Sinus Floor Research Articles

Clinical and radiographic changes following transcrestal sinus augmentation: A scoping review of the last 25 years.

Maxillary sinus floor elevation is a surgical procedure intended to increase the volume of the bone vertically to accommodate dental implant placement. This intervention is frequently required for implant installation in the posterior maxilla, where the bone may be insufficient for securing implants of necessary length and stability. Sinus floor elevation can be completed either through a direct approach with a "window" through the lateral wall of the alveolar ridge or an indirect "transcrestal/transalveolar" sinus floor elevation (TSFE), which accesses the sinus floor through the crest of the edentulous ridge. Our study aims to provide a comprehensive scoping review of research conducted over the past 25 years on TSFE, specifically. A literature search aimed at identifying pertinent literature for the purpose of this PRISMA-ScR-compliant scoping review was conducted. Only randomized controlled trials, non-randomized controlled trials, prospective cohort studies, and case series that met the eligibility criteria were selected. Relevant data from these studies were extracted. Primary outcome measures included radiographic bone levels and implant failure >5 years. Secondary outcome measures included implant stability at time of placement and complications. Interventions reported in the selected studies were grouped based on treatment modality, which were then compared with the control therapy (traditional osteotome technique) after a minimum of 12 months healing period. Our search yielded 633 records, and after deduplication, 574 of these were screened. Application of the eligibility criteria led to the inclusion of 37 articles in the final selection. Case selection for included studies enrolling subjects: Four different transcrestal sinus elevation treatment modalities were identified: (a) osteotome, (b) piezoelectric surgery, (c) osseodensification, and (d) hydraulic techniques. Due to the heterogeneity of the studies, no superior approach for TSFE could be identified. Overall, all techniques demonstrated high implant survival rates. Comprehensive understanding of the patient's medical history, available armamentarium, and post-operative complications/management strategies are all essential to the completion of a successful TSFE approach for implant placement in the posterior maxilla, regardless of the treatment modality used.

Does alveolar ridge preservation reduce the need for sinus floor elevation: A comparative study to spontaneous healing.

In cases of atrophy in the maxillary posterior region, characterized by reduced vertical bone volume, implant placement becomes challenging. Augmentation procedures like sinus lifts are often needed to address insufficient bone volume. This study aims to explore if alveolar ridge preservation, using a bovine bone substitute and a porcine collagen membrane, significantly decreases the need for sinus lifts compared to natural wound healing after tooth extraction. In this comparative clinical study, 40 patients requiring a total of 53 extractions were assigned to one of the following groups: a test group with bovine bone substitute material (Straumann® XenoFlex) and a porcine collagen membrane (Jason® membrane), or a control group with spontaneous socket healing. After 6 months, digital volume tomography was performed for implant planning. For seven patients from the control group (n = 22 extracted sites) sinus lift augmentations were performed while only four sinus lift procedures were performed in the test group (n = 31 extracted sites), indicating a higher need for sinus augmentation procedures in the control group, however not statistically different on a p value of 0.05 (p = 0.168). In the control group, the mean value of the radiographically measured bone height (mesial and distal) was 11.13 ± 2.12 mm preoperatively before tooth extraction, while it was 11.3 ± 2.17 mm postoperatively after implant placement. In contrast, the mean value in the test group was 11.78 ± 3.09 mm preoperatively and 11.92 ± 2.79 mm postoperatively. Statistical analysis revealed no significant difference between the two groups (odds ratio 0.32; 95% CI: 0.08, 1.26; p = 0.951). The implant survival rate in the control group was 100%, compared to 96.77% in the test group. Within the limits of this study, the use of bovine bone substitute and a porcine resorbable membrane after tooth extraction in the posterior maxilla seems to reduce the need for sinus augmentation in comparison to spontaneous healing although the difference was not statistically significant. Additionally, the Alveolar Ridge Preservation in the test group made external sinus floor elevation unnecessary compared to the control group. The change in radiographically measured bone height pre- and postoperatively showed no significant difference between the two groups.

The effect of maxillary sinus floor elevation with lateral antrostomy approach on nasal mucociliary functions.

