Maxillary Sinus Floor Elevation Research Articles

Resorption Rates of Bone Graft Materials after Crestal Maxillary Sinus Floor Elevation and Its Influencing Factors.

The aim of this study is to analyze the resorption rate of bone graft materials after crestal sinus floor elevation, study its influencing factors, and improve the long-term success rate of implants after crestal maxillary sinus floor elevation. Measurement and analysis were conducted at six postoperative timepoints (0 months, 6 months, 12 months, 18 months, 24 months, and 30 months) using cone beam computed tomography (CBCT) data on 31 patients from the Chenghuaxinguanghua Dental Clinic who underwent crestal maxillary sinus floor elevation, involving 38 graft sites. The materials resorption rates of the bone graft height (BH) and bone graft width (BW) were assessed. BH and BW resorption rates followed the same trend (p = 0.07), with BH and BW resorption rates decreasing with time (rBH = -0.32, p < 0.01; rBW = -0.18, p < 0.01), and were maximal in the 0-6 month interval, with BH and BW resorption rates of 3.42%/mth and 3.03%/mth, respectively. The average monthly BH and BW resorption rates in the 6-12 month interval rapidly decreased to 1.75%/mth and 1.29%/mth, respectively. The monthly BH and BW resorption rates in the 12-30 month intervals stabilized at 1.45%/mth (p > 0.05) and 1.22%/mth (p > 0.05), respectively. The higher the initial bone graft height (BH0), the lower the BH resorption rates (rBH = -0.98, p < 0.05), and the BW resorption rate was different for different graft sites (p = 0.01). The resorption rates of bone graft materials implanted through crestal maxillary sinus floor elevation decreased rapidly within the first 12 months post operation and remained stable after 12 months. BH0 was identified as a significant factor influencing the resorption rates of bone graft materials. These results could suggest dentists should pay attention to the trend of resorption rates over time and carefully manage the initial height of bone grafts and inspire the research of new bone grafting materials for crestal maxillary sinus floor elevation.

Maxillary Sinus Floor Elevation and Simultaneous Implant Installation via Osseodensification Drills: A Retrospective Analysis of Bone Gain in 72 Patients Followed for 6 Months.

Background/Objectives: The aim of this retrospective study was to radiographically evaluate the endo-sinus bone gain (ESBG) following osseodensification procedures using CBCT and compare the results to more conventional sinus lifting techniques. Methods: A total of 72 patients underwent crestal sinus floor elevation procedures and were provided with 102 implants with a sand-blasted and acid-etched surface with microthreads (Medentika® Microcone Implants, Hugelsheim, Germany). Patients were divided into two groups; the osseodensification group (OD; n = 36) and the osseodensified augmentation group (ODA; n = 36). Results: The mean residual bone height (RBH) was 5.71 (1.77) and 4.30 (0.94) mm in the OD and ODA groups, respectively. An ESBG of 3.45 (1.18) and 5.74 (1.31) mm was observed in the OD and ODA groups, respectively, and as compared to the baseline RBH, the ESBG was statistically significant in both groups after 6 months (p < 0.001). Conclusions: Within the limits of this retrospective study, crestal sinus lifting with the osseodensification technique seems to be a fast, effective, and safe method. Longer follow-up studies with full intrasinus bone topography and structure analyses are needed to prove the success rate of endo-sinus bone gain.

Clinical evaluation of maxillary sinus floor elevation with or without bone grafts: a systematic review and meta-analysis of randomised controlled trials with trial sequential analysis.

