Maxillary Sinus Augmentation for Dental Implant Rehabilitation of the Edentulous Ridge: A Comprehensive Overview of Systematic Reviews. IMPLANT DENT. 2017;26:438-464. [PMID: 28520572 DOI: 10.1097/id.0000000000000606]

Maxillary sinus lift augmentation: A randomized clinical trial with histological data comparing deproteinized bovine bone grafting vs graftless procedure with a 5-12-year follow-up

INTRODUCTION

Different protocols and procedures for sinus lift and implant placement are available, generally involving the use of grafts to increase the tissue volume and/or prevent the Schneiderian membrane from collapsing. Among xenografts, deproteinised bovine bone graft (DBBP) is frequently used in sinus lift procedures. Leaving an ungrafted space following membrane elevation has proven to have a bony regenerative potential as well. This study aimed to compare the clinical and histological features of sinus lift surgery performed with or without biomaterials.

METHODS

Patients with severe maxillary posterior atrophy (residual bone height 2-6 mm and residual crest thickness ≥4 mm), and in need of sinus lift surgery to allow the placement of three implants were enrolled and randomly divided into two groups. They underwent sinus lifts with DBBP (control) or with a graftless technique (test) and immediate placement of two implants (a mesial and distal one). After 6 months, a bone sample was retrieved from the area between the previously inserted fixtures, and a third, central implant was placed. The collected bone samples were analyzed morphologically and histomorphometrically. The patients were provided with prosthetic restorations after 6 months and followed up for 5-12 years.

RESULTS

Ten patients were enrolled in the test and nine in the control group. The 6-month follow-up showed in the control group an average augmentation of 10.31 mm (±2.12), while in the test group it was 8.5 mm (±1.41) and a success rate of 96.3% in the control and 86.7% in the test group (p > 0.05). The histological analysis evidenced the presence of new bone tissue surrounded by immature osteoid matrix in the test group, and a variable number of DBBP particles surrounded by an immature woven bone matrix in the control group.

CONCLUSION

The results of the present trial indicate that, with residual bone height of 2-6 mm and residual crest thickness ≥4 mm, sinus lift surgery with or without biomaterials followed by implant restoration, produces similar clinical and histological outcomes.

Effectiveness of zygomatic-implant fixed rehabilitation for the atrophic edentulous maxilla: protocol for a systematic review and network meta-analysis

BACKGROUND

Atrophic edentulous maxilla is a debilitating condition caused by the progressive and irreversible bone resorption following loss of teeth, that results in bone of inadequate volume and density. This makes conventional implant therapy extremely challenging without complex reconstructive procedures. Several techniques such as sinus augmentation, short implants, and tilted implants have been used for the rehabilitation of the atrophic maxilla. In recent years, zygomatic implants have emerged as a graftless rehabilitation technique. However, few studies compare zygomatic-implant fixed rehabilitation with other fixed rehabilitation techniques. The existing body of evidence on zygomatic implants is largely based on clinical and disease-oriented outcomes.

METHODS

A network meta-analysis (NMA) will be conducted in order to compare the effectiveness of zygomatic-implant fixed rehabilitation with the other rehabilitation techniques. Experimental and observational studies comparing different implant-assisted fixed rehabilitation in adults with atrophic maxilla will be included. The primary and secondary outcomes will be patient's satisfaction and quality of life respectively. Additional outcomes include the implant's survival/success, and biological and prosthetic complications. An electronic search will be performed through various databases for articles in English and French, without time limits. Risk of bias will be assessed using the Revised Cochrane Risk-of-Bias tool for randomized controlled trials, and ROBINS-I for non-randomized and observational studies. Two independent reviewers will screen the titles and abstracts and extract data. Any discrepancy between reviewers will be discussed and resolved through consensus or with the help of a third reviewer. Pairwise meta-analyses will be performed using a random effects model. I2, τ2, transitivity, subgroup/meta-regression analyses will assess and explain heterogeneity and distribution of effect modifiers. A network plot will be created to connect the different interventions directly and indirectly. Interventions will be ranked using the surface under cumulative ranking curve. Confidence in the results of the NMA will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

DISCUSSION

This study will be the first to assess the effectiveness of zygomatic-implant fixed rehabilitation for the atrophic maxilla using NMA. The evidence obtained will aid clinical decision-making and will advance the knowledge of the rehabilitation techniques for the atrophic maxilla.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42023353303.

