Elevation Procedure Research Articles

Osteotome sinus floor elevation with and without grafting: an animal study in Labrador dogs

To evaluate implant stability and histological outcomes after osteotome sinus floor elevation (OSFE) procedure, and to compare new bone formation and implant osseointegration with and without grafting. OSFE with simultaneous implant placement was conducted bilaterally on 6 Labrador dogs. Twenty-four implants were placed. The right side sinus (Group 1) was grafted with biphasic calcium phosphate (BCP), whereas the left side (Group 2) was left without any grafting materials. The animals were euthanized 8 and 24 weeks after surgery for histological and histomorphometric assessment. Bone-to-implant contact (BIC%), alveolar bone height (ABH), bone density (BD) and grafting material density (GMD) were measured. The implant stability (ISQ) was assessed using resonance frequency analysis (RFA) at implant placement and 1, 2, 4, 8, 12, 24 weeks after surgery. Endo-sinus new bone with direct contact to implant surface were observed in two groups at both time points. ABH showed no difference between groups at both time points. BIC% and BD in Group 2 (40.05%, 35.90%) was higher than those in Group 1 (23.30%,25.59%) at 24 weeks. Significant shrinkage of grafting material was seen in Group 1. The GMD in Group 1 at 8 weeks was 24.35%, while it dropped to 19.90% at 24 weeks. The changing pattern of ISQ for both groups were similar. Spontaneous new bone formation and better bone-to-implant contact were found for OSFE without grafting. The grafting material application during OSFE procedure showed no advantages in histological results.

Intraoperative mediale Seitenbandschädigung – was tun?

Intraoperative damage to the medial collateral ligament is a rather rare condition given only scant attention in the literature. Observing international medical journals (over the recent years), one finds very few case histories. What is more, these case histories vary significantly with regards to their approaches to the problem at hand. This survey lists essential publications and case histories in question and - following their analysis and in light of the fairly low number of respective cases - attempts to create a 'treatment algorithm'. Approaches to treatment vary considerably throughout the medical literature. Reasons are the localisation of the actual damage, pertaining to the medial collateral ligament as well as surgeons' aptitudes and preferences with regards to hinged or constraint implants. Eventually, there are five different treatment options: (i) solely conservative treatment by means of an orthesis; (ii) primary reconstruction of the medial collateral ligament; (iii) medial collateral ligament augmentation; (iv) inlay elevation and lateral release procedure; and (v) a higher degree of coupling regarding the TKA. It is strongly advised to refrain from conducting a release at the femoral origin of the medial collateral ligament. In stages, a tibial release should be carried out strictly subperiostally. A high expenditure of energy during tension examination needs to be utterly avoided. Reconstruction of the femoral origin/insertion can be carried out rather safely, while reconstruction of the tibial origin/insertion is more complicated due to the more complex anatomic line-up/constellation. Likewise, the reconstruction of the median ligament portion is considerably more difficult; in this case, the application of a primary suture or augmentation by use of the semitendinosus or quadriceps tendon are recommended. In addition, the temporary application of an orthesis is recommended regardless. In any case, a higher degree of coupling should be considered as a fallback. Introduced is an algorithm which differentiates the ligament damage location.

A new approach to the alveolar ridge reconstruction (ARR) using a bony plate from the lateral maxillary sinus wall (BP)

Background and objectives: Resorption of the alveolar bone creates anatomically less favorable foundation for ideal implant placement. Many different predictable ARR techniques have been developed and autogenous bone is still considered ‘the golden standard’ for oral bone reconstruction. However, its application in some cases is objectionable due to an unavoidable second surgical-donor site, meaning morbidity and possible complications related to it and relatively invasive procedure. Still, recently developed ARR according to ‘shell’ technique is preferred for regeneration of small to medium defects for its optimal outcome results. Therefore, when ARR and open sinus floor elevation procedures are indicated for the same patient, it is reasonable to perform both procedures simultaneously. In such case, BP can be used for ARR, thus, the second surgical-donor site can be avoided. The aim of this study was to develop and apply clinically a new surgical protocol that optimizes the clinical outcome results of ARR: by reducing operation morbidity, risk of complications, time and cost compared to conventional ARR techniques.

