Crestal Approach Sinus Research Articles

Crestal approach for maxillary sinus augmentation in individuals with limited alveolar bone height: An observational study.

In cases where the bone presence is <4 mm, the lateral approach is typically the first approach considered. Nevertheless, for patients who prefer minimally invasive procedures or wish to reduce postoperative discomfort, the crestal approach is a viable option. The objective of this study was to investigate the potential of crestal sinus augmentation for achieving adequate bone in individuals with residual bone measuring <3 mm. The study comprised 11 participants (63.6 ± 10.9 years of age) who were treated at Seoul St. Mary's Hospital between 2021 and 2023 and received crestal approach sinus augmentation due to insufficient bone density of <3 mm using the crestal approach kit. Pre-augmentation and post-augmentation cone-beam computed tomographic images were analyzed using the imaging software to measure vertical bone height, bucco-palatal width, and mesio-distal width. Before the intervention, the height of the vertical bone was 2.1 ± 0.5 mm, while the width from buccal to palatal was 10.6 ± 2.9 mm, and the width from mesial to distal was 9.9 ± 1.2 mm. Following the intervention, these measurements increased to 8.8 ± 0.9 mm, 12.2 ± 2.2 mm, and 10.2 ± 1.2 mm, respectively. The change in height of the vertical bone was 6.7 ± 1.0 mm, in bucco-palatal width was 1.6 ± 1.4 mm, and in mesio-distal width was 0.3 ± 0.4 mm. The results revealed a significant rise in the height of the vertical bone and bucco-palatal width. Crestal sinus augmentation has been demonstrated to be a highly effective approach for achieving an adequate quantity of bone in patients with residual bone <3 mm. Nonetheless, further observation is required to evaluate the long-term prognosis of the procedures.

Lateral approach sinus (LAS) and crestal approach sinus (CAS): The unravelled paraphernalia for maxillary sinus membrane advancement

The permanent replacement of missing teeth in the maxillary posterior tooth region becomes a tedious task when it is confounded with bone atrophies. To overcome this problem and achieve successful rehabilitation, maxillary sinus membrane elevation procedures have been advocated as the most reliable means. The lateral window technique and the crestal approach are two of the most common approaches. These technologically developed procedures have reported high success rates in cases of deficient residual bone. Over time, there have been many advancements in these techniques that led to the development of user-friendly kits like the Lateral approach Sinus (LAS) kit and the Crestal approach Sinus (CAS) kit. In this case series, we have reported two cases, treated with either of these approaches and have compared the same. We aim at highlighting their ease of application in the clinical field and the promising results obtained with their use. Our clinical experience disclosed that maxillary sinus membrane advancement using both the kits have proven to be a reliable technique for implant placement in sites where insufficient bone is available.

Crestal Approach Sinus (CAS) kit: A novel technique for posterior maxillary rehabilitation: A case series of 10 prospective patients

Crestal Approach Sinus (CAS) kit: A novel technique for posterior maxillary rehabilitation: A case series of 10 prospective patients

Comparison of clinical and radiological outcomes using crestal approach sinus kit and piezoelectric surgery for sinus membrane elevation: A prospective clinical trial

To overcome the drawbacks of sinus floor augmentation procedures newer surgical techniques to reduce sinus perforation such as crestal approach sinus kit (CAS) and piezosurgery, which are minimally invasive procedures enabling uncomplicated sinus elevation have evolved. The aim of the present study was to investigate the performance of CAS kit compared to piezosurgery during maxillary sinus membrane elevation. A total of 40 subjects requiring maxillary sinus membrane augmentation for rehabilitation with implant prosthesis in posterior maxilla were included in the study. The current study was a prospective clinical trial where osteotomy and sinus elevation was done using CAS kit in Group 1 and piezosurgery in Group 2. Platelet-rich fibrin was placed in osteotomy site and dental implants were inserted. Implant stability was evaluated at baseline and 3 months. Crestal bone loss was measured at 3, 6, and 12 months. Apical bone gain was measured at 6 and 12 months. Intragroup comparison of the study groups was done by Paired t-test, ANOVA test, and Friedman test. Intergroup comparison was done by unpaired t-test and Mann-Whitney U-test. P < 0.05 was considered statistically significant. Implant stability improved in both the groups, i.e., 79.2 ± 5.02 and 79 ± 5.31 in Group 1 and Group 2, respectively, at 3 months. Intergroup comparison showed no difference in all parameters; however, crestal bone loss was greater in piezosurgery group with a mean difference of 0.74 mm. Both CAS and piezosurgery groups showed definitive improvement in all parameters. CAS group resulted in added benefits in terms of less crestal bone loss and intraoperative surgical time compared to piezosurgery group.

