Objective: To investigate the ameliorative effect of alveolar ridge preservation (ARP) on maxillary sinus mucosal thickening caused by severe periodontitis, as well as its positive significance in preventing the occurrence of pathological maxillary sinus pneumatization. Methods: This retrospective study included 49 patients with severe periodontitis who underwent unilateral ARP of maxillary molar at the Department of Periodontology, School and Hospital of Stomatology, China Medical University, between April 2020 and April 2025. A total of 98 sites were analyzed, including 49 ARP sites and 49 contralateral control sites. According to the completeness of follow-up cone beam CT (CBCT) data and the study objectives, the analysis was divided into two parts: ①Longitudinal study: 31 patients with complete preoperative and 6-month postoperative CBCT records were included (31 ARP sites) to evaluate changes in residual alveolar bone height and maxillary sinus vertical height before and after surgery. Among these, 18 sites with odontogenic maxillary sinusitis (OMS) at baseline were further analyzed for changes in Schneiderian membrane thickness. ②Cross-sectional study: 40 patients with complete 6-month postoperative CBCT records were included (80 sites in total). The maxillary sinus vertical height at ARP sites was compared with that at contralateral naturally healed post-extraction sites (12 pairs) or contralateral healthy natural tooth sites (28 pairs). Results: In the longitudinal analysis, the vertical alveolar bone height at ARP sites significantly increased from 3.60(1.77, 5.82) mm at baseline to 6.84(4.96, 9.46) mm at 6 months postoperatively (n=31, Z=4.74, P<0.05), whereas no significant change was observed in maxillary sinus vertical height (P>0.05). At sites with OMS, Schneiderian membrane thickness significantly decreased from 5.13 (3.17, 10.90) mm preoperatively to 1.19 (0.57, 2.09) mm at 6 months postoperatively (n=18, Z=-3.62, P<0.05). In the cross-sectional analysis, the maxillary sinus vertical height at ARP sites [33.69 (28.97, 36.70) mm] was significantly lower than that at contralateral naturally healed post-extraction sites [36.45(32.76, 39.08) mm] (n=12, Z=2.98, P<0.01), while with no significant difference compared to contralateral healthy natural tooth sites (P>0.05). After adjustment for age and sex, maxillary sinus vertical height was negatively correlated with residual alveolar bone height (rpartial=-0.448, P<0.001). Conclusions: ARP may help reduce Schneiderian membrane thickening associated with severe periodontitis and may have potential clinical value in limiting post-extraction maxillary sinus pneumatization. 目的： 探究牙槽嵴保存术（ARP）对重度牙周炎所致上颌窦黏膜增厚的改善效果，以及对预防病理性上颌窦气化发生的积极意义。 方法： 回顾性纳入2020年4月至2025年4月于中国医科大学口腔医学院·附属口腔医院牙周病科因重度牙周炎行单侧上颌磨牙ARP的患者49例，共获取98个位点（含49个ARP患牙位点及49个对侧对照位点）。根据随访锥形束CT（CBCT）资料的完整性与研究目的，研究分为两部分：①纵向研究，纳入具备完整术前及术后6个月CBCT资料的31例患者（31个ARP位点），观察术前、术后剩余牙槽骨高度及上颌窦垂直高度变化；并选取其中基线伴发牙源性上颌窦炎（OMS）的18个位点，分析上颌窦底黏膜厚度的变化；②横向研究，纳入具备完整术后6个月CBCT资料的40例患者（共80个位点），比较ARP侧与对侧拔牙后自然愈合位点（12对）或对侧健康天然牙（28对）的上颌窦垂直高度差异。 结果： 纵向研究结果显示，相较于术前基线水平，ARP术后6个月31例患者（31个位点）牙槽骨垂直高度由［3.60（1.77，5.82）mm］显著提升至［6.84（4.96，9.46）mm］（Z=4.74，P<0.05），上颌窦垂直向高度与术前相比差异无统计学意义（P>0.05）；存在OMS的位点，术前18例患者（18个位点）上颌窦底黏膜厚度值［5.13（3.17，10.90）mm］在术后6个月显著降低至［1.19（0.57，2.09）mm］（Z=-3.62，P<0.05）。横向研究结果显示，12例患者（12个位点）ARP术后位点的上颌窦垂直高度［33.69（28.97，36.70）mm］显著低于对侧拔牙后自然愈合位点［36.45（32.76，39.08）mm］（Z=2.98，P<0.01），与对侧健康天然牙的上颌窦垂直高度相比差异无统计学意义（P>0.05）。在校正年龄与性别因素后，上颌窦垂直高度与剩余牙槽骨高度呈负相关关系（偏相关系数rpartial=-0.448，P<0.001）。 结论： ARP有助于改善重度牙周炎引起的上颌窦底黏膜炎性增厚，并可能在减少拔牙后上颌窦气化方面具有潜在临床价值。.
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arXiv · 2025-11-18
arXiv · 2022-05-17
arXiv · 2025-11-18