Sinus Bone Augmentation Research Articles

Prospective and Randomized Evaluation of ChronOS and Bio-Oss in Human Maxillary Sinuses: Histomorphometric and Immunohistochemical Assignment for Runx 2, Vascular Endothelial Growth Factor, and Osteocalcin

The aim of this study was to compare ChronOS (β-tricalcium phosphate), Bio-Oss, and their addition to an autogenous bone graft in a 1:1 ratio in human maxillary sinus bone augmentation. Thirty maxillary sinuses were divided in 5 groups: group 1 included 6 maxillary sinuses grafted with autogenous bone graft alone; group 2 included 6 maxillary sinuses grafted with ChronOS; group 3 included 6 maxillary sinuses grafted with ChronOS and autogenous bone graft in a 1:1 ratio; group 4 included 6 maxillary sinuses grafted with Bio-Oss; and group 5 included 6 maxillary sinuses grafted with Bio-Oss and autogenous bone graft in a 1:1 ratio. The number of samples for each group was determined by the statistical power test. The median areas of new bone formation in groups 1, 2, 3, 4, and 5 were 121,917.0, 83,787.0, 99,295.0, 65,717.0, and 56,230.0μm2, respectively. Statistically significant differences were found between groups 3 and 5, groups 1 and 4, and groups 1 and 5 (P<.05). The median areas of remaining biomaterial were 2,900.5, 5,291.0, 2,662.0, 56,258.5, and 64,753.5μm2 in groups 1, 2, 3, 4 and 5, respectively. Statistically significant differences occurred between groups 1 and 5, groups 3 and 5, and groups 2 and 5 (P<.05). Areas of connective tissue were 67,829.0±22,984.6μm2 in group 1, 97,445.9±18,983.3μm2 in group 2, 88,256.0±21,820.5μm2 in group 3, 65,501.8±6,297.6 in group 4, and 70,203.2±13,421.3μm2 in group5. ChronOS combined with autogenous bone graft presented a behavior similar to that of autogenous bone graft alone. However, the groups treated with Bio-Oss showed immuno-labeling results indicating maturation of grafted bone.

Complexity of comprehensive care treatments in undergraduate dental programs: The benefits of observing and assisting experienced faculty members.

ObjectiveTo improve the confidence of the final year dental students in completing occlusal and oral rehabilitation of patients, with complexities beyond their scope, based on full analysis of the biomechanical and esthetic considerations of each case.Material & methodsTwo comprehensive patient situations presenting with special difficulties including extensive, reduced vertical dimension of occlusion, limited interocclusal space and maxillary alveolar bone for implant insertion necessitating bone augmentation and a sinus lift surgery was managed by two students at our institute. Procedures like surgical crown lengthening, sinus lifting, and bone augmentation were performed by senior faculty with the respective two students’ assisting as well as following up at the healing phase and reporting progress of healing and any possible complications to the supervisor. Students’ reported significant improvement in decision making skills; time management; interpersonal skills, management of cases in an evidence –based interdisciplinary approach as well as increase in their confidence in managing complex cases independently. Follow up with both cases showed optimum outcome and patients’ satisfaction.ResultsStudents’ reported significant improvement in decision making skills; time management; interpersonal skills, management of cases in an evidence –based interdisciplinary approach as well as increase in their confidence in managing complex cases independently. Follow up with both cases showed optimum outcome and patients’ satisfaction.ConclusionsExposing students to manage complex oral rehabilitation including procedures like sinus lifting and bone augmentation, through an evidence-based interdisciplinary approach during the undergraduate comprehensive clinical dentistry course enhances their confidence and clinical acumen as an independent practitioner.

Histomorphometric and immunohistochemical assessment of RUNX2 and VEGF of Biogran™ and autogenous bone graft in human maxillary sinus bone augmentation: A prospective and randomized study.

Few studies have been conducted to assess new bone formation using Biogran, a bioactive glass, in maxillary sinus bone augmentation through a prospective and randomized evaluation. Moreover, there are no studies that evaluate cellular behavior by immunohistochemical assessment for osteoblastic and vascular activity during bone repair. The aim of this study is to compare new bone formation and cellular behavior with Biogran alone, a 1:1 combination of Biogran and autogenous bone graft, and autogenous bone graft alone in human maxillary sinuses. Ten maxillary sinuses were grafted with Biogran (Group 1), 10 grafted with Biogran added to autogenous bone graft in a 1:1 ratio (Group 2), and 10 grafted with autogenous bone graft alone (Group 3). After 6 months of bone healing, samples were obtained concurrent to the dental implants' placement to be evaluated by histomorphometric and immunohistochemical assessment for RUNX2 and vascular endothelial growth factor (VEGF). The amount of new bone formation in Group 1 was 42.0 ± 7.3% in the pristine bone region, 40.7 ± 14.0% in the intermediate region, and 45.6 ± 13.5% in apical region. In Group 2, for pristine bone, intermediate, and apical regions, new bone formation was 36.6 ± 12.9%, 33.2 ± 13.3%, and 45.8 ± 13.9%, respectively. Group 3 showed new bone formation of 37.3 ± 11.6%, 35.3 ± 14.7%, and 39.9 ± 15.8% in pristine bone, intermediate, and apical regions, respectively. The immunolabeling for RUNX2 showed low cellular activity in osteoblasts for all groups, and the VEGF assessment demonstrated moderate cellular activity in Groups 1 and 2; however, Group 3 presented with low activity in the pristine bone region, followed by moderate activity in the intermediate and apical region. This study demonstrates that Biogran and its combination with autogenous bone graft 1:1 are good bone substitutes due to their similarity to autogenous bone graft.