Crestal approach for maxillary sinus augmentation by using navigation surgical guide: case report

Objective : The purpose of this study is to introduce a novel method for safe and precise crestal approach technique for sinus augmentation and implant placement using digital technology. The study further aims to verify effectiveness of the technique in implant placement and sinus augmentation.Materials and Methods : 5 patients who needed crestal approach sinus augmentation for implant placement were collected. There were more than 4mm residual bone in those patients. Intraoral image taking and CBCT taking were performed for digital planning. Digital planning was conducted for crestal approach sinus augmentation and implant placement. 2 navigation surgical guides(crestal/implant) were fabricated for each patient.Results : 10 implants were placed in the patients without specific problems by using crestal approach surgical guide and implant surgical guide.Conclusion : Crestal approach for maxillary sinus augmentation by using navigation surgical guide would be a reliable treat-ment option for successful implant placement in insufficient residual bone height of maxilla.

Histomorphometric Comparison of New Bone Formed After Maxillary Sinus Lift With Lateral and Crestal Approaches Using Periostal Mesenchymal Stem Cells and Beta-Tricalcium Phosphate: A Controlled Clinical Trial.

The present study investigated clinical and histomorphometric data after sinus lift procedures performed with and without mesenchymal stem cells (MSCs) added to a graft. Twenty-four patients underwent maxillary sinus lift for implant placement. Twelve patients each were assigned to control (Group 1) and test (Group 2) groups. An MSC suspension was added to the graft used in patients of Group 2. Five of 12 patients in both groups underwent crestal-approach sinus lift with immediate implant placement, while seven patients received a lateral-approach sinus lift. The MSC suspension was obtained using the Rigenera protocol. Samples from the grafted site were evaluated, processed, and stained using three staining techniques 90 days after surgery. Histomorphometric analysis was performed using an imaging software (ImageJ). Two types of tissues were defined: Type 1 'mature bone' and Type 2 'osteoid tissue'. The mean Type 1 tissue percentage was 27.24% in Group 1 and 44.45% in Group 2 (P < 0.05). The mean Type 2 tissue percentage was 10.86% and 7.04% in Groups 1 and 2, respectively. The mean Type 1 tissue percentages for the crestal approach were 24.52% for Group 1 and 50.78% for Group 2, while the mean Type 1 tissue percentages for the lateral approach were 29.18% for Group 1 and 39.92% for Group 2. Patients treated with grafts containing MSCs showed 63.18% increased bone formation compared to those treated with grafts not containing MSCs (P < 0.05). Although our data showed a positive trend in patients treated with MSCs, differences between subgroups were not significant (P > 0.05).

Application of two-stage crestal approach sinus elevation in severe atrophic posterior maxilla

