Maxillary Posterior Region Research Articles

Image-based Bone Density Classification Using Fractal Dimensions and Histological Analysis of Implant Recipient Site.

Background:Success of dental implants is affected by the quality and density of the alveolar bone. These parameters are essential for implant stability and influence its load-bearing capacity. Their assessment is usually based on preoperative radiographs used as a tool prior to implant procedures.Objective:The aim of the study was to compare the bone density of surgically harvested bone specimens at implant recipient sites in the maxillary and mandibular posterior region using histological analysis to the radiographic bone density using fractal dimension for reliability and determining an image based classification of bone density prior surgery.Methods:Fifty implants were placed in the posterior region of male patients, (twenty five implants in the maxilla and twenty five in the mandible). The edentulous regions were presurgically assessed using Photo Stimulable Phosphor Plate (PSP) intra-oral radiographs and the fractal dimension box counting of region of interest was calculated at the implant recipient site. During surgery, bone core specimens were trephined, and bone densities and minerals parameters were evaluated based on histological analysis using SEM (Scanning Electron Microscopy), and atomic absorption spectrometry.Results:Fractal dimensions (FD) values for the same region of interest (ROI) selected on the radiographs of bone blocks and edentulous sites were different but showed a proportional variation in molar and premolar region of the maxilla and mandible. Bone density results, calculated by the ratio of bone mass (BM) to the bone volume (BV) of the bone core specimen (D=M/V), increased in the mandibular bone blocks, and decreased in the maxilla specimens. Moreover, fractal dimension values of preoperative radiographs at implant recipient sites and bone density of trephined showed a statistically similar distribution. However, no significant difference was shown in the percentage of minerals contents and mass of calcium phosphate of each bone specimen between maxilla and mandible based on scanning electron microscopy analysis. Four types of bone densities were classified according to the distribution of FD values based on preoperative radiographs and on the densities of bone cores calculations.Conclusion:Radiographic estimation of bone quality calculated with fractal dimension could be a useful, non-invasive tool when using preoperative intra-oral radiographs to predict bone density at implant recipient sites with caution and limits concerning the kind of digital radiographs and size of region of interest, especially when these results were based with bone specimens harvested from implant site as an absolute reference.

Sinus augmentation in atrophic maxilla: Lateral window approach

Rehabilitation of edentulous posterior maxillary regions by means of implant placement often poses challenging situations due to inadequate alveolar ridge height and poor bone quality. Since resorption of posterior residual ridge is caused by sinus pneumatization or traumatic extractions, maxillary sinus floor elevation (SFE) and bone augmentation with graft materials remains the method of choice. This scientific, evidence-based, preprosthetic procedure is a corrective technique available for almost two decades in such surgically compromised cases. In this article, we will discuss and review instrumentation by lateral window approach for SFE in conjunction with bone augmentation for delayed implant placement postgraft maturation in the healing period.

Reabilitação protética após fratura dento-alveolar extensa – relato de caso

Bucco-sinus communications are common incidences and may be associated with posterior superior tooth extraction. In large maxillary losses, repairing prostheses have a categorical or essential indication. Thus, the objective of this study is to report a clinical case of prosthetic rehabilitation using a removable partial denture (RPD) due to absence of teeth in the posterior maxilla region resulting from a dento-alveolar fracture as consequence of traumatic injury. A 21-year-old male patient attended the dental clinic at Nilton Lins University, reporting masticatory failure, discomfort and sensitivity when eating cold foods in the right upper molars region. After clinical and radiographic examination, it was observed that in addition to the absence of teeth 16, 17 and 18, there was an extensive bone loss in the right posterior hemiarch, with surgically sealed bucosinusal communication. As treatment plan, rehabilitation using a removable partial prosthesis modified and adapted to the acquired defect was proposed. In the consultations, the stages of study model manufacturing, assemble in a semi-adjustable articulator and delineation. The modification of the metallic frame consisted of a larger connector, like a wide palatal plate 10 mm long without relief on the palate, complemented by indirect twinned clamps and direct “T” type on tooth 15. The case was concluded with the steps of metal frame test, teeth assembly, teeth testing, acrylization and installation. The rehabilitation treatment by means of restorative PPR was satisfactory, as it was observed that after its installation, the patient showed extreme satisfaction with the result obtained, with an explicit improvement in chewing and swallowing.

