Sinus Elevation Research Articles

Management of an implant projected into the maxillary sinus associated with chronic sinusitis: A case report

An x-ray examination allowed the implant to be visualized and the amount of bone to be assessed at the site of the implant placement. Maxillary implants may have close relationships with the maxillary sinus. A preliminary X-ray examination of the implant site was used to assess the quality and quantity of bone and to assess the proximity of the sinuses. The authors report the extraction of a dental implant projected into the left maxillary sinus, associated with chronic sinusitis in a 65-year-old patient who did not previously receive sinus lift. An orthopantogram was used to visualize the cylindrical implant in an upright position in a very prominent sinus. With the maxillary scanner, the implant was located with more precision in 3D, surrounded by a frame image representing the purulent collection. The extraction of the implant projected into the sinus by a simple technique under local anesthesia was decided. A control orthopaontogram showed the emptiness of the sinus cavity. The surgical suites were simple. Elimination of an enlarged crestal intra sinusal implant should be undertaken first-line in oral surgery as it is simple and less invasive. To prevent these incidents, short implants or sinus elevation technique are alternatives for prominent bone and/or sinus deficits visualized through 3D imaging. Keywords: Implant projection, Maxillary sinus, Chronic sinusitis.

Minimally Invasive Sinus Membrane Elevation Techniques: A Literature Review

Sinus augmentation surgery has become a well-accepted pre-prosthetic procedure for placement of endo-osseous implants in compromised posterior edentulous maxilla. Various procedures for bone augmentation have been used to achieve sufficient bone volume for dental implants with the lateral and crystal surgical approaches being the most common. But these bone augmentation methods, including the conventional lateral maxillary approach and sinus elevation by osteotome, have several limitations. Sinus membrane perforation is one of the most common complications of the sinus lift procedure. Thus, to overcome these limitations various minimally invasive techniques have been introduced. These techniques cause minimal postoperative pain, faster recovery and are more economical due to shorter remission period. Hence, the aim of this review article is to discuss the various minimally invasive maxillary sinus floor elevation techniques introduced.

Histologic and histomorphometric analysis of two biomaterials of xenogenous origin for maxillary sinus elevation: a clinical study.

Objective: This study analyzed two xenogenous biomaterials based on deproteinized bovine bone mineral applied for maxillary sinus elevation. Method and materials: Fourteen patients were submitted to maxillary sinus augmentation with one of the following biomaterials: Criteria Lumina Bone Porous (test group) or Geistlich Bio-Oss (control group), both of large granules (1 to 2 mm). After 6 months, trephine biopsies were collected at the time of implant placement: 27 samples (11 patients) in the test group; 7 samples (3 patients) in the control group. Biopsies were analyzed by descriptive histology and histomorphometry, in which the percentages of newly formed bone, residual biomaterial particles, and connective tissue were evaluated. Results: Histomorphometry showed means for test and control groups, respectively, of 32.41% ± 9.42% and 26.59% ± 4.88% for newly formed bone, 22.89% ± 4.58% and 25.00% ± 4.81% for residual biomaterial, and 44.70% ± 9.54% and 48.41% ± 3.36% for connective tissue. There were no differences between groups (P > .05). Conclusion: This study concluded that Criteria Lumina Bone Porous presented similar histologic and histomorphometric characteristics to Geistlich Bio-Oss 6 months after sinus elevation surgery, identifying the tested biomaterial as an interesting alternative for bone augmentation in the maxillary sinus.