Survival analysis of implants placed simultaneously with lateral sinus floor elevation in severely atrophic maxilla: A 3- to 12-year retrospective cohort study

OBJECTIVES

To retrospectively evaluate whether implants placed simultaneously with lateral sinus floor elevation (LSFE) in severely atrophic maxilla (residual bone height [RBH] ≤3 mm) could achieve long-term survival and comprehensively analyze the factors influencing their survival rates.

MATERIALS AND METHODS

A total of 123 patients receiving LSFE and simultaneous implant placement from 2010 to 2019 and their 123 implants in sites with RBH ≤3 mm were included in this study. Basic characteristics of patients and implants were collected from the medical record system and cone-beam computed tomography (CBCT) images. Kaplan-Meier survival curves were applied to estimate cumulative survival rates (CSRs) and Cox proportional hazards regression models were used to detect factors influencing implant survival.

RESULTS

The 6-year and 12-year CSR of implants placed in sites with RBH ≤3 mm were 95.7% (95% confidence interval [CI]: 92.1%-99.5%) and 76.6% (95% CI: 58.1%-100%), respectively. Eight patients presented late implant failure. Univariate and multivariate Cox regression analyses demonstrated that RBH ≤2 mm (hazard ratio [HR]: 20.63, p = 0.000) and smoking habit (HR: 6.055, p = 0.024) were significantly associated with long-term implant survival. Specifically, the 10-year CSR of implants in sites with RBH ≤2 mm (53.3%, 95% CI: 27.5%-100%) was dramatically lower than those in sites with RBH >2 mm (92.9%, 95% CI: 81.7%-100%, p = 0.000).

CONCLUSIONS

Implants placed simultaneously with LSFE in sites with RBH ≤3 mm can achieve long-term survival. However, caution is required especially for implantation in sites with RBH ≤2 mm. Besides, the smoking habit is also considered a risk factor jeopardizing long-term implant survival.

Curriculum of gross anatomy education in Korean dental hygiene programs: Perceptions of clinical dental hygienists

It is essential for dental hygienists to have basic knowledge of gross anatomy to provide efficient treatment. However, gross anatomy course is relatively neglected due to their disparity from actual clinical dental practice. This study aimed to propose an effective dental hygiene gross anatomy curriculum that reflects the opinions of professional clinical dental hygienists. The study had an online-based cross-sectional design and the survey was distributed to clinical dental hygienists via social networks (n = 200). The questionnaire consisted of questions on the utilization of anatomical knowledge in clinical practice, opinions on the contents and methods of gross anatomy education, and general characteristics. The present study found that 186 (93%) used anatomical knowledge at an above-average level. Qualitative analysis indicated that dental implant surgery, radiography, and extraction were the clinical procedures that required the most anatomical knowledge. The clinical dental hygienists answered that the most-necessary knowledge is that of the mandibular nerve, followed by that on the temporomandibular joint, mandible, maxilla, maxillary nerve, and masticatory muscle. The methods proposed to improve gross anatomy education were (in decreasing order of importance) using videos or photographs (X-rays, CT, MRI, etc.), integrating education with clinical subjects, and using a three-dimensional visualization program. Higher education levels of respondents have increased their tendency to believe that the contents and methods of the presented education were necessary. Dental hygienists who utilized anatomical knowledge more often tended to be had a greater appreciation of the necessity of all educational contents and methods.

