Maxillary Sinus Lift Procedures Research Articles

Maxillary Sinus Lift Procedures: An Overview of Current Techniques, Presurgical Evaluation, and Complications.

A maxillary sinus lift procedure is indicated if a dental implant needs to be placed in the posterior maxilla with limited bone available to accommodate a dental implant. Both open and closed sinus lifting procedures are reliable approaches for increasing the bone volume needed to support proper implant positioning. However, these methods can lead to several complications. In addition to the general complications commonly linked to oral surgery, such as swelling or hematoma, the primary complication in open sinus lifting is typically the perforation of the Schneiderian membrane during osteotomy. Detailed and extensive presurgical evaluation is crucial to minimize such complications. The objective of this study was to delineate contemporary trends in sinus lift surgery, with a specific emphasis on different techniques of sinus lift procedure, anatomical and surgical factors, presurgical evaluation, bone grafting, and the practical implications of these factors in implant dentistry cases involving a deficient posterior maxilla. In conclusion, while both osteotome and lateral window techniques can assist clinicians in addressing the complexities of implant placement in a deficient posterior maxilla, bone height before implantation remains a critical factor in determining the success and longevity of implants.

Simultaneous Implant Placement and Sinus Lift Using Leukocyte-Platelet Rich Fibrin: A Retrospective 40-Month Study.

The aim of this study was to report the 40-month clinical radiographical outcomes of maxillary sinus floor augmentation using leukocyte-platelet rich fibrin (L-PRF) as a single graft in combination with immediately placed implants. Twenty partially edentulous individuals with missing teeth in the region associated to maxillary sinus were included in this retrospective study. A lateral sinus floor elevation was performed considering a complete wear of the bone wall of the maxillary sinus and immediately placing the implant and filled the maxillary sinus with L-PRF clots as a single graft. After 5 months, all the implants received single screwed implant-supported prostheses. Subsequent evaluation was every 4 months assessing the success rate and biological complications. Two maxillary sinus membrane were perforated and covered with L-PRF clots. The mean bone height gain was 62.6%, observing a 100% of success and that in all the cases achieved at least the implant height. In conclusion, the use of platelet-rich fibrin clot as a single graft biomaterial during the maxillary sinus lift procedure combined with immediate implant placement may be a reliable clinical alternative, even to repair the sinus membrane.

Maxillary sinus lift using osteotomes: An indirect approach for implant placement in atrophic posterior maxilla

The maxillary posterior edentulous region presents many challenges in implant dentistry. Deficient alveolar ridges often jeopardize the placement of implants in posterior maxilla. This problem mostly occurs when due to ridge resorption, sinus pneumatization is encountered. The procedure of choice is the elevation of the floor of the sinus with the use of the osteotome technique so as to increase the alveolar ridge height for the placement of implant. The purpose of this case report is to demonstrate indirect maxillary sinus lift procedure through alveolar crest using osteotomes to prevent perforation of sinus lining during implant placement and restoring the implants using early loading protocol.

Demineralized freeze-dried bone allograft vs biphasic calcium phosphate: A comparison of two graft materials in sinus augmentation procedures - A pilot study

