Sinus Floor Augmentation Procedures Research Articles

The Use of CAD-CAM Templates in Lateral Sinus Floor Augmentation Procedure: A Systematic Review.

Maxillary sinus floor augmentation is a procedure known for its long-term success and predictable outcomes. However, the perforation of the Schneiderian membrane remains the most common complication associated with this procedure. This systematic review aims to determine the presence of complications during maxillary sinus floor augmentation procedures using CAD-CAM surgical templates. An electronic search was carried out in MEDLINE (via PubMed), Web of Science, and Scopus. A descriptive analysis of the data was performed. Studies that have performed lateral sinus floor augmentation were included in the inclusion criteria. The CAD-CAM surgical template design and the intraoperative complications were registered. A total of 13 studies were included. Seven were case reports, four were case series, and two were randomized clinical trials. A total of 94 lateral SFA procedures were included (84 using CADCAM templates and 10 without using templates). Three of the 84 maxillary sinus floor augmentation procedures using a CAD-CAM template presented intraoperative complications. Maxillary sinus floor augmentation performed by using CAD-CAM surgical templates could be related to low rates of complications, however, due to the heterogeneity of the articles included, more standardized studies are needed to confirm these outcomes.

Bone-Regenerative Ability of Platelet-Rich Plasma Following Sinus Augmentation with Anorganic Bovine Bone: A Systematic Review with Meta-Analysis.

Background: The objective of this systematic review is to assess the effect of the adjuvant use of platelet-rich plasma (PRP) and its type on new bone formation by anorganic bovine bone during maxillary sinus floor augmentation procedure. Methods: PubMed, Cochrane Central Register of Controlled Trials, and Ovid databases were searched for relevant studies published up to 16 September 2021. Randomized clinical trials (RCTs) and non-randomized controlled clinical trials (CCTs) that reported data on the new bone formation (measured by histomorphometric analysis) were considered. Risk of bias and quality assessment of included studies were evaluated following the Cochrane Handbook for Systematic Reviews of Interventions and the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool. Strength of evidence was assessed following the approach of the Agency for Healthcare Research and Quality (AHRQ) through its evidence-based practice center (AHRQ EPC). The meta-analysis was based on the primary outcome of newly formed bone, for which the standard mean difference was calculated. Results: After the application of eligibility criteria, six clinical trials (three RCTs and three CCTs) covering 85 maxillary sinus floor elevation procedures were included. The pooled new bone formation value for PRP was 1.67 (95% CI: −0.15 to 3.49; I2: 86%), indicating the absence of significant effect. Plasma rich in growth factors (PRGF) was the pure PRP tested in five of the included studies. When sub-group (type of PRP) meta-analysis was performed, significantly higher new bone formation was observed in the PRGF group [2.85 (95% CI: 0.07 to 5.64; I2: 88%)] in comparison to the control group. Conclusions: A beneficial effect on new bone formation after maxillary sinus floor elevation can be obtained when anorganic bovine bone is mixed with PRGF.

The Relation between Morphology of Maxillary Sinus after Augmentation in Three Classification Methods and Residual Bone Height: A Retrospective Study.

Maxillary sinus augmentation is critical to oral implantology, particularly in some cases. The morphology of the sinus floor reflects the lifting effect to a certain extent; however, there has been limited research on the morphology after sinus augmentation. The present study aims to investigate the relationship between residual bone height (RBH) and the morphology of the sinus floor and determine whether a correlation exists between the different evaluation classifications. Maxillary sinus floor augmentation procedures were performed in 56 patients and 68 teeth using the sinus crest approach (SCA). Imaging results obtained after one year of sinus augmentation were analyzed and simultaneously classified along the coronal plane, the sagittal plane, and the biplane (coronal-sagittal). The higher the RBH, the closer the result tends to be to A, A', or type 1 (more satisfactory). There was a significant correlation between the three different evaluation classifications (p < 0.05). The morphology of perforation cases was involved in types C, D, C', and D'. A more satisfactory post-lifting morphology (tent type and flat type) is probably related to an optimal preoperative bone height, and an unsatisfactory post-lifting morphology is related to a low preoperative sinus floor height. The sagittal plane evaluation correlates with the coronal plane and biplane evaluation and is thus more recommended.

