Osteotome Sinus Floor Elevation Technique Research Articles

Predictors of peri-implant bone remodeling outcomes after the osteotome sinus floor elevation: a retrospective study

BackgroundThis study aimed to evaluate the radiographic outcomes of implants after osteotome sinus floor elevation (OSFE), and further identify the separate predictors for these radiographic outcomes.MethodsIn this retrospective cohort study, a total of 187 implants were inserted into 138 patients using the OSFE technique. Seventy-four patients in the grafted group, and 64 patients in the non-grafted group completed this study. The vertical bone gain (VBG) and marginal bone loss (MBL) at 3 years following surgery were assessed as outcome variables. Based on extensive literature results, variables considered potential predictors of outcome variables included sex, age, tooth position, implant length, implant diameter, with or without grafting materials, residual bone height, sinus width, bone density, and sinus membrane thickness. Subsequently, the binary logistic regression analysis was applied with VBG and MBL as dependent variables, respectively. The receiver operating characteristic curve (ROC) with its area under the curve (AUC) was performed to further determine the predictive value of these predictors.ResultsOne hundred and six implants in grafted group and 81 implants in the non-grafted group were analyzed. The average VBG was 2.12 ± 1.94 mm for the grafted group and 0.44 ± 1.01 mm for the non-grafted group at 3 years (P < 0.05). The mean MBL was 1.54 ± 1.42 mm for the grafted group and 1.13 ± 1.69 mm for the non-grafted group at 3 years (P > 0.05). After the adjustment for confounders, logistic regression analysis demonstrated that implant length, grafting, residual bone height, and sinus membrane thickness were predictors of VBG. The odds ratio for VBG was 3.90, 4.04, 4.13 and 2.62, respectively. Furthermore, grafting exhibited the largest AUC at 0.80. While tooth position and implant length were predictors of MBL, the odds ratio for MBL was 3.27 and 7.85, respectively. Meanwhile, implant length exhibited the largest AUC at 0.72.ConclusionsOSFE with or without simultaneous grafting materials both showed predictable clinical outcomes. Additionally, the present study is the first quantitative and significant verification that VBG has a significant association with sinus membrane thickness, as well as residual bone height, implant length and grafting. Whereas tooth position and implant length are markedly associated with MBL.

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

Recent short-term studies suggested the use of short and ultra-short implants in association with a modified osteotome sinus floor elevation (internal sinus lift) technique for the treatment of edentulous resorbed posterior maxilla. The aim of this retrospective study was to investigate this hypothesis in locking-taper implants with a mid-term follow-up of 5 years. Overall, 155 implants (32, 100, and 23 of, respectively, 5.0 mm, 6.0 mm, and 8.0 mm length) were positioned in the atrophic upper maxilla of 79 patients, and 151 implants were loaded with single crowns. Overall implant survival after 5 years was 94.84%. Implant survival for each length group was 93.75%, 94%, and 100% for 5.0, 6.0, and 8.0 mm length, respectively. Preoperative residual crestal bone height of 4.45 (1.3) mm increased to 9.25 (2.13) mm after implant placement and settled at 6.35 (1.73) mm after loading and at 5.25 (1.68) mm at follow-up. Elevation of the Schneiderian membrane was 4.8 (2.46) mm after implant placement, 3.06 (1.3) mm after loading, and 1.46 (1.06) mm at follow-up. Mean variations of peri-implant crestal bone loss and first bone-to-implant contact point were, respectively, -0.36 (1.3) mm and -0.62 (1.15) mm. It can be confirmed that internal sinus lift procedure revealed stable bone gain and negligible resorption at mid-term follow-up for atrophic upper crests with reduced height.

Comparative Evaluation of Endo-sinus Bone Augmentation After Osteotome Sinus Floor Elevation Without Grafting Using Two Radiographic Methods.