ObjectiveTo compare the bone quality histologically and radiologically using two graft materials i.e. demineralized freeze-dried bone allograft (DFDBA) and biphasic calcium phosphate (BCP) along with platelet-rich plasma (PRP) as an adjuvant in both; for bilateral maxillary sinus lift procedures. Material and methodsThis split mouth pilot study consisted of 5 healthy patients who required bilateral sinus lift procedures in 10 sites. Allocation concealment for site selection was done. Site A was DFDBA with PRP and site B was BCP with PRP. Evaluation of bone density was done as per Misch criteria-preoperatively and 6 months postoperatively with CBCT scans. 6 months after the augmentation procedure, implants were placed and a trephine drill biopsy was taken, for histological evaluation of bone quality. Patients were followed up for 18 months after implant placement. ResultsFive patients with a mean age of 47 ± 9.27 years (range of 35–60 years) underwent 10 maxillary sinus augmentation procedures. Radiologically, the bone density showed no statistically significant differences between site A: D4 and site B: D5; pre and post operatively. Histologically, the average value calculated for the percentage of marrow spaces was: site A, mean 40.92 ± 2.41 SD; site B mean: 31.48 ± 7.97 SD (t = 2.56, p = 0.03). The architecture of bone formed for all the 5 cases at site A was 100% trabecular pattern of bone, site B had 40% trabecular pattern of bone and 60% compact bone formation. ConclusionDemineralized freeze-dried bone allograft with platelet rich plasma exhibited a superior quality of bone formation and a higher percentage of marrow spaces, it satisfied and met the evaluation parameters for bone quality. Clinical relevance: The conclusive findings of this research could guide clinicians towards utilising the amalgamation of DFDBA and PRP for bone augmentation procedures-as a safe and dependable option.

A comparative evaluation of bone regeneration using mesenchymal stem cells versus blood coagulum in sinus augmentation procedures.

Objective:The present study evaluated the quality and quantity of new bone formation in the maxillary sinus lift procedures and stability of implants in posterior atrophic maxilla.Materials and Methods:This prospective randomized controlled split-mouth study included 20 patients (16 males and 4 females having a mean age of 36.7 years) having atrophic maxilla. They were divided randomly into two groups: Group A using mesenchymal stem cells and Group B into blood coagulum. They were radiographically evaluated using cone-beam computed tomography (CBCT) for residual bone height preoperatively and availability of new bone formation around implants, density, and stability of implants 6 months postoperatively.Results:The placement of dental implants in posterior maxilla is challenging due to rapid resorption of alveolar bone after extraction of teeth due to pneumatization of maxillary sinuses. In both the groups, more pain and swelling were observed in the 2nd postoperative day which gradually decreased over a period of 7 days. Membrane perforation occurs in only four cases (20%). A significant gain in alveolar bone height was observed in Group A (7.69 mm ± 2.5 mm) and Group B (9.32 mm ± 2 mm) after 6 months. On comparing both the groups, there is a similar significant increase in bone density in Hounsfield units postoperatively at various levels buccally and palatally. Total 40 sinuses were lifted and 42 implants were placed, respectively. All implants showed primary stability.Conclusions:Such findings provide a significant contribution in future perspective studies that the use of stem cells had the same success rate as blood coagulum.

Classification and Management for Safer and More Predictable Maxillary Sinus Lift Procedure

Classification and Management for Safer and More Predictable Maxillary Sinus Lift Procedure

Maxillary Sinus Lift Procedure Efficacy and Adversities: A Review Article

Maxillary Sinus Lift Procedure Efficacy and Adversities: A Review Article

Bone Formation After Maxillary Sinus Floor Elevation Using Titanium Mesh Versus Titanium Screws Without Any Graft Material: A Preliminary Study

Aim: The purpose of the present study is to evaluate the bone volume and quality formed following graftless maxillary sinus lifting through lateral window approach to compare the efficiency of the use of titanium screws versus the use of titanium mesh in preserving the space below the uplifted maxillary sinus membrane allowing for stable blood clot formation in severly atrophied posterior maxillary ridge. Subjects and Methods: The current study include 10 maxillary sinuses, The study patients were partially or completely edentulous in the posterior maxilla and required unilateral or bilateral maxillary sinus augmentation. All patients were selected from the out-patient clinic of Oral and Maxillofacial Surgery Department, faculty of oral and dental medicine, Cairo University. Results: The sinuses were divided into two equal groups (study and control groups), both groups underwent maxillary sinus lift procedures using either space-maintaining titanium screws for the study group or space-maintaining titanium mesh for the control group. The study was a double blind one (participants and outcome assessors were blinded throughout the study). Conclusion: application of titanium mish with micro screws to support the sinus membrane was easier clinically than using long titanium screws alone, as the accessibility and direction of drilling was more difficult when long titanium screws were used

