Maxillary Sinus Membrane Elevation Research Articles

Autogenous Bone with Collagen Material and Surgicel for Maxillary Sinus Membrane Elevation (Sinus Lift) in Human Subjects

Autogenous Bone with Collagen Material and Surgicel for Maxillary Sinus Membrane Elevation (Sinus Lift) in Human Subjects

Functional Endoscopic Sinus Surgery for a Patient with Maxillary Sinusitis Occurring after Implant Placement

Maxillary sinus membrane elevation and bone graft have been performed routinely in alveolar bone with insufficient residual bone height. There are a number of causes for development of maxillary sinusitis after these procedures. When maxillary sinusitis is caused by sinus membrane elevation, bone graft, and implant placement, various treatment such as medication, incision and drainage (I&D), implant removal, and the Caldwell-Luc procedure can be considered. Removal of an implant or the Caldwell-Luc procedure can be harmful if inflammation is not present in the oral cavity and survival of grafted bone and implant osseointegration can be expected despite the presence of maxillary sinusitis. In this case, functional endoscopic sinus surgery, which was often used in the otorhinolaryngology department, was performed without removal of the implant for a patient with maxillary sinusitis after one month following implant placement. Thus, we report on this case with a review of the literature.

Immediate Loading of Implants Placed Simultaneously with Sinus Membrane Elevation in the Posterior Atrophic Maxilla: A Two‐Year Follow‐Up Study on 10 Patients

Clinical studies on immediate loading of implants in the posterior atrophic maxilla are rare. The study aims to evaluate immediate loading of implants placed with sinus membrane elevation without additional grafting material for bone augmentation of the maxillary sinus floor. The study group comprised of 10 patients in whom a total of 10 maxillary sinus floor augmentations were performed. A total of 21 dental implants (1 to 4) were inserted through the residual bone to protrude into the maxillary sinus under the elevated sinus membrane. The implant site was underprepared to improve primary stability. All the implants were inserted with a torque insertion no less than 20 Ncm. Implants were loaded immediately after surgery with a screw-retained temporary acrylic restoration. Intraoral X-rays were taken at implant insertion, after 6 months loading, and after 1st and 2nd year of loading. Resonance frequency analysis (RFA) was performed at the time of initial placement and after 6 months of functional loading. RFA after implant insertion gave an implant stability quotient (ISQ) level with a range from 62 to 72. All implants remained clinically stable during the follow-up period of 2 years. Radiography demonstrated on average 5.7 ± 3.4 mm of intrasinus new bone formation after 6 months of implant loading. RFA measurements showed ISQ mean values of 67 (range: 62-72) and 68 (range: 62-71) at placement and after 6 months of loading, respectively. Within the limits of this case series report, it is concluded that maxillary sinus membrane elevation with simultaneous placement and immediate loading of implants without the use of any additional grafting material shows predictable results after 2 years of functional loading. Moreover, evidence of intrasinus bone formation around the implants was found in all patients. Further studies are needed to study the influence of immediate loading on the mineralization of bone forming at dental implant sites.

Assessment of dentists' subjective satisfaction with a newly developed device for maxillary sinus membrane elevation by the crestal approach.

PurposeThe purposes of this study were to assess the dentists' subjective satisfaction with the crestal approach sinus (CAS) kit, a device for maxillary sinus membrane elevation by the crestal approach using a special drilling system and hydraulic pressure, and to summarize the subjective satisfaction of dental implants placed after a sinus lift procedure with the CAS kit.MethodsThirty dental clinicians who had experience with dental implant placement after a sinus lift procedure with the CAS kit from June 2010 to May 2012 were included in this study. The questionnaire for the evaluation of the dentists' subjective satisfaction with the CAS kit was sent to the respondents and returned. The questionnaire was composed of two main parts. The first part was related to the sinus membrane perforation rate. The second part was related to the dentists' subjective satisfaction with the CAS kit.ResultsA total of 28 dentists answered the questionnaire. Among 924 implant cases, sinus membrane perforation occurred in 38 cases (4.1%). Among the 28 dentists, 26 dentists (92.9%) were satisfied or very satisfied with the CAS kit. In particular, 24 dentists (85.7%) reported that safety, cutting performance, and user-friendliness of the CAS drill were advantages of the CAS kit. However, 7 dentists (25%) did not routinely use the hydraulic lifter for sinus membrane elevation.ConclusionsFrom the survey, it was shown that the respondents were generally satisfied with the CAS kit and that the cutting performance and safety of the drill component were considered strengths of the CAS kit.

