Lateral Sinus Floor Elevation Research Articles

One-Stage Lateral Sinus Floor Elevation Using Different Grafts: A Systematic Review of Controlled Clinical Trials.

The purpose of this systematic review was to assess histological and imaging outcomes related to new bone formation around implants, inserted simultaneously with sinus augmentation, comparing different types of grafts. Systematic Review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta- Analysis (PRISMA), and the Cochrane Handbook for Systematic Reviews of Interventions. LILACS/BVS, Medline/PubMed, Cochrane Library and Embase databases, including gray literature and manual investigation, were searched to identify clinical trials reporting human histological and imaging data of bone formation around implants, inserted into the maxillary sinus at the same moment of the elevation and augmentation procedure, using several materials. Study selection, risk of bias (Rob 2.0 or ROBINS I), quality of evidence (GRADE), and data collection were performed by two independent reviewers. Of the 1101 potentially eligible articles, 44 were retrieved, 12 were assessed for eligibility and 5 were included in this systematic review (4 randomized and one controlled clinical trials). As a result, 130 grafted sinuses with 179 installed implants in 103 patients, aged between 24 and 79 years and followed up from 6 to 15 months, were analyzed. The heterogeneity between studies did not allow the data to be combined for meta-analyses. All graft materials proved to be viable options for the intervention. The use of BCP was related to higher bone-to-implant contact. All the assessed grafts are viable options for the intervention addressed. The use of some material is justified to maintain the sinus volume and allow bone formation in the apical site of implants under the sinus membrane. Longer chair time and the morbidity of the donor site should be considered when choosing autogenous bone. Synthetic biphasic materials can be selected for this intervention due to superior values of %BIC when compared to DBB.

Lateral Sinus Floor Elevation in Cases of an Intact and Perforated Schneiderian Membrane

The study comprised 20 lateral sinus floor elevation cases performed in 18 patients. During surgery, in four cases, a perforation of the Schneiderian membrane was detected. An attempt to suture the perforated membrane may increase the risk of enlarging the perforation. Therefore, we suggest a more conservative protocol be applied in all four cases where perforation occurred. The procedure consists of the 3-layer technique: an absorbable oxidized cellulose gauze moisturized with Dicynone was placed in this area. Under it, as a second layer, a PRF membrane is applied and then covered with a slow-resorbable collagen membrane. At that point, the surgery continues with the placement of the bone substitute material, and the sinus-lifting is finalized according to the selected protocol.
 The clinical studies demonstrate that the bone graft has a slower healing rate in areas with perforation, which is a proof of the osteogenic properties of the Schneiderian membrane. The cases described reveal that using this surgical protocol is risk-free and has a high success rate.

Clinical and radiographic outcomes of lateral sinus floor elevation with simultaneous hydrophilic implants placement: A retrospective study of 2-5 years.

To investigate the clinical and radiographic outcomes of a chemically modified sandblasted large-grit acid-etched implant (hydrophilic) in lateral sinus floor elevation (LSFE), compared with a conventional one (hydrophobic). A retrospective study design was adopted. Patients who received LSFE with simultaneous implant placement were recruited. According to different types of implant surfaces, patients were divided into two groups (the hydrophilic group and the hydrophobic group). Implant survival rate (SR), endo-sinus bone stability on the radiographs, mean probing depths, percentage of bleeding on probing, marginal bone loss, and patient satisfaction were evaluated. A total of 106 patients with 180 implants (hydrophilic:101, hydrophobic:79) in 119 maxillary sinuses were included. The follow-up period ranged from 2 to 5 years. Three hydrophobic implants and one hydrophilic implant in four different patients failed. The SR of the hydrophilic group was higher than that of the hydrophobic group but without a significant difference (p > .05). The change and change rate of endo-sinus bone height (ΔESBH and RΔESBH) and bone volume (ΔESBV and RΔESBV) in the hydrophilic group were less than those in the hydrophobic group, with a significant difference at 6 months after implantation. No other significant difference was found between the two groups. Within the limitations of this study, both hydrophilic and hydrophobic implants were suitable for LSFE with predictable clinical outcomes. Meanwhile, hydrophilic implants could contribute to the grafted endo-sinus bone stability during healing time.