Using panoramic radiograph and CBCT to compare the measurement errors of the residual bone height in the same site before implant placement in the posterior maxilla and endo-sinus bone gain after osteotome sinus floor elevation without grafting, and to evaluate endo-sinus bone augmentation before stage-two surgery with CBCT. Also, some related factors of new bone formation in the sinus were analyzed, such as small bone block elevated by osteotome at the implant apex intraoperatively. Patients were enrolled in the retrospective study; dental implants were placed in the maxillary posterior region using osteotome sinus floor elevation without grafting. The panoramic radiograph and CBCT were taken preoperatively, immediate postoperatively, and before the stage-two surgery. Endo-sinus bone augmentation was evaluated. A generalized linear model was made to explore the related factors of endo-sinus bone gain. Also, some clinical indexes, such as sinus membrane perforation rate, implant success, and failure criteria were assessed. One hundred two dental implants were inserted in 91 patients. Preoperatively, the mean residual bone height was 8.53 ± 1.76 mm and 7.87 ± 1.45 mm measured using a panoramic radiograph and CBCT, respectively, with significant statistical differences (P < .05). Endo-sinus bone gains of 1.31 °æ 1.05 mm by panoramic radiograph and 1.80 ± 1.72 mm by CBCT were observed, with statistically significant differences (P < .05). The final endosinus bone gain was positively correlated with the implant protrusion length at baseline without any other relevant factors, such as elevated small bone block. Measurement errors could be relatively minimized when using CBCT. Using the osteotome sinus floor elevation technique without grafting, approximately 2 mm of endo-sinus bone could be acquired. The final endo-sinus bone gain was positively correlated with implant protrusion length at baseline. Small bone block elevated intraoperatively did not gain more endo-sinus bone.

Evaluation of bone formation following the osteotome sinus floor elevation technique without grafting using cone beam computed tomography: a preliminary study

BackgroundOsteotome sinus floor elevation (OSFE) is used to increase the bone volume at the site of the maxillary sinus through the transalveolar approach. However, there is uncertainty regarding the necessity of the use of grafting material in order to maintain the space for new bone formation.ObjectiveThis study aimed to evaluate new bone formation 6 months after osteotome sinus floor elevation without grafting and to evaluate the correlations between residual bone height (RBH), implant protrusion length (IPL), and endo-sinus bone gain (ESBG).Material and methodsThirty-one implants (27 patients) from area 14–17 and 24–27 were included in the study. All implants had a history of OSFE without grafting, with cone beam computed tomography (CBCT) taken prior to the surgery. The clinical examination and radiographic examination using CBCT were performed again 6 months after implantation. The RBH, new bone level, ESBG, and IPL were measured. Paired sample t test and Pearson correlation were used to analyze the data.ResultsThe average RBH before surgery was 7.14 ± 1.07 mm and 6 months after surgery was 8.95 ± 1.17 mm. There was a significant increase in new bone formation in the 6 months following surgery (p < 0.05). The average ESBG and IPL were 1.8 ± 0.79 mm and 2.02 ± 0.73 mm, respectively. There was a significant positive correlation between the IPL and ESBG (p < 0.05) while there was a negative correlation between RBH and ESBG. This study also demonstrates a decrease in the percentage of bone formation in relation to IPL as the IPL increases. The survival rate of the implant was 100%.ConclusionSignificant new bone formation can be detected around the implant site 6 months after implantation using OSFE technique without grafting. There is a negative correlation between the RBH and ESBG. While IPL is correlated to ESBG and appears to be the influencing factors of bone formation changes in the maxillary sinus. The preliminary radiographic results suggest that OSFE technique without grafting in combination with optimal IPL can provide sufficient bone height for implant support with a 100% implant survival rate.

Intrasinus Bone Gain with the Osteotome Sinus Floor Elevation Technique: A Review of the Literature.

To evaluate the mean amount of intrasinus bone obtainable with the osteotome technique for transcrestal maxillary sinus elevation combined with simultaneous implant insertion, with and without the use of grafting materials. A review was conducted on PubMed, Scopus, and Cochrane central databases. Only human studies in which implant placement was contextual to the sinus elevation procedure, without additional crestal regenerative procedures and with a minimum 1-year follow-up, were selected. Seventeen studies were found to meet the selection criteria. No statistically significant difference between the two procedures was detected. The mean intrasinus bone gain at 3 years after surgery was 2.99 mm in cases where no grafting material was used and 4.24 mm in cases in which grafting materials were used. The mean percentage of crestal height increase at the implant site at 3 years after surgery, referring to a selection of studies with initial bone height > 4 mm, was 47.28% in procedures without grafting material and 62.68% in procedures with grafting material. A different dimensional behavior of the newly formed bone during the first 3 years after surgery was found: a slight volumetric shrinkage in grafting procedures and a slight bone increase in procedures without grafting material. No statistically significant difference in implant survival rate was found. Both osteotome transcrestal sinus elevation procedures seem to guarantee predictable short- and medium-term results with reference to the intrasinus bone gain. However, the use of grafting materials, compared with their nonuse, does not seem to have substantial advantages in the short and medium term as far as mean intrasinus bone gain is concerned.

