>
网站首页期刊介绍通知公告编 委 会投稿须知电子期刊广告合作联系我们
最新消息:
吸烟对上颌窦底植骨种植修复术短期疗效的影响
作者:李国阳2  朱艳香1  王文梅2  王翔2  牟永斌1 
单位:1. 南京大学医学院附属口腔医院/南京市口腔医院 种植科, 江苏 南京 210008;
2. 南京大学医学院附属口腔医院/南京市口腔医院 黏膜科, 江苏 南京 210008
关键词:种植修复 上颌窦底植骨 吸烟 疗效 
分类号:R782.13
出版年·卷·期(页码):2018·37·第六期(960-965)
摘要:

目的:探讨吸烟对上颌窦底植骨种植修复术短期临床疗效的影响。方法:对因上颌后牙区牙齿缺失行种植修复术的981例患者(置入种植体1 911枚)进行随访,从其中行上颌窦底植骨种植修复术的患者中筛选出完全符合入组条件且获有效回访者28例(置入种植体71枚)进行分析,根据患者有无吸烟习惯将其分为吸烟组14例(置入种植体27枚)和非吸烟组14例(置入种植体44枚),平均随访时间为(16±11)个月。比较两组间种植体存留率、边缘骨吸收以及植入窦底的骨粉在术后当日(T1)、术后6个月(T2)和功能负载后随访期(T3)的变化。结果:随访的981例患者中,行上颌窦底植骨种植修复术的吸烟患者种植体存留率(91.0%)明显低于不吸烟者(98.3%),差异有统计学意义(P<0.05)。获有效回访的行上颌窦底植骨种植修复术的28例患者在观察期内无种植体脱落。与T1期比较,T2期吸烟组和非吸烟组种植体的边缘骨在颊侧、腭侧、近中和远中均表现为吸收(P<0.05),但两组之间的边缘骨吸收在4个方向上差异均无统计学意义。与T1期比较,T3期两组种植体的边缘骨在颊侧、腭侧、近中和远中均表现为吸收(P<0.05),且腭侧边缘骨吸收吸烟组[(-0.78±0.91)mm]比非吸烟组[(-0.34±0.59)mm]明显(P<0.05),颊侧、近中、远中边缘骨吸收在两组间无显著性差异。与T1期比较,T2、T3期吸烟组、非吸烟组上颌窦底植入的骨粉均有吸收(P<0.05),但两组间骨粉吸收差异无统计学意义。吸烟组与非吸烟组植入窦底骨粉的密度在T2期有增加,而在T3期则出现下降趋势,但较之T1期仍表现为密度升高,两组间差异无统计学意义。结论:上颌窦底植骨种植修复术后短期功能负载的患者中,吸烟组种植体的存留率明显低于不吸烟组,且与烟雾接触面积大的腭侧边缘骨吸收比不吸烟组的腭侧明显,一定程度上反映出吸烟是上颌窦底植骨种植修复术的危险因素,可能与术后种植体的存留率降低、边缘骨吸收增加相关。

Objective:To evaluate the short-term clinical effects of smoking on maxillary sinus augmentation with dental implant. Methods:Nine hundred and eighty-one patients (1 911 implants) who were treated with dental implantation for maxillary posterior tooth loss were followed up. Among them, 28 patients (71 implants) who were treated with maxillary sinus augmentation and followed-up effectively were analyzed and divided into two groups according to smoking condition:the smoking group (14 patients treated with 27 implants) and the non-smoking group (14 patients treated with 44 implants). The average follow-up time was (16±11) months.The survival rate of implants, marginal bone loss (MBL) and the changes of bone substitutes in sinus floor of the two groups were recorded and compared at the day of surgery(T1), 6 months (T2), and follow-up after functional loading (T3).Results:Among the 981 patients, the implant survival rate in the smoking group (91.9%) treated with maxillary sinus augmentation was statistically significantly lower than that of non-smoking the group (99%) (P<0.05). Twenty-eight patients who were treated with maxillary sinus augmentation and followed-up effectively were found no loss of implants during the observation period. Compared with T1, MBL of the both groups showed reduction in the buccal and palatal side, mesial and distal side at T2 (all P<0.05). But there was no statistically significant difference in MBL of 4 directions between the two groups. At T3, MBL of the both groups showed significant reduction in the buccal and palatal side, mesial and distal side compared with baseline (T1). MBL in palatal side of smoking group[(-0.78±0.91) mm] was more obviously than that of non-smoking group[(-0.34±0.59) mm] (P<0.05). And MBL in buccal, mesial and distal side of the both groups showed no statistical difference. Compared with T1, the obvious bone substitutes absorption of the maxillary sinus was found in the both groups at T2 and T3(all P<0.05), with no statistical difference between the two groups. In the both groups, the density of bone powder implanted into sinus floor increased at T2, and decreased at T3, which was still higher compared to baseline(T1). Conclusions:In the patients with short-term functional load after maxillary sinus augmentation with dental implant, the survival rate of implant in the smoking group is significantly lower than that in the non-smoking group. And the MBL of palatal side largely exposed to smoke in smoking group is more obvious compared with non-smoking group. To some extent, smoking is a risk factor for maxillary sinus augmentation with dental implant, which may be closely related to the decrease of implant survival rate and the increase of marginal bone loss.