Our goal was to systematically review the current evidence comparing the relative effectiveness of two maxillary sinus floor elevation (MSFE) approaches (internal and external) without bone grafts with that of conventional/grafted MSFE in patients undergoing implantation in the posterior maxilla. Medical databases (PubMed/Medline, Embase, Web of Science, and Cochrane Library) were searched for randomised controlled trials published between January 1980 and May 2023. A manual search of implant-related journals was also performed. Studies published in English that reported the clinical outcomes of MSFE with or without bone material were included. The risk of bias was assessed using the Cochrane Handbook Risk Assessment Tool. Meta-analyses and trial sequence analyses were performed on the included trials. Meta-regression analysis was performed using pre-selected covariates to account for substantial heterogeneity. The certainty of evidence for clinical outcomes was assessed using GRADEpro GDT online (Guideline Development Tool). Seventeen studies, including 547 sinuses and 696 implants, were pooled for the meta-analysis. The meta-analysis showed no statistically significant difference between MSFE without bone grafts and conventional MSFE in terms of the implant survival rate in the short term (n = 11, I2 = 0%, risk difference (RD): 0.03, 95% confidence intervals (CI): -0.01-0.07, p = 0.17, required information size (RIS) = 307). Although conventional MSFE had a higher endo-sinus bone gain (n = 13, I2 = 89%, weighted mean difference (WMD): -1.24, 95% CI: -1.91- -0.57, p = 0.0003, RIS = 461), this was not a determining factor in implant survival. No difference in perforation (n = 13, I2 = 0%, RD = 0.03, 95% CI: -0.02-0.09, p = 0.99, RIS = 223) and marginal bone loss (n = 4, I2 = 0%, WMD = 0.05, 95% CI: -0.14-0.23, p = 0.62, no RIS) was detected between the two groups using meta-analysis. The pooled results of the implant stability quotient between the two groups were not robust on sensitivity analysis. Because of the limited studies reporting on the visual analogue scale, surgical time, treatment costs, and bone density, qualitative analysis was conducted for these outcomes. This systematic review revealed that both non-graft and grafted MSFE had high implant survival rates. Owing to the moderate strength of the evidence and short-term follow-up, the results should be interpreted with caution.

Volume change after maxillary sinus floor elevation with apatite carbonate and octacalcium phosphate

PurposeMaxillary molars have low alveolar bone height diameter due to the presence of the maxillary sinus; thus, a sinus lift may be required in some cases. Changes in the volume of bone substitutes can affect the success of implant therapy. Therefore, this study aimed to compare the changes in the volume of two different bone substitutes—one based on carbonate apatite and the other on octacalcium phosphate—used in maxillary sinus floor elevation.MethodsNineteen patients and 20 sites requiring maxillary sinus floor elevation were included in the study. Digital Imaging and Communications in Medicine data for each patient obtained preoperatively and immediately and 6 months postoperatively were used to measure the volume of the bone grafting material using a three-dimensional image analysis software. The immediate postoperative volume of octacalcium phosphate was 95.3775 mm3 per piece of grafting material used. It was multiplied by the number of pieces used and converted to mL to determine the immediate postoperative volume.ResultsThe mean resorption values of carbonate apatite and octacalcium phosphate were 12.7 ± 3.6% and 17.3 ± 3.9%, respectively. A significant difference in the amount of resorption of the two bone replacement materials was observed (P = 0.04).ConclusionsThe results of this study indicate that both bone substitute materials tend to resorb. The two bone grafting materials that are currently medically approved in Japan have not been in the market for a long time, and their long-term prognosis has not yet been reported. Further clinical data are warranted.

A Comprehensive Clinical Review of Maxillary Sinus Floor Elevation in Patients with Well-Defined Faintly Radiopaque Lesions in the Antrum.

Well-defined, faintly radiopaque lesions are occasionally observed in the antrum of the maxillary sinus in asymptomatic patients during maxillary sinus floor elevation. These lesions are treated as antral pseudocysts (AP) based on the clinical diagnosis in some cases, and maxillary sinus floor elevation is performed without enucleating these lesions. However, further surgery is required after implant placement if the lesion is a mucocele, odontogenic cyst, or tumour. This comprehensive clinical review aimed to identify an appropriate approach for maxillary sinus floor elevation in patients with well-defined, faintly radiopaque lesions in the antrum based on our clinical experience.

Assessment of the osteogenic effect after maxillary sinus floor elevation and simultaneous implantation with or without bone grafts by analyzing trabecular bone parameters: a retrospective study.

