Sinus Bone Graft Research Articles

Sinus Floor Augmentation with Synthetic Hydroxyapatite (NanoBone®) in Combination with Platelet-Rich Fibrin: A Case Series.

Several techniques have been described for maxillary sinus graft augmentation, including the lateral window technique and crestal approach with osteotomes or osseodensification. Platelet-rich fibrin has been used in maxillary sinus lift procedures due to its ability to accelerate soft and hard tissue healing. The aim of this study was to evaluate the potential of PRF in combination with the synthetic hydroxyapatite NanoBone® to enhance bone regeneration in sinus floor elevation with the lateral window technique. Out of the 50 individuals screened in a preoperative assessment visit from the CESPU-Famalicão clinical unit and intervened upon between January 2023 and December 2023, only 6 patients who met the study's inclusion criteria consented to participate. In a split-mouth study, twelve sinus graft surgeries were carried out. Our observations reveal that for the test group (NanoBone®/PRF), there is a 27.5 ± 4.9% increase new vital bone, 23.0 ± 3.7% increase in inert bone particles, and 49.4 ± 2.8% increase in connective tissue. Meanwhile, for the control group (NanoBone®), there is a 19.5 ± 3.0% increase in new vital bone, 23.4 ± 5.7% increase in inert bone particles, and 57.0 ± 3.5% increase in connective tissue. The results strongly indicate that mixing liquid PRF with NanoBone® does not have a negative influence on the amount of viable bone formation, and it seems to slightly increase the amount of new bone formation and revascularization in sinus bone graft procedures with the lateral window technique compared to the single use of NanoBone®.

A Novel Approach to Treat Dental Implant-related Maxillary Sinusitis via Intentional Oroantral Fistula: Case Series

The recent increase in dental implant placement and advances in maxillary sinus bone grafting have improved the oral environment and greatly benefited patients, but there has also been an increase in dental implant-related maxillary sinusitis. Implant-related maxillary sinusitis is a form of odontogenic maxillary sinusitis, which usually presents as a chronic form of maxillary sinusitis. While acute (4 weeks or less) maxillary sinusitis is treated with removal of the associated implant, decontamination of the contaminated bone graft materials, and antibiotics. However, implant-related maxillary sinusitis is most often diagnosed as a chronic maxillary sinusitis condition that has been present for more than 12 weeks and should be treated similarly to chronic maxillary sinusitis. Treatment for chronic implant-related maxillary sinusitis is accompanied by endoscopic sinus surgery (ESS) to open the obstructed maxillary ostium. ESS is usually performed by referral to an ENT specialist and can be a burdensome treatment for patients due to the discomfort of surgery and the risk of orbital and cranial complications.In this case series, we aim to help dentists treating chronic implant-related maxillary sinusitis by reporting the complete cure of implant-related maxillary sinusitis without performing ESS by creating an intentional oroantral fistula after removing the causative implant. We also report important pathologies that should be differentiated from typical implant-related maxillary sinusitis.

Zygomatic Implant Rehabilitation: A Prosthodontic Driven Approach: A Review

Zygoma implants, sometimes called zygomatic implants, are different from conventional dental implants in that they are affixed in the zygomatic bone, not the maxilla. They can be used in situations when there is not enough maxillary bone, either in terms of quantity or consistency, to support a dental implant. Insufficient maxillary bone volume may result from a combination of maxillary sinus pneumatization and bone resorption. To guarantee proper implant survival, the normal implant placement in the posterior maxilla requires a bone height of about 10 mm. Increased bone volume can be achieved by sinus elevation and bone grafting techniques in cases when there is insufficient bone available. The drawbacks of bone grafting procedures in the jaws include the need for prolonged care, restrictions on denture wear, morbidity at the donor surgical site, and graft rejection. Keywords: Zygomatic implants, Prosthodontic Rehabilitation, Prosthetically driven approach

Association between maxillary sinus floor perforation by dental implants and mucosal thickening: A cone-beam computed tomography study

