上颌窦气化对微种植体植入颧牙槽嵴区域时骨质厚度的影响

doi:10.3969/j.issn.1674-8115.2026.06.009

摘要/Abstract

摘要：

目的·探讨上颌窦气化（maxillary sinus pneumatization，MSP）程度对植入颧牙槽嵴（infrazygomatic crest，IZC）区域的微种植体（miniscrew implant，MI）植入路径上全层骨质厚度（bone thickness，BT）和全层皮质骨厚度（cortal bone thickness，CBT）的影响。方法·选取18~34岁成人正畸患者，分析其初诊时采集的锥形束计算机断层扫描（cone-beam computed tomography，CBCT）数据；根据其上颌第一磨牙近中颊根根尖至上颌窦底距离（sinus floor-apex，SFA）将样本分为3组：高窦底组（HS组），SFA≥3 mm；中窦底组（MS组），0 mm≤SFA<3 mm；低窦底组（LS组），SFA<0 mm。在上颌第一磨牙近中颊根（U6M）、上颌第一磨牙远中颊根（U6D）和上颌第二磨牙近中颊根（U7M）根尖水平及其颅方2 mm处，分别沿与腭平面呈50°或60°角植入MI，测量植入路径上的BT和CBT并进行比较。结果·共有87例患者被纳入研究，其中HS组（n=33）SFA为（4.88±1.32）mm，MS组（n=27）SFA为（1.57±0.76）mm，LS组（n=27）SFA为（-1.82±0.96）mm。在U6M、U6D处植入时，各组的BT和CBT均随MSP程度增大而减小；在U7M处植入时BT和CBT在HS组与MS组间比较，差异无统计学意义，但均厚于LS组（均P<0.05）。MS组和LS组在不同矢状位点上的BT比较，差异无统计学意义。HS组在远中方向上BT逐渐减小。所有组均显示出越向颅方BT越薄的趋势。HS组在根尖水平以50°角植入时，与60°角植入时比较，获得较厚的BT；在根尖颅方2 mm处以50°与60°角植入，BT无显著差异。MS组在根尖水平及其颅方2 mm处以60°角植入时，均可获得较50°角更厚的BT。LS组在根尖颅方2 mm处以60°角植入时，可获得较50°角更厚的BT；但以50°或60°角植入，LS组均无法获得充足BT。结论·IZC区BT和CBT随MSP程度增大而显著减小。HS患者可在IZC区安全植入MI，MS患者可在根尖水平植入MI；而对于LS患者，不推荐在IZC区植入MI。

关键词: 上颌窦气化, 成人, 颧牙槽嵴, 微种植体, 锥形束计算机断层扫描

Abstract:

Objective ·To investigate the effect of the degree of maxillary sinus pneumatization (MSP) on total bone thickness (BT) and cortical bone thickness (CBT) along the insertion path of miniscrew implants (MIs) placed in the infrazygomatic crest (IZC) region. Methods ·Young adult orthodontic patients aged 18‒34 years were included. Cone-beam computed tomography (CBCT) data collected at the initial visit were analyzed. Based on the distance from the apex of the mesiobuccal root of the maxillary first molar to the sinus floor (sinus floor-apex distance, SFA), the samples were divided into three groups: high sinus floor group (HS group, SFA≥3 mm), middle sinus floor group (MS group, 0 mm ≤ SFA < 3 mm), and low sinus floor group (LS group, SFA<0 mm). MIs were placed at angles of 50° or 60° relative to the palatal plane at the apex levels of the mesiobuccal root of the maxillary first molar (U6M), the distobuccal root of the maxillary first molar (U6D), and the mesiobuccal root of the maxillary second molar (U7M), as well as 2 mm cranial to these apex levels. BT and CBT along the insertion path were measured and compared. Results ·A total of 87 patients were included: HS group (n=33) with an SFA of (4.88±1.32) mm, MS group (n=27) with an SFA of (1.57±0.76) mm, and LS group (n=27) with an SFA of (-1.82±0.96) mm. At the U6M and U6D insertion sites, BT and CBT in all groups decreased as the degree of MSP increased. At U7M, no statistically significant differences in BT and CBT were found between the HS and MS groups, but both were greater than those in the LS group (all P<0.05). No statistically significant differences in BT were observed between the MS and LS groups at different sagittal sites. In the HS group, BT gradually decreased in the distal direction. All groups showed a trend toward thinner BT in the more cranial direction. In the HS group, at the apex level, a 50° insertion angle resulted in greater BT than a 60° insertion angle; at 2 mm cranial to the apex, no significant difference in BT was found between the 50° and 60° insertion angles. In the MS group, at both the apex level and 2 mm cranial to the apex, a 60° insertion angle provided greater BT than a 50° insertion angle. In the LS group, at 2 mm cranial to the apex, a 60° insertion angle provided greater BT than a 50° insertion angle; however, regardless of whether a 50° or 60° insertion angle was used, sufficient BT could not be obtained in the LS group. Conclusion ·BT and CBT decreased significantly with increasing MSP in the IZC region. For HS patients, MI placement in the IZC region is generally safe. For MS patients, MI placement at the apex level is relatively safe. For LS patients, MI placement in the IZC region is not recommended.