Does a Severely Resorbed Subantral Ridge Decrease Long-Term Implant Survival Rate with Sinus Floor Augmentation?

To identify the impact of residual bone height on 5-year implant survival and prosthetic complication rates in patients who underwent maxillary sinus grafting. A total of 87 consecutive patients were treated with 104 lateral approach maxillary sinus floor augmentation procedures with 100% deproteinized bovine bone and received 169 implants. The analysis considered patient age, sex, time of implant placement, and residual bone height. Patients with < 3 mm residual bone height were assigned to the study group; otherwise, they were placed in the control group. The mean follow-up was 68.2 months (0 to 103 months). The mean residual bone height was 1.8 mm in the study group and 4.1 mm in the control group. The 5-year implant survival and prosthetic complication rates were, respectively, 97.4% and 8.0% in the study group and 100% and 12.5% in the control group. Residual bone height, sex, age, and time of implant placement were not significant factors for the 5-year implant survival or prosthetic complication rate. The lateral bone wall was significantly thinner in the study group. The grafted bone height reduction was significantly different at 6 months and 2 years postoperation in both groups, but there was no difference in the change in grafted bone height reduction over time between the two groups. A residual bone height < 3 mm did not impact the survival rates of implants placed in grafted maxillary sinuses or the prosthetic complication rate after 5 years of functional loading.

Short versus Standard Length Implants with Sinus Floor Elevation for the Atrophic Posterior Maxilla.

Objectivesthe aim of this clinical study was to compare clinical and radiological outcomes of short dental implants inserted in pristine bone to standard length implants inserted in combination with sinus floor elevation.Materials and methodsFor this clinical study, the clinical and radiological outcome of 126 short dental implants (84 patients), inserted in pristine bone were compared with 312 standard length implants (156 patients), placed in combination with maxillary sinus floor elevation procedures.ResultsThe short implant group (test group [TG]; mean follow-up (± standard deviation (SD) 56.6 ± 42.9 months) and the augmented group (control group [CG]; mean follow-up 41.6 ± 37.6 months) showed cumulative survival rates of 91.8% and 92.4%. Cumulative 5-year implant survival rates were 91.8% for the TG and 90.7% for the CG (p=0.421). Mean marginal bone loss was significantly higher in the CG than in the TG, with a mean MBL of 0.70 ± 0.72 mm in the TG and 0.96 ± 0.91 mm in the CG (p<0.001). A comparable and promising oral health-related quality of life (OHRQoL) was observed in the control and test groups.ConclusionsAfter over 3 years, short implants placed in the resorbed posterior maxilla obtained similar results to standard implants combined with maxillary sinus floor augmentation procedures.

Comparison of clinical and radiological outcomes using crestal approach sinus kit and piezoelectric surgery for sinus membrane elevation: A prospective clinical trial

To overcome the drawbacks of sinus floor augmentation procedures newer surgical techniques to reduce sinus perforation such as crestal approach sinus kit (CAS) and piezosurgery, which are minimally invasive procedures enabling uncomplicated sinus elevation have evolved. The aim of the present study was to investigate the performance of CAS kit compared to piezosurgery during maxillary sinus membrane elevation. A total of 40 subjects requiring maxillary sinus membrane augmentation for rehabilitation with implant prosthesis in posterior maxilla were included in the study. The current study was a prospective clinical trial where osteotomy and sinus elevation was done using CAS kit in Group 1 and piezosurgery in Group 2. Platelet-rich fibrin was placed in osteotomy site and dental implants were inserted. Implant stability was evaluated at baseline and 3 months. Crestal bone loss was measured at 3, 6, and 12 months. Apical bone gain was measured at 6 and 12 months. Intragroup comparison of the study groups was done by Paired t-test, ANOVA test, and Friedman test. Intergroup comparison was done by unpaired t-test and Mann-Whitney U-test. P < 0.05 was considered statistically significant. Implant stability improved in both the groups, i.e., 79.2 ± 5.02 and 79 ± 5.31 in Group 1 and Group 2, respectively, at 3 months. Intergroup comparison showed no difference in all parameters; however, crestal bone loss was greater in piezosurgery group with a mean difference of 0.74 mm. Both CAS and piezosurgery groups showed definitive improvement in all parameters. CAS group resulted in added benefits in terms of less crestal bone loss and intraoperative surgical time compared to piezosurgery group.

