A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation

Evaluation of factors affecting implant failure: A 13-year retrospective cohort study

Dental implant failure remains a significant concern in oral rehabilitation, with multiple risk factors contributing to early and late implant failure. While numerous studies have examined implant failure rates, limited research distinguishes between early implant failure (EIF) and late implant failure (LIF) based on patient-related, implant-specific, and surgical variables. This study aimed to evaluate the risk factors associated with EIF and LIF and to determine the impact of patient-related, implant-specific, and surgical variables on implant survival. This retrospective cohort study was conducted at Ondokuz Mayıs University. It is based on the treatments provided by an experienced surgeon to individuals who applied for implant treatment between January 2011 and January 2024. This study analyzed 490 patients who met the inclusion criteria out of 3720 who received implant treatment during the relevant years. The patients' ages ranged from 21 to 90, with a mean age of 53.92 ± 13.82 years. Sex, smoking, and implant length (≤10 mm) were identified as risk factors in analyzing parameters affecting EIF, while maxilla, implant length (<8 mm), SLA surface modification, sinus lift procedures, smoking, and short osteointegration duration were identified as risk factors in analyzing parameters affecting LIF. Our findings highlight the distinct risk profiles for EIF and LIF, emphasizing the importance of patient selection, surgical technique, and implant characteristics in optimizing long-term success rates. Recognizing EIF and LIF risk factors enables clinicians to refine treatment protocols and reduce implant failure rates, ultimately improving patient outcomes.

Hydraulic sinus floor elevation using advanced platelet-rich fibrin: A randomized clinical trial with two-dimensional radiographic results

PURPOSE

To assess the radiographic outcomes, complications, and implant survival rates of advanced platelet-rich fibrin versus xenografts in hydraulic sinus floor elevation.

METHODS

In this randomized trial, 40 patients with 46 implants were divided into two groups: a test group (advanced platelet-rich fibrin alone) and a control group (xenograft alone). The key outcome measures included bone regeneration, implant survival, and complications.

RESULTS

Both groups achieved 100% implant survival. One case of maxillary sinus infection occurred in the control group after surgery. There was no significant difference in bone regeneration between the two groups at 6 months post-surgery and 12 months post-load (P > 0.05). The residual bone height and sinus width at the apex of the implant were significant negative predictors of bone regeneration (P < 0.05), whereas the presence of adjacent teeth was a significant positive predictor (P < 0.05).

CONCLUSIONS

Both advanced platelet-rich fibrin and xenografts effectively enhanced bone growth at sinus floor elevation, achieving high implant survival rates over one year. Advanced platelet-rich fibrin alone may be a viable xenograft alternative, necessitating further long-term studies to confirm its efficacy. The study was registered in the Chinese Clinical Trial Registry (http://www.chictr.org.cn/) with the registration number ChiCTR2100042060. This clinical trial was not registered before participant recruitment or randomization.

Maxillary Sinus Floor Augmentation With Autogenous Bone Versus Bovine Bone Mineral Mixed With 25% Autogenous Bone: A 1-Year Multicenter, Split-Mouth, Randomized Controlled Trial

OBJECTIVES

To compare autogenous bone (AB) harvested from the mandibular ramus or a mixture of bovine bone mineral (BBM) with 25% locally harvested autogenous bone chips from the maxilla for maxillary sinus floor augmentation (MSFA).

MATERIAL AND METHODS

Patients requiring bilateral MSFA and implant placement were enrolled in this study. Maxillary sinuses were randomly assigned (1:1) to one of the two groups: MSFA + AB (AB group) or MSFA + AB + BBM (BBM group). AB was harvested from the mandible (AB group) or locally during MSFA (BBM group). Implants were placed after 4-6 months of healing and loaded 4-6 months later. Patients were examined at baseline (1 month post-loading) and 12 months post-loading. Outcome measures included clinician- and patient-reported outcomes.

RESULTS

Fifty patients with 198 implants were included (AB = 99, BBM = 99). Twelve implants failed before loading (AB = 6, BBM = 6), and three failed post-loading (AB = 2, BBM = 1). Implant survival was 92.9% (AB group) and 93.9% (BBM group) at 12 months post-loading, with no significant differences between the groups (HR, 0.85; 95% CI, 0.28-2.54; p = 0.770). Implant success was 98.8% (AB group) and 97.6% (BBM group), with no significant differences between the groups (HR, 0.49; 95% CI, 0.03-8.05; p = 0.620). No significant differences in marginal bone loss or clinical parameters were found between groups (p > 0.05). Patient satisfaction significantly improved at follow-ups compared to screening (p = 0.005).

CONCLUSION

Implants placed after MSFA with AB or BBM showed comparable results. This indicates that MSFA can be successfully performed without requiring AB from an additional donor site, potentially reducing patient morbidity.

TRIAL REGISTRATION

This study was registered in the Dutch Trial Register with number NL59578.078.16 on 09-05-2017. The study start date was on 21-08-2017.

Clinical, Radiological, and Histomorphometric Comparison of the Use of Deproteinized Bovine Bone Mineral and Titanium-Prepared Platelet-Rich Fibrin in Maxillary Sinus Augmentation: A Split-Mouth Randomized Controlled Clinical Study

BACKGROUND

Maxillary sinus augmentation (MSA) is a standard and predictable procedure to increase bone height in the atrophic posterior maxilla. Many biomaterials are employed in this technique; however, autologous platelet concentrates have been found to reduce clinical recovery time and improve bone gain in MSA.

PURPOSE

This study aimed to compare the radiographic, histomorphometric, and implant stability outcomes of titanium-prepared platelet-rich fibrin (T-PRF) and deproteinized bovine bone mineral (DBBM) in a two-stage MSA technique.

STUDY DESIGN, SETTING, SAMPLE

This randomized controlled split-mouth study included patients requiring bilateral two-stage MSA at the Periodontology Department of Kutahya Health Sciences University between March 2022 and April 2023. Patients with systemic comorbidities and residual bone height >5 mm in the bilateral posterior maxilla were excluded.

PREDICTOR VARIABLE

The predictor variable was the two-stage MSA technique. Each surgical site was randomly assigned to the T-PRF or DBBM group for two-stage MSA.

MAIN OUTCOME VARIABLES

The primary outcome was the histomorphometric evaluation of the percentage of new bone between the 2 groups. Secondary outcomes included radiographic evaluation of total bone height (ToBH), bone gain, bone density (BD), and graft volume (GV) on cone-beam computed tomography 6 months post-MSA, clinical assessment of primary implant stability at implant placement and secondary stability 3 months postplacement, and histomorphometric evaluation of the percentage of residual particles, percentage of connective tissue, and percentage of blood vessels from bone biopsy samples collected 6 months after MSA.

COVARIATES

Age, sex, periodontitis susceptibility, and smoking status were treated as covariates.

ANALYSES

The Wilcoxon signed-rank test was used for bivariate comparisons between 2 groups, and the Pearson or Spearman test was used to analyze correlations of variables within groups. A P value ≤ .05 was considered statistically significant.

RESULTS

The sample was composed of 10 patients with bilateral maxillary sinuses, 20 MSA regions, 8 (80%) males and 2 (20%) females with a mean age of 51.30 (9.06) year. The percentage of new bone was 19.48 ± 14.60 μm2 in the T-PRF group and 8.31 ± 5.47 μm2 in the DBBM group, and there was no statistically significant difference between the groups (P = .074). Radiographic measurements showed ToBH, GV, and BD values of 10.64 ± 3.96 mm, 989.89 ± 523.07 mm3, and 192.09 ± 127.90 hounsfield unit in the T-PRF group and 14.25 ± 1.65 mm, 1,519.39 ± 432.61 mm3, and 492.77 ± 117.35 hounsfield unit in the DBBM group, respectively. ToBH, GV, and BD values were statistically significant between the groups (P = .01 and P = .00). Primary and secondary implant stability in the T-PRF group were 71.11 ± 12.48 implant stability quotient (ISQ) and 68.03 ± 6.81 ISQ, respectively, compared with 67.94 ± 19.84 ISQ and 72.46 ± 11.21 ISQ in the DBBM group. The difference was not statistically significant between the groups (P = .41 and P = .33).

CONCLUSION AND RELEVANCE

Although T-PRF demonstrated inferior radiographic outcomes compared with DBBM during the initial6-month healing phase, both techniques yielded comparable results regarding new bone formation and implant stability. Further research is warranted to explore the efficacy of different T-PRF applications in MSA. This trial is registered at ClinicalTrials.gov (NCT05596084).

Minimally Invasive Sinus Augmentation: A Systematic Review

AIM

Technology improvement and a better understanding of sinus anatomy and wound healing in the past decade have allowed the development of minimally invasive surgical techniques. This systematic review focused on identifying and describing these techniques for vertical and lateral sinus augmentation (VSA and LSA).

MATERIALS AND METHODS

Electronic and hand search were conducted to screen the literature published from January 2003 to May 2024. The selected studies had to include detailed techniques for minimally invasive SA. Data extraction included the study types, sample size, technique/instrument details, and outcome measurements.

