Maxillary Sinus Floor Elevation Research Articles

Maxillary sinus floor elevation surgery with BioOss® mixed with a bone marrow concentrate or autogenous bone: test of principle on implant survival and clinical performance

The purpose of this study was to assess implant survival and 1-year clinical performance of implants placed in the posterior maxilla that had been subjected to maxillary sinus floor elevation surgery with bovine bone mineral (BioOss®) mixed with autogenous bone marrow concentrate or autogenous bone. In a randomized, controlled, split-mouth design study, a bilateral sinus floor augmentation procedure was performed in 12 edentulous patients. At random, one side was treated with BioOss® seeded with an iliac crest bone marrow concentrate enriched in mesenchymal stem cells (test side) and the other with BioOss® mixed with autogenous bone (control side). Three to four months after augmentation, 66 implants were placed. Implant survival, plaque, gingival, and bleeding indices, probing depth, and peri-implant radiographic bone levels were assessed at baseline and 12 months after functional loading. During osseointegration, three implants failed on the test side (two patients) and no implants failed on the control side, resulting in 3-month survival rates of 91% and 100%, respectively. No implants were lost after functional loading and no differences in soft tissue parameters or peri-implant bone loss were observed between the control and test sides. After 1 year in function, no clinically relevant differences were observed regarding soft tissue parameters or peri-implant bone loss.

Comparison of the Use of Adipose Tissue–Derived and Bone Marrow–Derived Stem Cells for Rapid Bone Regeneration

Stem cell–based bone tissue engineering has been recognized as a new strategy for maxillary sinus floor elevation. More rapid bone formation may enhance this technique when simultaneous dental implant placement is desired. Adipose tissue–derived stem cells (ADSCs) and bone marrow stem cells (BMSCs) are the most well-characterized cell sources for bone regeneration, but comparative studies on the osteogenic potential of these cells have yielded conflicting conclusions. This study aimed to compare the rapid bone formation capacity of ADSCs and BMSCs in a canine sinus floor augmentation model. In in vitro studies, BMSCs had a higher proliferative ability and greater osteogenic differentiation potential at both the mRNA and protein levels. When GFP-labeled cells on calcium phosphate cement (CPC) scaffolds were implanted subcutaneously into nude mice, both ADSCs and BMSCs survived for 4 wks, but only BMSCs formed new bone. Furthermore, according to sequential fluorescence labeling results for the canine sinus, BMSCs promoted rapid and greater bone regeneration during the entire observation period. In contrast, obvious mineralization was detected starting from 3 wks after implantation in the ADSC group. These results suggest that BMSCs might be more useful than ADSCs for rapid bone regeneration for sinus augmentation with simultaneous implant placement.

Maxillary sinus floor elevation with a space maintaining mesh: titanium versus resorbable

Background: The placement of dental implant in the edentulous posterior maxilla often present difficulties as a result of insufficient bone due to pneumatization of the maxillary sinus and bone resorption after extraction. The lateral window Technique is usually accomplished by creating lateral bony window and elevation the sinus membrane. The new compartment created between the floor of maxillary sinus and the elevated membrane was filled either with autograft, bone graft substitutes or combination of them to maintain space for new bone formation.

Piezoelectric surgery in maxillary sinus floor elevation with hydraulic pressure for xenograft and simultaneous implant placement

Because of the low bone quality in the posterior maxilla, edentulism in this area often results in a resorbed osseous structure and a pneumatized maxillary sinus, which makes dental implant surgery in the posterior maxilla a challenge. Two main surgical approaches are available for the sinus lift procedure: lateral and crestal. Improvement of the maxillary sinus floor elevation technique and increase in predictability are desirable. This article describes an innovative approach to maxillary sinus floor elevation with piezoelectric surgery and hydraulic pressure for xenograft and simultaneous implant placement in situations with insufficient residual alveolar bone.