Histologic and Immunohistochemical Assessment of the Effect of Various Biomaterials on New Bone Formation in the Maxillary Sinus Floor Augmentation Procedure.

To assess the effect of different kinds of biomaterials placed with maxillary sinus floor augmentation (MSFA) on bone regeneration. Thirty-six New Zealand rabbits were used in the study. A standardized method of surgical approach was used for MSFA under anesthesia in all groups. The procedure was performed for each animal. Six separate groups with 12 cases were created. In group 1, no graft was used in MSFA. Advanced platelet-rich fibrin (A-PRF), absorbable collagen cone (ACC), venous blood, the combination of ACC and platelet-rich plasma (PRP), and the combination of ACC and enamel matrix derivative (EMD) were used in groups 2, 3, 4, 5, and 6, respectively. At the end of 4 and 12 weeks, three rabbits from each group were sacrificed by applying high-dose anesthetic, and samples were examined histologically and immunohistochemically. Groups 2 and 5 showed significantly increased new bone formation compared with groups 1 and 4, 4 weeks after MSFA (P < .05). Twelve weeks after sinus floor augmentation, groups 2, 3, 5, and 6 showed significantly higher new bone formation than group 1 (P < .05). Groups 2 and 5 showed significantly higher hard tissue response than groups 1 and 4 at the end of 4 weeks (P < .05). Groups 5 and 6 demonstrated significantly higher hard tissue response than group 1 at the end of 12 weeks (P < .05). Group 5 also showed significantly higher hard tissue response than group 4 at the end of 12 weeks (P < .05). Immunohistochemical analysis showed a significant difference between the osteocalcin scores of groups 2 and 4 and group 1 at the end of 4 and 12 weeks (P < .05). There was also a statistically significant difference between osteocalcin scores at 4 and 12 weeks for groups 1 and 5 (P < .05). When osteopontin scores were compared, there was no significant difference between groups at 4 and 12 weeks (P > .05). Groups 1, 2, and 5 showed significant changes in osteopontin scores between 4 and 12 weeks (P < .05). The combination of ACC and PRP and the combination of ACC and EMD showed increased new bone formation and hard tissue response. A-PRF also showed promising results in new bone formation at the end of both 4 and 12 weeks. The usage of ACC as a carrier for liquid-form biomaterials may be more beneficial than the usage of ACC alone.

Comparative Study of Deproteinized Bovine Bone Mineral and Bovine Bone Mineral Enriched with a Polymer and Gelatin in Maxillary Sinus Floor Elevation Procedures.

The aim of this histomorphometric study was to compare the outcome of sinus floor augmentation procedures using bovine bone mineral and a xenograft enriched with gelatin and a polymer. In 20 patients a single sinus floor elevation procedure with a lateral window approach was performed. In half of the patients, sinuses were grafted with a deproteinized bovine bone mineral-DBBM (control group)-while in the remaining 10, a xenograft enriched by polymer and gelatin-NBS (test group)-was applied. In the DBBM group, histomorphometric analysis revealed 23.14 ± 10.62% of lamellar bone, 19.43% ± 9.18% of woven bone, 23.35% ± 6.04% of osteoid, 17.16% ± 6.13% of biomaterial particles, and 16.93% ± 9.78% of medullary spaces. In the NBS group, histomorphometric analysis found 39.64% ± 12.02% of lamellar bone, 16.28% ± 7.75% of woven bone, 17.51% ± 4.87% of osteoid, 12.72% ± 5.36% of biomaterial particles, and 13.84% ± 6.53% of medullary spaces. Differences between groups for proportion of lamellar bone (P = .004) and osteoid (P = .0287) were statistically significant. Inflammatory infiltration was appreciated only in the NBS group. The enriched xenograft showed a statistically significant higher proportion of lamellar bone and osteoid; however, this was accompanied by an accentuated inflammatory infiltrate.