ObjectiveTo investigate the association of perforation of the maxillary sinus floor by dental implants with mucosal thickening and to describe its characteristics in perforated cases. Study designOne-hundred and twenty-nine maxillary sinuses of 93 patients presenting 202 dental implants in the maxillary posterior region were retrospectively assessed in cone-beam computed tomography scans and classified according to maxillary sinus perforation, bone graft, mucosal thickening, and mucosal appearance. Logistic regression determined the chance of mucosal thickening in perforated maxillary sinuses. The chi-square test compared categorical variables between maxillary sinus perforated or not by implants and maxillary sinus with or without mucosal thickening. The significance level assumed was 5 % (α = 0.05). ResultsThere was perforation of 60 maxillary sinuses floor (46.5 %) by 74 dental implants. The chance of mucosal thickening was higher when the implant tip was trespassing on the maxillary sinus floor (p < 0.001). There was a significant association between maxillary sinus mucosal thickening and perforation by a dental implant with the tip trespassing the maxillary sinus floor (p < 0.05). ConclusionMaxillary sinus mucosal thickening is associated with sinus floor perforation by dental implants and does not depend on the number of implants perforating it. Clinical relevanceThere is an association between dental implants’ perforation of the maxillary sinus floor and the thickening of the maxillary sinus. In those cases, the appearance of the mucosa thickening may be irregular, local, or total opacification of the sinus cavity.

Immediate dental implantation after indirect sinus elevation using osseodensification concept: a case report.

A 52-year-old male presented to the oral and maxillofacial surgery department with a main complaint of chewing difficulties in the right posterior area maxilla (teeth numbers: 26 and 27). A cone-beam computed tomography (CBCT) imaging showed that the residual bone height ranged between 1 and 4mm and the width ranged between 9 and 12mm in the area of teeth numbers 16 and 17. The treatment plan was to extract the teeth (numbers: 16 and 17) and conduct internal sinus lifting and bone grafting using the OD burs with immediate implantation. OD is proposed as an alternative procedure to the direct (lateral window) sinus floor elevation procedure. The amount of vertical bone gain obtained by this technique in transcrestal sinus lifting can be the same as external sinus lifting in this case. OD can be considered a promising technique for direct sinus floor elevation, considering the amount of vertical bone gain obtained by this technique.

ESEM-EDX Mineralization and Morphological Analysis of Human Retrieved Maxillary Sinus Bone Graft Biopsies before Loading.

This study aimed to analyze the morphology of bone graft granules, the presence of granule demineralization, and bone morphology in retrieved human maxillary sinus bone graft biopsies. Healthy patients underwent sinus bone augmentation using lateral access. Two different dimensions of the antrostomy were performed, a 4 mm or 8 mm height. After 6 months, all sites received one implant using a flap technique, crestal positioning, and submerged healing. Implant biopsies were retrieved after 3 months and were histologically processed. The ESEM analysis was performed on the entire portion of the peri-implant bone (up to 750 µm from the implant thread). Three different regions of interest (ROIs) were selected: the coronal, middle, and apical portions of the implant. In these areas, EDX was performed, and calcium (Ca), phosphate (P), nitrogen (N), and their atomic ratios (Ca/P, Ca/N, and P/N) were calculated. Different bone tissue electron-dense areas were detected through grayscale intensity quantification of ESEM images with different organic (N) or inorganic (Ca,P) compositions. A total of 16 biopsies from 16 healthy patients were analyzed. Bone graft granules were mostly detected in the apical ROI. New bone tissue bridges were detected in the apical and middle ROI. These structures, with lower Ca/N and P/N ratios, were connected and enveloped the bone graft granules. Cortical ROI revealed the most mineralized bone tissue. Conclusions: After 9 months, bone graft resorption was only partially completed and new bone tissue appeared less mineralized in the middle and apical ROI than in the coronal ROI.

Inflammatory endotype of odontogenic sinusitis.

