Edentulous Posterior Maxilla Research Articles

Long-term evaluation of osteotome sinus floor elevation and simultaneous placement of implants without bone grafts: 10-Year radiographic and clinical follow-up.

Insertion of an implant in the edentulous posterior maxilla is a challenging procedure because of poor bone quality and increased pneumatization of the maxillary sinus after tooth extraction. To increase the amount of bone, several surgical bone grafting techniques have been used-with considerable morbidity for patients. Osteotome sinus floor elevation (OSFE) is a less invasive technique. The clinical and radiographic outcome of 53 implants placed with this technique without bone graft has been reported previously. Here we report the clinical and radiographic findings after 10 years of implant load bearing. In a retrospective study, 34 Astra implants in 25 patients were subjected to 10-year follow-up radiologically and clinically. Each patient received 1 or 2 conical Astra implants. The level of the marginal bone and the height of the residual peri-implant alveolar bone (RPAB) for each implant were measured from digital intra-oral radiographs. Two implants in edentulous patients were lost at the 1-year follow-up, and 1 more at the 3-year examination. There was no loss between 3-year and 10-year follow-up. At 10-year follow-up 36 implants were included. Implants used in single-tooth replacements and in partially edentulous cases had a 100% survival rate. The mean marginal bone loss was 0.6 ± 0.8 mm. The bone height at the time of implant insertion ranged from 1.8 to 6.9 mm, with a mean value of 4.3 ± 1.0 mm. At 10-year follow-up the mean gain in bone at the implant sites for all implants was 2.6 ± 1.2 mm. The OSFE technique is a reliable method for rehabilitation of patients with atrophied posterior maxilla. However, the success of this method is associated with the amount of the residual bone. In the present study, this surgical approach without bone graft showed reliable long-term results with Astra implants.

Bioresorbable versus titanium space-maintaining mesh in maxillary sinus floor elevation: a split-mouth study

Maxillary sinus pneumatization limits implant placement in the edentulous posterior maxilla. Grafted sinus floor augmentation through Schneiderian membrane elevation and space obliteration with autogenous bone grafts, bone substitutes, or a combination of the two has often been used to resolve this problem. More recently, non-grafted sinus floor elevation has been established. This is based on the concept of membrane elevation and support either by tenting technique or using space-maintaining mesh. The aim of this study was to evaluate the predictability of new bone formation after sinus floor elevation using space-maintaining mesh without graft material and to illustrate the difference between the use of bioresorbable and titanium meshes. Eight patients with bilateral sinus pneumatization were selected for implant placement in the edentulous posterior maxilla. Pneumatized sinuses were approached through the lateral window technique; these were elevated and maintained with resorbable or titanium meshes. All patients were evaluated clinically and radiographically immediately and at 6 months postoperative. At 6 months, a core bone biopsy was obtained from the planned implant position using a trephine drill, and the bone formed was examined histologically. Healing was uneventful in all patients, and radiographic, clinical, and histological evidence of new bone formation was seen in both groups. Titanium and resorbable meshes were found to be reliable and predictable as space-maintaining devices.

Long-Term Implant Survival After 100 Maxillary Sinus Augmentations Using Plasma Rich in Growth Factors.

To identify determinants of long-term implant survival after sinus augmentation procedure (SAP) using a combination of plasma rich in growth factors (PRGF) and graft material. Patients were included in this retrospective study if they underwent SAP through a lateral wall approach using PRGF in combination with mainly xenograft, and received implants restored for at least 1 year. Sociodemographic, behavioral and implant characteristics (clinical factors, implant details, surgical details, prosthesis details, and complications) were analyzed. Sixty-seven patients received 217 implants in 100 augmented sinuses. The mean follow-up was 7.2 years. Overall, 22 implants failed in 15 patients (90% cumulative implant survival). Multivariable models showed greater implant survival with implants placed with ≥5 mm of residual crestal bone height (RBH) compared with those placed with <3 mm of RBH. There was also an improvement in survival comparing implant lengths. In addition, immediate loading of implants significantly increased the risk of implant failure. The use of PRGFs for maxillary sinus grafting may be an effective and safe treatment option for the rehabilitation of atrophic edentulous posterior maxillae. However, randomized clinical trials are needed to confirm these findings.

