Sinus Elevation Research Articles

Finding Better Ways to Perform Graftless Full Rehabilitation of a Compromised Maxilla: New Platform-Switched Zygomatic Implants Placed Extra-Sinus Improve Prosthetic Restoration—A Preliminary Study of 25 Cases and 85 Implants

Standard treatment for full rehabilitation of compromised maxillae with regular implants includes sinus elevation grafting, a minimum of two to three surgeries, and a minimum treatment time of 9 to 15 months. Zygomatic implants are a viable alternative. However, prosthetic restorations have been compromised due to abutments emerging on the palate. The purpose of this study was to find ways that abutments will emerge on the ridge (occlusal surface). The presented results show it can be done if zygomatic implants are placed in the sinus wall (extra-sinus) and use an internal, conical connection with platform-switching and 45-degree abutments. Thus, marginal tissue prognosis and primary stability may also be improved by adding coronal threads to an implant design. These improvements, if confirmed in longer follow-ups and further studies, may encourage more graftless rehabilitations of severely compromised maxillae, reducing the number of surgeries and overall treatment time.

Maxillary sinus pneumatization and augmentation: A three-dimensional finite element analysis

This study aimed to explore the biomechanical behaviors of maxillary sinus elevation with bone grafts of various heights and widths using three-dimensional (3D) finite element analysis. We constructed 27 3D finite element models according to bone graft dimensions for three maxillary sinuses. These models were classified as (i) tapered, (ii) ovoid, and (iii) square. Each maxillary sinus type was analyzed with bone graft heights of 3 mm, 6 mm, and 9 mm and mesiodistal bone graft widths of 8 mm, 10 mm, and 12 mm. Different sinus pressure of 100 Pa, 500 Pa, and 1,000 Pa was applied to each aspect of the maxillary sinus. The maximum von Mises (max-VM) stress for each bone graft model was highest in the square group. The bone graft’s max-VM stress was decreased while increasing bone graft height from 3 to 9 mm in the tapered and square groups. In the ovoid group, the max-VM stress of all bone graft models decreased when the bone graft height increased from 3 to 6 mm. Thus 6 mm is the most appropriate bone graft height for all types of maxillary sinus elevation.

Short Dental Implants (5 to 7 mm) with Expandable Apex in the Posterior Maxilla-Preliminary Results.

The purpose of this study was to examine whether the use of short dental implants with an expandable compressive design could be a proper alternative to the conventional sinus elevation procedure in cases of deficient alveolar ridge height in the posterior maxillary area. Fifty patients with 73 short dental implants with an expandable compressive design who were treated for posterior maxillary alveolar ridges of 5 to 7 mm in the vertical dimension between 2012 and 2018 were included in a retrospective study. All patients had a minimum postrehabilitation period of 1 year. Patient demographics, implant properties, primary stability, and implant success and survival rates were analyzed. The total success rate was 97.2%, with two failed implants at implant uncovering. The mean bone loss was 1.03 mm. No difference in bone loss was found between sexes or age groups. The results of this study suggest that short dental implants with an expandable apical compressive design could be an alternative to sinus elevation procedures in selected cases of vertically deficient maxillary alveolar ridges.

Sub-antral volumetric variation after a modified trephine sinus elevation approach: An 8-month prospective study

