Maxillary Surgery Research Articles

Modified Approach to Segmental Maxillary Surgery: Midline Osteotomy and Parasagittal Soft tissue Incisions

Modified Approach to Segmental Maxillary Surgery: Midline Osteotomy and Parasagittal Soft tissue Incisions

Comparison of static teeth exposure in different postures and its influencing factors of orthognathic surgery patients.

This study aimed to explore the differences and influencing factors of static teeth exposure in different postures of orthognathic surgery patients. A total of 148 patients were collected before or after orthognathic surgery. Photographs were taken in the upright and supine positions, and the static teeth exposure values were measured to compare whether the difference among different positions was statistically significant. The patients were classified in accordance with gender, presence or absence of orthodontic brackets, measurement time (preoperative or postoperative), and maxillary movement direction (forward or backward), and the difference of static teeth exposure was compared. The correlation between the difference of static teeth exposure and age was analyzed. The diffe-rence of static teeth exposure between the two positions was 0.99 mm±0.95 mm, which was statistically significant (P=0.000). A statistical difference in the difference of static exposure was observed between female and male (P<0.05). No statistical difference in the difference of static exposure was observed among orthodontic brackets, preoperative or postoperative time points, and maxillary movement direction. In addition, no significant correlation was found between the difference of static teeth exposure and age (r=-0.087, P=0.291). Compared with the upright position, the static exposure of teeth increased by approximately 0.99 mm in the supine position. The difference of static exposure under different postures was greater in males than in females. Furthermore, orthodontic bracket, maxillary surgery, maxillary movement direction, and age had no effect on the difference of static teeth exposure in different postures.

Nonsurgical correction of occlusal canting using temporary anchorage devices: A systematic review

ObjectiveThe recent development of temporary anchorage devices (TADs) allows orthodontic canting correction by selective intrusion of the molars. The purpose of this study was to review the treatment strategy and outcomes after orthodontic correction of occlusal canting using the TADs based on published literature including the case reports. Materials and methodsA systematic review of published English-language human clinical studies was conducted by electronic search of PubMed, Embase & Medline, and Scopus reviews up to Dec 2023. For inclusion, reports required documentation of subject demographic characteristics; location or type of TADs; diagnosis; presence of maxillary occlusal canting (MOC); and treatment outcomes (MOC correction). Studies were excluded if they involved orthognathic surgery to correct MOC. Critical appraisal for all included studies were conducted with the case reports/case series appraisal checklist of the Joanna Briggs Institute (JBI). The current study was registered in PROSPERO (CRD42021226432). ResultsThe search identified 260 reports and a total of 33 case reports met inclusion criteria with 46 individual patient cases. The results reported that occlusal canting could be resolved by unilateral intrusion of maxillary posterior teeth using TADs. The reported the amount of maxillary molar intrusion ranged from 1 mm to 4.8 mm. However, there were fundamental limitations in study subjects, paucity of data regarding the long-term stability, lack of standardization in intrusion mechanics, and variations in TAD devices. ConclusionsAlthough the previous reports mentioned that orthodontic canting correction with TADs could avoid maxillary surgery or orthognathic surgery itself, it cannot be concluded that non-surgical correction of occlusal canting can be comparable to surgical treatment. Further comparative investigation between surgical and nonsurgical canting correction is needed to clarify whether orthodontic intrusion can be an alternative to surgical canting correction in terms of efficacy and stability.

Modern Oncologic Maxillary Reconstruction.

After studying this article, the participant should be able to: (1) Have a broad understanding of the oncological principles relating to cancers involving the maxilla. (2) Define anatomically the various types of maxillectomy defects and their associated morbidity. (3) Understand the goals and principles of maxillary reconstruction. (4) Demonstrate an understanding of the strengths, limitations, and alternative reconstructive options for the various types of maxillectomy defects. Reconstruction of the maxilla following cancer resection has evolved over the past decade. Underpinned by advances in virtual surgery technology and an increased focus on dental rehabilitation, more sophisticated workflows using free bone flaps have become more commonplace. There are few reconstructions anywhere in the body that require the restoration of similarly intricate bone and soft-tissue relations with implications for both form and function, like the maxilla. Success demands careful anatomical definition of the defect, an understanding of the goals and principles of reconstruction, and the understanding of relative strengths and limitations of the various reconstructive options. Equally, as no one technique is without shortcomings and maxillary surgery can be associated with a significant complication profile, it is just as important to match the patient and oncologic context to the reconstruction. This article is intended to provide the reader with a broad overview of these core factors.