The Maxillary Sinus Membrane Elevation Procedure: Augmentation of Bone around Dental Implants without Grafts—A Review of a Surgical Technique

Background. Long-term edentulism may in many cases result in resorption of the alveolar process. The sinus lift procedure aims to create increased bone volume in the maxillary sinus in order to enable installation of dental implants in the region. The method is over 30 years old, and initially autogenous bone grafts were used and later also different bone substitutes. Since 1997, a limited number of studies have explored the possibility of a graftless procedure where the void under the sinus membrane is filled with a blood clot that enables bone formation. Aim. To describe the evolution of the sinus-lift technique and to review the literature related to the technique with a focus on long-term studies related to the graft-less technique. Methods. The electronic database PubMed was searched, and a systematic review was conducted regarding relevant articles. Results. A relatively few long-term studies using the described technique were found. However, the technique was described as reliable considering the outcome of the existing studies. Conclusion. All investigated studies show high implant survival rates for the graftless technique. The technique is considered to be cost-effective, less time-consuming, and related to lower morbidity since no bone harvesting is needed.

Dental Implants in Posterior Maxilla: Diagnostic and Treatment Aspects

Dental implantology is one of the most popular and intensively researched topics of current dental medicine. The necessity for the former complicated preprosthetic surgical procedures to facilitate the partial dentures has recently been decreased with the widespread construction of implant-supported prosthesis. Nevertheless, the alveolar deficiency that impedes the insertion of dental implants makes a number of similar reconstructive procedures inevitable. The posterior maxilla is one of the most challenging anatomic locations for the implant placement that requires adjunctive surgical procedures. This special issue covers leading researches and reviews on this topic that we believe would contribute to clinicians. Insufficient bone quality and quantity in posterior maxilla is a common clinical state which makes the implant applications challenging in this site. The main reason for that is the pneumatization of sinus subsequent to the tooth loss and the concomitant excessive alveolar resorption. Insufficient subantral bone and coexisting increased interarch distance necessitate a combined sinus lifting and augmentation procedures. T. Kanno et al. reported the results of their retrospective study entitled “Simultaneous sinus lifting and alveolar distraction of a severely atrophic posterior maxilla for oral rehabilitation with dental implants” in which they performed combined sinus lifting and alveolar distraction osteogenesis in a case series with 27 individuals. The study revealed a histomorphometric similarity between the new bone formed by the presented technique and the bone generated via the sinus lifting only. They also accomplished stable implant rehabilitations within this topic. The quality and the quantity of the host bone are the key determinants for successful dental implants. The quantity of the bone may be estimated via advanced radiological techniques in a high precision. However, a definitive accuracy cannot be pronounced although a number of techniques are available to evaluate the quality of bone. H. Bilhan et al. have reviewed the current techniques used for the estimation of the quality of the host bone while they simultaneously reported the results of a pilot experimental study that compares the densitometric evaluation of the dental volumetric tomography (DVT) with micro CT with their study entitled “How precise is dental volumetric tomography in the prediction of bone density?”. The results of this study revealed that the Hounsfield unit evaluation via DVT is not a reliable method to evaluate the density of bone. C. Riben and A. Thor have published their review on “graftless augmentation procedures” which became a popular topic on sinus floor elevation, regarding a conventional surgical approach for the posterior maxillae. Their study entitled “The maxillary sinus membrane elevation procedure: augmentation of bone around dental implants without grafts—a review of a surgical technique” includes the technical details of the procedure. The alveolar bone loss principally initiates with the tooth loss and this state may complicate the ideal placement of the implants. A number of surgical methods is advocated to prevent the bone loss. G. Pagni et al. reviewed these techniques in their study entitled “Postextraction alveolar ridge preservation in the molar area: biological basis and treatments”. The study provides comprehensive information about the socket healing and biology of the alveoloar bone resorption subsequent to extraction. They stated that the improvements in the grafting technologies would give rise to less invasive surgical interventions. The recent advances in the implant surface characteristics led to major modifications in former fundamentals. An increased osseointegration rate with the improvement of the surface characteristics of dental implants resulted in a numerous successful reports for the implants shorter than 10 mm. Today, many companies appear in the dental market with their recently introduced 6 mm or shorter dental implants. Owing to this, clinicians now can be able to offer effective and noninvasive remedies to their patients avoiding advanced complicated surgeries in case of severe alveolar atrophy. Although a number of clinical reports reveals high success rates for the mandible, the use of short implants in the maxilla is still debatable especially for the single-tooth replacements due to its porous nature. D. Lops et al. compared the clinical success rates for 8 mm. Implants with that of 10 mm. In their long-term study entitled “Short implants in partially edentulous maxillae and mandibles: a 10 to 20 years retrospective evaluation”. In general, they declared similar success rates for 8 mm and longer implants. The results of this study revealed that the use of 8 mm implants seems to be safe in the posterior maxilla.