Comparative Radiologic Analyses of Newly Formed Bone After Maxillary Sinus Augmentation With and Without Bone Grafting

The present study examined the formation and density of new bone after sinus membrane elevation, with and without bone grafting, and evaluated the bone formation at the apices of the implants with these 2 different maxillary sinus floor elevation techniques. In a prospective randomized controlled study design, patients requiring reconstruction of their atrophic maxilla were included and divided randomly into grafted and nongrafted groups. Implants were inserted in each group by way of sinus membrane elevation. The formation and density of new bone were evaluated using cone beam computed tomography, performed preoperatively and 1 week, 3 weeks, and 6 months postoperatively. A total of 24 implants were placed in 14 patients, with all implants maintaining stability during 6months of follow-up. New bone formation was determined in both groups using radiography. No significant differences were found between the 2 groups in terms of new bone density preoperatively nor at 1week or 3 months postoperatively. However, the density of bone in the nongrafted group was higher than that in the grafted group 6 months after surgery. These results suggest that the simple elevation of the sinus membrane without bone grafting material can lead to bone formation around implants and that the newly formed bone in the nongrafted group was denser than that in the grafted group.

Sinonasal Complications Resulting from Dental Treatment: Outcome-Oriented Proposal of Classification and Surgical Protocol

Odontogenic sinusitis is a relevant infectious condition of the paranasal sinuses. The widespread use of dental implants and reconstructive procedures for dental implant placement has led to new types of complication. To the authors' knowledge, no publication has extensively examined sinonasal complications resulting from dental treatment, and no classification system allowing standardization and comparison of results is currently available. This study was designed to (a) analyze the results obtained from surgical treatment of complications resulting from dental procedures combining functional endoscopic sinus surgery (FESS) and an intraoral approach and (b) propose a new classification system and standardized treatment protocols for sinonasal complications resulting from dental procedures. A total of 257 patients consecutively treated with FESS (136 in conjunction with oral surgery) were included in the study. Different clinical situations were integrated into a new classification system based on the pathogenesis and clinical aspects of each case, with the aim of identifying homogenous treatment groups. Results were evaluated for each class. Of the 257 patients, 254 were successfully treated with surgery performed according to the proposed protocols. Three of 257 patients required a second surgery, after which they completely recovered. Complications of implant and preimplant surgery (maxillary sinus floor elevation) showed longer recovery times. The results obtained are very encouraging. The majority of patients (254/257; 98.8%) were successfully treated with the proposed protocols. These results seem to indicate that the rationalization of surgical treatment protocols according to the initial clinical situation may significantly improve the clinical outcome.

Elevación de seno maxilar y colocación simultánea de implantes utilizando plasma rico en factores de crecimiento (PRFC), hidroxiapatita y aloinjerto. Reporte de un caso de siete años

Maxillary sinus floor elevation is a predictable surgical procedure meant to vertically increase the amount of bone in the posterior region of the upper jaw to enable placement of a prosthetic rehabilitation device supported by implants. The aim of the present article was to describe elevation of the maxillary sinus floor using plasma rich in growth factors, absorbable hydroxyapatite and bone allograft as subantral graft materials with simultaneous placement of two surface treated implants (Osseotite, 3i). The present article also reported clinical and radiographic results obtained at seven days, six months and seven years after the surgery. From the clinical and radiographic standpoint suitable healing was observed. The surgical procedure used in the present clinical case was considered a suitable option to place implants in atrophic maxillary areas.

A novel approach revealing the effect of a collagenous membrane on osteoconduction in maxillary sinus floor elevation with β-tricalcium phosphate

