Sinus Elevation Procedure Research Articles

Comparative evaluation of efficacy of calcium silicophosphate putty versus particulate xenograft in maxillary sinus augmentation procedure: A clinical and tomographical study

Introduction: Remodeling of bone and pneumatization of maxillary sinus posttooth extraction results in loss of residual bone height in maxillary posterior segment. Hence, maxillary sinus elevation procedure is a commonly practiced procedure for the placement of dental implant in maxillary posterior region with inadequate residual bone. Various graft materials are being used in the space created after elevation of sinus membrane to maintain sinus lining in place and formation of new bone. Aim and Objective: The aim of this study is to compare efficacy of calcium silicophosphate putty and particulate xenograft material in direct maxillary sinus elevation procedure, clinically as well as tomographically. Materials and Methods: Twenty patients with the residual alveolar bone height between 3.5 and 6.5 mm in the edentulous maxillary posterior region requiring direct maxillary sinus lift were selected for the study and divided into two groups. In Group A, calcium silicophosphate putty (NovaBone® Dental Putty) was used as graft material and in Group B, particulate xenograft (Bio-Oss®) was used. In both the groups, simultaneous implant placement was done after maxillary sinus elevation. Patients were assessed radiographically (cone-beam computed tomography) after a period of 6 months for increase in bone height and density of new bone formed. Results: The mean increase in bone height postsinus elevation was found to be statistically significant with xenograft (9.8 ± 1.21 mm). It was also found that the new bone formed postsinus elevation was much more denser than existing bone in cases where xenograft was placed in cavity postsinus membrane elevation (759 ± 211 Hounsfield unit). Conclusion: All the implants placed were successfully rehabilitated. Statistically significant difference was observed an increase in bone height and density of new bone formed with xenograft.

Success and Failure Rates of 1,344 6- to 9-mm-Length Rough-Surface Implants Placed at the Time of Transalveolar Sinus Elevations, Restored with Single Crowns, and Followed for 60 to 229 Months in Function.

To assess the success and stability of 6-, 7-, 8-, and 9-mm-long, 6.5-mm-wide-neck tissue-level implants placed at the time of transalveolar sinus augmentation therapy, utilizing a trephine and osteotome approach, which were restored with single crowns. In total, 1,344 implants were placed by the author, varying in length from 6 to 9 mm, with parallel-wall 4.8-mm-diameter implant bodies and 6.5-mm-diameter implant necks. The implants were restored with single abutments and crowns by a variety of practitioners. They were followed for 60 to 229 months in function, with a mean time of 121.1 months in function. Implant success was evaluated by the author utilizing a combination of the Albrektsson et al criteria, and buccal and palatal/lingual bone sounding under anesthesia. The overall cumulative success rate was 98.8%. One hundred ninety 6-mm-long implants demonstrated a cumulative success rate of 97.5% at a mean time of 109.2 months in function. Eleven 7-mm-long implants demonstrated a cumulative success rate of 100% at a mean time of 218.5 months in function. One thousand ninety-four 8-mm-long implants demonstrated a cumulative success rate of 98.9% at a mean time of 112.3 months in function. Forty-nine 9-mm-long implants demonstrated a cumulative success rate of 100% at a mean time of 212.1 months in function. Implants of 6 to 9 mm in length, placed at the time of trephine and osteotome transalveolar sinus elevation procedures and restored with abutments and single crowns, demonstrate a high level of long-term clinical success, assuming specific comprehensive treatment criteria are met.

Impact of Sex, Age, and Season on Sinus Membrane Thickness.

Sinus membrane thickness has been associated with the incidence of membrane perforation during the sinus elevation procedure. Understanding the sinus membrane thickness is essential for prevention of this specific surgical complication. Therefore, the aim of this retrospective study was to investigate the impact of sex, age, and season on the membrane thickness. The charts of 144 healthy patients were included in the study. Cone beam computed tomography (CBCT) images from these patients were analyzed to determine the sinus membrane thickness in the coronal and sagittal views. Sex, age, and season were correlated with the membrane thickness. The mean thickness of the sinus membrane was 1.81 ± 1.66 mm (range: 0.47 to 9.49 mm). In 22.12% of the CBCT images, the sinus membrane was not visible. Membrane thickness of less than 2 mm was found in 70.8% of the cases. Age was found to be strongly correlated (P < .05) with sinus membrane thickness but not sex or season. Based on CBCT assessment, age was found to be a factor influencing sinus membrane thickness but not sex or season.