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

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

Three-dimensional assessment of root changes after Le Fort I osteotomy

The study aim was to assess the volumetric, linear, and morphological changes of the maxillary incisor, canine, and premolar roots following Le Fort I osteotomy. Sixty patients (585 teeth) were included retrospectively from among individuals who underwent combined orthodontics and orthognathic surgery. The study group comprised 30 patients who underwent orthodontics and one-piece Le Fort I osteotomy, while the control group consisted of 30 patients who underwent orthodontics and bilateral sagittal split osteotomy but no maxillary surgery. CBCT scans were obtained at four time points: preoperative, 6 months, 1 year, and 2 years postoperative. A fully automated three-dimensional evaluation protocol was utilized to assess root changes of the maxillary teeth. Significant differences in the apical and middle parts of the teeth were observed between the study and control groups at 1 and 2 years postoperative, with greater percentage changes in the study group (all P < 0.05). Greater root remodelling in the canines, first and second premolars was observed in the study group (all P < 0.005). Spearman correlation analysis indicated a positive relationship between root remodelling and maxillary advancement, with larger advancements contributing to increased root remodelling in the apical and middle root parts (both P < 0.05). These findings can be valuable for surgeons and orthodontists in evaluating root changes.

The Use of Clear Aligners in Multi-Segmental Maxillary Surgery: A Case-Control Study in Cleft Lip and Palate and Skeletal Class III Patients.

Background: Maxillary hypoplasia and mandibular asymmetry may be corrected with orthognathic surgery after growth completion. For most stable results, some cases may require segmental Le Fort I osteotomies. Unfortunately, Invisalign's software (6.0 version) still has some inherent limitations in predicting outcomes for complex surgeries. This study explores the potential of aligners, particularly in multiple-piece maxillary osteotomies in both cleft and non-cleft patients. Method: Thirteen patients who underwent pre-surgical treatment with Invisalign were retrospectively matched in terms of diagnosis, surgical procedure, and orthodontic complexity with thirteen patients treated using fixed appliances. Virtual curves following the lower arch were employed to guide the correct pre-surgical positions of the upper teeth with a simple superimposition technique. The amount of impressions required in both groups to achieve satisfactory pre-surgical alignment of the segmented arches was compared. Results: one or no refinement phases were needed in the Invisalign group to reach an acceptable pre-surgical occlusion, while the amount of pre-surgical impressions needed to reach adequate coordination with fixed appliance treatment was slightly higher (p > 0.05). Conclusions: it appears that clear aligner could serve as an effective treatment for individuals necessitating segmental Le Fort I osteotomies when aided by the suggested simple superimposition approach.

The Accuracy of Intraoral Registration for Dynamic Surgical Navigation in the Edentulous Maxilla.

Despite the high clinical accuracy of dynamic navigation, inherent sources of error exist. The purpose of this study was to improve the accuracy of dynamic-navigated surgical procedures in the edentulous maxilla by identifying the optimal configuration of intraoral points that results in the lowest possible registration error for direct clinical implementation. Six different four-area configurations (left and right sides; n = 12) were tested by three operators against two negative controls (left and right sides) and one positive control (three-area and eight-area configurations, respectively) using a skull model. The two dynamic navigation systems (X-Guide and Navident) and the two registration methods (bone surface tracing and fiducial markers) produced four registration groups: XG tracing, ND tracing, XG fiducial, and ND fiducial. The accuracy of the registration was checked at the frontal process of the zygoma. Intra- and interoperator reliabilities were reported for each registration group. Multiple comparisons were conducted to find the best configuration with the minimum registration error. Ranking revealed one configuration in the tracing groups (Conf.3) and two configurations in the fiducial groups (Conf.3 and Conf.5) that had the best accuracy. When the inferior surfaces of the zygomatic buttress were excluded, fiducial registration produced better accuracy with both systems (P = .006 and < .0001). However, bilaterally tracing 1-cm areas at these surfaces resulted in similar registration accuracy to placing fiducial markers there (P = .430 and .237). Navident performed generally better (P = .049, .001, and .002), but the values had a wider margin of uncertainty. Changing the distribution of the four tracing areas or fiducial markers had a less pronounced effect with the X-Guide than with the Navident system. For surgery in the edentulous maxilla, four fiducial markers placed according to Conf.3 or Conf.5 resulted in the lowest registration error. Where implants are being placed bilaterally, an additional two sites may further reduce the error. For bilateral zygomatic implant placement, it is optimal to place two fiducial markers on the inferior surfaces of the maxillary tuberosities, two on their buccal surfaces, and another two on the anterior labial surface of the alveolar bone. Utilizing the inferior zygomatic buttress is recommended over the inferior maxillary tuberosities in other types of maxillary surgeries.