Posteriyor Maksillanın Kemik Morfolojisi ve Maksiller Sinüsün Seyri: İmplant Tedavisi için Üç Boyutlu Analiz

Objective: The purpose of this study was to assess morphologic features of alveolar bone supporting maxillary premolars and molars and to determine the relationship between maxillary sinus and teeth using cone beam computed tomography (CBCT).Material and Methods: In CBCT scans of 100 patients, the thickness of both trabecular bone and cortical plates surrounding 652 posterior teeth were measured and the relationship between teeth and maxillary sinus was classified. Also, the angle between the teeth and the alveolar crest was measured.Results: Of the teeth examined, 25 % were in contact with the inferior wall of maxillary sinus, 12% had penetrated the sinus and 63 % were far away from maxillary sinus. The closest root to the maxillary sinus floor was mesiobuccally root of second molar teeth with 1.3 mm distance. The teeth which had thinnest bone configuration were maxillary first premolars. There were no significant differences for measurements between sides and gender (p>005). Buccal bone thickness and distance to the maxillary sinus floor showed a negative correlation in molars (p˂0.001 and 0.003).Conclusion: In order to prevent possible complications, a three-dimensional analysis of the posterior maxilla and maxillary sinus is required before implant procedures to be performed on the maxillary posterior region.

Management of Short Alveolar Bone with Implant Retained Splinted Crown

Implant placement on maxillary posterior region has some limitations because of limited bone height, low bone density, and anatomical consideration involving the floor of the maxillary sinus. A 56-year-old male with a history of hypertension and stroke, consulted for edentulous in teeth 25 and 26 with limited bone height. A short implant for 26 (Ø 4.8 mm; 4 mm) and 25 (Ø 4.1 mm; 10 mm) were placed and splint crown was performed after 6 months.

The thickness of posterior buccal attached gingiva at common miniscrew insertion sites in subjects with different facial types

The purpose of this study was to assess the thicknesses of maxillary and mandibular posterior buccal approximal attached gingiva at common miniscrew insertion sites, which has critical importance in determining miniscrew length, in subjects with different facial types. One hundred seventy-four subjects with no transversal skeletal discrepancy were included in this study. The facial types of these subjects were evaluated in the sagittal and vertical directions. In the sagittal direction, the subjects were assigned into 3 groups: skeletal Class I, II, and III. Also, each of these groups was divided into subgroups in the vertical direction: low angle, norm, and high angle. Transgingival probing was used to measure the thickness of the buccal attached gingiva. The thickness of the buccal attached gingiva between the second premolar-first molar ranged from 1.18±0.33 to 1.46±0.28 mm and from 1.28±0.30 to 1.58±0.37 mm in the maxilla and mandible, respectively. The thickness of the buccal attached gingiva between the first-second molars ranged from 1.31±0.41 to 1.60±0.62 mm and from 1.36±0.43 to 1.72±0.52 mm in the maxilla and mandible, respectively. In terms of the thicknesses of the buccal attached gingiva of second premolar-first molar and first-second molars, no statistically significant difference was found between subjects with different facial types. It was determined that the thicknesses of maxillary and mandibular posterior buccal approximal attached gingiva varied between 1.18-1.72. At this point, the insertion of miniscrews of 7-8mm in length was recommended for maxillary and mandibular posterior buccal regions, in order to obtain adequate insertion depth.