Calcium phosphates are used in maxillary sinus floor elevation (MSFE) procedures to increase bone height prior to dental implant placement. Whether a collagenous barrier membrane coverage of the lateral window affects bone formation within a bone substitute augmentation is currently an important matter of debate, since its benefit has not been irrefutably proven. Therefore, in this clinical study twelve patients underwent an MSFE procedure with β-tricalcium phosphate (β-TCP). The lateral window was either left uncovered, or covered with a resorbable collagenous barrier membrane. After a 6-months healing period, bone biopsies were retrieved during implant placement. Consecutive 1mm regions of interest of these biopsies were assessed for bone formation, resorption parameters, as well as bone architecture using histology, histomorphometry and micro-computed tomography. Comparable outcomes between the groups with and without membrane were observed regarding osteoconduction rate, bone and graft volume, osteoclast number and structural parameters of newly formed bone per region of interest. However, osteoid volume in grafted maxillary sinus floors without membrane was significantly higher than with membrane. In conclusion, our results - obtained with a novel method employed using 1mm regions of interest - demonstrate that the clinical application of a bioresorbable collagenous barrier membrane covering the lateral window, after an MSFE procedure with β-TCP, was not beneficial for bone regeneration and even decreased osteoid production which might lead to diminished bone formation in the long run.

Engineering of bone using rhBMP-2-loaded mesoporous silica bioglass and bone marrow stromal cells for oromaxillofacial bone regeneration

In present study, CaO–P2O5–SiO2-system mesoporous silica (MS) scaffolds were synthesized and loaded with recombinant human bone morphogenetic protein-2 (rhBMP-2), while their protein release properties and other characteristics were investigated. Furthermore, rabbit bone marrow stromal cells (bMSCs) were cultured and seeded on rhBMP-2-loaded MS (rhBMP-2/MS) scaffolds. Cell adhesion and proliferation were evaluated by scanning electron microscopy (SEM) and MTT assays, while osteogenic differentiation was measured by ALP activity and real-time PCR analysis on the osteogenic markers of runt-related transcription factor 2 (Runx2), collagen type 1 (COL1), osteocalcin (OCN), and osteopontin (OPN). Finally, twenty-four rabbits received unilateral maxillary sinus floor elevation surgery at each time point (2 and 8weeks), and randomly filled with one of the following four materials: MS alone; autologous bMSCs/MS complexes; rhBMP-2/MS complexes; or autologous bMSCs/rhBMP-2/MS complexes. New bone formation and mineralization were detected by histological/histomorphometric analysis, and fluorochrome labeling. The results showed that MS scaffolds presented excellent hierarchically large pore and well-ordered mesopore properties; moreover, rhBMP-2/MS scaffolds efficiently released rhBMP-2 in a sustained manner. Furthermore, rhBMP-2/MS scaffolds significantly enhanced the proliferation and osteogenic differentiation of bMSCs. In the maxillary sinus floor elevation experiments, rhBMP-2/MS scaffolds promoted new bone formation and augmented the height of the sinus floor, while the addition of bMSCs further enhanced new bone formation and mineralization. The present study revealed that CaO–P2O5–SiO2-system MS scaffolds could act as drug delivery carriers for rhBMP-2 and could be used to construct tissue-engineered bone with bMSCs for oromaxillofacial bone regeneration.

A comparison between 4 and 6 implants in the maxillary posterior region to support an overdenture; 1‐year results from a randomized controlled trial

To compare the treatment outcome of 4 vs. 6 bar-connected implants in the posterior region of the maxilla to support an overdenture during a 1-year follow-up period. Sixty-six edentulous patients with an insufficient amount of bone volume in the maxilla to place implants were asked to participate in this study. Randomization assigned patients to either 4 or 6 implants. In all patients, a maxillary sinus floor elevation procedure with bone from the iliac crest was performed, and after a 3-month healing period, 4 or 6 dental implants were inserted in the maxillary posterior region in a one-stage procedure. After 3 months of osseointegration, a bar-supported overdenture was constructed. Implant survival, overdenture survival, clinical scores, peri-implant bone height changes and patients' satisfaction were assessed. Study analysis was performed according a non-inferiority design. All patients completed the one-year follow-up. After a functional period of 1-year, implant survival was 100% in the 4 implants group and 99.5% in the 6 implants group. Overdenture survival was 100% in both groups. Mean clinical scores were very low and did not significantly differ between groups. Mean marginal bone resorption was 0.35 ± 0.31 mm and 0.46 ± 0.34 mm in the 4 and 6 implants group, respectively. Patients' satisfaction improved significantly in both groups, but did not differ between groups. A bar-supported overdenture on 4 implants in the posterior maxillary region is not inferior to an overdenture supported by 6 bar-connected dental implants.

