Nasal Floor Elevation Research Articles

Successful Implant Placement via Simultaneous Nasal Floor Augmentation in an Inferior Meatus Pneumatization Case

Partially edentulous patients who present with inadequate bone height in the posterior maxillary can predictably be rehabilitated with lateral wall sinus augmentation and subsequent implant placement. However, the sinus augmentation is defined by variations observed in the anatomical presentation of the maxillary sinus. Herein, we describe a case study managing sinus augmentation when a rare anatomic variant termed inferior meatus pneumatization was observed. A 65-year-old female patient presented, wherein the inferior meatus of the nasal cavity was located directly above the maxillary posterior dentition as opposed to the maxillary sinus. The clinically atrophied maxilla was rehabilitated by employing nasal floor elevation, bone augmentation, and simultaneous implant placement. Post-operatively, no sino-nasal complications were recorded. Subsequently, 8 months after the initial procedure, osteointegration of the implants along with the presence of vital bone was observed. The patient posterior occlusion in the upper right quadrant was rehabilitated by engaging the stable implants with a cement-retained fixed final prosthesis. Follow-ups recorded for up to 2 years demonstrated no further complications. The case report demonstrates diagnosis, appropriate treatment, and management of inferior meatus pneumatization and a viable surgical approach for augmentation and implant treatment.

Different Surgical Techniques in the All-on-4 Treatment Concept: Evaluation of the Stress Distribution Created in Implant and Peripheral Bone with Finite Element Analysis.

To examine the stresses caused by different All-on-4 surgical techniques-conventional, a combination of monocortical and bicortical, bicortical, and nasal floor elevation-on the implant and the surrounding bone using 3D finite element analysis (FEA). A 3D bone model of the atrophic maxilla was created based on CT imaging of the fully edentulous adult patient. All implants used in the models were 4 mm in diameter, and the length was 13 mm in the anterior and 15 mm in the posterior. Implants were applied to four different atrophic maxillary models with the All-on-4 technique: anterior and posterior monocortical implants in the first model, anterior monocortical and posterior bicortical in the second model, anterior and posterior bicortical in the third model, and anterior and posterior bicortical with nasal floor elevation in the fourth model. Eight linear analyses were performed by applying force from both vertical and 45-degree oblique directions to the four models prepared in our study. When the cortical and cancellous bone around the anterior implants was examined, it was observed that the oblique and vertical loading conditions and the stresses around the implant were similar in all models. When the posterior implants were examined, model 1 (ie, anterior and posterior monocortical implants) showed the greatest oblique compression, vertical compression, and vertical tension forces. According to the Von Mises stress (VMS) analysis results for anterior and posterior implants, higher values were observed in model 1 compared to models 3 and 4 under oblique and vertical forces. It was observed that bicortical placement of the implants reduced the stresses on the bone and implant-abutment system but had no significant effect on the stress on the bar. According to the results of our study, in the All-on-4 technique, bicortical placement of the implants reduced the stresses on the bone and implant when the anatomical limitations allowed. In addition, nasal floor elevation can be applied in the atrophic maxilla in appropriate indications.

Nasal Floor Elevation—An Option of Premaxilla Augmentation: A Case Report

The atrophic edentulous maxilla is demanding for dental implant placement because of extensive resorption of the alveolar ridge after teeth loss and, consequently, the proximity of the anatomical structures, nasal cavity, and maxillary sinus. Treatment options are short implants, guided bone regeneration, onlay grafts, Le Fort I osteotomy with interpositional bone grafting, distraction osteogenesis, or nasal floor elevation. Nasal floor elevation is a method of augmentation of premaxilla by raising the base of the nose. The aim of this case report is to evaluate the success of implants placed after nasal floor elevation. A 75-year-old female patient came to the Clinical Department of Oral Surgery, University Hospital Centre Zagreb, unsatisfied with her complete removable denture. Clinical and radiological examination revealed severe maxillary alveolar ridge atrophy. Nasal floor elevation was made under local anesthesia through aperture piriformis and lateral window in the distal part. After eight months, four implants were placed and, after period of osseointegration, a bar-retained implant overdenture was made. This case report shows that nasal floor augmentation can be considered among the surgical techniques to allow implant-supported rehabilitation of the atrophic anterior maxilla.

Dental Implants Survival After Nasal Floor Elevation: A Systematic Review.

