Crestal Approach Research Articles

Comparison of three different methods of internal sinus lifting for elevation heights of 7\xa0mm: an ex vivo study

BackgroundVarious techniques are available for elevating the sinus membrane. The aim of this study is to evaluate three methods of indirect sinus floor elevation regarding elevation heights of 7 mm on the outcomes of membrane perforation, length of perforation, and time required to perform the procedure.MethodsThree different methods for indirect sinus lifting, bone added osteotome sinus floor elevation (BAOSFE), sinus floor elevation with an inflatable balloon, and crestal approach system (CAS kit) from OSSTEM, were assessed for their ability to lift the sinus without causing laceration of the Schneiderian membrane. The study was performed on 18 freshly slaughtered sheep heads (36 sinus lifts were done, 12 for each method). CBCT images of the heads were taken to assess the best location for the sinus lift. Then, the heads were bisected and the membrane was exposed from the medial aspect. After that, each method was performed. The intended elevation height was 7 mm. If the 7 mm were not reached, the maximum height of elevation was measured.ResultsThe method used was significantly associated with the occurrence of perforation (p value = 0.014) where BAOSFE was associated with the largest number of perforations (58.4%, n = 7) compared to 8.3% and 8.3% for the balloon and CAS kit methods, respectively. The odds ratio for perforation occurrence from BAOSFE compared to the CAS kit was significant (OR = 0.091, p = .022). No significant odds ratio was found for the balloon method compared to CAS kit. Additionally, the method used was significantly associated with time of operation and with the length of perforation (p value < 0.001) where CAS kit required the longest time and BAOSFE caused the biggest perforations.ConclusionsThe study shows that both the balloon and the CAS kit were superior to the BAOSFE in terms of safety in elevating the sinus membrane. Further, in vivo studies have to prove these findings.

Minimal Invasive Sinus Membrane Elevation Using Crestal Approach: Case Reports and Literature Review

Minimal Invasive Sinus Membrane Elevation Using Crestal Approach: Case Reports and Literature Review <!--Minimal Invasive Sinus Membrane Elevation Using Crestal Approach: Case Reports and Literature Review-->

Minimal Invasive Sinus Membrane Elevation Using Crestal Approach: Case Reports and Literature Review

Minimal Invasive Sinus Membrane Elevation Using Crestal Approach: Case Reports and Literature Review

Sinus Membrane Elevation by the Crestal Approach Using a Novel Drilling System.

The purpose of this study was to evaluate the clinical outcomes of patients undergoing sinus membrane elevation by a minimally invasive crestal approach using a novel drilling system. From May 2008 to November 2009, 21 implants were placed in 19 patients (10 men and 9 women) ranging from 23 to 69 years of age (average of 49.5 years). Implants were placed in maxillary premolar and molar areas that demonstrated insufficient residual bone quality; maxillary sinus membrane elevation was performed using a crestal approach with the sinus crestal approach kit (Neobiotech, Seoul, Korea). There was no sinus perforation or osseointegration failure. The implant survival rate was 100%. The postsurgical, augmented volume of the alveolar height ranged from 2 to 9.2 mm (average of 5.81 ± 2.06 mm). Six months after maxillary sinus elevation, the bone reduction volume ranged from 0.06 to 1.42 mm (average of 0.6 ± 0.38 mm). At final F/U, the amount of bone-height reduction ranged from 0.06 to 2.60 mm (average of 0.82 ± 0.63 mm). Sinus membrane elevation by the crestal approach using special reamers is advantageous because of the noticeable reduction in the risk of perforation and the ability to perform the surgery rapidly.

Goat Model for Direct Visualizing the Effectiveness of Detaching Sinus Mucosa in Real Time During Crestal Maxillary Sinus Floor Elevation.

