0 Patient Assessment
- 0.1 Patient demand
- 0.2 Overarching considerations
- 0.3 Local history
- 0.4 Anatomical location
- 0.5 General patient history
- 0.6 Risk assessment & special high risk categories
  - 5.1 Risk assessment & special high risk categories
  - 5.2 age
  - 5.3 Compliance
  - 5.4 Smoking
  - 5.5 Drug abuse
  - 5.6 Recreational drugs and alcohol abuse
  - 5.7 Parafunctions
  - 5.8 Diabetes
  - 5.9 Osteoporosis
  - 5.10 Coagulation disorders and anticoagulant therapy
  - 5.11 Steroids
  - 5.12 Bisphosphonates
  - 5.13 BRONJ / ARONJ
  - 5.14 Radiotherapy
  - 5.15 Risk factors
1 Diagnostics
- 1.1 Clinical Assessment
  - 0.1 Lip line
  - 0.2 Mouth opening
  - 0.3 Vertical dimension
  - 0.4 Maxillo-mandibular relationship
  - 0.5 TMD
  - 0.6 Existing prosthesis
  - 0.7 Muco-gingival junction
  - 0.8 Hyposalivation and Xerostomia
- 1.2 Clinical findings
  - 1.1 Occlusion
  - 1.2 Alveolar atrophy and insufficiency
  - 1.3 Skeletal consequences of edentulism
  - 1.4 Head-neck cancer
- 1.3 Clinical diagnostic assessments
  - 2.1 Microbiology
  - 2.2 Salivary output
- 1.4 Diagnostic imaging
  - 3.1 Imaging overview
  - 3.2 Intraoral radiographs
  - 3.3 Panoramic
  - 3.4 CBCT
  - 3.5 CT
- 1.5 Diagnostic prosthodontic guides
  - 4.1 Prosthodontic guides overview
  - 4.2 Wax-up, arrangement, mock-up
  - 4.3 Splints and imaging for surgery
  - 4.4 Provisionals
2 Treatment Options
- 2.1 Mucosally-supported
  - 0.1 Mucosally supported - Overview and important considerations
  - 0.2 Complete denture
  - 0.3 Immediate denture
  - 0.4 Occlusal schemes
- 2.2 Implant-retained/supported, general
  - 1.1 Prosthodontic options overview
  - 1.2 Number of implants maxilla and mandible
  - 1.3 Time to function
  - 1.4 Submerged or non-submerged
  - 1.5 Soft tissue management
  - 1.6 Hard tissue management, mandible
  - 1.7 Hard tissue management, maxilla
  - 1.8 Need for grafting
  - 1.9 Healed vs fresh extraction socket
  - 1.10 Digital treatment planning protocols
    
    9.1 Digital treatment planning protocols, introduction
    
    9.2 Digital treatment planning protocols, NobelClinician
- 2.3 Implant prosthetics - removable
  - 2.1 Implant overdenture, overview
    
    0.1 Implant overdenture, introduction
    
    0.2 Overdenture retention devices, overview
  - 2.2 Secondary splinting
  - 2.3 Primary splinting
- 2.4 Implant prosthetics - fixed
  - 3.1 Fixed implant prosthesis, introduction
  - 3.2 Screw-retained restorations
    
    1.1 Screw-retained
    
    1.2 Implant-supported vs abutment-supported
  - 3.3 Cement-retained restorations
    
    2.1 Cement-retained
    
    2.2 Abutment materials
  - 3.4 Framework materials
    
    3.1 Framework materials
    
    3.2 Veneering with ceramic
    
    3.3 Veneering with Acrylic
- 2.5 Comprehensive treatment concepts
3 Treatment Procedures
- 3.1 Surgical
  - 0.1 Surgical considerations
    