The aim of this work is to assess the clinical outcomes of implants placed after a nasal floor elevation procedure. A systematic review was conducted using 4 electronic databases: MEDLINE (PubMed), Cochrane Library, Directory of Open Access Journals, and Scopus, following the PRISMA (Preferred Reporting Items for Systematic Reviews) statement recommendations to answer the PICO (Population, Intervention, Comparison, Outcome) question: "In patients undergoing dental implant placement in the maxillary anterior region (P), Do implants placed after nasal floor elevation (I) have a different survival (O) from those implants placed without grafting procedures (C)? The study was pre-registered in PROSPERO (CRD42021229479). Included article quality was assessed using the "NIH quality assessment tool", "The Newcastle-Ottawa scale," and "JBI critical appraisal tools for case reports." Twelve articles were finally selected, including 151 patients and 460 implants. The weighted mean follow-up was 32.2 months, and the weighted survival rate after this period was 97.64% (range: 89.2%-100%). No statistical differences could be inferred between the treatments performed in 1- or 2-stage, following a lateral approach or a transcrestal approach or using different grafting materials. A great heterogeneity was found in study design and methodological aspects. For this reason, a quantitative analysis followed by meta-analysis was not possible. Within the limitations of this study, implants placed after a nasal floor elevation present a good survival and a low range of complications. In absence of randomized studies, the level of evidence was low, attending the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) system and based on the study quality level, the strength of evidence attending the SORT (Strength Of Recommendation Taxonomy) was B.

Different bone anchorages for Morse taper implants with different lengths in maxilla anterior: An in silico analysis

This study aimed to evaluate the stress distribution in bone tissue, in Morse tapper implants and components supporting a single crown in the maxillary anterior area, under different bone anchorages (conventional, bicortical and bicortical with nasal floor elevation) and implant lengths (8.5 mm, 10 mm and 11.5 mm) using 3D finite element analyses. Three 3D models including element #11 were simulated using software InVesalius, Rhinoceros 3D and SolidWorks. Bone block models were reconstructed from computed tomography and simulated the placement of one implant of 4 mm of diameter and lengths above mentioned, supporting cemented zirconia crown. The 3D models were processed by the finite element FEMAP and NeiNastran software, using a load of 178N were applied at 0º, 30º and 60º, considering the implant long axis. Results were visualized as the von Mises stress, maximum principal stress and microstrain maps. Bicortical bone anchorages showed lower stress and microstrain bone tissue when compared to conventional bone anchorage. However, no differences were observed between bicortical and nasal floor elevation. Regarding implants and components, the stress distribution was similar between models with little stress relief in the apical region of the implants for implants with conventional anchorage. The conclusion drawn from this study is that non-axial loading showed worse biomechanical behavior for bone tissue and implants/components. The bicortical techniques (bicortical and nasal floor elevation) should be preferred during the implant placement to reduce the stress and microstrain in the bone tissue.

Biomechanical Three-Dimensional Finite Element Analysis of Single Implant–Supported Prostheses in the Anterior Maxilla, with Different Surgical Techniques and Implant Types

The aim of this study was to use three-dimensional finite element analysis to analyze the stress distribution transferred by single implant-supported prostheses placed in the anterior maxilla using different connections (external hexagon, internal hexagon, or Morse taper), inclinations of the load (0, 30, or 60 degrees), and surgical techniques for placement (monocortical/conventional, bicortical, or bicortical with nasal floor elevation). Nine models representing a bone block of this region were simulated by computer-aided design software (InVesalius, Rhinoceros, SolidWorks). Each model received one implant, which supported a cemented metalloceramic crown. Using FEMAP software, finite elements were discretized while simulating a 178-N load at 0, 30, and 60 degrees relative to the long axis of the implant. The problem was solved in NEi Nastran software, and postprocessing was performed in FEMAP. Von Mises stress and maximum principal stress maps were made. The von Mises stress analysis revealed that stress increased with increasing inclination of the load, from 0 to 30 to 60 degrees. Morse taper implants showed less stress concentration around the cervical and apical areas of the implant. The bicortical technique, associated or not with nasal floor elevation, contributed to decreasing the stress concentration in the apical area of the implant. Maximum principal stress analysis showed that the increase in inclination was proportional to the increase in stress on the bone tissue in the cervical area. Lower stress concentrations in the cortical bone were obtained with Morse taper implants and the bicortical technique compared with other connections and surgical techniques, respectively. Increasing the inclination of the applied force relative to the long axis of the implant tended to overload the peri-implant bone tissue and the internal structure of the implants. The Morse taper connection and bicortical techniques seemed to be more favorable than other connections or techniques, respectively, for restoring the anterior maxilla.