It is aimed to evaluate the effect of maxillary sinus elevation with lateral antrostomy approach on mucociliary functions using the saccharin test. The study was planned prospectively. 29 patients who underwent maxillary sinus elevation were included in the study. The age and gender information of the patients were noted. Saccharin test was performed in the nasal cavity on the operated side. Mucociliary functions were evaluated with the results of the saccharin test performed before the operation and the saccharin test results at the 1st week, 1st month, and 3rd month postoperatively. Comparisons were made with these values. The mean age of the patients was 42.10 ± 4.99 years. Of the patients, 14 (48.3%) were female and 15 (51.7%) were male. Preoperative saccharine test results were found to be significantly lower than the postoperative values. As the postoperative recovery period increased, a significant decrease was observed in the saccharin test results. However, preoperative values were within normal limits, while postoperative values were above the normal range. In our study, it was observed that mucociliary functions improved as the postoperative period increased in patients who underwent maxillary sinus elevation, but were still above normal limits.

A transcrestal sinus floor elevation strategy based on a haptic robot system: An in vitro study.

To reveal the force profiles recorded by haptic autonomous robotic force feedback during the transcrestal sinus floor elevation (TSFE) process, providing a reference for the surgery strategy during TSFE. A total of 42 maxillary sinus models with different angles of the sinus floor (30°, 40°, 50°, 60°, 70°, 80°, and 90°, compared to vertical plane) were 3D printed. Implant site preparation was performed using a robotic system, and the total force (Ft) and axial force along the drill (Fz) during the surgery were recorded by the haptic robotic arm. The actual initial breakthrough point (drill contacting sinus floor) and complete breakthrough point (drill penetrating the sinus floor) were defined visually (the actual IBP and the actual CBP). The theoretical initial breakthrough point (the theoretical IBP) and the theoretical complete breakthrough point (the theoretical CBP) defined by the robot-guided system and the CBCT were determined by real-time force feedback and imaging distance measurement, respectively. The distance from the bottom of the resin model to the actual IBP and the actual CBP was defined as Di and Dt, respectively. The difference in Fz began to increase significantly at 70°, while the difference in Ft became significant at 60°. When the angle was greater than 70°, there was no significant difference in the discrepancy between the actual and theoretical perforation points. Compared to judging the breakthrough point by CBCT, real-time force feedback TSFE under robotic surgery achieved more accurate initial breakthrough point detection. The smaller the angle, the larger the breakthrough force for the drill. The real-time force feedback of haptic robotic system during TSFE could provide reliable reference for dentists. More clinical studies are needed to further validate the application of robotic surgery assisted TSFE.

Introduction and overview on autogenous Platelet concentrates.

This special issue on autologous platelet concentrates (APCs) provides clinicians with an overview on the current understanding of the use of these biomaterials for soft and hard-tissue regeneration. The included papers summarize scientific evidence and the clinical findings, presented in simple tables that outline potential benefits including Patient Reported Outcome Measures (PROMs). This approach enables clinicians to assess clinical relevance and researchers to identify significant gaps in the literature. The first part provides a comprehensive summary of the basic science surrounding APC, with particular focus on their preparation methods. Clear recommendations are outlined, which are crucial for obtaining high-quality APCs, alongside an exploration of how APCs may influence both soft and hard tissue healing processes. Part 2 delves into the clinical evidence for the potential benefits of APCs across a range of applications: alveolar ridge preservation, sinus floor elevation, periodontal plastic surgery, guided tissue regeneration, guided bone regeneration, the healing of Medication-Related Osteonecrosis of the Jaw (MRONJ), and endodontic surgery. In the part 3, the discussion turns to the effects of APCs on the healing of extra-oral wounds, including diabetic foot ulcers, venous leg ulcers, pressure injuries, burns, and more. For those clinicians persuaded by the evidence, the fourth section offers a detailed, step-by-step flowchart for each treatment modality, providing a clear guide for clinical application.

Three-dimensional volumetric assessment and stability of simultaneously placed implant following sinus floor augmentation with deproteinized human demineralized tooth matrix or deproteinized bovine bone mineral: a randomized controlled clinical trial.