Cone Beam Computed Tomography in observing the presence and location of canalis sinuosus.

Cone Beam Computed Tomography (CBCT) was used to observe and describe the distribution of canalis sinuosus (CS) in the Chinese population and the location of CS in the maxillary alveolar bone, so as to help oral surgeons evaluate the intraoperative risk and prognosis before maxillary surgery and reduce the complications caused by the injury of this structure in anterior surgery. CBCT images of 600 patients admitted from 2021 to 2022 were collected to observe the anatomical structure of CS in the maxillary region. The following parameters were recorded: age, sex, number of CS, left and right distribution of CS, CS diameter, and location. Statistical analysis was performed on all of the collected data. The discovery rate of CS in this study was 59.75%, and it is commonly found in the lateral incisor area (64.82%). No significant difference can be found in the presence and number of CS in different gender and age groups (p>0.05). The use of high-resolution CBCT before implantation is of irreplaceable significance in the diagnosis and analysis of CS, which is conducive to reducing implantation complications and failure rate. The incidence of CS was independent of age or sex, while the location of CS was statistically significant.

Morphological and Morphometric Study of Greater Palatine Foramen in Dry Skulls of Eastern Indian Population

Abstract Background: Greater palatine foramen (GPF) transmits important neurovascular structures which may get injured during different operative procedures such as intraoral maxillary nerve block, cleft palate repair, and operative procedures involving maxillary sinus and maxillary molars. Hence, proper knowledge about the GPF is very essential. The aim of this study was to study the shape of GPF and its location in relation to molar tooth, measure the diameters of GPF, and measure the distances of GPF from different landmarks of palate. Methodology: A dry bone-based study was conducted on dry human skulls of Eastern Indian population using digital Vernier caliper. At first location of GPF in relation to maxillary molars was noted, followed by anteroposterior (AP) and transverse diameter of GPF and distance of GPF from incisive fossa, posterior border of hard palate (PBHP) and interpalatine suture was measured. Results: In 69.64% of cases, GPF was present medial to the maxillary molar tooth and most common shape is oval type which is found in 44.64% of cases. AP diameter was almost same in both the sides which is 5.13 mm in average and transverse diameter is 2.91 mm. The mean distance of GPF from incisive fossa, PBHP, and interpalatine suture (IPS) is as follows in sequence, 37.24 mm, 3.21 mm, and 13.68 mm. Conclusion: The findings from the present study can be used as a guide for locating GPF during different operative procedures such as palatal reconstruction in cleft palate, maxillary surgeries, and intraoral maxillary nerve block. GPF is located about 3 mm in front of PBHP, most commonly medial to the third maxillary molar, about 15 mm lateral to IPS in the present study among Eastern Indian population.

Characterization of labiomandibular movements induced after isolated LeFort I osteotomy in the surgical management of class III malocclusion.

Maxillary surgery alone can be proposed for the surgical management of class III malocclusion, but anticipating outcomes for the labiomental muscle complex is challenging due to the mandibular autorotation phenomenon. The objective of this study was to quantify the mandibular and labiomental movements induced by maxillary osteotomy alone in the management of class III malocclusion according to different clinical and surgical variables. The post-operative changes in mandibular and labiomental shapes were studied by geometric morphometry from the pre- and post-operative lateral cephalometric radiograph of 25 patients. The explanatory variables tested were maxillary advancement, maxillary rotation, and divergence. Soft tissues repositioning are different from postoperative mandibular repositioning after maxillary osteotomy. Neuromuscular adjustments of mandible depend on divergence and the maxillary rotation. Labiomental response only depends on divergence. The surgical procedure does not have the same bone-related and musculocutaneous effects on patients with the same class III malocclusion. It is therefore essential for surgeons to understand the effects of their procedure on musculocutaneous tissues in order to best anticipate post-operative outcomes.