THE EFFECT OF PLATELET RICH FIBRIN ( PRF) VERSUS XENOGRAFT IN CLOSED SINUS LIFT WITH IMPLANT PLACEMENT ON IMPLANT STABILITY IN MAXILLARY POSTERIOR AREA Randomized Clinical Trial

Aim of the study: The aim of this study is to compare the effect of PRF versus xenograft on implant primary stability after closed sinus elevation in the maxillary posterior area . MATERIAL AND METHODS: Patients were divided in to two equal groups: Group A: closed sinus lifting by Osteotome using PRF as grafting material with implant placement in 8 partially edentulous patients. Group B: Closed sinus lifting by osteotome using xenograft as a grafting material with implant placement in 8 partially edentulous patients. After implant placement, Smart peg was placed on implant and Ostell is used to record ISQ. Implant stability was measured intraoperative and at week 2, 4, 6, 8 and 10 for both groups. The collected results were tabulated and statistically analyzed. Results: The study results showed that there was no statistically significant difference between (PRF) and (Xenograft) groups in ISQ reading. Conclusion: Maxillary sinus elevation by osteotome technique and using PRF or xenograft as a grafting material is a predictable and effective procedure for correcting limited bone resorption in posterior areas of the maxilla.

Histological and Histomorphometric Analyses after Sinus Floor Augmentation with Different Grafting Materials

Homogeneous grafts from a bone bank, heterogeneous grafts and allow plastic grafts have already been studied and used for maxillary sinus elevation in order to reconstruct the bone for placement of dental implants. The present work aims to histologically assess bone neoformation from autogenous and heterogeneous (or xenogenous) bone grafts, in maxillary sinus lift surgery, an invasive technique. Six patients (total of 10 elevated maxillary sinuses) participated in the study with an alveolar bone remnant in the posterior region of the maxilla, less than 5mm, classification by Misch SA-4, evidenced through panoramic radiography. After a waiting period of tissue repair of 8 months, samples were collected and microscopic analysis was performed in 3 groups: autogenous group, Bio-Oss® group and Endobon® group. It was observed that the autogenous group has a statistically higher amount of bone matrix when compared to the other 2 groups. These did not differ from each other. The three types of grafts used promoted the expected new bone formation. Thus, one can choose any of the grafts evaluated to enable the installation of Osseointegrated implants and prosthetic rehabilitation in patients with the atrophic posterior maxilla.

Levantamento de seio maxilar bilateral por duas técnicas diferentes com concomitante instalação de implantes: relato de caso

Esse artigo buscou demonstrar, através de um relato de caso clínico, a abordagem de levantamento de seio maxilar bilateral por duas diferentes técnicas, uma traumática via janela lateral e uma atraumática através da crista óssea, associadas à instalação de implantes osseointegrados. Paciente com 75 anos, gênero feminino procurou atendimento na clínica do Curso de Extensão em Implantodontia em uma universidade do Rio de Janeiro com quadro álgico em região de molares superiores. Após anamnese, exame clínico e análise da tomografia computadorizada, evidenciou-se extensa lesão de furca nos elementos 16 e 26, sendo indicada exodontia e reabilitação com implantes oseeointegrados. Ainda, devido à pouca altura óssea subantral, o levantamento de seio maxilar bilateral foi incluído ao plano de tratamento. No lado direito, foi realizada a técnica de Summers e no lado esquerdo a técnica da janela lateral associada ao uso de biomaterial sintético particulado e membrana de colágeno reabsorvível. A radiografia panorâmica de controle pós-cirúrgico demostrou o êxito das duas técnicas com adequada relação anatômica do enxerto e de ambosmplantes ao leito receptor. Assim, a cirurgia de elevação do seio maxilar com a concomitante instalação de implantes se mostrou um procedimento seguro, de boa previsibilidade e baixa taxa de complicações.

Uso de hidroxiapatita como recubrimiento en odontología. Una revisión breve.

Desde principios del siglo XX la ingeniería de los tejidos ha desarrollado múltiples estudios relacionados como respuesta a la búsqueda de biomateriales similares al tejido óseo, intentando encontrar solución a los fracasos de implantación. Dentro de los biomateriales más importantes y con mayor sustento científico que existe, se encuentra la hidroxiapatita (HA). El objetivo de este artículo es revisar conceptos básicos y la evidencia en torno al uso de HA en odontología. La aplicación clínica de HA ha mostrado excelentes resultados, en ambientes tanto in vitro como in vivo, convirtiéndose en una excelente alternativa como coadyuvante en la cicatrización, mostrando óptimos resultados respecto a la calidad ósea, para terapias periodontales, elevaciones de seno o rehabilitaciones sobre implante.El objetivo de este artículo es revisar conceptos básicos y evidencia en torno al uso de HA como recubrimiento en odontología.