Retrospective Analysis of Dental Implants Placed Between 2012 and 2014: Indications, Risk Factors, and Early Survival.

The aim of this study was to review the indications for implant placement, early outcomes, and associated risk factors. A retrospective cohort study design was used. The study was composed of a group of 509 consecutive patients, which represented the total number of patients treated from 2012 to 2014 in the Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium. The authors analyzed the indications for implant placement and the potential risk factors for early implant failure. A total of 509 patients received 1,139 dental implants. The group consisted of 240 men and 269 women, with a median age of 58 years. The most frequent indication for implant placement was restoration of a partially edentulous arch (80.1%, n = 408). For 152 implants (13.3%), additional bone-augmentation or sinus elevation procedures were required. Early failures were recorded for 52 (4.6%) implants in 33 patients (6.5%). Smoking, male gender, total edentulism, implant diameter, and bone augmentation surgery were found to be associated with early implant failure. Patients referred for implant placement were more likely to be partially edentulous and older than 50 years. Singletooth replacement in the posterior mandible was the most frequent indication (24.4%) for treatment. This study found an early success rate of 95.4% and identified risk factors for early failures.

The factors that influence postoperative stability of the dental implants in posterior edentulous maxilla

BackgroundAll clinicians are aware of the difficulty of installing a dental implant in posterior maxilla because of proximate position of maxillary sinus, insufficient bone width, and lower bone density. This study is to examine which factors will make the implantation in the posterior maxilla more difficult, and which factors will affect the postoperative implant stability in this region.MethodsFive hundred seventy-three fixtures on the maxilla posterior were included for this study from all the patients who underwent an installation of the dental implant fixture from January 2010 to December 2014 at the Department of Oral and Maxillofacial Surgery in Pusan National University Dental Hospital (Yangsan, Korea). The postoperative implant stability quotient (ISQ) value, fixture diameter and length, presence of either bone graft or sinus lift, and graft material were included in the reviewed factors. The width and height of the bone bed was assessed via preoperative cone beam CT image analysis. The postoperative ISQ value was taken just before loading by using the OsstellTM mentor® (Integration Diagnostics AB, Gothenburg, Sweden). The t test and ANOVA methods were used in the statistical analysis of the data.ResultsMean ISQ of all the included data was 79.22. Higher initial bone height, larger fixture diameter, and longer fixture length were factors that influence the implant stability on the posterior edentulous maxilla. On the other hand, the initial bone width, bone graft and sinus elevation procedure, graft material, and approach method for sinus elevation showed no significant impact associated with the implant stability on the posterior edentulous maxilla.ConclusionsIt is recommended to install the fixtures accurately in a larger diameter and longer length by performing bone graft and sinus elevation.

Treatment concepts for the posterior maxilla and mandible: short implants versus long implants in augmented bone.

The aim of this narrative review is to describe treatment options for the posterior regions of the mandible and the maxilla, comparing short implants vs. longer implants in an augmented bone. The dental literature was screened for treatment options enabling the placement of dental implants in posterior sites with a reduced vertical bone height in the maxilla and the mandible. Short dental implants have been increasingly used recently, providing a number of advantages including reduced patient morbidity, shorter treatment time, and lower costs. In the posterior maxilla, sinus elevation procedures were for long considered to be the gold standard using various bone substitute materials and rendering high implant survival rates. More recently, implants were even placed without any further use of bone substitute materials, but the long-term outcomes have yet to be documented. Vertical bone augmentation procedures in the mandible require a relatively high level of surgical skill and allow the placement of standard-length dental implants by the use of autogenous bone blocks. Both treatment options, short dental implants, and standard-length implants in combination with vertical bone augmentation procedures, appear to result in predictable outcomes in terms of implant survival rates. According to recent clinical studies comparing the therapeutic options of short implants vs. long implants in augmented bone, the use of short dental implants leads to a number of advantages for the patients and the clinician.