Odontogenic sinusitis (ODS) is distinct from non-odontogenic rhinosinusitis with regard to clinical features as well as diagnostic and therapeutic approaches. While numerous studies have explored immune profiles of chronic rhinosinusitis, very few studies have explored the inflammatory endotype of ODS. Odontogenic sinusitis was diagnosed by confirming infectious sinusitis adjacent to infectious maxillary odontogenic pathology. Maxillary sinus cultures and mucosal biopsies were obtained during endoscopic endonasal surgery in ODS and control patients. Controls were patients undergoing endoscopic skull base surgery with no sinus disease. Specimens were snap frozen in liquid nitrogen and stored at -80°C. Analysis was performed using a multiplex assay to measure Th-1 (TNFα, IFNγ, IL-2,12,18), Th-2 (IL-4,5,9,13), Th-17 (IL-17A,17F,22), and innate (CCL5,CXCL9,CXCL10, IL-6,8,10,12,23,27) immune pathways. Groups were compared via independent sample t-tests; if assumptions were violated, nonparametric Wilcoxon ranked sum tests were performed. Specimens from 22 ODS patients were compared to nine controls. ODS mucosal tissue was sampled in the setting of the following dental pathologies: post-dental extraction (n=15), untreated apical periodontitis (n=2), apical periodontitis after root canal therapy (n=2), and maxillary sinus bone grafting with or without dental implantation (n=3). The following cytokines were significantly elevated in ODS compared to controls: IFNγ, TNFα, IL-6, 8, 10, 27, and CXCL9. IL-17 levels were similar in both ODS and controls. Therefore, ODS demonstrated heightened innate and Th1 immune activity. ODS demonstrated both innate immune and Th1 inflammatory endotypes. Further studies are needed to explore ODS immunopathobiology and its potential impact on ODS management.

Autogenous Bone is Still the Gold Standard of Graft Materials in 2022.

I read with interest the recent editorial entitled “Is Autogenous Bone Grafting Still the “Gold Standard” in Oral Bone Grafting?”.1 As the authors pointed out, I wrote a similar editorial in 2010 and concluded that indeed autogenous bone was the gold standard of graft materials.2 However, the authors have challenged my conclusion. To support their opinion, they referenced two publications on sinus bone grafting evaluating histomorphometric results and implant survival.3,4 They claimed these studies found that “bone substitutes either performed in a like manner or superior to autogenous bone alone”. However, the histomorphometric analysis showed autogenous bone resulted in the highest amount of new bone formation compared to bone substitutes, but bone substitutes seem to be a good alternative.3 The systematic review on sinus bone grafting concluded implant survival rates using bone substitutes were as effective as autogenous bone when used alone or in combination with autogenous bone.4 Although the implant survival was lower with 100% autogenous bone (87.7%) compared to autograft with bone substitutes (94.9%) or bone substitutes alone (96%), the data clearly shows that the majority of machined implants were placed in sinuses grafted with autogenous bone. The review found rough surface implants had superior survival rates compared to machined implants (96% vs. 85.6%), so this explains the lower implant survival rate in autogenous grafts. Pjetursson et al5 performed a systematic review evaluated the grafting of pneumatized sinuses that had 6.0 mm or less residual bone height. Focusing on outcomes using only rough surface implants they found high implant survival rates for all types of grafts (> 96%). However, rough implants placed in particulate autogenous bone had a significantly higher estimated three-year survival (99.8%). There are limitations in using a secondary outcome measure, such as implant survival, to evaluate graft success. The assumption is that if the implant survived the graft was successful. The influence of the amount of native bone supporting the implant is unknown in some studies unless the residual bone limit was defined, such as in the Pjetursson et al study.Another important distinction is the relationship of the augmentation to the osseous defect. Bone defects inside the bony contour, such as sockets and the maxillary sinus floor, are much easier and predictable to reconstruct than horizontal and vertical augmentation outside the bone contour. Intrabony defects have a greater number of bone walls with a higher regenerative capacity. There is also greater ease in achieving soft tissue coverage, space maintenance, graft stability and protection. As such bone substitutes perform well in treating these types of contained defects. However, horizontal and vertical bone augmentation outside the bone contour is more biologically challenging. The greater the distance from the native bone, the more difficult it may become for vascular ingrowth, cell migration and bone formation at the outer limits of the graft. As such a graft material with greater regenerative capacity may be needed to obtain the required bone gains. Autogenous bone has superior biologic qualities compared to osteoconductive bone substitutes. It is the only bone graft material that fulfills all three aspects of the tissue engineering triad - osteogenesis, osteoinduction and osteoconduction. Autogenous bone contains osteocompetent cells and osteoconductive growth factors that can positively influence bone formation. Although cancellous bone contains a higher amount of osteoblasts and mesenchymal stem cells, cortical bone grafts contain cells that have the ability to proliferate and differentiate into the osteogenic lineage, suggesting that these cells can also contribute to bone regeneration following transplantation.6 Research has found cortical bone chips contain over 40 different growth factors that can modulate the cellular aspects of bone regeneration.7 The healing time of autogenous bone grafts also is shorter than bone substitutes.8Rather than focus on implant survival, it would be more clinically relevant to evaluate horizontal and vertical bone gains produced by different graft materials. When reviewing studies measuring bone gains it becomes evident that autogenous bone is needed for larger bone augmentations and vertical gains.9,10,11,12 While I agree with my colleagues that bone substitutes may be used effectively in many clinical situations, I still maintain that autogenous bone is the gold standard of graft materials. This does not mean it is the first choice option, but it does offer biologic advantages unmatched by bone substitutes. The use of a local donor site and bone scrapers can decrease the morbidity of bone harvest. In addition, some donor sites for block grafting, such as the mandibular ramus, have a lower incidence of postoperative complications.13 Surgeons should weigh the advantages and disadvantages of each material and select an approach that has the highest likelihood of clinical success.14