Techniques and Graft Materials used in Maxillary Sinus Lift Procedure for Dental Implant Placement – A Review

Maxillary sinus is the first paranasal sinuses to develop, which is pyramidal in shape and it completes developing around 20 years of age with the eruption of the maxillary third molars. Pneumatization of the maxillary sinus occurs with time. Tooth loss may lead to loss of bone density, atrophy of bone and further pneumatization of the maxillary sinus leading to insufficient quality and quantity of bone for placing implants. Despite lots of literature and research being done, there is no clarity in obtaining consensus regarding the techniques and materials used in maxillary sinus lift procedures. This article reviews the various techniques and bone graft materials used in maxillary sinus lift procedures. The techniques include lateral window approach, hydraulic sinus lift technique, Piezoelectric Surgery technique, Transcrestal Approach, Osteotome Technique, and Balloon elevation technique. It can be concluded that the balloon antral elevation technique and Hydraulic Sinus Lift technique are more efficient techniques for maxillary sinus lift procedures. These techniques are known to result inless perforations, less chair-side time, comparatively easier, and the need for elaborate instrumentation is minimized. It can also markedly increase the success rates of implants in contrast to the conventional techniques which pose greater risks to the patient, more soft tissue trauma, more chair-side time and can expose patients to infections.

Histologic, Histomorphometric, and Clinical Analysis of the Effects of Growth Factors in a Fibrin Network Used in Maxillary Sinus Augmentation.

This randomized controlled clinical trial evaluated the effect of mineralized plasmatic matrix (MPM), comprised of synthetic graft and platelet concentrates, on new bone formation and volume stability over time in maxillary sinus lifting (MSL). Unilateral MSL was performed in 20 patients with either beta-tricalcium phosphate (β-TCP) or MPM grafts (10 sinuses each). Six months postsurgery, specimens were obtained with a trephine bur prior to implant placement in 39 cases. Volumetric changes in sinus augmentation were analyzed between 1 week (T-I) and 6 months (T-II) postsurgery. Histomorphometric and histological analyses of biopsy samples revealed mean new bone percentages of 35.40% ± 9.09% and 26.92% ± 7.26% and residual graft particle areas of 23.13% ± 6.16% and 32.25% ± 8.48% in the MPM and β-TCP groups, respectively (p < 0.05). The mean soft-tissue areas in the MPM and β-TCP groups were 41.48% ± 8.41% and 40.83% ± 8.86%, respectively (p > 0.05). Graft reductions between baseline and 6-months postprocedure in the β-TCP and MPM groups were 17.12% ± 13.55% and 14.41% ± 12.87%, respectively, with significant graft volume reduction observed in both groups (p < 0.05) while there is no significant difference between MPM and β-TCP groups (p > 0.05). Thus, MPM, representing growth factors in a fibrin network, increases new bone formation and has acceptable volume stability in MSL procedures

Automatic three-dimensional analysis of bone volume and quality change after maxillary sinus augmentation.

Maxillary sinus augmentation is a widely used surgical procedure to increase the bone volume before implant placement. In order to predict the stability of the implant, analysis of the change in bone volume and quality after a sinus graft procedure is necessary. The purpose of this study was to analyze the change in volume and quality of bone graft material after maxillary sinus augmentation using cone beam computed tomography (CBCT). Maxillary sinus lift procedures using bovine bone materials (Bio-Oss, Geistrich, Swiss) without immediate implantation were performed at the Pusan National University Dental Hospital in 22 patients, from 2014 to 2017. CBCT images were captured before surgery (T1), a day after surgery (T2), and after 4 to 7 months at follow-up (T3). The T2 and T3 images were registered to the T1 image using histogram matching and intensity-based registration. A total of 30 sinuses were analyzed three-dimensionally (3-D), using self-made software MATLAB 2018a (MathWorks, Natick, Massachusetts). The volume and structural indices of the bone graft material were measured and analyzed. The average volume of graft material showed a decrease, while the average gray value showed an increase during the follow-up period, but these changes were not statistically significant. The structural indices of the graft material after histogram matching showed a significant difference in homogeneity, connectivity, thickness, and roughness at the postoperative follow-up. The volume and gray value showed no statistically significant changes after the maxillary sinus lift procedures. The results of this study show that structural analysis using histogram matching can be used as a promising tool to analyze the quality of graft materials.

