Osteotome Sinus Floor Elevation Research Articles

Three-dimensional changes and influencing factors of tent space following osteotome sinus floor elevation without grafting: A 48-month retrospective radiographic study.

To analyze the three-dimensional stability and morphologic changes of tent space after the osteotome sinus floor elevation (OSFE) procedures without bone grafts. Forty-six implants placed using the OSFE technique with simultaneous implant placement without bone grafts were included in this retrospective study. Cone-beam computed tomography (CBCT) scans of the augmented sinuses were obtained pre- and postoperatively up to 48 months of follow-up. The maxillary sinus cavity profiles were outlined using three-dimensional virtual reconstruction and superimposition of CBCT scans. The three-dimensional changes in the tent space were measured. A generalized estimating equation (GEE) was used to explore potential factors. The implant survival rate was 97.8%. The mean volume of remaining tent space immediately after surgery was 96.8 ± 70.5 mm3, shrinking to 31.0 ± 24.9 mm3 after 48 months, while the mean percentage of remaining tent space volume decreased to 29.1 ± 20.7%. The tent space volume and the percentage of residual tent space volume only decreased significantly within 12 months after surgery (p = .008, .013). GEE results indicated positive correlations between the percentage of remaining tent space volume and implant protrusion length (p = .000) and apical height (p = .000), with a negative correlation between the sinus floor area immediately after surgery (p = .002) and the healing time (p = .022). The volume of the tent space rapidly shrank after OSFE without bone grafts. Several factors might influence the tent space stability. Long-term clinical trials with larger sample sizes are necessary to further validate the results.

Implant stability and clinical outcome between implant placement using internal sinus floor elevation with alloplastic bone material grafting and without grafting: A 1-year randomized clinical trial.

To compare implant stability and clinical outcome in implant placement between osteotome sinus floor elevation (OSFE) with biphasic calcium phosphate (BCP) which consisted of 30% of hydroxyapatite (HA) and 70% of beta-tricalcium phosphate (β -TCP) grafting material and OSFE without using bone grafting material. The research questions is whether the BCP provides any benefit in OSFE or not. Thirty patients (30 implants) with a single edentulous area of upper premolar or molar were randomly separated into OSFE with BCP (n = 15) and OSFE without grafting (n = 15). The patients were reevaluated 3, 6, 9, and 12months after implant loading. The clinical assessments (implant stability quotient (ISQ), implant survival-failure rate, and surgical complication) were analyzed. Together with radiographic assessments in 2D (endo-sinus bone gain (ESBG), mean marginal bone change (MMBC)) and 3D (endo-sinus bone gain in CBCT (ESBG-CT)) were evaluated, with a mean follow-up time of at least 12months of functional loading and prosthetic complication. 20 remaining implants (OSFE with BCP, n = 10; OSFE without grafting, n = 10) were analyzed. Mean ISQ was 79.18 3.43 in 1-year follow-up (ISQ; OSFE with BCP = 78.72 3.46, OSFE without grafting = 79.65 3.52). ISQ in both groups increased steadily without significant differences in each follow-up. (p = 0.56). In radiographic evaluation, at 6-, 9-, and 12-month, OSFE without grafting group showed statistically significant lower MMBC (p < 0.05). The 1-year clinical results showed that 2 implants failed in OSFE with BCP, and 1 implant failed in OSFE without grafting. Graft material "BCP" (HA30:TCP70) coupled with OSFE presents no extraordinary benefit in implant stability, clinical and radiographic outcome in 1-year follow-up. Clinically, OSFE with grafting materials provides no additional benefit. TCTR20210517008 (date of registration: May 17, 2021).

Evaluation of immediate implant placement with osteotome sinus floor elevation without graft material.