Sinus floor elevation and simultaneous dental implantation: A long term retrospective study of sinus bone gain

To evaluate the sinus bone gains after sinus floor elevation procedures with or without grafts when implants were placed simultaneously. The research included 26 edentulous patients in the maxillary posterior region, who were divided into 2 different groups according to the sinus lift procedures employed: group of osteotome sinus floor elevation with bone grafts (group A) and group of osteotome sinus floor elevation without bone grafts (group B). The implants were placed simultaneously, and were followed for a period of 30-50 months after sinus floor elevation as routine and then were observed for sinus bone change. There were 27 implants (13 implants for group A and 14 implants for group B) and the following time was 40.23 (36.20, 48.07) months. The residual bone height (RBH) was (6.64±1.21) mm for group A and ( 6.96±1.36) mm for group B; the difference between the two groups was not statistically significant (P=0.459).The sinus bone gain (SBG) when followed was (2.20±1.71) mm for group A, and 1.77 (0.94, 2.05) mm for group B; the difference between the two groups was not statistically significant (P = 0.583). The quality of apical bone around implant apex was divided into 3 categories which were excellent, fine and fair.The quality of apical bone around implant apex was excellent and fine for 9 implants in group A and 8 implants in group B, and the difference between the two groups was not statistically significant (Fisher exact test, P=0.695).The implant apex when followed was (0.09±1.32) mm below the new sinus floor for group A and (0.03±0.91) mm for group B, and the difference between the two groups was not statistically significant (P = 0.898). The SBG for the total was 1.85 (1.10, 2.20) mm. The SBG was statistically significantly only related to the protrusion height of the implant apex (r=0.383, P=0.049). Sinus floor elevation procedures with or without grafts can all gain good results. The SBG is related to the protrusion height of the implant apex significantly.

The role of cone beam computed tomoraphy (CBCT) for direct sinus lift in atrophic maxillary posterior region: Report of a case

In the posterior maxilla, unfavourable ridge resorption following dental extractions, sinus pneumatisation and poor quality of bone remain areas of concern. It becomes imperative to increase the height of the alveolar bone to facilitate implant placement in such regions. Pre surgical radiographic assessment using Cone Beam Computed Tomography (CBCT) allows the surgeon to plan implant insertion with ease. The article discusses the radiographic evaluation of gain in residual bone height after direct sinus lift technique using CBCT, thereby discussing its versatility and usage. Keywords: Direct sinus lift, Radiographic assessment, Cone beam computed tomography (CBCT).

Immediate nonfunctional loading of implants placed simultaneously using computer-guided flapless maxillary crestal sinus augmentation with bone morphogenetic protein-2/collagen matrix.

Immediate loading has shown positive results for total, partial, or single edentulism. The effects of BMP-2 addition to graft materials on bone formation and implant stability in the early stages of healing have rarely been studied, especially in patients with severely atrophic maxillae. To evaluate the effects of simultaneously placed immediate non-functional loaded implants and bone morphogenetic protein-2 (BMP-2)-loaded Bio-Oss collagen, on bone formation and implant stability during the early healing stages of patients with a severely atrophic posterior maxilla using crestal approach. Thirty-three cases presenting posterior maxillary residual alveolar bone height of 1-3 mm were evaluated. Flapless crestal sinus augmentation surgery was performed using BMP-2-loaded Bio-Oss collagen, with non-functional implants immediately loaded after surgery. The bone height was assessed using preoperative and postoperative cone beam computed tomography (CBCT). Bone density of the sinus graft sites and implant stability (after 3 months) were evaluated using postoperative CBCT scans and Periotest, respectively. The periodontal parameters and marginal bone loss around the implant were checked after 37.3 months of final prosthesis. The survival rate of the implants was 100% and the gingiva around the implants remained healthy. All implants remained integrated, and all sinus grafts showed radiographic bone formation. The results indicated high level of bone density and good implant stability, showing minimal marginal bone loss after 37.3 months. This technique could be used in the posterior maxillary region exhibiting poor bone quantity.

