Maxillary Sinus Floor Research Articles

Autogenous Bone is Still the Gold Standard of Graft Materials in 2022.

I read with interest the recent editorial entitled “Is Autogenous Bone Grafting Still the “Gold Standard” in Oral Bone Grafting?”.1 As the authors pointed out, I wrote a similar editorial in 2010 and concluded that indeed autogenous bone was the gold standard of graft materials.2 However, the authors have challenged my conclusion. To support their opinion, they referenced two publications on sinus bone grafting evaluating histomorphometric results and implant survival.3,4 They claimed these studies found that “bone substitutes either performed in a like manner or superior to autogenous bone alone”. However, the histomorphometric analysis showed autogenous bone resulted in the highest amount of new bone formation compared to bone substitutes, but bone substitutes seem to be a good alternative.3 The systematic review on sinus bone grafting concluded implant survival rates using bone substitutes were as effective as autogenous bone when used alone or in combination with autogenous bone.4 Although the implant survival was lower with 100% autogenous bone (87.7%) compared to autograft with bone substitutes (94.9%) or bone substitutes alone (96%), the data clearly shows that the majority of machined implants were placed in sinuses grafted with autogenous bone. The review found rough surface implants had superior survival rates compared to machined implants (96% vs. 85.6%), so this explains the lower implant survival rate in autogenous grafts. Pjetursson et al5 performed a systematic review evaluated the grafting of pneumatized sinuses that had 6.0 mm or less residual bone height. Focusing on outcomes using only rough surface implants they found high implant survival rates for all types of grafts (> 96%). However, rough implants placed in particulate autogenous bone had a significantly higher estimated three-year survival (99.8%). There are limitations in using a secondary outcome measure, such as implant survival, to evaluate graft success. The assumption is that if the implant survived the graft was successful. The influence of the amount of native bone supporting the implant is unknown in some studies unless the residual bone limit was defined, such as in the Pjetursson et al study.Another important distinction is the relationship of the augmentation to the osseous defect. Bone defects inside the bony contour, such as sockets and the maxillary sinus floor, are much easier and predictable to reconstruct than horizontal and vertical augmentation outside the bone contour. Intrabony defects have a greater number of bone walls with a higher regenerative capacity. There is also greater ease in achieving soft tissue coverage, space maintenance, graft stability and protection. As such bone substitutes perform well in treating these types of contained defects. However, horizontal and vertical bone augmentation outside the bone contour is more biologically challenging. The greater the distance from the native bone, the more difficult it may become for vascular ingrowth, cell migration and bone formation at the outer limits of the graft. As such a graft material with greater regenerative capacity may be needed to obtain the required bone gains. Autogenous bone has superior biologic qualities compared to osteoconductive bone substitutes. It is the only bone graft material that fulfills all three aspects of the tissue engineering triad - osteogenesis, osteoinduction and osteoconduction. Autogenous bone contains osteocompetent cells and osteoconductive growth factors that can positively influence bone formation. Although cancellous bone contains a higher amount of osteoblasts and mesenchymal stem cells, cortical bone grafts contain cells that have the ability to proliferate and differentiate into the osteogenic lineage, suggesting that these cells can also contribute to bone regeneration following transplantation.6 Research has found cortical bone chips contain over 40 different growth factors that can modulate the cellular aspects of bone regeneration.7 The healing time of autogenous bone grafts also is shorter than bone substitutes.8Rather than focus on implant survival, it would be more clinically relevant to evaluate horizontal and vertical bone gains produced by different graft materials. When reviewing studies measuring bone gains it becomes evident that autogenous bone is needed for larger bone augmentations and vertical gains.9,10,11,12 While I agree with my colleagues that bone substitutes may be used effectively in many clinical situations, I still maintain that autogenous bone is the gold standard of graft materials. This does not mean it is the first choice option, but it does offer biologic advantages unmatched by bone substitutes. The use of a local donor site and bone scrapers can decrease the morbidity of bone harvest. In addition, some donor sites for block grafting, such as the mandibular ramus, have a lower incidence of postoperative complications.13 Surgeons should weigh the advantages and disadvantages of each material and select an approach that has the highest likelihood of clinical success.14

Intraoperative complications and early implant failure after transcrestal sinus floor elevation with residual bone height ≤5 mm: A retrospective multicenter study.

