Osteotome Sinus Floor Elevation Procedure Research Articles

Comparison of different sinus augmentation techniques for implant placements

Aim: The purpose of the present research was to evaluate various sinus augmentation techniques for implant placements. Methodology: Four techniques were evaluated: 1-stage bone-added osteotome sinus floor elevation procedure (BAOSFE) with simultaneous implant placement; 2-stage BAOSFE with delayed implant placement; 1-stage lateral window sinus floor elevation with simultaneous implant placement; and 2-stage lateral window sinus floor elevation with delayed implant placement. Patients were followed for 18 to 72 months (mean: 52.5 months) after prosthesis placement. Data were analyzed with cone-beam computed tomography. Results: A total of 96 implants from 71 patients were analyzed; pre-treatment, there were no significant differences between patients. Total implant survival was 98.9%. The mean residual bone height was significantly higher in the 1-stage BAOSFE group than the other groups (P <.01); 1 implant in this group failed at 3 months. There was no significant difference in total bone height gain between groups. However, the bone height gain of 1st sinus lifting with 2-stage BAOSFE was significantly lower than the 2-stage lateral window procedure (P<.01). There was no prosthesis failure. Conclusion: The favorable implant outcomes suggest these 1-stage and 2-stage MSFA procedures should be considered as alternative treatment options for patients with extremely atrophic posterior maxilla.

Comparison of 4 sinus augmentation techniques for implant placement with residual alveolar bone height ≤3 mm.

This study compared implant outcomes following maxillary sinus floor augmentation (MSFA) in edentulous patients with a residual alveolar bone height ≤3 mm. Four techniques were evaluated: 1-stage bone-added osteotome sinus floor elevation procedure (BAOSFE) with simultaneous implant placement; 2-stage BAOSFE with delayed implant placement; 1-stage lateral window sinus floor elevation with simultaneous implant placement; and 2-stage lateral window sinus floor elevation with delayed implant placement. Patients were followed for 18 to 72 months (mean: 52.5 months) after prosthesis placement. Data were analyzed with cone-beam computed tomography. A total of 96 implants from 71 patients were analyzed; pretreatment, there were no significant differences between patients. Total implant survival was 98.9%. The mean residual bone height was significantly higher in the 1-stage BAOSFE group than the other groups (P < .01); 1 implant in this group failed at 3 months. There was no significant difference in total bone height gain between groups. However, the bone height gain of 1st sinus lifting with 2-stage BAOSFE was significantly lower than the 2-stage lateral window procedure (P < .01). There was no prosthesis failure. The favorable implant outcomes suggest these 1-stage and 2-stage MSFA procedures should be considered as alternative treatment options for patients with extremely atrophic posterior maxilla.

Single-Crown, Short and Ultra-Short Implants, in Association with Simultaneous Internal Sinus Lift in the Atrophic Posterior Maxilla: A Three-Year Retrospective Study.

As the atrophic posterior maxilla often presents serious limitations for dental implant procedures, a minimally invasive technique was proposed. The study aimed to retrospectively evaluate the outcomes of short and ultra-short locking-taper implants, placed in combination with a modified osteotome sinus floor elevation procedure (internal sinus lift technique) in the posterior maxilla. A total of 31 patients received 51 locking-taper implants. Clinical and radiographic examinations were performed before treatment, at loading time, and after three years. Seven implants of 8.0 mm, 23 implants of 6.0 mm, and 21 implants 5.0 mm in length were rehabilitated with single-crown restorations. Implant survival at three-year follow-up was 96.08%. Pre-operative residual crestal bone height of 5.2 (1.41) (median (interquartile range)) mm increased to 7.59 (1.97) mm at the 36-month follow-up, with an average intra-sinus bone height gain of 3.17 ± 1.13 (mean ± standard deviation) mm. Mean peri-implant crestal bone loss was 0.29 (0.46) mm and mean first bone-to-implant contact point shifted apically to 0.12 (0.34) mm. It can be suggested with confidence that implants used in the study, placed in conjunction with an internal sinus floor elevation technique, can be restored with single crowns as a predictable treatment for the edentulous regions of the posterior maxilla.

Osteotome sinus floor elevation procedure for first molar single-gap implant rehabilitation: a case series.

This case series describes single implant rehabilitation in the maxillary first molar sites. It aims to show the surgical approaches carried out versus the residual bone height (RBH) and to evaluate implant success rate and bone anchorage height after 1 year. Placement of 10-mm-long tapered bone level implants was carried out according to the RBH: when RBH ≥10 mm, standard implant placement; when 6 mm < RBH < 10 mm, osteotome sinus floor elevation procedure (OSFE) without graft; and, when RBH ≤6 mm, OSFE with graft. Fourteen patients received 15 implants in a mean RBH of 5.0 ± 2.4 mm (range, 2.0-11.0 mm). One implant was placed with a standard placement technique, 4 using OSFE without graft, and 10 using OSFE with graft. The 1-year success rate was 100%, and mean bone anchorage height reached at least 9.5 mm. Almost all cases of maxillary single implant rehabilitation might be performed by using OSFE. In the extremely atrophic maxilla, simultaneous grafting ensures implant embedding in bone.