Key words: maxillary sinus pneumatization, adult, infrazygomatic crest, miniscrew implant, cone-beam computed tomography

中图分类号:

R783.5

张舒婷, 杨鑫. 上颌窦气化对微种植体植入颧牙槽嵴区域时骨质厚度的影响[J]. 上海交通大学学报（医学版）, 2026, 46(6): 770-777.

Zhang Shuting, Yang Xin. Effects of maxillary sinus pneumatization on bone thickness of infrazygomatic crest for miniscrew implant placement[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(6): 770-777.

图/表 6

图1 植入位点测量Note： CEJ—cementoenamel junction level.H1—Apex level.H2—2 mm cranial to the apex level. E,F,H,G,L,K,M, and N are the intersections between the cancellous bone and cortical bone along the implantation paths. C, D, I, and J are the intersections between the cortical bone of the maxillary sinus floor and the soft tissue of the maxillary sinus along the implantation paths. A50-BT=AD, A60-BT=AJ, B50-BT=BC, B60-BT=BI. A50-CaBT=GH, A60-CaBT=MN, B50-CaBT=EF, B60-CaBT=KL.

Fig 1 Insertion site measurements

表1 各种植入路径下不同窦底高度组间的BT及CBT比较（mm）

Tab 1 Comparison of BT and CBT among different sinus floor height groups under various insertion paths （mm）

Insertion path	U6M		U6D		U7M
Insertion path	$x ¯$ ±s	P value	$x ¯$ ±s	P value	$x ¯$ ±s	P value
A50-BT		<0.001		<0.001		0.012
HS	6.79±2.21		5.67±1.71		4.05±1.69
MS	4.03±1.02		3.96±1.03		4.35±0.88
LS	2.28±0.82		2.27±0.81		2.64±1.54
A60-BT		<0.001		<0.001		0.002
HS	6.35±1.97		5.42±1.47		4.19±1.62
MS	4.13±1.06		3.96±1.06		4.47±1.00
LS	2.30±0.83		2.29±0.87		2.54±1.36
B50-BT		<0.001		<0.001		0.028
HS	4.91±1.38		4.19±1.34		3.08±1.29
MS	3.14±0.94		2.96±0.98		3.21±0.91
LS	1.87±0.64		1.84±0.65		2.09±1.01
B60-BT		<0.001		<0.001		0.017
HS	4.98±1.83		4.21±1.35		3.22±1.32
MS	3.27±1.04		2.99±1.00		3.35±1.01
LS	1.94±0.66		1.90±0.68		2.12±0.98
A50-CBT		<0.001		<0.001		0.002
HS	3.49±0.73		3.31±0.69		3.09±0.95
MS	3.12±0.77		2.97±0.67		3.43±0.87
LS	2.19±0.65		2.08±0.54		2.16±0.68
A60-CBT		<0.001		<0.001		<0.001
HS	3.62±0.88		3.52±0.78		3.37±0.91
MS	3.42±0.79		3.11±0.61		3.96±1.08
LS	2.23±0.70		2.09±0.59		2.28±0.74
B50-CBT		<0.001		<0.001		0.002
HS	3.42±0.82		2.99±0.65		2.73±0.81
MS	3.01±0.80		2.63±0.63		2.96±0.87
LS	1.84±0.66		1.78±0.55		1.89±0.50
B60-CBT		<0.001		<0.001		<0.001
HS	3.53±0.94		3.12±0.70		2.90±0.89
MS	3.14±0.86		2.72±0.68		3.13±0.88
LS	1.94±0.66		1.86±0.60		1.95±0.51

表1 各种植入路径下不同窦底高度组间的BT及CBT比较（mm）

Tab 1 Comparison of BT and CBT among different sinus floor height groups under various insertion paths （mm）