The procedure of crestal maxillary sinus floor elevation presents a great challenge to the field of implant dentistry. Due to the limited visualization in this procedure, the effectiveness of detaching sinus mucosa could not be assessed in real time. We recently developed an ex vivo goat sinus model by cutting the goat residual skulls along four lines determined from computerized tomography (CT) scans, extracting the maxillary premolar or molar teeth, and preparing implant socket in the maxilla. The generated ex vivo goat sinus models exposed the maxilla and the whole maxillary sinus mucosa, thus enabling real-time observation of detaching maxillary sinus mucosa via directly visualizing the working situation of sinus lift tool in the models and directly measuring the length of detached mucosa and space volume generated under the elevated sinus mucosa. One commercially available umbrella-shaped sinus lift curette was used to detach the maxillary sinus mucosa to evaluate the effectiveness of the ex vivo goat sinus models. The results showed that this curette could detach the sinus mucosa 3.75 mm in length in the mesiodistal direction and 2.81 mm in the buccal-palatal direction. Moreover, a space volume of 52.7 μl could be created under the elevated sinus mucosa in the goat ex vivo models. All the experimental results suggested that this ex vivo goat sinus model might be useful in the evaluation of improved or newly designed sinus lift tools for elevating the maxillary sinus mucosa via the crestal approach.

Implant Survival in One-Stage Lateral versus Crestal Sinus Lift Procedures - A Systematic Review and Meta-Analysis

Objectives: The aim of this systematic review was to study the survival of dental implants placed in posterior maxilla with 4-8 mm residual bone height using one-stage lateral versus crestal sinus lifting approaches Methods/Statistical Analysis: Three electronic databases and hand searching were performed up to February 2016 for studies, comparing lateral versus crestal sinus lifting approaches. The scientific terms: “Crestal approach”, “Lateral approach”, “Internal Sinus Lift”, “External Sinus Lift”, “Sinus Floor Augmentation” and “Dental Implants” were used. Initially, title and abstract screening was performed for the retrieved articles followed by a full-text evaluation. Meta-analysis for implant survival was performed using RevMan 5.1 software. Findings: Screening of 1321 papers resulted in four eligible articles. The included retrospective cohort studies showed high risk whereas in RCT, the risk of bias was low. Meta-analysis revealed no differences in implant survival [RR = 1.01 (95% CI: 0.98-1.05)] between both approaches. Application/Improvements: The less invasive crestal approach can successfully replace the one-stage lateral approach in patients with 4-8 mm residual bone height.

Implant placement simultaneously sinus augmentation using crestal approach in severely atrophic maxilla; minimally invasive approach

Implant placement simultaneously sinus augmentation using crestal approach in severely atrophic maxilla; minimally invasive approach

Association Between Bone Graft Volume and Maxillary Sinus Membrane Elevation Height.

Maxillary sinus augmentation via crestal approach has been advocated as an alternative approach for sinus membrane elevation. Presently, no study has examined the relationship between the amount of bone grafting material placed and the final sinus membrane elevation height. Therefore, the present study was aimed at investigating the extent of sinus membrane elevation height depending on the amount of bone grafting material inserted as well as three-dimensionally assessing the likelihood of membrane perforation during membrane elevation. A total of 34 subjects (16 females and 18 males) with 61 crestal sinus elevation sites were recruited. The following changes in elevated sinus membrane area were recorded: vertical elevation height (VEH), buccopalatal elevation (BPE), and mesiodistal elevation (MDE). Cone beam computed tomography (CBCT) was used to measure the elevated height of the maxillary sinus floor at the initial examination, during surgery, and immediately after surgery. In addition, the VEH:BPE and VEH:MDE ratios at each site were calculated using CBCT to determine the probability of sinus membrane perforation. In average, 0.1 mL of bone graft material placed elevated VEH an average of 3.5 mm, while 0.2 mL and 0.3 mL of graft placed elevated VEH 5 mm and 6 mm, respectively. Furthermore, it was demonstrated that the VEH:BPE and VEH:MDE ratios play a determinant role on membrane integrity. As such, a ratio greater than 1.0 may jeopardize membrane integrity, while a ratio ≤ 0.8 might represent a lower risk of membrane perforation. An initial 0.1 mL of bone material filling can elevate sinus membrane vertically by 3.5 mm. To avoid sinus membrane perforation, a VEH:BPE or VEH:MDE ratio of ≤ 0.8 should be obtained.

