One-stage or Two-stage In Sinus Augmentation?

最近整理電腦,發現2010年的一篇自己寫的小文章,還記得考專科醫師時候,委員們也有問到類似的問題,後來回想自己沒有回答得很好,趁這次機會複習一下:

文章完成日2010/9/9,文章第一次編修2014/3/3

要不要同時放置植體,主要取決於residual bone height。

根據Summer 1994, osteotome technique 同時implant placement 至少需要5-6mm residual bone height. Zitzmann 1998 建議 ≦4 mm residual bone height,應進行two-stage implantation with lateral approach。4-6mm 建議one-stage implantation with lateral approach。而≧6mm則進行one-stage implantation by osteotome technique

如果以implant survival or failure rate考量,以crestal approach and simultaneous implantation較著名的study 有兩篇。Rosen 1999提出4mm or less residual bone height,survival rate 為85.7%, 5mm more survival rate 則提升至96%。Toffler 2004也做過相關的study,4mm or less residual bone height 失敗率為26.7,5mm or more bone,失敗率則降到5.1~5.5%。

另外,醫師的手術經驗、不同植體系統、螺紋設計,都會使得implant primary stability不同。能不能夠在有限的residual bone height達到理想的implant primary stability,才是決定simultaneous approach or two-staged implantation的關鍵。

Related article : Crestal Approach or Lateral Approach In Sinus Lift?

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