Factors influencing the prevalence of peri-implantitis in implants inserted in augmented maxillary sinuses: A multicenter cross-sectional study.

Peri-implantitis is widely recognized as a major cause of late implant failure, both in pristine and regenerated bone. The present study aims to evaluate the prevalence of peri-implantitis in implants inserted in augmented maxillary sinuses and to analyze possible risk factors. A cross-sectional study was conducted in four centers including patients who underwent lateral or transcrestal sinus augmentation and received dental implants. Clinical and anamnestic data were collected using a standardized form. Univariate and multivariate logistic regression analyses have been performed for both implant-level and patient-level variables. Subsequently, a multilevel logistic mixed-effect model was built to analyze variables correlated with the occurrence of peri-implantitis. A total of 156 patients (61 males and 95 females; mean age: 60.9 ± 11.6 years) with 315 implants inserted into augmented maxillary sinuses with a follow-up ranging from 1 to 18 years were evaluated. Seven implants in seven patients were previously lost for peri-implantitis (2.2% and 4.5% at implant- and patient-level, respectively); 250 implants showed no signs of peri-implant diseases (79.4%), 34 implants presented mucositis (10.8%), and 24 implants exhibited peri-implantitis (7.6%). Corresponding data evaluated at patient-level were 125 (80.1%), 17 (10.9%), and 14 (9.0%), respectively. At the multilevel analysis, history of periodontitis, sinus elevation with lateral approach, and one-stage sinus floor elevation significantly correlated with the occurrence of peri-implantitis (P<0.001). History of periodontitis confirmed its well-known role as a risk factor for peri-implant pathologies. In addition, both lateral window technique and one-stage sinus floor elevation seemed to represent significant risk factors for peri-implantitis.

Retrospective study on transcrestal sinus floor elevation with simultaneous implantation of short implants

To explore the changes in bone height of the maxillary sinus floor at different sinus ridge heights after transcrestal sinus floor elevation (tSFE) with the simultaneous implantation of short implants. A total of 74 Bicon short implants were implanted into 37 patients during the same period of maxillary sinus elevation. The residual bone height (RBH)<4 mm group has 43 sites, and the RBH≥4 mm group has 31 sites. After 5 years of follow-up observation, the implant survival rate and the change in bone height achieved in the maxillary sinus over time were measured and analyzed via clinical examination and X-ray imaging. In the 74 implantation sites, the elevation height of the sinus floor was (6.64±1.32) mm and the bone height of the sinus floor was (3.35±1.29) mm 5 years after loading. No statistical difference was observed in the bone resorption of the implant neck between the RBH<4 mm and RBH≥4 mm groups. Meanwhile, a statistical difference was noted in the bone height obtained in the maxillary sinus between the two groups. When RBH in the maxillary posterior tooth area was <4 mm, the simultaneous implantation of Bicon short implants with tSFE can achieve a high implant survival rate and bone gain in the maxillary sinus, but does not increase the absorption of the alveolar ridge bone.

Histological and Histomorphometric Evaluation of Applying a Bioactive Advanced Platelet-Rich Fibrin to a Perforated Schneiderian Membrane in a Maxillary Sinus Elevation Model.