Changes in the Maxillary Sinus Membrane Thickness and Sinus Health Following Lateral Sinus Floor Elevation: Comparing Preoperative Mucosal Thicknesses of Less than and Greater than 5 Millimeters.

To investigate the effect of lateral sinus floor elevation (LSFE) on sinus membrane (SM) thickness and sinus health in mucosa thickness less and more than 5 mm. LSFE was performed in a prospective controlled clinical trial on two groups with less than and more than 5 mm (group A & B) SM thickness and followed for 6 months. Using preoperative and 6-month postoperative CBCT and clinical evaluation, SM thickness changes (primary outcome variable), sinus health, augmented bone height, and length (augmentation adequacy), membrane-related variables, and operation time were measured. Forty unilateral sinus augmentations (A:20, B:20) with simultaneous installation of 52 fixtures were performed on 40 subjects (72.5% males, mean age of 48.8±7.6). The mean preoperative and 6- month SM thicknesses in group A and group B were 1.4±0.9 and 1.3±0.6 mm, and 6.8±1.0 and 3.4±1.7 mm, respectively. The mean postoperative SM thickness significantly decreased (P<0.001) only in group B. The mean SM thickness changes also revealed a noticeable difference between the two groups (P<0.001). Augmentation adequacy and membrane perforation rate were similar in both groups. Clinical and radiographic rhinosinusitis was not detected in any of the patients. Bleeding during separation and resistance to elevation in group B were significantly higher than in group A (P=0.003, P=0.001). Surgical time in group B (12.08 ± 8.26 minutes) was longer than in group A (8.64 ± 3.70 minutes), without reaching a significant level (P=0.097). LSFE in thickened mucosa (≤10 mm) and thinner mucosa (≤5 mm) does not cause abnormal changes in the sinus membrane and sinus health. LSFE in thickened mucosa results in adequate sinus augmentation. Thickened SM also shows a significant thickness reduction. The thickened membrane does not appear to be a contraindication to SFE.

Effectiveness, Morbidity, and Costs of Transcrestal and Lateral Sinus Floor Elevation at Sites with Different Residual Bone Heights: A Re-Analysis of Data from a Parallel-Arm Randomized Trial

Effectiveness, Morbidity, and Costs of Transcrestal and Lateral Sinus Floor Elevation at Sites with Different Residual Bone Heights: A Re-Analysis of Data from a Parallel-Arm Randomized Trial

Do autologous platelet concentrates (APCs) have a role in intra-oral bone regeneration? A critical review of clinical guidelines on decision-making process.

In the past decades, personalized regenerative medicine has gained increased attention. Autologous platelet concentrates (APCs) such as PRP, PRGF, and L-PRF, all serving as a source of a large variety of cells and growth factors that participate in hard and soft tissue healing and regeneration, could play a significant role in regenerative periodontal procedures. This narrative review evaluated the relative impact of APCs in alveolar ridge preservation, sinus floor augmentation, and the regeneration of bony craters around teeth, both as a single substitute or in combination with a xenograft. L-PRF has a significant beneficial effect on alveolar ridge preservation (<alveolar bone resorption, >bone quality). The data for PRGF are less convincing, and PRP is controversial. L-PRF can successfully be used as a single substitute during transcrestal (≥3.5 mm bone gain) as well as 1-stage lateral window sinus floor elevation (>5 mm bone gain). For PRGF and especially PRP the data are very scarce. In the treatment of bony craters around teeth, during open flap debridement, L-PRF as a single substitute showed significant adjunctive benefits (e.g., >PPD reduction, >CAL gain, >crater depth reduction). The data for PRP and PRGF were non-conclusive. Adding PRP or L-PRF to a xenograft during OFD resulted in additional improvements (>PPD reduction, >CAL gain, >bone fill), for PRGF no data were found. Autologous platelet concentrates demonstrated to enhance bone and soft tissue healing in periodontal regenerative procedures. The data for L-PRF were most convincing. L-PRF also has the advantage of a greater simplicity of production, and its 100% autologous character.