Autologous Fibrin Glue With Collagen Carrier During Maxillary Sinus Lift Procedure.

This study aimed to describe the use of autologous fibrin glue (AFG) with a collagen carrier during maxillary sinus lift procedures with immediate implants during 3 years of follow-up. Twelve patients who had lost their teeth in the region associated to maxillary sinus, with a bone remnant 3 to 5 mm in height, were selected to perform a maxillary sinus augmentation with AFG and collagen membrane, placing the implant immediately. After 5 months, the implants were connected and rehabilitated. The patients were followed-up for a 3-year period, being evaluated every 6 months. At the end of the 3-year follow-up period, 100% implant success was observed, with a mean of bone augmentation of 7.75 mm. Three maxillary sinus membranes were perforated and healed by using AFG and collagen membrane without identify any complication during the follow-up period. Finally, the use of collagen carrier combined with AFG as a filling material during the maxillary sinus lift procedure may be a low-cost and reliable alternative that allows bone formation.

Density of bone formed after sinus augmentation with Nanobone versus that of bone formed after sinus lift with tenting technique : Preliminary study

Aim: Comparing the density of bone formed after sinus lifting and augmentation with Nanobone graft to that of the newly formed bone after non-augmented sinus lifting with tenting technique.Materials and Methods: A total of 12 maxillary sinuses requiring lifting and augmentation procedures were divided into two groups: Group 1: comprised six patients in which grafted maxillary sinus lifting with Nanobone graft procedures were performed, Group 2: comprised six patients in which non-grafted maxillary sinus lifting procedures were performed.Simultaneous implant placement was performed in both groups. Implants were left for six months after placement in bone to ensure complete osseointegration before loading.Results: Immediately post-operative, after 6 months and after 9 months, the mean bone density of grafted group showed statistically significantly higher value than non grafted group. This is due to the continued bone formation in the grafted group.Conclusion: There is significant increase in density of bone formed after augmented sinus lifting with Nanobone more than that of newly formed bone after non-augmented sinus lifting in the first nine months after the maxillary sinus lifting operation with simultaneous implants placement.

Histological analysis of the use of biphasic ceramics based on hydroxyapatite and β-tricalcium phosphate in maxillary sinus floor elevation surgery: pilot study

Abstract Objective To evaluate the bone repair associated with the use of biphasic ceramics based on hydroxyapatite and β-tricalcium phosphate (HA/TCP) in the procedures of maxillary sinus membrane elevation in human beings. Material and method Ten patients with a residual bone ridge in the posterior maxillary region between 3 mm and 5 mm in height were selected and indicated for procedures of bone grafting associated with maxillary sinus lift procedure. The maxillary sinuses were filled with HA/TCP, and after 8 months, the implants were implanted and a bone biopsy was collected with the aid of a trephine drill, which was then submitted to histological analysis for the evaluation of the composition of the grafted area. Result The histological description analysis of the biopsies revealed the presence of vital and immature bone tissue, juxtaposed to the biomaterial. Histomorphometric analysis showed that the biopsy composition was in average 28.8%, 27.4%, and 43.6% of bone tissue, biomaterial, and soft tissue, respectively. Conclusion The areas grafted with HA/TCP presented the adequate amount of bone formation that allowed the implantation of the implants. The success of the grafting procedure with this biomaterial was associated with its osteoconduction potential that allowed the formation of bone tissue in close contact with HA/TCP.