Two-Year Follow-Up of 4-mm-Long Implants Used as Distal Support of Full-Arch FDPs Compared to 10-mm Implants Installed after Sinus Floor Elevation. A Randomized Clinical Trial.

Background: In edentulous patients, bone resorption cannot allow the installation of standard implants and it is demanded to use short implants in the residual alveolar bone or longer implants in grafted bone. Aim: To compare the survival and bone level changes of standard plus short 4-mm implants used as distal support of a maxillary full-arch fixed dental prostheses (FDPs) with standard (10-mm) implants placed in association with a bilateral sinus floor augmentation procedure. Material and Methods: Full-arch FDPs supported by six implants were randomly placed in both groups. In the control group, all implants were 10 mm long and 4.1 mm in diameter. The distal implant in both sides of the maxilla was installed after 4 months from bilaterally sinus floor elevation. In the test group (short group), the distal implant in both sides of the maxilla was 4 mm long and 4.1 mm in diameter. No sinus floor elevations were performed in the test group. Clinical assessments and X-rays were taken at prosthesis delivering and after 6, 12, 18, and 24 months. Patient-reported outcome measures (PROMs) were also evaluated before surgery and after 6, 12, and 24 months. Results: The changes over time of the bone level for the short implants were −0.01 ± 0.11 mm, −0.04 ± 0.13 mm, −0.17 ± 0.29 mm, and −0.28 ± 0.37 mm after 6, 12, 18, and 24 months from prosthesis delivering, respectively. For the standard implants, bone changes were −0.21 ± 0.33 mm (p = 0.103), −0.30 ± 0.32 mm (p = 0.023), −0.40 ± 0.37 mm (p = 0.144), and −0.54 ± 0.49 mm (p = 0.128), respectively. A statistically relevant difference was found only at 12 months after loading between the two groups. Conclusions: Similar results on implant survival rate and marginal bone loss were observed for the short and standard implants, placed in association with a bilateral sinus floor augmentation procedure, used as distal support of a maxillary full-arch FDP. A statistically relevant difference was found only at 12 months after loading between the two groups (p = 0.023).

Sinus Floor Augmentation—Associated Surgical Ciliated Cysts: Case Series and a Systematic Review of the Literature

This study aimed to characterize the demographic and clinical features of underreported surgical ciliated cysts developing after sinus floor augmentation, based on a series of cases from our files and a systematic review of the literature. A series of five cases (four patients) of microscopically confirmed surgical ciliated cysts following sinus floor augmentation procedures from our files are described. A systematic literature search (1991–2020) with strict clinical-, radiological- and microscopic-based exclusion and inclusion criteria was performed to detect additional similar cases. The systematic review revealed only five cases that fulfilled the inclusion criteria. Altogether, surgical ciliated cysts associated with sinus floor augmentation have been rarely reported in the literature, and have not been characterized either demographically or clinically. Graft materials were diverse, implants were placed simultaneously, or up to two years post-augmentation. The associated surgical ciliated cysts developed between 0.5 and 10 years post-augmentation. Although limited in its extent, this study is the first series to characterize possible underreported sequelae of surgical ciliated cysts associated with sinus floor augmentation. It emphasizes the need for long post-operative follow-up and confirmation of lesion by microscopic examination.

The Influence of Residual Alveolar Bone Height on Graft Composition after Maxillary Sinus Augmentation Using Two Different Xenografts: A Histomorphometric Comparative Study.

