Clinical evaluation of modified transalveolar sinus floor elevation and osteotome sinus floor elevation in posterior maxillae: study protocol for a randomized controlled trial

Evaluation of accuracy and membrane perforation in robotic-assisted implant surgery for transalveolar sinus floor elevation: a retrospective case series

BACKGROUND

The potential of the robotic system for transalveolar sinus floor elevation (TSFE) with simultaneous implant placement has not been verified. This study aimed to assess implant placement accuracy and membrane perforation in robotic computer-assisted implant surgery (r-CAIS) for TSFE.

METHODS

Patients who underwent r-CAIS for TSFE were enrolled in this study. Positioning markers were placed in the patient's oral cavity, and cone-beam computed tomography (CBCT) was performed. Subsequently, the surgical plan was generated using robotic software. After the markers were registered with the robotic arm, TSFE and implant placement were performed using the robotic arm and crestal approach sinus (CAS) kit drills under the control of the surgeons. Deviations between the planned and placed implants were assessed using preoperative and postoperative CBCT data. In addition, perforation of the Schneiderian membrane was evaluated intraoperatively using the Valsalva maneuver and postoperatively using CBCT images.

RESULTS

Ten patients were enrolled, and no adverse events occurred during the surgery. The mean global coronal, global apical, and angular deviations were 0.55 ± 0.20 mm (95% confidence interval [CI]: 0.41 to 0.69 mm), 0.56 ± 0.23 mm ( 95%CI:0.40 to 0.73 mm), and 1.38 ± 0.83° ( 95%CI: 0.78 to 1.97°), respectively. No membrane perforation was observed during or after the surgery.

CONCLUSIONS

Within the limitations of this study, r-CAIS for TSFE showed high accuracy and a low membrane perforation rate.

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.

Radiographic Study of Transcrestal Sinus Floor Elevation Using Osseodensification Technique with Graft Material: A Pilot Study

This pilot study aimed to evaluate the level of implant success after transcrestal sinus floor elevation (tSFE) using the osseodensification technique (OD) combined with beta-tricalcium phosphate (β-TCP) by analyzing clinical and radiographic results. Moreover, the increase in bone height was analyzed immediately after surgery, 3 months after, and before loading by taking standardized radiographic measurements. Thirteen patients, four males and nine females, with a mean age of 54.69 ± 5.86 years, requiring the placement of one implant in the upper posterior maxilla, with a residual bone height of <8 mm and a minimum bone width of 5 mm, participated in the study. The bone gain data was obtained using cone-beam computed tomography (CBCT) immediately after surgery and twelve months after the placement. The correlation between initial and final bone height with implant stability was also assessed. The results were analyzed using SPSS 23 software (p < 0.05). The results of the study indicated a 100% implant success rate after a follow-up period of twelve months. Preoperative main bone height was 5.70 ± 0.95 mm. The osseodensification technique allowed a significant increase of 6.65 ± 1.06 mm immediately after surgery. After a twelve-month follow-up, a graft material contraction of 0.90 ± 0.49 mm was observed. No correlation was observed between the bone height at the different times of the study and the primary stability of the implant. Considering the limitations of the size sample of this study, the osseodensification technique used for transcrestal sinus lift with the additional bone graft material (β-TCP) may provide a predictable elevation of the maxillary sinus floor, allowing simultaneous implant insertion with adequate stability irrespective of bone height limitations.

Efficacy of Two Different Hydrodynamic Sinus Lift Systems for Atraumatic Elevation in Immediate Implant Placement

Purpose

To evaluate the efficacy of two hydrodynamic sinus lifting procedures and to successfully place immediate implants in maxillary posterior sites that have a compromised native bone as a result of periodontal or endodontic disease.

Patients and Methods

A total of 26 patient sites were enrolled with 13 sites each in the Minimally Invasive Antral Membrane Balloon Elevation (MIAMBE) and Drill Integrated Hydrodynamics for the transcrestal sinus floor elevation (DIHSFE) groups who received transcrestal sinus floor elevation followed by immediate implant placement. Clinical parameters such as sinus membrane perforations, nasal bleeding, postoperative sinusitis, VAS scores at Day-7 for pain and discomfort, primary implant stability and time taken were evaluated.

Results

The DIHSFE had greater sinus membrane perforations and incidence of nasal bleeding when compared with MIAMBE with (p = 0.066) and (p = 0.141). Post-operative sinusitis was evident in both the groups with (p = 0.619). The mean VAS score was statistically significant between both the groups (p ≤ 0.005). The insertion torque values, and mean time taken for surgical procedure was not statistically significant between groups.

Conclusion

The present study highlighted that MIAMBE is superior to DIHSFE in its ability to cause less severe patient morbidities and post-operative complications.

Efficacy of simultaneous placement of dental implants in osteotome-mediated sinus floor elevation with and without bone augmentation: A systematic review and meta-analysis

Background

The aim of the present systematic review was to assess the effectiveness of simultaneous placement of implant in osteotome-mediated sinus floor elevation (OMSFE) procedure with and without bone augmentation.