Aim To overcome vertical deficiency of atrophic posterior maxilla, sinus floor elevation has been used for several decades either through a transcrestal or a lateral approach. In 1999, Fugazzotto et al. described a modified trephine/osteotome technique for sinus floor augmentation at the time of maxillary molar extraction without implant placement. A trephine was used to create a bone core in the middle of the extraction site and was gently malleted apically. In 2002, Fugazzotto et al. used the same principle to place dental implants in healed maxillary molars sites with limited residual height (RH). This procedure demonstrated a 98.3% implant survival rate at 4 years but lacked radiographic information. The aim of the present study was to assess the efficacy of the modified trephine/osteotome sinus elevation with implant placement, using a clinical and a radiographic cone beam evaluation. Materials and methods Twenty-one implants were placed in premolar and molar sites with 3≤ RH ≤6mm using the modified trephine/osteotome sinus elevation approach and were evaluated clinically and radiographically at baseline (T1), 3 (T3) and 8 (T8) months. Results Implant survival was 100% at 8 months. Sub-antral volumetric bone gain between T1 and T8 was 20.34%. Linear bone gain was 2.1 ± 1.1 mm buccally; 2.0 ± 1.4 mm palatally; 2.5 ± 1.6 mm mesially; and 1.5 ± 1.5 mm distally. Mean linear bone gain was 2.0±1.1 mm calculated on the CBCT. Implant stability quotient (ISQ) at T1 was 66.378±7.931, and 67.921±14.369 at T3 without a statistically significant difference between the two measurements. Residual height was positively correlated to vestibular, palatal, and mesial bone gain. Signs of Schneiderian membrane tearing were noticeable in one case. Conclusion This study demonstrated that sufficient subantral bone formation can be obtained with the modified trephine/osteotome technique with high implant survival rate and low post-operative morbidity.

Retrospective study on the merits of bone grafts and the influence of implant protrusion length after osteotome sinus elevation surgery.

This study aims to evaluate the endo-sinus bone remodeling of dental implants placed via osteotome sinus floor elevation (OSFE) after 6 months and using different implant protrusion lengths and bone grafts through cone beam computed tomography (CBCT). Ninety-six patients with 124 implants were included and assigned into four groups. Group 1: implant protrusion length<4 mm with bone graft; group 2: implant protrusion length>4 mm with bone graft; group 3: implant protrusion length<4 mm without bone graft; group 4: implant protrusion length>4 mm without bone graft. Apical bone gain (ABG), cortical bone gain (CBG), bone density gain (BDG), and marginal bone loss (MBL) were observed and analyzed at baseline and 6 months after implant surgery. The CBG in grafted groups 1 and 2 was higher than that in non-grafted groups. The ABG and BDG were higher in non-grafted groups 3 and 4 than in grafted groups, and the levels in group 3 were higher than those in group 4. The CBG in grafted group 2 was higher than that in group 1. No significant difference was observed in MBL analysis. The BDG of IPL<4 mm implants was higher than IPL>4 mm implant when bone grafts were not applied. No relevance was observed between IPL and CBG. Bone grafts can accelerate endo-sinus bone remodeling by increasing CBG and dissipating the influence of IPL on BDG.

Syncope and pneumomediastinum during the maxillary sinus elevation with an air-syringe: a case report

Syncope and pneumomediastinum during the maxillary sinus elevation with an air-syringe: a case report

Crestal approach for the repair of the Schneiderian membrane perforated during transalveolar sinus elevation

Aim The most common complication during maxillary sinus floor elevation is perforation of the Schneiderian membrane. Most of studies presented repair procedures via a lateral approach, which can induce additional complications. Therefore, in the present study the procedure was performed via crestal approach. Case report This study included three patients who showed a low residual alveolar bone height in the maxillary posterior edentulous region and in whom the placement of implants with sinus floor elevation was planned via a transalveolar approach. Perforation of the sinus membrane occurred during the procedure, and so collagen dressing material was inserted through the drilling hole to cover the perforated membrane. Xenogeneic bone was grafted under the elevated sinus membrane, and implants were placed simultaneously. The final prostheses were delivered at 6 to 8 months after the surgery. There were no complications in any of the patients. Results All implants showed successful stability, and no specific clinical or radiographic complication was observed during follow-ups lasting 2 to 3 years. Conclusion A crestal approach can be a reliable option when repairing a sinus membrane that is perforated during transalveolar sinus floor elevation.

Comparative Assessment of the Primary Stability of Straumann BLX Implant Design Using an In Vitro Sinus Lift-Simultaneous Implant Insertion Model.