Minimally Invasive Transcrestal Guided Sinus Lift (TGSL): A Clinical Prospective Proof‐of‐Concept Cohort Study up to 52 Months

This study describes a new procedure for sinus elevation using computer-guided planning and guided surgical approach through the use of computer-aided design (CAD)/computer-aided manufacturing (CAM)-generated surgical template in combination with expander-condensing osteotomes thus providing a minimally invasive surgical technique. Sixty-six consecutive patients were treated with 136 implants placed by transcrestal-guided sinus floor elevation technique and the patients were followed for at least 3 years in function. The drilling protocol is customized based on the bone density of each implant site to achieve an insertion torque ranging between 45 and 55 Ncm. Titanium temporary abutments were connected to the implants with prosthetic screws tightened to 35 Ncm and an acrylic resin provisional restoration was adapted and delivered immediately. Six months after initial loading, a definitive CAD/CAM-generated restoration was delivered. Outcome measurements assessed were implant and prosthesis survival rate, biological or biomechanical complications, marginal bone level changes, total alveolar ridge bone height before and after procedure, periodontal parameters measured as well as patient's perception of pain levels during recovery period. Mean follow-up was 43.96 (range from 36 to 52) months. Cumulative implant survival rate was 98.53% at 3 years. No biological or mechanical complications were encountered and no prosthetic failures occurred during the entire follow-up period. Mean marginal bone loss (MBL) during the first year of function was 0.33 ± 0.36 mm, while at the 3-year follow-up, the mean MBL was 0.51 ± 0.29 mm. The mean residual bone height of the alveolar crest prior to grafting was of 6.7 ± 1.6 mm (range 5.1-9.2 mm), while, the mean bone height gained was 6.4 ± 1.6 mm (range 3.2-8.1 mm). All patients reported low levels of pain and found to have normal periodontal parameters. This proof-of-concept study suggests that the use of guided surgery to perform transcrestal maxillary sinus floor elevation for alveolar ridge height augmentation is a successful minimally invasive technique for the short- to medium-term follow-up, thus avoiding the extended treatment time and morbidities associated with maxillary sinus floor augmentation.

Surgical Elevation of Bilateral Maxillary Sinus Floor with a Combination of Autogenous Bone and Lyophilized Bovine Bone

Realize the surgery of sinus lifting floor to allow the installation of osseointegrated implants for oral rehabilitation, with the combination of different biomaterials, autogenous bone and lyophilized bovine bone. Oral rehabilitation using the installation of osseointegrated implants is an alternative surgical approach that results in the satisfactory form, function and esthetics of the dental units. After clinical, dental and laboratory assessment, a 47-year-old female patient underwent full maxillary oral rehabilitation involving the installation of osseointegrated implants to allow her to meet the physiological demands of occlusion and mastication. It was found that the patient had fully pneumatized maxillary sinuses with insufficient height to anchor implants, with a loss of the vertical dimension of the occlusal and masticatory functions due to general dental loss, compounded by the use of ill-fitting dentures; hence, the choice was made to take autogenous bone from the patient's chin area and supplement it with lyophilized bovine bone as collateral for larger areas to be grafted. It was also decided to avulse the remaining tooth units due to their impairment by periodontal disease. Bone grafts do not constitute suitable alternatives in the cosmetic and functional rehabilitation of the maxilla in patients requiring bilateral sinus elevation. The chin region provides bone tissue that, when complemented by lyophilized bovine bone grafts, ensures greater volume and less invasive surgery. In the case described here, a height gain of approximately 550% was obtained, making it possible to anchor seven implants. In this study, the surgical procedures used for grafting a combination of autogenous and lyophilized bovine bone, aimed to elevate the maxillary sinus floor to allow the installation of osseointegrated implants for oral rehabilitation.