Molecular, Cellular and Pharmaceutical Aspects of Bone Grafting Materials and Membranes During Maxillary Sinus-lift Procedures. Part 1: A General Overview.

Sinus augmentation procedure has been demonstrated to be a highly predictable treatment in posterior maxilla atrophy. All the surgical interventions in the maxillary region require deep knowledge of anatomy and possible anatomical variations. In this article, pre-operative and post- operative assessments of sinus cavity as well as novel approaches to deepen our knowledge of the behavior of bone substitute materials are described. The awareness of the patient's morphologic conditions enables exact planning of invasive surgery and aids to avoid complications. Pre- operative radiologic evaluation of the region before sinus lift is advisable both for a planning of the sinus augmentation and for selection and alignment of the optimum placement of implants. On the orthopantomography it is possible to measure the vertical dimension of graft, but not the volume and 3D changes. Cone-beam computed tomography (CBCT) has become the "gold standard" to plan a comprehensive implant treatment and to achieve a post-operative assessment. A computer-aided design/computer-aided manufacturing (CAD/CAM) technique is proposed to produce custom-made block grafts for sinus lift procedure, and a customized cutting guide to accurately place the lateral wall and ease membrane elevation. This procedure allows to reduce intervention time, to precisely adapt the scaffold, to reduce risk of complications and to improve operation quality. Recently, a novel approach has been used to deepen our knowledge of the behavior of BSBs: by means of synchrotron micro-tomography (SCT). It is a 3-D analyzing method, suitable to examine the dynamic and spatial arrangement of regenerative phenomena in complex anatomical structures such as bone, where tissues with several morphologies (alveolar process, unmineralized extracellular matrix, regenerated vessels, etc.) compete to achieve the final goal of bone regeneration.

Molecular, Cellular and Pharmaceutical Aspects of Bone Grafting Materials and Membranes During Maxillary Sinus-lift Procedures. Part 2: Detailed Characteristics of the Materials.

Various grafts or combination of bone substitute materials have been used in sinus lift procedures. Currently, ongoing developments in several disciplines, from molecular biology and chemistry to computer science and engineering, have contributed to the understanding of biological processes leading to bone healing after the use of bone substitute materials (BSBs) and therefore of the behavior of BSBs. The understanding of the properties of each graft enables individual treatment concepts and therefore allows shift from a simple replacement material to the modern concept of an individually created composite biomaterial. Indeed, the choice of the best BSB still remains crucial for success in maxillary sinus augmentation procedures. The present article provides an overview of most of the materials currently available for sinus lift, with a specific focus on their histological, molecular, cellular and pharmaceutical aspects.

Three-Year Clinical and Radiographic Implant Follow-up in Sinus-Lifted Maxilla With Lateral Window Technique.

The aim of this study was to evaluate retrospectively the 3-year outcome of implants placed in augmented maxillary sinuses with minimal residual alveolar bone heights (≤3 mm). A total of 28 sinus floors were augmented with xenograft, and 58 implants were placed. The outcome measures were implant success based on implant stability and the absence of periimplantitis, and marginal and apical bone resorption on periapical radiograph and prosthesis survival. Fifty-seven of 58 implants with their prostheses remained functional with a success rate of 98.28%. None of the implants showed any signs of mobility or periimplantitis. Both apical and cervical bone resorption around the implants were highest by the end of the first year. The success rate of the implants placed with staged approach in augmented maxillary sinuses with the residual alveolar bone height of ≤3 mm was high in a 3-year term. Bio-Oss is an acceptable substitute autogenous bone and can be used as an augmentation material during the maxillary sinus lift procedure.

Clinical, Radiographic, and Histologic Evaluation of Maxillary Sinus Lift Procedure Using a Highly Purified Xenogenic Graft (Laddec(®)).