参考文献:

[1] LEE J,TANEJA V,VASSALLO R.Cigarette smoking and inflammation:cellular and molecular mechanisms[J].J Dent Res,2012,91(2):142-149.
[2] WHEELER S L,HOLMES R E,CALHOUN C J.Six-year clinical and histologic study of sinus-lift grafts[J].Int J Oral Maxillofac Implants,1996,11(1):26-34.
[3] CHAMBRONE L,PRESHAW P M, FERREIRA J D,et al.Effects of tobacco smoking on the survival rate of dental implants placed in areas of maxillary sinus floor augmentation:a systematic review[J].Clin Oral Implants Res,2014,25(4):408-416.
[4] LEVIN L.Smoking may decrease the survival rate of dental implants placed in areas of maxillary sinus floor augmentation[J].J Evid Based Dent Pract,2014,14(4):183-184.
[5] FELDMAN C,ANDERSON R.Cigarette smoking and mechanisms of susceptibility to infections of the respiratory tract and other organ systems[J].J Infect,2013,67(3):169-184.
[6] GHASEMI S,FOTOUHI A,MOSLEMI N,et al.Intra-and postoperative complications of lateral maxillary sinus augmentationin smokers vs nonsmokers:a systematic review and meta-analysis[J].Int J Oral Maxillofac Implants,2017,32(4):759-767.
[7] GALINDO-MORENO P,FERNANDEZ-JIMENEZ A,AVILA-ORTIZ G,et al.Marginal bone loss around implants placed in maxillary native bone or grafted sinuses:a retrospective cohort study[J].Clin Oral Implants Res,2014,25(3):378-384.
[8] SAKKA S,COULTHARD P.Bone quality:a reality for the process of osseointegration[J].Implant Dent,2009,18(6):480-485.
[9] FRANCESCHETTI G,FARINA R,STACCHI C,et al.Radiographic outcomes of transcrestal sinus floor elevation performed with a minimally invasive technique in smoker and non-smoker patients[J].Clin Oral Implants Res,2014,25(4):493-499.
[10] 孔祥槐, 胡圣望.上颌后牙种植术与上颌窦的关系探讨[J].现代医学,2011,39(3):339-340.
[11] CRIVELLARO V R,ZIELAK J C,DELIBERADOR T M,et al.Pneumatization within a maxillary sinus graft:a case report[J].Int J Implant Dent,2016,2(1):3.
[12] MOHLHENRICH S C,HEUSSEN N,ELVERS D,et al.Compensating for poor primary implant stability in different bone densities by varying implant geometry:a laboratory study[J].Int J Oral Maxillofac Surg,2015,44(12):1514-1520.
[13] PASQUALI P J,TEIXEIRA M L,de OLIVEIRA T A,et al.Maxillary sinus augmentation combining bio-oss with the bone marrow aspirate concentrate:a histomorphometric study in humans[J].Int J Biomater,2015,2015:121286.
[14] BASSI A P,PIOTO R,FAVERANI L P,et al.Maxillary sinus lift without grafting, and simultaneous implant placement:a prospective clinical study with a 51-month follow-up[J].Int J Oral Maxillofac Surg,2015,44(7):902-907.

服务与反馈:
文章下载】【发表评论】【查看评论】【加入收藏
提示:您还未登录,请登录!点此登录
您是第 169525 位访问者


copyright ©《东南大学学报(医学版)》编辑部
联系电话:025-87232481 83272483
电子邮件:
bjb@pub.seu.edu.cn

苏ICP备09058364