Objective: To investigate the feasibility of two-stage crestal approach sinus elevation in severe atrophic maxilla. Methods: A total of 25 patients (male: 13 cases,female: 12 cases) who attended Department of Implant Center, Stomatological Hospital, Southern Medical University from May 2016 to May 2018 were included in this study. The age of the patients was 32-49 years old. The inclusion criteria were: single or multiple tooth loss in posterior maxilla with residual bone height ranged from 1.5 to 3.0 mm and vertical bone width≥6 mm, no pathological changes or septum were detected in the sinus. The elevated sides were divided into three groups according to different buccal-palatal sinus width (SW): wide (16 case, SW＞15 mm), normal (12 case, 12 mm≤SW≤15 mm), narrow (5 case, SW<12 mm). Finally, 23 patients with 33 implants were placed by the two-stage crestal approach for sinus elevation. Six months after implant placement, final restorations were delivered. Implant survival rate, implant stability quotient (ISQ), immediate vertical bone height (VBH) after surgeries, changes of sinus elevation height (cSEH), marginal bone loss (MBL) at 1 year follow-up were examined. Results: Twenty-three patients were finally included in the study, including 12 males and 11 females, aged (41.2±7.6) years old. All implants healed uneventfully. ISQ (wide: 50.81±2.69; normal: 60.58±2.54; narrow: 63.12±3.58), immediate VBH after 1st surgery [wide: (7.99±1.13) mm; normal: (8.95±0.81) mm; narrow: (9.18±0.90) mm] and 2nd surgery [wide: (11.46±0.88) mm; normal: (12.77±0.49) mm; narrow: (12.57±0.55) mm], cSEH six months after 1st [wide: (3.87±0.43) mm; normal: (2.01±0.65) mm; narrow: (1.49±0.33) mm] and 2nd [wide: (1.16±0.29) mm; normal: (1.04±0.33) mm ; narrow: (0.97±0.41) mm] surgery, MBL [wide: (0.91±0.05) mm; normal: (0.79±0.10) mm; narrow: (0.74±0.07) mm] were significantly different among three groups (P<0.05). In all the three groups, cSEH was barely detected at 1-year follow-up (P>0.05). Conclusions: Two-stage crestal approach for sinus elevation might be an alternative protocol in severe atrophic posterior maxilla, especially in cases with narrow and normal buccal-palatal width. There is an urgent need for long time follow-up and more clinical cases.

Noticeable Bone Regeneration beyond the Implant Tip after A Crestal Approach Sinus Lift Using Only Platelet Rich Fibrin: A Report of Two Cases

Purpose: To present two cases with noticeable bone gain beyond the implant tip after a crestal approach sinus lift using PRF as the sole grafting material. Materials and Methods: Two PRFs were packed into each implant hole to elevate the Schneiderian membrane and sandblasted acid-etched implants were inserted simultaneously. Results: The follow-up panoramic radiographs and CTs showed that the new sinus floor was above the implant tip and the cortical outline was clear. Conclusion: The findings from both cases suggest that the PRF can promote noticeable bone gain in the crestal approach sinus lift procedure. A greater number of patients and a longer follow-up period are needed to investigate the reliability of this technique.

Clinical evaluation of two transalveolar methods for sinus augmentation with placing 1 204 implants immediately

Objective: To compare the clinical outcomes of posterior maxillary implant surgery when using the regular transalveolar approach or with the crestal approach-sinus (CAS-KIT), a device for maxillary sinus membrane elevation by the crestal approach using a special drilling system and hydraulic pressure. Methods: In this retrospective study 887 patients during Jan 2012 to July 2015 in Hangzhou Dental Hospital with underwent either regular transalveolar approach or CAS-KIT approach for maxillary augmentation; whereas 11 patients dropped out for the reason of serious membrane perforations. Totally, 876 patients with 1 204 plants, placed immediately after transalveolar maxillary augmentation, were included in this study. The data analysis was performed by radiological measures to assess the changes in height of maxillary sinus floor after the transalveolar augmentation at different time points. In addition, the complications after surgery, failure rates, osseointegration condition and the performance of rehabilitation were evaluated as well. Results: Five hundred and three patients were experienced with regular transalveolar approach, and 7 patients were drop out for the serious membrane perforations. Thus, 496 patients received 653 implants in this group; the average lifted range in maxillary sinus floor height changes was (4.08±3.45) mm. The complications were minor membrane perforations during procedure in 64 patients, postoperative maxillary sinus infection happening in 2 patients and 13 patients experienced rehabilitation failure. Three hundred and eighty-four patients had CAS-KIT approach with 4 patients dropped out. Three hundred and eighty patients get 551 implants with the mean lifted range of (8.36±4.07) mm in maxillary sinus floor height changes. Minor membrane perforations during procedure occurred in 31 people and 2 got postoperative maxillary sinus infection. The 4 year overall survival rate of 1 204 implants was 97.26%, with four implants fell off after 3 months of rehabilitation and one implant occurred after one year of rehabilitation. Conclusions: The regular transalveolar sinus lift technique is easier and time saving, but the compromised lifting range in maxillary sinus floor height and the comparatively high occurrence of intraoperative membrane perforations should be concerned. Using CAS-KIT could be an alternative method to perform maxillary sinus augmentation with a reduced incidence of complications. There was no statistically difference in implant failure rates and incidence of postoperative maxillary sinus infection between two groups.