Comparison ofSLA®orSLActive®implants placed in the maxillary sinus with or without synthetic bone graft materials – an animal study in sheep

To assess the influence of an activated implant surface and a synthetic graft material in the maxillary sinus in combination with sinus floor elevation on bone-to-implant contact (BIC) as compared to implants with conventional surfaces. In 16 sheep, sinus bone augmentation was performed using a synthetic bone graft material according to the methods described by Haas et al (Clinical Oral Implants Research, 9, 1998, 107; Clinical Oral Implants Research, 13, 2002, 396). Another 16 sheep received a sinus floor elevation procedure without graft material. Using a paired design, in one sinus of each animal, a conventional implant was placed, whereas an implant with activated surface was placed in the other. Eight animals of each group were sacrificed at 12 weeks and the others at 26 weeks after surgery. Histological analysis was performed to analyse BIC. Results were statistically compared at a significance level of P < 0.05. After 12 weeks, the BIC for conventional and activated implants with or without graft showed comparable results, with mean values of 14.8%, 16.5%, 21.5% and 20.1% (P > 0.05). For ungrafted sinuses after 26 weeks, no increase in BIC was recorded (12.1% conventional surface, 15.8% activated surface; P > 0.05). In grafted sinuses after 26 weeks, mean values increased to 28.7% for conventional and 34.1% for activated implants (P = 0.014; P = 0.015). However, only BIC of the latter was statistically significantly higher compared with ungrafted sinuses (P = 0.038). After 12 weeks of healing, neither grafting nor implant type seemed to influence BIC. Use of an activated implant surface did not increase BIC when compared with a conventional implant. The synthetic graft seemed to improve BIC values after 26 weeks.

A Novel Technique for Osteotome Internal Sinus Lifts With Simultaneous Placement of Tapered Implants to Improve Primary Stability

A Novel Technique for Osteotome Internal Sinus Lifts With Simultaneous Placement of Tapered Implants to Improve Primary Stability

A Comparative Study of the Incidence of Schneiderian Membrane Perforations during Maxillary Sinus Augmentation with a Sonic Oscillating Handpiece versus a Conventional Turbine Handpiece

Sonic instruments may reduce perforation rates of the schneiderian membrane during lateral window sinus augmentation procedures. This study compares the incidence of membrane perforations using a sonic handpiece with an oscillating diamond insert versus a turbine handpiece with a conventional rotary diamond stone during lateral window sinus augmentation procedures. A retrospective chart analysis identified all lateral window sinus augmentation procedures done during a defined period. Among these procedures, those performed with a sonic handpiece and an oscillating diamond insert (experimental) and those performed with a conventional turbine and rotary diamond stone (conventional) were selected for this study. Reported occurrences of sinus membrane perforations during preparation of the osteotomy and elevation of the sinus membrane, as well as postoperative complications, were recorded and compared between treatment groups. Ninety-three consecutive patients were identified for a total of 130 sinus augmentation procedures (51 conventional, 79 experimental). Schneiderian membrane perforations were noted during preparation of the lateral window osteotomy in 27.5% of the sinuses in the conventional group and 12.7% of sinuses in the experimental group. During membrane elevation, perforations were noted in 43.1% of the sinuses in the conventional group and 25.3% of sinuses in the experimental group. Both differences in perforation rates were statistically significant (p < .05). There was no statistically significant difference in postoperative complications. In this study, the use of a sonic instrument to prepare the lateral window osteotomy during sinus elevation procedures resulted in a reduced perforation rate of the Schneiderian membrane compared with the conventional turbine instrument.