Aim: To evaluate the hypothesis of a correlation between the preoperative residual alveolar bone height (RBH) and graft maturation after maxillary sinus floor augmentation procedures using two different bone substitutes. Methods: A total of 20 patients who underwent unilateral maxillary sinus floor augmentation with either mineralized deproteinized bovine bone (DBBM) or a xenograft enriched with polymer and gelatin (NBS) were included in this prospective study. Six months after sinus surgery, bone biopsies were harvested with a 3.2 mm diameter trephine bur, prior to dental implant placement. Histomorphometric analysis was performed, and the results were correlated with the individual RBH. Implants were loaded after 5 months of insertion, and 1-year implant success and marginal bone level change were assessed. Results: RBH was 2.17 ± 1.11 mm (range 0.5–3.5 mm) and 2.14 ± 0.72 mm (range 0.5–3.0 mm) in the NBS and DBBM group, respectively. The biopsy analyses for the DBBM group showed woven bone increases by 5.08% per 1-mm increment of RBH; medullary spaces decreased by 9.02%, osteoid decreased by 4.4%, residual biomaterial decreased by 0.34%, and lamellar bone increased by 5.68% per 1-mm increase of RBH. In the NBS group, samples showed woven bone increases by 8.08% per 1-mm increase of RBH; medullary spaces decreased by 0.38%; osteoid increased by 1.34%, residual biomaterial decreased by 0.58%, and lamellar bone decreased by 5.50% per 1-mm increase of RBH. There was no statistically significant difference in the correlation between RBH and lamellar bone, woven bone, and osteoid, independently of the material used. Implant success was 100% in both groups, and marginal bone loss was 1.02 ± 0.42 mm in DBBM and 0.95 ± 0.31 mm in the NBS group after the 1-year follow-up. Conclusion: In spite of the absence of significance, the observed trend for woven bone to increase and medullary spaces to decrease when RBH increases deserves attention. Residual bone dimension might be a determinant in the bone graft maturation after maxillary sinus augmentation.

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.

Maxillary Sinus Floor Elevation Surgery With BioOss Mixed With Enamel Matrix Derivative: A Human Randomized Controlled Clinical and Histologic Study.

Xenograft bone substitutes are commonly used to increase bone volume and height in the deficient posterior maxilla. The addition of enamel matrix derivate (Emdogain) could increase the efficiency of the bone healing process. The aim of this prospective randomized, controlled split-mouth design study was to compare the percentage of newly formed bone in sinus floor augmentation with deproteinized bovine bone mineral with or without the addition of enamel matrix derivative after 6 months of healing. Sixteen bilateral sinus floor augmentation procedures were performed. Deproteinized bovine bone mineral combined with enamel matrix derivative (test) and deproteinized bovine bone mineral alone (control) groups were randomly allocated within each patient. Six months after augmentation and concurrent to implant placement, bone biopsies were taken for histomorphometric analysis. Additionally, implant survival and peri-implant bone levels were radiographically assessed at baseline and 24 months after functional loading. Histomorphometric analysis revealed a significantly higher amount of newly formed bone in the test group compared with the control group (22.6% and 15.5%, respectively; P = .033). No significant differences in the amount of remaining graft or connective tissue was found. Enamel matrix derivative added to deproteinized bovine bone mineral particles significantly increased new bone formation in sinus lift procedures in edentulous or partially edentulous patients with deficient bilateral posterior alveolar ridges requiring augmentation for implant placement.

Flowable platelet rich fibrin a new trend for enhancing bone augmentation results in maxillary sinus floor augmentation. (Radiographic and histologic evaluation)

Flowable PRF enriched and vibrant bioactivity, simplified preparation, high healing potentials and easy incorporation with other biomaterials were the key aspects to stimulate the applications of flowable PRF in various medical fields. The current study aimed to evaluate if flowable PRF has superior bone augmentation properties over the conventional PRF in sinus floor augmentation procedures. In this study 18 maxillary sinuses were augmented, which were divided into 2 groups, group A maxillary sinuses were augmented using a mixture of xenograft bone substitute, group B maxillary sinuses were augmented using a mixture of xenograft bone substitute and flowable PRF. Results: Clinically flowable PRF showed ease of preparation and improved the handling and manipulation of the bone graft particles. Radiographic results showed that Group A average gained bone height of 10.4±1.2 mms while in group B mean gained bone height was 11.6±1.9 mms, bone densities results of both groups showed that bone density units of group A were 578 ± 56 Hounsfield Units(HU), while group B calculated augmented bone densities were 586.2 ± 68 HU. Histologic evaluation stated that group I and group II revealed a lot of similarities regarding the amount and the quality of the newly formed bone. There by concluding that flowable PRF resulted in similar results to that of the conventional PRF, however the ease of preparation, application and manipulation emphasizes its benefits and recommends its application.