Multidisciplinary approach to oral rehabilitation with dental implants after gunshot injury: A clinical report

This clinical report describes a multidisciplinary approach to treat a patient with edentulism and a severe anatomic defect in the mandible caused by a gunshot injury by using an implant-fixed complete dental prosthesis. An immediate loading interim implant-fixed complete dental prosthesis in the mandible associated with a maxillary removable complete denture prosthesis was initially provided to restore the intermaxillary relation. Nasal floor elevation and maxillary sinus augmentation were subsequently performed to increase the maxillary bone volume. Definitive implant-fixed complete dental prostheses were placed in both arches in order to rehabilitate this initially compromised anatomic condition, which ensured patient satisfaction and improvement in masticatory function and esthetics.

Influence of bicortical techniques in internal connection placed in premaxillary area by 3D finite element analysis

The aim of study was to evaluate the stress distribution in implant-supported prostheses and peri-implant bone using internal hexagon (IH) implants in the premaxillary area, varying surgical techniques (conventional, bicortical and bicortical in association with nasal floor elevation), and loading directions (0°, 30° and 60°) by three-dimensional (3D) finite element analysis. Three models were designed with Invesalius, Rhinoceros 3D and Solidworks software. Each model contained a bone block of the premaxillary area including an implant (IH, Ø4 × 10 mm) supporting a metal-ceramic crown. 178 N was applied in different inclinations (0°, 30°, 60°). The results were analyzed by von Mises, maximum principal stress, microstrain and displacement maps including ANOVA statistical test for some situations. Von Mises maps of implant, screws and abutment showed increase of stress concentration as increased loading inclination. Bicortical techniques showed reduction in implant apical area and in the head of fixation screws. Bicortical techniques showed slight increase stress in cortical bone in the maximum principal stress and microstrain maps under 60° loading. No differences in bone tissue regarding surgical techniques were observed. As conclusion, non-axial loads increased stress concentration in all maps. Bicortical techniques showed lower stress for implant and screw; however, there was slightly higher stress on cortical bone only under loads of higher inclinations (60°).

Four-years' experience with dynamic implants with internal port for minimally invasive sinus elevation.

The purpose of this article is to describe long-term results of the dynamic implant valve approach (DIVA) for the dental implant procedures when the implant system with internal ports was used. During 2012 to 2015, 378 titanium-aluminum-vanadium implants (Ti6Al4V ELI; diameter 3.75 mm; length 11.5 and 13 mm) were implanted in 172 patients (one to nine implants per patient) using the DIVA technique. The DIVA implants were used in cases when sinus membrane and/or nasal floor elevation procedures were needed. The condition of the implants was assessed during the follow-up period up to 60 months. Out of 378 inserted implants, 257 implants were inserted in the maxilla with the bone level < 5 mm, and 121 implants were inserted in the maxilla with the bone level > 5 mm. In 357 cases (94.5%), the implantation was totally successful both from objective CBCT clinical and subjective patients' viewpoints. The comparison of complication rates between the cases with the bone level < 5 mm and the cases with the bone level > 5 mm indicated no significant difference (P = .32). Preliminary results that the DIVA simplifies the dental implantation procedure and augmentation treatment were confirmed. The implant with an inner sealing screw can be used in cases with elevation of the maxillary sinus membrane, and simplifies the surgery and secures optimal dental implant placement. This new type of implant simplifies the maintenance phase of implant dentistry and helps to overcome possible complications.

Nasal floor elevation in the rehabilitation of atrophic maxilla with dental implants

Nasal floor elevation in the rehabilitation of atrophic maxilla with dental implants

Three‐Dimensional Finite Element Analysis of Anterior Single Implant‐Supported Prostheses with Different Bone Anchorages

The aim of this study was to evaluate the stress distribution of monocortical and bicortical implant placement of external hexagon connection in the anterior region of the maxilla by 3D finite element analysis (FEA). 3D models were simulated to represent a bone block of anterior region of the maxilla containing an implant (4.0 × 10.0 mm) and an implant-supported cemented metalloceramic crown of the central incisor. Different techniques were tested (monocortical, bicortical, and bicortical associated with nasal floor elevation). FEA was performed in FEMAP/NeiNastran software using loads of 178 N at 0°, 30°, and 60° in relation to implant long axis. The von Mises, maximum principal stress, and displacement maps were plotted for evaluation. Similar stress patterns were observed for all models. Oblique loads increased the stress concentration on fixation screws and in the cervical area of the implants and bone around them. Bicortical technique showed less movement tendency in the implant and its components. Cortical bone of apical region showed increase of stress concentration for bicortical techniques. Within the limitations of this study, oblique loading increased the stress concentrations for all techniques. Moreover, bicortical techniques showed the best biomechanical behavior compared with monocortical technique in the anterior maxillary area.