Accidental Migration of a Dental Implant into the Ethmoid Sinus following a Transalveolar Sinus Elevation Procedure

Migration of a dental implant into the paranasal sinuses may be the result of sinus membrane perforation, loss of osseointegration, and lack of initial stability. The majority of displaced implants migrate into the maxillary sinus, which may cause sinusitis. The purpose of this study is to report an extremely rare ethmoid sinus migration of a dental implant after crestal approach in a resorbed posterior maxilla. A 60-year old Korean male with a noncontributory medical history was referred from a local clinic to remove the migrated dental implant in the right ethmoid sinus. The patient had symptoms of mild sinusitis. The implant had been placed 6 months earlier through the bone-added transalveolar approach in a severely resorbed maxilla. The displaced implant was removed through the intraoral approach. A lateral window was made and an endoscopic surgery was performed to remove the implant. Healing was uneventful, and sinusitis symptom had ceased. The crestal approach for severely resorbed posterior maxillae should be performed when there is a potential for primary stability. If bone quality is poor and initial stability cannot be achieved, lateral window sinus elevation procedure is a better option for successful implant placement. Migrated implant may be removed with antrostomy and endoscopic surgery.

Effects of tobacco smoking on the survival rate of dental implants placed in areas of maxillary sinus floor augmentation: a systematic review

The objective of this systematic review was to evaluate the effects of smoking on the survival rate of dental implants placed in areas of maxillary sinus floor augmentation. The Cochrane Oral Health Group's Trials Register (CENTRAL), MEDLINE and EMBASE were searched in duplicate up to, and including, October 2012 without language restrictions. Studies were considered eligible for inclusion if they involved the treatment of smokers and non-smokers with titanium implants and sinus floor elevation procedures. The Newcastle-Ottawa Scale and the Cochrane Collaboration's quality assessment tool were used for the assessment of the risk of bias in included studies. Random effects meta-analyses were used to assess the number of implants lost in smokers vs. number of implants lost in non-smokers. Of 3360 potentially eligible papers, eight studies were included. More than half (62.5%) of the studies found that smoking adversely affects implant survival in sites of sinus floor augmentation. Similarly, the pooled analysis indicated a statistically significantly increased risk of implant failure in smokers when the outcomes of all studies available to be included into meta-analysis were evaluated [RR: 1.87 (95% CI: 1.35, 2.58), P=0.0001]. Conversely, a subgroup analysis including only prospective studies (3 studies) did not reveal significant differences in implant failure between smokers and non-smokers [RR: 1.55 (95% CI: 0.91, 2.65), P=0.11]. Although smoking was associated with implant failure in most of individual studies and in the overall meta-analysis, the detrimental effect of smoking was not confirmed when only prospective data were assessed.

Onlay Rib Bone Graft in Elevation of Reconstructed Auricle: 17 Years of Experience

BackgroundA cartilage wedge block and covering flap are standard procedures for firm elevation of the ear in microtia correction. However, using costal cartilage for elevation of the reconstructed auricle can be insufficient, and the fixed cartilage wedge block may be absorbed or may slip out. Furthermore, elevating covering flaps is time-consuming and uses up fascia, a potential source of reconstruction material. Therefore, we propose an innovative method using autologous onlay rib bone graft for auricular elevation of microtia.MethodsFrom February 1995 to August 2012, 77 patients received a first stage operation with a rib cartilage framework graft. In the second stage operation, a small full thickness of rib bone was harvested through the previous donor scar. The bihalved rib bone was inserted into the subperiosteal pocket beneath the cartilage framework.ResultsThe follow-up time ranged from 1 month to 17 years, with a mean of 3 years. All of the patients sustained the elevation of their ears very well during the follow-up period. Donor site problems, except for hypertrophic scars, were not observed. Surgery-related complications, specifically skin necrosis, infection, or hematoma, occurred in 4 cases.ConclusionsOnlay rib bone graft used to elevate the reconstructed auricle is a more anatomically appropriate material than cartilage, due to the bone-to-bone contact between the bone graft and the temporal bone. Postoperative minor correction of the elevation degree is straightforward and the skin graft survives better. Therefore, reconstructed auricle elevation using onlay rib bone graft is a useful and valuable method.