Is there a difference in frequency and type of maxillary sinus septa between dentate and edentulous posterior maxillae?

Is there a difference in frequency and type of maxillary sinus septa between dentate and edentulous posterior maxillae?

The factors that influence postoperative stability of the dental implants in posterior edentulous maxilla

BackgroundAll clinicians are aware of the difficulty of installing a dental implant in posterior maxilla because of proximate position of maxillary sinus, insufficient bone width, and lower bone density. This study is to examine which factors will make the implantation in the posterior maxilla more difficult, and which factors will affect the postoperative implant stability in this region.MethodsFive hundred seventy-three fixtures on the maxilla posterior were included for this study from all the patients who underwent an installation of the dental implant fixture from January 2010 to December 2014 at the Department of Oral and Maxillofacial Surgery in Pusan National University Dental Hospital (Yangsan, Korea). The postoperative implant stability quotient (ISQ) value, fixture diameter and length, presence of either bone graft or sinus lift, and graft material were included in the reviewed factors. The width and height of the bone bed was assessed via preoperative cone beam CT image analysis. The postoperative ISQ value was taken just before loading by using the OsstellTM mentor® (Integration Diagnostics AB, Gothenburg, Sweden). The t test and ANOVA methods were used in the statistical analysis of the data.ResultsMean ISQ of all the included data was 79.22. Higher initial bone height, larger fixture diameter, and longer fixture length were factors that influence the implant stability on the posterior edentulous maxilla. On the other hand, the initial bone width, bone graft and sinus elevation procedure, graft material, and approach method for sinus elevation showed no significant impact associated with the implant stability on the posterior edentulous maxilla.ConclusionsIt is recommended to install the fixtures accurately in a larger diameter and longer length by performing bone graft and sinus elevation.

NON-GRAFTED MAXILLARY SINUS LIFTING TECHNIQUE UTILIZING THERMOPLASTIC BIORESORBABLE SPACE MAINTAINING MESH

Non-grafted maxillary sinus floor elevation which is based on the concept of membrane elevation and support either by tenting technique or space maintaining mesh solved the problem of maxillary sinus pneumatization by creating a space for new bone formation with subsequent implant placement in the edentulous posterior maxilla. The aim of this study is to evaluate the predictability of new bone formation after sinus floor elevation using a bioresorpable mesh. Eight patients with sinus pneumatization were selected for implant placement in the edentulous posterior maxilla. Pneumatized sinuses were approached through lateral window technique and the membrane was elevated and sustained with a bioresorbable mesh. All patients were clinically and radiographically evaluated immediately and at 6 months postoperatively. At six months post-operatively, core bone biopsy was performed for histological examination of the formed bone using a trephine drill at the planned implant position. All patients showed uneventful healing and radiographic, clinical and histological evidence of new bone formation and it was concluded that the bioresorpable mesh was reliable and predictable as a space maintaining device.

Prevalence and location of the posterior superior alveolar artery using cone-beam computed tomography.

PurposeInsufficient knowledge of the anatomy of the maxillary sinuses prior to sinus graft surgery may lead to perioperative or postoperative complications. This study sought to characterize the position of the posterior superior alveolar artery (PSAA) within the maxillary sinuses using cone-beam computed tomography (CBCT).Materials and MethodsA total of 300 patients with edentulous posterior maxillae, including 138 females and 162 males with an age range of 33-86 years, who presented to a radiology clinic between 2013 and 2015 were enrolled in this retrospective cross-sectional study. The distance from the inferior border of the PSAA to the alveolar crest according to the residual ridge classification by Lekholm and Zarb, the distance from the PSAA to the nasal septum and zygomatic arch, and the diameter and position of the PSAA were all assessed on patients' CBCT scans. The data were analyzed using the Mann-Whitney test and the t-test.ResultsThe PSAA was detected on the CBCT scans of 87% of the patients; it was located beneath the sinus membrane in 47% of cases and was intraosseous in 47% of cases. The diameter of the artery was between 1 and 2 mm in most patients (72%). The mean diameter of the artery was 1.29±0.39 mm, and the mean distances from the PSAA to the zygomatic arch, nasal septum, and alveolar crest were 22.59±4.89 mm, 26.51±3.52 mm, and 16.7±3.96 mm, respectively.ConclusionThe likelihood of detecting the PSAA on CBCT scans is high; its location is intraosseous or beneath the sinus membrane in most patients. Determining the exact location of the PSAA on CBCT scans preoperatively can help prevent it from being damaged during surgery.

