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Sinusbodenelevation und -augmentation

Evidenzgestützte Aussagen zu Prognose und Risikofaktoren

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Zusammenfassung

Ziel

Ziel der vorliegenden Arbeit war die Analyse der Evidenzlage und die Gewinnung evidenzgestützter Erkenntnisse zu Prognose beeinflussenden Faktoren bei der Sinusbodenelevation und -augmentation (SBEA).

Material und Methoden

Eine MEDLINE-Literaturrecherche unter Auswertung der Literatur von 1990 bis 2002 wurde mittels spezifischer Suche zu den Begriffen „sinus floor elevation and dental implants“, „complications“ und „success“ nach Limitierung (randomisierte oder klinische prospektive Studien, retrospektive Studien, Reviews, englisch oder deutsch) durchgeführt.

Ergebnisse

Von 229 aufgefundenen Publikationen erfüllten 72 die Einschlusskriterien (22 prospektive und 47 retrospektive Studien, 3 Reviews). Die Implantatverlustrate unterschied sich in Bezug auf die verwendeten Augmentationsmaterialien (autologer Knochen [aK], Knochenersatzmaterial [KEM] und aK kombiniert mit KEM) nicht signifikant (8%, 9% bzw. 5%, p>0,09) nach 2–4 Jahren Beobachtungszeit. Die durchschnittliche Einheilungszeit betrug bei einzeitigem Vorgehen 6 Monate (aK) bzw. 8 Monate (KEM), bei zweizeitigem Vorgehen nach 6-monatiger Integrationszeit des Augmentats 6–7 Monate (aK und KEM). Die Implantatverluste unterschieden sich in Bezug auf die einzeitige oder zweizeitige SBEA und Implantation nicht (7–8%). In 3–8% traten postoperative Sinusitiden auf. Als Prädiktoren für das Auftreten von Komplikationen wurden das Rauchen, anamnestische Sinusitiden, obstruktive Veränderungen der Nase bzw. des Ostium naturale, eine Rhinitis allergica, die Verwendung kurzer Implantate (<13 mm), die Behandlung des zahnlosen Oberkiefers (im Vergleich zum teilbezahnten Oberkiefer), Bruxismus und unkontrollierte Frühbelastungen der Implantate identifiziert.

Schlussfolgerung

Die SBEA ist bei kritischer Indikationsstellung bei einer mittleren kumulativen Implantatverweilrate von 90% nach 4 Jahren als wissenschaftlich fundierte und etablierte Methode zur implantatprothetischen Rehabilitation des posterioren atrophierten Oberkiefers anzusehen.

Abstract

Aim

It was the aim of this investigation to analyze evidence of prognosis, predictors, and risk factors concerning sinus floor elevation and augmentation (SFEA).

Materials and methods

A MEDLINE search was performed to analyze the literature published between 1990 and 2002, limited to keywords (“sinus floor elevation and dental implants”, “complications”, “success”), study type (randomized as well as clinical prospective studies, retrospective studies, reviews), and language (German or English).

Results

Of 229 publications identified, 72 met the inclusion criteria (22 prospective and 47 retrospective studies, 3 reviews). Considering the augmentation material [autogenous bone (AB), bone substitution materials (BSM), and combinations of AB and BSM], the frequency of implant loss was not significantly different (AB 8%, BSM 9%, AB + BSM 5%, p>0.09) after an observation period of 2–4 years . The average duration of the healing period was 6 months (AB) and 8 months (BSM) with simultaneous SFEA and implantation and 6–7 months (AB and BSM) for the staged approach after an average healing period of 6 months for the augmentation materials. Frequency of implant loss was not different between simultaneous and staged approaches (7–8%). Postoperative sinusitis occurred in 3–8% of the cases. Smoking, positive sinusitis history, obstructive pathoses of the nose and ostium, allergic rhino-pathoses, use of short implants (<13 mm), treatment of edentulous maxilla compared to partially edentulous maxilla, bruxism, and uncontrolled early loading of implants were identified as predictors for complications.

Conclusions

Presupposing proper consideration of indications, SFEA should be considered as an evidence-based and clinically established method for implant prosthetic rehabilitation of the atrophic posterior maxilla with an overall cumulative survival rate of 90% within an average observation period of 4 years.

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  1. Zentrum für Zahnmedizin, Universitätsklinikum Charité der Humboldt-Universität zu Berlin

    F. P. Strietzel

  2. Abteilung für Oralchirurgie und zahnärztliche Röntgenologie, Zentrum für Zahnmedizin, Universitätsklinikum Charité der Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin

    F. P. Strietzel

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Correspondence to F. P. Strietzel.

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Strietzel, F.P. Sinusbodenelevation und -augmentation. Mund Kiefer GesichtsChir 8, 93–105 (2004). https://doi.org/10.1007/s10006-004-0530-3

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