RESULTS

A total of 36 articles (27 VSA, 8 LSA with an additional 1 article included both procedures) with 2732 sinus augmentation met the inclusion criteria. Minimally invasive VSA includes the use of modified rotary instruments with stopper, balloon, hydraulic pressure, digital planning, endoscope, and operating microscope. These techniques aim for conservative flap reflection, precise sinus window preparation, and/or controlled sinus membrane elevation. Most of the selected studies (n = 15) did not report the incidence of sinus membrane perforation.

CONCLUSION

Within the limitations of this review, minimally invasive VSA and LSA achieved sufficient sinus augmentation and implant success with the potential advantages of reduced surgical complications and morbidity. Comparative studies with defined outcomes are encouraged to further validate these useful minimally invasive techniques for SA.

Autogenous bone ring augmentation and simultaneous implant placement in the atrophic posterior maxilla: A case report

INTRODUCTION AND IMPORTANCE

Restoring lost teeth in the posterior atrophic maxilla presents a significant challenge due to insufficient bone volume for implant placement. Simultaneous implant placement during lateral sinus lift is often considered, but the decision is typically based on the amount of existing bone. The aim of this study was to investigate the feasibility of simultaneous implant placement and maxillary sinus floor augmentation in the atrophic posterior maxilla using autogenous bone ring.

CASE PRESENTATION

A 58-year-old man presented with teeth loss in the posterior upper jaw and significant sinus pneumatization on the left side, resulting in only 2.6 mm of available alveolar bone height. This limited the possibility of simultaneous implant placement. As a solution, lateral maxillary sinus floor augmentation using an autogenous bone ring was performed, along with the insertion of the implant.

CLINICAL DISCUSSION

Anatomical limitations in the atrophic posterior maxilla present significant challenges for implant placement, often necessitating a two-stage approach: the first stage involves maxillary sinus floor augmentation, followed by implant placement in the second stage after bone graft maturation. However, by employing lateral sinus floor elevation combined with immediate implant placement using autogenous bone ring, treatment time can be significantly shortened.

CONCLUSION

This clinical case provides a comprehensive demonstration of implant insertion in an atrophic maxilla utilizing a single-stage approach. It underscores the significant advantage of reducing overall treatment time by concurrently addressing both bone augmentation and immediate implant placement within a single procedural session. This approach not only shortens the treatment process but also enhances patient acceptance by minimizing the need for multiple interventions.

Prevention and management of intra-operative complications in maxillary sinus augmentation: A review

Maxillary sinus floor elevation is usually performed in two different ways: the lateral approach involves the creation of a bony window on the maxillary sinus lateral wall, providing direct access to the sinus cavity for membrane elevation and subsequent graft placement, and the transcrestal approach is considered less invasive. The aim of this article is to describe, based on the literature, how to anticipate, avoid, and manage the intraoperative complications that can occur with both approaches. For both approaches, the most common complication is the sinus membrane perforation. For the lateral approach, an average frequency ranging from 15.7% to 23.1% is reported, but because of the better visibility, their management will be easier compared to the transcrestal approach. Mean perforation rate reported for the transcrestal approach is lower (3.1%-6.4%), but it should be noted that a significant number of perforations cannot be detected and managed given the blind nature of this technique. Anatomical parameters such as sinus width and buccal wall thickness may be a risk factor for one approach and not the other. As it is impossible to assess the resistance of the Schneiderian membrane, the transcrestal approach is more likely to lead to infectious complications in the event of perforation. Others, such as the risk of vascular damage, are encountered only with the lateral approach, which can be prevented easily by dissecting the alveolo-antral artery. For both approaches, prevention is essential and consists in analyzing the anatomy, mastering the surgical technique, and collaborating with the ENT to manage the essentially infectious consequences of intraoperative complications.

Long-Term Clinical Outcomes of Transalveolar Maxillary Sinus Floor Elevation with Rotatory Instruments: An 8-Year Follow-Up Prospective Clinical Study

Background: Transalveolar sinus floor elevation (TSFE) is a surgical technique for the placement of dental implants in patients with reduced height of the maxillary posterior alveolar bone. This study aims to demonstrate the clinical outcomes of TSFE using the minimal invasive sinus elevation (MISE) technique in partially and totally edentulous maxillary patients. Methods: This prospective clinical study followed STROBE guidelines. TSFE was performed using the MISE technique with the simultaneous placement of implants. Dental implants were loaded at 6 months. Maxillary vertical bone gain was measured by CBCT, and marginal bone loss was assessed by periapical radiographs. Results: Ninety-one patients, with a mean age of 62.1 ± 11.8 years, were treated with TSFE and the placement of 107 implants, with a mean follow-up of 96.2 ± 11.7 months. An increase of 4.3 ± 0.4 mm in bone height was achieved, with a dental implant cumulative survival rate of 97.2%. Peri-implantitis was observed in 9.3% of implants, and membrane perforation occurred in 7.7% of cases. Technical complications were noted in 5.5% of patients. Conclusions: Within the limitations of this clinical study, it can be concluded that the MISE technique is a successful protocol for the placement of implants in the posterior maxilla with reduced height of the alveolar ridge, with a rate of biological and prosthetic complications below 10% over an average follow-up period of 8 years.

Impact of Collagenated and Non-Collagenated Deproteinized Bovine Bone Mineral on Schneiderian Membrane Integrity in Rabbits

Background: This investigation focused on the influence of collagen on the integrity of the Schneiderian membrane during maxillary sinus augmentation in a rabbit model. The aim of this study was to elucidate the relationship between membrane integrity and bone regeneration in augmented maxillary sinuses using collagenated and non-collagenated grafts, through detailed histological and histomorphometric analyses. Methods: In this forward-looking, randomized, split-mouth design, bilateral maxillary sinus augmentation was conducted on 12 rabbits. One sinus was filled with deproteinized bovine bone material (DBBM) as the grafting material (non-collagenated; control), while a combination of DBBM particles integrated with 10% porcine-derived type I collagen was used in the contralateral sinus (collagenated; test). Histological analyses were carried out following healing periods of 2 and 12 weeks. Results: At the 2-week time point, six sites of thinned mucosa (<40 µm) and no perforations were observed in the collagenated group, while twenty-one thinned mucosa sites (p = 0.027 between test and control) and two perforations (p = 0.175 between test and control) were found in the non-collagenated group. After 12 weeks of healing, the number of sites with thinned mucosa was 20 in the collagenated group and 19 in the non-collagenated group, with four perforations observed in each group. These perforations were distributed across three sinuses in the collagenated group and two sinuses in the non-collagenated group. No statistically significant differences were found between the groups. Conclusions: The addition of 10% collagen to deproteinized bovine bone mineral initially provided protection against mucosal thinning and perforation after 2 weeks of healing. However, by week 12, this protective effect diminished, resulting in similar rates of mucosal thinning and perforations in both groups.

Intraoral Approach for Dental Implant Placement in Pneumatized Maxillary Sinuses With Postoperative Maxillary Cysts: A Report of Two Cases

A postoperative maxillary cyst (POMC) is a delayed complication of the original Caldwell-Luc operation, which was once widely performed to treat chronic rhinosinusitis. Two patients who had previously undergone Caldwell-Luc operations desired dental implant treatment. In both cases, preoperative cone-beam computerized tomography (CBCT) revealed a POMC occupying the entire maxillary sinus on the side where the implants were to be placed. The residual bone height was 3-4 mm. Furthermore, the sinuses were divided into compartments by septum-like structures. An intraoral approach was applied for POMC enucleation and implant placement. The implants were placed with sinus floor penetration due to the small residual bone height. No bone substitute material was grafted in the sinus. Postoperative healing was uneventful. All implants were successfully osseointegrated and performed well (4 and 5 years for each patient). No sinonasal complications were reported. Follow-up CBCTs showed that the exposed implant parts were covered by newly formed bone. The intraoral approach is a feasible option for implant placement in a pneumatized maxillary sinus with POMC.

Alveolar ridge preservation in posterior maxillary teeth for reduction in the potential need for sinus floor elevation procedures: A pilot study

OBJECTIVES

To investigate the effects of alveolar ridge preservation (ARP) on ridge height, sinus pneumatization and the potential need for lateral sinus augmentation following extraction in the posterior maxilla.

MATERIALS AND METHODS

This randomized controlled pilot study included 28 patients requiring extraction in the posterior maxilla with bone height between 6 and 8 mm. The sites were randomly allocated to either unassisted socket healing (Control), ARP with deproteinized bovine bone mineral (DBBM) (Test 1), or collagen-stabilized DBBM (Test 2) groups. Pre- and post-operative CTs at 4 months were taken to determine changes in ridge heights, sinus volume, and the need for sinus floor elevation (SFE) procedures for cases where the residual mid-ridge height was < 5 mm. Site-level analyses for changes in vertical ridge dimensions and sinus volume pre- and post-extraction/ARP were conducted using paired t-tests. Differences in mean changes in vertical ridge dimensions and sinus volume between the groups were determined using one-way ANOVA.

RESULTS

Significantly greater mean mid-ridge height reduction occurred in the control group (-2.7 ± 0.9 mm) compared to Test 1 (0.9 ± 3.7 mm) and Test 2 (1.0 ± 2.8 mm) groups (p < .05). No significant changes in mean mid-ridge height were found in either test groups. Volumetric analysis showed a significantly greater increase in sinus volume in the control group (0.7 ± 0.7 cm3) compared to Test 1 (n = 3, -0.7 ± 0.8 cm3) group (p = .03). 89% of patients in the control group would require lateral window SFE  compared to Test 1 (42.8%) and Test 2 (40%) groups.

