Sinus Augmentation Procedures Research Articles

The Impact of Posterior Maxillary Teeth on Maxillary Sinus: Insights From Cone-Beam Computed Tomography Analysis.

Background Odontogenic maxillary sinusitis arises mainly from dental origins, emphasizing the connection between dental health and sinus issues. Understanding these relationships is crucial for implant planning, sinus augmentation procedures, and managing post-extraction complications. This knowledge can help clinicians make informed decisions about treatment timing and approach. In this study, the influence of tooth periapical and periodontal conditions on maxillary sinus mucous membrane thickening using cone-beam computed tomography (CBCT) imaging was evaluated. Methods In this retrospective cross-sectional study, 124 patients who underwent CBCT for dental treatment covering 248 maxillary sinuses and 992 teeth were examined.Coronal and sagittal sections were examined to assess the maxillary sinus mucosal thickening (MT), the periodontal bone loss for maxillary posterior teeth, and their proximity to the maxillary sinus (RPMS). The mean ± standard deviation of quantitative variables was compared using a one-way ANOVA test. Multivariable logistic regression analysis was used to assess the relation between the different independent variables and MT of the maxillary sinus. P < 0.05 was considered to be statistically significant. Results MT was detected in 90 (72.6%) patients. We found 42 (33.9%) patients bilaterally. Grade 1 mucosal thickness was the most prevalent grade (72.5%), followed by Grade 2 (19.2%). Almost half the teeth examined were not in contact with the cortical borders of the sinus (56.0%). Most of the teeth showed mild to moderate periodontal bone loss (80.2%).Logistic regression analysis showed that the variables significantly associated with higher oddsof MTof maxillary sinus occurrence were tooth location (second molar vs. first premolar AOR = 2.30, 95% CI: 1.29-2.79, first molar vs. first premolar AOR = 3.79, 95% CI: 1.82- 3.10, and second premolar vs. first premolar AOR = 1.57, 95% CI: 1.27-2.84), the relation of roots of posterior maxillary teeth to the sinus floor (Type 2 vs. Type 0AOR = 2.27, 95% CI: 1.38-3.34, and Type 1 vs. Type 0 AOR = 2.24, 95% CI: 1.54-3.26), periodontal bone loss (severe vs. non-periodontitis AOR = 2.75, 95%CI: 1.29-5.86, and mild-moderate periodontitis vs. non-periodontitis AOR = 1.68, 95%CI: 1.19-4.93), and periapical and periodontal tooth condition (periapical lesion vs. extracted AOR = 32.7, 95% CI: 4.53-83.61, and no periapical lesion vs. extracted AOR = 19.8, 95% CI: 8.18-74.23). Conclusions Second molars, severe periodontal bone loss, and periapical lesions were associated with increased sinus MT risk, highlighting the need for dental health consideration in maxillary sinus management.

Survival Rates and Risk Factors of Resorbable Blast Media Surface Dental Implants: A Retrospective Cohort Study with an Average 60-Month Follow-Up.

This retrospective cohort study aimed to evaluate the survival rates and risk factors associated with Resorbable Blast Media (RBM) surface dental implants. The study involved 1,130 implants placed in 260 patients, with a follow-up ranging from a minimum of 26 months to a maximum of 120 months, for an average of 60 months. 1,130 RBM surface implants with hybrid macro-geometry were placed in 260 patients. Implant survival and failure rates were analyzed over an average 60-month follow-up. Failure rates were examined based on implant length, patient gender, and sinus lift procedures. Additional factors, including patient age, implant placement timing (immediate vs. delayed), guided bone regeneration (GBR), implant diameter, and implant location, were assessed to determine their impact on long-term implant success. The overall survival rate for the implants was 94.4%, with most failures occurring within the first 12 months postplacement. Male patients experienced significantly higher failure rates (7.36%) than female patients (4.0%). Short implants (8 mm) were particularly vulnerable to failure, with an 8.65% failure rate. Sinus augmentation procedures also presented an increased risk, with 10% failure for lateral sinus augmentation and 9.78% for crestal sinus elevation. In contrast, factors such as patient age, timing of implant placement, GBR, implant diameter, and implant location did not significantly influence failure rates. Notably, narrow-diameter implants (3.3 and 3.7 mm; n=97) in the molar region did not increase the risk of failure, with only 5 experiencing failure. Failures post-prosthetic loading were most common after about 3 years. This study confirms the long-term viability of RBM surface implants, with high survival rates when early failures are mitigated. Short implants and sinus lift procedures pose greater risks of failure, particularly in the early stages. However, simultaneous GBR and sinus procedures did not significantly impact long-term outcomes, affirming the safety and efficacy of these complex interventions.