Insertion path	U6M		U6D		U7M
Insertion path	$x ¯$ ±s	P value	$x ¯$ ±s	P value	$x ¯$ ±s	P value
A50-BT		<0.001		<0.001		0.012
HS	6.79±2.21		5.67±1.71		4.05±1.69
MS	4.03±1.02		3.96±1.03		4.35±0.88
LS	2.28±0.82		2.27±0.81		2.64±1.54
A60-BT		<0.001		<0.001		0.002
HS	6.35±1.97		5.42±1.47		4.19±1.62
MS	4.13±1.06		3.96±1.06		4.47±1.00
LS	2.30±0.83		2.29±0.87		2.54±1.36
B50-BT		<0.001		<0.001		0.028
HS	4.91±1.38		4.19±1.34		3.08±1.29
MS	3.14±0.94		2.96±0.98		3.21±0.91
LS	1.87±0.64		1.84±0.65		2.09±1.01
B60-BT		<0.001		<0.001		0.017
HS	4.98±1.83		4.21±1.35		3.22±1.32
MS	3.27±1.04		2.99±1.00		3.35±1.01
LS	1.94±0.66		1.90±0.68		2.12±0.98
A50-CBT		<0.001		<0.001		0.002
HS	3.49±0.73		3.31±0.69		3.09±0.95
MS	3.12±0.77		2.97±0.67		3.43±0.87
LS	2.19±0.65		2.08±0.54		2.16±0.68
A60-CBT		<0.001		<0.001		<0.001
HS	3.62±0.88		3.52±0.78		3.37±0.91
MS	3.42±0.79		3.11±0.61		3.96±1.08
LS	2.23±0.70		2.09±0.59		2.28±0.74
B50-CBT		<0.001		<0.001		0.002
HS	3.42±0.82		2.99±0.65		2.73±0.81
MS	3.01±0.80		2.63±0.63		2.96±0.87
LS	1.84±0.66		1.78±0.55		1.89±0.50
B60-CBT		<0.001		<0.001		<0.001
HS	3.53±0.94		3.12±0.70		2.90±0.89
MS	3.14±0.86		2.72±0.68		3.13±0.88
LS	1.94±0.66		1.86±0.60		1.95±0.51

表2 不同植入路径下U7M处不同窦底高度组间BT和CBT测量的事后检验（mm）

Tab 2 Post-hoc tests for BT and CBT among different sinus floor height groups at the U7M site under various insertion paths （mm）

Insertion path		$x ¯$ ±s	P value	Insertion path		$x ¯$ ±s	P value
A50-BT				A50-CBT
HS	MS	-0.30±0.56	0.598	HS	MS	-0.34±0.32	0.305
HS	LS	1.41±0.53	0.012	HS	LS	0.93±0.31	0.005
MS	LS	1.71±0.61	0.008	MS	LS	1.27±0.35	<0.001
A60-BT				A60-CBT
HS	MS	-0.28±0.53	0.605	HS	MS	-0.60±0.35	0.093
HS	LS	1.66±0.51	0.002	HS	LS	1.09±0.33	0.002
MS	LS	1.93±0.58	0.002	MS	LS	1.69±0.37	<0.001
B50-BT				B50-CBT
HS	MS	-0.12±0.43	0.771	HS	MS	-0.24±0.28	0.407
HS	LS	0.99±0.40	0.019	HS	LS	0.83±0.27	0.004
MS	LS	1.12±0.46	0.020	MS	LS	1.07±0.31	<0.001
B60-BT				B60-CBT
HS	MS	-0.14±0.44	0.752	HS	MS	-0.23±0.30	0.454
HS	LS	1.09±0.41	0.012	HS	LS	0.95±0.29	0.002
MS	LS	1.23±0.47	0.013	MS	LS	1.18±0.33	<0.001

表2 不同植入路径下U7M处不同窦底高度组间BT和CBT测量的事后检验（mm）

Tab 2 Post-hoc tests for BT and CBT among different sinus floor height groups at the U7M site under various insertion paths （mm）

Insertion path		$x ¯$ ±s	P value	Insertion path		$x ¯$ ±s	P value
A50-BT				A50-CBT
HS	MS	-0.30±0.56	0.598	HS	MS	-0.34±0.32	0.305
HS	LS	1.41±0.53	0.012	HS	LS	0.93±0.31	0.005
MS	LS	1.71±0.61	0.008	MS	LS	1.27±0.35	<0.001
A60-BT				A60-CBT
HS	MS	-0.28±0.53	0.605	HS	MS	-0.60±0.35	0.093
HS	LS	1.66±0.51	0.002	HS	LS	1.09±0.33	0.002
MS	LS	1.93±0.58	0.002	MS	LS	1.69±0.37	<0.001
B50-BT				B50-CBT
HS	MS	-0.12±0.43	0.771	HS	MS	-0.24±0.28	0.407
HS	LS	0.99±0.40	0.019	HS	LS	0.83±0.27	0.004
MS	LS	1.12±0.46	0.020	MS	LS	1.07±0.31	<0.001
B60-BT				B60-CBT
HS	MS	-0.14±0.44	0.752	HS	MS	-0.23±0.30	0.454
HS	LS	1.09±0.41	0.012	HS	LS	0.95±0.29	0.002
MS	LS	1.23±0.47	0.013	MS	LS	1.18±0.33	<0.001

