Sinus Floor Elevation Procedure Research Articles

Maxillary Sinus Floor Elevation and Simultaneous Implant Installation via Osseodensification Drills: A Retrospective Analysis of Bone Gain in 72 Patients Followed for 6 Months.

Background/Objectives: The aim of this retrospective study was to radiographically evaluate the endo-sinus bone gain (ESBG) following osseodensification procedures using CBCT and compare the results to more conventional sinus lifting techniques. Methods: A total of 72 patients underwent crestal sinus floor elevation procedures and were provided with 102 implants with a sand-blasted and acid-etched surface with microthreads (Medentika® Microcone Implants, Hugelsheim, Germany). Patients were divided into two groups; the osseodensification group (OD; n = 36) and the osseodensified augmentation group (ODA; n = 36). Results: The mean residual bone height (RBH) was 5.71 (1.77) and 4.30 (0.94) mm in the OD and ODA groups, respectively. An ESBG of 3.45 (1.18) and 5.74 (1.31) mm was observed in the OD and ODA groups, respectively, and as compared to the baseline RBH, the ESBG was statistically significant in both groups after 6 months (p < 0.001). Conclusions: Within the limits of this retrospective study, crestal sinus lifting with the osseodensification technique seems to be a fast, effective, and safe method. Longer follow-up studies with full intrasinus bone topography and structure analyses are needed to prove the success rate of endo-sinus bone gain.

Histomorphometric Comparison of Bio-Oss vs. Osteodens in Maxillary Sinus Floor Elevation Procedures

Introduction: The loss of dental elements can lead to excessive bone loss in the posterior maxillary segments, which can limit the placement of dental implants in that area, the pneumatization of the maxillary sinus and the absence of dental elements to keep the bone active are some of the main causes. Among the wide range of available grafting materials, bovine hydroxyapatite has been extensively studied and has shown excellent clinical and histological results. Materials and methods: A total of 17 maxillary sinus floor elevations were performed (n = 8 Osteodens, n = 9 Bio-Oss). After a healing period of 6 to 8 months, a block of the grafted area was obtained using trephines and analyzed by histomorphometry. Results: The percentage of neoformed bone tissue was higher for Bio-Oss (39.0% ± 11.1) compared to Osteodens (33.4% ± 8.3), while the remaining graft values were slightly lower in Bio-Oss compared to Osteodens (16.3% ± 11.2 and 20.8% ± 12.1, respectively). The proportion of connective tissue was similar in both groups (44.7% Bio-Oss and 45.8% Osteodens). Age, gender, and residual height of the sinus floor did not show statistically significant differences. Conclusions: In this study, both graft materials (Bio-Oss and Osteodens) showed no statistically significant differences in their ability to regenerate suitable bone tissue for implant placement after 6 months of healing. Further studies with a larger sample size are needed to validate these results.

Efikasiteti i aplikimit të plazmës të pasuruar me trombocite (PRP) si graft autolog në procedurën kirurgjikale për ngritjen e fundit të sinusit maksilar për vendosjen e implanteve dentare

Placement of dental implants in the upper jaw can pose difficulties due to insufficient bone volume caused by si- nus pneumatization and physiological bone resorption. The aim of this study was to evaluate the impact of using autologous platelet-rich plasma as a graft material for si- nus lift procedures. The mean height of the alveolar bone between the floor of the maxillary sinus and the alveolar crest was 2.50 ± 0.73 mm preoperatively, 16.90 ± 1.93 mm post-surgical procedure, and 14.4 mm after 6 months (p &lt; 0.05). There were statistically significant differences in the changes of the values of the most mesial and distal distances in the augmented region. The average dimen- sions of the placed dental implants were 10 mm in length and 3.98 mm in diameter, with 88% high primary stabili- ty in the placed implants and 100% implant survival after a 6-month period. The application of platelet-rich plasma in maxillary sinus floor elevation procedures yields good results in terms of new bone formation, implant osseointe- gration, and positive clinical outcomes. However, further research is needed over a longer time interval to better understand the role and potential of this autogenous graft material in regenerative dentistry.

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

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

CBCT for Diagnostics, Treatment Planning and Monitoring of Sinus Floor Elevation Procedures.