Short dental implants in the posterior maxilla: a review of the literature.

The purpose of this study was to perform a literature review of short implants in the posterior maxilla and to assess the influence of different factors on implant success rate. A comprehensive search was conducted to retrieve articles published from 2004 to 2015 using short dental implants with lengths less than 10 mm in the posterior maxilla with at least one year of follow-up. Twenty-four of 253 papers were selected, reviewed, and produced the following results. (1) The initial survival rate of short implants in the posterior maxilla was not related to implant width, surface, or design; however, the cumulative success rate of rough-surface short implants was higher than that of machined-surface implants especially in performance of edentulous dental implants of length <7 mm. (2) While bone augmentation can be used for rehabilitation of the atrophic posterior maxilla, short dental implants may be an alternative approach with fewer biological complications. (3) The increased crown-to-implant (C/I) ratio and occlusal table (OT) values in short dental implants with favorable occlusal loading do not seem to cause peri-implant bone loss. Higher C/I ratio does not produce any negative influence on implant success. (4) Some approaches that decrease the stress in posterior short implants use an implant designed to increase bone-implant contact surface area, providing the patient with a mutually protected or canine guidance occlusion and splinting implants together with no cantilever load. The survival rate of short implants in the posterior edentulous maxilla is high, and applying short implants under strict clinical protocols seems to be a safe and predictable technique.

Sinus Lift Procedure and Immediate Implant Placing: A Piezo-Surgery and Platelet Rich Plasma Approach: A Case Report

Insufficient bone volume is a common problem occurring during the rehabilitation of the edentulous posterior maxilla with implant supported prostheses. The bone available for implant placement may be limited by the presence of the maxillary sinus together with loss of alveolar bone height and it may be increased by augmentation. This case report presents the rehabilitation of the right maxillary molar region using direct sinus lift followed by immediate placement of two Implants. It helps in reducing the treatment time and increases the patient comfort. Recently, several clinical studies have been performed to evaluate the use of Platelet-rich Plasma (PRP) in maxillary sinus augmentation. Aim of this case report is to evaluate Surgical Procedure of Sinus lifting associated with PRP use and Piezosurgical technique to open the lateral window and to elevate Schneider Membrane before implant positioning and intrasinusal bone augmentation procedures. Our conclusion is that Piezosurgery and Platelet Rich Plasma can make sinus lift procedure safer with a slightly faster recovery time. However it remain a good alternative (worldwide recognized by results) to other procedure only for skilled Practitioner if performed after scheduling a seriously therapeutic Programme. Inclusion criteria, procedural steps and healing time must be strictly observed. Overall, results, encourage us to follow choosen scheme for the future.

Evaluation of implant stability simultaneously placed with sinus lift augmented with putty versus powder form of demineralized bone matrix in atrophied posterior maxilla