Straumann BLX is a novel implant system that has been proclaimed to provide an ideal primary stability in all types of bone. In the current study, the primary stability of the Straumann BLX implant systems with Straumann tapered effect (TE) implants have been comparatively assessed in bovine ribs by using a simultaneous sinus elevation and implant insertion model. In the study group, BLX (4.0 × 12 mm), TE (4.1 × 12 mm), BLX (4.5 × 12 mm), and TE (4.8 × 12 mm) were placed in each bony window, which resembles the sinus maxillaris. As a control, BLX and TE implants with the same sizes were inserted into the proximal diaphysis of the bovine ribs. A total of 40 implant insertions were performed. Stability was measured with resonance frequency analysis. In the study group, 4.8-mm TE implants showed significantly higher values compared with 4.5-mm BLX implants (P = .116). However, 4.0-mm BLX implants in the control group showed higher stability compared with 4.0-mm-diameter TE (P = .014). The primary stability of the BLX implants in the control group was significantly higher compared with the experimental group in both widths (P= .018 for BLX 4.0 mm and P = .002 for BLX 4.5 mm, respectively). The use of the TE design with a wide diameter in simultaneous implant placement with sinus lift could present higher implant stability quotient values and might be a more appropriate option for implant recipient sites with poor bone volume and quality. However, the advantage of BLX design in standard implant insertion protocols could be of value.

Flapless Localised Management of Sinus Floor (LMSF) for trans-crestal sinus floor augmentation and simultaneous implant placement. A retrospective non-randomized study: 5-year of follow-up

BackgroundTrans-crestal sinus lift procedures are well established. Purposeto retrospectively analyse the efficacy of a flapless trans-crestal maxillary sinus floor elevation and simultaneous dental implant placement based on the Localised Management of Sinus Floor (LMSF) technique suitable for cases with sufficient width of keratinized tissue and of crestal bone but insufficient vertical dimensions of the bone below the sinus. Materials and methods71 sinus elevations with simultaneous implant placement were performed on 52 consecutive patients. Following an initial pilot bur transmucosal perforation, the Magnetic Mallet was used with progressively larger osteotomes. The mallet osteotomes are initially directed palatally, towards the cortex of the medial wall of the sinus, below the palato-nasal recess (PNR) and then redirected in a more vertical direction to create the final osteotomy for implant placement. ResultsNo significant complications were reported in the post-operative phase. The cumulative success rate during the observation period was 95%. All successful implants were successfully loaded with metal-ceramic or monolithic zirconia crowns and bridges and remained in function during the observation period. ConclusionsFlapless Localised Management of Sinus Floor (LMSF) is a safe and effective surgical technique with minimal risks and with the advantage of low morbidity. Also, only native bone is used for augmentation and there is no need for additional grafting.

Maxillary Implant Placement in a Limited Residual Bone Height

The limitation of residual bone height (RBH) and vital structures such as sinuses in the maxillary often make the implant placement procedure becomes complicated. Clinicians may perform sinus elevation prior to implant placement to accommodate the length of the implant fixture. Sinus elevation is an invasive procedure and complication may occur during the surgery including the most frequent complication is perforation of Schneiderian membrane. Objectives: To discuss a comprehensive management of implant placement and its complication step by step from surgical procedures to crown placement Case Report: 67-year-old female patient with partial edentulism in the right maxillary region, presence of sinus septum, and RBH was 4mm. The patient was planned to do sinus elevation surgery prior to implant placement, perforation of the Schneiderian membrane occurred while surgery performed and pericardium membrane was attached around the perforation site. Sinus re-entry and implant placement were performed after 3 months followed by prosthetics procedures in the next 6 month. Conclusion: Dental implant is a complicated treatment and complication may occur during the placement, thus a comprehensive management is very essential to minimize the risk of complications.