Two-stage closed sinus lift for severe bone deficiency in the posterior maxilla imrpoves long-term clinical outcomes

To evaluate the long-term clinical outcomes of two-stage closed sinus lift for the maxillary sinus with residual bone height (RBH) of 1-3 mm in the posterior maxillary. Seventy-eight patients with maxillary posterior tooth loss (1 mm≤RBH≤3 mm and alveolar ridge width ≥5 mm) were treated with two-stage closed sinus lift at the Dental Implantation Center of our hospital between March, 2012 and December, 2014. Coral hydroxyapatite powder and 148 implants were implanted. The superstructure was fixed within 6 months after the operation and the patients were followed up for 1-5 years for assessing the patients' satisfaction, postoperative response, stability and survival rates of the implant, soft tissue condition, bone height of maxillary sinus floor elevation and the marginal bone loss. Perforation of the maxillary sinus floor occurred in 3 (3.85%) of the cases. Twenty-three (30.67%) patients complained of mild pain, and 52 (69.33%) did not experience headache or fever or reported obvious pain or swelling after the operation. The overall response to the operation was favorable. The ISQ value was 58.39±1.39 immediately after the operation, and increased significantly to 81.88±1.22 at 6 months (P < 0.05). During the healing period and the follow-up, none of the implants fell off, and the implant survival rate was 100%. The peri-implant probing depth and modified sulcus bleeding index at 1 year after sinus lifting were similar to those at 5 years after the operation (P > 0.05), but the sinus floor elevation and marginal bone resorption at the two time points differed significantly (P < 0.05). Compared with lateral wall lifting, two-stage close lifting of the maxillary sinus floor is associated with less trauma and less discomfort, and effectively solves the problem of severe alveolar bone height deficiency in the maxillary posterior region to achieve favorable long-term clinical outcomes.

Dental implant primary stability in different regions of the Jawbone: CBCT-based 3D finite element analysis

AimThis study aimed to analyze the primary stability of dental implant in maxillary and mandibular anterior and posterior regions using a finite element analysis. Materials and methodsCBCT images of maxillary and mandibular regions were collected from patients’ radiographic data and transformed to 3D models. A Straumann Dental implant was inserted in each bone model and then pulled-out, where amount von-Mises stress was obtained and analyzed for each. A comparison between the insertion and the pull-out was evaluated. ResultsTwenty-four images were randomly selected for analysis from 122 scans. In both the insertion and the pull-out of the dental implant, von-Mises stress was high in cortical as compared to the cancellous bone (p < 0.0001). Maxillary posterior region had a low von-Mises stress (p < 0.001). Bone plastic deformation was higher in cancellous than the cortical bone in all bone regions and was the lowest in maxillary posterior region (p < 0.001). Bone displacement decreased from Type I to type IV bone. ConclusionEvaluation of von-Mises stress showed different measurements in maxillary and mandibular regions. Bone deformation was low in the maxillary posterior region.

Quantitative Assessment of the Edentulous Posterior Maxilla for Implant Therapy: A Retrospective Cone Beam Computed Tomographic Study.

Dimensional changes of the alveolar bone are often noted in horizontal and vertical planes as a sequel to tooth extraction, particularly in the maxillary posterior region due to alveolar bone resorption combined with pneumatization of the sinus. The aim of this retrospective study was to quantitatively assess the maxillary residual alveolar ridge using cone beam computed tomography (CBCT) scans. A total of 349 edentulous sites from 250 CBCTs were evaluated. The apico-coronal bone height and bucco-palatal crest width were measured in sagittal and coronal slices, respectively. Additionally, the obliqueness of the sinus floor at the edentulous sites was also evaluated. One hundred and twelve (55.45%) of the molar and 74 (54.42%) of the premolar sites had a horizontal ridge dimension < 6mm, whereas 137 (67.83%) of the molar and 61 (44.86%) of the premolar sites showed an apico-coronal height < 8mm. Furthermore, 183 (54.14%) of the evaluated sites had an oblique sinus floor morphology. Additional augmentative procedures are thus required in a high percentage of the population at the edentulous maxillary posterior site for rehabilitation using a standard dimension implant. This study stresses on the need for a three-dimensional CBCT prior to implant surgery for proper treatment planning.