Long-term evaluation of osteotome sinus floor elevation and simultaneous placement of implants without bone grafts: 10-Year radiographic and clinical follow-up.

Insertion of an implant in the edentulous posterior maxilla is a challenging procedure because of poor bone quality and increased pneumatization of the maxillary sinus after tooth extraction. To increase the amount of bone, several surgical bone grafting techniques have been used-with considerable morbidity for patients. Osteotome sinus floor elevation (OSFE) is a less invasive technique. The clinical and radiographic outcome of 53 implants placed with this technique without bone graft has been reported previously. Here we report the clinical and radiographic findings after 10 years of implant load bearing. In a retrospective study, 34 Astra implants in 25 patients were subjected to 10-year follow-up radiologically and clinically. Each patient received 1 or 2 conical Astra implants. The level of the marginal bone and the height of the residual peri-implant alveolar bone (RPAB) for each implant were measured from digital intra-oral radiographs. Two implants in edentulous patients were lost at the 1-year follow-up, and 1 more at the 3-year examination. There was no loss between 3-year and 10-year follow-up. At 10-year follow-up 36 implants were included. Implants used in single-tooth replacements and in partially edentulous cases had a 100% survival rate. The mean marginal bone loss was 0.6 ± 0.8 mm. The bone height at the time of implant insertion ranged from 1.8 to 6.9 mm, with a mean value of 4.3 ± 1.0 mm. At 10-year follow-up the mean gain in bone at the implant sites for all implants was 2.6 ± 1.2 mm. The OSFE technique is a reliable method for rehabilitation of patients with atrophied posterior maxilla. However, the success of this method is associated with the amount of the residual bone. In the present study, this surgical approach without bone graft showed reliable long-term results with Astra implants.

Improvement of Implant Placement after Bone Augmentation of Severely Resorbed Maxillary Sinuses with 'Tent-Pole' Grafting Technique in Combination with rhBMP-2.

To study the clinical effect of short implant placement using osteotome sinus floor elevation technique and tent-pole grafting technique with recombinant human bone morphogenetic protein 2 (rhBMP-2) in severely resorbed maxillary area. Eleven patients with insufficient bone height in the posterior maxillary area were included. According to the native bone height and crown height space (CHS), the patients were divided into two groups: immediate placement of short implants with simultaneous bone augmentation (group A, 5 patients) and delayed dental implant placement (4 to 6 months) after bone augmentation. The rhBMP-2 was added into a deproteinised bovine bone mineral (DBBM) bone grafting material to shorten the treatment procedure and enhance the final effect of bone augmentation in both groups. Tent-pole grafting technique was applied for vertical bone augmentation in group B (6 patients). The success rate of the implants placed was 100% in both groups. In group A, the short implants treatment was successful, with a vertical gain of 1.5 to 6.4 mm in bone height after 4 to 6 months. In group B, the tent-pole grafting procedure in combination with DBBM and rhBMP-2 increased vertical bone height between 3.1 and 8.1 mm, an optimistic and adequate increase for implant placement. This bone increase was maintained following implant placement and final crown placement in the maxillary region (3.5 to 7.3 mm). The tent-pole grafting technique was a viable alternative choice to lateral sinus floor elevation in cases with excessive CHS. The application of rhBMP-2 with a shortened treatment time demonstrated positive outcomes in sinus floor augmentation procedures.

Influences of Schneiderian membrane conditions on the early outcomes of osteotome sinus floor elevation technique: a prospective cohort study in the healing period.

To radiographically investigate early outcomes of osteotome sinus floor elevation in the healing phase utilizing cone beam computed tomography and evaluate influences of Schneiderian membrane conditions. One hundred patients were consecutively recruited for osteotome sinus floor elevation (OSFE) surgery using deproteinized bone mineral. CBCT was taken prior to (T0), immediately post-operatively (T1), and after the healing period (T2). Linear and volumetric measurements of the elevated region from T0 to T1 were performed for evaluation on computed tomography (CT). Osteotome sinus floor elevation were performed in 100 patients. One implant of each patient was selected. Mean residual bone height (RH) was 7.21±1.12mm. Mean sinus floor elevation height (SE) was 4.81±0.75mm. The mean endo-sinus bone gain after the healing period was 3.25±0.83mm. Pre-opterative CBCT scans revealed that 72 patients had a normal sinus membrane in osteotome region, 13 patients presented with flat thickened mucosa and 15 patients with antral pseudocysts. There is no significant difference in sinus mucosa elevation height, bone graft volume and new bone formation in group of Thickening membrane and Antral pseudocysts compared with normal. The radiographical results show that OSFE is a safe and predictable surgical procedure in residual bone height of 7.21±1.12mm. Mild flat thickening (>2 and <5mm) and antral pseudocysts in a small size without clinical symptoms may not be contraindications to OSFE surgery.