Significant difficulties can be encountered when installing posterior maxillary implants. Osteotome sinus floor elevation (OSFE) enables insertion of implants with insufficient bone height at the posterior maxilla using a special instrument known as the "osteotom." This study aimed to evaluate the implant survival rates and radiographical bone gain data after OSFE with simultaneous implant placement performed without grafting material. Further, we have discussed whether the osteotom tapping distance to sinus floor affects the amount of new bone gain (NBG). Forty dental implants were inserted in 36 patients (20 women and 16 men) aged between 24 and 80 years (mean = 55.7 years). Residual bone height and NBG were analyzed using a commercially available software program on panoramic films. The mean residual bone height at the intended implant sites was 5.4 mm ± 2.2 mm, ranging from 3.5 mm to 6.9 mm. The mean NBG was 1.5 mm ± 0.87 mm, ranging from 0.1 mm to 4 mm. At 64.4 months of follow-up, one implant had been lost in the osseointegration period. The remaining 39 implants were in function, with a survival rate of 97.5%. No significant difference was seen between the osteotome tapping distance to sinus floor and NBG at the implant apex (P = 0.395). OSFE without using bone grafts with simultaneous implant installation is a safe and reliable method with successful long-term results for he rehabilitation of edentulous posterior maxillae.

Indirect Sinus Lift in Maxillary Posterior Region using BAOSFE Technique

Implant placement in edentulous posterior maxilla along the maxillary sinuses poses difficulties following tooth extraction due to ridge resorption and pneumatization of sinuses resulting in inadequate vertical bone height. The maxillary sinus lying close to the posterior maxillary edentulous ridge can be augmented by various methods such as lateral window sinus floor elevation, crestal approach, and grafting procedures. Summers introduced the less invasive approach for the sinus floor elevation known as osteotome sinus floor elevation technique in which the vertical bone height was attained by retaining and relocating existing bone using different graded osteotomes. He further modified this technique by addition of bone graft to the osteotomy site before sinus elevation known as bone added osteotome mediated sinus floor elevation (BAOSFE). This case report shows placement of implant in atrophic maxillary region using BAOSFE technique.

Otolaryngologist Referral Required for Maxillary Sinus Pathology Observed on Cone-beam Computed Tomography Before Sinus Floor Elevation: A Case Report

Inverted papilloma is an uncommon sinus pathology usually affecting the maxillary sinus walls in its early stages. Although histologically benign, it has a relatively strong potential for local destruction, high recurrence rate, and the possibility of carcinomatous change. The current standard treatment is surgical removal by endoscopic sinus surgery. Since cone-beam computed tomography (CBCT) in dental clinics provides precise views of the maxillary sinus via high-resolution images, dentists can detect pathological alterations in the maxillary sinus, including inverted papilloma, and refer the patients to otolaryngologists in the early stage. This report documents a case of inverted papilloma detected on CBCT in the initial stage, which was treated by an otolaryngologist before implant placement. Finally, implant placement with osteotome sinus-floor elevation was safely performed after treating the neoplasm.

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.

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 &lt;.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&lt;.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.

Flapless osteotome-mediated sinus floor elevation using platelet-rich fibrin versus lateral approach using deproteinised bovine bone mineral for residual bone height of 2-6mm: A randomised trial.

To evaluate patient-reported outcomes and radiographic results of simultaneous implant placement in severely atrophic maxilla using flapless endoscope-assisted osteotome sinus floor elevation with platelet-rich fibrin (PRF), also defined as PESS, and to compare the results with those of lateral sinus floor elevation (LSFE). Patients with a residual bone height (RBH) of 2-6mm were included in a randomised controlled trial. PESS was performed with PRF as the sole grafting material. LSFE was performed using deproteinised bovine bone matrix. Patient-reported outcomes were recorded on a visual analogue scale (VAS-pain) and visual rating scale (VRS-swelling and VRS-willingness). Peri-implant bone height (PBH), bone mineral density (BMD) and sinus grafting remodelling index were measured using CBCT immediately postoperatively and 3rd, 6th and 18th months post-surgery. The study population consisted of 20 patients in each group. The RBH of two groups averaged 3.35±0.79mm and 2.92±0.63mm with no significant difference (p>.05). VAS-pain was 18.0 (IR 15.0-22.5) and 35.0 (IR 32.5-37.0) in the PESS and LSFE groups, respectively (p<.01). VAS-pain decreased with time in both groups. VRS-swelling was lower in the PESS group than LSFE group. VRS-willingness was higher in the PESS group than LSFE group (p<.01). At 18months post-surgery, the marginal bone loss was 0.60±0.25mm and 0.69±0.35mm in the two groups with no significant difference (p=.52). Within the limitations of this study, PESS was associated with lower postoperative morbidity and was more tolerable than LSFE. PESS could be a reliable procedure for sinus floor elevation in patients with insufficient RBH.