Materials and Methods

An exploration of randomized clinical trials (RCTs) was systematically done in three databases comprising PubMed, Cochrane, and Google Scholar complemented by a thorough manual search of periodontology/implantology-related journals. A final inclusion of 6 RCTs (2010-2020) was done to investigate the efficiency of simultaneous implant placement with OMSFE in conjunction with bone augmentation. A meta-analysis was further conducted with comparable studies which assisted in attaining a final conclusion regarding the survival rate, endosinus bone gain (ESBG), and marginal bone loss (MBL).

Results

Data synthesis was performed on the basis of 6 trials and further meta-analysis was performed to statistically validate the clinical and radiographic outcomes. Meta-analysis on the parameters indicated greater ESBG (mean difference [MD]: 0.82; [95% confidence interval [CI]: 0.72-0.91, P ≤ 0.0001]), which was also associated with minimal MBL (MD: -1.11; [95% CI: -1.53-0.68, P ≤ 0.0001)] in the bone augmentation group. However, the parameter of implant survival rate (risk ratio: 1.04; [95% CI: 0.83-1.31, P = 0.6849)] failed to reveal significant difference between the two groups.

Conclusions

In the restoration of masticatory apparatus, simultaneous placement of implant in OMSFE with bone augmentation can be considered as successful and predictable treatment approach in deficient posterior maxillary ridges. It contributes toward bone neoformation resulting in greater ESBG as well as a substantial decrease in MBL.

Displacement of the full body of a dental implant into the sinus space without membrane perforation and subsequent osseointegration: a case report

An increasing number of studies have investigated the use of osteotome sinus floor elevation (OSFE) with simultaneous implant placement for maxillary sinus floor residual bone height (RBH) <4 mm. Many studies have reported good clinical results, but very few have reported complications related to this procedure. Here, the case of a 50-year-old female patient with an RBH in the left upper posterior region of 1–4 mm, who underwent OSFE with simultaneous placement of three Bicon short® implants, is described. One of the implants was found to be displaced during the second-stage surgery. The displaced implant was removed using piezosurgery, OSFE with simultaneous implant placement was repeated, and the missing tooth was reconstructed 6 months later. This case suggests that OSFE with simultaneous implant placement is feasible for severely atrophic maxillary sinus floor, but carries a risk of implant displacement.

A Combined Lateral-Crestal Approach of Sinus Floor Elevation: Three Case Reports

This clinical report describes a combined lateral-crestal approach to elevate the sinus floor when placing implants on a wide maxillary posterior ridge. The buccally enlarged osteotomy broadens the vision of practitioners and facilitates access of instruments in the sinus. Compared with the traditional lateral approach of sinus lift, the proposed technique offers a more conservative treatment modality. A clinical study with sufficient subjects and long-term follow-up is needed to validate the potential and limitations of the proposed technique.

[Two-stage closed sinus lift for severe bone deficiency in the posterior maxilla imrpoves long-term clinical outcomes]

OBJECTIVE

To evaluate the long-term clinical outcomes of two-stage closed sinus lift for the maxillary sinus with residual bone height (RBH) of 1-3 mm in the posterior maxillary.

METHODS

Seventy-eight patients with maxillary posterior tooth loss (1 mm≤RBH≤3 mm and alveolar ridge width ≥5 mm) were treated with two-stage closed sinus lift at the Dental Implantation Center of our hospital between March, 2012 and December, 2014. Coral hydroxyapatite powder and 148 implants were implanted. The superstructure was fixed within 6 months after the operation and the patients were followed up for 1-5 years for assessing the patients' satisfaction, postoperative response, stability and survival rates of the implant, soft tissue condition, bone height of maxillary sinus floor elevation and the marginal bone loss.

RESULTS

Perforation of the maxillary sinus floor occurred in 3 (3.85%) of the cases. Twenty-three (30.67%) patients complained of mild pain, and 52 (69.33%) did not experience headache or fever or reported obvious pain or swelling after the operation. The overall response to the operation was favorable. The ISQ value was 58.39±1.39 immediately after the operation, and increased significantly to 81.88±1.22 at 6 months (P &lt; 0.05). During the healing period and the follow-up, none of the implants fell off, and the implant survival rate was 100%. The peri-implant probing depth and modified sulcus bleeding index at 1 year after sinus lifting were similar to those at 5 years after the operation (P &gt; 0.05), but the sinus floor elevation and marginal bone resorption at the two time points differed significantly (P &lt; 0.05).

CONCLUSIONS

Compared with lateral wall lifting, two-stage close lifting of the maxillary sinus floor is associated with less trauma and less discomfort, and effectively solves the problem of severe alveolar bone height deficiency in the maxillary posterior region to achieve favorable long-term clinical outcomes.