图2 HS组在相同植入高度和角度下不同矢状植入位点BT比较

Fig 2 Comparison of BT among sagittal insertion sites in the HS Group under the same insertion height and angulation

图3 以50°或60°角植入时不同植入高度下BT比较Note： A.A50-BT and B50-BT. B.A60-BT and B60-BT.

Fig 3 Comparison of BT between two insertion heights at 50°or 60° insertion angles

表3 不同植入高度下以50°及60°角植入时BT比较（mm）

Tab 3 Comparison of BT between 50° and 60° insertion angles at two insertion heights （mm）

Insertion height	HS		MS		LS
Insertion height	$x ¯$ ±s	P value	$x ¯$ ±s	P value	$x ¯$ ±s	P value
A50-BT	6.79±2.21	0.036	4.03±1.02	0.037	2.28±0.82	0.244
A60-BT	6.35±1.97		4.13±1.06		2.30±0.83
B50-BT	4.91±1.38	0.749	3.14±0.94	<0.001	1.87±0.64	<0.001
B60-BT	4.98±1.83		3.27±1.04		1.94±0.66

表3 不同植入高度下以50°及60°角植入时BT比较（mm）

Tab 3 Comparison of BT between 50° and 60° insertion angles at two insertion heights （mm）

Insertion height	HS		MS		LS
Insertion height	$x ¯$ ±s	P value	$x ¯$ ±s	P value	$x ¯$ ±s	P value
A50-BT	6.79±2.21	0.036	4.03±1.02	0.037	2.28±0.82	0.244
A60-BT	6.35±1.97		4.13±1.06		2.30±0.83
B50-BT	4.91±1.38	0.749	3.14±0.94	<0.001	1.87±0.64	<0.001
B60-BT	4.98±1.83		3.27±1.04		1.94±0.66