Minimally Invasive Crestal Sinus Lift Technique and Simultaneous Implant Placement.

To evaluate the effectiveness and clinical results of a new crestal sinus lift technique used to elevate the sinus floor simultaneously with bone grafts and implant placement. Eleven patients underwent this crestal sinus lift technique performed using an SCA KIT. The mean residual bone height was 6.4 mm (range: 4.1 mm to 8.6 mm). Bio-Oss collagen was used as the graft material, and 12 implants were simultaneously placed after sinus augmentation. Radiographic and clinical examinations were conducted during follow-up. All procedures were successfully performed with no obvious Schneiderian membrane perforation. The sinus floor was augmented with a mean height of 4.8 mm (range: 2.8 to 7.4 mm). Twelve implants healed uneventfully with healing abutments. Peri-implant marginal bone was stable, with a mean follow-up of 49.4 months (range: 33 to 71 months). No complications were observed during follow-up. According to the limited data collected in this study, the novel crestal sinus lift approach could effectively lift the sinus floor and reduce the incidence of postoperative complications. Additional cases with long-term follow-up are needed to confirm and improve this crestal sinus lift technique.

Inferior Alveolar Nerve Mobilization Using Ultrasonic Surgery With Crestal Approach Technique, Followed by Immediate Implant Insertion: Evaluation of Neurosensory Disturbance.

Many techniques are described for atrophied mandibles rehabilitation. This article reports on 12 clinical patients of severely atrophied posterior mandibles. In all the patients, a cone beam is performed before the crestal surgical approach to inferior alveolar nerve (IAN) mobilization. For the realization of this technique the piezosurgery device was used to minimize IAN injuries. With the help of this device the selective cutting of the bone has been possible until IAN exposure, in the implant placement site. At the same time, the authors performed the implant osteotomy and implant placement. After 4 months of healing, all implants were osseointegrated and the implant-supported bridges were done.Evaluation by means of neurosurgery function test over a 36-months period found that all patients had a return to normal sensation, after a brief period of neurosensory disturbance.

Improvements in the Crestal Osteotome Approach Have Decreased the Need for the Lateral Window Approach to Augment the Maxilla

The use of the crestal approach to augment vertical height of the posterior maxilla for dental implant placement is reviewed in this article. The review of the literature documents the success of using a procedure that has minimal complications associated with it when performed correctly. An algorithmic approach is presented to guide surgeons on using the crestal osteotome approach for posterior maxillary augmentation.

Coagulo e membrana sinusale: connubio ideale per la rigenerazione ossea all’interno dei seni mascellari

ObjectivesThe aim of this study was to evaluate the behaviour of a series of tapered implants placed in atrophic posterior maxillae using a crestal approach without bone grafting materials. Materials and methods20 patients participated in this retrospective study, and 21 implants (Neoss Tapered, Neoss Ltd., Harrogate, UK) were placed with crestal approach in the posterior maxilla from March 2012 to June 2013 with a 5-24 months follow-up of prosthetic loading. ResultsOut of a total of 21 implants placed in 20 patients, through a crestal technique under maxillary sinus, only one implant was lost during the osteointegration period. The remaining 20 implants recovered without complication and were loaded with single crowns after 4 months of healing. Excluding the lost implant, the remaining 20 implants had a clinical success of 100% after a 5-24 months follow-up of prosthetic loading. The average vertical bone height, at the moment of surgery, was 5.3±1.7mm, reaching 8.8±3.1mm after 5-24 months of loading, with a vertical sinus bone regeneration of 3.5±1.4mm. The average implant stability registered at the surgery was 73.8±10.4 ISQ and 76.3±4.6 ISQ at the second stage of surgery after 4 months of recovery. ConclusionsThe crestal approach can be a valid alternative, in specific cases, to the more invasive lateral window sinus elevation technique. Good results can be obtained without using biomaterials, and bone regeneration develops around the implants simultaneously with osteointegration without extending the recovery process.