CONCLUSION

ARP was effective in attenuating height changes in the middle of the ridge and may reduce sinus pneumatization following extraction in the posterior maxilla. This could potentially decrease the need for more invasive sinus augmentation procedures.

Dental Pathophysiology of Odontogenic Sinusitis: Oral Surgical Complications

The article explores the understudied pathophysiology of odontogenic sinusitis (ODS) development as a result of oral surgical complications such as oroantral communication (OAC) or fistula (OAF), maxillary sinus bone grafting, and dental implantation. A temporary OAC presents most often after dental extraction, especially with posterior maxillary teeth, though can happen with any oral surgical intervention. Maxillary sinus augmentation can also cause ODS, and while the pathophysiology is incompletely understood, it may be related to OAC/OAF formation or bone graft infection. Dental implants may also lead to ODS either via displacement into the sinus, partial protrusion into the sinus, or peri-implantitis.

Sequential Bone Repair in Rabbit Sinus Lifts Using Bio-Oss and Hyaluronic Acid-Polynucleotide Gel (Regenfast)

BACKGROUND

A comprehensive investigation to associate the use of polynucleotides and hyaluronic acid with bovine bone in maxillary sinus lift procedures in rabbits has not been performed yet. The aim was to evaluate the influence of this novel association on the processes of bone regeneration in maxillary sinus augmentation.

METHODS

In this prospective, randomized, within-animal model, maxillary sinus augmentation was performed bilaterally in 12 rabbits. Deproteinized bovine bone material (DBBM) was used as filler material. A hyaluronic acid-polynucleotide gel was aggregated at the test site. Histological evaluations were performed after 2 and 10 weeks of healing.

RESULTS

After 2 weeks of healing, similar amounts of new bone were observed at both the control (7.7 ± 4.3%) and test sites (8.1 ± 3.8%; p = 0.697). Bone formation was observed predominantly along the osteotomy margins and adjacent sinus walls. After 10 weeks of healing, the total new bone fraction reached 28.0 ± 10.1% at the control sites and 27.3 ± 10.5% at the test sites (p = 0.563). Multiple perforations of the sinus mucosa were observed in both groups when in contact with the biomaterial granules.

CONCLUSION

The present study failed to demonstrate a positive effect on bone formation when incorporating hyaluronic acid-polynucleotide gel (Regenfast) into a xenograft for maxillary sinus augmentation. Additionally, the use of this gel did not mitigate the occurrence of thinned mucosa or reduce the risk of subsequent sinus mucosa perforation.

Effectiveness of concentrated growth factors with or without grafting materials in maxillary sinus augmentation: a systematic review

Concentrated Growth Factor (CGF) is a highly effective biomaterial known for its ability to promote tissue regeneration. While it's been studied extensively in intraoral procedures and bone grafting, its benefits in maxillary sinus lifting lack substantial evidence. This review aimed to evaluate CGF's effectiveness in maxillary sinus augmentation, focusing on clinical, radiographic, and histological outcomes.A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, Google Scholar, and Cochrane Library databases using specific mesh terms and keywords and adhered to PRISMA guidelines. Studies up to March 2024 involving transcrestal or lateral maxillary sinus floor elevation with CGF, either alone or in combination with grafting materials, were included.Out of 783 publications, 13 studies met the eligibility criteria. The review assessed CGF's role in minimizing postoperative complications, enhancing new bone formation, and improving implant survival. Despite data variability among studies, the majority reported that CGF positively influenced maxillary sinus augmentation outcomes.While more robust randomized clinical trials are required to draw definitive conclusions, initial results are promising, and the findings suggest that CGF utilization in maxillary sinus augmentation seems to enhance clinical outcomes by promoting vascularization and regeneration at the surgical sites and improving both the quality and quantity of newly formed sinus bone. Furthermore, it exhibits potential for improving postoperative sequelae and achieving high implant survival rates.

Research trends and mapping knowledge for maxillary sinus augmentation in oral and maxillofacial surgery

BACKGROUND

The method most frequently employed to alleviate the deficiency of vertical bone volume in the maxillary posterior region is maxillary sinus augmentation. Given its importance in the field of dental implants and its possible impact on implant survival, it is crucial to assess the caliber and bibliometric characteristics of research related to maxillary sinus augmentation. This study aimed to understand the development and trends of studies and guide future studies by performing a bibliometric analysis of research related to maxillary sinus augmentation.

METHODS

The Web of Science database was searched on 29.05.2024 with the developed search strategy. Articles were listed in descending order according to the number of citations and analyzed using the Bibliometrix program prepared in R base. The articles were analyzed in four sections: performance analysis, word analysis, collaboration analysis, and thematic analysis.

RESULTS

Wang HL is the most frequently listed author on this topic with 24 h-indexes and 1686 total citations. The highest number of articles were published in 2017, with 102 articles with an average of 2.7 citations. The most popular keyword was "dental implants." with 426 usages. Italy and the USA are the countries that have published the most collaborative papers. Clinical Oral Implants Research comes at the top when evaluating the journals that publish on maxillary sinus augmentation based on the h-index. Basic research and technical-oriented studies between 1999 and 2005 have given way to more clinical and patient-oriented research.

CONCLUSION

This bibliometric study will serve as a guide for future research by illustrating the existing state of knowledge and limitations regarding the development of sinus lifting methods, given the constantly growing demand for implant therapy.

Comparison of three approaches for treating the bony access window in lateral sinus floor elevation: a retrospective analysis

The aim of this study was to retrospectively determine the effects of applying different treatment methods to the bony access window on the healing outcomes in lateral sinus floor elevation (SFE). Lateral SFE with implant placement was performed in 131 sinuses of 105 patients. The following three treatment methods were applied to the bony access window: application of a collagen barrier (group CB), repositioning the bone fragment (group RW) and untreated (group UT). Radiographic healing in the window area, augmented bone height changes and marginal bone level changes were examined. Mixed logistic and mixed linear models were analyzed. Over 4.3 ± 1.4 years of follow-up, the implant survival rate was 100% in groups CB and UT, and 96.9% in group RW. The treatment applied to the window did not significantly influence the radiographic healing in the window area, augmented bone height changes or marginal bone level changes (p > 0.05). The healed window areas had generally flat morphologies and were fully corticalized. The mean changes in the augmented bone were less than 1.5 mm in all groups. Marginal bone level changes were minimal. In conclusion, Healing outcomes were not different among three different methods to treat the bony access window in lateral SFE.

Evolving Techniques and Trends in Maxillary Sinus Lift Procedures in Implant Dentistry: A Review of Contemporary Advances

The most challenging aspects of planning implant rehabilitation for the posterior maxillary region are the pneumatization of the maxillary sinus and the resorption of the residual alveolar ridge. To address the first aspect, there are two primary modalities for sinus augmentation: the direct or lateral window technique and the indirect or crestal technique. Clinicians must possess comprehensive knowledge of the maxillary sinus anatomy and be able to diagnose pathognomonic abnormalities through presurgical imaging and investigations. This skill is essential for performing technique-sensitive augmentation of the maxillary sinus with or without using biomaterials such as bone grafts, membranes, and platelet concentrates. These materials help create a suitable bone bed for either simultaneous or delayed implant placement through various traditional and evolving modified sinus augmentation techniques. It is also critical to effectively elevate the Schneiderian membrane during sinus floor elevation surgery, as complications in this process can adversely affect implant survival and potentially lead to implant failure. This review explores various aspects of maxillary sinus augmentation, ranging from traditional methods to evolving contemporary techniques, and draws on existing literature to examine their advantages, limitations, indications, and contraindications.

Long-term effectiveness of UV functionalised short (≤ 6 mm) dental implants placed in the posterior segments of the atrophied maxilla: controlled case series

This study evaluated long-term effectiveness UV functionalised short implants (≤ 6 mm) placed in the posterior segments of the atrophied maxilla. The study included 47 patients from 2018 to 2023 (aged 27 to 56 years, 24 women and 23 men) without any systemic diseases, with unilateral/bilateral missing teeth and vertical atrophy of the posterior maxillary area. Total installed were 64 short UV-functionalized implants and 62 standard implants over 10 mm in length in segments maxilla with sufficient bone parameters. Clinical, laboratory and cone beam computed tomography (CBCT) methods were used to plan implant therapy. The clinical indices included the following parameters: ISQ, MBL, OHIP-G scale. For short implants, the median ISQ at placement was 62.2 for primary stability and the median ISQ at 5 months was 69.6 ISQ. For standard implant, the mean ISQ at placement was 64.3 ISQ, and ISQ after 5 months was 71.6 ISQ. After 6 months mean MBL short implants 0.87 mm, after 1 year 1.13 mm, after 5 years was 1.48 mm. After 6 months mean MBL standard implants 0.84 mm, after 1 year 1.24 mm, after 5 years was 1.58 mm. Mean OHIP-G scores-patients satisfaction with the implant at 4.8 ± 0.3, satisfaction with the operation 4.6 ± 0.4; satisfaction with prosthetics 4.7 ± 0.5. Cumulative success rate 5 years short implants was 96.7%, standard implants was 97.4%, and prosthesis cumulative survival rate was 97.2%. Short ultraviolet functionalized implants used in the posterior resorbed segment of maxilla have been shown to be a reliable alternative to sinus lift, demonstrating fewer complications, reduction in the number of additional surgical interventions and showed satisfactory long-term survival.