BackgroundRehabilitation of edentulous posterior maxilla with dental implants is a challenging problem in oral and maxillofacial surgery due to alveolar resorption and excessive pneumatisation of maxillary sinus. This study was designed to compare the efficacy of Putty Versus Powder Form of Demineralized Bone Matrix (DBM) augmented in lifted maxillary sinus in atrophied posterior maxilla with evaluating the implant stability simultaneously placed with both of them.Patients and Methods: sixty four implants were placed in twelve patients in the period between 2013 and 2016. Lateral approach, open window method for sinus lift with peizosurgical unit and placement of Putty or Powder Form of DBM were carried out simultaneously with implant placement. The implant success was defined when the prosthesis had been delivered and followed for 18 months without infection, pain, marginal bone loss and the implant stability quotient (ISQ) of each implant was measured using resonance frequency analysis. ResultsRadiographic bone formation was evident in all 12 patients, and all implants were stable after 18 months of placement. No statistically significant differences were observed in marginal bone loss around the implants between the powder and the putty groups at 6 months (p = 0.60), 12 months (p = 0.85) and 18 months (0.49). The difference between ISQ values in both groups was only significant at the baseline (p = 0.023). ConclusionSinus lifting with simultaneous implant placement could be used to treat atrophic maxilla with initial stability obtained by using taper designed implants and with minimal intraoperative complication susing peizosurgery. No statistically significant differences in the stability were observed between implants placed with both putty and powder forms of DBM.

Sinus floor elevation procedures to enable implant placement and integration: techniques, biological aspects and clinical outcomes.

Implant treatment in an atrophied edentulous posterior maxilla constitutes a challenge for the therapeutic team. The authors of the present study acknowledge that modern micro-rough surface implants in lengths of about 8-10mm or longer and of different brands are similarly successful. Consequently, the authors propose that the use of different sinus floor elevation techniques should be considered when < 8mm of bone is available below the maxillary sinus. The type of sinus floor elevation technique selected is mainly based on residual vertical bone height, marginal bone width, local intrasinus anatomy and the number of teeth to be replaced, although other factors (such as surgical training and surgical experience) may have an impact. It is proposed that a transcrestal sinus floor elevation approach can be considered as a first-choice method for single tooth gaps insituations with sufficient width for implant placement and a residual bone height of 5-8mm, while lateral sinus floor elevation, with or without grafting materials, is indicated when < 5mm of bone is available and when several teeth are to be replaced. With regard to time of implant placement, a one-stage procedure is preferred provided that high primary stability can be ensured.

TRANSCRESTAL SINUS LIFT AND IMPLANT PLACEMENT USING THE SINUS BALLOON TECHNIQUE

INTRODUCTION: Rehabilitation of the edentulous posterior maxilla with dental implants is challenging. The deficient alveolar ridge interferes with implant insertion of adequate length placed in the correct position and with the accurate inclination. The transcrestal sinus elevation procedure has become an important preprosthetic surgical procedure for bone creation in the posterior maxilla prior to implant placement. OBJECTIVES: Clinical and radiographic evaluation of using ballooning technique for sinus lift simultaneous with implant placement. MATERIALS AND METHODS: A randomized clinical trial was conducted on fourteen patients who were divided into two groups. Patients, with limited bone height below the floor of the maxillary sinus, were selected on the basis of history, clinical and radiographic examination using cone beam computed tomography. In group A, elevation of sinus membrane using ballooning technique without graft material and implants were placed simultaneously. While in group B, after sinus membrane elevation using ballooning technique, augmentation using biphasic calcium phosphate simultaneously with the implant placement were done. The bone density was measured in Hounsfield unit using ondemand3d software of the cone beam computed tomography. Also, the bone height was measured using cone beam computed tomography. RESULTS: Successful sinus membrane balloon lifting procedures were performed in 14 cases; in both groups there was no sinus membrane perforation. A total of 14 implants were placed. The radiographic examination showed the mean elevated height after 6 months by balloon in group A was 10.43 with SD ±1. 56mm.while in group B was10.31 ± 1.86. CONCLUSIONS: The use of balloon technique to elevate the sinus membrane is a minimally invasive technique and is associated with very little discomfort and complication.

A novel implant system dedicate to hydraulic Schneiderian membrane elevation and simultaneously bone graft augmentation: An up-to 45months retrospective clinical study.