Characteristics of Chronic Maxillary Sinusitis in Patients With a History of Long-term Bisphosphonate Use.

Background Bisphosphonates are widely used as bone stabilizers, which can cause major side effects including bisphosphonate-related osteonecrosis of the jaw (BRONJ) that occurs more frequently in the mandible. Consequently, there is a need for a detailed investigation of BRONJ of the maxilla and, in particular, of involvement of the maxillary sinus. Objective Our aim was to evaluate the characteristic radiologic and clinical manifestations in patients with maxillary sinusitis and a history of long-term bisphosphonate use. Methods Between January 2015 and July 2018, 55 patients with symptoms consistent with chronic rhinosinusitis who underwent a paranasal sinus computed tomography (CT) and had a history of &gt;12 months of bisphosphonate therapy were included in the analysis. Results Radiologically and clinically evident chronic rhinosinusitis was noted in 24 of the 55 patients, of whom more than half (14/24, 58.3%) had BRONJ. The CT studies demonstrated that the maxillary sinus was involved in all 24 patients, characterized by unilateral involvement (70.8%) and bony remodeling in the posterior maxillary region (90.5%). The evidence of osteitis on CT and/or single-photon emission CT was observed in the majority of cases (19/21, 90.5%) and 12 patients (50.0%) had oroantral fistula. However, there were no differences in the clinical appearance of the diseases with respect to the radiologic aspects. Conclusions Besides its well-known effects on the mandible, long-term bisphosphonate use can also affect the maxillary sinus, with typical clinical and radiological manifestations.

MON-350 Disseminated Histoplasmosis Manifesting as Adrenal Insufficiency: A Rare Presentation of a Common Infection

Background: Histoplasmosis is a common fungal infection in endemic areas, however it can rarely cause symptomatic disease requiring medical care in some patients. 1 We describe the case of a patient with untreated human immunodeficiency viral (HIV) infection who developed adrenal insufficiency (AI) from disseminated histoplasmosis (DH). Clinical Case: A 56-year-old male with untreated HIV infection and hypertension was evaluated for left upper jaw swelling and pain of 3 months duration. Exam was remarkable for palpable cervical lymph nodes, oral thrush, mass in the posterior maxillary region near the left molars and generalized rash on the upper chest and back. CT chest showed bilateral adrenal gland enlargement measuring 4.1 x 3.6 cm on the left and 2.7 x 2.3 cm on the right with ground glass opacity on the right lower lobe of the lung and hilar lymphadenopathy. MRI brain showed a 3.9 x 5.8 x 4.3 cm soft tissue mass in the posterior aspect of the left maxilla with erosion into maxillary sinus. Biopsy from maxillary mass was positive for histoplasmosis. Laboratory testing showed significant hyponatremia and hyperkalemia. A 250 mcg cosyntropin test was obtained and was consistent with primary AI with an elevated ACTH level of 86 pg/ml (7-69 pg/ml). He was treated with amphotericin for histoplasmosis with good clinical response. He was also started on mineralocorticoid and glucocorticoid replacement for adrenal insufficiency and eventually weaned off mineralocorticoids. Repeat adrenal CT scan 3 years after treatment showed reduction in the size of the adrenal gland however patient continues to be on glucocorticoid replacement for AI. Conclusion: Adrenal involvement is not commonly seen in DH. Even in patients with adrenal involvement, development of adrenal insufficiency in DH is rare.2 Addison’s disease was reported in 14.3% of patients with adrenal histoplasmosis in one case series 3. Kauffman et al reported only 12 out of 58 elderly patients with histoplasmosis had adrenal involvement and none of them had adrenal insufficiency. Adrenal histoplasmosis though rare, should be considered as a differential in patients presenting with unilateral or bilateral adrenal masses and adrenal insufficiency, especially in endemic areas. Our case demonstrates the importance of being vigilant about this association, since delay in treatment could result in life threatening consequences.