BackgroundSchneiderian membrane (SM) perforation is a major complication of maxillary sinus elevation with simultaneous bone grafting, yet under this scenario there is no standard biomaterial that maximizes favorable tissue healing and osteogenic effects.PurposeTo compare the effect of advanced platelet-rich fibrin (A-PRF) and collagen membrane (CM) on a perforated SM with simultaneous bone grafting in a maxillary sinus elevation model.Materials and MethodsAfter perforation of the SM was established, 24 animals were randomly divided into two groups: (i) group CM: CM and deproteinized bovine bone mineral (DBBM) (n = 12), (ii) group A-PRF: A-PRF and DBBM (n = 12). Radiographic and histological evaluations were performed at 1 and 4 weeks post-operation.ResultsAt 1 week, an intact SM was found in group A-PRF. At each time point, the number of inflammatory cells at the perforated site was higher in group CM, and the area of new osteoid formation was significantly greater in group A-PRF (p < 0.0001). At 4 weeks, the osteogenic pattern was shown as from the periphery to the center of the sinus cavity in group A-PRF.ConclusionThe higher elasticity, matching degradability, and plentiful growth factors of A-PRF resulted in a fully repaired SM, which later ensured the two osteogenic sources from the SM to generate significant new bone formation. Thus, A-PRF can be considered to be a useful bioactive tissue-healing biomaterial for SM perforation with simultaneous bone grafting.

Application of two-stage crestal approach sinus elevation in severe atrophic posterior maxilla

Objective: To investigate the feasibility of two-stage crestal approach sinus elevation in severe atrophic maxilla. Methods: A total of 25 patients (male: 13 cases,female: 12 cases) who attended Department of Implant Center, Stomatological Hospital, Southern Medical University from May 2016 to May 2018 were included in this study. The age of the patients was 32-49 years old. The inclusion criteria were: single or multiple tooth loss in posterior maxilla with residual bone height ranged from 1.5 to 3.0 mm and vertical bone width≥6 mm, no pathological changes or septum were detected in the sinus. The elevated sides were divided into three groups according to different buccal-palatal sinus width (SW): wide (16 case, SW＞15 mm), normal (12 case, 12 mm≤SW≤15 mm), narrow (5 case, SW<12 mm). Finally, 23 patients with 33 implants were placed by the two-stage crestal approach for sinus elevation. Six months after implant placement, final restorations were delivered. Implant survival rate, implant stability quotient (ISQ), immediate vertical bone height (VBH) after surgeries, changes of sinus elevation height (cSEH), marginal bone loss (MBL) at 1 year follow-up were examined. Results: Twenty-three patients were finally included in the study, including 12 males and 11 females, aged (41.2±7.6) years old. All implants healed uneventfully. ISQ (wide: 50.81±2.69; normal: 60.58±2.54; narrow: 63.12±3.58), immediate VBH after 1st surgery [wide: (7.99±1.13) mm; normal: (8.95±0.81) mm; narrow: (9.18±0.90) mm] and 2nd surgery [wide: (11.46±0.88) mm; normal: (12.77±0.49) mm; narrow: (12.57±0.55) mm], cSEH six months after 1st [wide: (3.87±0.43) mm; normal: (2.01±0.65) mm; narrow: (1.49±0.33) mm] and 2nd [wide: (1.16±0.29) mm; normal: (1.04±0.33) mm ; narrow: (0.97±0.41) mm] surgery, MBL [wide: (0.91±0.05) mm; normal: (0.79±0.10) mm; narrow: (0.74±0.07) mm] were significantly different among three groups (P<0.05). In all the three groups, cSEH was barely detected at 1-year follow-up (P>0.05). Conclusions: Two-stage crestal approach for sinus elevation might be an alternative protocol in severe atrophic posterior maxilla, especially in cases with narrow and normal buccal-palatal width. There is an urgent need for long time follow-up and more clinical cases.

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

Background 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. Methods 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. Results 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. Conclusions 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.

