Article record

上颌正畸微种植体过度植入：上颌窦、鼻底及切牙管穿孔的系统综述。

Over-insertion of orthodontic mini-implants in the maxilla: A systematic review of maxillary sinus, nasal floor and incisive canal perforations.

综述 Meta鼻科IF 1.8Q3

文献信息

PMID	42759072
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	Lars Stucki 查看其他 6 位作者 Hermann Schuster；Julia Schwab；Andreas Hoenigl；Klaus Hoenigl；Martin Kauke-Navarro；Ali-Farid Safi
作者单位	Department of Orthodontics and Dentofacial Orthopedics, LMU University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany. Electronic address: lars.stucki@med.uni-muenchen.de. 查看其他 5 条单位信息 Medical Faculty, University of Bern, Bern, Switzerland.；Division of Restorative Dentistry, Periodontology and Prosthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, Graz, Austria; Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy.；Division of Oral Surgery and Orthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, Graz, Austria.；Division of Reconstructive and Plastic Surgery, Yale School of Medicine, New Haven, CT, United States; Center for Craniomaxillofacial Surgery, Craniologicum, Bern, Switzerland.；Medical Faculty, University of Bern, Bern, Switzerland; Center for Craniomaxillofacial Surgery, Craniologicum, Bern, Switzerland; Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, Bern, Switzerland.
期刊	International orthodontics
SCI 分区	Q3
IF	1.8
研究类型	综述 Meta · 临床
所属专科	鼻科

中文摘要

目的： 正畸微种植体（OMIs）可提供骨骼支抗，但可能被过度植入，导致上颌窦、鼻腔或切牙管穿孔。本系统综述评估了上颌此类过度植入的发生频率及后果。
方法： 本系统综述已在PROSPERO注册（CRD420261377587），并遵循PRISMA指南。检索了PubMed、Livivo、Cochrane和Google Scholar中报告上颌OMI过度植入患病率及并发症的研究。在98条记录中，纳入7项研究。两名评价者独立筛选并提取数据，并使用Joanna Briggs Institute工具评估方法学质量。
结果： 在纳入的研究中，共包含702枚OMI，上颌窦穿孔率为8%至78.3%，平均穿透深度为0.79至3.23mm。在尸体模型中，窦穿孔率从6-mm螺钉的0%增至8-mm螺钉的10%和10-mm螺钉的15%。穿透>1mm使Schneiderian膜增厚率从37.5%升至88.2%，平均增加0.6mm，但未报告临床鼻窦炎。窦底厚度<6mm显著增加穿透风险（比值比21.63）。对于前部腭部OMI，切牙管穿孔影响25%的受试者（13.5%的OMI），鼻底穿孔影响高达21.2%的受试者（11.5%的OMI），平均深度为1.4±0.4mm（范围0.5-2.0mm）。骨整合腭部种植体取出后发生1例口鼻瘘，是唯一的重度并发症。
结论： 影像学穿孔相对常见，其风险受窦底厚度、螺钉长度、植入角度、年龄和前牙拥挤影响。尽管这些穿孔通常临床上无症状，仍建议谨慎选择长度并基于3D进行规划，以尽量减少可避免的组织反应。

英文摘要

OBJECTIVE: Orthodontic mini-implants (OMIs) provide skeletal anchorage but may be over-inserted, perforating the maxillary sinus, nasal cavity, or incisive canal. This systematic review evaluated the frequency and consequences of such over-insertion in the maxilla.
METHODS: This systematic review was registered in PROSPERO (CRD420261377587) and followed PRISMA guidelines. PubMed, Livivo, Cochrane, and Google Scholar were searched for studies reporting prevalence and complications of maxillary OMI over-insertion. Of 98 records, 7 studies were included. Two reviewers independently selected and extracted data, and methodological quality was assessed using Joanna Briggs Institute tools.
RESULTS: Across the included studies comprising 702 OMIs, maxillary sinus perforation ranged from 8 to 78.3%, with mean penetration depths between 0.79 and 3.23mm. In a cadaver model, sinus perforation increased from 0% with 6-mm screws to 10% with 8-mm and 15% with 10-mm screws. Penetration>1mm raised Schneiderian membrane thickening from 37.5 to 88.2%, with a mean increase of 0.6mm, but no clinical sinusitis was reported. A sinus floor thickness<6mm markedly increased penetration risk (odds ratio 21.63). For anterior palatal OMIs, incisive canal perforation affected 25% of subjects (13.5% of OMIs), and nasal floor perforation up to 21.2% of subjects (11.5% of OMIs), with mean depth 1.4±0.4mm (range 0.5-2.0mm). One oronasal fistula after osseointegrated palatal implant explantation was the only severe complication.
CONCLUSIONS: Radiographic perforations are relatively frequent, and risk is influenced by sinus floor thickness, screw length, insertion angle, age, and anterior crowding. Although these perforations are usually clinically asymptomatic, cautious length selection and 3D-based planning are recommended to minimize avoidable tissue reactions.