CBCT assessment of relationship between maxillary sinus floor and maxillary posterior teeth: A retrospective study

Introduction: Aim of the study was to assess the relationship between maxillary sinus floor and maxillary posterior teeth. Materials and Methods: Retrospectively 50 cone beam computed tomographic images in the age group of 20 to 60 years were procured from CBCT archives randomly, based on the inclusion and exclusion criteria set forth for the study. Results: Palatal root of right maxillary 1st premolar was farthest & mesiobuccal root of maxillary right 2nd molar was nearest to maxillary sinus (MS). Mean thickness of the distobuccal root for left maxillary 2nd molar with buccal cortical was maximum whereas mean thickness for the mesiobuccal root with buccal cortical plate for left maxillary 1st molar was minimum. Conclusion: Adequate radiographic investigations are required before any surgical procedure in maxillary posterior teeth region. We recommend to use CBCT a 3-dimensional imaging modality when required. Keywords: Cone beam computed tomography (CBCT), Maxillary posterior teeth, Maxillary sinus floor (MSF).

Using Absorbable Gelatin Sponge to Facilitate Sinus Membrane Elevation during Open Sinus Lift: Technical Notes and Case Series

Ridge atrophy accompanied by the pneumatization of maxillary sinus in the maxillary posterior region may lead to inadequate bone height, thereby precluding implant placement. Therefore, it may be mandatory to perform a sinus membrane elevation procedure and augmentation in the bone. The present study aimed to introduce a novel modification method for sinus floor elevation using a gelatin sponge (Gelatamp, COLTENE ROEKO, India) in order for better visualization, hemostasis, and conservative maxillary sinus membrane dissection with the low risk of complications. Implant placement was performed in a case series of 28 patients with hyperpneumatized sinus or a moderately resorbed posterior maxillary alveolus. According to the findings, implant placement caused no complications in the patients. Furthermore, none of the patients experienced infections, sinusitis or graft and implant failure clinically and radiographically at the three- and six-month follow-up. Therefore, it could be concluded that gelatamp-assisted sinus lift is a simple, safe, noninvasive, and innovative technique for sinus membrane elevation. In addition, it is predictable and efficient, especially in the cases where piezoelectric surgery armamentarium is not available.

Four or six implants in the maxillary posterior region to support an overdenture: 5-year results from a randomized controlled trial.

To compare clinical and patient-reported outcomes when providing maxillary overdentures on four bar- and six bar-connected implants placed in the posterior region during a 5-year follow-up period. Sixty-six fully edentulous patients with functional maxillary denture complaints and insufficient bone volume to allow implant placement were scheduled for a maxillary sinus floor elevation procedure with bone from the anterior iliac crest and randomized to receive either four or six implants in the posterior maxilla and four implants in the mandible. After 3months of osseointegration, a bar-supported overdenture was constructed. Maxillary implant survival, overdenture survival, clinical scores, peri-implant bone height changes and patient satisfaction were assessed. Sixty patients completed the 5-year follow-up. Implant survival was 100% in the four-implant group and 99.5% in the six-implant group. No new overdentures had to be made in the four-implant group, and three new overdentures were made in the six-implant group due to excessive wear of the denture base and teeth (90.9% overdenture survival). Clinical parameters did not differ significantly between groups. Mean marginal bone loss compared to baseline was 0.58±0.51mm in the four-implant group and 0.60±0.58mm in the six-implant group, respectively. Overall, patient satisfaction improved significantly, but did not differ between groups. Following a bilateral maxillary sinus floor elevation procedure, a bar-supported overdenture on four implants in the posterior maxillary region is not inferior to an overdenture supported by six implants after a 5-year evaluation period in patients with functional maxillary denture complaints and marked posterior resorption (Clinical trial registration number: NTR2969).