Evaluation of Sinus Membrane Perforation in Osteotome Sinus Floor Elevation With and Without Grafting.

The purpose of this study was to evaluate, using cone-beam computerized tomography (CBCT), the rate of sinus membrane perforation in osteotome sinus floor elevation (OSFE) performed with and without a graft material. Thirty patients with 52 OSFE sites were included in the study. Patients were divided into the control group (OSFE performed without graft material) and test groups (OSFE performed with autograft or xenograft). The autograft was harvested from the maxillary tuberosity using bone forceps. The xenograft was a commercial product originating from bovine bone. Graft volume was measured using the water displacement method. CBCT was performed at the initial examination and immediately after surgery to measure the residual bone height and to evaluate the endo-sinus bone gain and membrane perforation. The rate of sinus membrane perforation was 15.4%. Of the 52 OSFE procedures, 26.9% were performed without grafting and 34.6% and 38.5% were performed with autografts and xenografts, respectively. Membrane perforation was significantly higher in the autograft group (P = .033). The median volume of graft materials was 0.3 mL. The difference in graft volume between the autograft and xenograft was not statistically significant (P = .768). The mean endo-sinus bone gain was 6.55 mm in patients without membrane perforation and 8.71 mm in patients with membrane perforation; this difference was statistically significant (P = .035). The volume and physical properties of graft materials are important factors in membrane perforation. Further clinical studies with larger and standardized samples are needed to confirm the effect of graft materials on sinus membrane perforation in OSFE.

Osteotome sinus floor elevation with concentrated growth factor and simultaneous implant placement with or without bone grafting: a retrospective study

The aim of this study was to compare the clinical effects of osteotome sinus floor elevation (OSFE) combined with concentrated growth factor (CGF) and simultaneous implant placement with or without bone grafting in the maxillary posterior region, where the residual bone height (RBH) was 4–6 mm. A total of 44 patients who underwent OSFE combined with CGF and the simultaneous placement of 60 implants (group A, 31 implants with bone grafting; group B, 29 implants without bone grafting) were included in this retrospective study. The clinical indicators of implants were observed for 24 months. Sinus floor lift height was 6.02 ± 0.99 mm in group A and 5.81 ± 0.72 mm in group B (P = 0.360) after surgery. There was no significant difference in the vertical bone resorption between the two groups at 24 months (P = 0.097). Postoperative pain at 14 days (visual analogue scale) was significantly greater in patients with bone grafting when compared to those without bone grafting (P < 0.001). There was no significant difference in marginal bone loss (MBL) between the two groups (P = 0.707 for MBL during the first 12 months, P = 0.922 for MBL during months 12–24). The implant success rate was 100% with or without bone grafting. The technique of OSFE with CGF, either with or without bone grafting, is safe and reliable in patients with RBH 4–6 mm.

Osteotome-Induced Blood Clot and Subsequent Bone Formation with the Use of Collagen Sponge for Integration of Single Dental Implants into the Atrophied Posterior Maxilla: A Retrospective Follow-Up of 36 Implants after 5 to 13 years.