A Histomorphometric meta-analysis of sinus elevation with various grafting materials

Several grafting materials have been used in the sinus floor augmentation procedures including autogenous bone(AB), Xenograft (Bio-Oss), inorganic bovine bone (ABB), platelet rich fibrin (PRF) , plasma rich fibrin (PRF), hydroxy appatite (HA), calcium sulfate and pegen P15 used AB as a comparator and the other six materials as interventions. Up to now a subject of controversy in maxillofacial surgery and dentistry is what is the most appropriate graft material for sinus floor augmentation. Materials and Methods: The literature searches were performed using PubMed search. The search covers only English, human and RCT literatures. For analyzing the quality and quantity of bone. After search strategy on PubMed we found 336 articles then after applying the inclusion and exclusion criteria the remaining RCT articles which met the criteria are 2 studies, which measures the bone quality only by Histomorphometric and no included RCT paper using CBCT. Results: In the remaining 2 articles the comparison occur between 2 materials which are autogenous bone and Bio-Oss using Histomorphometric analysis on 48 patients, which gives result in the first study AB=37.7 ± 31.3%, Bio-Oss=41.7 ± 26.6% and in the second study AB=42.74 ± 2.10%, Bio-Oss=24.90 ± 5.76%. Conclusion: The bone quality formed by Bio-Oss is less than autogenous bone by 17.1% so that the autogenous bone remains the gold standard grafting material.

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.

Bone augmentation by replica-based bone formation

ObjectiveThe sources of iliac crest bone grafts are limited. Alternatives are evaluated due to the progress in biomaterial sciences. Synthetical hydroxyapatite (HA), ß-tricalcium phosphate (ß-TCP) or biphasic compounds, or even a mélange of HA and ß-TCP will replace bovine ceramics. The goal is maintenance of replica-based-bone formation (RBBF) for bone augmentation. Methods2 female and 2 male patients between 41 and 73 years with 5 sinus elevations were evaluated. Sinus elevations with lateral fenestration, trapezoidal-muco-periosteal flaps and filling with micro-chambered beads (1.5 mm) was performed. A porcine-collagenous membrane and the refixated flap covered the defect. A biopsy program over 20 months was confirm confirm the maintenance of the newly formed bone. ResultsA fast bone formation was pronounced. The biopsies revealed mature lamellar bone and full osseointegration of the ß-TCP implant. The biopsy after 20 months showed compact bone with osseointegration of minor rests of the ceramic implant. The defect revealed a mature bone stock already after 5 weeks. SignificanceThe introduction of the replica-based-bone formation (RBBF) around micro-chambered beads will change the paradigm of bone augmentation. The next step of the ongoing study has to redefine the interval for implant insertion.The clinical approach confirms the breakthrough to primary mature lamellar bone formation and will permit reduction of placement time for a dental implant.

Lateral Window Design for Maxillary Sinus Graft Based on the Implant Position.

The purpose of this study was to devise a classification and lateral window design method based on implants and to evaluate whether these classifications and methods are applicable to clinical practice. When applying the maxillary sinus elevation technique using the lateral window, possible situations were classified into four: (A) two or more sites for implants are required for maxillary sinus augmentation, (B) a single implant is required when there are no adjacent teeth, (C) a single implant is required when one adjacent tooth is present at the mesial or distal area, and (D) a single implant is required when both mesial and distal adjacent teeth are present. In order to verify whether this classification can be used in all situations, 76 patients who underwent maxillary sinus elevation with a lateral window were selected and investigated. Of them, 47 (62%) were included in Group A, 9 (12%) in Group B, 8 (11%) in Group C, and 12 (15%) in Group D. Lateral window designing in the lateral approach of sinus augmentation can be classified into four clinical situations. There were no unclassified cases. This classification and window positioning method can be applied to most cases.

Sinus membrane elevation and implant placement.

Sinus Schneiderian membrane elevation surgery is widely performed for dental implant placement in the maxillary posterior region. With regard to sinus elevation surgery, various complications can occur and lead to implant failure. For successful implants in the maxillary posterior region, the clinician must be well acquainted with sinus anatomy and pathology, a variety of bone graft materials, the principles of sinus elevation surgery, and prevention and management of complications.