Implant failure rate and the prevalence of associated risk factors: a 6-year retrospective observational survey

Introduction: The purpose of this monocentric retrospective observational investigation is to evaluate the implant failure rate observed in an oral surgery department and analyze the risk factors associated with them. Preventative measures will be suggested to reduce the incidence of implant failure. Material and method: All implants removed between 2014 and 2020 were analyzed. The main criterion assessed was the overall failure rate over 6 years of activity;the secondary criteria were the risk factors associated with implant failure. Results: 12 out of 376 implants placed between 2014 and 2019 in 11 patients (mean age: 55.5 ±11.5 years);sex ratio M/F=5/6) were removed, for an overall failure rate of 3.11%. The majority, 83% (10/12) of the lost implants, were in the maxilla, while only 17% (2/12) were placed in the mandible. The main risk factors identified were: a III−IV bone type density (75%, 9/12), pre-implant sinus lift surgery (42%, 5/12) smoking (8.3%, 1/12), surgical site infection (8.3%, 1/12) and rheumatoid arthritis (8.3%, 1/12). Conclusion: The failure rate observed in this oral surgery unit is consistent with the other international studies, confirming the compliance with good clinical practices of the healthcare team. Pre-implant bone surgery is the major risk factor to consider before implant surgery.

Does new bone formation vary in different sites within the same maxillary sinus after lateral augmentation? A prospective histomorphometric study

OBJECTIVE

The aim of this study was to evaluate histomorphometric outcomes of lateral maxillary sinus augmentation in different areas of the same cavity and to correlate results to bucco-palatal sinus width (SW) and residual bone height (RBH).

MATERIAL AND METHODS

Patients needing maxillary sinus floor elevation (RBH <5 mm) to insert two nonadjacent implants were treated with lateral augmentation using a composite graft. Six months later, two bone-core biopsies (mesial/distal) were retrieved in implant insertion sites. SW and RBH were measured on cone beam computed tomography, and correlations between histomorphometric and anatomical parameters were evaluated by multivariate linear regression analysis.

RESULTS

Twenty patients underwent sinus augmentation, and eighteen were included in the final analysis (two dropouts for membrane perforation). Mean newly formed mineralized tissue percentage (%NFMT) after 6 months in mesial and distal sites was 17.5 ± 4.7 and 11.6 ± 4.7, respectively (p = .0004). Multivariate linear regression showed a strong negative correlation between SW and %NFMT (β coefficient=-.774, p < .0001) and no correlation between RBH and %NFMT (β coefficient =-.038, p = .825).

CONCLUSIONS

The present study confirms that %NFMT after lateral sinus augmentation occurs at different rates in different anatomical areas of the same maxillary sinus, showing a strong negative correlation with SW, whereas no influence of RBH was observed. Clinicians should regard SW as a guide for graft selection and to decide duration of the healing period. Researchers should consider SW as a predictor variable, when comparing regenerative outcomes of different biomaterials by using maxillary sinus as an experimental model.

Staged Sinus Floor Elevation Using Novel Low-Crystalline Carbonate Apatite Granules: Prospective Results after 3-Year Functional Loading

The aim of this study was to evaluate clinical outcomes of staged sinus floor elevation (SFE) using novel low-crystalline carbonate apatite (CO₃Ap) granules. Patients who needed SFE for implant placement were recruited into this clinical trial. A staged procedure (lateral window technique using CO₃Ap granules, followed by implant placement after 7 ± 2 months) was employed in 13 patients. Bone-height increase and insertion torque values (ITVs) were assessed along with histological evaluation. The survival and success rates of 3-year functioning implants were also evaluated. Mean of bone-height increase after SFE using CO₃Ap granules was 7.2 ± 2.5 mm and this increase allowed implant placement in all cases (17 implants). Mean of ITV was 25.1 ± 13.2 Ncm and primary stability was achieved successfully in all cases. Histological analyses revealed mature new bone formation (36.8 ± 17.3%) and residual CO₃Ap granules (16.2 ± 10.1%) in the compartment after SFE. The survival and success rates after 3-year functional loading were 100% and no complications were found. These results clearly indicate the clinical usefulness of CO₃Ap granules for SFE.