The past forty-three years of dental implantology literature. A global mapping and scientometric analysis

PURPOSE

The aim of this research is to make a scientometric analysis of the dental implantology literature and to present the results in a more understandable way to the reader by visualizing them with maps.

METHODS

The dental implantology literature was accessed through the Web of Science database. Scientometric data was obtained with Citespace 6.1 software, co-citation, clustering analysis, citation burst, and mapping analyzes were performed. Scimago Graphica software was used for additional visualizations.

RESULTS

A total of 35,704 articles were included in the analysis. There were 88,616 authors, 72,333 institutes, 142 countries/regions, and 3,265 journals contributing to the dental implantology literature. The United States was first with 7,334 publications and 225,868 citations. The literature between 1980 and 2023 was divided into 19 different clusters, and the literature between 2000 and 2023 was divided into 16 different clusters.

CONCLUSIONS

Key themes in the field include the use of autogenous bone, advancements in implant surface technology, and the use of platform switching and intraoral scanners. Emerging topics of interest include esthetic considerations in the treatment of the anterior region, stress distribution, the use of zirconia, and the impact of implant treatment on oral health-related quality of life. With similar scientometric analysis studies to be done in the future, the progress of the literature can be followed on the basis of evidence.

Cone-beam computed tomography assessment of palatal-nasal recess of maxillary sinus in dentulous and edentulous subjects

Background

Implant placement in the posterior maxilla is challenging in the case of maxillary sinus pneumatization. Increasing the vertical dimension by grafting the sinus floor is a common surgical modality. Cone-beam computed tomography (CBCT) scans are used to assess the presurgical anatomic variations of the maxillary sinus and determine the difficulty that might be encountered while performing sinus elevation. The sinus membrane is elevated from both the lateral and mesial walls of the sinus. The location and angulation of the palatal-nasal recess (PNR) on the medial wall of the sinus could complicate the elevation of the sinus membrane in this region. This study aimed to assess the angulation of the PNR and its position with respect to the alveolar crest in dentulous and edentulous subjects in the 1st molar region on CBCT scans.

Materials and Methods

One hundred and fifty-two scans were selected from the department database. Sagittal sections including the 1st molar region were selected and measurements made. The PNR height was measured from the alveolar crest in millimeters and angulation in degrees and compared between the dentulous and edentulous groups.

Results

The dentulous group showed a statistically significant greater distance (10.4 ± 2.8 mm) between the alveolar crest and PNR as compared to the edentulous group (8.08 ± 3.1 mm). The edentulous group showed a statistically significant greater PNR angle (139.6o ± 13.6o) as compared to the dentulous group (133.4o ± 16.4o).

Conclusion

Maxillary sinuses with acute-angled PNR and lesser distance from the alveolar crest should be carefully evaluated to avoid complications such as membrane perforation during their elevation from the bony wall of the sinus.

Histomorphometric and microtomographic analysis of maxillary sinus augmentation surgeries with and without collagen membrane on the lateral window: A randomized clinical trial

OBJECTIVE

To evaluate the histomorphometric and computerized microtomographic (Micro-CT) analysis of the regenerated bone tissue from maxillary sinus augmentation surgery, with and without using the collagen membrane on the external osteotomy window.

MATERIALS AND METHODS

Twelve patients were selected for this prospective, controlled, and randomized study. The patients were submitted to bilateral maxillary sinus surgery in a split-mouth design. On the test side, the maxillary sinus augmentation procedure included using Geistlich Bio-Oss® and a Geistlich Bio-Gide® collagen membrane covering the lateral osteotomy window. On the control side, only Geistlich Bio-Oss® was used without the presence of the membrane. After 6 months, the surgeries for implant installation were performed. In this surgical phase, specimens of the regenerated tissue were collected for histological and Micro-CT analysis.

RESULTS

In the histomorphometric evaluation, the mean (±SD) percentages of newly formed bone were 43.9% (±11.5) and 40.8% (±8.9) in the test and control groups, respectively. The corresponding values of the Micro-CT analysis were 36.6% (±3.4) and 37.2% (±4.7) in the test and control groups, respectively. There was no statistically significant difference between the test and control groups in the two methods. In addition, there was no statistically significant difference between the mean percentage of biomaterial remaining between the test and control groups. However, the mean percentage of newly formed bone was significantly higher and the mean percentage of remaining biomaterial was significantly lower in the histomorphometric analysis compared to the values obtained through microtomography.

CONCLUSION

The additional use of collagen membranes in maxillary sinus surgery does not offer advantages in newly formed bone.

The Role of Bone Tacks in Sinus Floor Lift Surgery: A Single-Center Experience

Background: Maxillar atrophy is a prevalent condition associated with diminished bone volume, which precludes the conventional placement of dental implants. Sinus floor lift is a surgical procedure that aims to address this atrophy through the insertion of a graft within the sinus cavity. A multitude of techniques have been documented in the international literature for the management of the sinus bone window, though each approach has its own set of advantages and disadvantages. Methods: The present study is a retrospective analysis of traditional sinus floor lift surgery, comparing the outcomes of two surgical approaches: placement of a collagen membrane over the maxillary lateral bone window with or without bone tacks. The study enrolled a total of 48 consecutive patients. Twenty-four patients underwent sinus floor lift surgery, with the placement of a collagen membrane over the maxillary lateral bone window without bone tacks (control group). The remaining 24 patients underwent the same procedure, but with bone tacks (study group). All patients received an amoxicillin 875 mg + clavulanic acid 125 mg administration for six days and underwent Cone Beam Computed Tomography (CBCT) before the sinus floor lift surgery and six months later before the implant surgery. The parameters measured on the preoperative Cone Beam Computed Tomography (CBCT) scan included residual bone, the preoperative thickness of the lateral bone in the center, and the distance between the lateral wall and the medial wall of the sinus. Only the bone height increment was measured on the postoperative CBCT scan. Postoperative complications and the visual analogue scale (VAS) score were also recorded. A statistical analysis was performed, and the correlation between the parameters was evaluated using Pearson's correlation coefficient. A comparison of the mean of the parameters between the treatment group and the control group was conducted using the t-test. Results and Conclusions: The study group was found to have superior outcomes in terms of bone height increment (p = 0.001) and VAS after 7 days (p = 0.11) compared to the control group. The novel application of bone tacks on the collagen membrane over the bone window following sinus elevation surgery was associated with superior outcomes in terms of bone height and reduced pain at seven days, as measured by the VAS, with no postoperative complications.

Simplified Sinus Floor Augmentation: An Economical Approach Using a Modified Balloon Technique

Longstanding partial edentulism in the posterior segment of the maxilla is a challenging treatment and typically involves extensive and invasive sinus floor augmentation. Various methods have been employed for sinus floor elevation, including the application of hydraulic pressure using the balloon technique. This case report describes a modified ballooning technique to elevate the sinus floor using a Foley catheter to apply the hydraulic pressure method to elevate the Schneiderian membrane prior to the placement of bone grafts and an endosseous implant in a 37-year-old male patient who presented with an atrophic alveolar ridge height of 3.0 mm in the area of the extracted left first maxillary molar. Sinus floor elevation using the Foley catheter led to a sinus floor elevation of 7 mm and a gain in alveolar bone height of 7.8 mm. The patient was asymptomatic with a stable implant during the one-year follow-up period after prosthetic implant loading.

Effect of Implant Instrumentation Techniques in the Success of Implants: An Original Research

Background

The success rates of dental implants are largely dependent on implant instrumentation procedures. It's still unknown, nevertheless, how successful sophisticated instrumentation techniques are in comparison to older methods.

Methods

One hundred patients receiving dental implants participated in a prospective study that was carried out in a tertiary care facility. Random assignments were made to place patients in Group B (advanced instrumentation) or Group A (conventional instrumentation). Following implant implantation, clinical indicators, such as implant stability and peri-implant bone loss, were evaluated on a regular basis. A statistical analysis was conducted in order to compare the results among the groups.

Results

Compared to implants placed using conventional procedures (75.2 ± 3.4), implants placed using advanced instrumentation techniques showed considerably improved stability (82.6 ± 2.9) (P < 0.001). Furthermore, there was a statistically significant difference in peri-implant bone loss between the advanced instrumentation group (0.4 ± 0.1 mm) and the traditional instrumentation group (0.8 ± 0.2 mm) (P = 0.003).

Conclusion

In summary, current research indicates that, in comparison to conventional methods, sophisticated instrumentation techniques enhance implant stability and decrease peri-implant bone loss. These findings have significant ramifications for implant dentistry clinical procedures as well as patient outcomes.