TRANSCRESTAL SINUS LIFT AND IMPLANT PLACEMENT USING THE SINUS BALLOON TECHNIQUE

INTRODUCTION: Rehabilitation of the edentulous posterior maxilla with dental implants is challenging. The deficient alveolar ridge interferes with implant insertion of adequate length placed in the correct position and with the accurate inclination. The transcrestal sinus elevation procedure has become an important preprosthetic surgical procedure for bone creation in the posterior maxilla prior to implant placement. OBJECTIVES: Clinical and radiographic evaluation of using ballooning technique for sinus lift simultaneous with implant placement. MATERIALS AND METHODS: A randomized clinical trial was conducted on fourteen patients who were divided into two groups. Patients, with limited bone height below the floor of the maxillary sinus, were selected on the basis of history, clinical and radiographic examination using cone beam computed tomography. In group A, elevation of sinus membrane using ballooning technique without graft material and implants were placed simultaneously. While in group B, after sinus membrane elevation using ballooning technique, augmentation using biphasic calcium phosphate simultaneously with the implant placement were done. The bone density was measured in Hounsfield unit using ondemand3d software of the cone beam computed tomography. Also, the bone height was measured using cone beam computed tomography. RESULTS: Successful sinus membrane balloon lifting procedures were performed in 14 cases; in both groups there was no sinus membrane perforation. A total of 14 implants were placed. The radiographic examination showed the mean elevated height after 6 months by balloon in group A was 10.43 with SD ±1. 56mm.while in group B was10.31 ± 1.86. CONCLUSIONS: The use of balloon technique to elevate the sinus membrane is a minimally invasive technique and is associated with very little discomfort and complication.

One-Step Maxillary Sinus Augmentation in Association With Endoscopic Sinus Surgery: Case Series and Review of the Literature.

Sinonasal anatomical anomalies and inflammatory conditions may reduce success rates of maxillary sinus elevation (MSE) procedures used to allow implant placement in the atrophic posterior maxilla. Approaches combining endoscopic sinus surgery (ESS) and MSE were firstly proposed by our group and have already been described in the literature. This article aims to re-evaluate the procedure in a larger sample of patients comparing results and indications with the pertaining literature. Thirty-three patients (19 men and 14 women, mean age 52.79 ± 11.95 years) underwent combined ESS/MSE with 48 MSE procedures performed. No intraoperative complications were reported. An uneventful and complete graft integration was obtained after 6 months in all but one patient. All patients completed prosthetic rehabilitation within 9 to 12 months. Combined ESS and MSE has proven to be a safe and reliable procedure, which can be proposed to selected patients presenting with reversible sinonasal contraindications to MSE and should be no more considered an experimental procedure.

Rehabilitation of the Atrophic Posterior Maxilla Using Splinted Short Implants or Sinus Augmentation with Standard-Length Implants: A Retrospective Cohort Study.

To retrospectively compare short implants (6 to 8 mm) (short group) to standard-length implants (≥ 11 mm) inserted in combination with a lateral sinus elevation procedure (sinus group), supporting partial fixed prostheses in the atrophic posterior maxilla. Records of 118 patients treated with fluoride-modified implants in the atrophic posterior maxilla between January 2009 and December 2011 were screened in two private practices. Two to four implants were placed in each patient and loaded after 5 to 6 months with partial fixed prostheses. Patients were followed for at least 3 years after implant placement. Patients were contacted and invited for clinical and radiologic follow-up examinations. Outcome measures were implant failures, complications, soft tissue parameters, and marginal bone levels. Fisher exact and unpaired t tests were used to compare proportions and means at the .05 level of significance. A total of 101 patients attended the examination: 53 (112 implants) in the sinus group and 48 (109 implants) in the short group. The mean observation period was 47.03 ± 7.46 months for the sinus group and 44.18 ± 6.42 months for the short group. Ten surgical complications occurred in nine patients of the sinus group versus only one complication in the short group; the difference was statistically significant (P = .01). Six implants failed in five patients of the sinus group versus two implants in two patients of the short group. At follow-up, mean marginal bone loss was 0.64 ± 0.58 mm in the sinus group vs 0.48 ± 0.5 mm in the short group. No significant difference was observed in terms of implant failures, prosthetic complications, soft tissue parameters, or marginal bone loss between the two groups. Within the limitations of this study, both techniques showed similar medium-term outcomes, but short implants provided advantages in terms of a reduced number of surgical complications.