Sinus floor elevation (SFE) is a standard surgical technique used to compensate for alveolar bone resorption in the posterior maxilla. Such a surgical procedure requires radiographic imaging pre- and postoperatively for diagnosis, treatment planning, and outcome assessment. Cone beam computed tomography (CBCT) has become a well-established imaging modality in the dentomaxillofacial region. The following narrative review is aimed to provide clinicians with an overview of the role of three-dimensional (3D) CBCT imaging for diagnostics, treatment planning, and postoperative monitoring of SFE procedures. CBCT imaging prior to SFE provides surgeons with a more detailed view of the surgical site, allows for the detection of potential pathologies three-dimensionally, and helps to virtually plan the procedure more precisely while reducing patient morbidity. In addition, it serves as a useful follow-up tool for assessing sinus and bone graft changes. Meanwhile, using CBCT imaging has to be standardized and justified based on the recognized diagnostic imaging guidelines, taking into account both the technical and clinical considerations. Future studies are recommended to incorporate artificial intelligence-based solutions for automating and standardizing the diagnostic and decision-making process in the context of SFE procedures to further improve the standards of patient care.

Cone Beam Computed Tomography Analysis of Posterior-Superior Alveolar Canal from a Fixed Reference Point: Implications for Sinus Floor Elevation Procedure through Lateral Approach.

Sinus floor elevation is commonly done in the maxillary posterior region prior to dental implant placement. This study primarily aimed at assessing the location of the posterior superior alveolar artery (PSAA) canal on cone beam computed tomography (CBCT) scans and its relation to the alveolar ridge and maxillary sinus from a fixed reference point. A total of 226 edentulous maxillary molar sites were included in this retrospective analysis. The distance from the PSAA to the sinus floor (SF), alveolar crest (AC) and a fixed reference point, that is, the roof of sinus (RS) were measured. The alveolar bone height (ABH), thickness of the crestal keratinized mucosa (CKM) and thickness of Schneiderian membrane (SM) were also evaluated. 54 sites (23.89%) were excluded from the study. The SF, AC, RS and ABH values averaged at 11.91mm ± 3.63mm, 16.05mm ± 3.96mm, 25.32mm ± 7.13mm and 4.93mm ± 4.27mm respectively. SF and AC was higher in second molar than first molar region (p < 0.001), but RS did not show significant difference (p = 0.85). CKM and SM averaged at 2.02mm ± 0.68mm and 1.31mm ± 0.81mm respectively. The PSAA can be visualized in CBCT scans with a prevalence of 76.11% and may not be detected when adherent to the sinus membrane. This study stresses on the need for a CBCT, prior to sinus surgeries through lateral approach, to assess the PSAA.

Efficacy of simultaneous placement of dental implants in osteotome-mediated sinus floor elevation with and without bone augmentation: A systematic review and meta-analysis.

The aim of the present systematic review was to assess the effectiveness of simultaneous placement of implant in osteotome-mediated sinus floor elevation (OMSFE) procedure with and without bone augmentation. An exploration of randomized clinical trials (RCTs) was systematically done in three databases comprising PubMed, Cochrane, and Google Scholar complemented by a thorough manual search of periodontology/implantology-related journals. A final inclusion of 6 RCTs (2010-2020) was done to investigate the efficiency of simultaneous implant placement with OMSFE in conjunction with bone augmentation. A meta-analysis was further conducted with comparable studies which assisted in attaining a final conclusion regarding the survival rate, endosinus bone gain (ESBG), and marginal bone loss (MBL). Data synthesis was performed on the basis of 6 trials and further meta-analysis was performed to statistically validate the clinical and radiographic outcomes. Meta-analysis on the parameters indicated greater ESBG (mean difference [MD]: 0.82; [95% confidence interval [CI]: 0.72-0.91, P ≤ 0.0001]), which was also associated with minimal MBL (MD: -1.11; [95% CI: -1.53-0.68, P ≤ 0.0001)] in the bone augmentation group. However, the parameter of implant survival rate (risk ratio: 1.04; [95% CI: 0.83-1.31, P = 0.6849)] failed to reveal significant difference between the two groups. In the restoration of masticatory apparatus, simultaneous placement of implant in OMSFE with bone augmentation can be considered as successful and predictable treatment approach in deficient posterior maxillary ridges. It contributes toward bone neoformation resulting in greater ESBG as well as a substantial decrease in MBL.

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.