Assessment of the Quality of Sinus Elevation with Lateral Window Approach Procedure Videos on YouTube: A Content-quality Analysis

Although the lateral window approach allows for greater graft material delivery and bone formation, it is more challenging and invasive, prompting keen interest among dentists to master this method. YouTube is increasingly used for medical training; however, concerns regarding the quality of instructional videos exist. This study proposes new criteria for evaluating YouTube videos on maxillary sinus elevation with the aim of establishing standards for assessing instructional content in the field. We sourced 100 maxillary sinus elevation videos from YouTube and, following exclusion criteria, analyzed 65 remaining videos. The video characteristics, content quality, and newly developed criteria were evaluated. Statistical analyses, employing ordinal logistic regression, identified the factors influencing the quality of instructional videos and evaluated the significance of our new criteria. Although video interaction and view rate exhibited positive relations to content quality, they were not significant ( P =0.818 and 0.826, respectively). Notably, videos of fair and poor quality showed a significant negative relation ( P <0.001). Audio commentary, written commentary, and descriptions of preoperative data displayed positive but statistically insignificant relationships ( P =0.088, 0.228, and 0.612, respectively). The comparison of video evaluation results based on the developed criteria with content quality scores revealed significant negative relationships for good, fair, and poor videos ( P <0.001, Exp(B)=-4.306, -7.853, -10.722, respectively). Among the various video characteristics, only image quality showed a significant relationship with content quality. Importantly, our newly developed criteria demonstrated a significant relationship with video content quality, providing valuable insights for assessing instructional videos on maxillary sinus elevation and laying the foundation for robust standards.

Distribution of the intraosseous branch of the posterior superior alveolar artery relative to the posterior maxillary teeth

Purpose

Preoperative identification of the intraosseous posterior superior alveolar artery (PSAA) is critical when planning sinus surgery. This study was conducted to determine the distance between the cementoenamel junction and the PSAA, as well as to identify factors influencing the detection of the PSAA on cone-beam computed tomography (CBCT).

Materials and Methods

In total, 254 CBCT scans of maxillary sinuses, acquired with 2 different scanners, were examined to identify the PSAA. The distance from the cementoenamel junction (CEJ) to the PSAA was recorded at each maxillary posterior tooth position. Binomial logistic regression and multiple linear regression were employed to evaluate the effects of scanner type, CBCT parameters, sex, and age on PSAA detection and CEJ-PSAA distance, respectively. P-values less than 0.05 were considered to indicate statistical significance.

Results

The mean CEJ-PSAA distances at the second molar, first molar, second premolar, and first premolar positions were 17.0±4.0 mm, 21.8±4.1 mm, 19.5±4.7 mm, and 19.9±4.9 mm for scanner 1, respectively, and 17.3±3.5 mm, 16.9±4.3 mm, 18.5±4.1 mm, and 18.4±4.3 mm for scanner 2. No independent variable significantly influenced PSAA detection. However, tooth position (b=-0.67, P<0.05) and scanner type (b=-1.3, P<0.05) were significant predictors of CEJ-PSAA distance.

Conclusion

CBCT-based estimates of CEJ-PSAA distance were comparable to those obtained in previous studies involving cadavers, CT, and CBCT. The type of CBCT scanner may slightly influence this measurement. No independent variable significantly impacted PSAA detection.

Implant stability and clinical outcome between implant placement using internal sinus floor elevation with alloplastic bone material grafting and without grafting: A 1-year randomized clinical trial

OBJECTIVE

To compare implant stability and clinical outcome in implant placement between osteotome sinus floor elevation (OSFE) with biphasic calcium phosphate (BCP) which consisted of 30% of hydroxyapatite (HA) and 70% of beta-tricalcium phosphate (β -TCP) grafting material and OSFE without using bone grafting material. The research questions is whether the BCP provides any benefit in OSFE or not.

MATERIALS AND METHODS

Thirty patients (30 implants) with a single edentulous area of upper premolar or molar were randomly separated into OSFE with BCP (n = 15) and OSFE without grafting (n = 15). The patients were reevaluated 3, 6, 9, and 12 months after implant loading. The clinical assessments (implant stability quotient (ISQ), implant survival-failure rate, and surgical complication) were analyzed. Together with radiographic assessments in 2D (endo-sinus bone gain (ESBG), mean marginal bone change (MMBC)) and 3D (endo-sinus bone gain in CBCT (ESBG-CT)) were evaluated, with a mean follow-up time of at least 12 months of functional loading and prosthetic complication.

RESULTS

20 remaining implants (OSFE with BCP, n = 10; OSFE without grafting, n = 10) were analyzed. Mean ISQ was 79.18 ± 3.43 in 1-year follow-up (ISQ; OSFE with BCP = 78.72 ± 3.46, OSFE without grafting = 79.65 ± 3.52). ISQ in both groups increased steadily without significant differences in each follow-up. (p = 0.56). In radiographic evaluation, at 6-, 9-, and 12-month, OSFE without grafting group showed statistically significant lower MMBC (p < 0.05). The 1-year clinical results showed that 2 implants failed in OSFE with BCP, and 1 implant failed in OSFE without grafting.

CONCLUSIONS

Graft material "BCP" (HA30:TCP70) coupled with OSFE presents no extraordinary benefit in implant stability, clinical and radiographic outcome in 1-year follow-up.

CLINICAL RELEVANCE

Clinically, OSFE with grafting materials provides no additional benefit.

CLINICAL TRIAL REGISTRATION NUMBER

TCTR20210517008 (date of registration: May 17, 2021).

The comparison of visibility of the maxillary sinus septa between cone-beam computed tomography scans and panoramic radiograph images as dependent on the cortical bone thickness: a retrospective comparative study

PURPOSE

To analyze the visibility of the maxillary sinus septa (MSS) in panoramic radiography (PR) versus cone beam computed tomography (CBCT) and to investigate whether the buccal cortical bone thickness (BT) or the septa dimensions influence their visibility.

METHODS

Corresponding PR and CBCT images of 355 patients were selected and examined for MSS visibility. The septa dimensions (width, height, depth) and the BT were measured. Results were analysed statistically.

RESULTS

Comparing the corresponding regions on CBCT and PR, 170 MSS were identified; however, only 106 of these were also visible using PR. The MSS visibility was significantly higher on CBCT versus PR images (P1: p = 0.039, P2: p = 0.015, M1: p = 0.041, M2: p = 0.017, M3: p = 0.000), except region C (p = 0.625). Regarding the measurements of MSS dimensions, only the height in region M1 (p = 0.013) and the width in region P2 (p = 0.034) were significantly more visible on CBCT. The BT in the area of the MSS was found to have a marginal influence on its visibility on the PR images only in regions M3 and M1 (M3: p = 0.043, M1: p = 0.047). In terms of MSS visibility based on the dimensions, significance was found for all three influencing variables only in region P2 (width; p = 0.041, height; p = 0.001, depth; p = 0.007). There were only isolated cases of further significance: M3 for width (p = 0.043), M2 for height (p = 0.024), and P1 for depth (p = 0.034), no further significance was noted.

CONCLUSION

MSS visibility appears significantly higher on CBCT versus PR images. It is concluded that the septa dimensions and BT can influence MSS visibility on PR images just in certain regions.

Effectiveness of Autologous Platelet Concentrates in the Sinus Lift Surgery: Findings from Systematic Reviews and Meta-Analyses

Maxillary sinus augmentation is one of the most predictable procedures for the rehabilitation of the posterior maxilla. The current overview aimed to summarize the findings provided by systematic reviews (SRs) and meta-analyses on the effectiveness of autologous platelet concentrates (APCs) in sinus lift and to assess the methodological quality of the included SRs. Three electronic databases have been explored. SRs and meta-analyses addressing the effectiveness of APCs in sinus lift technique were included. Clinical, radiographic and histomorphometric findings were considered for APCs as solely grafting materials and APCs in combination with biomaterials. Outcomes were implant survival rate (ISR), implant stability (IS), implant failure (IF), postoperative complications, histomorphometric findings, radiographic bone gain, bone volume and bone density. The methodological quality of the included SRs was assessed using the updated version of "A Measurement Tool to Assess Systematic Review" (AMSTAR-2). Thirty SRs were included. The methodological quality of the included reviews ranged from critically low (3 studies) to high (9 studies). The included SRs showed favorable clinical outcomes, short-term new bone formation and no biological complications when APCs were used both as solely graft material or in combination with other biomaterials. However, no significant additional effects in the long-term period were observed. APCs did not add any further positive effects compared to the physiological healing derived by the natural blood clot. The current overview of SRs highlighted the need for high-quality SRs evaluating the role of APCs in sinus lift though network meta-analyses, in order to identify the most powerful material for sinus lift augmentation. The use of APCs improves the healing of soft tissues and the postoperative quality of life in the short-term period. Thus, its application can be recommended.

Outcome Difference between Short and Longer Dental Implants Placed Simultaneously with Alveolar Bone Augmentation: a Systematic Review and Meta-Analysis

Objectives

This systematic review and meta-analysis aim to provide detailed insights into the clinical performance of short and longer dental implants placed simultaneously with bone augmentation.

Material and Methods

The search for literature was performed across MEDLINE (PubMed), ScienceDirect and the Cochrane Library databases, adhering to specific selection criteria and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only articles published in English between 2014 and 2024 were considered for data collection. Primary outcomes were survival rate (SR), marginal bone loss (MBL) and complications. Clinical outcomes were as follows: bleeding on probing (BOP), periodontal pocket depth (PPD), and implant stability quotient (ISQ). Quality and risk of bias assessment were evaluated by the Critical Appraisal Checklist tool for randomized controlled trials developed by the Joanna Briggs Institute.