Cone Beam Computed Tomography Evaluation of Bone Remodeling Following the Osteotome Sinus Floor Elevation Technique for Future Site Development.

The effectiveness of the osteotome technique for sinus augmentation was evaluated using cone beam computed tomography (CBCT) analysis. Clinical results of two-stage sinus floor elevation using the osteotome technique performed on 15 patients at the Nakajima Dental Clinic between 2006 and 2013 were evaluated retrospectively. CBCT imaging revealed that the maxillary sinus floor was elevated by an average of 7.28 mm (SD 1.62) immediately following surgery, with a mean bone height of 9.55 mm (SD 1.43). In all cases, the osteotome technique provided sufficient bone height for implant placement. No pre- or postoperative complications (eg, mucosal perforation) were reported. The minimal surgical stress and morbidity further underscore the practicality of this approach for two-stage maxillary sinus floor augmentation.

Paradigm shift in the management of the atrophic posterior maxilla.

When the posterior maxilla is atrophic, the reference standard of care would be to perform sinus augmentation with an autologous bone graft through the lateral approach and delayed implant placement. However, placement of short implants with the osteotome sinus floor elevation technique and without graft can be proposed for an efficient treatment of clinical cases with a maxillary residual bone height of 4 to 8 mm. The use of grafting material is recommended only when the residual bone height is ≤4 mm. Indications of the lateral sinus floor elevation are limited to cases with a residual bone height ≤ 2 mm and fused corticals, uncompleted healing of the edentulous site, and absence of flat cortical bone crest or when the patient wishes to wear a removable prosthesis during the healing period. The presented case report illustrates osteotome sinus floor elevation with and without grafting and simultaneous implant placement in extreme conditions: atrophic maxilla, short implant placement, reduced healing time, and single crown rehabilitation. After 6 years, all placed implants were functional with an endosinus bone gain.

Autotransplantation of tooth by osteotome sinus floor elevation technique with beta-tricalcium phosphate (β-TCP)

The osteotome sinus floor elevation technique has commonly been used for implant placement in cases of thin residual alveolar bone height between the alveolar ridge and the maxilla sinus. This report describes a case in which the technique was used for tooth autotransplantation and beta-tricalcium phosphate (β-TCP) was used for sinus floor augmentation. The patient was a 38-year-old male. The upper left first molar region was close to the maxilla sinus, and the residual alveolar bone height was only 2mm. The donor tooth, an upper right third molar, was transplanted into the space vacated by the missing upper left first molar. At 42 months post-operation, a CT scan radiograph showed what appeared to be bone regeneration around the root of the transplanted tooth. Alveolar bone was visible around the root apex, and the radiograph showed a continuous periodontal space around the root of the transplanted tooth. There was no residual OSferion®, no thickened sinus membrane, and no inflammation or root resorption. The main benefit of this procedure was that the patient ended up with a functional tooth after a single operation despite having only 2mm of residual alveolar bone height in the maxilla.

Osteotome Sinus Floor Elevation without Bone Grafts – A 3‐Year Retrospective Study with Astra Tech Implants