Three-dimensional guided lateral window sinus lift and simultaneous implant placement: A dental technique

Lateral window sinus floor elevation is typically performed blind, and complications may be encountered. Guided surgery can help make the procedure more predictable with fewer complications and a shorter surgical time. The presented technique uses a surgical template for simultaneous implant placement and sinus floor elevation. An implant platform is used for determining the size, shape, and location of the window and the osteotomy depth. The technique uses a Ø5mm bone profiler with a stop compatible with the surgical guide design to conduct the osteotomy, conservatively guiding the lateral window osteotomy in 3 dimensions.

The Radiological Evaluation of the Anatomy of the Alveolar Antral Artery and the Lateral Wall Thickness Using Cone-Beam Computed Tomography: A Retrospective Study.

This study included CBCT scans from 238 patients. The detection diameter of AAA and distance of the lower border of AAA to the maxillary sinus floor at the first premolar, second premolar, first molar, and second molar locations were evaluated. The route of AAA was observed with novel classification. Furthermore, the distance from the maxillary sinus floor to the alveolar crest at four posterior tooth locations was measured respectively. Moreover, the lateral wall thickness at four locations was assessed. Data were subjected to statistical analysis. AAA was observed in 62.18% of all sinuses. The mean diameter was 0.99±0.21 mm, with significant differences within gender. Half of the route of AAA was intrasinus intraosseous type. The mean distance between the maxillary sinus floor and AAA was 8.00±2.68 mm, with a significant difference between dentate and edentulous status at the first molar location. Distance from the sinus floor to the alveolar ridge crest in edentulous status negatively correlated with the distance from the sinus floor to AAA at the first molar location. The mean thickness of the lateral wall was 2.03±0.91 mm, and the difference in thickness between males and females at the four locations was statistically significant. intrasinus-intraosseous type, is the most common route. Special care should be taken at the first molar location during a lateral window sinus floor elevation. CBCT is highly recommended to before lateral wall maxillary sinus floor elevation.

Lateral sinus floor elevation in patients with sinus floor defects: A retrospective study with a 1- to 9-year follow-up.

We aimed to retrospectively evaluate the long-term clinical outcomes of lateral sinus floor elevation (LSFE) in patients with sinus floor defects. Between 2008 and 2020, patients with sinus floor defects were recruited after confirmation on preoperative cone-beam computed tomography (CBCT). The split-thickness flap technique with a palatal crestal incision was used to manage tissue adhesion in the bone defects area. A resorbable collagen membrane was used to close the sinus floor defects from the crestal side before bone substitute placement. Of 58 implants, 47 (81.0%) were placed after an 8-month healing period, whereas 11 were placed simultaneously. Patients were followed up by radiography and clinical examination for 1-9 years. Finally, the cumulative survival rate (CSR) of implants, surgical complications, and marginal bone loss (MBL) were recorded and analyzed. In total, LSFE was performed in 36 sinuses (35 patients) with sinus floor defects, of which surgery was completed in 35 sinuses (97.2%) in the first attempt. Schneiderian membrane perforations (SMP) occurred in 10/36 (27.8%) sinuses; nine were repaired carefully, whereas one surgery was suspended due to complicated SMP, and successful re-entry LSFE was performed 4 months later. After a follow-up period of 1-9 years, the CSR was 96.5% at the 1-year, 3-year, 5-year, and 7-year follow-ups and 64.3% at the 8-year follow-up. Within the limitations of this study, sinus floor defects seem not to compromise LSFE therapy after appropriate management and long-term clinical outcomes are predictable.

Graftless Sinus Augmentation via Crestal Sinus Floor Elevation using Densah Burs with Simultaneous Implant Placement: A Clinical Report after Two Years in Service

Maxillary sinus floor elevation is a reliable surgical procedure to establish oral rehabilitation using implant prostheses in the atrophic maxilla. Both lateral sinus floor elevation (LSFE) and crestal sinus floor elevation (CSFE) are viable to augment inadequate alveolar bone height. Still, the results of post-surgical trauma, complications, and patient-reported outcome measures (PROMs) vary. Furthermore, combining bone grafting for maxillary sinus augmentation (MSA) is suggested to increase the volume of the alveolar ridge, yet more researches have demonstrated outcomes of the graftless method. This clinical report describes a graftless sinus augmentation with simultaneous implant placement utilizing Densah burs implementing CSFE through the osseodensification method.