Lateral window technique: A focus review

AbstractThe posterior alveolar bone region of the maxilla has, in more than 40% of the cases, a height inferior to 4 mm, thus making rehabilitation with implants a clinical challenge. This focus literature review was carried out through an exhaustive literature search in PubMed, ScienceDirect, LILACS, Web of Science, Scielo and Cochrane Library. The aim was to illustrate and analyse various factors that should be accounted for while applying the maxillary sinus elevation technique. The lateral osteotomy technique is carefully described including its indications, complications, contraindications, as well as, different factors to take into account, such as the use of electric piezo, graft materials, membranes and the expected success rates.

Incidence of Sinus Mucosa Perforations During Healing After Sinus Elevation Using Deproteinized Bovine Bone Mineral as Grafting Material: A Histologic Evaluation in a Rabbit Model.

To examine the reaction of mucosa over time to a close contact with biomaterial after sinus elevation performed with deproteinized bovine bone mineral (DBBM) granules of two different sizes. Bilateral sinus mucosa elevation was performed in 18 New Zealand rabbits through access on the nasal dorsum. DBBM with granule dimensions of either 1 to 2 mm (large group) or 0.250 to 1.0 mm (small group) were used to randomly fill the subantral hollow spaces. Biopsy specimens of the experimental sites from six animals in each group were obtained 2, 4, and 8 weeks after the surgery. The integrity of the sinus mucosa was clinically evaluated during surgery using a ×2.5 magnifying visual device. The sinus mucosa in contact with the biomaterial granules was found to be thinned compared with the pristine mucosa in all periods examined. Three hundred fifty-two thinned zones were found considering all 36 sinuses treated. Perforations of the sinus mucosa with extrusion of granules toward the sinus were observed, increasing in number over time. In the 8-week healing period, five perforations in three sinuses and eight perforations in four sinuses were found in the large and small groups, respectively. No differences were seen between the large and small groups. The differences between 2 and 8 weeks were statistically significant for the thinned mucosa width in both the large and the small groups and for the number of sinuses and perforations for the small group. Thinning zones and perforations of the sinus mucosa were seen increasing in number over time in regions in contact with graft granules in both the large and small groups.

Autotransplantation of third molar for oro-antral communication closure: evidence of sinus elevation after healing.

Oro-antral communication is a complication due to the extraction of the posterior teeth of the upper arch. Small lesions are able to spontaneously close, but larger diameter lesions require a surgical treatment. A compromised upper first molar had to be extract determining an oro-antral communication (OAC). Several techniques have been described for the management of OACs, but none of these techniques guarantees bone healing or immediate rehabilitation. In the case of the present report an autotransplantation of the ipsilateral third molar was performed for closing the communication and rehabilitate the extracted tooth. The transplantation of the third molar determined the immediate closure of the oroantral communication without resorting to more invasive surgical procedures. The 1,5 years follow up showed the bone healing and the complete oro-antral communication closure. During healing, the palatal root, that was invading the sinus, caused a vertical bone augmentation making a sinus lifting. When a donor tooth is available, the autogenous transplantation could be used to manage the closure of oro-antral communication due to its high regenerative potential.

Zygomatic Implant: State of the Art

&#x0D; Introduction: In the dental implant scenario, the rehabilitation of the maxilla severely reabsorbed with endosseous implants remains a challenge. There are less aggressive alternatives, including short implants, inclined implants, and especially zygomatic (ZI) implants. In cases where the height and width of the residual bone do not allow the placement of conventional dental implants, the ZI can be considered. Objective: Conducted a concise systematic review to analyze the main literary findings on the use of the zygomatic implant as an important alternative for a dental implant, to present the state of the art to the dental community. Methods: The present study followed a concise systematic review model. The search was carried out in the PubMed, Embase, Ovid, Cochrane Library, Web Of Science, and Scopus databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: Zygomatic implants appear to be a consolidated therapeutic option for significantly atrophic maxilla, offering a promising alternative to costly heavy bone graft techniques, fewer complications, less time for rehabilitation, less required prosthodontic work, and significantly higher survival rates. Thus, the zygomatic implant is revolutionizing the implant procedure in the posterior atrophic maxilla, eliminating the complications of bone augmentation and sinus elevation, with delayed healing, showing better clinical results compared to the bone graft, pointing to a possible gold standard for a dental implant.&#x0D;

Different techniques in transalveolar maxillary sinus elevation: A literature review.