An Assessment of the Efficacy of Sinus Balloon Technique on Transcrestal Maxillary Sinus Floor Elevation Surgery

Background: A minimally invasive antral membrane balloon elevation (MIAMBE) has been introduced to overcome the invasiveness of modified Caldwell-Luc (lateral approach) and the drawbacks of the osteotome (summers' technique) in maxillary sinus floor elevation surgery. Materials and methods: A total of 13 adult Iraqi patients aged 28-55 years, 4 males and 9 females underwent sinus floor elevation surgery via crestal approach by using sinus balloon technique. A panoramic radiograph and (Cone beam computed tomography (CBCT)/or medical CT scan) were obtained before and after surgery. Postoperative gained bone was assessed and the patient reactions including pain, nasal bleeding, and ecchymosis were recorded. The whole follow up period was 1year following the sinus lift surgery. Results:The total performed sinus floor elevation cases were 17 with a total of 27 sinus floor elevation sites. The maximum gained bone with sinus balloon technique was 10.6 mm. Twenty three dental implants placed in augmented maxillary sinuses, two implants early failed 8.70 % and the survival rate of the dental implants was (91.30 %). Schneider's membrane perforation didn’t occur in any case of this study 0%. Conclusion: Sinus floor elevation via crestal approach using the balloon technique solve the limitations for original osteotome technique (summers' technique) for cases even when the subantral bone height is less than 3 mm. The utilization of hydraulic pressure in combination with balloon technique also shows a great role in both sinus membrane elevation and as a diagnostic aid of Schneider's membrane perforation. Key words: Sinus lift surgery, antral membrane balloon elevation, Schneiderian membrane perforation.

Histological and histomorphometric study using an ultrasonic crestal sinus grafting procedure. A multicenter case study.

BackgroundThe aim of this study was to evaluate the efficacy of a hydrodynamic ultrasonic driven transcrestal sinus grafting procedure (Intralift ®, Acteon Company, Bordeaux, France) and the use of a bovine high temperature sintered grafting material in sinus sites with less than 5 mm remaining bone height with no additional autogenous bone in order to create a sufficient recipient site for implants.Material and Methods12 patients (16 sinus) in this multicenter case study were included. Using a crestal approach, bone under the sinus was prepared with ultrasonic tips until the Schneiderian membrane was reached. With a trumpet shaped instrument, the Schneiderian membrane was elevated. In the new created subantral space a high temperature sintered bovine grafting material was introduced (Bego Oss, BEGO Implant Systems GmbH & Co. KG, Bremen, Germany). After 6 months biopsies were taken with a trephine bur and histologies were generated following histomorphometric analysis.ResultsThe results showed new vital bone in average of 33.4% ± 17.05%, and 43.6% ± 16.70 of bone substitute material. No signs of abnormal inflammation were observed.ConclusionsThis procedure (Intralift ®) allows, using a bovine material with no additional autogenous bone, new bone formation in the sinus in order to allow place implant subantraly. Key words:Bone regeneration, sinus, intralift ®, xenogenic bone graft

Stage Characterization and Marginal Bone Loss Evaluation Up to 96 Months of Crestal Sinus Augmentation With Sequential Drills: A Retrospective Study.

The 2-stage crestal approach to augment the maxillary sinus is a little-used technique. The aim of this retrospective study was to assess events characterizing stages of this technique after implant placement in the posterior maxilla with residual bone height less than 4 mm and evaluate the marginal bone loss (MBL) changes over time. Thirty-three patients underwent unilateral sinus augmentations using the trancrestal technique with mineralized allograft. Six-months (6 m) after first surgery, if skeletal subsidence prevented insertion of a 10-mm-length implant, additional grafting was performed during implant (n = 33) insertion. Radiographs were taken before grafting (baseline), immediately after and at 6 months; immediately after and 6 months after implant placement; and at follow-up (24-96 m). One implant was lost (ISR = 96.97%). Of the remaining 32 patients, 14 (A group) underwent standard implant placement, whereas 18 (B group) underwent additional grafting immediately before implant placement. Given that B-group patients initially obtained lower crestal bone height after first surgery, additional grafting procedures provided greater crestal height in the B group. A significant relationship between ending (eMBL) and 6mMBL was found in both groups, with greater values in the B group. However, in both groups, eMBL was always greater if 6mMBL was greater than 0.44 mm. Results suggest a high and low skeletal-reactivity patient categorization. In both patient categories, MBL greatly depends upon 6-month values. Investigations are necessary to relate sinus size with results obtained by this 2-stage crestal approach. The 2-stage crestal sinus lift procedure not only provides predictable results, but also allows low skeletal-reactivity patient recovery.