Incidence of Sinusitis Postoperatively in Orthognathic Surgery: A Systematic Review and Meta-Analysis.

Maxillary osteotomies as a component of orthognathic surgery disrupt the normal anatomy and function of the sinus. The osteotomy with advancement of the inferior component of the sinus leaves a bony and mucosal opening in the sinus. Immediately after surgery, nasal drainage is impeded because of intranasal swelling. Acute and chronic maxillary sinusitis would be expected; however, its incidence as an expected complication is not well documented. A systematic review and meta-analysis was completed using PubMed to determine the incidence of sinusitis after maxillary orthognathic surgery. Studies were reviewed by two authors, and incidence data were extracted. Two hundred six articles were identified with 24 meeting the criteria for analysis. The incidence of sinusitis was based on 4213 participants who had undergone orthognathic surgery. Twenty-three studies reported a total number of sinusitis cases, and the results demonstrated a pooled incidence of 3.3% (95% confidence interval: 1.77, 6.06). One study did not report a total number of cases but reported chronic sinusitis survey-duration-based and Lund-Mackay scores. These scores, respectively, worsened from 7.6 to 14.8 and from 1.58 to 2.90 postoperatively. Despite the variability of maxillary surgery, the surgical technique, and the postoperative management, the incidence is low but sinusitis does occur. Prospective studies with validated questionnaires within the context of a specific protocol may further elucidate the causality of sinusitis. Further, patients with sinonasal symptoms postsurgery should be encouraged to consult with an otolaryngologist to ensure prompt treatment.

The Transverse Turbinate Line: A Reliable Landmark for the Maxillary Sinus Natural Ostium.

Approximating the maxillary sinus natural ostium's (MSNO) natural position during anterograde surgery is challenging, as only a single visual "landmark," the maxillary line, is routinely offered to guide the identification of the MSNO in three-dimensional space. Despite almost 40 years of endoscopic sinus surgery (ESS) experience in North America, maxillary recirculation and discontinuity between the natural and surgical ostia are commonly encountered during revision ESS. Consequently, we feel an additional visual landmark would assist in localizing the MSNO with or without image guidance. In this study, we aim to provide a second reliable landmark in the sinonasal cavity. We present a cadaveric anatomical landmark series that provides a second visual landmark for the MSNO, which we have labeled the transverse turbinate line (TTL): a 2-millimeter zone of confidence for the craniocaudal positioning of the MSNO that can be combined with the anteroposterior (AP) landmark of the maxillary line. In our study, 40 cadaveric sinuses were dissected, and the TTL was found to correspond consistently with the zone between the superior and inferior aspects of the MSNO. We anticipate that this second relational landmark may decrease the time required for anterograde access to the MSNO in trainees, increase the accuracy of identification, and translate to lower long-term recirculation and maxillary surgery failure rates. NA Laryngoscope, 133:3285-3291, 2023.

Effect of physical activity level on orthodontic pain perception after separator placement in adult patients managed at a tertiary care teaching public sector hospital in Lahore

Background: Different behavioral therapies are used to reduce pain severity in patients undergoing separator placement apart from pharmacological treatments. However, there is limited local data.This study aimed to determine the frequency of high and low levels of activity in adult patients who needed separator placement and compared the mean pain scores with respect to baseline physical activity level following the intervention.&#x0D; Subjects and methods: It was a descriptive case series carried out at the Orthodontics Department, De’Montmorency College of Dentistry, Lahore, for a period of 3 months from 15.7. 2022 to 15.9.2022. Total 120 patients aged 18 to 40 years of both genders, who needed separator placement were included in the study. Patients were excluded if they had medical conditions or systemic diseases that was a contraindication for usage of fixed orthodontic appliances, had chronic pain or pain in the orofacial or dental region, had maxillary or mandibular fracture and who had previous history of mandibular or maxillary surgery. Baseline physical activity level was noted down as per clinical history. Patients then underwent separator placement.&#x0D; Results: Mean age of the patients was 28.67±6.312 years. There were 62 (51.7%) males and 58 (48.3%) females. Baseline low physical activity was found in 77 (64.2%) patients while high activity was found in 43 (35.8%) patients. Mean pain scores in the low physical activity group were 3.9±2.056 and in the high physical activity group were 2.26±2.094 and the difference was statistically significant i.e. p=0.001 as assessed by independent t-test.&#x0D; Conclusion: Frequency of low physical activity level was higher in patients and it was found to be associated with higher mean pain scores compared to patients who had high baseline level of physical activity.&#x0D;

Rhinoplasty as an Adjunct to Orthognathic Surgery:: A Review.