Nasal Floor Elevation for Implant Treatment in the Atrophic Premaxilla: A Within‐Patient Comparative Study

There is a lack of evidence regarding success of implants placed in atrophic premaxilla using the nasal floor elevation technique. This study aimed to compare implants placed in augmented bone in the anterior maxilla using the nasal floor elevation technique with implants placed in the maxillary sinus region using the sinus lift technique. A within-patient controlled clinical trial was performed on 14 patients receiving 78 implants. The implants were assigned to one of two study groups on the basis of implant location. A total of 37 implants were placed in the nasal fossa region (NF group), and 41 implants were placed in the maxillary sinus region (MS group). Patients were followed up for 4.5 ± 2.2 years, with comparable follow-up times for implants in NF and MS groups (4.7 ± 2.1 and 4.9 ± 2.1 years, respectively; p > .05). Treatment outcomes were assessed and statistically analyzed. Implant success rate was 89.2% in the NF group and 95.0% in the MS group, with no statistically significant difference between them (p > .05). No nasal or sinus membrane perforation or other complications were reported within the follow-up period. Significant differences were found between the two groups in terms of residual bone height, augmented bone height, and implant diameter. Nasal floor elevation is an effective and safe procedure that can be used for implant placement in atrophic premaxilla with success rates that are comparable to those of implants placed in the maxillary sinus.

Nasal floor elevation combined with dental implant placement: a long-term report of up to 86 months.

The aim of this paper is to present a large-scale long-term follow-up of dental implants placed simultaneously with nasal floor augmentation using osteoconductive bovine bone substitutes. Patients who received dental implants combined with nasal floor elevation in three dental centers between 2006 and 2012 were included in this report. Preoperative available bone height was measured on computed tomographic scans. Implant parameters as well as implant survival rates were recorded. The cohort consisted of long-term follow-up of this previously reported cohort, combined with a cohort of newly treated patients. Overall, 67 patients were included in this study. Cigarette smoking was reported by 16 patients. Two hundred three implants were inserted in combination with nasal floor elevation. No nasal mucosa perforations were observed. The mean follow-up periods were 65.93 ± 13.2 months (range, 33 to 86 months) for the original cohort and 23.14 ± 9.4 months (range, 7 to 44 months) for the newly treated patients. The available bone height prior to bone augmentation was 8.89 ± 1.1 mm (range, 5 to 11.2 mm) and a mean of 3.65 ± 0.9 mm (range, 1.1 to 7 mm) of additional height was achieved with nasal floor elevation. During the follow-up period, no implants were lost, resulting in a 100% survival rate. Nasal floor augmentation, as shown in this report, might serve as a reliable method for reconstruction of the anterior atrophic maxilla when residual height is insufficient.

Nasal Floor Elevation Combined with Dental Implant Placement

The aim of the present study was to report on the survival of dental implants placed in conjunction with nasal floor elevation. A retrospective cohort of 32 consecutive patients from two private practices was evaluated. All patients presented with alveolar bone height deficiency in the anterior region, which was not sufficient to place a dental implant according to a computed tomography (CT) scan preformed prior to implantation. Elevation and augmentation of the nasal mucosa was performed simultaneously with dental implant placement. Data collection included demographic information, as well as records of the pre-operative available bone height, implant dimensions, bone addition following nasal floor augmentation, and survival of the implants at last follow-up. Overall, 32 patients received 100 implants that were performed in conjunction with nasal floor elevation. The average pre-operative available bone height according to a CT scan that was preformed prior to implantation was 9.1 ± 0.9 mm and ranged from 7.3 to 11.2 mm. Bone addition following nasal floor augmentation was 3.4 ± 0.9 mm and ranged between 1.1 and 5.7 mm. The mean follow-up time was 27.8 ± 12.4 months, and during that follow-up period, no implant failure was recorded, resulting in 100% implant survival. Nasal floor elevation might serve as a predictable procedure, which allows implant placement in areas with significant atrophy together with increased implant stability due to the bicortical support.

Particulate Inlay Nasal Graft With Immediate Dental Implant Placement in a Patient With Repaired Alveolar Cleft: Case Report

Primary bone grafts in congenital cleft alveolus do not always provide sufficient bulk or height of bone for ideal placement of endosseous implants. Thus, maxillary sinus or nasal floor elevation and inlay bone grafts in previously grafted areas are not exceptions in the daily routine. This case report stresses the need of a detailed treatment plan and careful surgical management of nasal floor elevation with particulate autogenous bone graft to successfully provide the patient with osseointegrated prostheses.