Features of Odontogenic Sinusitis Associated With Dental Implants.

With the increase in dental implants for tooth loss, odontogenic sinusitis following maxillary dental implants is frequently encountered in otorhinolaryngology practice. The authors aimed to reveal the association between implant extrusion into maxillary sinus, along with implant-related complications in patients diagnosed with implant-related odontogenic sinusitis (IR-ODS). Case-control study. This study enrolled 60 patients who received functional endoscopic sinus surgery due to IR-ODS. The preoperative sinus computed tomography was retrospectively reviewed. Among the 120 maxillary sinuses of the 60 patients, 68 sides were diagnosed with IR-ODS sides, whereas 27 sides showed no clinical or radiological evidence of this condition after the implant insertion and were defined as the control sides. Statistical analysis between these two groups was conducted, in addition to odds ratio (OR) calculations for associations with IR-ODS. The mean age of the IR-ODS subjects was 59.5 ± 19.1, with a male to female ratio of 32/28 (53.3%/46.7%). Implants extruding by more than 4 mm into the maxillary sinus, peri-implantitis, bone graft disruption-extrusion were associated with a significantly higher incidence in the IR-ODS (p=0.035, p=0.003, p=0.011, respectively). The IR-ODS sides showed an adjusted-OR (95% confidence interval) of 27.4 (2.7-276.5) for extrusion length >4 mm, 11.8 (3.0-46.5) for peri-implantitis, and 34.1 (3.3-347.8) for bone graft disruption (p=0.005, p < 0.001, and p=0.003, respectively). Maxillary dental implants extruding more than 4 mm into the maxillary sinus, peri-implantitis, and disrupted-extruded bone grafts show significant association with IR-ODS. 4 Laryngoscope, 133:237-243, 2023.

Survival Rate of Implants Placed in Residual Bone Height Less than 4.5 Millimeters with or without Bone Grafting Using Summers Method.