Management of sinus graft infection-a systematic review

Sinus graft infections are rare but serious complications, as they are associated with significant morbidity and sinus graft loss. The aim of this study was to systematically review the management of sinus graft infection in order to define which protocols should be implemented. The terms searched in each database were "sinus graft infection management", "maxillary sinus lift infection", "maxillary sinus graft infection", "maxillary sinus elevation infection", and "maxillary sinus augmentation infection". The management of the sinus graft infection was assessed. The outcomes evaluated were maxillary sinus health and dental implantation results. The initial search yielded 1190 results. Eighteen articles were included, reporting a total of 3319 patients and 217 sinus graft infections. Drainage was performed with an intraoral approach in 13 studies, an endoscopic approach in two studies, and a combined approach in three studies. In every study, a disease-free sinus was finally obtained in all patients, but the outcomes of the graft and the dental implant were more varied. It is not possible to define the best treatment protocol for sinus graft infections based on the published data, since the level of evidence is poor. Management is very heterogeneous. This review highlights the necessity of surgical treatment associated with antibiotic therapy.

Flapless Localised Management of Sinus Floor (LMSF) for trans-crestal sinus floor augmentation and simultaneous implant placement. A retrospective non-randomized study: 5-year of follow-up

Background

Trans-crestal sinus lift procedures are well established.

Purpose

to retrospectively analyse the efficacy of a flapless trans-crestal maxillary sinus floor elevation and simultaneous dental implant placement based on the Localised Management of Sinus Floor (LMSF) technique suitable for cases with sufficient width of keratinized tissue and of crestal bone but insufficient vertical dimensions of the bone below the sinus.

Materials and methods

71 sinus elevations with simultaneous implant placement were performed on 52 consecutive patients. Following an initial pilot bur transmucosal perforation, the Magnetic Mallet was used with progressively larger osteotomes. The mallet osteotomes are initially directed palatally, towards the cortex of the medial wall of the sinus, below the palato-nasal recess (PNR) and then redirected in a more vertical direction to create the final osteotomy for implant placement.

Results

No significant complications were reported in the post-operative phase. The cumulative success rate during the observation period was 95%. All successful implants were successfully loaded with metal-ceramic or monolithic zirconia crowns and bridges and remained in function during the observation period.

Conclusions

Flapless Localised Management of Sinus Floor (LMSF) is a safe and effective surgical technique with minimal risks and with the advantage of low morbidity. Also, only native bone is used for augmentation and there is no need for additional grafting.

Argon Bioactivation of Implants Installed Simultaneously to Maxillary Sinus Lifting without Graft. An Experimental Study in Rabbits

Background: The treatment of the surface of titanium implants with argon plasma improved its hydrophilicity and cell adhesion, resulting in higher bone apposition on implant and graft surfaces. The spontaneous perforation over time of the sinus mucosa after sinus augmentation has been documented in experimental studies at both implants and graft particles. The aim of the present study was to evaluate the influence of plasma argon treatment of the implant surface on bone apposition and on the rate of sinus mucosa perforations. Methods: A sinus lifting procedure was performed bilaterally in sixteen rabbits, and implants, either treated with argon plasma or left without treatment (control), were placed simultaneously without grafts. After 8 weeks, histological analyses were carried out. Results: A collapse of the sinus mucosa was observed at all implants. Twenty-four out of thirty-two implants presented sinus mucosa perforations at the apex. Several perforations were also found at the threads. Thinned mucosa sites (width < 40 µm) were found around almost all implants. About 2.6–2.9 mm of the apical regions of the implant did not present signs of osseointegration and about 1.3 mm were exposed to the sinus cavity. No statistically significant differences were found between plasma and control sites. Conclusions: In conclusion, the sinus mucosa was damaged and perforated by direct contact with treated and non-treated implant surfaces. The treatment of the implant surface with argon plasma did not affect the outcomes.

Relative performance of various biomaterials used for maxillary sinus augmentation: A Bayesian network meta-analysis

OBJECTIVES

To assess the histomorphometric outcomes obtained in randomized clinical trials (RCTs) with different biomaterials used for maxillary sinus augmentation (MSA).