The bone support for implants in the posterior part of the maxilla is often poor. This condition may be treated with augmentation of the maxillary sinus floor. The most common technique used is to elevate the sinus floor by inserting a bone graft through a window opened in the lateral antral wall. In 1994, a less-invasive technique using osteotomes was suggested by Summers. The aim of this study was to evaluate the clinical and radiographic outcome of implants placed in the posterior maxilla with the osteotome sinus floor elevation (OSFE) technique without grafting. The study population comprised 36 consecutive patients in whom 53 implants were inserted with the OSFE technique. The indication for sinus floor elevation was that the bone height below the maxillary sinus was considered to be 10 mm or less. The mean height of the alveolar process in the intended implant sites was 6.3 ± 0.3 mm, and the mean elevation of the sinus floor was 4.4 ± 0.2 mm. Two implants in edentulous patients were lost at the 1-year follow-up, and one more at the 3-year examination. The remaining 50 implants inserted were in function, giving a 3-year cumulative survival rate of 94%. Implants used in single-tooth replacements and in partially edentulous cases had a 100% survival rate. The marginal bone level at the time of loading of the implants was 0.1 ± 0.04 mm below the reference point. One year later, the corresponding value was 0.5 ± 0.06 mm. The mean bone loss between the two examinations was 0.4 ± 0.05 mm. At the final examination after 3 years, the mean bone level was situated 0.6 ± 0.09 mm below the reference point, indicating a nonsignificant change between 1 year and 3 years. The OSFE technique, without bone grafts, was found to produce predictable results in the treatment of 36 patients with restricted bone volume in the posterior part of the maxilla.

Postextraction Osteotome Sinus Floor Elevation Technique Using Plasma-Rich Growth Factors

To evaluate a modified osteotome sinus floor elevation technique with immediate postextraction implant placement and the adjunct of a platelet-derived fibrin plug for the rehabilitation of maxillary premolar sites. Fifteen patients with nonrestorable fractured endodontically treated maxillary premolars were consecutively enrolled in the study. After extraction, the membrane was gradually elevated using osteotomes, with the interposition of a fibrin clot. Subsequently, an implant embedded with plasma very rich in growth factors was inserted. No implant failed after a mean follow-up of 35 months. The average membrane lift was 2.9 ± 0.8 mm. After 1 year of loading, marginal bone loss averaged 0.36 ± 0.19 mm. No postoperative symptoms were reported. All patients reported full satisfaction for mastication function, phonetics, and aesthetics. The present technique represents a viable option for the rehabilitation of fresh postextraction maxillary premolar sockets.

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.

Maxillary Sinus Augmentation by the Crestal Core Elevation Technique

The crestal core elevation (CCE) technique is reportedly a less invasive procedure than the lateral window elevation technique. We retrospectively evaluated long-term outcomes of CCE procedures over an 11-year time period. Core preparations were made after extractions of 57 upper molars in 45 patients. Extraction sites were drilled with a calibrated trephine bur to an estimated distance of 1 mm from the sinus membrane. The trephined interradicular bone and underlying sinus membrane were imploded into the sinus. The surgical crater and residual extraction socket were filled with deproteinized bovine bone mineral or freeze-dried bone allograft, stabilized, and protected with an absorbable collagen membrane and fully covered with coronally positioned flaps. Implants were placed 4 months later. Success was defined if ≥9 mm available bone height was available. Where the available bone height varied between 7 and 9 mm, implant placement was complemented using the bone-added osteotome sinus floor elevation technique; those sites were defined as a "partial success." The CCE technique was successful in 31 (68.9%) out of 45 sites, and partially successful in six (13.3%) out of 45 sites. Eight sites failed (17.8%). Surgical failures were caused by core detachment resulting in large tears of the sinus membrane. Implants placed in successful sites presented a 100% survival rate during the study duration. CCE implemented simultaneously with molar extractions provided therapeutic benefits and clinical limitations. The subsequent implant placement using CCE revealed an excellent survival rate in the study population evaluated.

An unusual complication of osteotome sinus floor elevation: benign paroxysmal positional vertigo

Maxillary sinus floor elevation in cases of reduced vertical bone height in the posterior maxilla allows predictable implant placement. The osteotome sinus floor elevation (OSFE) technique has shorter healing and waiting times because the fixture can be placed in the implant recipient site simultaneously with the ridge augmentation. Implant site preparation is more comfortable for the patient when performed with spiral drills than with continuous malleting of the osteotomes. Membrane perforation is the most frequent complication with the OSFE technique; postoperative infection is rare. Benign paroxysmal positional vertigo (BPPV) may be a complication of OSFE and may cause stress if not identified correctly and managed properly. The available treatment options, diagnostic strategies and the pathophysiology of this unusual complication are discussed. The authors present a case in which intense BPPV developed during OSFE, focusing on dental and maxillofacial surgery as risk factors for this pathology.