Does alveolar ridge preservation reduce the need for sinus floor elevation: A comparative study to spontaneous healing.

In cases of atrophy in the maxillary posterior region, characterized by reduced vertical bone volume, implant placement becomes challenging. Augmentation procedures like sinus lifts are often needed to address insufficient bone volume. This study aims to explore if alveolar ridge preservation, using a bovine bone substitute and a porcine collagen membrane, significantly decreases the need for sinus lifts compared to natural wound healing after tooth extraction. In this comparative clinical study, 40 patients requiring a total of 53 extractions were assigned to one of the following groups: a test group with bovine bone substitute material (Straumann® XenoFlex) and a porcine collagen membrane (Jason® membrane), or a control group with spontaneous socket healing. After 6 months, digital volume tomography was performed for implant planning. For seven patients from the control group (n = 22 extracted sites) sinus lift augmentations were performed while only four sinus lift procedures were performed in the test group (n = 31 extracted sites), indicating a higher need for sinus augmentation procedures in the control group, however not statistically different on a p value of 0.05 (p = 0.168). In the control group, the mean value of the radiographically measured bone height (mesial and distal) was 11.13 ± 2.12 mm preoperatively before tooth extraction, while it was 11.3 ± 2.17 mm postoperatively after implant placement. In contrast, the mean value in the test group was 11.78 ± 3.09 mm preoperatively and 11.92 ± 2.79 mm postoperatively. Statistical analysis revealed no significant difference between the two groups (odds ratio 0.32; 95% CI: 0.08, 1.26; p = 0.951). The implant survival rate in the control group was 100%, compared to 96.77% in the test group. Within the limits of this study, the use of bovine bone substitute and a porcine resorbable membrane after tooth extraction in the posterior maxilla seems to reduce the need for sinus augmentation in comparison to spontaneous healing although the difference was not statistically significant. Additionally, the Alveolar Ridge Preservation in the test group made external sinus floor elevation unnecessary compared to the control group. The change in radiographically measured bone height pre- and postoperatively showed no significant difference between the two groups.

Histomorphometric and Micro-CT Evaluation of Cerabone and Bio-Oss in Maxillary Sinus Lifting: A Randomized Clinical Trial.

Background and Objectives: The loss of teeth in the posterior maxillary region often leads to significant alveolar bone resorption and maxillary sinus pneumatization, complicating dental implant placement. Maxillary sinus grafting, typically using autogenous bone, is a common solution. However, autogenous bone grafts require additional surgical procedures, leading to increased morbidity. This study aims to compare the efficacy of two xenografts, Bio-Oss and Cerabone, in promoting new bone formation in maxillary sinus grafting through histomorphometric analysis and micro-computed tomography (micro-CT). Materials and Methods: A total of 22 maxillary sinuses (12 right and 10 left) were grafted, with 12 using Cerabone and 10 using Bio-Oss. Six months post-grafting, biopsies were collected for histomorphometric analysis to measure new bone formation, connective tissue, and residual biomaterial. Additionally, micro-CT analysis was performed to assess bone volume fraction, trabecular thickness, number, and separation. Results: Histomorphometric analysis showed that the Cerabone group had a higher average new bone formation (25.94% ± 10.55) compared to the Bio-Oss group (17.29% ± 4.61), with a statistically significant difference (p = 0.02). Micro-CT analysis revealed that the bone volume fraction in the Cerabone group was significantly higher compared to the Bio-Oss group, with significant differences in trabecular thickness (p = 0.02) but not in trabecular number or separation. Conclusions: The study demonstrates that both xenografts are effective in promoting new bone formation in maxillary sinus grafting. However, Cerabone showed superior performance in terms of new bone formation and bone volume fraction, suggesting it may be a more effective option for maxillary sinus augmentation procedures.