Orthognathic surgery is a well-recognized method to correct dentofacial deformities. The main goal of orthognathic surgery is to improve soft tissue change. Soft tissue changes to the nose have been well documented. Simultaneous rhinoplasty during orthognathic surgery can be performed to correct existing inherent nasal deformities and also the unfavorable changes that arose from the maxillary surgery. Challenges for concurrent nasal surgery with jaw surgery include preoperative, perioperative, and postoperative which can be overcome with meticulous planning and experience. In complex cases, rhinoplasty can be staged in the last 6months after the orthognathic surgery.

Accuracy of mandibular repositioning surgery using new technology: Computer-aided design and manufacturing customized surgical cutting guides and fixation plates

Recent 3-dimensional technology advancements have resulted in new techniques to improve the accuracy of intraoperative transfer. This study aimed to validate the accuracy of computer-aided design and manufacturing (CAD-CAM) customized surgical cutting guides and fixation plates on mandibular repositioning surgery performed in isolation or combined with simultaneous maxillary repositioning surgery. Sixty patients who underwent mandibular advancement surgery by the same surgeon were retrospectively evaluated by 3-dimensional surface-based superimposition. A 3-point coordinate system (x, y, z) was used to identify the linear and angular discrepancies between the planned movements and actual outcomes. Wilcoxon rank sum test was used to compare the outcomes between the mandible-only and the bimaxillary surgery groups with significance at P<0.05. Pearson correlation coefficient compared planned mandible advancement to the outcome from advancement planned. The centroid, which represents the mandible as a single unit, was computed from 3 landmarks, and the discrepancies were evaluated by the root mean square error (RMSE) for clinical significance set at 2 mm for linear discrepancies and 4° for angular discrepancies. There was no statistically significant difference between the planned and actual position of the mandible in either group when considering absolute values of the differences. When considering raw directional data, a statistically significant difference was identified in the y-axis suggesting a tendency for under-advancement of the mandible in the bimaxillary group. The largest translational RMSE for the centroid was 0.77 mm in the sagittal dimension for the bimaxillary surgery group. The largest rotational RMSE for the centroid was 1.25° in the transverse dimension for the bimaxillary surgery group. Our results show that the precision and clinical feasibility of CAD-CAM customized surgical cutting guides and fixation plates on mandibular repositioning surgery is well within clinically acceptable parameters. Mandibular repositioning surgery can be performed predictably and accurately with the aid of CAD-CAM customized surgical cutting guides and fixation plates with or without maxillary surgery.

Clear aligner orthognathic surgery: an overview

: To assess the differences in treatment planning, surgical intervention, and post operative care between conventional orthognathic surgery and clear aligner (Invisalign) orthognathic surgery. Orthognathic surgery is surgery dedicated to the correction of skeletal maxillofacial malocclusion. Traditionally, these procedures are completed utilizing conventional orthodontic appliances (braces). More recently, with the increasing popularity of clear aligner technology to move dentition, more and more orthodontists are requesting their surgeons to complete orthognathic surgery with Invisalign. The author notes that there are some challenges, planning alternatives, and adjustments that need to be made. A retrospective review of one surgeon’s experience with clear aligner (Invisalign) orthognathic surgery, from 2016–2020. Comprehensive literature review as well as review of cases from the author’s surgical practice. There are some significant differences in the planning and treatment of Invisalign orthognathic surgery compared to conventional surgery. During the treatment planning stage, the surgeon must be aware that planning a segmental maxillary surgery is trickier when using Invisalign as compared to conventional orthodontics. Further, clear aligner surgery may require different types of occlusal splints, as well as custom plating, and novel approaches to maxilla-mandibular fixation.