    0.1 Anesthesia
    
    0.2 Peri-operative care
    
    0.3 Post-operative care
    
    0.4 Flap-or flapless
    
    0.5 Wound closure
    
    0.6 Intra-operative complications
    
    0.7 Guided vs non-guided
    
    0.8 Semi-guided surgery with prosthetic template
    
    0.9 Guided surgery with drill guides
  - 0.2 Surgical protocols - general
    
    1.1 Crestal incision
    
    1.2 Choice of implant
    
    1.3 Parallel implant placement
    
    1.4 Tapered implant placement
    
    1.5 Insertion torque
    
    1.6 Insertion height
    
    1.7 Implant angulation
  - 0.3 Surgical protocols - mandible
    
    2.1 Implant placement with open flap procedure - mandible
    
    2.2 Grafting, mandible
  - 0.4 Surgical protocols - maxilla
    
    3.1 Implant placement - maxilla
    
    3.2 Grafting, maxilla
    
    3.3 Sinus lifting
    
    3.4 Zygomatic implants
    
    3.5 Pterygoid implants
    
    3.6 Problems and complications in maxillary implant surgery
- 3.2 Removable prosthetics
  - 1.1 Complete dentures
    
    0.1 Complete denture clinical protocol
    
    0.2 Complete denture impressions
    
    0.3 Complete denture - maxillo-mandibular relations
    
    0.4 Complete denture trial placement
    
    0.5 Complete denture placement
    
    0.6 Complete denture post-placement
  - 1.2 Implant overdentures
    
    1.1 Overdenture clinical protocol
    
    1.2 Implant overdenture impressions
    
    1.3 Implant overdenture maxillo-mandibular relations
    
    1.4 Implant overdenture trial placement
    
    1.5 Implant overdenture placement
    
    1.6 Implant overdenture post-placement
- 3.3 Fixed prosthetics
  - 2.1 Fixed implant prosthesis clinical protocol
  - 2.2 Impressions
    
    1.1 Impressions - overview
    
    1.2 Splinted vs unsplinted impression copings
    
    1.3 Open versus closed tray
    
    1.4 Parallel vs non-parallel
  - 2.3 Maxillo-mandibular relations
  - 2.4 Trial placement
  - 2.5 Framework trial placement
  - 2.6 Placement
  - 2.7 Post-placement
4 Aftercare
- 4.1 Surgical aftercare
  - 0.1 Medication
  - 0.2 Post-operative soft tissue management
  - 0.3 Suture removal
  - 0.4 Post-surgical recommendations
- 4.2 Prosthetic aftercare
  - 1.1 Esthetic and function check
  - 1.2 Provisionals / temporary prosthesis
  - 1.3 Oral hygiene instructions
  - 1.4 Occlusal guard
- 4.3 Post-treatment complications and management
  - 2.1 Bleeding
  - 2.2 Soft tissue and hard tissue
  - 2.3 Patient compliance / recall
  - 2.4 Biologic complications
  - 2.5 Esthetic complications
- 4.4 Recall visits and logistics
  - 3.1 Recall visits - overview
  - 3.2 Patient expectations
  - 3.3 General health check
  - 3.4 Professional oral hygiene
  - 3.5 Implant overdenture maintenance
  - 3.6 Occlusion check
  - 3.7 Probing
  - 3.8 Inflammation, infection
    
    7.1 Inflammation and infection - overview
    
    7.2 Infection, microbiological diagnostics
  - 3.9 Radiological control

治疗指南

Sinus lifting

Key points

在上颌无牙颌的后段，上颌窦移植是最为常用、也是一种非常可预测的垂直骨增量手术
窦底提升术可通过外部或内部（经牙槽嵴）方法来实施
窦底提升术可通过即刻或延期种植体植入（就初期种植体稳定性来说）来实施
对于窦底提升来说，骨替代材料与自体骨效果相同。