Results

A total of 14678 articles were screened, with 9 meeting the inclusion criteria and being utilized for this systematic review and meta-analysis. A total of 495 patients with 984 implants (491 short and 493 longer implants) showing a SR of 93.91% for the short implants and 91.83% for the longer implants. Meta-analysis revealed statistically significant difference between short implants and longer implants simultaneously placed with alveolar bone augmentation in relation to MBL (-0.513 mm, 95% CI = -0.93 to -0.096; P = 0.02), and in PPD (-0.247, 95% CI = -0.515 to 0.022; P = 0.07).

Conclusions

When comparing the results of treatment with short and longer dental implants combined with alveolar bone augmentation, short implants showed better clinical results regarding the parameters of survival rate, marginal bone loss and complications.

Randomized controlled multi-centre study comparing shorter dental implants (6 mm) to longer dental implants (11-15 mm) in combination with sinus floor elevation procedures: 10-year data

AIM

To compare implant survival and complication rates between shorter and standard-length implants with sinus augmentation and restored with single crowns, at 10 years of loading.

MATERIALS AND METHODS

One-hundred and one patients (137 implants) with a ridge height of 5-7 mm in the posterior maxilla were randomly assigned to two treatment modalities: shorter implants (6 mm) (group short [GS]) or standard-length implants (11-15 mm) with sinus grafting (group graft [GG]). Following the insertion of final restorations, patients were regularly recalled for up to 10 years. Assessed outcomes encompassed implant survival, marginal bone levels (MBLs), biological and technical parameters and patient-reported outcome measures (OHIP-49 = Oral Health Impact Profile). Non-parametric statistical analysis was used to analyse the data.

RESULTS

For the 5- to 10-year follow-up period, 77 patients with 105 implants (GS: 36 patients/48 implants; GG: 41/57) were available for re-examination (drop-out rate 21%). Implant survival rates at the patient level were 96.0% (GS; 2 failures) and 100% (GG) (inter-group p = .24). Median MBLs amounted to 0.00 mm (min 0.00; max 3.25; GS) and 0.00 mm (min 0.00; max 4.55; GG) (inter-group p = .73). Technical complications predominantly occurred within the first 5 years (inter-group p > .05). Peri-implantitis rates were 4.2% (GS) and 13.3% (GG) (intergroup p = .37). Median OHIP-49 scores were 7.00 (0.00; 39.00; GS) and 9.00 (0.00; 196; GG) (inter-group p = .61) at 10 years.

CONCLUSIONS

Based on similar 10-year implant survival rates, reduced patient morbidity and lower costs, the use of shorter dental implants might well serve as an alternative treatment concept to longer implants placed in conjunction with sinus grafting for patients with a limited ridge height in the posterior maxilla. Study register: https://clinicaltrials.gov/ct2/show/NCT01030523.

Radiographic assessment of maxillary sinus membrane and lateral wall thickness using cone-beam CT in different facial types in southwestern Saudi Arabia

The anatomy of the edentulous posterior maxilla and maxillary sinus possess unique challenges in implant dentistry. The purpose of this study was to assess maxillary sinus membrane thickness (MT) and lateral wall thickness (LWT) in different facial index profiles and to describe the clinical implications. A retrospective image analysis of 75 CBCT scans was done, which yielded a total of 150 sinus images. The facial index was calculated as per the formula given in the text and grouped as euryprosopic, mesoprosopic and leptoprosopic. The images obtained were of 36 women (48%) and 39 men (52%), with maximum subjects in 30-39 years age group. MT and LWT were measured at three different points on the radiograph at every 3mm from the base of the sinus floor in premolar and molar regions of each image. Results showed females had significant differences from males in LWT in both premolar and molar regions (p = 0.018 and 0.032 respectively). Subjects in 40-49 years of age had significant differences (p = 0.021) in MT in premolar region only. Also, difference in MT in premolar and molar regions were also statistically significant. Lastly, the present study did not find any statistically significant difference in MT and LWT in all three facial indices groups. It can be concluded that different facial indices have no positive correlation with maxillary sinus membrane thickness and lateral wall thickness. Hence, surgical complications are avoidable with proper detailed knowledge and appropriate identification of the anatomic structures characteristic to the maxillary sinus.

Classifying Maxillary Sinuses of Polish Patients for Sinus Lift: A Pilot Study

To date, there is no systematic anatomical classification available that could help clinicians in choosing between the lateral and palatal approach in sinus lift procedures. The aim was to provide a simple-to-use and memorable classification of the maxillary sinus concerning the thickness of lateral and palatal walls to facilitate the most adequate choice for the window location during direct sinus floor elevation. Cone beam computed tomography scans were consecutively obtained for 200 maxillary sinuses of patients needing dental implant placement with potential maxillary sinus augmentation. The thickness and height of the alveolar bone of the lateral and palatal walls of the maxillary sinuses were assessed. Four variants were distinguished. Class 0: an adequate sub-sinus residual bone height; without the need for sinus floor augmentation. Classes 1-3 had a reduced sub-sinus residual bone height. Class 1: a thinner lateral than palatal sinus wall. Class 2 (the most frequent; 49%): the comparable thickness of both walls in which either lateral, palatal, or crestal window osteotomies can be applied. Class 3 (the least frequent; 3%): a thinner palatal sinus wall in comparison to the lateral wall. The presented anatomical classification simplifies the decision-making process of choosing the most adequate window location and osteotomy technique.

Maxillary Sinus Augmentation with Xenogenic Collagen-Retained Heterologous Cortico-Cancellous Bone: A 3-Year Follow-Up Randomized Controlled Trial

Sinus augmentation procedures have become a valuable solution for patients with posterior maxillary edentulism. The objective of this study was to explore the efficacy and safety of porcine xenograft with collagen supplementation as a potential alternative to autologous bone grafts in lateral sinus augmentation over a three-year follow-up period. Twelve patients, each with bilateral posterior maxillary edentulism, were enrolled and randomly allocated to receive either a porcine xenograft or an autologous graft. Comprehensive assessments, including clinical and radiographic evaluations, were conducted at specific intervals, including implant stability, marginal bone loss, prosthetic and biological complications, and patient preferences. The results demonstrated no significant differences between the two graft materials in terms of implant survival, marginal bone loss, and patient preferences after three years of follow-up. Only one implant was affected by peri-implantitis, and prosthesis-related complications were present in one patient possibly due to bruxism. In conclusion, these findings suggest that a porcine xenograft with collagen supplementation may be a viable alternative to an autograft in lateral sinus augmentation procedures. The high implant survival rate, minimal complications, and patient satisfaction indicate the potential clinical relevance of this graft material and should be further investigated to confirm these promising results.

Mini Crestal Sinus Lift With Bone Grafting and Simultaneous Insertion of Implants in Severe Maxillary Conditions as an Alternative to Lateral Sinus Lift: Multicase Study Report of Different Techniques

The present study evaluates the efficacy and clinical outcomes of crestal sinus lift techniques used to elevate the sinus floor simultaneously with bone grafting and implant placement as a possible and reproducible alternative to lateral sinus lift. Patients underwent different crestal sinus elevation techniques. The heterologous biomaterial was used as graft material, and multiple implants were placed simultaneously after sinus augmentation. Radiographic and clinical examinations were performed during follow-up. All procedures were successfully performed without any apparent perforation of the Schneider membrane. The sinus floor was augmented with an average height of 5 mm (range: 2.8-7.4 mm). The implants healed smoothly with healing screws. Peri-implant marginal bone was stable with a mean follow-up of 50 months (range: 33-71 mo). No complications were observed during the follow-up. Based on the limited data collected in this study, the new crestal sinus elevation approach can effectively raise the sinus floor and reduce the incidence of postoperative complications. Other cases with long-term follow-up are needed to confirm and improve this crestal sinus lift technique.

Comparative evaluation of hard and soft tissue parameters by using short implants and standard long implants with sinus lift for prosthetic rehabilitation of posterior maxilla

Objective

The objective is to compare and evaluate the hard and soft tissue parameters by using short and standard long implants with sinus lifting in the posterior maxilla.

Materials and Methods

Eleven patients with complaints of missing upper back teeth were enrolled in the study for implant-supported rehabilitation and were categorized into two groups: Group long (GL): longer implant (>8 mm) placement, preceded by Sinus Augmentation. Group short (GS): short implant (≤8 mm) placement, without sinus augmentation. The primary outcome measured was cumulative survival rate (CSR) in the compromised partial edentulous posterior maxilla. Secondary outcomes measured were implant stability (IS), marginal bone level alterations (MBL), pocket probing depth (PPD), crown-to-implant ratio, and any complications.

Results

The difference in CSR between the groups was not statistically significant (P = 0.317). High stability was achieved immediately after the placement of the implants, in both groups (GS: 64 ± 4.07, GL: 65.58 ± 9.75); this difference in the mean ISQ (IS quotients) values was not found to be statistically significant at implant placement (P = 0.7). The mean MBL reported in the study at the end of 12 months of prosthesis function was - 0.762 ± 0.48 mm and - 0.7 ± 0.34 mm for GS and GL, respectively. The mean PPD measurements in GS and GL groups were 1.917 ± 0.68 mm and 1.833 ± 0.38 mm, respectively, and it was not statistically significant (P = 0.8).