Survival analysis of implants placed simultaneously with lateral sinus floor elevation in severely atrophic maxilla: A 3- to 12-year retrospective cohort study.

To retrospectively evaluate whether implants placed simultaneously with lateral sinus floor elevation (LSFE) in severely atrophic maxilla (residual bone height [RBH] ≤3 mm) could achieve long-term survival and comprehensively analyze the factors influencing their survival rates. A total of 123 patients receiving LSFE and simultaneous implant placement from 2010 to 2019 and their 123 implants in sites with RBH ≤3 mm were included in this study. Basic characteristics of patients and implants were collected from the medical record system and cone-beam computed tomography (CBCT) images. Kaplan-Meier survival curves were applied to estimate cumulative survival rates (CSRs) and Cox proportional hazards regression models were used to detect factors influencing implant survival. The 6-year and 12-year CSR of implants placed in sites with RBH ≤3 mm were 95.7% (95% confidence interval [CI]: 92.1%-99.5%) and 76.6% (95% CI: 58.1%-100%), respectively. Eight patients presented late implant failure. Univariate and multivariate Cox regression analyses demonstrated that RBH ≤2 mm (hazard ratio [HR]: 20.63, p = 0.000) and smoking habit (HR: 6.055, p = 0.024) were significantly associated with long-term implant survival. Specifically, the 10-year CSR of implants in sites with RBH ≤2 mm (53.3%, 95% CI: 27.5%-100%) was dramatically lower than those in sites with RBH >2 mm (92.9%, 95% CI: 81.7%-100%, p = 0.000). Implants placed simultaneously with LSFE in sites with RBH ≤3 mm can achieve long-term survival. However, caution is required especially for implantation in sites with RBH ≤2 mm. Besides, the smoking habit is also considered a risk factor jeopardizing long-term implant survival.

Minimally invasive techniques for lateral maxillary sinus floor elevation: small lateral window and one-stage surgery—a 2–5-year retrospective study

This study aimed to introduce a minimally invasive technique for maxillary sinus floor elevation using the lateral approach (lSFE) and to determine the factors that influence the stability of the grafted area in the sinus cavity. Thirty patients (30 implants) treated with lSFE using minimally invasive techniques from 2015 to 2019 were included in the study. Five aspects of the implant (central, mesial, distal, buccal, and palatal bone heights [BHs]) were measured using cone-beam computed tomography (CBCT) before implant surgery, immediately after surgery (T0), 6 months after surgery (T1), and at the last follow-up visit (T2). Patients’ characteristics were collected. A small bone window (height, (4.40 ± 0.74) mm; length, (6.26 ± 1.03) mm) was prepared. No implant failed during the follow-up period (3.67 ± 1.75) years. Three of the 30 implants exhibited perforations. Changes in BH of the five aspects of implants showed strong correlations with each other and BH decreased dramatically before second-stage surgery. Residual bone height (RBH) did not significantly influence BH changes, whereas smoking status and type of bone graft materials were the potentially influential factors. During the approximate three-year observation period, lSFE with a minimally invasive technique demonstrated high implant survival rate and limited bone reduction in grafted area. In conclusion, lSFE using minimally invasive techniques was a viable treatment option. Patients who were nonsmokers and whose sinus cavity was filled with deproteinized bovine bone mineral (DBBM) had significantly limited bone resorption in grafted area.

The Impact of Sinus Floor Elevation Techniques on Sinus Membrane Perforation: A Systematic Review and Network Meta-analysis.