ObjectiveClinical indications for maxillary sinus floor elevation with transcrestal techniques have increased in recent years even in sites with minimal residual bone height (RBH). Nevertheless, limited information is currently available on incidence of intraoperative complications and early implant failure in these cases.Material and MethodsThis retrospective multicenter study was performed on anonymized clinical and radiographic records of patients who underwent transcrestal sinus floor elevation in seven clinical centers. Influence of different factors related to patient, and sinus anatomy and surgical technique on the incidence of intraoperative complications and early implant failure rate after transcrestal sinus lift were investigated.ResultsA total of 430 patients treated with transcrestal sinus floor elevation for single‐implant insertion in sites with RBH ≤5 mm were included in the final analysis. After 1 year of loading, 418 implants of 430 were satisfactorily in function. Early implant failure was recorded in 12 cases (2.8%); results were significantly associated with the presence of large sinus cavities and with the occurrence of membrane perforation.The following adverse events were recorded: membrane perforation (7.2%), acute sinusitis (0.9%), implant displacement into the sinus cavity (0.7%), oro‐antral fistula (0.2%), and benign paroxysmal positional vertigo (0.5% of osteotome cases). A strong direct correlation between sinus membrane perforation and bucco‐palatal sinus width (p = .000) was demonstrated.ConclusionsEarly implant failure after transcrestal sinus elevation showed significant direct correlation with bucco‐palatal maxillary sinus width and the presence of membrane perforation. Sinus membrane perforation was strongly associated with bucco‐palatal sinus width (extremely low perforation rate in narrow and much higher incidence in wide sinuses).

Comparison of biological and mechanical properties of different paranasal sinus mucosa in goat

ObjectiveThe present study was designed to explore endurable pressure intensity of different paranasal sinus mucosa in goats.MethodMucosa commonly involved in maxillary sinus augmentation, including mucosa from maxillary sinus crest, maxillary sinus floor, and frontal sinus, were harvested in a computed tomography-guided manner. The obtained mucosa was then sectioned into square and irregular ones for maximum endurable pressure intensity determination and morphological observation, respectively.ResultsThickness of paranasal sinus mucosa, as determined under morphological staining by an optical microscope with a graduated eyepiece, were calculated. And the results showed that the average thickness of maxillary sinus crest mucosa, floor mucosa, and frontal sinus mucosa in goats were 410.03 ± 65.97 μm, 461.33 ± 91.37 μm and 216.90 ± 46.47 μm, respectively. Significant differences between maxillary sinus crest and frontal sinus, maxillary sinus floor, and frontal sinus were observed (P < 0.05). Maximum endurable pressure intensity was determined by utilizing a self-made clamp device and the results revealed maximum endurable pressure intensity of maxillary sinus crest mucosa, floor mucosa and frontal sinus mucosa in goats were 260.08 ± 80.12Kpa, 306.90 ± 94.37Kpa and 121.72 ± 31.72Kpa, respectively. Also, a statistically significant difference was observed when comparing the endurable pressure intensity between maxillary sinus crest and frontal sinus, maxillary sinus floor, and frontal sinus (P < 0.05). Further correlation analysis also revealed a positive correlation between the thickness of mucosa of the maxillary sinus and frontal sinus and maximum endurable pressure intensity (P < 0.05).ConclusionMucosal thickness and maximum endurable pressure intensity of maxillary sinus crest and floor were larger than that of frontal sinus mucosa and a positive correlation between the thickness of mucosa and endurable pressure intensity was observed. Our results thus might provide an experimental basis and guidance for mucosa-related problems involved maxillary sinus augmentation.