The Modified Caldwell-Luc Approach for Treating Odontogenic Maxillary Sinusitis Without Need for Functional Endoscopic Sinus Surgery: A Retrospective Study

BackgroundOdontogenic maxillary sinusitis is a common inflammatory condition resulting from the violation of the Schneiderian membrane by conditions arising from the dentoalveolar unit, which includes teeth, their supporting structures, and adjacent tissues. This study aims to evaluate a modified surgical approach for treating this condition. PurposeThe purpose of this study is to measure the frequency of re-treatment of maxillary sinusitis of odontogenic origin following treatment with a modified Caldwell-Luc approach, which involves accessing the maxillary sinus through the canine fossa without creating a counter-opening in the inferior nasal meatus. Study DesignThis retrospective cohort study included 82 cases (83 sinuses) with odontogenic sinusitis treated surgically with the modified Caldwell-Luc technique at the Department of Oral and Maxillofacial Surgery, Poriya Medical Center, between 2014 and 2021. Patients with non-odontogenic sinusitis were excluded. Predictor VariablesAnatomic findings defined as the presence or absence of ostiomeatal complex abnormalities and oroantral communication, as identified through clinical examination and CT imaging. Main Outcome VariablesThe need for retreatment, defined as the requirement for functional endoscopic sinus surgery (FESS) due to persistent signs and symptoms of maxillary sinusitis after the modified Caldwell-Luc procedure, including facial pain/pressure, nasal congestion, purulent nasal discharge, or radiographic evidence of persistent sinus opacification on CT scan, lasting more than 4 weeks despite appropriate medical management. CovariatesCovariates included demographic data (age, sex [male/female as identified at birth]), smoking status, etiologies of odontogenic sinusitis, and surgical conditions. AnalysesDescriptive statistics, Cox proportional hazards regression was used to compute hazard ratios. Kaplan-Meier survival analysis was performed to estimate the probability of remaining FESS-free over time. The level of statistical significance was set at p < 0.05. ResultsThe sample was composed of 82 patients (83 sinuses) with a mean age of 52.3 years (SD 13.5), and 47 (56.6%) were male. Dental implantation and sinus augmentation procedures were the most common etiologies of odontogenic sinusitis (50.6%). The median follow-up time was 6.03 months (IQR: 2.57 - 10.93 months). The incidence rate of FESS requirement was 2.64 per 100 person-months of follow-up. The FESS-free frequency was 89.2% (95% CI: 80.4% - 94.4%). The Kaplan-Meier analysis estimated the probability of remaining FESS-free at 12 months to be 89.1% (95% CI: 79.8% - 94.4%). Patients with OMC abnormalities had a hazard ratio of 2.25 (95% CI: 0.47-10.84, p = 0.31) for requiring FESS, while those with OAC had a hazard ratio of 1.85 (95% CI: 0.46-7.39, p = 0.38). Conclusions and RelevanceThe modified Caldwell-Luc procedure was effective in treating the majority of odontogenic sinusitis cases. FESS may be necessary in a small percentage of cases with persistent symptoms. Further research is needed to identify predictors for FESS requirement. Of note, we recommend that oral and maxillofacial surgery surgeons review sinusitis cases with a FESS surgeon before performing the modified Caldwell-Luc procedure creating the opportunity for simultaneous or closely timed procedures when necessary

Maxillary Sinus Augmentation with Autogenous Tooth Grafting Material: A Systematic Review.

The aim of this systematic review was to determine whether autogenous tooth grafting material (ATGM) is as safe and effective as other bone substitutes used for maxillary sinus augmentation procedures, evaluating histomorphometric and/or histological data, implant primary stability, associated complications and radiographic bone height measurements. An automated electronic search was conducted using four databases (Medline/PubMed, Scopus, Web of Science and Cochrane Library), supplemented by a manual search, to identify clinical human studies using particulate ATGM for the aforementioned procedure. The included studies had a sample size of at least four patients and were published before 31st July 2024. The Newcastle-Ottawa scale (NOS) and Joanna Briggs Institute (JBI) Critical Appraisal Checklist were used to assess the risk of bias in cohort studies and case series, respectively. Seven studies were included in the descriptive analysis, obtaining 128 participants (46.8% only treated with ATGM) and 192 placed implants. Due to the heterogeneity of the studies, meta-analysis could not be performed. The authors concluded that ATGM appears to be a feasible and safe alternative for maxillary sinus augmentation procedures. These results should be interpreted with caution due to the limited amount of scientific evidence on this topic and the heterogeneity between the included studies.