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.

Evaluation of Bone Regeneration After Three Different Lateral Sinus Elevation Procedures Using Micro-computed Tomography of Retrieved Experimental Implants and Surrounding Bone: A Clinical, Prospective, and Randomized Study

To compare three different lateral sinus elevation procedures concerning new bone formation by using micro-computed tomography (micro-CT) of retrieved implants. Twenty-four consecutive partially dentate patients with a mean age of 64 years were included in the study and provided with 30 sinus elevation procedures. Three procedures for lateral sinus elevation were used: lateral sinus elevation with replacement of bone window and without bone graft (BW), lateral sinus elevation and covering osteotomy site with a collagen membrane and without bone graft (CM), and lateral sinus elevation with autogenous bone graft (ABG). Experimental implants were retrieved after 7 months of healing and analyzed by micro-CT. One implant was found not to be integrated at the time of implant retrieval. This implant belonged to group CM and was excluded when calculating bone-to-implant contact (BIC) and intrasinus bone levels. The integrity of the lateral sinus bony wall was determined at the time of implant removal. In group ABG, all lateral sinus walls were ossified. In group BW, one lateral sinus wall was not completely ossified and in group CM, two lateral sinus walls. There were no statistical differences in %BIC between the groups: 93.5% (BW), 92.0% (CM) and 93.5% (ABG). Additionally, no statistical differences were found in apical intrasinus bone levels between the groups. When surfaces were compared within the same implant, a statistical difference was found between the apicobuccal distance and the apicolingual distance. The mean apicobuccal distances/apicolingual distances were 0.6 mm/1.2 mm for the BW group, 0.5 mm/0.8 mm for the CM group, and 0.6 mm/0.8 mm for the ABG group (P = .003). All three procedures were statistically equal when new bone formation was compared. Most of the examined implants' apices were not covered with bone at the time of retrieval.

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.

Eyelid Surgery in Ocular Myopathies

ABSTRACTObjective: To retrospectively analyse surgical outcome and complications in patients with ocular myopathy undergoing ptosis correction and to introduce preoperative prophylactic lower lid elevation in this group.Methods: The medical records of all ocular myopathy patients who had undergone oculoplastic surgery between June 1995 and May 2006 were obtained. Patients’ demographics, surgical details and measurements, and complications were recorded.Results: 29 patients were identified; 21 with chronic progressive external ophthalmoplegia (CPEO), 7 with myotonic dystrophy (MD) and 1 with oculopharyngeal muscular dystrophy (OPMD). Then, 61 procedures to adjust eyelid height were performed, comprising levator resection, brow suspension, anterior lamellar repositioning, lower lid elevation and upper lid lowering. Palpebral aperture was significantly increased in all patient groups, by procedure and diagnosis, more significantly following brow suspension compared with levator resection. The patients’ feedback was very positive. Post-operative complications were few, included corneal exposure and ulceration, ptosis recurrence, arched brow, and sling infection, all of which were successfully treated.Conclusion: Our results demonstrate subjective and objective benefit following surgery in these patients, with a low complication rate. The use of pre-operative prophylactic lower lid elevation procedures is a promising modality.

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.

Maxillary Sinus Functions and Complications with Lateral Window and Osteotome Sinus Floor Elevation Procedures Followed by Dental Implants Placement: A Retrospective Study in 60 Patients

The aim of the study was to evaluate retrospectively maxillary sinus functions and complications by using generally accepted diagnostic criteria with lateral window and osteotome sinus floor elevation (OSFE) procedures followed by dental implants placement. A group of 60 patients in whom a SFE with the two procedures (lateral window and OSFE) followed by dental implants placement had been performed were evaluated retrospectively for sinus functions and complications from the time of procedure up to 24 months using a questionnaire, conventional clinical and radiographic examination. Number of patients suffered dizziness accompanied by nausea immediately after OSFE was more than the lateral window procedure and the symptoms disappeared within 2 to 4 weeks. Maxillary sinus membrane perforations occurred and small for 4 out of 79 procedures, two cases for OSFE and two for lateral window procedure had been repaired. No more complications had been detected for all the patients up to 24 months. Based on the results of this study, SFE with lateral window and osteotome procedures followed by dental implants placement did not interfere with maxillary sinus function and no obvious complications had been detected up to 24 months. The clinician performs SFE with either lateral window or osteotome procedures needs to understand the difficulties and morbidity arising in the event of complications and must be able to correctly judge the individual risk and the presence of modifying factors that may cause these complications.