Background Atrophy of the posterior maxilla as a consequence of tooth loss and sinus pneumatization is a frequent condition encountered in the clinical practice. Prosthetic rehabilitation with implants in these patients often requires some kind of bone regeneration procedure to increase the bone volume. Aim The aim of the present retrospective study is to analyze the survival and success rates of a series of implants placed in the atrophic posterior maxilla with a transcrestal osteotome procedure, without placing a bone grafting material. Materials and Methods From 2006 to 2014, 36 dental implants (Neoss Ltd., Harrogate, UK) were inserted in 36 patients with at least 4 mm of bone below the maxillary sinus using transcrestal osteotome sinus floor elevation and placement of collagen sponge below the sinus membrane. ISQ measurements were made after implant placement and at abutment surgery after 4 to 6 months. The vertical bone height (VBH) was evaluated in intraoral radiographs taken prior to surgery and in radiographs from annual check-up appointments 5 to 13 years after implant placement. In addition, marginal bone loss (MBL) was evaluated. Results One implant was lost after four years of prosthetic loading. The remaining 35 implants showed no complications and were loaded with single crowns after 4–6 months of healing. All 35 implants showed clinical success after 8.5 ± 2.8 years of prosthetic loading (from 5 to 13 years). The vertical bone height was 5.9 ± 1.4 mm at surgery, 9.7 ± 1.1 mm at second surgery after 4–6 months, and 8.3 ± 1.8 at the follow-up at 8.5 ± 2.8 years (from 5 to 13 years). The implant stability registered was 73.2 ± 6.2 ISQ at the surgery and 75.8 ± 3.9 at the second surgery after 4–6 months. Conclusions The present long-term follow-up study showed that the crestal approach for sinus floor bone augmentation without additional bone grafting results in predicable bone formation and high implant survival. The osteotome technique is a valid alternative to the more invasive lateral window technique in single cases with a minimum of 4 mm of VBH below the maxillary sinus.

Extraction site reconstruction by alveolar ridge preservation and indirect sinus lifting procedure for dental implant placement

Dimensional changes to the alveolar ridge are inexorable following tooth extraction. To avoid this hard-tissue loss, alveolar ridge preservation (ARP) soon after extraction needs to be done. However, despite taking precautions to prevent the ridge loss, some cases might require ridge and sinus augmentation procedures for dental implant placement subsequent to tooth extraction. The present case report briefs on management of extraction site by ARP and indirect sinus lifting by osteotome sinus floor elevation approach, for dental implant placement.

Retrospective study on the merits of bone grafts and the influence of implant protrusion length after osteotome sinus elevation surgery.

This study aims to evaluate the endo-sinus bone remodeling of dental implants placed via osteotome sinus floor elevation (OSFE) after 6 months and using different implant protrusion lengths and bone grafts through cone beam computed tomography (CBCT). Ninety-six patients with 124 implants were included and assigned into four groups. Group 1: implant protrusion length<4 mm with bone graft; group 2: implant protrusion length>4 mm with bone graft; group 3: implant protrusion length<4 mm without bone graft; group 4: implant protrusion length>4 mm without bone graft. Apical bone gain (ABG), cortical bone gain (CBG), bone density gain (BDG), and marginal bone loss (MBL) were observed and analyzed at baseline and 6 months after implant surgery. The CBG in grafted groups 1 and 2 was higher than that in non-grafted groups. The ABG and BDG were higher in non-grafted groups 3 and 4 than in grafted groups, and the levels in group 3 were higher than those in group 4. The CBG in grafted group 2 was higher than that in group 1. No significant difference was observed in MBL analysis. The BDG of IPL<4 mm implants was higher than IPL>4 mm implant when bone grafts were not applied. No relevance was observed between IPL and CBG. Bone grafts can accelerate endo-sinus bone remodeling by increasing CBG and dissipating the influence of IPL on BDG.

Influence of maxillary antrolith on the clinical outcome of implants placed simultaneously with osteotome sinus floor elevation: A retrospective radiographic study.