Maxillary Sinus Membrane Elevation Using a Special Drilling System and Hydraulic Pressure: A 2-Year Prospective Cohort Study.

The purpose of this study was to evaluate clinical and radiologic outcomes using a newly developed device for maxillary sinus membrane elevation. Patients with a residual bone height of at least 3 mm were enrolled. Crestal sinus lift elevation and sinus graft were performed using the crestal approach sinus (CAS) kit. Graft was avoided if the residual bone crest was ≤ 2 mm less than the length of the planned implant. Outcome measures were implant and prosthesis failure, any biologic or technical complications, and marginal bone loss (MBL). A total of 35 consecutive patients underwent 49 crestal elevations of the sinus membrane. All the implants were followed for at least 2 years after placement (mean follow-up 37.3 months; range 24 to 54 months). No implants or prostheses failed during follow-up, and no membrane tears or other intraoperative or postoperative adverse events were observed. At the 2-year follow-up, mean MBL was 0.33 ± 0.24 mm (95% confidence interval: 0.08 to 0.30 mm). A total of 32 implants were placed after filling the sinus with anorganic bovine bone, while 17 implants were placed without grafting the sinus. Post-hoc analysis was performed using the sinus grafting remodeling index (SGRI) to evaluate radiographically the tissue remodeling patterns. The SGRI was statistically significantly higher when the sinus was grafted (P = .000). The CAS kit may provide a new option for minimally invasive crestal sinus surgery. Long-term randomized controlled trials with larger sample size are needed to confirm these preliminary results.

Minimally invasive crestal approach sinus floor elevation using Densah burs, and Hydraulic lift utilising putty graft in cartridge delivery

Minimally invasive crestal approach sinus floor elevation using Densah burs, and Hydraulic lift utilising putty graft in cartridge delivery

Hydraulic Transcrestal Sinus Lift: Different Patterns of Elevation in Pig Sinuses.

The aim of this study was to evaluate different patterns of sinus membrane elevation in pig jaws. A total of 30 pig jaws (60 sinuses) were used for the present investigation. The hydraulic Crestal Approach Sinus kit was used to elevate sinus membrane, and different elevation patterns were recorded. There were 4 different scenarios of membrane separation patterns: center dome-shaped elevation, off-center dome-shaped elevation, horizontally spreading membrane elevation, and perforation. The incidence of each different type was 35.0% (n = 21) in center dome-shaped separation, 51.7% (n = 31) in off-center dome-shaped separation, 10.0% (n = 6) in horizontally spreading separation, and 3.3% (n = 2) in membrane perforation. Different patterns of membrane elevations are observed in pig sinuses and introduced in this study. The off-center dome-shaped elevation was the most common pattern followed by the center dome-shaped elevation and horizontally spreading elevation, respectively.

Survival/success rate of implants placed with crestal approach sinus lift in patients with &lt;4 mm of residual bone height (RBH) and &gt;4 mm of RBH

Survival/success rate of implants placed with crestal approach sinus lift in patients with &lt;4 mm of residual bone height (RBH) and &gt;4 mm of RBH

Comparison of autogenous tooth bone graft and synthetic bone graft materials used for bone resorption around implants after crestal approach sinus lifting: a retrospective study.

This retrospective study compares the amount of bone resorption around implants between an autogenous tooth bone graft (AutoBT) and a synthetic bone graft after a bone-added crestally approached sinus lift with simultaneous implant placements. In all, 37 patients participated in this study. Seventeen patients were grouped as group I and underwent an AutoBT-added sinus lift using the crestal approach. The remaining 20 patients were grouped as group II and underwent synthetic bone grafting. Both groups received the implant placements simultaneously. Of the 37 participating patients, only 22 patients were included in the final results: Eleven patients of group I and 11 patients of group II. Before the surgery, the distance from the alveolar crest to the sinus floor was measured using panoramic radiography. After the surgery, the distance was measured again from the neck of the implant thread to the most superior border of the added graft materials. Then, the amount of sinus lift was calculated by comparing the two panoramic radiographs. After a year, a panoramic radiograph was taken to calculate the resorption of the bone graft material from the radiograph that was taken after the surgery. The significance of the resorption amount between the two types of graft materials was statistically analyzed. The bone height was increased to an average of 4.89 mm in group I and 6.22 mm in group II. The analysis of panoramic radiographs 1 year after the surgery showed an average bone resorption of 0.76 mm and 0.53 mm, respectively. However, the degree of lifting (P=0.460) and the amount of bone-grafted material resorption (P=0.570) showed no statistically significant difference. Based on this limited study, AutoBT can be considered a good alternative bone graft to a synthetic bone graft in a bone-added sinus lift, when extraction is necessary prior to the surgery.