Osteotome sinus floor elevation with and without grafting material in the severely atrophic maxilla. A 1‐year prospective randomized controlled study

(1) To measure and compare endo-sinus bone levels around implants randomly placed with an osteotome sinus floor elevation (OSFE) procedure in grafted (control) and non-grafted (test) sinuses, (2) to evaluate the OSFE efficacy with short, tapered, and chemically modified hydrophilic surfaced implants in extremely atrophic maxillae, (3) to show that fused corticals may constitute a complication risk. The TE(®) SLActive 8 mm-long implants (Straumann AG) were placed using an OSFE procedure in 4 mm or less of bone height. Healing time before prosthetic rehabilitation was 10 weeks. One year after implant placement, bone levels were measured on standardized periapical radiographs. Thirty-seven (17 tests, 20 controls) implants were placed in 12 patients with a mean maxillary residual bone height (RBH) of 2.4 ± 0.9 mm. Before loading, two control implants failed (RBH 1.4 and 1.2 mm); two others rotated at loading (one test, RBH 0.9 mm; one control, RBH 1.5 mm) but were uneventfully loaded after three additional months of healing. These adverse events and complications occurred when implants were placed in merged corticals. Endo-sinus bone gain was 3.9 ± 1.0 and 5.0 ± 1.3 mm for the test and control groups (P = 0.003). The 1-year success rate was 100% and 90%, respectively (P = 0.49). Although more bone is gained when grafting material is used, this may not be required to promote endo-sinus bone gain. The OSFE procedure with or without grafting material could be efficient when the RBH is ≤ 4 mm. However, when both corticals merged, the risk of complication could increase.

Osteotome sinus floor elevation without bone grafting and simultaneous implant placement in the atrophic maxilla: A pilot study

This study evaluated the clinical and radiographic outcome of implants placed in the posterior maxilla with the osteotome sinus floor elevation (OSFE) technique without graft material. Twenty-seven 4.1-mm-diameter dental implants (Straumann AG, Basel, Switzerland) were placed to 17 sinuses with residual bone height of ≤ 10 mm and ≥ 5 mm to rehabilitate 23 molar and 4 premolar sites. Implants were simultaneously placed with the OSFE procedure without graft material. All implants were successfully integrated after 8-12 weeks healing time. At the 2-year follow-up, all the implants presented the survival criteria proposed by Buser et al. and Cochran et al. The OSFE technique without grafting material may be predictable because the success rate was 100% in this study. Implants gained endo-sinus bone despite the lack of graft material. More patients and longer follow-up are needed to validate the results of this pilot study.

Osteotome sinus floor elevation technique without grafting material: 3‐year results of a prospective pilot study

In a prospective pilot study, short< or =10 mm ITI-SLA implants were placed in the resorbed posterior maxilla by means of an osteotome sinus floor elevation (OSFE) procedure without grafting material. This paper presents 3-year data assessing bone-level changes around implants. Twenty-five implants were placed in 17 patients to rehabilitate 16 molar and nine premolar sites. The mean residual bone height (RBH) was 5.4 +/- 2.3 mm. A healing period of 3-4 months was allowed before abutment tightening. Most implants (21/25) were 10 mm long, and the others were 8 and 6 mm long. At the 3-year control, endo-sinus bone gain, implant length protruding into the sinus and crestal bone loss (CBL) were measured on periapical radiographs. All implants fulfilled the survival criteria. Despite the absence of grafting material, implants were embedded into newly formed bone tissue. All implants gained endo-sinus bone; the mean gained bone was 3.1 +/- 1.5 mm. The residual protrusion length decreased from 4.9 +/- 2.1 to 1.8 +/- 2.1 mm. CBL was 0.9 +/- 0.8 mm. This study confirms that the OSFE procedure without grafting material is sufficient to create bone beyond the natural limit of the sinus. On the mid-term of 3 years, the technique was found to be predictable in the posterior maxilla when the RBH is limited. Implants gained endo-sinus bone despite the lack of grafting material. Bone gain was still improving over the first-year control. No shrinkage of the augmented area was observed.

Osteotome Sinus Floor Elevation Technique Without Grafting Material and Immediate Implant Placement in Atrophic Posterior Maxilla: Report of 2 Cases

This case report discusses 2 patients who required implant placement in the atrophic posterior maxilla to support a fixed prosthesis with the least invasive and shortest procedure. The reference standard of care would be to perform sinus augmentation with an autologous bone graft through the lateral approach with delayed implant placement. However, in these cases, the posterior maxillas were treated with an osteotome sinus floor elevation procedure without grafting material and simultaneous placement of short, 8- and 10-mm-long, tapered implants. All implants achieved primary stability and were successfully loaded after 3.6 months of healing. At the 1- and 2-year follow-up visits, they were clinically stable and the final prostheses were functioning. The mean endosinus bone gain was 5.1 +/- 1.3 mm. In 1 of the patients, the implants were completely embedded in the newly formed bone and the sinus floor had been relocated apical to its previous demarcation. The findings from these 2 cases suggest that the osteotome sinus floor elevation procedure without grafting material, and immediate placement of tapered implants, might be applied in situations for which previously only the lateral approach was considered (at the condition that implants achieve firm primary stability). More patients and longer follow-up are warranted to investigate how reliable this technique can be when applied to the atrophic maxilla.