Histomorphometric and microtomographic analysis of maxillary sinus augmentation surgeries with and without collagen membrane on the lateral window: A randomized clinical trial.

To evaluate the histomorphometric and computerized microtomographic (Micro-CT) analysis of the regenerated bone tissue from maxillary sinus augmentation surgery, with and without using the collagen membrane on the external osteotomy window. Twelve patients were selected for this prospective, controlled, and randomized study. The patients were submitted to bilateral maxillary sinus surgery in a split-mouth design. On the test side, the maxillary sinus augmentation procedure included using Geistlich Bio-Oss® and a Geistlich Bio-Gide® collagen membrane covering the lateral osteotomy window. On the control side, only Geistlich Bio-Oss® was used without the presence of the membrane. After 6 months, the surgeries for implant installation were performed. In this surgical phase, specimens of the regenerated tissue were collected for histological and Micro-CT analysis. In the histomorphometric evaluation, the mean (±SD) percentages of newly formed bone were 43.9% (±11.5) and 40.8% (±8.9) in the test and control groups, respectively. The corresponding values of the Micro-CT analysis were 36.6% (±3.4) and 37.2% (±4.7) in the test and control groups, respectively. There was no statistically significant difference between the test and control groups in the two methods. In addition, there was no statistically significant difference between the mean percentage of biomaterial remaining between the test and control groups. However, the mean percentage of newly formed bone was significantly higher and the mean percentage of remaining biomaterial was significantly lower in the histomorphometric analysis compared to the values obtained through microtomography. The additional use of collagen membranes in maxillary sinus surgery does not offer advantages in newly formed bone.

Efficacy of Alveolar Ridge Preservation in Periodontally Compromised Molar Extraction Sites: A Systematic Review and Meta-Analysis.

To investigate the efficacy of alveolar ridge preservation (ARP) in periodontally compromised molar extraction sites. An electronic search was performed on 10th November 2023 across five databases, seeking randomised/non-randomised controlled trials (RCTs/NCTs) that included a minimum follow-up duration of four months. The RoB2 and Robins-I tools assessed the risk of bias for the included studies. Data on alveolar ridge dimensional and volumetric changes, keratinized mucosal width, and need for additional bone augmentation for implant placement were collected. Subsequently, a meta-analysis was carried out to derive the pooled estimates. Six studies were incorporated in the present review, and a total of 135 molar extraction sockets in 130 subjects were included in the meta-analysis. ARP was undertaken in 68 sites, and 67 sites healed spontaneously. The follow-up time ranged from 4 to 6 months. The meta-analysis of both RCTs and NCTs showed significant differences in mid-buccal ridge width changes at 1 mm level below ridge crest with a mean difference (MD) of 3.80 (95% CI: 1.67-5.94), mid-buccal ridge height changes (MD: 2.18; 95% CI: 1.25-3.12) and volumetric changes (MD: 263.59; 95% CI: 138.44-388.74) in favour of ARP, while the certainty of evidence is graded low to very low. Moreover, ARP appeared to reduce the need for additional sinus and bone augmentation procedures at implant placement with low certainty of evidence. Within the limitations of this study, alveolar ridge preservation in periodontally compromised extraction sites may, to some extent, preserve the ridge vertically and horizontally with reference to spontaneous healing. However, it could not eliminate the need for additional augmentation for implant placement. Further, longitudinal studies with large sample sizes and refined protocols are needed.

Maxillary Sinus Augmentation and Implant Installation in Patients With Pseudocysts and Mucous Retention Cysts.

This case study systematically assessed diverse approaches to sinus augmentation in the presence of sinus pathology. Three patients were carefully selected and categorized as pseudocyst (PsC) (type 1), mucous retention cyst (MRC) smaller than 20mm (type 2), and MRC larger than 20mm in size (type 3). All patients underwent sinus augmentation procedures, with each case utilizing a unique surgical approach. Spontaneous drainage was performed for the patient with PsC (type 1), followed by uncomplicated sinus augmentation. For the patient with an MRC smaller than 20mm (type 2), aspiration of the cyst contents preceded sinus augmentation. Conversely, the patient with a larger MRC (type 3) underwent cyst enucleation followed by sinus augmentation after complete recovery of the sinus membrane. No complications were noted in any of the cases, and follow-up revealed stable implant installation at the site of sinus augmentation. Within the constraints of this study, the choice of surgical procedure, whether involving spontaneous drainage, aspiration, or enucleation, should be guided by an anticipated pathologic diagnosis and the size of the sinus cyst. This informed approach empowers clinicians to make well-informed decisions for the best possible outcomes and sustained results. Overall, this study offers valuable insights for clinicians seeking to optimize sinus augmentation procedures in the presence of sinus pathology.