Effect of the Maxillary Sinus on Tooth Movement during Orthodontics Based on Biomechanical Responses of Periodontal Ligaments

The maxillary sinus is a common anatomic limitation for orthodontic tooth movement. The effect of orthodontic forces on a particular anatomy can be studied using finite element analysis (FEA). Our study aimed to determine the effect of different tooth penetration depths into the maxillary sinus floor (MSF) on the orthodontic force system for bodily tooth movement. Using the cone-beam computed tomography of a patient with low MSF, we modeled the geometry of canine, premolar, and molar teeth with their periodontal ligaments and the alveolar bone surrounding them. The models were manually modified to simulate different root penetration depths. Thereafter, the center of resistance and stress distributions for teeth penetrating into the MS were determined using FEA. Moreover, the force systems for teeth with a low MSF to varying degree were evaluated based on the FEA results. During orthodontic tooth movement, the individual differences in the periodontal anatomy should be considered. The CR position decreases with the penetration depth, while the average hydrostatic stress in the PDL increases rapidly. In this paper, we present the correction coefficients of the orthodontic force and moment for a tooth penetrating into the MSF, which is necessary for personalized treatment planning.

Short implant in posterior maxilla with 2 years follow- up: A case report

Placement of the dental implants in posterior maxilla requires maxillary sinus floor elevation. However, this is avoided by placing short implant, these implants are increasingly being seen as an alternative to more extensive bone augmentation procedures. Long term follows up revealed survival of the implants. This case report describes extraction of teeth, followed by immediate placement of implantswiss short implant in posterior maxilla using jig trial in the prepared socket with two-year follow-up.

Major clinical findings of maxillary sinus surgery and the use of bio stimulators: a systematic review

Introduction: In the scenario of maxillary sinus surgery, when there is a loss of a dental element in the posterior region of the maxilla, there is natural resorption of the alveolar process and at the same time there will be pneumatization of the maxillary sinus. For this reason, the maxillary sinus floor elevation procedure should be performed. When grafting procedures are needed, our focus is often on the types of biomaterials and their bio stimulating properties, as well as on other types of bio stimulators to be used. Objective: It was to analyze the main clinical findings of maxillary sinus surgery and the use of bio stimulators through a systematic review. Methods: The present study followed a systematic review model, following the rules of systematic review – PRISMA. The search strategy was performed in the PubMed, Cochrane Library, Web of Science and Scopus, and Google Scholar databases. The present study was carried out from January to March 2022. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: After analyzing the main clinical findings on maxillary sinus surgery and the use of bio stimulators, it was concluded that bone regeneration processes using biomaterials and the main molecular and cellular constituents such as mesenchymal stem cells, cytokines, platelet-rich plasma, fibrin-rich plasma, exosomes, microRNAs, TNF-α, IL-1, LIF and IL-6 and prostaglandin E2 (PGE2) are strategic for the solution to large bone defects, leading to tissue or bone regeneration. The main filler biomaterials can be fibrin-rich plasma (FRP), Bio-Oss®. However, it is necessary to understand the chemical, physical and biological processes of both the biological material and the biological niche of the host for successful neovascularization and bone filling.

ПРИМЕНЕНИЕ ЖИРОВОГО ТЕЛА ЩЕКИ ПРИ ЗАКРЫТИИ ДЕФЕКТОВ ДНА ВЕРХНЕЧЕЛЮСТНОЙ ПАЗУХИ

Forty-nine patients with intra- and postoperative defects of maxillary sinus floor were included in this study. Buccal fat pad was used for closure of maxillary sinus floor defects. Development of oroantral communication was not detected in any patient. Thus, the use of buccal fat pad for closure of maxillary sinus floor defects is a predictable method, with the minimal complications and is offered as a method of choice.