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.

A Retrospective Study of Complications Associated with 100 Consecutive Maxillary Sinus Augmentations via the Lateral Window Approach

To report the complications encountered during 100 consecutive maxillary sinus augmentations via the lateral window approach and to propose solutions to manage these complications. Pretreatment residual bone heights and the presence of septa were recorded. The incidences of any intraoperative or postoperative sinus complications such as excessive bleeding, membrane perforation, infection, wound dehiscence, sinusitis, loss of bone graft, and implant success were reported. results: This study evaluated 42 men and 44 women requiring 100 consecutive sinus elevation procedures between March 2008 and February 2011. Five intraoperative membrane perforations were noted, and one subsequently developed an active infection (2 weeks after surgery). Eight instances of suppuration were noted, while 10 sites presented with wound dehiscence 1 to 2 weeks after surgery. One example of partial loss of the bone graft 6 months after surgery was identified. Of a total of 151 implants placed in 97 sinuses (one patient with bilateral sinuses and one with unilateral sinus did not complete implant placement), 2 implants presented excessive bone loss prior to uncovering. One implant was removed and one was left submerged. conclusions: Sinus floor elevation utilizing the lateral window approach is a predictable approach to manage bone volume deficiency in the posterior maxilla for patients seeking dental implant-based treatment. However, complications may include membrane tear, infection, wound dehiscence, loss of graft, and implant failure. It is vital for the clinician to understand how to recognize and solve these complications.

A Novel Dental Implant System with an Internal Port for Endoscopic Closed Sinus Augmentation: A Feasibility Study in Pigs

This study describes the use of an innovative dynamic implant valve approach (DIVA) for dental implant placement and sinus augmentation procedures. The DIVA implant system was tested in vitro for leakage and mechanical fatigue. A closed sinus elevation procedure with a gel-type bone substitute was performed using the DIVA implant in a swine model (n = 6). Implants were placed and evaluated radiographically and histologically. Elevation of the maxillary sinus membrane and augmentation were performed in a simple, minimally invasive fashion. Histologic analyses demonstrated complete sealing of the DIVA implant and excellent osseointegration. The DIVA can be used as a simplified viable option for dental implantation and augmentation procedures. Hermetic sealing of this implant system, which features an inner screw, renders it safe.

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.

Relationship Between Prognosis of Dental Implants and Maxillary Sinusitis Associated with the Sinus Elevation Procedure

The aims of this study were to evaluate the incidence of maxillary sinusitis associated with the sinus elevation procedure and to analyze the influence of maxillary sinusitis on the prognosis of dental implants. Data were collected from medical records and dental radiographic findings of patients who received dental implant therapy along with a sinus elevation procedure at Seoul National University Bundang Hospital from June 2003 to December 2008. A total of 338 sinus elevation cases (643 implants) were included in this study, out of which maxillary sinusitis was reported in 33 cases (9.8%). The type of surgical approach used and the occurrence of sinus membrane perforation could be considered factors affecting maxillary sinusitis associated with the sinus elevation procedure. The implants at the site of the maxillary sinusitis associated with the sinus elevation procedure showed lower survival rates in male patients. Better clinical outcomes were achieved in the group receiving combined medical and surgical therapy for sinusitis associated with the sinus elevation procedure. Postoperative maxillary sinusitis decreased the survival rates of implants, whereas early diagnosis and combined medical and surgical therapy had the opposite effect.