Crestal Sinus Lift Research Articles

Antral membrane balloon technique versus Densah bur in crestal sinus lift with simultaneous implant placement: a randomized clinical trial

BackgroundThe posterior maxilla presents challenges for implant insertion because of the poor bone quality as well as the loss of vertical bone height. Indirect transcrestal sinus lift techniques are advised when a few millimeters of additional height are needed. This study aimed to evaluate the clinical and radiographic outcomes of antral membrane balloon technique versus Densah burs for transcrestal maxillary sinus lifting with simultaneous implant placement.Materials and methodsThis randomized clinical trial was conducted on 22 patients received 32 dental implants for replacement of missed maxillary posterior teeth after crestal maxillary sinus lifting. The patients were randomly divided into two groups. Group 1, patients underwent crestal sinus floor elevation with simultaneous implant placement using antral membrane balloon technique. Group 2, patients underwent crestal sinus floor elevation with simultaneous implant placement using Densah burs. Patients were evaluated clinically and radiographically using cone beam computed tomography (CBCT) at regular time intervals immediately, 6 months and 12 months after surgery. All clinical and radiographic parameters were statistically analyzed.ResultsAll dental implants were successful for 12 months of follow up. Regarding implant primary stability, there was a statistical significant difference between the study groups in favor of Densah group (P = 0.004), while there was no significant difference after 6 months (P = 0.07). Radiographically, balloon group showed a statistically significant immediate postoperative vertical bone height (P < 0.0001), and significant reduction in vertical bone height after 6 months (P < 0.0001). Densah group showed significant increase in bone density (P ≤ 0.05).ConclusionBoth techniques demonstrated successful clinical and radiographic outcomes for crestal sinus lift. The antral membrane balloon group demonstrated better immediate postoperative vertical bone gain, while Densah burs had higher implant primary stability and bone density.Trial registrationThis study was registered in Clinical-Trials.gov PRS (https://register.clinicaltrials.gov) under identification number NCT05922592 on 28/06/2023.

Crestal Sinus Lift with the Hydrodynamic Technique: Prospective Clinical Study at 3 Years Follow-Up

Aim: This study aimed to evaluate the implant survival rate, marginal bone loss (MBL), and surgical complications in single dental implants placed in the atrophic posterior maxilla using a transcrestal sinus lift with injectable graft materials. Materials and Methods: A prospective longitudinal study was conducted at IRCCS San Raffaele, Milan, Italy. Fifty-four patients with single edentulous sites and residual bone heights &lt; 5 mm were included. A transcrestal sinus lift was performed using non-cutting drills (Cosci’s technique) and xenogenic bone graft in gel form (Gel40, Tecnoss, Italy). Follow-up visits were at 1 week, 3 and 6 months, and annually for 3 years. Results: The implant survival rate was 98.04%, with one implant lost. MBL values were 0.71 ± 0.94 mm at 6 months, 1.00 ± 0.99 mm at 1 year, 1.03 ± 1.00 mm at 2 years, and 1.02 ± 1.01 mm at 3 years. Our ANOVA showed a significant MBL increase from 6 months to 1 year (p = 0.015), with no significant changes thereafter. Minimal surgical complications were observed, each occurring in 1.85% of cases. Conclusion: Transcrestal sinus lifts with injectable graft materials demonstrate high implant survival, acceptable MBL, and minimal complications, making it a reliable option for posterior maxilla rehabilitation.

Maxillary Sinus Floor Elevation and Simultaneous Implant Installation via Osseodensification Drills: A Retrospective Analysis of Bone Gain in 72 Patients Followed for 6 Months.

Background/Objectives: The aim of this retrospective study was to radiographically evaluate the endo-sinus bone gain (ESBG) following osseodensification procedures using CBCT and compare the results to more conventional sinus lifting techniques. Methods: A total of 72 patients underwent crestal sinus floor elevation procedures and were provided with 102 implants with a sand-blasted and acid-etched surface with microthreads (Medentika® Microcone Implants, Hugelsheim, Germany). Patients were divided into two groups; the osseodensification group (OD; n = 36) and the osseodensified augmentation group (ODA; n = 36). Results: The mean residual bone height (RBH) was 5.71 (1.77) and 4.30 (0.94) mm in the OD and ODA groups, respectively. An ESBG of 3.45 (1.18) and 5.74 (1.31) mm was observed in the OD and ODA groups, respectively, and as compared to the baseline RBH, the ESBG was statistically significant in both groups after 6 months (p < 0.001). Conclusions: Within the limits of this retrospective study, crestal sinus lifting with the osseodensification technique seems to be a fast, effective, and safe method. Longer follow-up studies with full intrasinus bone topography and structure analyses are needed to prove the success rate of endo-sinus bone gain.