This study aimed to analyze and compare three-dimensional volumetric bone changes and stability of simultaneously placed dental implants following sinus augmentation using deproteinized human demineralized tooth matrix (dpDTM) and deproteinized bovine bone mineral (DBBM). Twenty-four patients who required lateral maxillary sinus floor augmentation with simultaneous dental implant placement were randomly assigned to receive either dpDTM (n = 12) or DBBM (n = 12). Cone-beam computed tomography and resonance frequency analysis of implant stability were conducted immediately after surgery and 6 months postoperatively. Changes in the graft sinus floor and graft height volumes in the sagittal and coronal views, along with the implant stability quotient (ISQ), were analyzed and compared. Volumetric graft alteration was comparable between dpDTM (120.33 ± 77.48 mm3) and DBBM (108.51 ± 65.15 mm3) (p = 0.690). Reduction in the average graft height was also comparable: dpDTM group ranged from - 0.59 to - 0.93mm and the DBBM group ranged from - 0.55 to - 0.82mm (p > 0.05) at most examined levels. However, greater reduction in the mesial-graft height occurred in the dpDTM group (- 1.08 ± 0.70mm vs. -0.58 ± 0.39mm, p = 0.04). The ISQ values increased similarly in both groups to reach 70 at 6 months. dpDTM demonstrated comparable stability in graft volume and height during the healing process compared to DBBM and could serve as a viable alternative to DBBM for sinus floor augmentation with simultaneous implant placement.

Patient and implant-related risk factors for implant failure of one-stage lateral sinus floor elevation: A 2- to 10-year retrospective study.

This retrospective study aimed to evaluate the early and late implant failure rates of one-stage lateral sinus floor elevation (LSFE)and to identify the patient and implant-related risk factors associated with these failures. All patients treated with one-stage LSFE from January 2014 to December 2021 were evaluated for inclusion. A total of 618 patients with 936 implants met the inclusion criteria. Clinical and radiographic information about patient and implants was collected. Univariate and multivariate Cox proportional hazards frailty regression models were performed to identify risk factors for early and late implant failure. The cumulative implant survival rate was 95.62% (95% CI 93.90%-97.68%), with 16 early implant failures and 25 late implant failures. The Cox analysis indicated that ≤3 mm residual bone height (RBH) was associated with a higher early failure rate. For late implant failure, smoking habit, ≤3 mm RBH, and certain implant brand were independent risk factors. Narrow sinus ostium, long infundibulum, and flat thickening of Schneiderian membrane might be non-independent risk factors for late implant failure. No significance was found in other variables, including age, periodontitis history, implant characteristics (position, diameter, length, protrusion length, marginal bone loss), surgeon experience, healing time, opposing dentition, and prosthesis. One-stage LSFE is a predictable treatment for patients with atrophic maxilla. ≤3 mm RBH increased the risk of early implant failure, while smoking habit, ≤3 mm RBH, and certain implant brand were independent risk factors for late implant failure.

A retrospective comparative study of extensive sinus membrane perforations repairing using collagen membranes with pouch and nonpouch techniques

ObjectivesTo evaluate the clinical and radiological outcomes of employing collagen membranes with pouch and non-pouch techniques to repair extensive maxillary sinus membrane perforation. Study DesignPatients who experienced extensive maxillary sinus membrane perforation (>10 mm) during lateral window maxillary sinus floor elevation (LWMSFE) were included and treated with either the pouch or non-pouch techniques. ResultsThe number of patients treated with the pouch technique and those treated with the non-pouch technique was 10 each. For the pouch and non-pouch techniques, the mean vertical bone height gain were 17.04±1.64mm and 16.42±2.41mm; the mean bone density were 720.10±20.58HU and 692.85±40.03HU; and the mean bone augmentation volume were 2720.07±680.58mm3 and 3238.84±781.02mm3. The mean vertical bone height gain, bone density and bone augmentation volume were not statistically different between two techniques (P > 0.05). No implant was observed for loss during the follow-up period of 8-12 months after crown placement. ConclusionsThe success of the pouch and non-pouch techniques in repairing extensive membrane perforation is evident in terms of clinical and radiographic outcomes. Regardless of whether the pouch or non-pouch technique is used, secure and stable implant restoration results can be achieved after the maxillary sinus membrane perforation is repaired.