The aim of this population-based retrospective study was to compare the osteogenic effect of newly formed bone after maxillary sinus floor elevation (MSFE) and simultaneous implantation with or without bone grafts by quantitatively analyzing trabecular bone parameters. A total of 100 patients with missing posterior maxillary teeth who required MSFE and implantation were included in this study. Patients were divided into two groups: the non-graft group (n=50) and the graft group (n=50). Radiographic parameters were measured using cone beam computed tomography (CBCT), and the quality of newly formed bone was analyzed by assessing trabecular bone parameters using CTAn (CTAnalyzer, SkyScan, Antwerp, Belgium) software. In the selected regions of interest, the non-graft group showed greater bone volume/total volume (BV/TV), bone surface/total volume (BS/TV), trabecular number (Tb. N), and trabecular thickness (Tb. Th) than the graft group (p<0.001). The non-graft group showed lower trabecular separation (Tb. Sp) than the graft group (p<0.001). The incidence of perforation and bleeding was higher in the graft group than in the non-graft group (p<0.001), but infection did not significantly differ between groups (p>0.05). Compared to the graft group, the non-graft group showed lower postoperative bone height, gained bone height and apical bone height (p<0.001). MSFE with and without bone grafts can significantly improve bone formation. In MSFE, the use of bone grafts hinders the formation of good quality bone, whereas the absence of bone grafts can generate good bone quality and limited bone mass.

Histomorphometric Comparison of Bio-Oss vs. Osteodens in Maxillary Sinus Floor Elevation Procedures

Introduction: The loss of dental elements can lead to excessive bone loss in the posterior maxillary segments, which can limit the placement of dental implants in that area, the pneumatization of the maxillary sinus and the absence of dental elements to keep the bone active are some of the main causes. Among the wide range of available grafting materials, bovine hydroxyapatite has been extensively studied and has shown excellent clinical and histological results. Materials and methods: A total of 17 maxillary sinus floor elevations were performed (n = 8 Osteodens, n = 9 Bio-Oss). After a healing period of 6 to 8 months, a block of the grafted area was obtained using trephines and analyzed by histomorphometry. Results: The percentage of neoformed bone tissue was higher for Bio-Oss (39.0% ± 11.1) compared to Osteodens (33.4% ± 8.3), while the remaining graft values were slightly lower in Bio-Oss compared to Osteodens (16.3% ± 11.2 and 20.8% ± 12.1, respectively). The proportion of connective tissue was similar in both groups (44.7% Bio-Oss and 45.8% Osteodens). Age, gender, and residual height of the sinus floor did not show statistically significant differences. Conclusions: In this study, both graft materials (Bio-Oss and Osteodens) showed no statistically significant differences in their ability to regenerate suitable bone tissue for implant placement after 6 months of healing. Further studies with a larger sample size are needed to validate these results.

Efikasiteti i aplikimit të plazmës të pasuruar me trombocite (PRP) si graft autolog në procedurën kirurgjikale për ngritjen e fundit të sinusit maksilar për vendosjen e implanteve dentare

Placement of dental implants in the upper jaw can pose difficulties due to insufficient bone volume caused by si- nus pneumatization and physiological bone resorption. The aim of this study was to evaluate the impact of using autologous platelet-rich plasma as a graft material for si- nus lift procedures. The mean height of the alveolar bone between the floor of the maxillary sinus and the alveolar crest was 2.50 ± 0.73 mm preoperatively, 16.90 ± 1.93 mm post-surgical procedure, and 14.4 mm after 6 months (p &lt; 0.05). There were statistically significant differences in the changes of the values of the most mesial and distal distances in the augmented region. The average dimen- sions of the placed dental implants were 10 mm in length and 3.98 mm in diameter, with 88% high primary stabili- ty in the placed implants and 100% implant survival after a 6-month period. The application of platelet-rich plasma in maxillary sinus floor elevation procedures yields good results in terms of new bone formation, implant osseointe- gration, and positive clinical outcomes. However, further research is needed over a longer time interval to better understand the role and potential of this autogenous graft material in regenerative dentistry.

Research Progress on Titanium Implants for External Maxillary Sinus Augmentation

In patients with missing maxillary posterior teeth, the negative pressure generated by breathing leads to an increase in the gasification of the maxillary sinus cavity, as well as the absorption of alveolar bone due to the lack of physiological stimulation due to missing teeth. This often leads to insufficient bone height during implant restoration in the maxillary posterior tooth area, and maxillary sinus floor elevation surgery can effectively solve this problem. At present, there are two main techniques for lifting the maxillary sinus floor: internal lifting through the top of the alveolar ridge approach and external lifting through the lateral wall approach. Among them, the maxillary sinus alveolar ridge lifting surgery is widely used due to its advantages of small wound size, short surgical time, fewer postoperative complications, low cost, and easy acceptance by patients. With technological innovation, the indications for maxillary sinus floor elevation surgery have gradually expanded to cases with residual bone height (RBH) greater than 2 mm.

