Abstract
Background Atrophy of the posterior maxilla as a consequence of tooth loss and sinus pneumatization is a frequent condition encountered in the clinical practice. Prosthetic rehabilitation with implants in these patients often requires some kind of bone regeneration procedure to increase the bone volume. Aim The aim of the present retrospective study is to analyze the survival and success rates of a series of implants placed in the atrophic posterior maxilla with a transcrestal osteotome procedure, without placing a bone grafting material. Materials and Methods From 2006 to 2014, 36 dental implants (Neoss Ltd., Harrogate, UK) were inserted in 36 patients with at least 4 mm of bone below the maxillary sinus using transcrestal osteotome sinus floor elevation and placement of collagen sponge below the sinus membrane. ISQ measurements were made after implant placement and at abutment surgery after 4 to 6 months. The vertical bone height (VBH) was evaluated in intraoral radiographs taken prior to surgery and in radiographs from annual check-up appointments 5 to 13 years after implant placement. In addition, marginal bone loss (MBL) was evaluated. Results One implant was lost after four years of prosthetic loading. The remaining 35 implants showed no complications and were loaded with single crowns after 4–6 months of healing. All 35 implants showed clinical success after 8.5 ± 2.8 years of prosthetic loading (from 5 to 13 years). The vertical bone height was 5.9 ± 1.4 mm at surgery, 9.7 ± 1.1 mm at second surgery after 4–6 months, and 8.3 ± 1.8 at the follow-up at 8.5 ± 2.8 years (from 5 to 13 years). The implant stability registered was 73.2 ± 6.2 ISQ at the surgery and 75.8 ± 3.9 at the second surgery after 4–6 months. Conclusions The present long-term follow-up study showed that the crestal approach for sinus floor bone augmentation without additional bone grafting results in predicable bone formation and high implant survival. The osteotome technique is a valid alternative to the more invasive lateral window technique in single cases with a minimum of 4 mm of VBH below the maxillary sinus.
Highlights
Different sinus floor augmentation procedures can be used to enable placement and integration of dental implants into the atrophied posterior maxilla. e most common techniques are (i) a lateral approach using an infractured bone window and placement of graft material prior to or in conjunction with implant placement and (ii) a transcrestal technique using osteotomes and simultaneous implant placement [1, 2]
Summers was the first to describe the transcrestal technique, which was indicated in implant sites with at least 6 mm of bone height between the alveolar ridge and the floor of the maxillary sinus [3]. e technique makes use of a sequential set of osteotomes with increasing diameter. e principle is to prepare an osteotomy up to about one mm below the cortex of the sinus floor. ereafter, osteotomes of progressively increasing diameter are used to fracture and compact circumferential bone of the osteotomy toward the floor of the sinus
Additional autologous and/or heterologous bone can be added to the implant tunnel at the same time as the sinus floor is lifted with the sinus mucosa where after a dental implant is inserted. e crestal approach is suitable for single tooth replacements, and it is undoubtedly less invasive and creates less postoperative discomfort than the lateral window technique
Summary
Atrophy of the posterior maxilla as a consequence of tooth loss and sinus pneumatization is a frequent condition encountered in the clinical practice. Aim. e aim of the present retrospective study is to analyze the survival and success rates of a series of implants placed in the atrophic posterior maxilla with a transcrestal osteotome procedure, without placing a bone grafting material. E vertical bone height (VBH) was evaluated in intraoral radiographs taken prior to surgery and in radiographs from annual check-up appointments 5 to 13 years after implant placement. All 35 implants showed clinical success after 8.5 ± 2.8 years of prosthetic loading (from 5 to 13 years). E vertical bone height was 5.9 ± 1.4 mm at surgery, 9.7 ± 1.1 mm at second surgery after 4–6 months, and 8.3 ± 1.8 at the follow-up at 8.5 ± 2.8 years (from 5 to 13 years). E present longterm follow-up study showed that the crestal approach for sinus floor bone augmentation without additional bone grafting results in predicable bone formation and high implant survival. Conclusions. e present longterm follow-up study showed that the crestal approach for sinus floor bone augmentation without additional bone grafting results in predicable bone formation and high implant survival. e osteotome technique is a valid alternative to the more invasive lateral window technique in single cases with a minimum of 4 mm of VBH below the maxillary sinus
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