Purpose: To compare the risk of sinus membrane perforation (SMP) among lateral window sinus floor elevation (LSFE) and transcrestal sinus floor elevation (TSFE) techniques in prospective and retrospective studies for patients who underwent sinus augmentation for dental implant placement. Materials and Methods: A database search was conducted to screen the literature published from January 1960 to August 2021. The associations between SMP and surgical techniques as well as other clinical factors were evaluated via network meta-analysis. The impact of SMP on vertical ridge gain and implant survival was also evaluated. Results: Eighty-five studies with 5,551 SFE procedures were included. In LSFE techniques, using rotary burs showed the highest risk of SMP (surface under the cumulative ranking area [SUCRA] = 0.0745). In TSFE techniques, using reamers had the lowest risk of SMP (SUCRA = 0.9444). Increased SMP prevalence was significantly associated with reduced implant survival rate (odds ratio [OR] = 0.45 per 10% increase of SMP rate [95% credible interval (CreI): 0.21, 0.71], P < .001). Conclusions: With the inherent limitations, this network meta-analysis suggested that some techniques within either the LSFE or TSFE group may reduce SMP risk. Additional randomized controlled trials and better assessment of SMP are required to directly compare the risk of SMP between LSFE and TSFE.

Six-year extension results of a randomized trial comparing transcrestal and lateral sinus floor elevation at sites with 3-6 mm of residual bone.

To comparatively evaluate the 6-year outcomes of transcrestal and lateral sinus floor elevation (tSFE and lSFE, respectively). The 54 patients representing the per-protocol population of a randomized trial comparing implant placement with simultaneous tSFE versus lSFE at sites with a residual bone height of 3-6 mm were invited to participate in the 6-year follow-up visit. Study assessments included: peri-implant marginal bone level at the mesial (mMBL) and distal (dMBL) aspects of the implant, proportion of the entire implant surface in direct contact with the radiopaque area (totCON%), probing depth, bleeding on probing, suppuration on probing, and modified plaque index. Also, the conditions of the peri-implant tissues at 6-year visit were diagnosed according to the case definitions of peri-implant health, mucositis, and peri-implantitis from the 2017 World Workshop. Forty-three patients (21 treated with tSFE and 22 treated with lSFE) participated in the 6-year visit. Implant survival was 100%. At 6 years, totCON% was 96% (IR: 88%-100%) in tSFE group and 100% (IR: 98%-100%) in lSFE group (p = .036). No significant intergroup difference in patient distribution according to the diagnosis of peri-implant health/disease was observed. Median dMBL was 0.3 mm in tSFE group and 0 mm in lSFE group (p = .024). At 6 years following placement concomitantly with tSFE and lSFE, implants showed similar conditions of peri-implant health. Peri-implant bone support was high in both groups and was slightly but significantly lower in tSFE group.

Lateral sinus floor elevation with simultaneous mucosal cysts management

Introduction. Specialists in the field often face uncertainty in deciding whether to perform sinus lifting surgery in the presence of a mucosal cyst during the pre-implantation preparation of patients with maxillary sinus pathology. While some specialists believe that the sinus lifting operation cannot be performed in the presence of sinus pathology and should be resorted to after a long period of healing, others believe that it can be performed in the presence of sinus pathology or simultaneously with sinus sanitation. As a result, there are more controversies about the treatment tactics, stages, and timing required to achieve the rehabilitation of these patients, demonstrating the significance of the problem at hand. Materials and methods. The study included twenty patients who were referred to the Department of OMF Surgery and Oral Implantology “Arsenie Guţan” and the dental clinic “OmniDent” between 20.06.2016 and 01.01.2019 for implant-prosthetic rehabilitation due to partial edentulism in the upper jaw in the lateral area and the presence of a mucosal cyst in the maxillary sinus. The first group comprised of seven patients in whom the mucosal cyst was completely removed while simultaneously undergoing lateral sinus lifting. The second group consisted of five patients, aged between 18 and 67 years (average 45 years), who underwent marsupialization of the mucosal cyst. The third group comprised of six patients in whom the cyst content was only aspirated, without removal or marsupialization of the cyst. Results. All three methods were found to be effective, although total perforations of the sinus mucosa were recorded in the first two groups, preventing the performance of sinus lifting at that stage. The method of aspirating the cystic content, however, is a simple and low-risk procedure that does not carry the risk of perforating the sinus membrane and provides predictable results. Conclusions. The mucosal cyst does not present a contraindication to sinus lifting but requires additional surgical procedures.

Digitally-Guided Lateral Sinus Floor Elevation with Simultaneous Implant Placement: Three Case Reports with Technical Considerations.