MATERIALS AND METHODS

A search of the existing medical literature until October 1, 2019, was performed. Inclusion criteria were (a) RCTs assessing a two-stage MSA from the lateral approach using autologous bone or biomaterials for grafting and (b) reported histomorphometric outcomes based on crestal bone core biopsy samples. The Bayesian method was used to perform pairwise meta-analyses and network meta-analysis (NMA). The primary outcome, the new bone percentage (NB %), was calculated as mean differences with 95% credible intervals. The interventions were ranked by their posterior probability by calculating the surface under the cumulative ranking curve values.

RESULTS

Thirty-four RCTs (842 MSAs) were included in the analysis with a normal healing period (5-8 months). All comparisons were presented in a league table. On the basis of the ranking probability, the most effective bone grafting material for NB% was bovine xenograft + bone marrow concentrate (BMC) (81%), followed by bovine xenograft + platelet-rich plasma (PRP) (77%), bioactive glass ceramic + autologous bone 1:1 (70%), nanocrystalline hydroxyapatite in silica gel (70%), and bioactive glass ceramic (70%). Autologous bone graft alone took the twelfth position with 57%.

CONCLUSION

Within the limitations of the present NMA, the analysis did not confirm autologous bone alone as the gold standard for MSA and showed superiority of composite grafts such as bovine xenograft + BMC after 5-8 months of healing.

New bone ingrowth into β-TCP/HA graft activated with argon plasma: a histomorphometric study on sinus lifting in rabbits

BACKGROUND

In a previous experimental study, new bone was found growing within granules of HA/β-TCP. In vitro and experimental studies have shown increased protein adsorption and cell adhesion graft material bioactivated with Argon plasma. The aims of the present experiment were to study new bone ingrowth into β-TCP/HA granules used as filler material for sinus lifting and the influence on the healing of the bioactivation of the graft with argon plasma.

METHODS

Sinus lifting was carried out in 20 rabbits using 60% HA and 40% β-TCP as filler material either bio-activated with argon plasma (plasma group) or left untreated (control group). The antrostomies were closed with collagen membranes. Biopsies representing the healing after 2 and 10 weeks were collected, and ground sections were prepared for histomorphometric analyses. Various regions of the elevated space were analyzed both around (outer bone; OB) and inside (interpenetrating bone network, IBN) the graft particles.

RESULTS

After 2 weeks of healing, 8.2% and 9.3% (n = 10; p = 0.635) of total new bone (OB + IBN) was found in the plasma and control groups, respectively. Small fractions of IBN were found, spreading from the periphery inward of the graft particles. After 10 weeks of healing, the total new bone was 34.0% in the plasma and 31.3% in Control groups (n = 9; p = 0.594). The respective fractions of IBN were 18.0% and 16.0%. New bone was penetrating from the peripheral regions inside the remnants of graft particles, where it was forming a network of bridges in continuity to the remnants of biomaterial through its porosities. The biomaterial decreased in proportion between 2 and 10 weeks from 52.1 to 28.3% in the plasma group, and from 52.5% to 31.9% in the control group.

CONCLUSION

The bio-activation with argon plasma on a synthetic graft composed of 60% HA and 40% β-TCP used as filler material for sinus lifting showed a tendency to improve bone formation; however, the difference with the control group was neither statistically significant nor clinically relevant.

Efficacy of stem cell allograft in maxillary sinus bone regeneration: a randomized controlled clinical and blinded histomorphometric study

Purpose

This study aimed to evaluate the quality and quantity of newly generated bone in the maxillary sinus grafted with stem cell-based allograft material.

Methods

This study was a single site, prospective, blinded, randomized, and controlled clinical trial. Eleven subjects with 18 edentulous posterior maxillary sites requiring sinus augmentation for delayed implant placement using a lateral window approach were enrolled. At the time of sinus augmentation, test sinus was grafted with stem cell-based allograft (Osteocel Plus; NuVasive Therapeutics), while the control sinus was grafted with conventional cortico-cancellous allograft (alloOss; ACE Surgical). Cone beam computer tomography (CBCT) scan was taken before and 14 weeks post-sinus augmentation procedure, i.e., 2 weeks before implant placement. Thirty-six trephined core bone biopsies were harvested from the anterior and posterior grafted lateral-window osteotomy sites at the time of implant placement.