Use of Buccal Fat Pad for Closure of Perforation and Graft Material in a Maxillary Sinus Elevation Procedure: A Preliminary Study.

Maxillary sinus membrane elevation is a common procedure intended to increase the volume of the maxillary sinus osseous floor prior to insertion of dental implants. The aim of this study was to evaluate bone formation under a perforated sinus membrane grafted with buccal fat pad (BFP). Six consecutive patients (10 sinus augmentations, 24 dental implants) underwent sinus floor elevation, using the lateral window approach. The compartment around the implants under the sinus mucosal lining in the sinus floor was filled with adipose tissues, which were retrieved as free graft from BFP. Clinical and radiologic follow-up was conducted through the healing period; in all cases, samples were taken for biopsy during the stage-two surgery. New bone consolidation in the maxillary sinus was radiologically and histologically observed within an average of 7.2 months after the sinus augmentation. According to the histomorphometric data, 62.8% ± 13.1% vital bone formation was observed. Out of the 24 implants placed, only 1 failed, indicating a 95% overall implant survival rate. Despite the limited size of this case series, BFP can be considered an autologous osteogenic graft material and/or biologic membrane capable of achieving high success rates in sinus elevation procedures.

A New Method Using Autogenous Impacted Third Molars for Sinus Augmentation to Enhance Implant Treatment: Case Series with Preliminary Results of an Open, Prospective Longitudinal Study.

This prospective longitudinal study reports on the results in patients given autologous tooth material for augmentation in a sinus elevation procedure. Six patients with inadequate bone supply for augmentation in the maxillary posterior tooth region and at least one impacted maxillary third molar underwent sinus elevation surgery with lateral access using the particulate tooth material. One of the patients received four implants during the same session, while the other patients had a total of 15 implants placed after a healing phase of an average 5.5 months. Drill cylinders collected from the implant bed during the procedure were subjected to histologic/immunohistochemical evaluation. All six patients showed normal and unobtrusive postoperative healing, having undergone prosthetic restoration up to 5 years before. The average peri-implant probing pocket depth after a period of up to 5 years ranged between 1.86 mm (mesial and lingual) and 2.07 mm (distal and buccal). No bleeding could be triggered with any of the peri-implant probes. The average peri-implant bone resorption measured during the first year was up to 0.63 mm, with the lowest being 0 mm and the maximum 2.9 mm. Peri-implant bone remained stable for the follow-up time of up to 5 years. Histologically, six biopsy specimens collected from five patients showed osteoconductive osteogenesis with encapsulation of tooth enamel and dentin portions and partial resorption of the tooth components. Cementum shares were no longer discernible. Immunohistochemical assessment showed intense new vessel formation that could be observed in the area of loose stroma of reorganized tissue in the augmented area. Within the limits of these preliminary results and with adequate consideration of the small number of patients included, the use of autogenous crushed tooth material from impacted third molars may represent an alternative augmentation material for use in sinus elevation procedures.

Effect of Schneiderian membrane perforation on sinus lift graft outcome using two different donor sites: a retrospective study of 105 maxillary sinus elevation procedures.