Surgical exposure and fix orthondontic combination for maxilla canine impacted treatment

Objective: Teeth that are buried in the jawbone or obstructed by gum tissue and fail to emerge from the typical occlusive surface, causing malocclusion, are known as impacted teeth. Canine teeth are kept for masticatory function strength, aesthetics, and malocclusion repair. Impacted canines can be retrieved using a combination of surgery and fixed orthodontic equipment to restore a normal arch and position Methods: An impacted maxillary left canine caused edema in the palatal area in a 22-year-old female patient at RSKGM-P UNAIR who was referred by orthodontics. The impacted tooth's position was determined using radiography, occlusal projection, and CBCT. The procedures included flap surgery with a full thickness incision, flap opening, orthodontic button insertion on the crown of the buried canine, ligature wire implantation, and flap repositioning and suturing. Results: Combined surgical technique and orthodontic appliance placement on impacted canines can place canines in normal arches and in the space available and in the occlusive position of the teeth, Surgical exposure combined with fixed orthodontic treatment of the affected maxillary surgery on the left maxillary canine was performed. Conclusion: In terms of the ultimate position of the canines in the normal arch and aesthetic appearance, a combination of surgical exposure and fixed orthodontic treatment of the impacted maxillary left canine produced good results.

Changes in the pharyngeal airway after different orthognathic procedures for correction of class III dysplasia

ObjectiveThis study was conducted to compare changes in pharyngeal airway after different orthognathic procedures in subjects with class III deformity.MethodsThe study included CBCT scans of 48 skeletal class III patients (29 females and 19 males, mean age 23.50 years) who underwent orthognathic surgery in conjunction with orthodontic treatment. The participants were divided into three groups of 16, as follows: Group 1, mandibular setback surgery; group 2, combined mandibular setback and maxillary advancement surgery; and group 3, maxillary advancement surgery. CBCT images were taken 1 day before surgery (T0), 1 day (T1), and 6 months (T2) later. The dimensions of the velopharynx, oropharynx, and hypopharynx were measured in CBCT images.ResultsIn all groups, there was a significant decrease in airway variables immediately after surgery, with a significant reversal 6 months later (P < 0.05). In subjects who underwent maxillary advancement, the airway dimensions were significantly greater at T2 than the T0 time point (P < 0.05), whereas in the mandibular setback and bimaxillary surgery groups, the T2 values were lower than the baseline examination (P < 0.05). The alterations in airway variables were significantly different between the study groups (P < 0.05).ConclusionsThe mandibular setback procedure caused the greatest reduction in the pharyngeal airway, followed by the bimaxillary surgery and maxillary advancement groups, with the latter exhibiting an actual increase in the pharyngeal airway dimensions. It is recommended to prefer a two-jaw operation instead of a mandibular setback alone for correction of the prognathic mandible in subjects with predisposing factors to the development of sleep-disordered breathing.

A Comparative Histomorphometric Analysis of Two Biomaterials for Maxillary Sinus Augmentation: A Randomized Clinical, Crossover, and Split-Mouth Study.

Introduction Considering oral rehabilitation with dental implants, many studies have aimed at improving bone regeneration through the use of biomaterials. Objective This study aimed at comparing bone neoformation in patients undergoing bilateral maxillary sinus surgery with two bovine biomaterials. Materials and Methods This is a randomized, blinded, clinical crossover, and divided mouth study. Ten participants with an indication of maxillary sinus enlargement were selected and underwent surgical treatment with Bio-Oss® graft biomaterial (graft 1) on one side and Lumina-Porous® graft biomaterial (graft 2) on the other. The samples were collected after nine months and fixed and then decalcified in 10% ethylenediamine tetra-acetic acid (EDTA) solution for 30 days to process and make histological slides. Connective and bone tissue were further analyzed to identify the amount of newly formed bone. Results The graft 1 group had a greater formation of vital mineralized tissue when compared to the graft 2 group (p = 0.01). For nonvital mineralized tissue and amount of connective tissue, there was no statistical difference (p = 0.21 and p = 0.09, respectively). The medullary spaces were larger in the graft 2 group. The group treated with graft 1 presented a higher percentage of osteoclasts and viable osteocytes compared to the graft 2 group (p = 0.014 and p = 0.027, respectively). Conclusion Every day, new alternative biomaterials are offered as an option in oral rehabilitation. In this study, both treatments induced bone neoformation after 9 months; however, the group treated with Bio-Oss® showed a higher percentage of vital mineralized bone tissue.