Assessment of the autogenous bone graft for sinus elevation

ObjectivesThe posterior maxillary region often provides a limited bone volume for dental implants. Maxillary sinus elevation via inserting a bone graft through a window opened in the lateral sinus wall has become the most common surgical procedure for increasing the alveolar bone height in place of dental implants in the posterior maxillary region. The purpose of this article is to assess the change of bone volume and the clinical effects of dental implant placement in sites with maxillary sinus floor elevation and autogenous bone graft through the lateral window approach.Materials and MethodsIn this article, the analysis data were collected from 64 dental implants that were placed in 24 patients with 29 lacks of the bone volume posterior maxillary region from June 2004 to April 2011, at the Department of Oral and Maxillofacial Surgery, Inha University Hospital. Panoramic views were taken before the surgery, after the surgery, 6 months after the surgery, and at the time of the final follow-up. The influence of the factors on the grafted bone material resorption rate was evaluated according to the patient characteristics (age and gender), graft material, implant installation stage, implant size, implant placement region, local infection, surgical complication, and residual alveolar bone height.ResultsThe bone graft resorption rate of male patients at the final follow-up was significantly higher than the rate of female patients. The single autogenous bone-grafted site was significantly more resorbed than the autogenous bone combined with the Bio-Oss grafted site. The implant installation stage and residual alveolar height showed a significant correlation with the resorption rate of maxillary sinus bone graft material. The success rate and survival rate of the implant were 92.2% and 100%, respectively.ConclusionMaxillary sinus elevation procedure with autogenous bone graft or autogenous bone in combination with Bio-Oss is a predictable treatment method for implant rehabilitation.

Full rehabilitation with nobel clinician� and procera implant bridge�: case report

Implant surgery has been changing in different ways following improvements of computer technologies. Since its beginning, according to the original procedures of Branemårk system implants, guide-lines in implants-supported prosthetic rehabilitation have been founding on the placement of fixtures in a fairly upright position, after maxillary sinus floor elevation; while in the case of interforaminal rehabilitation, an upright distal implant may need to be placed anterior to the mental foramina without nerve damage (although the consequence would have been bilateral cantilevers to provide good chewing capacity). Some authors have proposed engaging the molar/tuberosity area: Bahat and Venturelli demonstrated these areas reliable and predictable alternative to distal cantilever prostheses or sinus elevation procedures. In recent years, the immediate loading of tilted implants with a provisional restoration has been proposed for the treatment of the atrophic maxilla. Tilted posterior implants in either arches could avoid (cantilever length) and provide to a better load distribution. Further studies have showed excellent outcomes for both tilted and axial implants; indeed this protocol allows to use longer implants, improve bone anchorage and avoid bone grafting procedures. Malò at al., in a retrospective clinical study, showed important results using two posterior tilted implants and two anterior non-tilted ones in the so-called All-on-four technique (Nobel Biocare, Göteborg, Sweden). Instead of the great loss of bone (amount and quality) in long-term edentuly the clinically documented computer-guided implantology software is able, through posterior tilted implants, to improve load distribution. Many authors have reported reduced surgical invasion (sinus grafting surgery is needless), shorter treatment time, lower cost, natural aesthetic profiles and functional bite.

Sinus Floor Elevation Using a Composite Graft: Clinical Outcome of Immediate Implant Placement