Comprehensive sinus contour classification and its characteristics from radiographic examination: a cross-sectional study

ObjectiveThe aim of this study was to propose a comprehensive maxillary sinus (MS) contour classification system based on the evaluation of anatomical characteristics from cone beam computed tomography (CBCT) examination and investigate the relationship between sinus contours and sinus floor elevation (SFE).MethodsA total of 283 CBCT scans from patients who had single tooth loss in the posterior maxilla and underwent SFE were analyzed. The MS was classified at each tooth position. For buccal-palatal evaluation, the classification from Type A to E was narrow-taper, taper, ovoid, square, and irregular, respectively. For mesial-distal evaluation, the classification from Type 1 to 4 was flat, slope, concave, and septa, respectively. The major anatomical parameters evaluated were (1) residual bone height (RBH), (2) sinus width (SW), (3) maxillary sinus angle (MSA), (4) buccal dip angle (BDA), (5) palatonasal recess (PNR), and (6) sinus depth.ResultsEleven groups of MS contour were classified after detailed calculation. Differences in the RBH, MSA, BDA, and SW among different groups were statistically significant. The narrow-taper and slope MS (A2) group had the highest RBH (8.66 ± 0.77 mm), largest BDA (79.9° ± 3.18°), smallest MSA (19.8° ± 2.01°), and narrowest SW (6.30 ± 1.23 mm). The lowest RBH was in the square and concave sinus (D3) group (5.11 ± 2.70 mm). The ovoid and concave sinus (C3) group had the smallest BDA (50.64 ± 8.73 mm) and largest MSA (74.11° ± 11.52°). The square and flat MS (D1) group had the widest SW (19.13 ± 3.69 mm). A strongly significant positive correlation was observed between the SW and MSA (r = 0.67) and a strongly negative correlation between the SW and BDA (r = − 0.65). The prevalence of PNR (mean angle: 104.06° ± 16.83°, mean height: 14.72 ± 11.78 mm) was 38% and frequently observed in the ovoid and slope MS (C2) group.ConclusionDespite certain characteristics at different tooth sites, the same tooth position was categorized differently using different classification systems, indicating large anatomical variations in the MS. The classification system proposed herein allows for classification based on general characteristics at a single tooth site, aiming to help surgeons in improving presurgical evaluation.

Anatomical relationship between maxillary posterior teeth and the maxillary sinus in an Indonesian population: a CT scan study

BackgroundThe anatomical proximity between the root apex of the maxillary posterior teeth and the maxillary sinus can lead to complications, including odontogenic maxillary sinusitis. While several studies have investigated similar variables in different populations, there is limited research on the Indonesian population. This study aimed to describe the anatomical position of the maxillary posterior teeth in relation to the floor of the maxillary sinus using CT scans.MethodsA total of 122 patients (432 maxillary premolars and 1,282 maxillary molars) underwent CT scans to evaluate 1,711 roots. The vertical relationship between the root apex of the maxillary posterior teeth and the maxillary sinus was classified into three types: IS (inside sinus), CO (sinus contact), and OS (outside sinus).ResultsThe IS type was predominantly found in the palatal roots of the first molars, accounting for 20% of the total roots in this type. The CO type was most frequently observed in the mesiobuccal roots of the second molars, representing 18% of the total roots in this type. The OS type was most commonly found in the first premolar, comprising 20% of the total roots in this type.ConclusionsThe palatal roots of the first molars exhibited the highest frequency of proximity to the maxillary sinus. CT scans can effectively assess the relationship between the root apex of the posterior teeth and the maxillary sinus.Clinical RelevanceClinicians should consider this information comprehensively when planning treatments for maxillary molars.

Maxillary sinus membrane perforation rate utilizing osseodensification-mediated transcrestal sinus floor elevation: A multicenter clinical study.