Conclusion

Within the limitations of the present study, the obtained results indicate that short implants provided a similar clinical and radiographic performance compared to long implants placed in combination with a sinus augmentation procedure (lateral window) up to 12 months after prosthetic loading.

Does Collagen Membrane Coverage Offer any Advantage for Lateral Window Sinus Augmentation? A Histologic and Histomorphometric Analysis

Background

We aimed to determine whether collagen membrane coverage in maxillary sinus floor elevation surgery, provides an advantage regarding bone regeneration.

Methods

This randomized clinical trial included all healthy adults presented for dental implant placement in the posterior edentulous maxilla at the Maxillofacial Surgery Department of Mashhad Dental School, Mashhad, Iran from 2021-2022. Participants were candidates for sinus floor elevation surgery. Patients were randomly allocated to control (with membrane) and test (without membrane) groups. Surgery was performed through the lateral window technique and using allograft particles. According to the assigned study group; either a collagen membrane was placed over the osteotomy window or it was left uncovered. Six months after surgery when patients were recalled for implant placement, a bone specimen was obtained and sent for histologic and histomorphometric analysis. The predictor variable was the use of collagenous membrane and the outcome variables were the amount of newly formed bone, native bone, and connective tissue.

Results

A total of 30 consecutive patients, with a mean age of 46.33±7.25 years completed the study. Histomorphometric measurements, six months after augmentation revealed that the mean area of connective tissue was significantly less in the group with membrane coverage (P=0.015). The area of newly formed bone was significantly greater in sites covered with a collagen membrane compared to grafted but uncovered sites; (P <0.001).

Conclusion

Covering the lateral osteotomy window with a bioabsorbable collagenous membrane is able to significantly enhance vital bone formation and decrease connective tissue proliferation.

Osteogenic Effect of a Bioactive Calcium Alkali Phosphate Bone Substitute in Humans

(1) Background: The desire to avoid autograft harvesting in implant dentistry has prompted an ever-increasing quest for bioceramic bone substitutes, which stimulate osteogenesis while resorbing in a timely fashion. Consequently, a highly bioactive silicon containing calcium alkali orthophosphate (Si-CAP) material was created, which previously was shown to induce greater bone cell maturation and bone neo-formation than β-tricalcium phosphate (β-TCP) in vivo as well as in vitro. Our study tested the hypothesis that the enhanced effect on bone cell function in vitro and in sheep in vivo would lead to more copious bone neoformation in patients following sinus floor augmentation (SFA) employing Si-CAP when compared to β-TCP. (2) Methods: The effects of Si-CAP on osteogenesis and Si-CAP resorbability were evaluated in biopsies harvested from 38 patients six months after SFA in comparison to β-TCP employing undecalcified histology, histomorphometry, and immunohistochemical analysis of osteogenic marker expression. (3) Results: Si-CAP as well as β-TCP supported matrix mineralization and bone formation. Apically furthest away from the original bone tissue, Si-CAP induced significantly higher bone formation, bone-bonding (bone-bioceramic contact), and granule resorption than β-TCP. This was in conjunction with a higher expression of osteogenic markers. (4) Conclusions: Si-CAP induced higher and more advanced bone formation and resorbability than β-TCP, while β-TCP's remarkable osteoconductivity has been widely demonstrated. Hence, Si-CAP constitutes a well-suited bioactive graft choice for SFA in the clinical arena.

Clinical and patient-centered outcomes following rehabilitation of atrophic edentulous maxilla using six implants placed simultaneously with bilateral maxillary sinus augmentation: A retrospective case series

OBJECTIVES

To evaluate treatment success, patient satisfaction, and oral health-related quality of life (OHRQoL) after rehabilitation of atrophic edentulous maxilla (AEM) with six implants placed simultaneously with bilateral maxillary sinus floor augmentation (MSFA).

MATERIALS AND METHODS

The selected patients were fully edentulous with atrophic maxillary posterior residual ridges and rehabilitated with six implants placed simultaneously with bilateral MSFA and immediate All-on-4 provisional fixed prosthesis (PFP). After 7-12 months of implant surgery, all patients have received an All-on-6 definitive fixed prosthesis (DFP). After at least one year of function with DFP, clinical and radiographic examinations were performed. Patient satisfaction was assessed through a visual analog scale (VAS). The OHRQoL before treatment (T0), during provisional (T1), and after definitive prosthesis (T2) was evaluated using OHI-14.

RESULTS

20 maxillary edentulous patients were rehabilitated with 120 implants, 20 immediate All-on-4 PFP, and 20 All-on-6 DFP. Of those, 12 patients have passed at least a year follow-up after DFP insertion and were eligible to be included in the assessment of treatment success. After a mean of 20 (12-36) months follow-up, the implant and prosthesis survival rates were 100%. The success rate at the implant level was 98.6%. The mean marginal bone loss (MBL) was 0.09 ± 0.06 mm. No prosthetic or postoperative complications, and the mean general satisfaction was (91.75 ± 7.06). There was a significant improvement in all OHIP-14 domains during the final All-on-6 prosthesis (T2) (P < 0.01).

CONCLUSIONS

Rehabilitation of atrophic edentulous maxilla using six implants with simultaneous bilateral MSFA and immediate All-on-4 PFP is a successful treatment approach associated with minimal postoperative complications and significant improvement in OHRQoL.

Cone Beam Computed Tomography Analysis of Posterior-Superior Alveolar Canal from a Fixed Reference Point: Implications for Sinus Floor Elevation Procedure through Lateral Approach

Objective

Sinus floor elevation is commonly done in the maxillary posterior region prior to dental implant placement. This study primarily aimed at assessing the location of the posterior superior alveolar artery (PSAA) canal on cone beam computed tomography (CBCT) scans and its relation to the alveolar ridge and maxillary sinus from a fixed reference point.

Material and Methods

A total of 226 edentulous maxillary molar sites were included in this retrospective analysis. The distance from the PSAA to the sinus floor (SF), alveolar crest (AC) and a fixed reference point, that is, the roof of sinus (RS) were measured. The alveolar bone height (ABH), thickness of the crestal keratinized mucosa (CKM) and thickness of Schneiderian membrane (SM) were also evaluated.

Results

54 sites (23.89%) were excluded from the study. The SF, AC, RS and ABH values averaged at 11.91 mm ± 3.63 mm, 16.05 mm ± 3.96 mm, 25.32 mm ± 7.13 mm and 4.93 mm ± 4.27 mm respectively. SF and AC was higher in second molar than first molar region (p < 0.001), but RS did not show significant difference (p = 0.85). CKM and SM averaged at 2.02 mm ± 0.68 mm and 1.31 mm ± 0.81 mm respectively.

Conclusion

The PSAA can be visualized in CBCT scans with a prevalence of 76.11% and may not be detected when adherent to the sinus membrane. This study stresses on the need for a CBCT, prior to sinus surgeries through lateral approach, to assess the PSAA.

A retrospective study of the long-term survival of RESTORE® dental implants with resorbable blast media surface

PURPOSE

The aim of this study was to retrospectively evaluate the survival and failure rates of RESTORE® implants over a follow-up period of 10-15 years at a university dental hospital and to investigate the factors affecting the survival rate of these dental implants.

METHODS

A total of 247 RESTORE® dental implants with a resorbable blast media (RBM) surface inserted in 86 patients between March 2006 and April 2011 at the Department of Periodontology of Seoul National University Dental Hospital were included. Patients with follow-up periods of less than 10 years were excluded, and data analysis was conducted based on dental records and radiographs.

RESULTS

Over a 10- to 15-year period, the cumulative survival rate of the implants was 92.5%. Seventeen implants (6.88%) were explanted due to implant fracture (n=10, 4.05%), peri-implantitis (n=6, 2.43%), and screw fracture (n=1, 0.4%). The results of univariate regression analysis using a Cox proportional hazards model demonstrated that implants placed in male patients (hazard ratio [HR], 4.542; 95% confidence interval [CI], 1.305-15.807; P=0.017) and implants that supported removable prostheses (HR, 15.498; 95% CI, 3.105-77.357; P=0.001) showed statistically significant associations with implant failure.

CONCLUSIONS

Within the limitations of this retrospective study, the RESTORE® dental implant with an RBM surface has a favorable survival rate with stable clinical outcomes.

Survival rate of implants following maxillary sinus floor augmentation using freeze-dried allografts vs bovine derived xenografts: A retrospective multicenter study

INTRODUCTION

This study aims to compare the surgical and clinical complications, and the dental implant survival rate after maxillary sinus floor augmentation using demineralized freeze-dried bone allografts (DFDBA) versus bovine derived xenografts.

MATERIAL AND METHODS

A retrospective study enrolled 107 patients (52 males and 55 females, mean age group 1: 54,4 years; group 2: 56,4 years) requiring maxillary bone reconstruction prior to implantation. A total of 141 sinuses were grafted and 191 implants were placed. Data on various variables, including patient characteristics, implant placement details, and outcomes, were collected through medical records and patient questionnaires.