Crestal Approach for Maxillary Sinus Augmentation in Patients with ≤4 mm of Residual Alveolar Bone

Less morbidity is the major advantage to a one-stage crestal approach to maxillary sinus elevation. However, the ability to ensure high primary implant stability in a severely atrophied ridge is of chief concern. The purpose of this study is to measure and compare the success rate of implants placed at the time of crestal approach sinus lift in patients with ≤ 4 mm of residual alveolar bone (RAB) and >4 mm of RAB. In this three-site multicenter study, one hundred two patients, 53 males and 49 females, (23-89 years old; mean = 56.2) were evaluated. Three experienced surgeons (>15 years) performed the crestal approach sinus lift microsurgeries with simultaneous implant placement. At baseline and at the follow-up appointments, calibrated examiners measured radiographic interproximal bone level using ImageJ for Windows after calibration of the radiographs. References for the bone level measurements were the platform, first and second threads of the implants. Statistical analyses, using STATA version 12, stratified patients according to RAB height (group 1: RAB of ≤ 4 mm; n = 35 and group 2: RAB > 4 mm; n = 67), age, gender, and treatment center. The success rate was 100% for group 1 and 98.51% for group 2 at 6 to 100 months postprosthetic loading (mean = 29.7 months). The peri-implant bone loss averaged 0.55 mm (interquartile range [IQR] = 0.5 [0-1]) in group 1 and 0.07 mm (IQR = 0 [0-0]) in group 2. There was no statistically significant difference between the two groups. Clinical outcomes were independent of age, gender, and treatment center. The RAB height did not increase crestal bone loss or reduce the success rate of the implants and associated prostheses. The crestal approach should be considered a viable technique for use in patients with residual bone height of ≤ 4 mm and merits further evaluation.

Assessment of dentists' subjective satisfaction with a newly developed device for maxillary sinus membrane elevation by the crestal approach.

PurposeThe purposes of this study were to assess the dentists' subjective satisfaction with the crestal approach sinus (CAS) kit, a device for maxillary sinus membrane elevation by the crestal approach using a special drilling system and hydraulic pressure, and to summarize the subjective satisfaction of dental implants placed after a sinus lift procedure with the CAS kit.MethodsThirty dental clinicians who had experience with dental implant placement after a sinus lift procedure with the CAS kit from June 2010 to May 2012 were included in this study. The questionnaire for the evaluation of the dentists' subjective satisfaction with the CAS kit was sent to the respondents and returned. The questionnaire was composed of two main parts. The first part was related to the sinus membrane perforation rate. The second part was related to the dentists' subjective satisfaction with the CAS kit.ResultsA total of 28 dentists answered the questionnaire. Among 924 implant cases, sinus membrane perforation occurred in 38 cases (4.1%). Among the 28 dentists, 26 dentists (92.9%) were satisfied or very satisfied with the CAS kit. In particular, 24 dentists (85.7%) reported that safety, cutting performance, and user-friendliness of the CAS drill were advantages of the CAS kit. However, 7 dentists (25%) did not routinely use the hydraulic lifter for sinus membrane elevation.ConclusionsFrom the survey, it was shown that the respondents were generally satisfied with the CAS kit and that the cutting performance and safety of the drill component were considered strengths of the CAS kit.

Crestal Sinus Augmentation: A Simplified Approach to Implant Placement in the Posterior Maxilla

Implant placement in the posterior maxilla can be challenging with relation to the maxillary sinus and may necessitate the need foraugmentation to allow placement of implants. The crestal approach, initially reported by Summers has allowed a more simplified approachto augmenting the maxillary sinus compared to the lateral window approach. A review of the crestal approach using the crestal approachsinus kit (CAS-Kit) (Hiossen, South Korea) is discussed.