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 5mm (range: 2.8-7.4mm). The implants healed smoothly with healing screws. Peri-implant marginal bone was stable with a mean follow-up of 50 months (range: 33-71mo). 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.

Versatility of the Osseodensified Crestal Sinus Lifting Technique as Alternative Procedure for the Lateral Sinus Technique with Simultaneous Implant Placement

Versatility of the Osseodensified Crestal Sinus Lifting Technique as Alternative Procedure for the Lateral Sinus Technique with Simultaneous Implant Placement

Lateral and crestal sinus lift complications: a retrospective comparative study

Background: To explore the relationship between the operative methods for sinus lifting and related intra-and postoperative complications. Methods: 47 cases of sinus lift were traced, with 118 implants placed. 83 of them after lateral sinus lifting and 35 with a crestal approach. Presence of bone septum, thickness of the sinus membrane, bone density, and the height of residual bone were tracked out preoperatively, as prerequisites of complications during and after implant placement in the distal parts of the maxilla. Results: In eight cases (17.02%), sinus membrane perforations occurred. The most common location of the tearing was close to the lower medial edge of the bone window. After fixing perforation, a total of 37 implants were placed under these conditions. In three of them (5.41%), poor osseointegration was found after six mounts. Statistically significant impact of the thickness of the sinus membrane in cases of membrane tearing was found. Conclusions: Increasing the height of the available bone in the distal areas of the maxilla by elevating the maxillary sinus floor is a safe and predictable procedure. Both the crestal and lateral approaches have a high success rate. All possible complications during the operation need to be analyzed in advance, and when they occur, it is mandatory to fix them adequately. Therefore, a careful consideration of the local and systemic conditions affecting implant survival is essential for successful implant treatment.

Effect of Different Crestal Sinus Lift Techniques for Implant Placement in the Posterior Maxilla of Deficient Height: A Randomized Clinical Trial

This study evaluated dental implant stability, vertical bone gain, bone density, and crestal bone loss using different crestal sinus lift techniques (osteotomy, Densah burs, and piezosurgery). A total of 21 patients were randomly divided into three groups: Group 1: patients were treated using a Densah drill crestal sinus lift, Group 2: patients were treated using a piezoelectric crestal sinus lift and Group 3: patients were treated using an osteotome crestal sinus lift. The patients in all three groups underwent bone grafting and implant placement. An Osstell device was used to determine the implant stability by recording the values of the implant stability quotient (ISQ). CBCT was performed before and 6 months after implant placement for radiographic evaluation and comparison among the groups. All dental implants were completely successful, and statistically significant differences from baseline to 6 months were noted in all groups (p &lt; 0.05). The Densah burs technique resulted in the best implant stability of all groups, while the osteotome technique demonstrated better vertical bone augmentation. However, the values for bone density and crestal bone loss showed no significant difference among all treated groups (p &gt; 0.05). All three techniques were successful for crestal sinus lifts with good clinical outcomes at a 6-month follow-up. The Densah group demonstrated better implant stability, shorter surgery time, and fewer complications; however, the vertical bone gain was greater with the osteotome technique.

Application of Dynamic Navigation System to Simultaneous Crestal Sinus Lifting and Dental Implant Placement at Maxillary Molars: Report of Two Cases

&lt;p&gt;Abstract: Objectives: Various dynamic navigation systems have been developed to enhance the accuracy of implant positioning and prevent damage to anatomical structures such as the inferior alveolar nerve and maxillary sinus during osteotomies. This case report aims to demonstrate a surgical method that combines a dynamic navigation system with crestal sinus lifting and simultaneous implant placement in the maxillary molar region. Materials and Methods: Two systemically healthy patients with extraction and socket preservation of a hopeless maxillary second molar were included in the study. Preoperative cone-beam computed tomography (CBCT) revealed limited residual bone height for implant placement after the healing period. Virtual planning of the implant was conducted using dynamic navigation planning software. Both patients underwent crestal sinus lifting through hydraulic pressure and simultaneous single implant placement assisted by the dynamic navigation system. Postoperative CBCT was performed 6 to 7 months after the implant placement to evaluate the implant position and increase in bone height. The postoperative implant position and orientation were compared to the preoperative virtual plan. Results: In both cases, the surgeries were uneventful and no postoperative complications occurred. Postoperative evaluation revealed that the global platform deviation was 1.60 and 2.24 mm, the global apex deviation was 1.46 and 2.13 mm, and angular deviation was 1.18&amp;deg; and 5.50&amp;deg; in case 1 and case 2, respectively. Conclusion: Combined dynamic navigation system with crestal sinus lifting by hydraulic pressure and simultaneous implant placement is a safe, accurate, and reduced morbidity surgical protocol in the maxillary molar region.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Full digital workflow in prosthetically guided implantology associated with crestal sinus lift