The transalveolar approach with the small segmentation method for inclined maxillary sinus floor elevation: A retrospective study.

To evaluate the clinical outcome of the transalveolar approach with the small segmentation method for inclined maxillary sinus floor elevation. Sixty-one patients with an inclined maxillary sinus floor (tilt angle ≥ 10°) and insufficient residual bone height in the posterior maxilla were included and grouped according to the tilt angle of the sinus floor, with group A having patients with the tilt angle ≥ 10° and ≤ 30° and group B having patients with the tilt angle > 30°. After completing sinus membrane elevation and bone augmentation using bone substitute materials, the implants were inserted at the same appointment, and the restoration was completed after 5-6 months of osseointegration. The preoperative sinus floor level and sinus floor elevation achieved postoperatively were assessed and recorded. At pre- and post-operative timepoints, the sagittal plane of the cone beam computed tomography was used to evaluate the bone height changes at the peak, middle and valley points in the slope segment intended for implant implantation. Osseointegration was evident in all 61 patients, and the final restoration was completed with functional loading. After assessing the normality and homogeneity of variance, two-sample t-test or nonparametric tests were employed to estimate the differences in the bone height changes. The degrees of freedom (df) for this analysis were 59. The elevation attained at the middle point in groups A and B were 6.71 ± 1.38 and 5.75 ± 1.56 mm, respectively, demonstrating a significant difference (p < 0.05). Furthermore, at the peak and valley points, group A exhibited bone height changes of 5.79 ± 1.74 and 6.06 ± 1.45 mm, respectively, compared to group B with changes measuring 4.63 ± 2.18 and 5.58 ± 2.39 mm, respectively, with no significant difference in the two groups (p ≥ 0.05). The prevalence of intraoperative sinus membrane perforation was assessed using the chi-square test. It was found that four cases in group A and five cases in group B experienced sinus membrane perforation, with no significant difference in the two groups (p ≥ 0.05, df = 1). The transalveolar approach using the small segmentation method suggests a promising approach for elevating the inclined maxillary sinus floor.

Research Progress of Maxillary Sinus Cyst and Maxillary Posterior Dental Region Implantation

The loss of single or multiple teeth in the maxillary posterior region usually leads to alveolar bone resorption, atrophy, and maxillary sinus cavity gasification, resulting in insufficient vertical bone height of the maxillary posterior alveolar bone, which brings great difficulties to tooth implantation. Maxillary sinus floor lifting is an important method to solve the posterior maxillary bone mass deficiency, which can be divided into internal lifting and external lifting. In order to avoid the occurrence of complications such as maxillary sinus mucosa perforation and facilitate the selection of surgical methods, it is particularly important to accurately understand the anatomical characteristics of maxillary sinus before surgery. Maxillary sinus cyst is the most common benign disease of maxillary sinus. It has always been considered as an absolute contraindication for maxillary sinus floor elevation bone grafting, which seriously restricts the possibility of maxillary sinus bone increment. This article reviews the research progress of maxillary sinus cyst and maxillary posterior dental implantation at home and abroad.

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.

Long-Term Safety of Bone Regeneration Using Autologous Stromal Vascular Fraction and Calcium Phosphate Ceramics: A 10-Year Prospective Cohort Study.

This prospective cohort study aimed to assess long-term safety, dental implant survival, and clinical and radiological outcomes after maxillary sinus floor elevation (MSFE; lateral window technique) using freshly isolated autologous stromal vascular fraction (SVF) combined with calcium phosphate ceramics. All 10 patients previously participating in a phase I trial were included in a 10-year follow-up. They received either β-tricalcium phosphate (β-TCP; n = 5) or biphasic calcium phosphate (BCP; n = 5) with SVF-supplementation on one side (study). Bilaterally treated patients (6 of 10; 3 β-TCP, 3 BCP) received only calcium phosphate on the opposite side (control). Clinical and radiological assessments were performed on 44 dental implants at 1-month pre-MSFE, and 0.5- to 10-year post-MSFE. Implants were placed 6 months post-MSFE. No adverse events or pathology was reported during a 10-year follow-up. Forty-three dental implants (98%) remained functional. Control and study sides showed similar peri-implant soft-tissue quality, sulcus bleeding index, probing depth, plaque index, keratinized mucosa width, as well as marginal bone loss (0-6 mm), graft height loss (0-6 mm), and graft volume reduction. Peri-implantitis was observed around 6 implants (control: 4; study: 2) in 3 patients. This study is the first to demonstrate the 10-year safety of SVF-supplementation in MSFE for jawbone reconstruction. SVF-supplementation showed enhanced bone regeneration in the short term (previous study) and led to no abnormalities clinically and radiologically in the long term.