Results

The results showed a statistically significant difference in the vital bone percentage between the test and the control groups at the posterior grafted sites (p = 0.03). There was no significant difference in the percentage of vital bone between the anterior and posterior grafted sites within the test and control groups (p > .05). The CBCT analysis showed that the maxillary sinuses at the posterior grafted sites were statistically wider than those at the anterior grafted sites in both groups (p < .05).

Conclusions

Different allograft bone materials can be used in the maxillary sinus augmentation procedures. Stem cell allograft has more osteogenic potential with a better outcome in the wide posterior sinus.

Platelet-Rich Plasma in Maxillary Sinus Augmentation: Systematic Review

Background: Sinus augmentation can be performed with or without grafting biomaterials, and to date, there is no quality evidence regarding the augmentation of the sinus floor using only platelet concentrates, which can improve the healing period and enhance bone regeneration by stimulating angiogenesis and bone formation. The main objective of this paper was to assess the effect of the sole use of platelet concentrates in sinus augmentation in terms of newly formed bone, augmented bone height, and clinical outcomes and to assess the additional beneficial effects of platelet-rich fibrin (PRF) in combination with other grafting biomaterials. Methods: A systematic review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Pooled analyses were performed with the Review Manager software. Results: For sinus elevation only using platelet concentrates, 11 studies met the inclusion criteria and were included for qualitative synthesis. Only one study was a clinical trial, which reported improved outcomes for the allograft group compared to the titanium-PRF (T-PRF) group. A total of 12 studies where PRF was used in addition to grafting biomaterials met eligibility criteria and were included in the review. Results from meta-analyses provided no additional beneficial effects of PRF in sinus augmentation in terms of bone height and percentage of soft tissue area. There was a statistically significant lower percentage of residual bone substitute material in the PRF (+) group compared to the PRF (−) group. The percentage of newly formed bone was slightly higher in the PRF (+) group, but this was not statistically significant. Conclusion: There is no robust evidence to make firm conclusions regarding the beneficial effects of the sole use of platelet concentrates in sinus augmentation. However, studies have shown favorable outcomes regarding implant survival, bone gain, and bone height. The use of PRF with other grafting biomaterials appears to provide no additional beneficial effects in sinus lift procedures, but they may improve the healing period and bone formation. Well-conducted randomized clinical trials (RCTs) are necessary to confirm the available results to provide recommendations for the clinical practice.

Maxillary Sinus Floor Augmentation With or Without Barrier Membrane Coverage of the Lateral Window: a Systematic Review and Meta-Analysis

Objectives

Test the hypothesis of no difference in implant treatment outcomes after maxillary sinus floor augmentation with or without barrier membrane coverage of the lateral window.

Material and Methods

A MEDLINE (PubMed), Embase and Cochrane library search in combination with a hand-search of relevant journals was conducted. Human studies published in English until the 5th of July, 2019 were included. Randomised controlled trials and controlled trials with an observation period of minimum six months were included. Primary outcomes included survival of suprastructures and implants. Secondary outcomes included implant stability quotient, peri-implant marginal bone loss, bone regeneration, patient-reported outcome measures, biologic and mechanical complications.

Results

The electronic search and hand-searching resulted in 1068 entries. Six randomised controlled trials characterised by low to high risk of bias and one controlled trial with high risk of bias fulfilled the inclusion criteria. High implant survival rate was reported with both treatment modalities. Meta-analyses disclosed a mean difference of newly formed bone of 6.4% (confidence interval = 0 to 12.9) and non-mineralised tissue of -1.1% (confidence interval = -2.7 to 0.5), indicating more newly formed bone and diminished non-mineralised with barrier membrane coverage.

Conclusions

There seem to be no statistically significant differences in implant treatment outcomes after maxillary sinus floor augmentation with or without barrier membrane coverage of the lateral window. However, barrier membrane coverage increases percentage of newly formed bone and diminishes proliferation of non-mineralised tissue. Thus, barrier membrane coverage seems to be beneficial and also preventing displacement of the grafting material.