Resolution of edentulism of 2.4, 2.5, and 2.6 in a 60-year-old woman treated with bisphosphonates per os. CBCT (Planmeca ProMax 3D): good horizontal bone volume not enough vertical on 2.6 IOS (Planmeca Emerald): CAD design of three crowns before virtual implant placement Virtual placement of three implants in 2.4, 2.5, 2.6 positions guided by the virtual crowns previously designed (PlanCad). Regarding area 2.6, having only 4 mm of bone tissue was available in height, it was decided to virtually position the implant (4.2 × 6 MM) 2 mm out of the ridge, so as to arrive with the 6-mm burs, in the osteotomy phase, up to the cortical sinus without going beyond it. The lab .stl file was removed and matching of the intraoral scan stl file with dicom cbct file for the creation of the surgical guide with dental support was performed. The guide was printed using a 3D printer (Planmeca Creo C5). Osteotomies on 2.4 and 2.5 were performed and implants were inserted through the surgical guide. On 2.6 the osteotomy was performed only for 4 mm in depth in order to stop with the burs at the cortical wall of the maxillary sinus and to fracture it by the osteotomes. The implant was inserted manually. Endoral x-ray post-op showed the perfected match between virtual and real surgery. Intraoral scan was performed for an immediate load with a cad-cam zirconia bridge. Full digital workflow in implantology is a reliable technique to perform minimally invasive surgery.

Synthetic Putty and Simultaneous Short Implant Placement in Crestal Sinus Lifting Procedures: 13–36 Months Follow-Up: A Case Series

Introduction: Aim of this investigation is to show that in sites with less than 4 mm of bone height of the sinus floor, synthetic putty bone graft and simultaneous short implant placement in crestal sinus lifting procedures result in sufficient bone gain, and is a valuable option to the more invasive lateral-window approach. Case presentation: Four patients missing a single tooth or more in the posterior maxilla with remaining alveolar ridge height of less than 4mm underwent crestal sinus lift procedures with bone grafting using a synthetic putty material simultaneously. Loading of the short implants was done with a minimum of 4 months after placement showing bone growth around the implant and lift of the Schneiderian membrane between 2.3mm-7.3mm. Conclusion: Crestal sinus lift, in combination with a short implant and a synthetic putty bone graft, is a good alternative for lateral more invasive sinus lift when the thickness of the sinus floor is less than 4mm.

Implant Placement Following Crestal Sinus Lift with Sequential Drills and Osteotomes: Five Years after Final Loading Results from a Retrospective Study.

The aim of this retrospective study was to clinically evaluate the five-year outcomes of implants placed following a combined approach to the sinus, consisting of sequential drills and osteotomes. Medical records of patients with implants placed in combination with crestal sinus lift using sequential drills and osteotomes, with a residual alveolar bone crest between 4 to 8 mm, and a follow-up of at least five years after final loading, were evaluated. Outcomes were implant and prosthetic survival and success rates, any complication, and marginal bone loss. Data from 96 patients (53 women and 43 men; mean age 54.7 years; range 23–79 years) were collected. A total of 105 single implants were analyzed. After five years of function, two implants were lost and two prostheses failed. No major biological or prosthetic complications occurred. At the five-year examination, the marginal bone loss was 1.24 ± 0.28 mm. Within the limitations of this retrospective study it can be concluded that implants placed following a combined approach to the sinus consisting of sequential drills and osteotomes seem to be a viable option for the treatment of posterior atrophic edentulous maxilla.

A Minimally Invasive Technique for Short Spiral Implant Insertion with Contextual Crestal Sinus Lifting in the Atrophic Maxilla: A Preliminary Report.