Maxillary sinusitis following sinus bone augmentation:

Background: Maxillary sinusitis (MS) is a relatively rare complication following sinus bone augmentation (SBA); however, the majority of the complications may require additional surgical intervention which may delay or even prevent future implant placement.1Felisati G. Chiapasco M. Sinonasal complications of dental disease and treatment. Prevention-diagnosis-management. Thieme Publishers, Germany2016Google Scholar Objectives: The purpose of this study was to describe patients with MS which developed following SBA and to emphasise the importance of thorough evaluation of the patients preoperatively. Methods: The study included 17 patients presenting MS and treated due to failed lateral-approach SBA from 2010 to 2015. Eleven of the SBA operations were performed by one of the three authors and six were performed by different practitioners, with or without simultaneous implant placement. All relevant clinical, radiological and surgical data were recorded. Findings: The study group consisted of 7 female and 10 male patients aged 43–69 years. All patients were classified as Group I and Class 1a (1). Examination of both available preoperative radiographs and patient history indicated that 11 patients already had chronic MS before the procedures. All patients were given systemic antibiotic and nasal treatment. Five patients responded treatment without need for further surgery. In 12 patients infected graft material and seven implants (out of 11) were removed by Caldwell-Luc operation. Four patients required further endoscopic sinus surgery. SBA was reattempted in three cases. Conclusion: Detailed clinical and radiographical evaluation as well as close cooperation with an ear, nose and throat surgeon is prerequisite before SBA in order to minimise complications.

Imaging study of the anatomical variations and the maxillary sinus pathology in patients with missing lateral teeth for the application of dental implants

Preoperative evaluation of maxillary sinus anatomy is very important to avoid surgical complications due to close anatomical relations between the sinus and the posterior maxillary teeth and/or edentulous alveolar ridge. Posterior superior alveolar artery is a branch of the maxillary artery and provides the vascularization of the lateral sinus wall and underlying mucosa. Maxillary artery branches should be taken into consideration during sinus lifting procedures and bone augmentation due to increased risk of bleeding by damaging the artery during the osteotomy. Computed tomography (CT) explores three-dimensional anatomic structures and provides complex and accurate information about them. Cone Beam Computed Tomography (CBCT) offers an accurate view of the teeth and surrounding structures at high resolution, despite low-dose radiation used. In this study, the incidence of anatomical variations and sinus pathology were assessed using CBCT. The aim is to evaluate the presence of sinus pathology (sinus mucosal thickening, oro-antral communications, sinus tumors, cysts, polyps), presence and position of the posterior superior alveolar artery. These issues are important because they are about the limits of the dental implants in the posterior maxillary area. The presence of sinus pathology and anatomical variations may predispose to complications and even failures of implantation therapy.

Angulated implants: an alternative to bone augmentation and sinus lift procedure: systematic review.

Rehabilitation of completely edentulous patients with implant becomes challenging due to reduced amount of bone available and pneumatisation of maxillary sinus or both. To successfully treat such patients, prior to implant placement, patient has to undergo invasive procedures like sinus lift and/or bone augmentation which is not possible many time due to many reasons. This article focuses on an alternative treatment procedure in which two posterior implants are placed at an angle and two anterior implants are placed axially thereby eliminating the need for sinus lift or bone augmentation procedures. This article broadly discusses this "All on Four" concept in all aspects, its effects on bone, prosthesis survival, forces acting etc along with various related studies.

Evaluation of anatomical considerations in the posterior maxillae for sinus augmentation.

The edentulous posterior maxilla is considered a clinical challenge during dental implant treatment for many dental practitioners. This is because its insufficient bone quality, deficient alveolar ridge, spiny ridges, undercuts, and sinus pneumatization are often encountered after tooth loss. To overcome these problems, several approaches have been developed and are currently used, including sinus augmentation and bone augmentation. Today, two main procedures of sinus floor elevation for dental implant placement are in use: a two-stage technique using the lateral window approach, and a one-stage technique using a lateral or a crestal approach. In this study, we deal with the anatomic relations of the structures of the maxillary sinus during sinus augmentation. These anatomical findings can help in complications and potential injuries of the maxillary sinus procedures. It can be suggested that pre-operative evaluation is helpful for diagnosis and treatment planning and minimizing complication during the surgery.