This multicenter cross-sectional clinical study aimed to evaluate the membrane perforation rate during transcrestal sinus floor elevation (TSFE) using osseodensification (OD) burs and assess risk factors associated with the procedure. This study was conducted in six centers, following ethical standards and approved by local committees. It included patients over 18 years old missing maxillary posterior teeth with crestal residual bone height (RBH) ≥2 and ≤6 mm. Preoperative evaluations were done, including CBCT scans, to assess bone dimensions and sinus health. All centers and surgeons followed a standardized surgical protocol for TSFE using OD burs. Surgical complications, particularly sinus membrane perforations, were recorded and analyzed. Factors such as implant site, premolars or molars, as well as, healed or fresh socket, along with initial RBH were evaluated for their impact on membrane perforation rate. Descriptive statistics, χ2, and logistic regression analysis were used to analyze the data. A total of 621 subjects with an average age of 57.9 years were included. Sinus lifting was performed at 670 sites, with 621 implants placed in the maxilla. The majority of sinus lifts were done in the molar region (76.87%) and in healed bone sites (74.33%). The average RBH was 5.1 mm (ranging from 2 to 7 mm). Sinus membrane perforation occurred in 49 cases (7.31%). RBH ≤3 mm posed a risk factor for sinus membrane perforations followed by RBH >3 and ≤5 mm. Tooth region and implant site were not associated as risk factors for sinus membrane perforation. OD drilling used for TSFE resulted in low membrane perforation rate. Challenging scenarios of severe posterior maxillary atrophy presented as risk factors for increased perforation rate.

Advances in autogenous dentin matrix graft as a promising biomaterial for guided bone regeneration in maxillofacial region: A review.

Autogenous dentin matrix (ADM), derived from a patient's extracted tooth, can be repurposed as an autologous grafting material in reconstructive dentistry. Extracted teeth provide a source for ADM, which distinguishes itself with its low rejection rate, osteoinductive capabilities and ease of preparation. Consequently, it presents a viable alternative to autogenous bone. Animal studies have substantiated its effective osteoinductive properties, while its clinical applications encompass post-extraction site preservation, maxillary sinus floor augmentation, and guided bone tissue regeneration. Nevertheless, the long-term efficacy of ADM applied in bone regeneration remains underexplored and there is a lack of standardization in the preparation processes. This paper comprehensively explores the composition, mechanisms underlying osteoinductivity, preparation methods, and clinical applications of ADM with the aim of establishing a fundamental reference for future studies on this subject.

Impact of Strontium, Magnesium, and Zinc Ions on the In Vitro Osteogenesis of Maxillary Sinus Membrane Stem Cells.

Human Maxillary Sinus Membrane Stem Cells (hMSMSCs) contribute significantly to bone formation following maxillary sinus floor augmentation (MSFA). The biological behavior of mesenchymal stem cells is notably influenced by varying concentrations of magnesium (Mg2+), strontium (Sr2+), and zinc (Zn2+) ions; however, their specific effects on hMSMSCs have not been comprehensively studied. We isolated hMSMSCs and identified their mesenchymal stem cell characteristics by flow cytometry and multilineage differentiation experiments. Subsequently, the hMSMSCs were cultured in media containing different concentrations of these metal ions. The proliferation and viability of hMSMSCs were assessed using CCK-8 and Calcein AM/PI staining. After osteogenic induction, cells were evaluated for alkaline phosphatase (ALP) activity, ALP staining, and Alizarin Red staining. Additionally, qRT-PCR was used to detect differences in osteogenic gene expression, and immunofluorescence staining was used to observe variations in OCN protein levels. The results indicated that 1 mM Mg2+, 0.01 mM Sr2+, and 0.001 mM Zn2+ significantly improved the proliferation and activity of hMSMSCs. These concentrations also notably enhanced ALP secretion, increased bone-related gene expression, and augmented osteocalcin expression and formation of extracellular calcium nodules, thereby improving osteogenic differentiation. However, higher concentrations of Mg2+, Sr2+, and Zn2+ decreased cell viability and osteogenic differentiation. Mg2+, Sr2+, and Zn2+ promote osteogenic differentiation and proliferation of hMSMSCs in a concentration-dependent manner, indicating that the type and concentration of ions in the extracellular environment can significantly alter hMSMSCs behavior, which is a crucial consideration for material design in maxillary sinus elevation applications.

