不植骨骨凿冲顶法上颌窦底提升术后种植体根尖骨状况的影响因素分析

doi:10.19438/j.cjoms.2026.03.013

摘要/Abstract

摘要： 目的: 探讨不植骨骨凿冲顶法上颌窦底提升(osteotome sinus floor elevation, OSFE)术后种植体根尖骨状况（骨暴露/骨覆盖）及影响因素,为临床术式选择提供依据。方法: 选择2011年1月—2022年12月就诊于上海交通大学医学院附属第九人民医院接受不植骨OSFE的患者88例（112颗种植体）。根据种植体植入术后6个月根尖骨的CBCT评估结果,将患者分为种植体根尖骨覆盖组与根尖骨暴露组。测量剩余骨高度、窦腔宽度、种植体突入长度、上颌窦颊腭向轮廓等参数,建立基于二元逻辑回归的广义估计方程,分析种植体根尖骨暴露的危险因素。结果: 112颗种植体中,80.36%（90/112）术后6个月根尖骨覆盖,不植骨OSFE的平均窦内骨增量为（2.60±1.09） mm。广义估计方程分析显示,窦腔宽度增加 (OR=1.21, 95%CI: 1.00~1.46, P=0.045)、方形窦腔 (OR=4.46, 95%CI: 1.16~17.24, P=0.030)、种植体突出长度≥4 mm (OR=5.05, 95%CI: 1.64~15.59, P=0.005)、牙周炎 (OR=3.46, 95%CI: 1.09~10.92, P=0.035)是根尖骨暴露的独立危险因素。结论: 不植骨OSFE术后根尖骨状况受种植体突入长度、上颌窦颊腭向轮廓及上颌窦宽度影响,术前应基于CBCT评估解剖条件,制定合适的临床方案。

关键词: 种植牙, 上颌窦底提升术, 骨凿冲顶法, 根尖骨覆盖, 危险因素

Abstract: PURPOSE: To investigate the apical bone condition (bone exposure/bone coverage) of implants and influencing factors following graft-less osteotome sinus floor elevation (OSFE) and provide evidence for clinicians. METHODS: Patients who underwent non-grafted OSFE in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January 2011 to December 2022 were enrolled. Based on CBCT evaluations at 6 months post-implantation, the patients were divided into an apical bone coverage group and an apical bone exposure group. Parameters including residual bone height (RBH), sinus cavity width (SW), implant protrusion length (IPL), and bucco-palatal sinus contour were measured. A generalized estimating equation (GEE) with binary logistic regression was established to identify risk factors for apical bone exposure. RESULTS: A total of 88 patients (112 implants) were included. At 6 months postoperatively, totally 80.36% (90/112) of the implants achieved periapical bone coverage, with an endo-sinus bone gain of (2.60±1.09) mm. GEE analysis showed that increased sinus width (OR=1.21, 95%CI: 1.00-1.46, P=0.045), square-shaped sinus cavity (OR=4.46, 95%CI: 1.16-17.24, P=0.030), IPL≥4mm (OR=5.05, 95%CI: 1.64-15.59, P=0.005), and periodontitis (OR=3.46, 95%CI: 1.09-10.92, P=0.035) were independent risk factors for periapical bone exposure. CONCLUSIONS: Periapical bone coverage after graft-less OSFE is affected by implant protrusion length, bucco-palatal contour of the maxillary sinus, and sinus width. Preoperative CBCT evaluation of anatomical conditions should be conducted to formulate appropriate clinical plans.

Key words: Dental implant, Maxillary sinus floor elevation, Osteotome technique, Periapical bone coverage, Risk factors

中图分类号:

R782.1

刘自华, 杨清然, 徐光宙. 不植骨骨凿冲顶法上颌窦底提升术后种植体根尖骨状况的影响因素分析[J]. 中国口腔颌面外科杂志, 2026, 24(3): 288-295.

Liu Zihua, Yang Qingran, Xu Guangzhou. Analysis of influencing factors on the apical bone condition of implants after graft-less osteotome sinus floor elevation with simultaneous implant placement[J]. China J Oral Maxillofac Surg, 2026, 24(3): 288-295.

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