Large antroliths and those located adjacent to the sinus floor can affect clinical interventions and increase the difficulty of implant placement performed simultaneously with osteotome sinus floor elevation surgery. This retrospective study investigated the clinical outcomes of implants placed simultaneously with osteotome sinus floor elevation subjacent to maxillary antroliths. Twenty implants inserted subjacent to or intruding into the antrolith after sinus floor elevation were evaluated in 18 patients. Cone-beam computed tomography (CBCT) was used to measure antrolith size and membrane thickness at sites of osteotome sinus floor elevation. Periapical radiographs were used to assess the height of grafted bone. Generalized estimating equation (GEE) analysis was performed to correlate the occurrence of antroliths with patient background characteristics and dental outcomes, based on a sample population of 239, among whom 33 presented antroliths. The 20 implants remained clinically stable over a mean follow-up period of 42.4months. The mean thickness of the sinus membrane at osteotome sites was 5.4 ± 3.3 mm. None of the cases presented sinus membrane perforation or sinus symptoms following osteotome intervention. The mean gain in the height of grafted sinus bone was 4.0 ± 1.4 mm at the last follow-up. The occurrence of antroliths was higher among females and the elderly (>49 years old). The multivariable GEE analysis showed that the adjusted odds ratio for the occurrence of antroliths with root canal fillings was significantly lower than those without root canal fillings (odds ratio=0.33; 95% confidence interval=0.11-0.96). Our findings indicate that osteotome sinus floor elevation is a surgical procedure with a risk <17%. Thorough planning based on CBCT and careful management during surgery can eliminate the negative effects of antroliths on implant performance.

Influence of implant protrusion length on non-grafting osteotome sinus floor elevation with simultaneous implant: a 3- to 9-year retrospective study

BackgroundThis study analyzed the influence of implant protrusion length (IPL) on the possible factors that affect the long-term outcomes utilizing non-grafting osteotome sinus floor elevation (OSFE) with simultaneous implant placement, and to explore the optimal range of IPL.Materials and methodsA retrospective study design was adopted. The clinical and radiographic data of 105 implants in 65 patients were collected after 3–9 (mean 5.04) years follow-up. IPL was divided into three groups (group1, IPL<2mm; group2, 2mm≤IPL<4mm; group3, IPL≥4mm). Endo-sinus bone gain (ESBG), peri-implant marginal bone loss (MBL), bone to implant contact length (BICL), and percentage of ESBG (%ESBG) were used to evaluate non-grafting OSFE. A Kaplan-Meier analysis was performed to assess the cumulative survival rate. Multiple linear regression model was used to explore the relationship between the possible influence factors and ESBG. Analysis of variance (ANOVA) was applied to explore the correlation of IPL with ESBG, MBL, BICL, and %ESBG.ResultsA total of 102 implants in 62 patients fulfilled the survival criteria, giving the cumulative survival rates of 96.4% and 94.1% for implant-based analysis and patient-based analysis, respectively. The mean ESBG, MBL, and BICL at the latest follow-up were 1.95±0.88 mm, 0.58±0.68 mm, and 5.51±1.47 mm. ESBG was found to be positively correlated to IPL. A significant decreased bone formation efficiency was found when IPL was over 4 mm (P=0.02).ConclusionsAn optimal range of IPL within 4 mm was recommended for better long-term outcomes when applying non-grafting OSFE with simultaneous implant placement.

Clinical, radiographic and economic evaluation of short-6-mm implants and longer implants combined with osteotome sinus floor elevation in moderately atrophic maxillae: A 3-year randomized clinical trial.