To evaluate clinical and radiographic performance of a novel implant system that allows for hydraulic Schneiderian membrane elevation and simultaneously bone graft augmentation. Sixty-two consecutive patients with a mean age of 53.1 years and a severe atrophy of the posterior maxilla (3.0to 7.0mm) underwent 64 transcrestal sinus floor elevations and submerged implant placement. The following clinical and radiographic parameters were assessed: implant failure, any complications and bone gain measured using cone beam computed tomography. No patient dropped out. No implants failed and all the prostheses were uneventful at the last follow-up examination (mean 23.0 months; range 12-45). All the procedures were completed successfully, with elevation of the sinus membrane and insertion of bone graft and the dental implant at the planned site. No intraoperative or postoperative adverse events were observed, such as membrane tears or facial hematoma. The mean residual alveolar ridge height was 5.2±1mm (range 3.3-7.0mm). Mean bone gain was 10.9±2.43mm (range 5.3-16.5) after an average healing period of 8 months. Hydraulic elevation of the Schneiderian membrane using the iRaise sinus-lift system (Maxillent Ltd) can be considered a valuable treatment option for the rehabilitation of atrophic edentulous posterior maxillae.

Pneumatization within a maxillary sinus graft: a case report.

Rehabilitation of edentulous posterior maxilla with implant-supported prostheses frequently presents a challenge to dentists. This is due to insufficient bone within the region, in addition to other limiting factors such as anatomical pneumatization of the maxillary sinus. Thus, grafting of the maxillary sinus is a common procedure used to counteract these problems. Regardless of the type of biomaterial used, the success of the procedure is dependent on the formation of high-quality bone. Therefore, vascularization is a key factor for successful grafting and for the long-term maintenance of the treatment. This paper reports a clinical case of bone graft pneumatization and attempts to elucidate its potential etiology.

A piezoelectric surgery for direct sinus lift with immediate implant placement

Insufficient bone volume is a common problem encountered in the rehabilitation of the edentulous posterior maxilla with implant-supported prostheses. The bone available for implant placement may be limited by the presence of the maxillary sinus together with loss of alveolar bone height and it may be increased by augmentation. This case report presents the rehabilitation of the right maxillary molar region using direct sinus lift followed by immediate placement of the implant. It helps in reducing the treatment time and increases the patient comfort.

Rehabilitation of Atrophied Low-Density Posterior Maxilla by Implant-Supported Prosthesis.

The rehabilitation of edentulous posterior maxilla is a challenging task that could be complicated by the availability of low-density and reduced height of alveolar bone. Patients were enrolled in this study upon the presence of type IV bone and residual bone height <5 mm in posterior maxilla. Novel procedure for transalveolar sinus floor elevation was described to insert 10 short implants in 4 patients. Neither implant failure nor prosthetic failure was observed during a follow-up of 44 ± 3 months. Mesial bone loss of 0.5 ± 0.6 mm and a distal bone loss 1.3 ± 0.9 mm were measured after 35 ± 4 months of loading.

EVALUATION OF PLATELET RICH FIBRIN IN SINUS LIFTING WITH SIMULTANEOUS IMPLANT PLACEMENT

Introduction: Rehabilitation of the edentulous posterior maxilla with dental implants is challenging. The deficient alveolar ridge interferes with implant insertion of adequate length placed in the correct position and with the accurate inclination. The maxillary sinus elevation procedure has become an important preprosthetic surgical procedure for bone creation in the posterior maxilla prior to implant placement. The use of PRF during sinus-lift procedures has been advocated for many years. Objectives: This study was designed to evaluate the use of platelet rich fibrin (PRF) following sinus lifting with piezosurgery and simultaneous implant placement. Materials and methods: 7 patients were selected to perform sinus lifting with simultaneous implant placement using PRF as a sole agent and piezosurgery device. Results: Cone beam computerized tomography 6 months postoperatively showed statistically significant increase in bone height and density. The mean of the newly formed bone height was (6.55 ± 1.14 mm). The mean postoperative bone height measured from the floor of the maxillary sinus and alveolar crest was (11.35 ± 0.56 mm). The mean of the newly formed bone density was 507 HU. The mean of the postoperative bone density around the implants after 6 months was (547.71 ± 188.42 HU). The mean marginal bone loss was (0.82 ± 0.25 mm). Conclusion: PRF could be successfully used as a sole agent for bone regeneration in lateral sinus lifting with simultaneous implant placement.