The aim of this study is to assess the long-term outcome of a single-stage approach for implant placement and maxillary sinus floor elevation (MSFE) that used a combined scaffold of laminated calvarial bone, platelet-rich plasma (PRP), and beta-tricalcium phosphate. Thirty consecutive patients who required MSFE to allow rehabilitation with implant-supported prosthesis entered this survival study. All patients received their dental implants at the time of sinus elevation, and prosthetic loads were applied 4 to 6 months after implant insertion. Clinical outcomes used for evaluation included residual bone height at the subsinus area (height of subsinus bone [HSB], assessment of surgical morbidity, and implant success and survival rates. Simultaneous insertion of 86 implants, either 10 mm long (n = 76) or 12 mm long (n = 10), took place in a total of 22 bilateral and 8 unilateral sinus elevations. Loading was initiated a mean of 3.8 ± 1.5 months after the first surgery. A mean HSB of 4.9 ± 1.7 mm was present before surgery, with 50% of the sample displaying HSBs of less than 4.4 mm. The mean implant survival time was 33.1 months (95% confidence interval, 31.7 to 34.5 months), with high rates of success (94.2%) and survival (96.5%). When patients were classified by their HSB (HSB ≥ 5 mm vs HSB < 5 mm), no differences were seen with regard to age, sex, healing time, or follow-up in terms of implant survival rates (P > .05). Sinus floor elevation using mainly laminated calvarial bone, PRP, beta-tricalcium phosphate, and simultaneous stable implant placement is a predictable technique with low surgical morbidity that allows shorter healing times in patients with reduced bone height.

Remodeling of Autogenous Bone Grafts after Osteotome Sinus Floor Elevation Assessed by Limited Cone Beam Computed Tomography

This study assessed the radiographic appearance of bone graft domes longitudinally after osteotome sinus floor elevation using cone beam computed tomography (CBCT). This study presents the radiological findings of a 6-month follow-up CBCT study in maxillary osteotome sinus floor elevation. We examined 52 patients with a crestal bone height of less than 8 mm in the posterior maxilla who required sinus augmentation. Implants (n = 91) were subsequently placed in regenerated bone following osteotome sinus floor elevation; autogenous bone was used as the augmentation material. In all cases, the grafted augmentation material tended to be absorbed, but at least 1 mm of grafted augmentation material was recognized around the implant fixtures on CBCT at the second implant operation. The border between the grafted augmentation material and the existing bone was indistinct. The grafted area apical to the implants undergoes shrinkage and remodeling. It was suggested that sufficient grafted autogenous bone changes into bone to support an implant.

Analysis of the Karyotype of Expanded Human Adipose-Derived Stem Cells for Bone Reconstruction of the Maxillo-Facial Region

Mesenchymal stem cells (MSC) and adipose-derived stem cells (ASC) were recently proposed for bone maxillofacial reconstruction in association with biomaterials. For this application MSC must be ex-vivo expanded in order to obtain, for a given volume of implanted biomaterial, a relevant number of bone forming cells. Previously conducted pre-clinical studies suggested that a concentration of 6 x 10(8) ASC associated with 900 mg of anorganic bovine bone (ABB) could be effective for human maxillary sinus floor elevation. A keystone issue to guarantee the quality and safety of Advanced Therapy Medicinal Products containing expanded MSC and ASC is their chromosome stability in culture: this topic has been widely investigated and conflicting results have been published. Abnormal karyotype of human ex-vivo expanded MSC and ASC was found by some authors, while, at the same time, several other studies showed the MSC and ASC karyotype to be normal. It is therefore important that all the results obtained on MSC and ASC karyotype analysis be published. Given this context, the aim of this manuscript, aim of this manuscript is to verify the karyotype stability of ASC in view of their applications in clinical trials. ASC obtained from the adipose tissue of 4 donors were expanded over extended culture time. Based on previous ASC expansions we hypothesized to be able to obtain 6 x 10(8) cells by passage 7. Karyotype analysis of 30 metaphases was planned to be investigated at passage 2, 7, and 15 in all the cultures. No abnormalities were found in the karyotype of two donors at all the passages tested, while a translocation was found in 2 metaphases of a donor at passage 7, but not at passage 15, and in the fourth donor in 5 metaphases a trisomy was found at passage 15. Chromosomal abnormalities were detected only after extended ASC expansion. Whether these anomalies can be related to risk for the patient's safety will have to be demonstrated by in-vivo studies.