Long-term effectiveness of maxillary sinus floor augmentation: A systematic review and meta-analysis

AIM

To assess the long-term effectiveness (≥5 years) of maxillary sinus floor augmentation (MSFA) procedures applying the lateral window technique and to determine possible differences in outcome between simultaneous and delayed implant placement, partially and fully edentulous patients and grafting procedures.

MATERIALS AND METHODS

MEDLINE (1950-May 2018), EMBASE (1966-May 2018) and Cochrane Central Register of Controlled Trials (1800-May 2018) were searched. Inclusion criteria were prospective studies with follow-up ≥5 years and a residual bone height ≤6 mm. Outcome measures included implant loss, peri-implant bone level change, suprastructure survival, patient-reported outcome measures and overall complications. Data were pooled and analysed using a random effects model.

RESULTS

Out of 2,873 selected articles, 11 studies fulfilled all inclusion criteria. Meta-analysis revealed a weighted annual implant loss of 0.43% (95% CI: 0.37%-0.49%). Meta-regression analysis did not reveal significant differences in implant loss neither between edentulous and dentate patients nor implants placed simultaneously with or delayed after MSFA, nor implants placed in MSFA using solely autologous bone or bone substitutes. The results of the other outcome measures were favourable, and overall complications were low.

CONCLUSION

MSFA is a reliable procedure in the partially and fully edentulous maxilla for support of dental implants.

Minimally invasive endoscopic maxillary sinus lifting and immediate implant placement: A case report

BACKGROUND

This case report discusses a modified approach for maxillary sinus augmentation, in which platelet-rich fibrin, endoscope, simultaneous implant placement, and sinus floor elevation (PESS) were applied for a maxillary sinus floor lift in a 40-year-old patient.

CASE SUMMARY

A 40-year-old woman suffered missing upper right first molar. Implant stability quotient and cone-beam computed tomography (CBCT) were used to evaluate the diagnosis. CBCT showed insufficient posterior maxillary bone with a mean residual alveolar bone height of only 3.5 mm. The patient underwent a minimally invasive sinus floor elevation endoscopically. The sinus membrane was elevated in two stages, and a 12-mm implant was placed immediately. At 3 mo postoperatively, the final impressions were accomplished, and a full-ceramic crown was fit-placed. A 6-mo follow-up demonstrated satisfactory aesthetic and functional results.

CONCLUSION

This is the first report to use an endoscope for maxillary sinus floor lifting in cases with severe and insufficient bone height. This case report demonstrates the advantages of the PESS technique, which include minimal invasiveness with high precision, being applicable in cases with a residual alveolar bone height < 4 mm with a promising result, and a shortened treatment period from 12 to 3 mo.

Influence of Diabetes on the Survival Rate and Marginal Bone Loss of Dental Implants: An Overview of Systematic Reviews

We aimed to conduct an analysis of the systematic reviews (SRs) in literature about the implant survival rate (ISR) and marginal bone loss (MBL) in diabetic and nondiabetic patients. This work was registered in The International Prospective Register of Systematic Reviews (CRD42018095314) and was developed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Library Handbook. A search was performed on PubMed, Cochrane, Scopus, Embase, and LILACS. The PICO (problem/patient/population, intervention/indicator, comparison, outcome) question was "Do the survival rates of dental implants and marginal bone loss differ between diabetic and nondiabetic patients?" A total of 130 articles were retrieved. After eliminating repetitions, 118 were reviewed. Finally, 6 SRs were included. All the reviews indicated that there is no effect of diabetes on the ISR; however, a negative effect of the disease can be observed in MBL. Analysis of the quality of the studies was performed using the assessment of SRs in dentistry (Glenny Scale) and Assessing the Methodological Quality of Systematic Reviews (AMSTAR 2). Glenny Scale showed a moderate to high quality of the included studies. In contrast, AMSTAR 2 pointed out a critically low level for 4 studies, with no study fulfilling the criteria for high quality. It may be concluded that there is no effect of diabetes on the ISR; however, a negative effect of the disease can be observed on MBL.