Comparison of different sinus augmentation techniques for implant placements

Aim: The purpose of the present research was to evaluate various sinus augmentation techniques for implant placements. Methodology: Four techniques were evaluated: 1-stage bone-added osteotome sinus floor elevation procedure (BAOSFE) with simultaneous implant placement; 2-stage BAOSFE with delayed implant placement; 1-stage lateral window sinus floor elevation with simultaneous implant placement; and 2-stage lateral window sinus floor elevation with delayed implant placement. Patients were followed for 18 to 72 months (mean: 52.5 months) after prosthesis placement. Data were analyzed with cone-beam computed tomography. Results: A total of 96 implants from 71 patients were analyzed; pre-treatment, there were no significant differences between patients. Total implant survival was 98.9%. The mean residual bone height was significantly higher in the 1-stage BAOSFE group than the other groups (P &lt;.01); 1 implant in this group failed at 3 months. There was no significant difference in total bone height gain between groups. However, the bone height gain of 1st sinus lifting with 2-stage BAOSFE was significantly lower than the 2-stage lateral window procedure (P&lt;.01). There was no prosthesis failure. Conclusion: The favorable implant outcomes suggest these 1-stage and 2-stage MSFA procedures should be considered as alternative treatment options for patients with extremely atrophic posterior maxilla.

Molecular, cellular and surgical processes of osseointegration for dental implants: a systematic review

Introduction: The maxillary sinus floor elevation procedure should be performed based on the cellular and molecular process of osseointegration. In this sense, when grafting procedures are necessary, the success and predictability of the results do not depend only on the biomaterial, but as well as the morphology of the bone defect. Combinations have been proposed to obtain better regenerative conditions through volume preservation (osteoconduction) and induction of cell migration differentiation (osteoinduction). The surface microstructure of Bio Oss® supports the growth of osteoblasts, which are responsible for bone formation. Objective: To carry out a concise systematic review of the molecular and surgical processes of osseointegration for dental implants. Methods: The present study was followed by a systematic review model (PRSMA). The search strategy was performed in the PubMed, Cochrane Library, Web of Science and Scopus, and Google Scholar databases. The Cochrane Instrument was used to assess the risk of bias from the included studies. Results and Conclusion: In line with the objective of this study, it was observed that the understanding of bone bioengineering, understanding the entire bioprocess of bone formation through the main cells (mesenchymal stem cells and osteoblasts) and molecules (BMPs, PRP, PRF, cytokines and growth factors), can promote the use of biomaterials and epithelial barriers that help in the treatment as an adjuvant to bone grafting-techniques, favoring greater predictability in alveolar and peri-implant reconstructions and with a good prognosis.

Major clinical findings of maxillary sinus surgery and the use of bio stimulators: a systematic review

Introduction: In the scenario of maxillary sinus surgery, when there is a loss of a dental element in the posterior region of the maxilla, there is natural resorption of the alveolar process and at the same time there will be pneumatization of the maxillary sinus. For this reason, the maxillary sinus floor elevation procedure should be performed. When grafting procedures are needed, our focus is often on the types of biomaterials and their bio stimulating properties, as well as on other types of bio stimulators to be used. Objective: It was to analyze the main clinical findings of maxillary sinus surgery and the use of bio stimulators through a systematic review. Methods: The present study followed a systematic review model, following the rules of systematic review – PRISMA. The search strategy was performed in the PubMed, Cochrane Library, Web of Science and Scopus, and Google Scholar databases. The present study was carried out from January to March 2022. 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: After analyzing the main clinical findings on maxillary sinus surgery and the use of bio stimulators, it was concluded that bone regeneration processes using biomaterials and the main molecular and cellular constituents such as mesenchymal stem cells, cytokines, platelet-rich plasma, fibrin-rich plasma, exosomes, microRNAs, TNF-α, IL-1, LIF and IL-6 and prostaglandin E2 (PGE2) are strategic for the solution to large bone defects, leading to tissue or bone regeneration. The main filler biomaterials can be fibrin-rich plasma (FRP), Bio-Oss®. However, it is necessary to understand the chemical, physical and biological processes of both the biological material and the biological niche of the host for successful neovascularization and bone filling.

Bone regeneration processes with the use of biomaterials and molecular and cellular constituents for dental implants