参考文献 25

[1]	Khan J, Goyal M, Kumar M, et al. Comparative evaluation of displacement and stress distribution pattern during maxillary arch distalization with Infra Zygomatic Screw: a three dimensional finite element study[J]. Int Orthod, 2021, 19(2): 291-300.
[2]	Shaikh A, Jamdar A F, Galgali S A, et al. Efficacy of infrazygomatic crest implants for full-arch distalization of maxilla and reduction of gummy smile in class II malocclusion[J]. J Contemp Dent Pract, 2021, 22(10): 1135-1143.
[3]	Wu X X, Liu H B, Luo C, et al. Three-dimensional evaluation on the effect of maxillary dentition distalization with miniscrews implanted in the infrazygomatic crest[J]. Implant Dent, 2018, 27(1): 22-27.
[4]	Lima A Jr, Domingos R G, Cunha Ribeiro A N, et al. Safe sites for orthodontic miniscrew insertion in the infrazygomatic crest area in different facial types: a tomographic study[J]. Am J Orthod Dentofacial Orthop, 2022, 161(1): 37-45.
[5]	Liu H B, Wu X X, Yang L, et al. Safe zones for miniscrews in maxillary dentition distalization assessed with cone-beam computed tomography[J]. Am J Orthod Dentofacial Orthop, 2017, 151(3): 500-506.
[6]	Elsayed S A, Alolayan A B, Alahmadi A, et al. Revisited maxillary sinus pneumatization narrative of observation in Al-Madinah Al-Munawwarah, Saudi Arabia: a retrospective cross-sectional study[J]. Saudi Dent J, 2019, 31(2): 212-218.
[7]	Chang C H, Lin J H, Roberts W E. Success of infrazygomatic crest bone screws: patient age, insertion angle, sinus penetration, and terminal insertion torque[J]. Am J Orthod Dentofacial Orthop, 2022, 161(6): 783-790.
[8]	Wu X S, Cai Q D, Huang D, et al. Cone-beam computed tomography-based analysis of maxillary sinus pneumatization extended into the alveolar process in different age groups[J]. BMC Oral Health, 2022, 22(1): 393.
[9]	Tavares A, Crusoé-Rebello I M, Neves F S. Tomographic evaluation of infrazygomatic crest for orthodontic anchorage in different vertical and sagittal skeletal patterns[J]. J Clin Exp Dent, 2020, 12(11): e1015-e1020.
[10]	Vargas E O A, Lopes de Lima R, Nojima L I. Mandibular buccal shelf and infrazygomatic crest thicknesses in patients with different vertical facial heights[J]. Am J Orthod Dentofac Orthop, 2020, 158(3): 349-356.
[11]	陈立艳, 刘志杰, 苑芳连, 等. 颧牙槽嵴区骨宽度及皮质骨厚度的CBCT测量分析[J]. 口腔医学研究, 2017, 33(6): 637-641.
	Chen L Y, Liu Z J, Yuan F L, et al. Bone width and cortical bone thickness of infrazygomatic crest analysed with cone-beam computed tomography[J]. Journal of Oral Science Research, 2017, 33(6):637-641.
[12]	Farnsworth D, Rossouw P E, Ceen R F, et al. Cortical bone thickness at common miniscrew implant placement sites[J]. Am J Orthod Dentofacial Orthop, 2011, 139(4): 495-503.
[13]	Chang C C H, Lin J S Y, Yeh H Y. Extra-alveolar bone screws for conservative correction of severe malocclusion without extractions or orthognathic surgery[J]. Curr Osteoporos Rep, 2018, 16(4): 387-394.
[14]	Holmes P B, Wolf B J, Zhou J. A CBCT atlas of buccal cortical bone thickness in interradicular spaces[J]. Angle Orthod, 2015, 85(6): 911-919.
[15]	Whyte A, Boeddinghaus R. The maxillary sinus: physiology, development and imaging anatomy[J]. Dentomaxillofacial Radiol, 2019, 48(8): 20190205.
[16]	Göçmen G, Borahan M O, Aktop S, et al. Effect of septal deviation, concha bullosa and haller's cell on maxillary sinus's inferior pneumatization: a retrospective study[J]. Open Dent J, 2015, 9: 282-286.
[17]	Santos A R, Castellucci M, Crusoé-Rebello I M, et al. Assessing bone thickness in the infrazygomatic crest area aiming the orthodontic miniplates positioning: a tomographic study[J]. Dental Press J Orthod, 2017, 22(4): 70-76.
[18]	王鹏, 陈铮晰, 吴军, 等. 颧牙槽嵴微种植体植入与上颌窦底位置关系的解剖研究[J]. 上海口腔医学, 2017, 26(6): 623-627.
	Wang P, Chen Z X, Wu J, et al. Study of three-dimensional anatomical relationship between infrazygomatic crest and maxillary sinus for miniscrew insertion[J]. Shanghai Journal of Stomatology, 2017, 26(6): 623-627.
[19]	Hirai Y, Watanabe K, Deguchi T, et al. Influence of insertion depth on stress distribution in orthodontic miniscrew and the surrounding bone by finite element analysis[J]. Dent Mater J, 2021, 40(5): 1270-1276.
[20]	Murugesan A, Sivakumar A. Comparison of bone thickness in infrazygomatic crest area at various miniscrew insertion angles in Dravidian population-A cone beam computed tomography study[J]. Int Orthod, 2020, 18(1): 105-114.
[21]	仲伟洁,叶俊杰,王华,等. 不同垂直骨面型成年患者颧牙槽嵴有效骨量的CBCT研究[J]. 口腔医学, 2021, 41 (12): 1077-1080.
	Zhong W J, Ye J J, Wang H, et al. CBCT analysis of bone thickness of vgomatic crest in adults with different vertical skeletal patterns[J]. Stomatology, 2021,41(12):1077-1080.
[22]	Tavares A, Montanha-Andrade K, Cury P R, et al. Tomographic assessment of infrazygomatic crest bone depth for extra-alveolar miniscrew insertion in subjects with different vertical and sagittal skeletal patterns[J]. Orthod Craniofac Res, 2022, 25(1): 49-54.
[23]	Matias M, Flores-Mir C, Almeida M R, et al. Miniscrew insertion sites of infrazygomatic crest and mandibular buccal shelf in different vertical craniofacial patterns: a cone-beam computed tomography study[J]. Korean J Orthod, 2021, 51(6): 387-396.
[24]	Du B R, Zhu J Y, Li L T, et al. Bone depth and thickness of different infrazygomatic crest miniscrew insertion paths between the first and second maxillary molars for distal tooth movement: a 3-dimensional assessment[J]. Am J Orthod Dentofacial Orthop, 2021, 160(1): 113-123.
[25]	Reiser G M, Rabinovitz Z, Bruno J, et al. Evaluation of maxillary sinus membrane response following elevation with the crestal osteotome technique in human cadavers[J]. Int J Oral Maxillofac Implants, 2001, 16(6): 833-840.