Maxillary Sinus Augmentation with Xenogenic Collagen-Retained Heterologous Cortico-Cancellous Bone: A 3-Year Follow-Up Randomized Controlled Trial.

Sinus augmentation procedures have become a valuable solution for patients with posterior maxillary edentulism. The objective of this study was to explore the efficacy and safety of porcine xenograft with collagen supplementation as a potential alternative to autologous bone grafts in lateral sinus augmentation over a three-year follow-up period. Twelve patients, each with bilateral posterior maxillary edentulism, were enrolled and randomly allocated to receive either a porcine xenograft or an autologous graft. Comprehensive assessments, including clinical and radiographic evaluations, were conducted at specific intervals, including implant stability, marginal bone loss, prosthetic and biological complications, and patient preferences. The results demonstrated no significant differences between the two graft materials in terms of implant survival, marginal bone loss, and patient preferences after three years of follow-up. Only one implant was affected by peri-implantitis, and prosthesis-related complications were present in one patient possibly due to bruxism. In conclusion, these findings suggest that a porcine xenograft with collagen supplementation may be a viable alternative to an autograft in lateral sinus augmentation procedures. The high implant survival rate, minimal complications, and patient satisfaction indicate the potential clinical relevance of this graft material and should be further investigated to confirm these promising results.

Risk factors, Consequences and Treatment Alternatives of Schneiderian Membrane Perforation: Case Report and Review of the Literature

Maxillary sinuses are the greatest sinus cavities in the human cranium and they are the closest to the oral cavity. Thus, perforation of the Schneiderian membrane is a common complication that may be encountered during various oral surgery procedures in the molar and premolar regions of the maxilla such as teeth extractions, implant placement or sinus augmentation procedures. Membrane perforations lead to oroantral communications, which may later turn into oroantral fistulas. Moreover, these perforations may cause infections, loss of graft or implant if encountered during sinus augmentation procedures. The purpose of this review was to determine the risk factors associated with this complication and present the various treatment alternatives used to manage this type of complication. In the literature, the selected surgical technique, the thickness of the sinus membrane, the quality and quantity of the residual alveolar bone, the anatomy of the area and patients’ habits such as smoking were reported as points to be considered. A case of Schneiderian membrane perforation during implant placement and successful management of the complication was also presented.

Comparative evaluation of hard and soft tissue parameters by using short implants and standard long implants with sinus lift for prosthetic rehabilitation of posterior maxilla.

The objective is to compare and evaluate the hard and soft tissue parameters by using short and standard long implants with sinus lifting in the posterior maxilla. Eleven patients with complaints of missing upper back teeth were enrolled in the study for implant-supported rehabilitation and were categorized into two groups: Group long (GL): longer implant (>8 mm) placement, preceded by Sinus Augmentation. Group short (GS): short implant (≤8 mm) placement, without sinus augmentation. The primary outcome measured was cumulative survival rate (CSR) in the compromised partial edentulous posterior maxilla. Secondary outcomes measured were implant stability (IS), marginal bone level alterations (MBL), pocket probing depth (PPD), crown-to-implant ratio, and any complications. The difference in CSR between the groups was not statistically significant (P = 0.317). High stability was achieved immediately after the placement of the implants, in both groups (GS: 64 ± 4.07, GL: 65.58 ± 9.75); this difference in the mean ISQ (IS quotients) values was not found to be statistically significant at implant placement (P = 0.7). The mean MBL reported in the study at the end of 12 months of prosthesis function was - 0.762 ± 0.48 mm and - 0.7 ± 0.34 mm for GS and GL, respectively. The mean PPD measurements in GS and GL groups were 1.917 ± 0.68 mm and 1.833 ± 0.38 mm, respectively, and it was not statistically significant (P = 0.8). Within the limitations of the present study, the obtained results indicate that short implants provided a similar clinical and radiographic performance compared to long implants placed in combination with a sinus augmentation procedure (lateral window) up to 12 months after prosthetic loading.

Auto-dentin platelet-rich fibrin matrixis an alternative biomaterial for different augmentation procedures: A retrospective case series report.