适应证

在上颌后段，垂直残留骨高度不足 4-6 mm 即是窦提升手术的一种适应证 [Esposito]。

外部方法

从外部进入上颌窦时，手术实施位置位于侧颊牙槽面，施奈德氏膜将被提升，由此产生的空间将填充移植骨或骨替代品 [Esposito、Schmitt]。种植体可以利用窦提升术即刻植入，也可以延期植入。外部方法的优势之一是便于查看整体情况。关于是否需要用膜来盖住外窗，目前仍在争论当中。

内部方法

内部方法通过植床来实施。经过初期钻牙后，施奈德氏膜将会经牙槽嵴而提升（即采用骨凿），由此产生的空间将填充移植骨或骨替代品。接下来，便是种植体植入。使用侧窦提升法，可以显著增加垂直骨高度 [Esposito 2010]。

治疗方案

种植体可以在进行窦移植的同时植入（一期方法），或者在窦移植后经过 4-8 个月的愈合期（两期方法）再植入 [Esposito、Schmitt]。这取决于初期种植体稳定性。在文献中，适用一期方法的残留骨限制表述为 4 mm [Esposito]。

骨替代品

有多种骨替代材料和/或自体移植骨可用于窦提升术 [Schmitt]。就种植体成活率和新形成骨来说，骨替代品与颗粒自体骨不相上下 [Schmitt]。甚至，有一些种植体在不植入骨替代品的情况下就取得了成功 [Pinchasov 2014]。

并发症

最常见的并发症是施奈德氏膜穿孔。此问题可能会在入路制备和/或膈膜提升期间发生 [Esposito 2010]。小穿孔可用再吸收胶原膜覆盖，然后完成移植手术。如果是大面积穿孔，则必须终止手术，且无法进行移植。必须至少等待 6 个月，然后才能尝试重新手术。

临床分类

后牙种植鼻窦炎

治疗指南

Edentulous

治疗指南

Edentulous

移植（上颌）

在缺齿上颌中，种植体植入可能会因邻近解剖结构（鼻底、上颌窦）而受限。如果高度不足 5-6 mm，宽度不足 6 mm，则在种植体植入前需要进行骨增量。
在上颌前牙区，使用自体骨块移植进行垂直和/或水平骨增量是首选治疗方案（图 1）。作为一种备选方案，异体骨块也是值得关注的焦点，但由于证据有限，因此目前不建议使用。在牙槽嵴移植后，建议留出 4-6 个月的愈合期，然后在第二期手术中植入种植体。

骨移植&再生

鼻窦炎

立即观看

Additional resources

视频

Georg Watzek：无牙颌患者的窦抬高术——有风险的过度治疗或可靠的必要性

Watzek博士从如下方面对有以及没有窦抬高充填手术的移植治疗进行了比较：相对禁忌症和绝对禁忌症，手术中的风险，治疗的时间范围，成功率和成本。作为一个一般准则，手术干预越小，并发症的风险越低。窦抬高术的并发症可以为患者的医疗状况、药物干预、局部解剖条件（例如窦隔、血管穿孔以及随后的出血、膜穿孔以及随后的局部感染和外来物体错位进入窦）。罕见的随机对照数据显示，有进行窦抬高术的移植成功率为92 %，低于没有进行窦抬高术的移植成功率97%。相比之下，All-on-4®治疗方案仅需要一次手术干预，其术中风险较低，即刻种植情况中滑动现象和植体错位是最显着的并发症...

引导手术

无牙颌治疗

翻瓣种植

立即观看

问题

登陆或注册后发表评论

问题反馈

Sinus lifting

临床分类

Related articles

治疗指南

移植需要

治疗指南

移植（上颌）

Additional resources

视频

Georg Watzek：无牙颌患者的窦抬高术——有风险的过度治疗或可靠的必要性

问题

Sinus lifting

适应证

外部方法

内部方法

治疗方案

骨替代品

并发症

临床分类

Related articles

治疗指南

移植需要

治疗指南

移植（上颌）

Additional resources

视频

Georg Watzek：无牙颌患者的窦抬高术——有风险的过度治疗或可靠的必要性

Scientific References

问题