Comparison of a Novel Trephine Drill with Conventional Rotary Instruments for Maxillary Sinus Floor Elevation

The purpose of this study was to compare a newly designed trephine drill (SLA KIT, Neobiotech) with conventional rotary instruments for maxillary sinus floor elevation based on operative time, postoperative pain, and perforation rates. Twenty-five patients were treated with a bilateral sinus floor elevation procedure with rotary trephine and conventional instruments. One side was treated with conventional rotary instruments, while the contralateral side was treated with rotary trephine instruments, with a 2-week gap between surgeries. Operative time was measured with a chronometer in seconds as the time from soft tissue incision to primary closure of the incision with the last suture. Pain was scored on a 10-point visual analog scale at 24 hours after surgery. The presence of tears and perforations was determined by direct visualization and the Valsalva maneuver. Twenty-five patients were included in the study. Operative time was shorter when the trephine drill was used (11.1 ± 2.4 minutes) than with conventional rotary instruments (15.1 ± 2.9 minutes). Sinus membrane perforation was observed in eight patients when conventional rotary instruments were used, while the trephine drill resulted in two sinus perforations. Mean pain scores were 2.01 ± 0.11 after using the trephine drill and 2.25 ± 0.76 when conventional rotary instruments were used. No significant difference was found in postoperative pain scores. The trephine drill technique may result in decreased perforation rates and operative time.

Radiodensitometric Analysis of Maxillary Sinus-Lift Areas Enforced with Bone Substitute Materials Containing Calcium Phophate

SummaryIntroduction. An enforcement of atrophic maxilla with biomaterials during sinus-lift surgery improves size and quality of alveolar bone. Radiological densitometric analysis can prove it. Within the study a density of bone was investigated and findings were compared with natural bone around the implants.Aim of the Study.Was to determine if density around the implant inserted with one stage sinus-lift operation using bone substitute materials increase and if that can be detected radiologically.Materials and Methods.Totally there were examined 22 patients where 64 implants were inserted in maxilla: 48 implants were inserted with one stage sinus-lift operation using bone substitute materials; represented study group. Sixteen implants were inserted in natural maxillary alveolar bone of the same patients, representing control group. The density of implant supporting tissue was measured with cone beam computed tomography and expressed in Hounsfield units (HU). The measurements were performed according to standardized pattern.Results.Densitometric measurements were higher in the study group than in the control group in all points, but statistically significant difference was observed in two measurement sites: buccally in sinus elevation area (BSM) (p=0.005) and palatinally in sinus elevation area (PSM) (p=0.0012), and corresponding areas in control group.Conclusions.Surgical elevation of maxillary sinus floor using calcium phosphate bone substitute materials resulted in higher optical density compared to natural bone. Mineralization of the bone, induced by the bone substitute materials, can be detected radiologically

Predictive Factors for Maxillary Sinus Augmentation Outcomes

To determine the influence of different local and systemic factors on histologic, histomorphometric, and radiographic outcomes after maxillary sinus augmentation. Fifty-two sinus augmentation procedures were performed. Grafting material consisted of a mixture of anorganic bovine bone (ABB) and autogenous bone. After 6 months, bone core biopsies were harvested from implant sites for histologic and histomorphometric analyses. Data regarding age, gender, type of edentulism, alcohol consumption, smoking habits, and history of periodontal disease were recorded and statistically analyzed. Histomorphometric analyses revealed the presence of 35.75% ± 16.42% of vital bone, 40.56% ± 16.23% of nonmineralized tissue, and 23.69% ± 18.23% of residual ABB particles. Radiographic vertical bone resorption inversely correlated with residual ABB. A significant difference in bone resorption patterns was observed for completely edentulous patients and for those with a history of periodontitis. Tobacco and alcohol negatively influenced vital bone formation after sinus augmentation. Implant and prostheses survival after 2 years of functional loading was not directly affected by patient's individual habits. Certain patient-related variables such as history of periodontitis, type of edentulism, or smoking/drinking habits play an important role in bone graft maturation after maxillary sinus floor elevation.