Autologous dentin grafts derived from extracted teeth have shown promise as bone graft materials for promoting bone regeneration. This retrospective case series aimed to evaluate clinical, radiographic, and histologic outcomes of using autologous dentin matrices in various bone regeneration procedures. This case series included 26eligible patients and encompassed 4 socket preservation cases, 5 cases of guided tissue regeneration, 5 cases of guided bone regeneration (GBR), 10 cases of sinus augmentation procedures, 2 immediate placement implants, and 2 socket shields. Dentin grafts were prepared from extracted teeth, cleaned, and processed. These grafts were combined with platelet-rich fibrin (PRF) to create adhesive dentin matrices, then covered with collagen membranes for simultaneous guided bone augmentation cases. Cone beam computed tomography (CBCT) scans were conducted before surgery and 4 months postoperatively to assess ridge dimensions. Histologic evaluation was performed through bone core biopsies for socket preservation cases at the 4-month mark. A total of 42implants were placed in 26 patients, with an average follow-up of 32 months. Notably, two implant failures occurred following lateral maxillary sinus augmentation. CBCT scans at the 4-month interval revealed bone coverage over implant platforms in the majority of cases. Histologic analysis from two cases of socket preservation demonstrated dentin granules enveloped by newly formed bone undergoing continuous remodeling. The quantitative histomorphometric assessment revealed a bone area of 42.8 ± 3.56%, a remaining graft area of 19.05 ± 4.58%, and a viable bone of 38.15 ± 7.84%. The utilization of autologous dentin particles mixed with PRF proved effective as an alternative to conventional bone graft materials in GBRand maxillary sinus augmentation procedures. Larger controlled clinical trials are recommended to further substantiate these findings.

Early tissue and healing responses after maxillary sinus augmentation using horizontal platelet rich fibrin bone blocks

BackgroundThe effects of horizontal platelet-rich fibrin (H-PRF) bone block on the healing and immune response during sinus augmentation have not been fully investigated histologically at early time points.MethodsEighteenth male New Zealand white rabbits underwent bilateral sinus augmentation and were divided into two groups: deproteinized bovine bone mineral (DBBM) alone and H-PRF + DBBM (H-PRF bone block) group. Maxilla samples were collected at 3, 7 and 14 days post sinus augmentation procedures and analyzed using histological staining for the number of inflammatory cells, new blood vessels and evidence for early osteoclast bone turnover/remodeling. Furthermore, the effects of H-PRF bone blocks on the migration of osteoblasts and THP-1 macrophages were evaluated using a Transwell assay in vitro.ResultsA higher number of immune cells were found in the H-PRF bone block group at 3 and 7 days post-surgery when compared to the DBBM alone group,most notably in the regions close to the mucosal lining and bone plates. Furthermore, a significantly greater number of new blood vessel formations and early signs of osteoclast development were found in the H-PRF bone block group at 14 days. The in vitro transwell assay further confirmed that culture medium from H-PRF bone block markedly promote the migration of osteoblasts and THP-1 macrophages.ConclusionsThe findings from this study have shown that H-PRF bone block is capable of increasing early immune cell infiltration leading to the acceleration of neovascularization and speeding the process of bone metabolism in vivo following maxillary sinus grafting with DBBM.

From Synthesis to Clinical Trial: Novel Bioinductive Calcium Deficient HA/β-TCP Bone Grafting Nanomaterial.

Maxillary sinus augmentation is a commonly used procedure for the placement of dental implants. However, the use of natural and synthetic materials in this procedure has resulted in postoperative complications ranging from 12% to 38%. To address this issue, we developed a novel calcium deficient HA/β-TCP bone grafting nanomaterial using a two-step synthesis method with appropriate structural and chemical parameters for sinus lifting applications. We demonstrated that our nanomaterial exhibits high biocompatibility, enhances cell proliferation, and stimulates collagen expression. Furthermore, the degradation of β-TCP in our nanomaterial promotes blood clot formation, which supports cell aggregation and new bone growth. In a clinical trial involving eight cases, we observed the formation of compact bone tissue 8 months after the operation, allowing for the successful installation of dental implants without any early postoperative complications. Our results suggest that our novel bone grafting nanomaterial has the potential to improve the success rate of maxillary sinus augmentation procedures.