The aim of this retrospective study is to analyze the survival rate of implants placed in residual bone height (RBH) less than 4.5 mm during an overall follow-up of 5 years, by using Straumann and Astra implant designs with or without sinus bone grafting. A total of 77 patients were examined and treated in two private practices in the regions of Hamra and Jounieh, Lebanon, by two periodontists from 2009 to 2019. These patients received 104 implants (83 Straumann implants and 21Astra implants) where 94 implants underwent osteotomy sinus floor elevation with bone graft and 10 implants without bone graft. The radiographic images were analyzed by three examiners: two periodontists and one oral radiologist. Written informed consents were obtained from all patients prior to treatment. All patients had to fulfill the inclusion criteria elaborated hereinafter. A total of 75.96% of implants were placed at the molars sites and 24.04% at the premolars sites. All 104 implants were clinically stable except 2 Straumann implants which suffered early failure (before the implant loading) and 1 Straumann implant late failure (3 months after the implant loading). All the failed implants were placed in a RBH > 4 mm. The cumulative success rate was 97.12% during an overall follow-up of 5 years. The crestal approach for maxillary sinus floor elevation is a viable technique that can be used in patients with minimal RBH < 4.6 mm.

Minimal treatment options with one-piece implants

The aim of this publication is to present case reports to show what is possible with pterygoid implants for the rehabilitation of edentulous space in the jaw (maxilla) while avoiding sinus lifts and bone grafting procedures. In addition, the added value of one-piece implants for screwed retention is elucidated.

3D Volumetric Analysis and Anatomical Considerations for Sinus Bone Graft

The aim of this study is to evaluate anatomical considerations and assess the volume of the maxillary sinus bone graft. There were sixty-three patients (eighty-three sinuses) who had taken CT scans for implant surgery. Patients included those whose height of the residual alveolar bone was less than 5 mm. The position of posterior superior alveolar artery, the thickness of the maxillary sinus wall, and the volume of the maxillary sinus according to the amount of sinus floor elevation were measured. The mean vertical distance of posterior superior alveolar artery was 11.91 ± 4.79 mm from 3.03 mm to 24.05 mm. The mean thickness of the lateral wall was 1.71 ± 0.55 mm in the range of 0.74 mm to 3.93 mm. The volume of 3 mm, 5 mm, 7 mm, and 10 mm from the sinus floor was 0.173 ± 0.11 cm3, 0.526 ± 0.25 cm3, 1.068 ± 0.43 cm3, and 2.184 ± 0.74 cm3 on average, respectively. The knowledge of the posterior superior alveolar artery position, the lateral wall thickness, and the volume of the maxillary sinus can help the clinician for sinus bone graft.

Implant treatment to reduce complications : Maxillary sinus elevation and bone graft (lateral wall approach) Failures and Problem solving

Today, maxillary sinus graft is considered to be the most prognostic of bone augmentation surgery as a preprosthetic treatment. Implant survival rates of more than 95% can be expected if appropriate decisions are made on the basis of implants, implant surface morphology, and use of a shield over the maxillary sinus front-wall. In addition, maxillary sinus grafty has a low rate of complications, and even if complications occur during or after maxillary sinus graft, most are localized and easily recovered.

Clinical and radiographic outcomes of reentry lateral sinus floor elevation after a complete membrane perforation.