Background: Sinuslift is meanwhile an established method of bone augmentation in the posterior maxilla. Aim of the study was to evaluate the significance of intraoperative Schneiderian membrane perforations during maxillary sinus floor elevation surgery using autogenous bone harvested from two different donor sites using a Safescraper device on the success rate, graft survival and implant integration.Methods: The investigators conducted a retrospective cohort study at the Department of Oral and Maxillofacial Surgery of Military Hospital Ulm composed of patients with severe maxillary atrophy who underwent sinus augmentation from January 2011 until December 2011. Ninety-nine consecutive patients (89 men, 10 women) with a mean age of 43.1 years underwent sinus graft procedures in a 2-stage procedure using the lateral wall approach, as described by Tatum (1986). Data on patient age, smoking status, donor site and surgical complications were recorded and the relationship between Schneiderian membrane perforation and complication rate was evaluated. Dental implants were inserted 4 months after grafting.Results: A total of 105 sinus lift procedures were performed in 99 patients. Sixty-one patients (61.6%) underwent sinus elevation with autogenous bone from the buccal sinus wall, while 38 patients (38.4%) bone harvesting from the iliac crest. Intraoperative perforation of the Schneiderian membrane was observed in 11 of the 105 sinuses (10.4%). These perforations resulted in 4 (36.3%) of the cases in major postoperative complications accompanied by swelling and wound infection. Membrane perforations were slightly associated with the appearance of postoperative complications (p=0.0762). In 2.4% of all cases, regarding 2 patients the final rehabilitation with dental implants was not possible because of extensive bone resorption. Conclusion: Intraoperative complications performing sinus augmentation may lead to postoperative complications. With careful clinical and radiographic evaluation and appropriate treatment, the complications and risk for graft material displacement and implant loss can be eliminated.

Prevalence of bony septa, antral pathology, and dimensions of the maxillary sinus from a sinus augmentation perspective: A retrospective cone-beam computed tomography study.

PurposeSinus elevation procedures have become a routine and reliable way to gain bone volume in the edentulous maxilla for dental implant placement. Presence of bony septations and pathology in the maxillary sinus often cause complications leading to graft or implant failure or both. The aim of this study was to retrospectively evaluate the prevalence of pathology, direction of the septa, and sinus width measured at 2 mm, 5 mm, and 10 mm from the sinus floor in maxillary sinuses using cone-beam computed tomography (CBCT).Materials and MethodsSeventy-two sinuses from 36 random preoperative CBCT scans referred for implant therapy were retrospectively evaluated for the number, prevalence, and direction of bony septations and presence of pathology. Width of the sinus was also measured at 2 mm, 5 mm, and 10 mm from the sinus floor to account for the amount of bone available for implant placement.ResultsMaxillary sinus septa were found in 59.7%. Presence of a single septum was noted in 20 sinuses (27.7%), followed by two septa in 17 sinuses. The most common direction of the septum was the transverse direction. Retention pseudocyst and mucosal thickening were the most commonly seen abnormality/pathology.ConclusionBased on the high prevalence of septa and sinus pathology in this sample, a preoperative CBCT scan might be helpful in minimizing complications during sinus augmentation procedures for dental implant therapy.

EVALUATION OF PLATELET RICH FIBRIN IN SINUS LIFTING WITH SIMULTANEOUS IMPLANT PLACEMENT

Introduction: Rehabilitation of the edentulous posterior maxilla with dental implants is challenging. The deficient alveolar ridge interferes with implant insertion of adequate length placed in the correct position and with the accurate inclination. The maxillary sinus elevation procedure has become an important preprosthetic surgical procedure for bone creation in the posterior maxilla prior to implant placement. The use of PRF during sinus-lift procedures has been advocated for many years. Objectives: This study was designed to evaluate the use of platelet rich fibrin (PRF) following sinus lifting with piezosurgery and simultaneous implant placement. Materials and methods: 7 patients were selected to perform sinus lifting with simultaneous implant placement using PRF as a sole agent and piezosurgery device. Results: Cone beam computerized tomography 6 months postoperatively showed statistically significant increase in bone height and density. The mean of the newly formed bone height was (6.55 ± 1.14 mm). The mean postoperative bone height measured from the floor of the maxillary sinus and alveolar crest was (11.35 ± 0.56 mm). The mean of the newly formed bone density was 507 HU. The mean of the postoperative bone density around the implants after 6 months was (547.71 ± 188.42 HU). The mean marginal bone loss was (0.82 ± 0.25 mm). Conclusion: PRF could be successfully used as a sole agent for bone regeneration in lateral sinus lifting with simultaneous implant placement.