A sinus floor elevation via lateral window (LSFE) is one of the most widely used bone augmentation procedures for implant therapy in the posterior area of the maxilla. Locating and preparing a correct opening window on the lateral sinus wall is a key step of this procedure. Conventionally, the surgeon design and locate the window after the flap is reflected based upon the information obtained from cone-beam computed tomography (CBCT) images or other diagnostic aids. Nevertheless, in spite of the advancements in CBCT imaging, clinicians may still experience hardship in situating and procuring meticulous access to the maxillary sinus by using CBCT alone. Therefore, in cases requiring a LSFE simultaneous to implant placement, a maxillary sinus surgical guide (MSSG) has been tested and reported to be the amiable method to be utilized as a conjunct, to prevent unpredictable consequences according to its application in implying both the direction for the implant and the location of the lateral window. This article presents 3 clinical cases with a fully digital approach to guide the opening of the lateral wall of the maxillary sinus, as well as the simultaneous placement of a single implant in an ideal 3D position. Based on the CBCT images and intraoral scan, a surgical guide was fabricated base on 3D software. During the surgery, this teeth-supported template can be placed intraorally, guiding sinus window opening preparation. This technique makes the sinus window opening procedure simple and predictable, reduces surgical time as well as the risk of complications, and allows the placement of the implant in the ideal 3D position.

A Retrospective Evaluation of the Clinical Outcome of Dental Implants Following Maxillary Sinus Augmentation with and without Bone Grafting

The reintegration of partial edentulism patients is the utmost common treatment performed by dental practitioners in relations of frequency &amp; occurrence, even though the general decline in tooth loss seen in recent times. There is broad agreement among dental professionals that osseointegrated implant-supported prostheses are the preferred method for replacing an edentulous gap caused by one or more lost teeth. These implants have been shown to provide several benefits for both physical and mental health. Objectives: The current retrospective study sought to define and assess the 60 months follow-up of implants inserted in patients who needed sinus floor elevation surgery in the maxillary arch. Following a single-stage surgical method with delayed implant insertion, the impact of various RABH &amp; the usage of graft and graft less methods were evaluated. Methodology: Patients chosen for the current retrospective study were selected from the data-based logbooks kept by the oral surgery department between January 2017 and December 2022. All patients who had concomitant lateral sinus floor elevation &amp; implant insertion from the same department were evaluated in the current study after obtaining formal approval from the IRB of the institute. Results: 86 grafted sinuses received a sum of 239 implants, each assessing 10 &amp; 12 millimeters in length and 4 or 5 mm in breadth. Specific measurements revealed that the majority were 4 mm broad &amp; 10 mm long. Using a manual torque wrench, it was determined that all implants, regardless of size, attained an insertion torque of &gt;35 Ncm at the moment of implantation. In 41 patients, xenograft was employed, corresponding to 60 sinuses; in contrast, in 45 patients, graft-less surgery was performed, corresponding to 62 sinuses. An average follow-up of 43 months was used. Conclusion: Maxillary sinuses with a RABH of more than four millimeters can be effectively transplanted using a single-stage xenograft technique. One-stage graft-less surgeries with blood clot alone &amp; swift implant implantation should only be used in sinuses with a RABH &gt; 6 mm since they have lower success rates. Practical Implication: The following study will help oral surgeon in choosing the surgery carried out for the implant placement involving the sinuses. Keywords: Dental Implants, Bone Replacements, Sinus Augmentation, Grafting Materials

Effect of Maxillary Sinus Anatomy on Bone Gain After Lateral Window Sinus Floor Elevation: A Case-Control Study

Purpose: To evaluate the effect of maxillary sinus anatomy on sinus floor elevation (SFE) operations performed with the lateral window approach. Materials and Methods: CBCT and digital panoramic radiographs were evaluated before and at least 6 months after maxillary sinus floor elevation (SFE) operations performed in 33 maxillary sinus regions in 26 patients. Maxillary sinus volume, grafted volume (GV), sinus width (SW), residual bone height (RBH), and vertical graft resorption (VGR) were calculated. The effects of RBH and SW on GV and VGR were evaluated statistically. Results: The mean GV values in the maxillary sinuses classified as narrow, average, and wide were 2.60 ± 0.57, 3.44 ± 0.65, and 3.70 ± 0.64 cm3, respectively. The mean VGR was 2.12 ± 1.67 mm, and in the sites classified as narrow, average, and wide, the mean VGR values were 1.50 ± 0.79, 1.58 ± 1.28, and 3.46 ± 2.06 mm, respectively. A statistically significant difference in GV and VGR was found between the SW groups. The mean posterior maxillary RBH was 2.30 ± 1.05 mm, and 17 and 16 sinuses were classified as ≤ 2 and > 2 mm, respectively. There was no statistically significant difference in the effect of RBH on GV or VGR. Conclusion: Although posterior maxillary RBH did not affect new bone formation in the sinuses grafted only with hydroxyapatite-derived inorganic bovine bone, with increasing SW, the GV decreased and the VGR increased.

