[Clinical evaluation of two transalveolar methods for sinus augmentation with placing 1 204 implants immediately].

Objective: To compare the clinical outcomes of posterior maxillary implant surgery when using the regular transalveolar approach or with the crestal approach-sinus (CAS-KIT), a device for maxillary sinus membrane elevation by the crestal approach using a special drilling system and hydraulic pressure. Methods: In this retrospective study 887 patients during Jan 2012 to July 2015 in Hangzhou Dental Hospital with underwent either regular transalveolar approach or CAS-KIT approach for maxillary augmentation; whereas 11 patients dropped out for the reason of serious membrane perforations. Totally, 876 patients with 1 204 plants, placed immediately after transalveolar maxillary augmentation, were included in this study. The data analysis was performed by radiological measures to assess the changes in height of maxillary sinus floor after the transalveolar augmentation at different time points. In addition, the complications after surgery, failure rates, osseointegration condition and the performance of rehabilitation were evaluated as well. Results: Five hundred and three patients were experienced with regular transalveolar approach, and 7 patients were drop out for the serious membrane perforations. Thus, 496 patients received 653 implants in this group; the average lifted range in maxillary sinus floor height changes was (4.08±3.45) mm. The complications were minor membrane perforations during procedure in 64 patients, postoperative maxillary sinus infection happening in 2 patients and 13 patients experienced rehabilitation failure. Three hundred and eighty-four patients had CAS-KIT approach with 4 patients dropped out. Three hundred and eighty patients get 551 implants with the mean lifted range of (8.36±4.07) mm in maxillary sinus floor height changes. Minor membrane perforations during procedure occurred in 31 people and 2 got postoperative maxillary sinus infection. The 4 year overall survival rate of 1 204 implants was 97.26%, with four implants fell off after 3 months of rehabilitation and one implant occurred after one year of rehabilitation. Conclusions: The regular transalveolar sinus lift technique is easier and time saving, but the compromised lifting range in maxillary sinus floor height and the comparatively high occurrence of intraoperative membrane perforations should be concerned. Using CAS-KIT could be an alternative method to perform maxillary sinus augmentation with a reduced incidence of complications. There was no statistically difference in implant failure rates and incidence of postoperative maxillary sinus infection between two groups.目的： 分析比较冲顶提升法和CAS-KIT（crestal approach-sinus kit）工具提升法在上颌后牙区种植手术中的应用效果，为临床提供参考。 方法： 收集2012年1月至2015年6月杭州口腔医院种植中心887例分别采用上颌窦底冲顶提升法（冲顶组）和CAS-KIT工具提升法（CAS-KIT组）进行上颌窦底提升手术并同期种植的患者，因术中穿孔放弃植入11例患者的11个种植位点，共计876例患者同期植入1 204枚植体，其中冲顶组496例（653枚植体），CAS-KIT组380例（551枚植体）。分别在术前、术后即刻、术后1周、1个月、修复前、修复后3个月及0.5、1、2、3、4年检查两组种植位点的术前窦底高度、提升后窦底高度、提升幅度以及出现的并发症、失败情况、骨结合情况和修复后种植体存留情况，并进行统计学分析。 结果： 冲顶组窦底高度提升幅度[（4.08±3.45）mm]显著小于CAS-KIT组[（8.36±4.07）mm]（P<0.01）；冲顶组修复前植体脱落13枚，术中穿孔64例（穿孔率9.80%），术后上颌窦感染2例；CAS-KIT组修复前脱落15枚，术中穿孔31例（穿孔率5.63%），术后上颌窦感染2例；CAS-KIT组术中穿孔率显著小于冲顶组（P<0.01）。1 204枚种植体的4年存留率为97.26%（1 171/1 204）。4年内共33枚植体发生脱落。 结论： 冲顶法提升术方法简单、手术时间短，但提升幅度较小，术中穿孔率较高；CAS-KIT工具提升法手术简单，手术时间中等，提升幅度较大，穿孔率低。两种方法术后失败率和上颌窦感染发生率无显著差异。.