Osteotome sinus floor elevation technique without grafting: a 5‐year prospective study

To evaluate the long-term stability of peri-implant bone formation following implant placement without grafting into resorbed posterior maxillae. Twenty-five implants of 10 mm were placed in 17 patients to rehabilitate atrophic maxillae by means of an osteotome sinus floor elevation (OSFE) procedure without grafting. Mean residual bone height was 5.4±2.3mm. Bone levels were evaluated at 1, 3 and 5 years using periapical radiographs. All implants fulfilled survival criteria and gained peri-implant bone (mean increase 3.2±1.3mm). Implant protrusion into the sinus decreased from 4.9±1.9mm after surgery to 1.5±0.9mm after 5 years. Mean crestal bone loss amounting to 0.8±0.8mm stabilized over the 5-year observation interval. Twenty implants showed additional peri-implant bone gain following the 1-year control. Implant rehabilitation of atrophic maxillae may be greatly simplified using implants 10mm and the OSFE technique without grafting. Grafting material is not needed to gain at least 3mm of bone in the atrophic maxilla. The procedure appears predictable with favourable long-term results.

Osteotome sinus floor elevation with or without grafting: a preliminary clinical trial

This clinical trial aimed (1) to evaluate the predictability of the osteotome sinus floor elevation (OSFE) technique, (2) to study the influence of simultaneous grafting on the clinical success of placing dental implants in the posterior maxilla using OSFE and (3) to observe the bone changes in the elevated space with OSFE without grafting. Two hundred and eighty Straumann implants were placed in the posterior maxillae of 202 patients using OSFE. One hundred and ninety-one implants were placed in 125 patients without grafting. The implants were allowed to heal for 3-4 months for non-grafted implants and for 6-8 months for grafted cases. For radiographic analyses, periapical and panoramic radiographs were taken of 30 implants at 3 and 9 months to assess the bone changes for the elevated sites without grafting. Two hundred and sixty-eight of 280 implants fulfilling the survival criteria represented a cumulative survival rate of 95.71%. The residual bone height (RBH) was 5.6+/-2.5 mm for the non-grafted group and 4.7+/-2.1 mm for the grafted group. The perforation rate was 4.29%. No significant differences were found between the two groups in RBH, survival rate or membrane perforation rate. The radiographic analyses demonstrated that new bone formation in the elevated sinus was visible and the endo-sinus bone gain was 2.26+/-0.92 mm and 2.66+/-0.87 mm at 3- and 9- month follow-up, respectively. Crestal bone loss (CBL) was 0.89+/-0.5 and 1.2+/-0.48 mm at 3 and 9 months. For the two test groups, RBH did not have a significant influence on the survival of the implants. At the 9-month follow-up, the endo-sinus bone gain and CBL were not significantly correlated to RBH. The implant protrusion length was significantly correlated to the endo-sinus bone gain. The findings of this study indicated that uneventful osseointegration may be predictable on applying OSFE whether with or without grafting in atrophic posterior maxilla. Spontaneous new bone formation seemed to be expected with implants placed using OSFE without simultaneous grafting.

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.

Resonance frequency analysis of stability on ITI implants with osteotome sinus floor elevation technique without grafting: a 5‐month prospective study

The aim of the present study was to (1) monitor the stability changes of ITI implants placed in atrophic posterior maxillary ridges with osteotome sinus floor elevation (OSFE) without grafting during the first 5 months of healing utilizing resonance frequency analysis (RFA) and (2) determine the factors that affect the implant stability quotient (ISQ) at placement and healings. Forty-two ITI implants were placed in the posterior maxilla in 32 patients with OSFE without bone grafting. The residual vertical bone height ranged from 4 to 8 mm (average 6.36 mm). Bone type was classified into one to four groups according to the Lekholm and Zarb index. ISQ was tested on the day of surgery and consecutively at 2, 4, 6, 8, 12, 16, and 20 weeks by RFA. The 40 osseointegrated implants represented a survival rate of 95.2%. All the 40 implants achieved good primary stability and reached a comparably high stability at 16 weeks postoperation with a dip between 2 and 6 weeks in the stability curve. There was no significant difference of ISQ between type3 and type4 bone at implant placement and follow-up. The mean ISQ and its changing pattern did not demonstrate a statistically significant difference according to the pretreatment vertical bone height and implant length. The findings of this study indicated that uneventful osseointegration may be predictable applying OSFE alone with no grafting in atrophic posterior maxilla. Residual bone height (RBH), implant length, and bone type did not seem to affect the implant stability in this clinical situation.