Endonasal sinus lift as a new way of augmenting the alveolar process of the upper jaw

Aim to develop a new method of endonasal augmentation of the alveolar process of the upper jaw to reduce postoperative risks.&#x0D; Material and methods. The study involved 10 patients during the period of December, 2019, and June, 2021. The examination methods were: computed tomography of the nose and paranasal sinuses, upper and lower jaw, and video-endoscopy of the nasal cavity. The patients received the indonasal sinus inlay with the use of allogenic bone chips.&#x0D; Results. The surgical access through the lower nasal passage, under the lower nasal concha, allows to expose the maxillary sinus floor with preservation of mucous membrane integrity and to fill in the space between them with the allogenic bone material. Formation of a bone window in the lateral nasal wall using a piezotome prevents the rupture of the sinus mucous membrane. A bony fragment of the lateral nasal cavity wall transferred into the cavity of the maxillary sinus as one block with the mucosa creates additional protection for the Schneiderian membrane. Allogenic material introduced by endonasal method is substituted by the own organotypic tissue, restoring the lost volume of the maxillary sinus alveolar process.&#x0D; Conclusion. The endonasal method of alveolar augmentation may be used in clinical practice as an alternative to the classic methods.

Accuracy of intraoral digital radiography in assessing maxillary Sinus-Root relationship compared to CBCT

Background and ObjectivesThe proper assessment of the relation between the roots of the maxillary posterior teeth and the maxillary sinus floor represents a real concern for dental practitioners when conducting any procedure in the involved region. Many imaging techniques have been employed to assess this relation. This study aimed to (1) compare the accuracy of digital periapical radiographs with that of cone-beam computed tomography images in assessing the relationship between the maxillary molar roots and the maxillary sinus floor and (2) determine periapical radiographic features (if present) that could indicate the actual protrusion of roots into the sinus cavity. Materials and MethodsThis observational analyticalin vivo study was carried out on 23 Egyptian patients. Cone-beam computed tomography and digital periapical images were obtained for each patient and assessed by three oral radiologists. Results were statistically analyzed in terms of accuracy, specificity, and sensitivity in addition to the McNemar-Bowker and Fleiss's Kappa test. ResultsDespite the presence of a significant difference between the results of both techniques, periapical radiography demonstrated 73% accuracy in displaying the sinus-root relation. Moreover, the continuity of the lamina dura suggests (with more than 70% accuracy) that the root is located outside the sinus and vice versa. ConclusionThe digital periapical technique is considered an accurate method of assessing the sinus-root relation especially when the root is located outside the sinus. One of the most indictive periapical features of root intrusion into the maxillary sinus is the discontinuity of the lamina dura.

Influence of the use of autogenous bone particles to close the access window after maxillary sinus floor augmentation: a micro‐computed tomography and positron emission tomography study in rabbits

AimThe purpose of this study was to evaluate using microCT and positron emission tomography (PET) analysis, the influence on bone healing of the placement of particulate autogenous bone in the antrostomy, and in the subjacent region after maxillary sinus elevation with xenograft.Material and methodsThe sinus mucosa was elevated in sixteen male New Zealand rabbits and they were both grafted with a collagenated cortico-cancellous porcine bone. The antrostomy and the near subjacent region were filled with either the same xenograft (control site) or with particulate autogenous bone (test site) harvested from the tibia. The antrostomies were covered with collagen membranes. MicroCT (measured in Hounsfield Units) and microPET (kBq/cm3) using sodium fluoride infiltration (18F-NaF) were performed at the time of euthanasia that was performed after 1 and 8 weeks of healing, using 8 animals in each group. The Wilcoxon test was used for analysis.ResultsAt the microCT analysis, after 1 and 8 weeks of healing, no statistically significant differences were found between groups. Bone increased and xenograft decreased significantly between the two periods of healing. At the microPET analysis, the percentage of bone increased significantly over time in both test and control groups and no significant differences were found between groups.ConclusionThe placement of autogenous bone in the antrostomy and the subjacent region after maxillary sinus elevation did not enhance bone formation compared with sites where only xenograft was used. Both microCT and microPET showed increase bone formation over time.