Morphological Assessment of Maxillary Sinus Septa Variations with Cone-Beam Computed Tomography in a Turkish Population

Objective The purpose of this study was to measure and classify sinus septa variables (prevalence, numbers, heights, locations, orientations, and morphology) and to determine the effects of age, gender, and dental status on the presence of septa and also to evaluate the effects of septa on pathological mucosal thickening. Materials and Methods A total of 2,000 patients were analyzed through conebeam computed tomography (CBCT). The total of 500 maxillary sinuses were included in this study. The number of maxillary sinus septa was determined on axial sections of CBCT images. Their locations, orientations, and morphologies were determined on both the axial and sagittal sections, and their heights were determined only on the sagittal sections. The influence of age, gender, dental status, and pathological mucosal thickening on the presence of septa was statistically analyzed. Mann–Whitney U-test and descriptive statistics were used for statistical analysis. Results The average height of the determined 287 septa was measured as 7.36 mm. The highest rates of septa location, morphology, and orientation were found, respectively, in the middle region septa (57.49%), completed septa (75.95%), and transverse septa (93.37%). The effect of dental status, age, and gender on the presence of septa was not statistically significant ( p > 0.05). Conclusion These high rates of findings support the importance of CBCT in the diagnosis of the variations of the maxillary sinus septa. Therefore, it is important to evaluate CBCT images of the relevant region to increase the success of surgical interventions in the maxillary posterior region and to eliminate possible complications.

Comparative Evaluation of Bone Formation between PRF and Blood Clot Alone as the Sole Sinus-Filling Material in Maxillary Sinus Augmentation with the Implant as a Tent Pole: A Randomized Split-Mouth Study.

The lack of bone volume in the posterior maxillary region can be augmented with sinus elevation. Since the elevated sinus is a closed cavity, a blood clot that fills the sinus space itself can aid in bone formation. The aim of this study was to compare bone formation in the elevated maxillary sinus between platelet-rich fibrin (PRF) and blood clot alone as the sole sinus-filling material with the implant as a tent pole. The study was a randomized controlled trial with a split-mouth design involving seven patients. An implant was placed on one side only and blood was allowed to fill the elevated sinus cavity; on the other side, PRF plugs were inserted. The sinus window was covered by nonresorbable titanium-reinforced membrane. The results showed that there was no statistically significant difference between the two groups, but the PRF group showed increased bone gain in the mesial, buccal, and palatal regions, and increased average height and bucco-palatal width at the height of the old and new sinus floor. A greater increase in distal bone height was seen in the control group. It was concluded that PRF may be more effective as a sole sinus-filling material in the elevated sinus cavity with an implant as a tent pole.

Indirect Sinus Floor Elevation Technique with Simultaneous Implant Placement without Using Bone Grafts.

Context:Maxillary posterior region is a problem area for the placement of implants. The advanced resorption of alveolar bone is combined with an increase in pneumatization of maxillary sinus because of higher intra-antral pressure, giving rise to severely atrophied alveolar ridges with reduced bone height.Materials and Methods:A total of 26 implants were placed in 21 patients using indirect sinus lift with simultaneous implant placement without using bone grafts. Intra-oral periapical radiographs were taken to determine residual bone height, endosinus bone (ESB), and crestal bone level.Results:All the implants were clinically and radiographically stable at the end of 6 months follow-up. All the implants showed ESB gain, with mean being 1.97 mm and 1.99 mm on mesial and distal sides, respectively.Conclusion:The findings of this study indicate that successful osseointegration is predictable using osteotome sinus floor elevation without bone graft. Spontaneous new bone formation seemed to be expected with implants placed using indirect sinus lift.