Volumetric assessment and relationship of maxillary sinus floor with 1st & 2nd molar root apices in different sagittal skeletal patterns – A CBCT study

Volumetric assessment and relationship of maxillary sinus floor with 1st & 2nd molar root apices in different sagittal skeletal patterns – A CBCT study

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

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

The impact of antiplatelet and anticoagulant medications on early implant failure following sinus floor augmentation: A retrospective cohort analysis.

The effect of antiplatelet and anticoagulant medications on the outcomes of sinus floor augmentation remains unclear. This retrospective cohort study analyzed data from electronic medical records of consecutive patients undergoing sinus floor augmentation at a single medical center. Patients were categorized into three categories: patients under antiplatelet medications, patients under anticoagulation medications, and healthy individuals. Data collected included tobacco smoking, residual alveolar bone height, timing of implant placement, materials used, vertical bone gain, early implant failure (EIF), and complications such as Schneiderian membrane perforation and postoperative bleeding. Multivariable analysis was performed to assess risk factors for EIF. Statistical significance was considered below 5%. Among 110 patients with 305 implants, EIF occurred in 10% of patients and 4.65% of implants. No significant difference in postoperative bleeding or EIF was found between study groups. Univariate and multivariable analyses highlighted tobacco smoking (odds ratio [OR] = 7.92), lower residual alveolar ridge height (OR = 0.81), and staged implant placement (OR = 4.64) as significant EIF risk factors in this cohort. Anticoagulant and antiplatelet therapies do not significantly elevate the risk of EIF or postoperative bleeding following sinus floor augmentation. Tobacco smoking, residual alveolar ridge height and staged sinus floor augmentation were risk factors for EIF in patients using antiplatelet or anticoagulation medications undergoing sinus floor augmentation.

Randomized controlled trial on the efficacy of a custom-made, fully guided implant system for flapless crestal sinus floor elevation: Accuracy and patient-reported outcomes.

To compare fully guided flapless implant surgery using a light-cured surgical guide (FG group) with partially guided open flap surgery (PG group) in the posterior maxilla when performing simultaneous sinus floor elevation in terms of the accuracy, time requirements, and patient/clinician-reported outcomes (PROMs and CROMs). In this study, 56 tissue-level implants were placed with crestal sinus floor elevation in 56 patients at single-tooth sites, with 28 implants allocated to the PG group and 28 to the FG group. The deviations of the placed implants from the virtually planned positions were measured at the implant platform and apex and for the angular deviation. The presurgical preparation time and the duration of surgery were measured. PROMs and CROMs were made by administering questionnaires at multiple time points. Horizontal deviations at the platform and apex and the angular deviation were significantly smaller in the FG group than the PG group (p < .05). Presurgical preparation and surgery times were significantly shorter in the FG group (p < .001). Patient satisfaction and willingness to receive repeat treatment were significantly better in the FG group than in the PG group (p < .005 and .025, respectively). Clinicians were more satisfied in the FG group than the PG group (p < .05). When placing an implant with sinus floor elevation, the flapless approach using a fully guided surgical system can be more accurate, faster, and increase the satisfaction of both the clinician and patient compared to the partially guided surgery.

Variations in the alveolar bone morphology in maxillary molar area: a retrospective CBCT study

BackgroundThis study quantitatively analyzed the anatomic structure of the alveolar bone in the maxillary molar region at three potential locations for Temporary Anchorage Device (TAD) placement. Additionally, the study compared the variability in this region across different age groups, sagittal skeletal patterns, vertical facial types, and sexes.MethodsIn this retrospective cone-beam computed tomography study, the buccal alveolar bone was analyzed in the posterior molar area of 200 patients, the measurement items include buccal alveolar bone height, alveolar bone thickness, interradicular distance, and maxillary retromolar space.ResultsBuccal alveolar height was greatest in the U56 region. The interradicular space was largest in the U56 region and increased from the alveolar crest to the sinus floor. Buccal alveolar bone thickness was highest in the U67 region and generally increased from the alveolar crest to the sinus floor. The maxillary retromolar space gradually increased from the alveolar crest to the root apex.ConclusionsTADs are safest when placed in the buccal area between the maxillary second premolar and the first molar, particularly at the 9 mm plane. The U67 region is the optimal safe zone for TAD placement for maxillary dentition distalization. TADs placement in adolescents can be challenging. Maxillary third molar extraction can be considered for maxillary dentition distalization.