Resonance Frequency Analysis of Sinus Augmentation by Osteotome Sinus Floor Elevation and Lateral Window Technique

To evaluate the use of resonance frequency analysis (RFA) to quantitatively compare the stability of implants placed in the atrophic posterior maxilla using 3 sinus augmentation techniques: osteotome sinus floor elevation (OSFE) and 1- and 2-step lateral window techniques (LWTs). Data were retrospectively collected from 50 patients, 29 to 85years old. One hundred twenty-eight implants were subdivided based on sinus augmentation technique as determined by available native bone height. Thirty-three implants were placed using OSFE in at least 8.0mm of bone. Forty-four implants were synchronously placed using 1-step LWT in 3.0 to 7.9mm of bone. In cases with less than 3.0mm of bone, the 2-step LWT was performed and the remaining 51 implants were placed after a period of healing. Implant stability quotient (ISQ) was recorded from RFA at stage 1 and subsequently at stage 2 (follow-up) 3 to 12months later. Statistical analysis was completed using t test and analysis of variance to assess differences in implant stability over time and among techniques, respectively. ISQ values at placement averaged 70.9, 68.9, and 72.2 for OSFE, LWT, and LWT with delayed placement, respectively. These differences were not statistically significant (P= .2). At stage 2 (follow-up), average ISQ values were 76.7, 77.7, and 78.7 for OSFE, LWT, and LWT with delayed placement, respectively. These differences were not statistically significant (P= .3). In contrast, differences in ISQ at stage 2 (follow-up) versus stage 1 were statistically significant for all 3 techniques (P < .01). OSFE, 1-step LWT, and 2-step LWT yielded average increases in ISQ of 5.8, 8.8, and 6.5, respectively. The results support the use of OSFE, 1-step LWT, and 2-step LWT to augment bone in the atrophic edentulous posterior maxilla. All 3 methods provide predictable osseointegration and yield statistical increases in ISQ at stage 2 (follow-up) compared with time of placement. With appropriate case selection according to native vertical bone height, there are no statistical differences in ISQ among these 3 techniques at either stage.

Immediate functional loading of posterior implants placed in partially edentulous patients: a preliminary report on a prospective clinical study.

The goal of this study was to investigate outcomes of implants placed in the partially edentulous posterior maxilla and mandible and restored with two- to four-unit fixed prostheses that were functionally loaded immediately after implant placement. Forty-nine patients were treated, and 63 fixed prostheses were inserted on 140 implants. After an average of 8.6 months of follow-up, 2 implants failed-a cumulative success rate of 98.6%. These preliminary results support other findings that suggest patients with maxillary and mandibular partial posterior edentulism can confidently be treated with immediately loaded dental implants.

Correlation of fractal dimension with histomorphometry in maxillary sinus lifting using autogenous bone graft.

The aim of this study was to determine the pattern of bone remodeling after maxillary sinus lifting in humans by means of fractal dimension (FD) and histomorphometric analysis. Therefore, the correlation between FD and the histomorphometric findings was evaluated. Sixteen patients with posterior edentulous maxilla were enrolled in this study. Maxillary sinus lifting was performed using autogenous bone grafted from the mandibular retromolar area. Three direct digital panoramic radiographs were obtained: before surgery (Group 1), immediately postoperatively (Group 2) and after 6 months of healing (Group 3) for FD analysis. Biopsies were taken after 6 months, processed and submitted to histological and histomorphometric analysis. Data were analyzed by Shapiro-Wilk test and ANOVA test followed by a Tukey test (a = 0.05). The bone volume fraction of newly trabecular bone (TB) and medullary area (MA) was measured as 62.75% ± 17.16% and 37.25 ± 17.16%, respectively. Significant difference in FD analysis was measured between Group 1 and Group 3. No significant difference was found in the correlation between FD and histomorphometric analysis for TB and MA (p = 0.84). In conclusion, all performed analyses were effective in assessing the bone-remodeling pattern in the maxillary sinus, offering complementary information about healing and predictable outcomes. There were no correlations between FD and histomorphometric analysis.