Retrospective analysis of three different xenografts in maxillary sinus augmentation: histologic and three-dimensional radiologic study.

Low bone density and lack of adequate vertical bone dimension as a result of maxillary sinus pneumatization present some of the most problematic cases for endosseous implant applications in posterior maxillary regions that hinder prosthetic rehabilitation; Objectives: The overall objectives of the study were to assess the histologic, histomorphometric and radiological evaluation of biopsies gathered from maxillary sinuses which were grafted with three different bovine bone particles (Bio-Oss®, Cerabone® and Ti-Oss®) and analyze the volume of the bone graft and the quantity of new bone formation; Methods and materials: Thirty-six patients with <4mm of residual ridge height unilaterally in the posterior maxilla, were equally divided into 3 groups, each of which received different bovine bone particles for maxillary sinus augmentation. Six-months later, biopsies were harvested for histological and histomorphometric evaluations. Volumetric changes in maxillary sinus augmentation were analyzed at 1-week (T-I) and 6-months (T-II) time points following maxillary sinus augmentation surgery; Results: Histomorphometric and histological analysis revealed significant difference between Ti-Oss® group compared with Bio-Oss® and Cerabone® groups (P=0.011). In term of residual graft particles and soft tissue, there were no significant differences between groups. 3-D volumetric reductions between 1-week (baseline) and 6-month time points recorded significant graft volume reduction in all groups (P<0.05). Significantly greater bone resorption and lower new-bone formation were manifested in Ti-Oss® group in comparison to the other groups; Conclusions: Within the limits of this study, histological and radiological results indicated that, Bio-Oss® and Cerabone® could be used efficiently in sinus augmentation procedures, while further prospective studies are needed to evaluate the Ti-Oss® material in maxillary sinus augmentation.

Volumetric evaluations of the maxillary sinus before and post regenerative surgery.

The purpose of this study was to investigate possible differences in the filling of the various recesses of the maxillary sinus after the procedure of sinus floor elevation in relation with the initial volume of the same and if the sinus volume can influence long-term graft dimensions, by using cone beam computed tomography (CBCT) as diagnostic analysis device. This study included 32 sinuses corresponding to 16 patients referred for bilateral maxillary sinus augmentation procedures needing to increase the volume of the surgical site with the porcine cortical bone for dental implant placement in the posterior maxilla. The sinuses were analyzed by preoperative and postoperative (15 days and 6 months after sinus surgery) cone beam computed tomography. No statistically significant relations were observed between initial sinus dimensions and the entity of the contraction of the graft between T1 (15 days after surgery) and T2 (180 days after surgery). The behavior was the same either for the large sinus (> 15.65 cm3) and for the small one (< 15.65 cm3). Instead, about the filling of the various sinus recesses, a linear regression model was used to explain the difference between the mean preoperative and postoperative surgical spaces; in most of the samples, the filling of the anterior recess was ~15% of the total volume of the graft, i.e., the minor one among the main recesses. Our findings suggest that: (1) in the procedure of sinus floor augmentation by a lateral approach with deproteinized porcine bone there are no relations between the initial dimensions of the sinus and the long-term dimensional changes of the graft, and (2) that, among the main recesses of the sinus, the anterior one is generally the less filled.

Comparison of Stress Distribution Among Standard Dental Implants Placed in Grafted Bone, Zygomatic Implants, and Subperiosteal Implants in the Atrophic Edentulous Maxilla: 3D Finite Element Analysis.