To compare the 3-year clinical, radiographic and economic outcomes of short-6-mm implants and longer implants combined with osteotome sinus floor elevation (OSFE) in the posterior maxilla. This study enrolled 225 patients (225 implants with diameter of 4.1mm and 4.8mm) with a posterior maxillary residual bone height (RBH) of 6-8mm. Patients were randomly divided into three groups: Group 1 (6mm implants alone), Group 2 (8mm implants+OSFE) and Group 3 (10mm implants+OSFE). The following outcomes were recorded at 1 and 3-year examinations: implant survival, probing pocket depth (PPD), bleeding on probing (BOP), modified plaque index (mPI), marginal bone loss (MBL), biological and technical complications, complication-free survival and treatment costs. At the 3-year follow-up, 199 patients (Group 1: 67; Group 2: 62; Group 3: 70) were re-examined. Implant survival rates were 91.80%, 97.08% and 100.00% in groups 1, 2 and 3. Implant survival rate in Group 1 was significantly lower than that in Group 3 (p=0.029). A multivariate Cox model showed that the short-6-mm implants with wide diameter had a protective effect on implant survival (hazard ratio: 0.59, p=0.001). No significant differences in BOP%, PPD, mPI, MBL and complication-free survival rate were found among the three groups. The average costs of retreatment were 8.31%, 1.96% and 0.56% of the total costs in groups 1, 2 and 3. The cost to avoid a 1% increase in implant loss associated with 6-mm implants over a 3-year period was 369 CNY (56USD) using a 10-mm implant with OSFE and 484 CNY (74USD) using an 8-mm implant with OSFE. In the moderately atrophic posterior maxillae, the three treatments showed acceptable clinical, radiographic and economic outcomes with up to 3-year follow-up. 10-mm implants combined with OSFE showed more favourable implant survival and fewer maintenance costs in comparison with short-6-mm implants, which were less expensive.

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.

Radiography study on osteotome sinus floor elevation with placed implant simultaneously with no graft augmentation

OBJECTIVE To investigate the change of endo-sinus bone height and bone volume in osteotome sinus floor elevation (OSFE) without bone graft but placing implants simultaneously by using cone beam computed tomography (CBCT) and three dimensional analysis, and to find the impacting factors on endo-sinus bone augmentation. METHODS OSFE was performed in 38 edentulous patients with missing teeth at posterior maxillary region, and 44 implants were placed and referred for OSFE using no graft materials. CBCT was performed pre-surgery and 9－68 months post-surgery when the patients encountered another implant surgery. The gained bone height at mesial, distal, buccal and palatal sites around the implant in sinus were measured, volumetric measurements of the endo-sinus gained bone volume (ESGBV) in the elevated region were calculated by Mimics software. Univariate analysis and multiple linear regression were performed to investigate the impacting factors on the gained bone height and ESGBV. Marginal bone loss was recorded according to the periapical radiography after implant restoration. RESULTS The mean residual bone height (RBH) pre-surgery was (3.41±1.23) mm, the mean protruded length (PL) into sinus of implant post-surgery was (3.41±1.28) mm, the mean endo-sinus gained bone height was (2.44±1.23) mm at distal sites, (2.88±1.20) mm at mesial sites, (2.83±1.22) mm at buccal sites and (2.96±1.16) mm at palatal sites, the mean endo-sinus gained bone height at distal sites was significantly lower than the other three sites (P < 0.05). The average endo-sinus gained bone height was (2.78±1.13) mm. The mean ESGBV was (122.15± 73.27) mm3. Univariate analysis showed the more RBH, the less bone height gained in sinus, which existed at buccal, lingual, mesial and distal sites (P < 0.001), and the more RBH, the smaller ESGBV gained (P=0.012). The ESGBV was significantly higher in the subjects whose bone generation period was more than 24 months than those whose bone generation period less than 24 months (P=0.034). The more PL, the more bone height and ESGBV gained (P=0.008). Multivariate analysis showed after adjusting factors of gender, age, smoking, width of sinus floor, thickness of sinus membrane pre-surgery, diameter and length of the implant, PL and bone generation period was positively correlated with mean endo-sinus gained bone height and ESGBV, while RBH negatively correlated with mean endo-sinus gained bone height. During the follow-up, the mean marginal bone loss was 0 (0－1.41) mm and all the implants loaded successfully. CONCLUSION OSFE without bone graft but with placed implant simultaneously can increase endo-sinus gained bone height and ESGBV. RBH, PL and bone generation period are the significant factors impacting endo-sinus bone augmentation.

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.