ABSTRACTObjectivesThe aim of this study was to evaluate the clinical, radiographic and histologic results when a highly purified xenogenic bone (Laddec®) was used as grafting material in maxillary sinuses.Material and MethodsIn fifteen patients requiring unilateral maxillary sinus augmentation, the grafting procedure was performed with Laddec®. Forty-two implants were installed after a 6 month healing period. The height of the augmented sinus was measured radiographically immediately after augmentation and postoperatively up to 36 months. At the time of implant placement, a bone core was harvested in each patient for histological examination.ResultsThe cumulative implant survival rate was 97.6%. The original height was 3.65 (SD 0.7) mm and the augmented sinus height was 13.8 (SD 1.4) mm after the surgery. The reduced height of grafted xenogenic material (RDL) at the implant insertion was 0.83 (SD 0.38) mm, and at the final postoperative visit was 0.91 (SD 0.25) mm, showing no significant correlation with the follow-up periods by Spearman’s test (P = 0.118). In addition, no significant difference in the RDL was observed according to the site of implantation (P = 0.682). The mean implant marginal bone loss was 0.38 (SD 0.24) mm. Histological analysis showed the bone cores were composed of 64.72 (SD 3.44)% newly formed bone, 17.41 (SD 2.02)% connective tissue, 16.93 (SD 2.83)% residual graft particles, and 0.94 (SD 0.11)% inflammatory cells.ConclusionsAccording to our data, the highly purified xenogenic bone (Laddec®), used as graft material in the sinus lift procedure, may create adequate bone volume, and appropriate osseointegration of dental implants.

Use of autogenous bone and beta-tricalcium phosphate in maxillary sinus lifting: a prospective, randomized, volumetric computed tomography study

The correction of bone defects can be performed using autogenous or alloplastic materials, such as beta-tricalcium phosphate (β-TCP). This study compared the changes in bone volume (CBV) after maxillary sinus lifting using autogenous bone (n=12), autogenous bone associated with β-TCP 1:1 (ChronOS; DePuy Synthes, Paoli, CA, USA) (n=9), and β-TCP alone (n=11) as grafting material, by means of cone beam computed tomography (CBCT). CBV was evaluated by comparing CBCT scans obtained in the immediate postoperative period (5–7 days) and at 6 months postoperative in each group using OsiriX software (OsiriX Foundation, Geneva, Switzerland). The results showed an average resorption of 45.7±18.6% for the autogenous bone group, 43.8±18.4% for the autogenous bone+β-TCP group, and 38.3±16.6% for the β-TCP group. All bone substitute materials tested in this study presented satisfactory results for maxillary sinus lifting procedures regarding the maintenance of graft volume during the healing phase before the insertion of implants, as assessed by means of CBCT.

Maxillary sinus lift without grafting, and simultaneous implant placement: a prospective clinical study with a 51-month follow-up

A prospective clinical study of maxillary sinus lift procedures in the posterior region of the maxilla, using only blood clot as filling material, was conducted. Seventeen patients underwent a maxillary sinus lift procedure; 20 maxillary sinus regions were operated on and a total of 25 implants were placed. The sinus mucosa was lifted together with the anterior wall of the osteotomized maxilla and supported by the implants placed. Computed tomography (CT) scans were obtained immediately postoperative (Tinitial) and at 3 (T1) and 51 (T2) months postoperative for the measurement of linear bone height and bone density (by grey tones). Only one implant was lost in the first stage (96% success). After dental prosthesis placement and during up to 51 months of follow-up, no implant was lost (100% success, second stage). The difference in mean bone height between Tinitial (5.94mm) and T1 (13.14mm), and between Tinitial and T2 (11.57mm), was statistically significant (both P<0.001); comparison between T1 and T2 also presented a statistical difference (P<0.001). Bone density had increased at the end of the period analyzed, but this was not statistically significant (P>0.05). Thus, the maxillary sinus lift technique with immediate implant placement, filling with blood clot only, may be performed with a high success rate.