patient in the control group abandoned implantation and replaced it with fixed bridge after extraction.Finally,33 patients in the experimental group(average age 35.45 + 5.32 years;residual bone mass 4.7 + 0.52 mm)and 35 patients in the control group(average age 38.12 + 6.21 years;residual bone mass 4.9 + 0.63 mm)received the intervention of this study and completed the late follow-up.A total of 75 implants were implanted in 65 patients.The implant retention rate was 100% in both groups one year after permanent restoration.Maxillary sinus mucosal perforation occurred during maxillary sinus floor elevation at three implant sites(two in the experimental group and one in the control group).No complications such as implant loosening and maxillary sinusitis occurred during one year follow-up after permanent repair.From pre-operation(T1)to 6 months(T2)and 6months(T2)to 1 year(T3),the decrease of horizontal width and vertical height of alveolar bone in experimental group and control group was more obvious on buccal side than on lingual side.The horizontal bone resorption of alveolar ridge at each implant site from preoperative to 6 months after restoration was as follows: the buccal side of the experimental group(0.65(+0.12 mm),the buccal side of the control group(1.23(+0.32 mm),the palatal side of the experimental group(0.3(+0.10 mm),and the palatal side of the control group(0.28(+0.08 mm).There was significant difference in horizontal bone resorption on buccal side between the experimental group and the control group(p < 0.0001);there was no significant difference in palatal bone resorption between the two groups(p = 0.515).From 6months after restoration to 1 year after restoration,the vertical bone resorption of alveolar ridge at each point was as follows: buccal side(0.60 + 0.18 mm)in the experimental group,buccal side(1.53 + 0.19 mm)in the control group,palatal side(0.24 + 0.12 mm)in the experimental group and palatal side(0.29 + 0.13 mm)in the control group.There was significant difference in vertical bone resorption on the buccal side between the experimental group and the control group(p < 0.0001);there was no significant difference in palatal bone resorption between the two groups(P = 0.190).There was no significant difference in VAS score between the experimental group and the control group(8.36 + 1.01 vs 8.14 + 1.35)(P= 0.638).Conclusion:It is feasible to elevate the maxillary sinus floor and immediately implant the implant into the maxillary molar area to heal the teeth that meet the indication of extraction and have insufficient bone height. |
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