Long-Term Outcomes of Implants Placed in Maxillary Sinus Floor Augmentation with Porous Fluorohydroxyapatite (Algipore® FRIOS®) in Comparison with Anorganic Bovine Bone (Bio-Oss®) and Platelet Rich Plasma (PRP): A Retrospective Study.

Purpose: The objective of this retrospective study was to evaluate the long-term clinical outcomes of bone regeneration procedures using algae-derived plant hydroxyapatite (Algipore® FRIOS®) compared with demineralized anorganic bovine bone (Bio-Oss®), in combination with autologous blood-derived PRP. Materials and Methods: Partially edentulous patients with severe atrophy of posterior maxillary treated by means of the split bone technique in a two-stage grafting procedures were observed for up to seven years after implants placement. After surgeries, the natural porous fluorohydroxyapatite (FHA) (Algipore® FRIOS®; Group, n = 29) or anorganic bovine bone (Bio-Oss® Group, n = 28) with autogenous bone in a 50:50 composite ratio with PRP, were administered in a 2.8-mm critical-size defect (CSD). Four months later, implants were placed at second-stage surgery. Results: A sample of fifty-seven consecutive patients who required sinus augmentation was included in the study, and 57 implants were placed. There was no drop out or loss of follow-up of any case. Clinical and radiographic examinations revealed a comparable pattern of newly formed bone in both groups after seven years of functional loading for implants placed after sinus augmentation using porous fluorohydroxyapatite and anorganic bovine bone. No significant difference in marginal bone loss was found around implants in both groups. Conclusions: The favorable implant outcomes suggest both biomaterials are suitable for sinus grafting in severely atrophic maxillae.

Effects of missing teeth and nasal septal deviation on maxillary sinus volume: a pilot study

PurposeTooth extraction and the projection of the tooth roots into the maxillary sinus are reported to greatly reduce the bone height from the alveolar ridge to the maxillary sinus floor, while missing teeth are reported to lead to the expansion of the maxillary sinus, all of which are important considerations during dental implant treatment for the maxillary molar region. Therefore, assessing the anatomical characteristics of the maxillary sinus acting as complicating factors is crucial before sinus augmentation. We conducted a three-dimensional examination of the effects of missing teeth and nasal septal deviation (NSD) on maxillary sinus volume (MSV).MethodsWe selected participants with two or more missing teeth from patients who underwent maxillary sinus augmentation for a unilateral free-end saddle between April 2019 and December 2020. We calculated the MSV and NSD using cone-beam computed tomography (CBCT). We compared the relationships of the presence/absence of teeth and NSD with MSV bilaterally in each patient using the Wilcoxon t-test. p-values < 0.05 denoted statistical significance.ResultsThis study included 30 patients (30 sinuses; 12 men, 18 women). The average patient age was 58.2 ± 10.2 years (men, 60.4 ± 3.7 years; women, 59.2 ± 4.5 years; range, 40–77 years). The mean number of missing teeth was 2.98 ± 1.01: 13 patients had two missing teeth and 17 had three or more missing teeth. Nine patients (30%) had NSD. The mean MSV on the ipsilateral and contralateral sides of the NSD was 21.50 ± 3.84 cm3 and 22.10 ± 3.56 cm3, respectively; thus, NSD did not affect MSV (p = 0.150). The mean MSV on the edentulous and non-edentulous sides was 21.58 ± 3.89 cm3 and 21.77 ± 4.30 cm3, respectively; thus, the MSV was significantly smaller on the edentulous side (p = 0.00036).ConclusionAlthough this study was a limited preoperative study, three-dimensional measurement of the maxillary sinus with CBCT in partially edentulous patients revealed that missing teeth lead to substantial reductions in MSV, while NSD was not associated with MSV.