The Use of Tooth Derived Bone Graft Materials in Sinus Augmentation Procedures: a Systematic Review

OBJECTIVES

The goal of this systematic review was to assess the current literature about sinus augmentation procedure using different types of tooth derived bone graft materials, thorough analysing the outcomes of sinus grafting with tooth grafts compared to sinus grafting with xenografts, allografts and alloplasts by radiography and histomorphometry.

MATERIAL AND METHODS

An electronic search in the MEDLINE (NCBI PubMed and PubMed Central) database was conducted to identify articles concerning application of tooth bone grafts in sinus augmentation. The search was restricted to English language articles published in the last 10 years (December 2009 to March 2019).

RESULTS

In total, 21 articles were found, out of which 7 met the inclusion criteria and were included in the final synthesis. According to the type of diagnostic tool, data about graft material outcome in sinus was extracted, and included the residual alveolar height, augmented graft height, resorption height as seen in panoramic radiography and histomorphometric analysis of new bone formation and residual graft material.

CONCLUSIONS

Within the limitations of our review, we suggest that tooth derived graft materials are as successful as xenografts, allografts and alloplasts in sinus augmentation procedures according to the radiographic and histomorphometric showings. Additional wider research should be conducted in order to determine whether tooth derived graft materials are superior to the currently used materials.

Immediate dental implant placement in calvarial bone grafts to rehabilitate the severely resorbed edentulous maxilla: A prospective pilot study

PURPOSE

The aim of this study was to describe the surgical technique of immediate dental implant placement in calvarial grafts for augmentation of the severely resorbed maxilla and to assess the treatment results.

METHODS

In 13 patients the maxilla was augmented with calvarial bone followed by simultaneous dental implant placement (total: 68 implants). In the frontal "knife edge" region, implants were inserted in the buccal plated area. In the maxillary sinus area, implants were inserted into alveolar bone that was plated buccally or palatally through the sinus window. After 4 months, the implants were retrieved and subsequently loaded. Per-operative and post-operative variables were scored. One bone biopsy sample was taken for histological analysis.

RESULTS

The surgical procedure and wound healing was uneventful. During abutment connection after 4 months, all implants were fully osseointegrated with no signs of graft resorption. Radiographically, the mean (±SD) peri-implant bone loss after 1 year of functional loading was 0.23 ± 0.44 mm. No implants were lost. Histological examination revealed vital calvarial and maxillary bone with active remodeling.

CONCLUSION

Immediate dental implant placement in calvarial bone grafts to rehabilitate severely resorbed maxilla is technically feasible and seems to have a high success rate.

Maxillary Sinus Floor Augmentation: a Review of Selected Treatment Modalities

Objectives

The objective of the present study is to present the current best evidence for enhancement of the vertical alveolar bone height and oral rehabilitation of the atrophic posterior maxilla with dental implants and propose some evidence-based treatment guidelines.

Material and Methods

A comprehensive review of the English literature including MEDLINE (PubMed), Embase and Cochrane Library search was conducted assessing the final implant treatment outcome after oral rehabilitation of the atrophic posterior maxilla with dental implants. No year of publication restriction was applied. The clinical, radiological and histomorphometric outcome as well as complications are presented after maxillary sinus floor augmentation applying the lateral window technique with a graft material, maxillary sinus membrane elevation without a graft material and osteotome-mediated sinus floor elevation with or without the use of a graft material.

Results

High implant survival rate and new bone formation was reported with the three treatment modalities. Perforation of the Schneiderian membrane was the most common complication, but the final implant treatment outcome was not influenced by a Schneiderian membrane perforation.

Conclusions

The different surgical techniques for enhancement of the vertical alveolar bone height in the posterior part of the maxilla revealed high implant survival with a low incidence of complications. However, the indication for the various surgical techniques is not strictly equivalent and the treatment choice should be based on a careful evaluation of the individual case. Moreover, further high evidence-based and well reported long-term studies are needed before one treatment modality might be considered superior to another.