Osteotome sinus floor elevation without grafting material: a 1‐year prospective pilot study with ITI implants

The aim of the present pilot study was to evaluate: (1) the predictability of an osteotome sinus floor elevation procedure with ITI-SLA implants without placing a bone grafting material, and (2) the possibility to gain bone height without filling the created space with a bone grafting material. Seventeen patients received 25 implants protruding in the sinus. Most implants (21/25) were 10 mm long, eight were inserted in type 2 bone, 12 in type 3 and five in type 4 bone. At implant placement, the mean residual bone height (RBH) under the maxillary sinus was 5.4+/-2.3 mm; it was 5.7+/-2.6 mm on the mesial side and 5.1+/-1.9 mm on the distal side. Nineteen implants had less than 6 mm of bone on at least one side and six implants had less than 6 mm on both sides. A healing period of 3-4 months was allowed before abutment tightening at 35 Ncm. The percentage of stable implants at abutment tightening and at the 1-year control was calculated. The endo-sinus bone gain and the crestal bone loss (CBL) at the mesial and distal sides were measured. Abutments were tightened after 3.1+/-0.4 months. All implants but one (96%) resisted the applied 35 Ncm torque. At the 1-year control, all implants were clinically stable and supported the definitive prosthesis. All showed endo-sinus bone gain; the mean gain was 2.5+/-1.2 mm. The mean CBL was 1.2+/-0.7 mm. Endo-sinus bone gain and RBH showed a strong negative correlation (r=-0.78 on the mesial side and -0.80 on the distal side). A good correlation (r=0.73) was found between implant penetration in the sinus and endo-sinus bone gain. Elevation of the sinus membrane alone without addition of bone grafting material can lead to bone formation beyond the original limits of the sinus floor. Despite a limited RBH at implant placement, a healing period of 3 months was sufficient to resist a torque of 35 N cm and to lead to a predictable implant function at the 1-year control.

Paroxysmal positional vertigo as a complication of osteotome sinus floor elevation

Paroxysmal positional vertigo (PPV) is a high prevalence, vestibular end organ disorder due to the detachment of the utricular otoconia floating in the posterior or lateral semicircular canal. Even though in the majority of cases the etiology of PPV is unknown, it may follow viral infection, vascular disorders and head trauma after different surgical procedures. The aim of this study was to investigate the correlation between PPV and the surgical trauma induced by the vibratory and percussive forces on the upper maxilla during the osteotome sinus floor elevation procedure. We performed a complete otoneurological examination on 146 patients affected by atrophic ridges before and after upper maxilla surgery. Four patients showed a PPV of the posterior semicircular canal controlateral to the implanted side 1 or 2 days after the surgical procedure, which promptly was solved with the Epley re-positioning maneuver. We hypothesize that the surgical trauma, and specifically the pressure exerted by the osteotomes, determines the detachment of the otoliths from the utricular macula while the patient head position, hyper-extended and tilted opposite to the side where the surgeon is working, favors the entry of these free-floating particles in the posterior semicircular canal of the implanted side. Although this disease is rather frequent in the normal population and it is a benign, self-limiting peripheral disorder, it should be considered by the oral surgeon as a possible complication of pre-prosthetic upper maxilla surgery, and the patient should be informed before undergoing surgery.

Endoscopic evaluation of the bone-added osteotome sinus floor elevation procedure

Sinus floor augmentation using the bone-added osteotome technique (BAOSFE) has been advocated as a predictable procedure when initial residual bone height is 4–6mm. In this report, 16 Osseotite® implants were placed using the BAOSFE procedure in eight patients under endoscopic control. Intraoperative graft positioning, potential displacement of the graft material, Schneiderian membrane integrity and distension pattern were evaluated. A small-sized perforation of the sinus membrane was visualized during sinuscopic monitoring in two implant sites without significant loss of graft material confinement. Membrane vertical distension was restricted to the area surrounding the implant apices in four implant sites while a larger detachment of the membrane enfolding the implant tips, the in-between and circumferantial areas was observed in the remaining 12 sites. The two perforated sites demonstrated a localized vertical pattern of membrane distension limited to implant apices. None of the cases complicated by perforation showed clinical signs of ongoing sinus pathology throughout the follow-up period. This limited report suggests that: (1) the BAOSFE procedure in combination with implant placement yields various patterns of sinus membrane elevation; (2) potential membrane perforation may be expected when distension follows a localized vertical augmentation pattern; and (3) small membrane perforations during the BAOSFE procedure are compatible with clinically healthy postoperative sinus conditions.