Combined lesion of central giant cell granuloma and ossifying fibroma: A case report of a rare event in oral cavity.

Introduction and importanceGiant cell granulomas (GCG) and ossifying fibroma (OF) of the jaw are benign reactive lesions. GCG characterized by the presence of abundant multinucleated giant cells in a cellular stroma. On the other hand, the characteristic feature of OF is benign connective tissue replaces the normal bone. Combination of these two lesions, GCG with OF, in the jaw is extremely rare.Case presentationA 35-year-old woman presented with complains of right jaw swelling with no history of previous disease or lesion and no family history of such lesions. By physical examination, a painful swelling in the right jaw was observed. A computed tomography scan of the facial bone showed a large, expansible, lytic lesion with narrow zone of transition and internal septations, involving the right side of the maxilla and floor of the right maxillary sinus. Histopathologic examination revealed a lesion with combined features of OF and GCG.Clinical discussionGCG and OF are two of the most frequent oral lesions. Presence of both tumors in one patient as a combined lesion is highly unusual, with only a few reported cases in the literature. On clinical and radiologic examination, diagnosing such a combined lesion is not possible, however, such lesions can be easily diagnosed by microscopic examination, indicating the importance of pathologic examination.ConclusionOccurrence of combined OF and GCG is a rare event. Proper histopathologic evaluation can contribute to accurate diagnosis and better management of such lesions. Confirmative diagnosis of such lesions by radiology alone is not possible.

Three-dimensional assessment of the favorability of maxillary posterior teeth intrusion in different skeletal classes limited by the vertical relationship with the maxillary sinus floor

BackgroundUnderstanding the anatomical relationship between the maxillary sinus floor (MSF) and the posterior maxillary teeth (PMT) is important when planning the orthodontic intrusion of the posterior teeth. This study aimed to determine the vertical relationship between posterior maxillary teeth and maxillary sinus floor in different skeletal classes in the Chinese adult population.MethodsThis is a retrospective cross-sectional study involved cone beam computed tomography images of 298 adult patients (145 males and 153 females) between 20 and 45 years old. The sample was categorized according to A point, Nasion, B point (ANB) angle into 102 Class I, 102 Class II, and 94 Class III malocclusion. Non-parametric Wilcoxon Mann–Whitney U and Kruskal–Wallis tests were used to compare the studied groups. The Intra-class Correlation Coefficient (ICC) was used to assess the intra- and inter-observer reliability analysis.ResultsOverall, there was a statistically significant difference in the mean distance between both genders (P < 0.001). The measured distance increased with age in all posterior tooth roots (P < 0.001). The root apex in the sagittal view appeared to be closer to the maxillary sinus than in the coronal view; 2.2 ± 4.3 and 3.1 ± 5.5 mm, respectively. The most frequent root scores were Type 1 and Type 2P. In both sagittal and coronal views, Class I demonstrated a higher Type 2P prevalence, whereas Class III showed a lower prevalence. The second molars’ mesiobuccal root had the largest number of penetration in the three examined skeletal classes.ConclusionsMaxillary molars of Class I malocclusion with the majority of Type 2P root-sinus relationship have the highest possible risk of root resorption during molar intrusion due to cortical bone encroachment, while Class III malocclusion showed the least possible risk.