Comparison ofSLA®orSLActive®implants placed in the maxillary sinus with or without synthetic bone graft materials – an animal study in sheep

To assess the influence of an activated implant surface and a synthetic graft material in the maxillary sinus in combination with sinus floor elevation on bone-to-implant contact (BIC) as compared to implants with conventional surfaces. In 16 sheep, sinus bone augmentation was performed using a synthetic bone graft material according to the methods described by Haas et al (Clinical Oral Implants Research, 9, 1998, 107; Clinical Oral Implants Research, 13, 2002, 396). Another 16 sheep received a sinus floor elevation procedure without graft material. Using a paired design, in one sinus of each animal, a conventional implant was placed, whereas an implant with activated surface was placed in the other. Eight animals of each group were sacrificed at 12 weeks and the others at 26 weeks after surgery. Histological analysis was performed to analyse BIC. Results were statistically compared at a significance level of P < 0.05. After 12 weeks, the BIC for conventional and activated implants with or without graft showed comparable results, with mean values of 14.8%, 16.5%, 21.5% and 20.1% (P > 0.05). For ungrafted sinuses after 26 weeks, no increase in BIC was recorded (12.1% conventional surface, 15.8% activated surface; P > 0.05). In grafted sinuses after 26 weeks, mean values increased to 28.7% for conventional and 34.1% for activated implants (P = 0.014; P = 0.015). However, only BIC of the latter was statistically significantly higher compared with ungrafted sinuses (P = 0.038). After 12 weeks of healing, neither grafting nor implant type seemed to influence BIC. Use of an activated implant surface did not increase BIC when compared with a conventional implant. The synthetic graft seemed to improve BIC values after 26 weeks.

The effect of collagenated space filling materials in sinus bone augmentation: a study in rabbits

The inclusion of biomaterial particles used for alveolar bone regeneration in a carrier or in binding agents such as collagen gel or fibers is of interest as a means to help with surgical handling. However, the possible influence of collagen on bone tissue response to biomaterials is poorly studied. The objective of the present study was to investigate, in a sub-sinus bone augmentation model in rabbits, the effect of collagen at different stages of the osteogenesis process. Histologic, histomorphometric and volumetric analyses were performed. Rabbits underwent a double sinus lift procedure using bovine hydroxyapatite (BHA), collagenated bovine hydroxyapatite (BHAColl), and prehydrated and collagenated porcine hydroxyapatite (PHAColl). Animals were sacrificed at 1week, 5weeks or 6months. Samples were subjected to X-ray micro-tomography and histology. Qualitative analysis was performed on the non-decalcified sections and quantitative histomorphometric analyses were conducted using scanning electron microscopy (SEM). Volume variations of bone augmentations were calculated at different time points. The three biomaterials allowed an optimal bone formation and were able to equally withstand sinusal reexpansion. A comparable percentage of new bone, as well as 3D volume stability, was found between the groups at each time point. However, the PHAColl resorption rate was significantly higher than the rates in other groups (P=0.0003), with only 3.6% of the particles remaining at 6months. At 1week, both collagenated groups displayed the presence of inflammatory cells although BHA did not show any sign of inflammation. At 5weeks and 6months, the inflammatory process had disappeared completely in the BHAColl groups, whereas some inflammatory-like cells could still be observed around the remaining particles of PHAColl. Within the limitations of this study in rabbits, the findings showed the presence of inflammatory-like cells at the early stage of bone regeneration when collagenated xenogenic biomaterials were used compared to xenogenic granules alone. Nevertheless, similar bone formation occurred and comparable 3D volumes were found at 6months in the different groups.

A lateral approach to the maxillary sinus for simultaneous extraction of an ankylosed maxillary molar and sinus graft: a case report

Ankylosed tooth is defined as ‘the discontinuance of normal passive tooth eruption without any mechanical barrier’. Ankylosed tooth treatment is a challenge to dental clinicians. In treatment of maxillary molar ankylosis cases there are risks of oro-antral fistula, displacement of root fragments into the maxillary sinus, as well as the necessity for providing additional sinus bone augmentation for future implant placement. In this study, we suggested a new technique using a piezoelectric device and a lateral side approach to the maxillary sinus leading to the simultaneous removal of the ankylosed maxillary molar and sinus grafting for the purpose of implant site development.

Maxillary Sinus Bone Grafting with an Injectable Bone Substitute: a Sheep Study

The aim of this animal study was to verify the osteoconductivity and the biofunctionnality of an Injectable Bone Substitute (IBS) used to perform maxillary sinus bone augmentation. Autologous bone graft was used as control. Histological and quantitative analysis using Scanning Electron Microscopy (SEM) performed after three months, showed new bone formation in tested sinuses. The amount of newly formed bone was significantly higher for sinuses grafted with IBS.