Although small perforation of the maxillary sinus schneiderian membrane is a well-documented complication during lateral sinus floor elevation (LSFE), complete perforations larger than 10 mm often result in discontinuation of surgery. Reports on reentry LSFE and its long-term outcomes are sparse. To evaluate the long-term outcomes of reentry LSFE following complete membrane perforation to elucidate the technical details of the reentry procedure. We assessed the medical records of all patients receiving LSFE from 2008 to 2017 in the Department of Oral Implantology, Peking University Hospital of Stomatology. Twenty-two patients receiving reentry LSFE after complete membrane perforation were enrolled. Data were recorded using cone beam computer tomography: including the residual bone height, membrane thickness of the sinus prior to surgery (MT1 ), and before reentry (MT2 ), and height of the bone graft during the reentry procedure (HBG). Cumulative survival rate of implants (CSR), marginal bone loss (MBL), and subsequent complications were also recorded. From 2008 to 2017, 2023 consecutive patients (2262 sinuses) who underwent LSFE were screened. Complete membrane perforation occurred in 28 patients and resulted in discontinuation of surgery (1.2%). Twenty two patients were enrolled and received reentry LSFE within 3-6 months. Two patients undergoing the reentry procedure were suspended due to excessive membrane perforation, while the other 20 finished reentry sinus bone graft. In the reentry procedure, the HBG was 9.73 ± 2.67 mm with 34 implant placements. The MT1 and MT2 were 1.03 ± 0.43 and 1.91 ± 1.45 mm, respectively, showing a statistically significant difference (P < .05). After a follow-up of 2-10 years, CSR was 97.1%, and MBL was 0.64 ± 0.50 mm. The long-term outcome of reentry LSFE is predictable and reentry LSFE offers a reliable alternative following complete membrane perforation. However, the procedure is relatively sensitive and should be performed by experienced surgeons.

Remodelling of sinus bone grafts according to the distance from the native bone: A histomorphometric analysis.

To evaluate graft remodelling according to the distance from the native bone in maxillary sinuses grafted with anorganic bovine bone (ABB). Bilateral sinus grafting was performed in twenty patients with residual bone height <5mm before implant placement. After 8months, biopsy samples were harvested, and histomorphometric analysis was performed to examine bone formation according to the distance (in mm) from the native bone (sinus floor). In the grafted area, the percentages of new bone (NB), residual graft material (rABB), and soft tissue (ST) were evaluated. A total of 103 biopsy samples were evaluated, and the percentages of NB, rABB, and ST were 31.62±9.85%, 18.94±7.88%, and 49.41±9.52%, respectively, in the 1st mm; 27.15±9.83%, 23.33±9.45%, and 49.53±11.73%, respectively, in the 2nd mm; 23.61±13.02%, 21.35±11.08%, and 55.03±16.14%, respectively, in the 3rd mm; and 21.67±12.29%, 19.67±10.28%, and 58.66±12.46%, respectively, in the 4th mm. The 1st millimetre of the grafted area (closer to the native bone) presented a larger amount of NB than the other portions of the grafted areas and a smaller amount of rABB than the 2nd mm of the grafted area (p<.05). The amount of ST was larger in the 3rd and 4th mm of the grafted area than in the first 2millimetres (p<.05). The distance from the native bone influences bone formation following maxillary sinus augmentation.

Osseodensified Crestal Sinus Window Augmentation: An Alternative Procedure to the Lateral Window Technique.

A novel minimally invasive technique, osseodensification, is proposed to facilitate maxillary sinus bone graft augmentation. The osseodensified crestal window overcomes the previous limitations of traditional crestal approaches with respect to residual bone height (RBH) of ≤1.5 mm as well as vertical height of augmentation (>10 mm). Three patients, healthy and non-smoking, with 3 distinct and difficult clinical situations requiring sinus augmentation and having a maximum of 1.5 mm RBH (0.4-1.5 mm) were selected for this procedure. Edentulous sections were large (entire posterior sextant, with and without sinus septa), and small (single hyperpneumatized maxillary molar site). All healing was rapid and uneventful with no instances of sinus membrane perforation or other complications seen. The vertical increase in sinus bone height ranged from 10.3 mm to 13.6 mm. The increase in bone height is comparable to that obtained with lateral window procedures. The osseodensified crestal sinus window technique may be thus be proposed as a possible alternative procedure for the lateral sinus window technique for maxillary sinus bone augmentation.

Accuracy Evaluation of 14 Maxillary Full Arch Implant Treatments Performed with Da Vinci Bridge: A Case Series.