Osteotome technique: literature review

OBJECTIVE: This focus literature review aimed to identify, in a clear and systematic way, the various factors (indications, influence of biomaterials and survival rates of the implants) that a clinician must take into account when addressing the maxillary sinus using trasncrestal maxillary sinus floor elevation techniques. MATERIALS AND METHODS: The papers to include in this focus review were obtained via automatic search and screening of articles published in scientific journals with peer review and indexed in the well-known sources of scientific information e.g. PubMed, ScienceDirect, LILACS, Web of Science, Scielo, Cochrane Library. RESULTS: After screening, 25 papers were included in this focus review. Overall literature results highlight that the osteotome technique is a valid alternative when the remaining bone is &gt;5mm. Also, the most frequent complication is the perforation of the Schneider membrane. Furthermore, different grafts, or no graft at all, can be used with different results, depending on the individual case. Summarizing the results, the average sinus floor elevation was 3,8 mm with variation between 2.6±1.2mm and 5,65±1.93mm. Analyzing the implant survival rate with 5 years follow-up periods, the overall survival rate was 94,3% (varying between 91,9% and 98,3%). The 10 years’ follow-up studies report an average survival rate of 97% (varying between 94% and 100%). CONCLUSIONS: The consensual minimum residual bone height for the indication of osteotome technique is &gt;5mm. Osteotome techniques are predictable, well documented and present a high success rate when correctly carried on.

CLINICAL APPLICATIONS OF SAFESCRAPER® IN MAXILLARY SINUS FLOOR ELEVATION AND RIDGE AUGMENTATION

Introduction. Although there is a wide variety of bone grafting materials for the augmentation of the deficient alveolar ridge, autogenous bone is still considered to be the gold standard. There are various methods for harvesting autologous bone grafts. Among these, Safescraper® is conveniently used as a harvesting device of autogenous cortical bone in oral Implantology and reconstructive surgery, ensuring high volumes of grafting material with a minimally invasive and predictable procedure. Purpose. The purpose of this presentation is to showcase the clinical applications of Safescraper® in various augmentation procedures and to review the existing literature for the evidence supporting its application in clinical practice. Materials and Methods. In the presented cases, Safescraper® provided surface-derived autogenous bone graft deriving from the maxillary tuberosity, the zygomatic buttress, the lateral sinus wall, the pyriform aperture of the nose, the external oblique ridge and the mandibular symphysis. The collected autogenous bone has been mixed either with xenograft, or autologous venous blood, or platelet-rich fibrin and used in procedures such as: Maxillary sinus floor elevation, Reconstruction of periimplant defects, Reconstruction of alveolar ridge defects with onlay autogenous blocks, or bone rings, Ridge augmentations using resorbable collagen membranes, titanium-reinforced non-resorbable membranes or titanium meshes, Ridge augmentations using the Khoury technique. Results. Satisfactory amounts of autogenous bone have been harvested in all cases. The bone harvesting procedure was swift, reliable and devoid of any complications. Conclusion. Safescraper® is an extremely useful, cost-effective and minimally invasive device for collecting bone to adequately cover the needs in autogenous grafts everyday clinical practice.

Maxillary sinus dimensions in skeletal class II population with different vertical skeletal patterns.

The location of the maxillary sinus significantly affects the orthodontic treatment, particularly when temporary anchorage devices (TADs) are taking place. The current study aims to evaluate the maxillary sinus size and location in a skeletal class II population. The pre-orthodontic treatment CBCT images of the skeletal class II population were selected. The sinus's volumetric size, height, width, and depth were measured and compared among different skeletal vertical patterns and between genders. In addition, the height and width of the alveolar bone surrounding the maxillary sinus floor were quantified in the same manner. Patients who displayed a high-angle skeletal pattern had significantly greater maxillary sinus dimensions, shorter vertical distance between the maxillary sinus floor and the alveolar bone crest, and thinner alveolar bone surrounding the maxillary sinus. Meanwhile, the maxillary sinus dimension measurements were positively correlated with the SN-MP angle in both genders but only correlated with ANB angle in females. On the other hand, the vertical distance between the maxillary sinus floor and the alveolar bone crest was negatively correlated with the SN-MP angle in males but the ANB angle in females. In the skeletal class II population, the high-angle patients faced a higher risk of maxillary sinus perforations by TADs. In addition, gender-related variations were noticed warranting clinical attention, as males have a higher potential for maxillary sinus penetration from TAD placement than females. Maxillary posterior alveolar TADs are often prescribed to achieve the distalization of maxillary posterior teeth in class II patients. The current study provided more insight into the "safe zone" for TAD placement related to the maxillary sinus.