Thyroid stimulating hormone receptor novel mutation results in familial hereditary hearing loss.

The aim of this study was to evaluate the efficiency of bovine and equine bone substitute materials used in sinus augmentation techniques. The research protocol was carried out using the PubMed database, including articles from October 2019 until February 2020 and those in English only. The search on PubMed (MED-LINE) was carried out with the following keywords: sinus augmentation OR sinus lift AND bovine bone graft OR equine bone matrix. The articles identified included randomised clinical trials, cross-sectional studies and case series. Outcomes were the percentage of newly formed bone, remaining graft particles and soft tissue in a follow-up at least of 5 months. The use of bovine bone graft (ABB) as a graft material in maxillary sinus elevation was evaluated in 9 studies. According to the quality assessment, 4 of the 9 studies were analysed and an arithmetic mean was performed showing the following results: newly formed bone (NFB 22.74%), residual grafts (RG 29.36%) and soft tissue percentage (SF 48.51%). The use of equine bone matrix (EBM) was assessed in four different studies including an RCT, a cross-sectional study and two case series; a mean percentage calculated by the extracted data of the four studies was estimated with newly formed bone (NFB 44.51%), residual grafts (RG 17.24%) and soft tissue percentage (SF 36.62%). EBM appears to be as effective as ABB for the maxillary sinus floor augmentation procedure.

Evaluation of maxillary sinus findings after dental implant and sinus floor augmentation procedures with cone-beam computed tomography.

To assess maxillary sinus findings using dental volumetric tomography before and after surgery in patients with dental implants in the maxillary posterior region with or without sinus floor elevation due to insufficient bone height. Cone-beam computerized tomography images taken for surgical planning before implantation and controlling after implantation were reviewed in 50 patients applied to the Department of Oral, Dental and Maxillofacial Surgery and Radiology of Dentistry Faculty at Ondokuz Mayıs University. Maxillary sinus diseases (focal mucosal thickening, polyp, mucous retention cyst, sinusitis) were evaluated. The relationship between dental implant and sinus floor augmentation procedures and maxillary sinus findings was statistically evaluated using the Chi-square test and Wilcoxon rank test. In this study, 26 female (52%) and 24 male (48%) patients were examined. The mean age of all patients was 53.82 years (± 8.63). Focal mucosal thickening was most frequently observed in the study. There was no statistically significant correlation between implant applications and sinus pathologies with both internal and external elevation procedures and implant applications (P > 0.05). Sinus floor augmentation and dental implant applications seemed not to increase the risk of maxillary sinüs pathologies. However, it is suggested to carry out similar studies with more samples.

Is balloon-assisted maxillary sinus floor augmentation before dental implant safe and promising? A systematic review and meta-analysis.

We aimed to assess the complications of minimally invasive balloon-assisted maxillary sinus floor augmentation, compared with the conventional sinus floor augmentation procedures done before placing a dental implant. A structured question was formulated and an electronic search was conducted in three databases (MEDLINE via PubMed, Google Scholar, and Scopus). A separate search of gray literature and a hand search for missing articles were also conducted. Apart from animal studies, in-vitro studies, and case reports, all other types of studies where maxillary sinus floor augmentation was done using a balloon were considered for review. Our review was registered in International Prospective Registration of Systematic Reviews (PROSPERO) under number CRD42018086770. Our search produced 73 articles. However, only eight articles were found eligible to be included in our review (seven case series and one case-control study). Quality check was done using Methodological Index for Non-Randomized Studies (MINORS). Results suggest that balloon-assisted augmentation is associated with low rates of membrane tears (9 out of 272 sinus augmentation attempts), and high follow-up bone gain levels (mean 212.91%, 95% confidence interval 158.07%-267.75%, I2 = 97.62%). Balloon-assisted augmentation seems to be safe. More clinical trials are needed to assess the advantages and disadvantages of balloon-assisted maxillary sinus floor augmentation compared with other procedures.

Fresh-frozen homologous bone in sinus lifting: histological and radiological analysis.