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.

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.

Mucosal adhesion phenomenon after maxillary sinus floor elevation: A preclinical study.

To describe the histological events that occur after maxillary sinus floor elevation when the elevated and undetached sinus mucosa are in close proximity or in contact with each other. From 76 rabbits, 152 elevated maxillary sinuses were analyzed histologically. Sites without adhesions were classified as "No proximity," whereas the adhesion stages were divided into "Proximity," "Fusion," and "Synechia stages." The width of the pseudostratified columnar epithelium and the distance between the two layers of the elevated and undetached sinus mucosae were measured at various standardized positions. Thirty-one sites presenting with adhesions were found. Twelve sites were in the proximity stage," presenting cilia of the two epithelial layers that were shortened and interlinked within the mucous context. Hyperactivity of the goblet cells was also observed. In the other cases, the hyperplastic epithelium showed attempts to reach the contralateral mucosa. The 15 "fusion stage" sites presented regions with epithelial cells of the two mucosal layers that penetrated each other. Four sites presented "synechiae stages," represented by bridges of connective tissue connecting the two lamina propria. Close proximity or tight contact between the elevated and undetached mucosa adhering to the bone walls might occur after maxillary sinus floor elevation. This induced hyperplasia of the epithelial cells and adhesion of the two layers until synechiae formation.

Research Progress on Anatomical Structure of Alveolar Antral Artery

Alveolar antral artery is closely related to the bleeding of the maxillary sinus floor elevation. By reviewing the study of the alveolar antral artery, and analyzed the blood supply source, diameter, detection rate, relationship with bone wall and other characteristics of alveolar antral artery, so as to provide reference for avoiding alveolar antral artery injury in clinical practice.

How to avoid intraoperative and postoperative complications in maxillary sinus elevation.

Maxillary sinus floor elevation, via the lateral approach, is one of the most predictable bone augmentation procedures performed in implant dentistry. but both intra- and postoperative complications can occur, and some of them are severe. Our aim is as follows: To review the pertinent literature on the topic, especially assessing the risk factors related to complications. To give clinical recommendations to minimize intra- and postoperative complications with the ultimate scope of improving the standard of clinical care and patient safety.

A Study of Two Novel Techniques for One-stage Closure of Chronic Oroantral Fistula and Sinus Floor Lift.

This study aimed to compare two novel techniques for chronic oroantral fistula (OAF) closure combined with maxillary sinus floor elevation. Ten patients who had implant installation needs but suffered from a chronic OAF were enrolled in the study from January 2016 to June 2021. The technique applied involved OAF closure and simultaneous sinus floor elevation by either a transalveolar or lateral window approach. Bone graft material evaluation results, postoperative clinical symptoms and complications were compared between the two groups. Student's t -test and χ 2 test were used to analyze the results. In this study, 5 patients with a chronic OAF were treated with the transalveolar approach (group I), and 5 were treated with the lateral window approach (group II). The alveolar bone height was significantly higher in group II than in group I ( P ＜0.001). The pain at 1 day ( P =0.018) and 3 days ( P =0.029) postoperatively and facial swelling at 7 days ( P =0.016) postoperatively were obviously greater in group II than in group I. There were no severe complications in either group. The techniques combined OAF closure with sinus lifting to reduce surgical frequency and risks. The transalveolar approach resulted in milder postoperative reactions, but the lateral approach could provide more bone volume.

Techniques of Maxillary Sinus Floor Elevation

Posterior maxillary region is often limited for standard implant placement because of reduced residual vertical bone height. An elevation of the maxillary sinus floor is one option in solving this problem. This article describes the various surgical techniques that can be used to enter the sinus cavity, elevating the sinus membrane and placing the bone grafts for placement of dental implants in the resorbed posterior maxillary region.