Maxillary sinus floor augmentation using two different ratios of cancellous and cortical freeze-dried bone allograft mixtures: clinical and histological outcomes

Maxillary sinus floor augmentation using two different ratios of cancellous and cortical freeze-dried bone allograft mixtures: clinical and histological outcomes

Long-term clinical and radiographic evaluation after maxillary sinus floor augmentation with octacalcium phosphate-collagen composite: A retrospective case series study.

The purpose of this study was to evaluate, using clinical and radiological assessments, the stability of dental implants 5years after maxillary sinus floor augmentation with octacalcium phosphate-collagen composite (OCP/Col). Maxillary sinus floor augmentation was performed through a lateral window approach. Depending on the height of the host bone, a simultaneous approach (≥5mm) or a staged approach (less than 5mm) was employed. The primary outcome was the evaluation of clinical dental implant conditions such as infection, peri-implantitis, dental implant stability, pain, and paresthesia. Secondary outcomes were the evaluation of the augmented bone volume, change rate of augmented bone volume, vertical bone height, and marginal bone loss around dental implant fixture. The conditions of all dental implants were uneventful throughout the follow-up period. Augmented bone volume and changing rate of augmented bone volume were essentially unchanged following maturation of the OCP/Col-derived new bone. The change rate of new bone volume was 21.9% in the simulated approach and 16.8% in the staged approach at 1year and 5years postoperatively. The reduction rate in vertical bone height was 7.1% in the simultaneous approach and 7.5% in the staged approach between 1year and 5years postoperatively. Mean marginal bone loss was 1.76mm with the simultaneous approach, and 0.50mm with the staged approach at 5years postoperatively. In conclusion, the success of dental implants 5years after sinus floor augmentation by OCP/Col implantation was clarified by both clinical and radiological evaluations.

The impact of deproteinized bovine bone particle size on histological and clinical bone healing outcomes in the augmented sinus: A randomized controlled clinical trial.

The effect of different deproteinized bovine bone mineral (DBBM) particle sizes on bone healing in maxillary sinus floor augmentation remains unclear. This study compared the newly formed tissue and angiogenesis-related bone healing after sinus floor augmentation using large or small DBBM particles. Overall 32 patients were randomly divided into two groups using either large (1-2 mm) or small (0.25-1 mm) DBBM particles for sinus floor augmentation. After 6months, the mineralized tissue volume was calculated using micro-computed tomography (micro-CT) analysis. The newly formed tissue composition was histomorphometrically analyzed. Angiogenesis was also examined by means of vascular endothelial growth factor (VEGF) expression. Implant failure and marginal bone loss were measured at a 1-year follow-up. Statistical analysis was performed using independent samples t-test. Micro-CT analysis demonstrated that grafting with large particles resulted in higher bone volume (6.99 ± 2.72 mm3 , p=0.002) and Bone Volume/Tissue Volume (0.25 ± 0.1, p=0.03) compared with small particles (3.76 ± 1.83 mm3 and 0.14 ± 0.13, respectively). Small particles showed higher non-mineralized tissue volume (26.31 mm3 ) compared with large particle group (17.4 ± 5.34 mm3 ) with p=0.001. The histological data revealed significantly higher area of newly formed bone (32.15% ± 14.04% for the large particle and 15.99% ± 14.12% for the small particle groups, p=0.004). Likewise, non-mineralized tissue was significantly greater in the small particle group (66.48% ± 20.97%) compared with the large particle group (44.36%, p=0.016). Moreover, use of large particles resulted in a significantly higher VEGF staining intensity score and VEFG positive cells. No implant failure was recorded in both groups, while no difference was found in terms of marginal bone loss at the 1-year follow-up. Sinus floor augmentation using large DBBM particles resulted in more angiogenesis expression, higher bone volume, and new bone formation at 6months after sinus augmentation. However, clinical outcomes with regards to implant placement were similar in both groups.