Evaluation of maxillary sinus septal type and height in partially edentulous maxilla using spiral computed tomography

Background: The presence of anatomic variations within the maxillary sinus such as septa has been reported to increase the risk of sinus membrane perforation during sinus elevation procedure for implant placement. This study aimed to measure the septal heights and correlate it with different types of septa. Material and methods: Thirty patients (15 males and 15 females) with partially edentulous maxillae and mean age (35) years were enrolled in this study. Sixty sinuses scanned with Spiral multislice Computed Tompgraphy, septal height measured after evaluation of septal type whether it was primary or secondary. Results: The results showed that 72.5 % of the septa detected were primary and this is statistically significant when compared with the percentage of secondary type (27.5%). There was a statistically significant difference in the height of septa between the two types, and the primary septa were higher. There was no significant difference between septal type and sex. Conclusions: A sound knowledge of maxillary sinus anatomy and anatomic variations such as septa is essential to prevent complication during surgical interventions involving this region.

Volume changes of grafted bone after sinus lift procedure using tibia bone: 3 years after prosthesis radiological study

PurposeThis study evaluated patients who have passed 3 years or more after fixed prosthesis and have undergone two-stage sinus lift procedure with tibia bone. The aim of this study was to evaluate the transplanted bone by clinical aspects and panoramic radiographs. Materials and methodsTwelve patients and 30 implants were evaluated. The average age of the patients was 55.6±8.0 years. Patients were treated with the same surgical procedure by one surgeon. Panoramic radiographs were taken at the time the patients had fixed prosthesis, and 1, 2, and 3 years later accordingly. The radiographs were saved as DICOM data and reconstructed into two-dimensional images using 3D image analysis software in order to measure the distance between the elevated maxillary sinus floor and the apical of the implant body. ResultsThe amount of the resorption of the transplanted bone was 3.1±1.6mm 3 years after implant replacement. Statistical difference was observed in bone resorption in cases of the back site of the zygomaticoalveolar line, when the preoperative maxillary ridge bone was less than 4mm, among smokers and with complications of sinus membrane perforation. Survival and success rates of the implants were 100%. ConclusionMaxillary sinus elevation procedure with tibia bone was a predictable treatment method for implant rehabilitation.

Recombinant Human Bone Morphogenetic Protein 2 in Augmentation Procedures: Case Reports

To successfully rehabilitate edentulous patients using endosseous implants, there must be enough available bone. Several techniques have been proposed for augmentation of sites with insufficient bone volume. Although autogenous bone has long been considered the gold standard for such procedures, the limited availability of graft material and a high morbidity rate are potential disadvantages of this type of graft. An alternative is to use recombinant human bone morphogenetic protein 2 (rhBMP-2), which is able to support bone regeneration in the oral environment. These cases demonstrate the applicability of rhBMP-2 in maxillary sinus elevation and augmentation procedures in the maxilla to enable dental implant placement. The use of rhBMP-2 in alveolar augmentation procedures had several clinical benefits for these patients.

Twelve-Year Retrospective Follow-Up of Machined Implants in the Posterior Maxilla: Radiographic and Peri-Implant Outcome.

To retrospectively evaluate the survival rate of machined implants in sinus-lifted posterior maxilla after 12 years, with special reference to radiographic outcome and peri-implantitis. From 37 possible candidates, 29 patients with 59 implants were evaluated. Implants were placed in the posterior maxilla in combination with a sinus elevation procedure (27 patients) or 6 months after sinus elevation (2 patients). Marginal bone level changes were radiographically evaluated at baseline and 1, 7, and 12 years post-loading. Probing depth was measured; presence/absence of plaque and bleeding on probing were recorded. Four out of 59 implants failed in 4 out of 29 patients (cumulative survival rate = 93.2%). The mean bone loss was 0.78 mm (± 0.88) after 12 years. Changes in the mean bone level were statistically significant between baseline and all the other follow-up intervals (p < .001). Statistically significant differences could be demonstrated for the first- to 12th-year interval (p < .05) and for the seventh- to 12th-year interval (p < 0.001). No statistically significant differences could be demonstrated at the first- to seventh-year interval (p = .32). The mean overall probing depth was 2.9 ± 0.66 mm. Probing depth was moderately correlated with the marginal bone changes at 7 year and after 12 year follow up (p = .05). No signs of peri-implantitis were reported during the 12-year follow-up period. This follow-up demonstrates a very good prognosis when implants with machined surfaces are used. The frequencies of implant failures were very small. Within the limits of the results from this study, the risk of peri-implantitis in the posterior maxilla might be considered a minor problem when implants with machined surfaces are used.