Dental implant treatment in the posterior maxilla encounters bone quality and quantity problems. Sinus elevation is a predictable technique to overcome height deficiency in this area. Transalveolar sinus elevation is a technique that is less invasive and less time-consuming, first introduced for ridges with at least 5 mm of bone height. Many modifications and innovative equipment have been introduced for this technique. This review aimed to explain the modifications of this technique with their indications and benefits.An exhaustive search in PubMed Central and Scopus electronic databases was performed until December 2020. Articles were selected that introduced new techniques for the transalveolar maxillary sinus approach that had clinical cases with full texts available in the English language. Finally, twenty-six articles were included. The data were categorized and discussed in five groups, including expansion-based techniques, drill-based techniques, hydraulic pressure techniques, piezoelectric surgery, and balloon techniques. The operator’s choice for transalveolar approach techniques for sinus floor elevation can be based on the clinician’s skill, bone volume, and access to equipment. If possible, a technique with simultaneous implant placement should be preferred.

Clinical and Radiographic Evaluation of Modified Transalveolar Two-Step Osteotome-Mediated Localized Maxillary Sinus Elevation: A Retrospective Computed Tomography Study with a 3-Year Follow-up.

This study aimed to report a practicable and noninvasive two-stage technique for sinus elevation and delayed implant insertion in the augmented site with residual bone height down to 3 mm or even lower. The surgical technique employed a two-stage process for rehabilitation of posterior maxillary single-tooth edentulous areas, involving, in the first step, transcrestal maxillary sinus floor augmentation with a collagen sponge to fill the intrabony cavity resulting from the detachment of the sinus membrane; the second step consisted of another indirect sinus floor elevation using magnetoelectric surgery with immediate implant placement and no grafting material. Changes in bone height were evaluated by a comparison of the computed tomography scans acquired before treatment and after surgery (at 3 months and 5 years of the survey). Statistically significant differences between the times and the tooth sites were evaluated by nonparametric statistics (matched and independent), with P < .01. Forty patients were retrospectively selected. The preoperative height of the available alveolar bone was 2.9 ± 0.6 mm. A significant increase in bone height (P < .01) was found for both the first and the second surgery (3.1 ± 0.6 mm and 4.4 ± 0.6 mm, respectively). The overall bone height was measured at 3 years after the first surgery (10.3 ± 0.6 mm). Measurements of the bone height ranked for tooth positions showed no significant difference between premolars and molars. None of the selected patients registered an implant failure. Two-stage osteotome-mediated sinus elevation appeared to be a predictable technique that enabled practitioners to increase the bone height and to obtain successful outcomes even if the amount of bone was approximately 3 mm in height.

Patient-Related Risk Factors for Maxillary Sinus Augmentation Procedures: A Systematic Literature Review.

The posterior maxilla has traditionally presented a challenge for successful placement of dental implants due to a combination of poor bone quality, ridge atrophy, and pneumatization of the sinus floor following tooth extraction. However, with the successful and predictable surgical outcomes reported in the literature, more clinicians and patients are choosing an implant-supported restoration in the edentulous posterior maxilla. Consequently, sinus elevation and augmentation have gained more popularity. Extensive research has been conducted on types of bone graft materials and implants, less-invasive techniques to perform sinus augmentation, and timing for implant placement for sinus grafting. Despite the predictability of the techniques and biomaterials employed in sinus grafting procedures, intra- and postoperative complications are common. Much of the current literature discusses the local risk factors related to sinus augmentation, with few studies focusing on the patient-related risk factors. The purpose of this review is to identify, evaluate, and discuss the possible management of patient-related risk factors to allow for more predictable maxillary sinus floor augmentation outcomes.