Less Invasive Window Repositioning Technique for Sinus Floor Elevation: A Clinical and Radiographic Study

To determine whether a less invasive window repositioning technique could provide a feasible, safe, and reliable lateral sinus augmentation. The less-invasive window repositioning technique using a piezoelectric saw was performed on adult patient candidates for lateral sinus floor elevation. The augmented bone height (primary outcome variable), bone length, and posthealing outcome variables were evaluated to determine the augmentation adequacy, safety, and reliability of this technique overall and in one- and two-implant groups with different window dimensions. Data were analyzed using descriptive statistics, chi-square test, and Pearson correlation analysis. P < .05 was considered significant. A total of 50 consecutive sinus floor elevations with simultaneous placement of 66 implants (one-implant: 34, two-implant: 16) were performed on 44 subjects (72% men) with a mean age of 46.7 ± 10.3 years and followed for a mean of 13.28 ± 3.5 months. The overall, one-implant, and two-implant group mean window sizes were 31.38 ± 6.78 mm2, 28.38 ± 4.2 mm2, and 37.75 ± 6.88 mm2, respectively. The mean overall augmented bone height and length were 12.3 ± 1.04 mm and 19.67 ± 2.01 mm, respectively. The mean window size was significantly smaller in the one-implant group versus the two-implant group (P < .001). However, there was no correlation between window size and augmented bone height (r = -0.9, P = .54) and length (r = 0.05, P = .68). The posthealing outcome variables showed perfect window integration without soft tissue ingrowth. Six sinus perforations (12%) during membrane elevation that were not related to window osteotomy were observed and were appropriately managed. The less-invasive window repositioning technique is feasible, safe, and reliable for appropriate sinus augmentation in height and length. The reduction of window dimension does not influence the feasibility, augmentation adequacy, and surgical safety and does not increase surgical risks or membrane perforation. The repositioned window showed proper integration. Also, sinus floor elevation through this technique is an experience-based surgery that requires delicate instruments.

Risk factors and longitudinal regenerative outcomes of sinus membrane perforation during lateral window sinus floor elevation: A retrospective analysis up to 9 years.

Lateral-window sinus floor elevation (LSFE) is a reliable procedure to reconstruct the posterior maxilla for implant therapy. This retrospective study aimed to investigate risk factors associated with Schneiderian membrane perforation (SMP) occurrence during LSFE and longitudinal regenerative outcomes following LSFE up to 9 years. Patients who had LSFE between 2010 and 2019 were included. All demographic and surgical-related data were retrieved from existing electronic health records. Radiographs were used to evaluate the vertical dimensional changes of ridge and graft materials and the potential anatomic factors of SMP. A total of 122 LSFE procedures in 99 patients were included in the study. Mean ridge height gain and graft shrinkages were 9.5±3.47 and 1.57±2.85mm. The influence of the healing period on graft shrinkage showed a positive trend; the longer the healing period, the greater the graft shrinkage (p=0.09). The pathology in the sinus showed a positive correlation with SMP (p=0.07). However, other anatomical factors did not negatively impact SMP and subsequent ridge height gain (p>0.05). With inherent limitation, the findings with up to 9 years of follow-up indicate a consistent ridge remodeling lasting for about 3 years after LSFE procedures. SMP or membrane thickening may not significantly affect the ridge gain following LSFE. The healing period had the most significant influence on graft shrinkage, showing that the longer the healing time between LSFE and implant placement, the greater the graft shrinkage.