Accuracy of spiral computed tomography in evaluation of maxillary sinus septa among dentate and edentulous Iraqi subjects (Comparative study)

Background: Presence of maxillary sinus septa has been known to be a complicating factor for sinus elevation procedure and implant placement in posterior maxilla. The maxillary sinuses septa are thin walls of cortical bone inside the sinus. They vary in number, location, and height. This study aimed to discover the accuracy of Spiral Computed Tomographic Scan in evaluation the maxillary sinus septa (prevalence, location, height) in subjects with dentate, partially edentulous and completely edentulous maxilla. Material and method: This study included (267) subjects ranged from (20-70 years), (132) male and (135) female divided into three groups, (97) fully dentate group, (102) partially edentulous group and (68) completely edentulous group who admitted to Spiral Computed Tomography Scan in Al-Karkh General Hospital in Baghdad to have Computed Tomography Scan of the brain and paranasal sinuses for different diagnostic purposes from November 2012 to April 2013. The maxillary sinus septa were evaluated in the axial and sagittal views and the data were subjected to statistical analysis using Statistical Package for Social Sciences version 20. Result: The prevalence rate of septa was 77.3% among fully dentate maxilla sample. Almost the same prevalence rate was obtained in the other two study sample (partially edentulous maxilla 77.5% and completely edentulous maxilla 76.5%).No important or statistically significant difference in prevalence was observed between the three study groups. Age and gender showed no important or statistically significant difference in prevalence rate in each study group, the mean septal height was slightly higher in fully dentate group (7mm) compared to partially edentulous maxilla group (6.2 mm) and completely edentulous maxilla group (6.5 mm). The difference in mean between the 3 groups however was not significant statistically. The rate of septa at floor position was significantly lowest in fully dentate maxilla group (36.1%) compared to partially edentulous maxilla group (52.1%) and completely edentulous maxilla group (53.3%). Conclusion: Spiral Computed Tomography is a precise diagnostic tool for the examination of this zone capable for investigating their location and height during different maxillary sinus surgical procedures. In the posterior maxilla, regardless of type of ridge (atrophy/edentulous or non-atrophy/dentate), the anatomical variation of sinus septa is diverse in its prevalence and location.

Implant success remains high despite grafting voids in the maxillary sinus

Given that the nature and presence of voids present within grafted sinuses following maxillary sinus elevation procedures were not known, nor was the contribution of these factors to implant success, the purpose of this study was to investigate these parameters and their relationship to implant success. This study evaluated data from 25 subjects who had a lateral window maxillary sinus augmentation procedure. Cone-beam computed tomography (CBCT) was performed at baseline and 4 months after surgery. CBCT images were used to evaluate grafted sites prior to implant placement. Using CBCT images, three examiners independently measured bone-grafted areas (BG), void areas (V), and percentage of void areas (V%) from six different sections within grafted sites. The six sections were defined as a cross-sectional (CS) midpoint, CS mesial point, CS distal point, horizontal section (HS) low point, HS midpoint, and HS high point. Implant success was also determined. The calculated V% (V/BG) for the CS midpoint, CS mesial point, CS distal point, HS low point, HS midpoint, and HS high point were 5.30 ± 6.67%, 5.79 ± 8.51%, 6.67 ± 7.12%, 2.07 ± 2.56%, 5.30 ± 6.62%, and 4.92 ± 5.17% respectively. Implant success after 6 months of follow-up approximated 100%. Although voids within grafts varied in terms of distribution and size, the V% within the HS low point were significantly smaller compared to those within the CS midpoint and CS distal point, which had the most intra-subject V%. Thus, more attention should be given to the distal aspect of the sinus when compacting graft materials in the lateral wall sinus augmentation procedure. Implant success was not influenced by the existence of voids as implant success remained high.