Wire loop sinus membrane elevator: a novel instrument for lateral window sinus lift

This technical note introduces a novel instrument to facilitate lateral window sinus membrane elevation. The fabrication and use of the instrument are reported. The features of this instrument include easy control, good tactile sensation, flexibility in adjusting the instrument, and simple to replicate. Since its introduction, it has been the preferred instrument of our implant surgical trainees. Most importantly, it has proved to be an invaluable teaching tool, as it has helped not only to boost trainee confidence in the procedure, but also in their use of other sinus elevation instruments.

Histologic and Micro-CT Analyses at Implants Placed Immediately After Maxillary Sinus Elevation Using Large or Small Xenograft Granules: An Experimental Study in Rabbits.

To compare the osseointegration at the portion of the implant within the elevated space after sinus elevation using different sizes of xenograft. Eighteen New Zealand rabbits were selected, antrostomies were prepared bilaterally through the nasal dorsum, and the sinus mucosa was elevated. Deproteinized bovine bone mineral with granules of either 1 to 2 mm (large sites) or 0.250 to 1.0 mm (small sites) were randomly used to fill the elevated space of the two sinuses. Subsequently, mini-implants were placed through the antrostomy, one in each sinus. The animals were euthanized 2, 4, and 8 weeks after surgery, six animals for each group. Microcomputed tomography (micro-CT) and histologic analyses were performed. In the elevated space, at the histologic analysis after 2 weeks of healing, new bone formed on the implant surface was found in fractions of 18.8% ± 6.8% and 15.8% ± 9.6% in the large and small sites, respectively (P = .249). After 4 weeks, the respective fractions of new bone were 20.3% ± 3.5% and 23.3% ± 5.6% (P = .249). After 8 weeks, the proportions reached 33.9% ± 9.5% and 28.5% ± 10.3% (P = .173), respectively. At the micro-CT analysis, bone-to-implant contact percentage (BIC%) was 21.0% ± 2.3% and 21.2% ± 2.4% in the large and small sites, respectively (P = 1.000). The respective proportions of BIC% at the large and small sites were 20.5% ± 3.3% and 23.4% ± 5.4% after 4 weeks (P = .463), and 23.0% ± 2.7% and 25.8% ± 4.1% after 8 weeks (P = .249). The use of xenograft granules of different dimensions resulted in similar amounts of bone-to-implant contact at implants placed simultaneously with sinus floor augmentation.

Graftless Maxillary Sinus Floor Augmentation with Simultaneous Porcine Bone Layer Insertion: A 1- to 5-Year Follow-up Study.

Evidence suggests that maxillary sinus floor augmentation via a lateral approach can be performed without positioning a bone graft inside, when one or more implants can be placed simultaneously. The aim of this study was to test if the placement of a porcine cortical bone layer underneath the sinus membrane can increase bone formation and implant stability. One hundred seventy-two patients with posterior maxilla atrophy needing implant rehabilitation were selected. Two hundred six sinus augmentation procedures were performed via a lateral approach, and 295 implants were placed in the same session of the sinus elevation surgery. In all the surgeries, a porcine cortical bone layer was placed underneath the sinus membrane, without using any graft material. After 6 to 7 months of healing, the implants were uncovered, then restored with porcelain-fused-to-metal crowns and monitored with a followup of 1 to 5 years. The implant cumulative success rate was 95.2%, while the residual bone crest height changed from 2.67 ± 1.11 mm to 12.54 ± 1.42 mm, with an increase of 9.87 mm on average. Marginal bone resorption was 0.83 mm on average after 1 year of loading, while the mean implant stability measured at the moment of implant placement and 6 to 7 months later increased from an implant stability quotient (ISQ) of 62.61 ± 5.7 to an ISQ of 70.07 ± 8.2. This study confirms the validity of the graftless sinus elevation surgery when simultaneous implant placement is performed. The use of a porcine cortical bone layer seems to increase, from a radiologic point of view, the amount of bone around the implants, reducing healing time, cost, and biologic complications for the patient.