RESULTS

The study found no significant differences in implant survival rates between the two groups (94,0% versus 94,4%; p = 0,919). Overall complications were observed in 19.6% of patients, with a higher incidence in the allograft group (23,6% versus 15,4%; p = 0,283). Multiple logistic regression analysis identified a two-stage surgical protocol (OR= 2,8; p = 0,045), and a preoperative alveolar ridge height of less than 4 mm (OR= 5,3; p = 0,004) as significant predictors of complications. The risk of implant failure was raised by a preoperative alveolar ridge height of less than 4 mm (OR= 6,1; p = 0,038) and smoking (OR= 5,8; p = 0,012).

DISCUSSION

DFDBA is a reliable treatment option for extensive rehabilitation of atrophic maxilla, with a success rate comparable to xenografts used in sinus augmentation. Implant failure was significantly correlated with smoking and a residual ridge height of less than 4 mm.

Evaluation of crestal sinus floor elevation in cases exhibiting an oblique sinus floor with a residual bone height of 4.0-7.0 mm using Densah burs with simultaneous implant placement: a prospective clinical study

PURPOSE

To evaluate the effectiveness of using Densah burs for lifting the maxillary sinus membrane in cases with an oblique sinus floor with a residual bone height of 4-7 mm.

METHODS

The study was conducted on 16 patients, comprising 9 males and 7 females, aged 25-60 years, split into two groups of 8 each: group I with a residual bone height of 4-5.5 mm below the sinus floor and group II with a residual bone height of 5.5-7 mm. Exclusion criteria included smokers, presence of systemic or metabolic conditions that contraindicate implant placement and a local sinus pathology. The study involved the use of Densah burs, using the osseodensification concept to elevate the sinus floor, along with simultaneous dental implant placement. The integrity of the sinus membrane was verified via clinical examination and a confirmatory cone beam computed tomography scan.

RESULTS

The study revealed that out of the 16 cases, one case had a sinus membrane perforation, confirmed clinically at the time of the operation. The study achieved a mean lift of 4.42 mm and a mean final seating torque of 35.5 N/cm. At the 1-year follow-up, all cases showed clinical success, with no signs of sinus pathology or complications.

CONCLUSIONS

In cases with oblique sinus floors and a residual bone height of 4-7 mm in moderately atrophic posterior maxilla, the osseodensification concept proved to be a safe and effective method for performing sinus lift procedures with simultaneous implantation.

Comparison of osteogenesis and osseointegration following implant placement with simultaneous maxillary sinus augmentation using particulate and collagenated block types of deproteinized porcine bone mineral: a radiographic and histomorphometric analysis

OBJECTIVES

This study aimed to compare osseointegration and osteogenesis after single-stage maxillary sinus augmentation with the lateral window using particulate deproteinized porcine bone mineral (PDPBM) and collagenated block deproteinized porcine bone mineral (BDPBM).

MATERIALS AND METHODS

Bi-maxillary premolars of six beagle dogs were extracted. Eight weeks later, an implant was placed into each augmented sinus with PDPBM or BDPBM according to a split-mouth design. Eight weeks later, all specimens were harvested. Each specimen was separated into the region of interest with the implant (ROI-I) and region of interest with sinus augmented area (ROI-S) 5 mm away from ROI-I. ROI-I and ROI-S were evaluated through micro-computed tomography and histomorphometry.

RESULTS

Bone substitute insertion took longer for the PDPBM group than for the BDPBM group (P = 0.002). In ROI-I, three-dimensional bone-to-implant contact (BIC) did not show statistically significant differences between the groups. Two-dimensional BIC also showed comparable values for both groups. In ROI-S, the graft material volume/tissue volume, trabecular bone pattern factor, and structural model index were higher in the BDPBM group than in the PDPBM group (P < 0.05). The proportions of new bone, graft material, and connective tissue were not significantly statistically different between groups. Less new bone was found in the apical area than in the coronal or middle areas in the BCPBM group (P < 0.05).

CONCLUSIONS

BDPBM may save time in inserting bone substitutes and provide comparable osteogenesis and osseointegration to PDPBM.

CLINICAL RELEVANCE

When performing sinus augmentation, BDPBM might improve operator's convenience with comparable biological results compared to PDPBM.

Indications and surgical technique for distraction osteogenesis of the alveolar bone for augmentation prior to insertion of dental implants

When bone is limited, short, ultra-short, or narrow implants help to restore oral rehabilitation with an acceptable long-term outcome. This becomes more difficult with severe vertical bone loss. Guided bone regeneration, onlay block transplantation, or sandwich osteotomy have been established to build up these defects. The alternative to the alveolar distraction osteogenesis (ADO) has only been established in some centers, with a standardized protocol. On the one hand, ADO is a biological procedure that allows almost a "restitutio ad integrum" when building up hard and soft tissue. On the other hand, there are clear indications, limitations, and complications of the procedure in the literature. In addition to the literature, concept of Tissue Regeneration by Alveolar Callusdistraction Cologne (TRACC), which has been practiced successfully for over two decades, will be presented for different indications.

Treatment alternatives for the rehabilitation of the posterior edentulous maxilla

Rehabilitation of the edentulous maxilla with implant-supported fixed dental prostheses can represent a significant clinical challenge due to limited bone availability and surgical access, among other factors. This review addresses several treatment options to replace missing teeth in posterior maxillary segments, namely the placement of standard implants in conjunction with maxillary sinus floor augmentation, short implants, tilted implants, and distal cantilever extensions. Pertinent technical information and a concise summary of relevant evidence on the reported outcomes of these different therapeutic approaches are presented, along with a set of clinical guidelines to facilitate decision-making processes and optimize the outcomes of therapy.

The Effectiveness and Practicality of a Novel Barrier Membrane for the Open Window in Maxillary Sinus Augmentation with a Lateral Approach, with Risk Indicators for Bone Graft Displacement and Bone Height Decrease: A Prospective Study in Humans

Maxillary sinus augmentation with a lateral approach (MSA) is a well-established treatment. In this prospective study, we evaluated risk factors for postoperative bone graft displacement and reported the clinical application of long-term resorbable L-lactic acid/-caprolactone (PLA/PCL) as a barrier membrane to cover the open window in the lateral wall in MSA. Twenty-four patients underwent MSA according to the relevant criteria; CT data obtained before and 1 week (1 w) and 5-6 months (5 m) post-MSA, bone height changes, bone height reduction rates at 1 w and 5 m post-MSA, bone graft displacement measurements, and risk factors were examined. All patients showed bone height increments (p < 0.005). However, no difference was observed between 1 w and 5 m post-MSA. Bone graft displacement was observed in eight patients; the reduction rate from 1 w to 5 m post-MSA was 8.38% ± 4.88%. Sex, septa, maxillary sinus floor-palatal bone distance, and maxillary sinus floor-maxillary ostium distance were associated with bone graft displacement (p < 0.05). The height from the maxillary sinus floor to the palatal bone and the sinus angle influenced the augmentation degree (p < 0.05). The PLA/PCL membrane is compared favorably with other membranes and may be useful as a barrier membrane for the MSA open window.

Comparative diagnosis of the alveolar antral artery canal in the lateral maxillary sinus wall in corresponding panoramic radiography and cone-beam computed tomography

PURPOSE

Sinus lift operations are a tried and tested means of providing adequate implant prosthetics to patients with compromised jawbones. Knowledge of the arterial supply of the maxillary sinus region is essential for surgical treatment in this area. The aim of the present comparative study was to determine whether alveolar antral artery (AAA) canal can be diagnosed both in corresponding panoramic radiography (PR) and cone-beam computed tomography (CBCT).

METHODS

A total of 335 patients with 635 sites and corresponding maxillary sinus in both PR and CBCT were selected and examined for AAA canal visibility.

RESULTS

The visibility of the AAA canal was significantly higher in CBCT than in PR. A total of 154 (46.0%) AAA canals could be identified in the maxillary sinus on the right. However, only four (1.2%) of these were also visible in PR. The detected values of the AAA canals in the maxillary sinus on the left in the PR and CBCT images were similar to those of the right. While 164 AAA canals (49%) were observed in CBCT images, only 1 (0.3%) was identifiable in PR.

CONCLUSIONS

The results show that CBCT can be recommended for visualising the AAA canal when surgically planning sinus augmentation procedures.

Correlation between periodontal phenotype and sinus membrane thickness: A systematic review

AIM

To assess the correlation between the periodontal phenotype (PP) and sinus membrane thickness (SMT) in humans.

METHODS

This review was conducted according to the PRISMA guidelines. Two reviewers independently carried out electronic and manual literature searches of studies published in English, German, and Spanish, from 1970 to September 2022 in four electronic databases, PubMed/Medline, Scopus, Cochrane Library, and Web of Science, in addition to gray literature. Studies that assessed the correlation between PP and SMT in adults (aged 18 years) were included. Methodological quality was evaluated using the Appraisal Tool for Cross-Sectional Studies (AXIS) for articles that met the eligibility criteria.

RESULTS

Six studies, including 510 patients, were considered for qualitative analysis. All included studies were cross-sectional, and the correlation between the PP and SMT was evaluated, finding a positive and high correlation in 83.3% of them, based on a value of ≥0.7. All the included studies were assessed with a high overall risk of bias.

CONCLUSIONS

Periodontal phenotype and sinus membrane thickness are likely correlated. Nevertheless, further standardized studies are required to draw definitive conclusions.