Sinus floor elevation with a crestal approach using a press-fit bone block: a case series

This prospective study aimed to provide detailed clinical information on a sinus augmentation procedure, i.e., transcrestal sinus floor elevation with a bone block using the press-fit technique. A bone block is harvested with a trephine burr to obtain a cylinder. This block is inserted into the antrum via a crestal approach after creation of a circular crestal window. Thirty-three patients were treated with a fixed prosthesis supported by implants placed on 70 cylindrical bone blocks. The mean bone augmentation was 6.08±2.87mm, ranging from 0 to 12.7mm. Only one graft failed before implant placement. During surgery and the subsequent observation period, no complications were recorded, one implant was lost, and no infection or inflammation was observed. This proof-of-concept study suggests that the use of a bone block inserted into the sinus cavity via a crestal approach can be an alternative to the sinus lift procedure with the creation of a lateral window. It reduces the duration of surgery, cost of treatment, and overall discomfort.

Paradigm shift regarding sinus augmentation.

The atrophic posterior maxilla is a challenging site for oral rehabilitation with dental implants due to insufficient bone volume. Crestal or lateral window approaches for sinus augmentation are the most common surgical techniques to overcome the vertical deficiency of the atrophic posterior maxilla. Various bone graft materials have been used in recent decades as space makers in the compartment created under the elevated sinus mucosa. However, clinicians have occasionally experienced postoperative sinus complications after performing sinus bone graft. Sinusitis is the most serious complication associated with bone-added sinus augmentation. Sinusitis can be resolved using incision and drainage in some cases, but complete curettage of bone grafts and removal of implants is required when incision and drainage are not effective. When sinusitis occurs, the relationship between the patient and doctor can be harmed due to increased surgical costs and delayed healing; thus, prevention of sinusitis is key. To treat sinusitis is meaningless to our patients. How can we prevent sinusitis? Postoperative sinusitis is closely related to sinus mucosal perforation and bone graft. To reduce the rate of sinus perforation, first, clinicians should review in detail the step-by-step procedure for sinus augmentation. Second, a piezoelectric device should be used when preparing the bony window. A rotary bur has generally been used to prepare the bony window; however, surgeons who have limited experience with sinus augmentation may cause more frequent sinus membrane perforation during this part of the procedure. Mucosal perforation can delay surgery and lead to postoperative sinusitis. A piezoelectric surgical technique enables bone cutting with precision and has a low associated risk of sinus perforation. Furthermore, the ultrasonic piezoelectric surgical device minimizes damage to soft tissue and other structures, such as nerves and blood vessels, while cutting bone, even in cases of accidental contact. When a sizeable membrane perforation occurs, delay of sinus bone graft is recommended because mucosal perforation repair with a collagen membrane cannot completely prevent sinusitis. When the bone graft procedure is continued after sinus perforation and repair, numerous clinical studies have revealed high rates of sinusitis and implant failure1,2. Third, the use of bone grafts should be limited in the sinus. The key to inducing new bone formation in the sinus is not bone substitution, but, rather, space maintenance in the new compartment. Bone grafts, as a foreign material, are susceptible to infection. In addition, compared to bone-added sinus augmentation, more new bone formation is reported when bone grafts are not used.

Evaluation of anatomical considerations in the posterior maxillae for sinus augmentation.

The edentulous posterior maxilla is considered a clinical challenge during dental implant treatment for many dental practitioners. This is because its insufficient bone quality, deficient alveolar ridge, spiny ridges, undercuts, and sinus pneumatization are often encountered after tooth loss. To overcome these problems, several approaches have been developed and are currently used, including sinus augmentation and bone augmentation. Today, two main procedures of sinus floor elevation for dental implant placement are in use: a two-stage technique using the lateral window approach, and a one-stage technique using a lateral or a crestal approach. In this study, we deal with the anatomic relations of the structures of the maxillary sinus during sinus augmentation. These anatomical findings can help in complications and potential injuries of the maxillary sinus procedures. It can be suggested that pre-operative evaluation is helpful for diagnosis and treatment planning and minimizing complication during the surgery.