Maxillary Sinus Floor Augmentation Surgery with Autogenous Bone Grafts as Ceiling: A Pilot Study and Test of Principle

Studies have pointed out that the mere elevation of the maxillary sinus membrane might suffice to allow for bone formation indicating the additional use of augmentation materials to be redundant. The purpose of this study was to assess whether elevation of the sinus mucosal lining combined with applying an autologous bone graft as a ceiling and placement of a short implant would allow for bone formation around the implant thus surpassing the need for applying augmentation materials around the installed implants. Fourteen consecutive patients were subjected to maxillary sinus floor elevation surgery and simultaneous placement of an implant. Using the lateral bone-wall window technique, the membrane was exposed and elevated. Next, a bone graft taken from the zygomatic rim was placed as a ceiling above the inserted implant to ensure that the sinus membrane would not collapsed around a significant part of the implant. Finally, the bone window was returned in place. After connecting the healing abutment, the wound was closed. All implants were stable and no implants were lost. There were no complications after harvesting the bone graft. Radiographic evaluation showed a bone gain of 3.2 ± 0.9 mm after 3 months and 3.6 ± 0.9 mm after 1 year. Less than 6% of the implant was not covered by bone after 1 year. Maxillary sinus membrane elevation and simultaneous placement of short endosseous implants with a bone graft as a ceiling on top of the implant result in predictable bone formation around the implant and good osseointegration on radiographs.

Sinus bone formation and implant survival after sinus membrane elevation and implant placement: a 1‐ to 6‐year follow‐up study

To investigate the long-term clinical and radiographic results of the maxillary sinus membrane elevation technique where implants were inserted in a void space created by the elevation of the sinus membrane without adding any graft material. A total of 84 patients were subjected to 96 membrane elevation procedures and simultaneous placement of 239 implants. Changes of intra-sinus and marginal bone height in relation to the implants were measured in intraoral radiographs taken at insertion, after 6 months of healing, after 6 months of loading and then annually. Computerized tomography was performed pre-surgically and 6 months post-surgically. Resonance Frequency Analyses measurements were performed at the time of implants placement, at abutment connection and after 6 months of loading. The implant follow-up period ranged from a minimum of one to a maximum of 6 years after implants loading. All implants were stable after 6 months of healing. A total of three implants were lost during the follow-up period giving a survival rate of 98.7%. Radiography demonstrated on average 5.3±2.1 mm of intra-sinus new bone formation after 6 months of healing. RFA measurements showed adequate primary stability (implant stability quotient 67.4±6.1) and small changes over time. Maxillary sinus membrane elevation and simultaneous placement of implants without the use of bone grafts or bone substitutes result in predictable bone formation with a high implant survival rate of 98.7% during a follow-up period of up to 6 years. The intra-sinus bone formation remained stable in the long-term follow-up. It is suggested that the secluded compartment allowed for bone formation according to the principle of guided tissue regeneration. The high implant survival rate of 98.7% indicated that the implants sufficiently supported the fixed bridges throughout the study period. This technique reduces the risks for morbidity related to harvesting of bone grafts and eliminates the costs of grafting materials.

Long-Term Follow-Up of the Sinus Membrane Elevation Technique for Maxillary Sinus Implants Without the Use of Bone Grafts or Bone Graft Substitutes in Order to Facilitate Bone Formation

Long-Term Follow-Up of the Sinus Membrane Elevation Technique for Maxillary Sinus Implants Without the Use of Bone Grafts or Bone Graft Substitutes in Order to Facilitate Bone Formation

Bone Reformation and Implant Integration following Maxillary Sinus Membrane Elevation: An Experimental Study in Primates

Recent clinical studies have described maxillary sinus floor augmentation by simply elevating the maxillary sinus membrane without the use of adjunctive grafting materials. This experimental study aimed at comparing the histologic outcomes of sinus membrane elevation and simultaneous placement of implants with and without adjunctive autogenous bone grafts. The purpose was also to investigate the role played by the implant surface in osseointegration under such circumstances. Four tufted capuchin primates had all upper premolars and the first molar extracted bilaterally. Four months later, the animals underwent maxillary sinus membrane elevation surgery using a replaceable bone window technique. The schneiderian membrane was kept elevated by insertion of two implants (turned and oxidized, Brånemark System, Nobel Biocare AB, Göteborg, Sweden) in both sinuses. The right sinus was left with no additional treatment, whereas the left sinus was filled with autogenous bone graft. Implant stability was assessed through resonance frequency analysis (Osstell, Integration Diagnostics AB, Göteborg, Sweden) at installation and at sacrifice. The pattern of bone formation in the experimental sites and related to the different implant surfaces was investigated using fluorochromes. The animals were sacrificed 6 months after the maxillary sinus floor augmentation procedure for histology and histomorphometry (bone-implant contact, bone area in threads, and bone area in rectangle). The results showed no differences between membrane-elevated and grafted sites regarding implant stability, bone-implant contacts, and bone area within and outside implant threads. The oxidized implants exhibited improved integration compared with turned ones as higher values of bone-implant contact and bone area within threads were observed. The amount of augmented bone tissue in the maxillary sinus after sinus membrane elevation with or without adjunctive autogenous bone grafts does not differ after 6 months of healing. New bone is frequently deposited in contact with the schneiderian membrane in coagulum-alone sites, indicating the osteoinductive potential of the membrane. Oxidized implants show a stronger bone tissue response than turned implants in sinus floor augmentation procedures.