The most recently reported techniques for the rehabilitation of the atrophic posterior maxilla are increasingly less invasive, as they are generally oriented to avoid sinus floor elevation with lateral access. The authors describe a mini-invasive surgical technique for short spiral implant insertion for the prosthetic rehabilitation of the atrophic posterior maxilla, which could be considered a combination of several previously described techniques based on the under-preparation of the implant site to improve fixture primary stability and crestal approach to the sinus floor elevation without heterologous bone graft. Eighty short spiral implants were inserted in the molar area of the maxilla in patients with 4.5–6 mm of alveolar bone, measured on pre-operative computed tomography. The surgical technique involved careful drilling for the preparation of implant sites at differentiated depths, allowing bone dislocation in the apical direction, traumatic crestal sinus membrane elevation, and insertion of an implant (with spiral morphology) longer than pre-operative measurements. Prostheses were all single crowns. In all cases, a spiral implant 2–4 mm longer than the residual bone was placed. Only two implants were lost due to peri-implantitis but subsequently replaced and followed-up. Bone loss values around the implants after three months (at the re-opening) ranged from 0 to 0.6 mm, (median value: 0.1 mm), while after two years, the same values ranged from 0.4 to 1.3 mm (median value: 0.7 mm). Clinical post-operative complications did not occur. After ten years, no implant has been lost. Overall, the described protocol seems to show good results in terms of predictability and patient compliance.

Success and survival rate of the implant with crestal sinus lift using S-reamer and gel-type graft material: A retrospective study by more 5-years follow check up

Success and survival rate of the implant with crestal sinus lift using S-reamer and gel-type graft material: A retrospective study by more 5-years follow check up

Efficacy of Dental Implants Placements between Lateral and Crestal Sinus Lift Techniques: A Split-Mouth Study

Background:Bone atrophy and pneumatization of the maxillary sinus resulting from tooth loss, associated with low bone density in the region, do not usually allow adequate quantity and quality for the installation of osseointegrated implants.Objective:To evaluate the efficacy of crestal and lateral sinus lift techniques which are performed on same patients.Materials and Methods:Ten patients who required both crestal and lateral approaches in 20 sinus lifts were selected; 31 endosseous dental implants were placed into these patients, with a reported timeline for each approach. Assessment of the surgical procedures in all patients was done using a Visual Analog Scale (VAS). Clinical and radiographic parameters, including Pocket Probing Depth (PPD), distance between the implant shoulder and the mucosal margin (DIM) and distance between the implant shoulder and first visible bone-implant contact (DIB), were analyzed to compare implant survival for both approaches.Results:All implants were successfully osseointegrated. No significant differences were observed between lateral and crestal approaches in PPD, DIM and DIB (p-values = 0.0504, 0.7784 and 0.18170, respectively), and in the total VAS scores (p-value ≥ 0.05). Most of the patients preferred the crestal approach due to the delay in implant placements with the lateral approach.Conclusion:Evaluation of the sinus floor elevation is more precise when both techniques are performed on the same patient. Furthermore, although post-operative vertigo is a major concern with the crestal approach; patients preferred this approach over the lateral technique because it is less invasive and required less time for the procedure.

Bone formation after Gelfoam crestal sinus lifting and proposal of a drill‐less technique

Bone formation after Gelfoam crestal sinus lifting and proposal of a drill‐less technique

Use of bone compressors and atraumatic bone elevators in crestal sinus lift

We report a case of a 37-year-old caucasian woman presenting a 1 cm pinkish nodular asymptomatic lesion of the hard palate, slowly growing in the last years. The lesion underwent to biopsy. Histological analysis showed the nevus tissue layered under a continuous squamous epithelium. The stroma contained nests of medium-sized round cells, with regular monomorphous nuclei. The nevus cells were immunohistochemically positive for S-100 protein, while melanin, visualized by Masson-Fontana silver staining, was absent. Therefore a diagnosis of non pigmented melanocytic nevus was formulated. Because of its rarity and to avoid any risk of malignant transformation, a surgical treatment with wide excision was chosen; the surgical wound was previously covered with a membrane of fibrin and autologous platelets, and subsequently sutured, resulting in a total heal. This procedure seems to be the most reliable to approach melanocytic lesions of the oral cavity. Clinical diagnosis of non-pigmented nevi, either flat or protruding, is difficult, because the nevus shows a pinkish colour that is indistinguishable from that of the surrounding mucosa. Moreover, attention is required when similar clinical evidence occurs, because the localization inside the oral cavity may offer several problems of differential diagnosis.