The use of pterygoid implants can be an attractive alternative to sinus bone grafting in the treatment of posterior atrophic maxilla. This technique has not been widely used because of the difficulty of the surgical access, the presence of vital structures, and the prosthetic challenges. The use of dynamic computer aided implantology (DCAI) allows the clinician to utilize navigation dental implant surgery, which allows the surgeon to follow the osteotomy site and implant positioning in real time. A total of 14 patients (28 pterygoid implants and 56 intersinusal implants) were enrolled in the study for a full arch implant prosthetic rehabilitation (4 frontal implants and 2 pterygoids implants), using a dynamic navigation system. The reported accuracy of pterygoid implants inserted using DCAI was 0.72 mm at coronal point, 1.25 mm at apical 3D, 0.66 mm at apical depth, and 2.86° as angular deviation. The use of pterygoid implants in lieu of bone grafting represents a valid treatment opportunity to carry out a safe, accurate, and minimally invasive surgery, while reducing treatment time and avoiding cantilevers for a full implant prosthetic rehabilitation of the upper arch.

Histological Aspects of a Novel Technique Used for the Management of Infections Secondary to Sinus Bone Grafting.

Recently, a technical note describing a promising method for the management of infections after sinus bone grafting by irrigating the corresponding area with hydrogen peroxide based solution with an aid of a drain has been published. The aim of this paper was to present the histological and radiological results of the above mentioned technique. A total of 17 patients who have presented with infections secondary to sinus bone grafting enrolled in the study. During implant placement, bone was collected from the originally grafted site with a trephine burr for radiological examination via micro-computed tomography and histological examination. According to the results of the current study, Bio-Oss acted as a scaffold, and mature fibrous bone formed trabeculae, which assembled to an interlinked trabecular structure. Average results obtained from the microradiography confirmed the higher percentage of Bio-Oss (27.21% ± 3.31%) at the corresponding area; whereas the amount of newly formed bone was slightly lower (6.79% ± 1.13%) As a conclusion, this simple and minimally invasive technique might be beneficial in avoiding removal of bone graft material and could help in rescuing the former laborious procedure.

Effect of teriparatide on early sinus graft healing in the ovariectomized rabbit.

The purpose of this study was to determine the effect of administering intermittent parathyroid hormone 1-34 [teriparatide, (PTH)] on the maxillary sinus lift and bone grafting in osteoporotic rabbits induced by ovariectomy and glucocorticoid. Ovariectomies were performed on 20 female New Zealand white rabbits that were randomly divided into two groups: (a) the PTH group (n=10), in which 10μgkg-1 day-1 PTH was injected subcutaneously 5days a week for 5weeks (from 1week before until 4weeks after sinus surgery), and (b) the saline group (n=10), in which saline substituted PTH at the same dose, mode of administration, and duration. Bone grafting with bovine bone mineral was augmented into 13 sinuses, and bone grafts and implants were simultaneously performed in seven sinuses, in both groups. Animals were sacrificed at 4weeks after surgery. To determine whether PTH was an effective treatment for osteoporosis, we measured the bone mineral density (BMD) of the right femur using micro-computed tomography and performed radiographic and histometric analyses of the maxillary sinus surgery site. The Mann-Whitney test was used for statistical analysis. It was found that BMD increased in the femur, whereas none of the radiographic and histometric parameters differed significantly between the groups in the sinus, while there were large interindividual variations within groups. These findings suggest that intermittent PTH does not promote new bone formation in the augmented maxillary sinus of ovariectomized rabbits.

Minimally Invasive Transalveolar Sinus Augmentation: An Answer to Sinus Conundrum

Dental implants have become the routine option for replacement of missing teeth, but it is challenging to place implants in the posterior maxilla due to inadequate bone dimensions and pneumatization of the maxillary sinus. Several techniques have been introduced over the years for sinus augmentation and bone grafting; both lateral and crestal approaches to sinus lift have been used with good results. In recent times, a minimally invasive technique has been used as a modification of crestal approach to sinus augmentation called minimally invasive technique sinus augmentation (MITSA). This method utilizes the calcium phosphosilicate putty for hydraulic sinus membrane elevation along with osseodensification drills. MITSA has simplified the sinus lift technique with predictable good results.