Evaluation of anatomic variations in the posterior superior alveolar artery – A Cone-beam Computed Tomography (CBCT) study

Anatomical variation of the course of posterior superior alveolar artery (PSAA) within maxillary bone are vital information for surgeons before any maxillary surgery. This study was designed to evaluate the variations of PSAA by determining the prevalence of intraosseous PSAA and assessing the anatomical reference points and diameter of the PSAA. Comparison between dentate and edentulous alveolus was also done. One hundred CBCT images were included in this study to enumerate the prevalence of intraosseous PSAA in maxilla. Anatomical reference points which include the horizontal position of the PSAA and the vertical distance from the PSAA to the maxillary sinus floor and alveolar crest were identified. The diameter and horizontal position of PSAA were also analysed. The results were tested using independent t-test and chi square test. The PSAA was seen in 73.5% of the cases and 70.1% were located intraosseously. There was no significant difference in the vertical distance between PSAA and alveolar crest, as well as between maxillary sinus floor and alveolar crest for dentate and edentulous patients. Meanwhile, there was a significantly greater vertical distance between the PSAA and the maxillary sinus floor in edentulous (9.24 ± 4.75 mm) than in dentate patients (6.78 ± 3.43 mm) with p-value of 0.002. Mean diameter of the canal was 1.09 ± 0.43 mm. In conclusion, this study provides useful information regarding the most prevalent location and diameter of the PSAA which indicates the importance of preoperative evaluation through CBCT to reduce the risk of intraoperative bleeding that may complicate the treatment.

The Role of Bone Tacks in Sinus Floor Lift Surgery: A Single-Center Experience.

Background: Maxillar atrophy is a prevalent condition associated with diminished bone volume, which precludes the conventional placement of dental implants. Sinus floor lift is a surgical procedure that aims to address this atrophy through the insertion of a graft within the sinus cavity. A multitude of techniques have been documented in the international literature for the management of the sinus bone window, though each approach has its own set of advantages and disadvantages. Methods: The present study is a retrospective analysis of traditional sinus floor lift surgery, comparing the outcomes of two surgical approaches: placement of a collagen membrane over the maxillary lateral bone window with or without bone tacks. The study enrolled a total of 48 consecutive patients. Twenty-four patients underwent sinus floor lift surgery, with the placement of a collagen membrane over the maxillary lateral bone window without bone tacks (control group). The remaining 24 patients underwent the same procedure, but with bone tacks (study group). All patients received an amoxicillin 875 mg + clavulanic acid 125 mg administration for six days and underwent Cone Beam Computed Tomography (CBCT) before the sinus floor lift surgery and six months later before the implant surgery. The parameters measured on the preoperative Cone Beam Computed Tomography (CBCT) scan included residual bone, the preoperative thickness of the lateral bone in the center, and the distance between the lateral wall and the medial wall of the sinus. Only the bone height increment was measured on the postoperative CBCT scan. Postoperative complications and the visual analogue scale (VAS) score were also recorded. A statistical analysis was performed, and the correlation between the parameters was evaluated using Pearson's correlation coefficient. A comparison of the mean of the parameters between the treatment group and the control group was conducted using the t-test. Results and Conclusions: The study group was found to have superior outcomes in terms of bone height increment (p = 0.001) and VAS after 7 days (p = 0.11) compared to the control group. The novel application of bone tacks on the collagen membrane over the bone window following sinus elevation surgery was associated with superior outcomes in terms of bone height and reduced pain at seven days, as measured by the VAS, with no postoperative complications.