The aim of this study was to evaluate radiological and histological characteristics of fresh-frozen homologous bone as grafting material for maxillary sinus floor augmentation. Radiological, histological and clinical evaluations were made. Twenty-three patients with a 2 mm to 6 mm alveolar ridge height in the posterior maxilla have been enrolled. Unilateral or bilateral sinus floor augmentations were performed with fresh frozen morcelized homologous bone. Together with implant placement, 7 months after surgery, a bone core was harvested for histological analysis. Radiological measurements were obtained by superimposition of CT scans carried out at the surgery time and six months later. A total of 93 implants were positioned. A mean (±SD) increase in mineralized tissue height of 10.74±2.82 mm was noticed by comparing the CT scans. Histological analysis revealed the presence of newly formed bone in the grafted sites. The follow up period after the prosthetic load ranged from 8 to 31 months. One implant failure occurred. Fresh frozen homologous bone seems to have a good healing pattern and to be a successful and steady grafting material for the treatment of maxillary ridge atrophy. It might be considered a valid alternative to autologous bone in sinus floor augmentation procedures.

Aspergillus fumigatus biofilm formation on different bone substitutes used in maxillary sinus augmentation: an in vitro analysis

BackgroundFungus ball (FB) typically affects healthy adults, and Aspergillus fumigatus is the most frequent etiologic agent: iatrogenic factors represent an important issue in FB pathogenesis. Moreover, a recent study suggested a significant association between the use of anorganic bovine bone as sinus grafting material and subsequent development of FB. The aim of the present investigation is to evaluate in vitro eventual differences in the ability of Aspergillus fumigatus to colonize different bone grafting materials and grow on them as biofilm.FindingsFive different bone substitutes (demineralized bone matrix, anorganic bovine bone, ß-tricalcium phosphate, synthetic nano-hydroxyapatite, and synthetic hydroxyapatite), commonly used in sinus floor augmentation procedures, were inoculated with conidia suspensions of A. fumigatus and incubated at 37 °C for 4 and 8 h, in standardized conditions. Biofilm bound to the different materials underwent quantitative and qualitative analysis by confocal and scanning electron microscopy. A. fumigatus proved to be able to adhere and form biofilm on all the tested bone substitutes. The surface plot representation of the samples displayed some differences in the density of the superficial layer, due to the physical characteristics of the biomaterials. Nevertheless, Kruskal–Wallis test showed no significant differences in biomass amount among the five bone substitutes (p = 0.236 and p = 0.55 after 4 and 8 h adhesion, respectively).ConclusionsAll the bone substitutes normally used in sinus floor augmentation represent a favorable substrate for fungal growth, due to their physical and chemical characteristics. During sinus floor elevation procedures, Schneiderian membrane integrity should be maintained in order to avoid the exposure of the grafting material at the respiratory environment, with potential risks of fungal colonization.

Long-term effectiveness of maxillary sinus floor augmentation: A systematic review and meta-analysis.

To assess the long-term effectiveness (≥5years) of maxillary sinus floor augmentation (MSFA) procedures applying the lateral window technique and to determine possible differences in outcome between simultaneous and delayed implant placement, partially and fully edentulous patients and grafting procedures. MEDLINE (1950-May 2018), EMBASE (1966-May 2018) and Cochrane Central Register of Controlled Trials (1800-May 2018) were searched. Inclusion criteria were prospective studies with follow-up ≥5years and a residual bone height ≤6mm. Outcome measures included implant loss, peri-implant bone level change, suprastructure survival, patient-reported outcome measures and overall complications. Data were pooled and analysed using a random effects model. Out of 2,873 selected articles, 11 studies fulfilled all inclusion criteria. Meta-analysis revealed a weighted annual implant loss of 0.43% (95% CI: 0.37%-0.49%). Meta-regression analysis did not reveal significant differences in implant loss neither between edentulous and dentate patients nor implants placed simultaneously with or delayed after MSFA, nor implants placed in MSFA using solely autologous bone or bone substitutes. The results of the other outcome measures were favourable, and overall complications were low. MSFA is a reliable procedure in the partially and fully edentulous maxilla for support of dental implants.