Sinus floor elevation utilizing the transalveolar approach.

A transalveolar approach for sinus floor elevation with subsequent placement of dental implants was first suggested by Tatum in 1986. In 1994, Summers described a different transalveolar approach using a set of tapered osteotomes with increasing diameters. The transalveolar approach of sinus floor elevation, also referred to as 'osteotome sinus floor elevation', the 'Summers technique' or the 'Crestal approach', may be considered as being more conservative and less invasive than the conventional lateral window approach. This is reflected by the fact that more than nine out of 10 patients who experienced the surgical procedure would be willing to undergo it again. The main indication for transalveolar sinus floor elevation is reduced residual bone height, which does not allow standard implant placement. Contraindications for transalveolar sinus floor elevation may be intra-oral, local or medical. The surgical approach utilized over the last two decades is the technique described by Summers, with or without minor modifications. The surgical care after implant placement using the osteotome technique is similar to the surgical care after standard implant placement. The patients are usually advised to take antibiotic prophylaxis and to utilize antiseptic rinses. The main complications reported after performing a transalveolar sinus floor elevation were perforation of the Schneiderian membrane in 3.8% of patients and postoperative infections in 0.8% of patients. Other complications reported were postoperative hemorrhage, nasal bleeding, blocked nose, hematomas and benign paroxysmal positional vertigo. Whether it is necessary to use grafting material to maintain space for new bone formation after elevating the sinus membrane utilizing the osteotome technique is still controversial. Positive outcomes have been reported with and without using grafting material. A prospective study, evaluating both approaches, concluded that significantly more bone gain was seen when grafting material was used (4.1mm mean bone gain compared with 1.7mm when no grafting material was utilized). In a systematic review, including 19 studies reporting on 4388 implants inserted using the transalveolar sinus floor elevation technique, the 3-year implant survival rate was 92.8% (95% confidence interval: 87.4-96.0%). Furthermore, a subject-based analysis of the same material revealed an annual failure rate of 3.7%. Hence, one in 10 subjects experienced implant loss over 3years. Several of the included studies demonstrated that transalveolar sinus floor elevation was most predictable when the residual alveolar bone height was ≥5mm and the sinus floor anatomy was relatively flat.

Posterior immediate implant placement with simultaneous crestal approach maxillary sinus bone graft and flapless extraction

membrane) with a mineralized allograft in combination with a roughened titanium tenting screw placed 3-4 mm below the implant platform, and coronal advancement flap. The hard and soft tissues around the implant were evaluated at 6months and approximately 1 year after treatment. Preand post-operative clinical, cone beam computed tomography (CBCT), and restorative cast measurements were made for all patients. Methods of Data Analysis:Descriptive analysis, such as mean and standard deviation (SD) Results: The mean (SD) of pre-operative crestal (2 mm from crest) and mid-implant buccal bone thickness increased from 0.18 (0.45) mm and 0.64 (0.68) mm to 2.02 (0.88) mm and 2.71 (0.34) mm, respectively, approximately one year after treatment. The mean pre-operative soft tissue thickness [measured at implant platform level on study casts or by using CT scan if casts were not available (2)] increased from 1.53 (0.43) mm to 2.81 (0.45) mm. Further, the average width of the labial keratinized tissue improved, from 2.53 (1.26) mm to 3.82 (1.05) mm, and the mean gingival margin height (measured on soft tissue casts with a digital caliper) increased from 1.64 (0.50) mm to 2.87 (0.28) mm. The mean pre-operative tooth length reduced from 10.89 (1.26) mm to 9.64 (0.84) mm (measured using casts). Conclusions: The use of a mineralized allograft with roughened tenting screws and collagen membrane coverage was effective in improving peri-implant soft tissue around ailing implants with gingival recession.