Purpose: To compare the biomechanical behaviors of different surgical options that are preferred for implant-supported fixed prosthetic rehabilitation of the atrophic edentulous maxilla. Materials and Methods: A 3D finite element analysis (FEA) model was generated from the computed tomography data of a patient with an atrophic edentulous maxilla. Four scenarios were created in the atrophic maxilla. In model 1, the maxilla was reconstructed with an onlay bone graft harvested from the anterior iliac crest, and sinus augmentation procedures were performed. Standard dental implants were placed in the lateral incisor, first premolar, and first molar regions on each side. In model 2, the anterior part of the atrophic maxilla was reconstructed with an onlay bone graft harvested from the mandibular ramus, and zygomatic implants were placed in the posterior part of the maxilla. In models 3 and 4, two-piece subperiosteal implants made of titanium and polyether ether ketone (PEEK) materials, respectively, were placed in the atrophic maxilla. All implants were loaded with 150-N and 50-N forces in vertical and lateral directions, respectively. Stress accumulation on bones, implants, abutments, and prosthetic frameworks was investigated. Results: The tensile stress in both cortical and trabecular bone was highest in the iliac bone grafting group under vertical loading. The compressive stress in both cortical and trabecular bone was the highest in the PEEK subperiosteal implant model, and the compressive stress value on the trabecular bone exceeded the strength of the trabecular bone. The highest von Mises stress in the implants was obtained in the iliac bone grafting group under vertical loading. The highest stress value in the abutments was detected for the titanium subperiosteal implant. The highest von Mises stress in the prosthetic framework was detected in the titanium subperiosteal implant group, under both vertical and lateral loading. Conclusion: Based on the stress accumulation results of the four different scenarios, it can be seen that there is no ideal treatment modality for the fixed implant-supported prosthetic rehabilitation of the atrophic edentulous maxilla. Various intraoperative and prosthetic modifications are suggested to decrease the risk of biomechanical complications during long-term follow-up.

Residual Bone Height and New Bone Formation after Maxillary Sinus Augmentation Procedure Using Biomaterials: A Network Meta-Analysis of Clinical Trials.

Different factors may affect new bone formation following maxillary sinus floor augmentation for the rehabilitation of posterior edentulous maxilla. The purpose of this study was to determine the influence of residual bone height (RBH) on new bone formation after lateral sinus augmentation utilizing different biomaterials, through a network meta-analysis (NMA). PUBMED, Scopus, and Web of Science electronic databases were searched until 31 December 2022 to obtain relevant articles. A hand search was also conducted. Randomised controlled studies on maxillary sinus augmentation comparing different grafting materials in patients with atrophic posterior maxilla, in need of prosthetic rehabilitation, were included. The risk of bias was assessed following the guidelines of the Cochrane Collaboration. The primary outcome was new bone formation (NBF), assessed histomorphometrically. The statistical analysis was performed by splitting the data according to RBH (<4 mm and ≥4 mm). A total of 67 studies were eligible for conducting NMA. Overall, in the included studies, 1955 patients were treated and 2405 sinus augmentation procedures were performed. The biomaterials used were grouped into: autogenous bone (Auto), xenografts (XG), allografts (AG), alloplasts (AP), bioactive agents (Bio), hyaluronic acid (HA), and combinations of these. An inconsistency factor (IF) seen in the entire loop of the XG, AP, and Bio+AP was found to be statistically significant. The highest-ranked biomaterials for the <4 mm RBH outcome were XG+AG, XG+AP, and Auto. Similarly, the surface under the cumulative ranking curve (SUCRA) of biomaterials for ≥4 mm RBH was Auto, Bio+XG, and XG+Auto. There is no grafting biomaterial that is consistently performing better than others. The performance of the materials in terms of NBF may depend on the RBH. While choosing a biomaterial, practitioners should consider both patient-specific aspects and sinus clinical characteristics.

A Randomized Clinical Trial Comparing Implants Placed in Two Different Biomaterials Used for Maxillary Sinus Augmentation.

The objective of this study was to compare marginal bone loss, surgical and clinical complications, and dental implant survival rate in bilateral maxillary sinus augmented by autologous or porcine xenograft. A randomized controlled clinical trial using split-mouth design enrolled 12 consent adult patients (59.7 ± 8.7 years), who received bilateral maxillary sinus floor augmentation for oral rehabilitation with implant-supported prosthesis. Each patient received both the autologous bone from the mandible (control) or porcine xenograft (test) during the random bilateral sinus lift surgery. A total of 39 dental implants were placed in the posterior maxilla of the 12 patients after 6 months, being rehabilitated after the respective osseointegration period. Both graft materials demonstrated a high implant survival rate at 12 months: 95% for the xenograft side, only 1 implant without osseointegration, and 100% for the autologous side. Radiographic bone loss was low and similar for both groups: control group with a mean of 0.063 ± 0.126, and test group with a mean of 0.092 ± 0.163. No major surgical-related complications have occurred. Only one patient had several prosthetic complications due to fractures of prosthetic components. The maxillary sinus augmentation procedure, both with autologous bone and porcine xenograft materials, is an excellent clinical option procedure for the prosthetic rehabilitation of atrophic maxillae, with low marginal bone loss after one year follow-up, few clinical complications, and a high implant survival rate.