柔性两阶段穿牙槽嵴上颌窦底提升术治疗上颌后牙区骨高度严重不足1例报告及文献复习

doi:10.13481/j.1671-587X.20250525

摘要/Abstract

摘要：

穿牙槽嵴上颌窦底提升术（TSFE）在上颌后牙区垂直骨增量应用上具有侵入性小、术后反应小和手术时间短的优势。本文作者报道1例上颌后牙区剩余骨高度（RBH）严重不足，上颌窦外侧壁可见一血管且上颌窦底可见分隔患者的临床资料，应用柔性两阶段TSFE，在减小创伤和降低施耐德膜破裂及上颌窦感染等风险的同时，改善了术区的垂直骨高度，并结合相关文献进行复习。患者，男性，26岁，自诉左侧上颌后牙缺失1年余，要求修复。患者27牙缺失，角化龈正常，牙槽嵴丰满，对颌牙无伸长，缺牙近远中间隙宽度尚可，龈距离正常。锥形束CT（CBCT）显示27牙位处窦嵴距约3 mm，牙槽骨宽度约12.8 mm，骨密度正常，未见残留牙根及其他异常情况；双侧上颌窦壁未见囊肿样病变，左侧上颌窦底可见分隔，上颌窦外侧壁可见一血管。诊断为肯氏Ⅲ类上颌牙列缺损。经过两阶段TSFE，施耐德膜完整，上颌窦未发生感染，种植区骨高度由术前的3 mm提升至修复完成后的9.6 mm，骨增量效果稳定，骨结合良好，恢复了正常的咬合功能。对于上颌后牙区骨高度严重不足的患者，可以考虑柔性两阶段TSFE，在降低上颌窦感染和施耐德膜破裂等风险的同时，减小损伤并获得理想的骨增量效果。

关键词: 上颌窦底提升术, 穿牙槽嵴上颌窦底提升, 施耐德膜, 骨再生, 牙种植, 富血小板纤维蛋白

Abstract:

Transalveolar technique for sinus floor elevation（TSFE） offers the advantages of minimal invasiveness， reduced postoperative reaction， and shorter operative time for vertical bone augmentation in the maxillary posterior region. The clinical data of one patient with severe deficiency of residual bone height （RBH） in the maxillary posterior region， a blood vessel visible in the lateral wall of the maxillary sinus and a visible septum at the floor of the maxillary sinus were reported， and two-stage flexible TSFE was used to improve the vertical bone height of the operated area while reducing trauma， the risk of Schneiderian membrane rupture and maxillary sinus infection， etc.， and the relevant literatures were reviewed. The patient， male， 26 years old， complained of missing left maxillary posterior teeth for more than 1 year and requested restoration. The patient had 27 missing teeth， normal keratinized gingiva， full alveolar ridge， no elongation of the opposing teeth， fair width of the proximal and normal occlusal distance. The results of cone beam CT （CBCT） showed that the distance between the sinus crests at the site of the 27 teeth was about 3 mm， the width of the alveolar bone was about 12.8 mm， the bone density was normal， and there were no residual roots or other abnormalities； no cyst-like lesions were seen in the walls of the maxillary sinuses bilaterally， and separation was seen at the floor of the maxillary sinus on the left side and a blood vessel was seen in the lateral wall of the maxillary sinus. A diagnosis of Kennedy class Ⅱ maxillary tooth defects was made. After two stages of TSFE， the Schneiderian membrane was intact and the bone height of the implant area was elevated to 9.6 mm from 3 mm preoperatively after the completion of the restoration， with stable bone augmentation， good osseointegration，and restoration of normal occlusal function. For the patients with severe bone height deficiency in the maxillary posterior region， flexible two-stage TSFE should be considered， which can help to reduce the risk of maxillary sinus infection and Schneiderian membrane rupture while minimizing the damage and obtaining the ideal bone augmentation results.

Key words: Sinus floor elevation, Transalveolar technique for sinus floor elevation, Schneiderian membrane, Bone regeneration, Dental implantation, Platelet-rich fibrin

中图分类号:

R783.4

刘洋,翟少博,杨征,吴毓川,石晓璐,储顺礼. 柔性两阶段穿牙槽嵴上颌窦底提升术治疗上颌后牙区骨高度严重不足1例报告及文献复习[J]. 吉林大学学报(医学版), 2025, 51(5): 1370-1376.

Yang LIU,Shaobo ZHAI,Zheng YANG,Yuchuan WU,Xiaolu SHI,Shunli CHU. Flexible two-stage transalveolar technique for sinus floor elevation for resolution of severe bone height deficiency in maxillary posterior region： A case report and literature review[J]. Journal of Jilin University(Medicine Edition), 2025, 51(5): 1370-1376.

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