Short (6 mm) and Regular Dental Implants in the Posterior Maxilla-7-Years Follow-up Study.

Short 6 mm dental implants are considered as an alternative to the maxillary sinus elevation and bone augmentation procedure where there is a reduced alveolar ridge height. The aim of this study was to compare the implant survival rate between short dental implants (6 mm) and regular length implants (11–13 mm) when placed in combination with bone grafting and loaded with a single non splinted crown, seven years after placing the implant. It was conducted as a controlled clinical study of 30 patients with partial edentulism in the posterior maxilla. The protocol included radiological and clinical evaluation of the C/I ratio (length of the superstructure divided by the length of the implant crestal part), marginal bone level (MBL), ultrasonography measurement of soft tissue surrounding implant (STT), patient-reported outcomes, and biological and technical complications. A total number of 28 implants (93%) remained integrated during follow-up period. MBL of 0.50 and 0.52 mm was observed for short implants and regular implants, respectively. MBL was checked for correlation with STT, and a negative correlation was found between MBL: STT. Our study has demonstrated a significantly lower implant survival rate for short implants compared to regular implants (87% compared to 100%). Despite the loss of several implants, good clinical results were achieved in the remaining implants in both groups. It is, therefore, worth considering short implants as an alternative to regular implants with a sinus lift surgery.

Alveolar Ridge Preservation on Maxillary Molars Using Solvent Dehydrated Bone Allograft and d-PTFE Membrane: A CBCT and Histologic Human Pilot Study.

The purpose of this study was to evaluate vertical and horizontal alveolar resorption after the extraction of eight single maxillary molars using solvent-dehydrated bone allograft (Puros) covered with a nonresorbable membrane for ridge preservation. At implant placement 4 months later, ridge dimensions were measured clinically and radiographically and compared to baseline, and a histologic analysis was performed. The mean buccal height decreased by 1.51 mm at midpoint, 0.88 mm mesially, and 1.16 mm distally. The implants were placed without additional ridge augmentation, and six of eight required an internal sinus elevation. Within the limits of this study, this technique succeeded in preserving the alveolar bone.

Patient-reported outcomes and complication rates after lateral maxillary sinus floor elevation: a prospective study

ObjectivesOral surgery morbidity is highly variable based on patients’ characteristics and kind of surgical intervention. However, poor data are available in the literature regarding patient outcomes after oral surgery. The aim of this retrospective study was to evaluate patient-reported outcome and complication rates after maxillary sinus floor elevation.Materials and methodsData from the records of patients undergoing maxillary sinus elevation have been collected from a private dental office. Patient-reported outcome has been assessed using a 100-mm visual analog scale to evaluate the post-operative pain (VASpain) experienced in the first week following surgery and visual rating scales to evaluate discomfort level (VRSdiscomfort: 0 to 4) and willingness to repeat the same surgical procedure (VRSwillingness: 0 to 3). Analgesics intake, swelling onset and duration, and ecchymosis have been also recorded.ResultsVASpain showed moderate values in the first 2 days (< 50) post-surgery, with a tendency to progressively decrease over the next 2 days. Average assumption of painkillers was 3.93 ± 3.03. Discomfort level (VRSdiscomfort) after surgery was low (median: 1; IR: 1–0), while willingness to undergo the same surgical procedure was very high (77.63% of patients). Swelling and ecchymosis were experienced by 97.36% and 51.32% of patients, respectively, with a mean duration of 4.09 ± 1.43 and 2.21 ± 2.31 days, respectively. Membrane perforation occurred in 4 cases. Other post-operative complications were not observed.ConclusionsMaxillary sinus grafting is a safe procedure, with a low complication rate and moderate morbidity that is well tolerated by patients. Particular attention is needed in case selection, surgical planning and operator expertise.Clinical relevanceThe analysis of patient-reported outcomes can be of great help in surgical planning and in providing correct and adequate treatment.