Osseodensification for implant site preparation in the maxilla‐ a prospective study of 97 implants

Background Osseodensification (OD) is an innovative surgical technique for implant site preparation that avoids bone sacrifice, contrary to the conventional drilling protocols. This is possible because of special burs designed to rotate in counter-clockwise direction. It is a nonextraction technique that creates a layer of compacted bone along the surface of an osteotomy, while simultaneously plastically expanding the bony ridge, which can bring many advantages in clinical practice. Aim/Hypothesis To investigate the outcome of osseodensification technique for implant site preparation in the maxilla in different clinical situations. Material and Methods Ninety-seven implants were placed in 41 patients (all of them in the maxilla with OD technique for implant site preparation, except the first pilot drill which was used in clockwise rotation). The implants placed were divided into four different groups. In group A, 60 implants were placed in 24 patients (10 males and 14 females) with reduced bone ridge width (range 3.2–5.1 mm) – in all cases, after expanding the ridge with OD, guided bone regeneration procedure was performed for contour augmentation. In group B, 15 implants were placed in 14 patients (6 males and 8 females) simultaneously with sinus augmentation by crestal approach (initial bone height ranging from 2.9 to 6.1 mm). In group C, 3 implants were placed in 3 male patients immediately after single tooth extraction. In group D, 19 implants were placed in 3 female patients with immediate loading for full-arch rehabilitation. Outcome measures were success rate of osseointegration and gain in bone width and height after site preparation. Results The success rate of osseointegration was 96.9%. Three implants (2 from group A and 1 from group D) in three patients were removed before final impressions because of non-integration. All implants placed had insertion torque values ≥45 N cm at the time of placement. Greater bone expansion occurred at the coronal position compared to the apical. Group A showed a mean ridge expansion of 1.6 mm (range from 1.1 to 2.4 mm). The greatest amount of bone expansion was recorded on initially narrower ridges compared to wider ridges. In group B (sinus lift group), the mean gain in bone height was 5.8 mm (range from 4.2–6.3 mm). Osseodensification clearly helped to optimize the site for the immediate post-extraction implants (group C) and to achieve great values of implant stability and insertion torque for the immediate loading full-arch cases from group D. Conclusions and Clinical Implications Osseodensification is a biomechanical site preparation technique that preserves bone bulk and allows to avoid bone sacrifice. This study validated the bone expansion capacity of OD for predictable ridge expansion with enhanced primary stability and higher insertion torque values. This may be clinically relevant in minimizing implant dehiscences or fenestrations, as was noted in this study. OD can also be used for crestal sinus lift in a simple, safe and predictable way with reduced morbidity.

The incidence of sinus membrane perforation in crestal sinus lift technique

The incidence of sinus membrane perforation in crestal sinus lift technique

Does intraoperative perforation of Schneiderian membrane during sinus lift surgery causes an increased the risk of implants failure?: A systematic review and meta regression analysis.

There is still debate whether intraoperative Schneiderian membrane (SM) perforation in the maxillary sinus lift causes an increase the risk of implants failure. The aim of this study was to assess an association between SM perforation and implants loss following the maxillary sinus lift. A systematic review and meta-analysis of clinical studies assessing association between SM perforation and implants failure based on PRISMA was conducted. Three major databases were used to gather research dating from their respective inception up until March 2018. All clinical studies expressly reported the number of the SM perforation and implants loss that installed in the perforated and nonperforated sinuses were included. The statistical analyses used were Pearson's correlation, simple linear regression, and meta regression. The risk ratio (RR) of implant loss between perforated and nonperforated sites was estimated. A total of 2947 patients with 3884 maxillary sinuses augmentations who received 7358 implants, enrolled in 58 studies were included in this study. There was a significant relationship between the implants' failure and SM perforation according to simple linear regression (P < .001) and meta regression analysis (P = .06). There was a significant decrease (moderate quality evidence) in implant loss in the nonperforated sinuses compared to perforated sunrises (RR = 2.17, CI: 1.52-3.10, P = .001). There was also no significant association between implant loss in the perforated sinuses and the surgical devices used (piezosurgical or rotary), surgical approach applied (lateral or crestal sinus lift), barrier membrane used and type of bone grafting materials. The results of this study showed that an intraoperative SM perforation could increase the risk of implant failure after the sinus lift surgery.

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.