Introduction: When a dental element is lost in the posterior region of the maxilla, there is a natural reabsorption of the alveolar process and, at the same time, pneumatization of the maxillary sinus will occur. For this reason, the maxillary sinus floor elevation procedure should be performed, or short implants when possible. Often the focus is on the type of biomaterial to be used and the success and predictability of our results does not depend only on the biomaterial. It is also necessary to consider the type of defect to be treated, its morphology. The characteristics of the biomaterials to be used must be considered, as well as the characteristics of the bed and the bone defect for treatment. Objective: It was to carry out a concise systematic review of bone regeneration processes using biomaterials and the main molecular and cellular constituents for subsequent dental implantation. Methods: The present study followed by a systematic review model (PRISMA). The search strategy was performed in the PubMed, Cochrane Library, Web of Science and Scopus, and Google Scholar databases. The Cochrane Instrument was used to assess the risk of bias of the included studies. Results and Conclusion: 152 articles involving implantology and biomaterials were found. A total of 64 articles were fully evaluated and 28 were included in the present study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 5 studies with high risk of bias (studies with small sample size) and 3 studies with uncertain risk (studies with results without statistical significance). The search for a solution for large bone defects directed studies to tissue regeneration therapy or bone regeneration. These studies can promote the use of fillers and epithelial barriers that help in the treatment as an adjuvant to bone graft techniques, favoring greater predictability in alveolar and peri-implant reconstructions and with a good prognosis. The main filler biomaterials can be fibrin-rich plasma, Bio-Oss®. However, it is necessary to understand the chemical, physical and biological processes of both the biological material and the biological niche of the host. Crossing compatible information between microenvironments allows cell recognition and signaling cascades for neovascularization and regeneration and bone filling for successful posterior dental implant.

Combined Sinus Grafting and Lateral Augmentation by a Hyaluronic Acid-Facilitated Guided Bone Regeneration Protocol – Case Series Supported by Human Histologic Analysis

Guided Bone Regeneration (GBR) is a well-established procedure for the regeneration of alveolar bone defects. In the case of highly complex defect situations, however, inconsistent treatment results are often achieved. Hyaluronic Acid (HA) fulfills several relevant preliminary success criteria for improved regenerative treatment outcomes in complex defects: HA supports the creation of a toxin-free wound area, HA improves wound space stabilization, accelerates wound healing and supports regenerative processes crucial for bone regeneration. The novelty in the reported cases is the use of porcine derived bone substitute particulate hydrated with a cross-linked hyaluronic acid for simultaneous sinus grafting and lateral/vertical ridge augmentation in combination with a ribose cross-linked collagen membrane. The approval of the feasibility is provided with the clinical and histological observations. Three consecutive cases received the abovementioned material combination for staged sinus floor elevation and additional augmentation procedure by one operator according to a standardized protocol. All three sites constantly demonstrate superior clinical outcomes in terms of radiographically impressive tissue enhancement and implant function. The clinical outcomes are supported by qualitative histological analysis reflecting great similarity between samples regarding the observed process of new bone formation and bone substitute behavior. The specific staining allows for detection of osteoclastic activity and indicates the tendency of the particulate bone substitute to degrade over time once integrated.

Morphometric and histomorphometric evaluations of high-purity macro/microporous beta-tricalcium phosphate in maxillary sinus floor elevation: preliminary results on a retrospective, multi-center, observational study

BackgroundThe present study examined the effectiveness of high-purity macro/microporous beta-tricalcium phosphate (HPMM β-TCP) as a bone grafting material for maxillary sinus floor elevation by morphometric, histopathological, and histomorphometric evaluations.MethodsTen unilateral maxillary sinus floor elevation procedures using 100% HPMM β-TCP were performed in 10 patients. Morphometric evaluation was carried out by computed tomography (CT) imaging immediately after augmentation and prior to dental implant placement 7 months later. Histopathological and histomorphometric evaluations were carried out by bone biopsy retrieval at the time of dental implant placement 7 months after sinus floor elevation.ResultsAll 10 sinus floor elevations were successful. Morphometric evaluation by CT showed that the vertical height and volume gained by sinus floor elevation decreased 7 months after surgery. Histopathological evaluation of bone biopsy retrieval specimens showed no signs of inflammation at the newly formed bone area and the native alveolar bone area. New bone formation was observed at the cranial side from the native alveolar bone. The newly formed bone had a trabecular structure and was in intimate contact with the HPMM β-TCP material. Histomorphometric evaluation of bone biopsy retrieval specimens showed an average new bone volume of 33.97% ± 2.79% and an average residual HPMM β-TCP volume of 15.81% ± 4.52%.ConclusionsIn this study, HPMM β-TCP showed osteoconductive properties for vertical augmentation of the atrophied maxilla by means of a maxillary sinus floor elevation procedure allowing subsequent dental implant placement after a 7-month healing period.

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.

Combination of a Hydraulic Device and Nanohydroxylapatite Paste for Minimally Invasive Transcrestal Sinus Floor Elevation: Procedure and 4-Year Results.

The objectives of this retrospective study were to describe a transcrestal sinus floor elevation technique combining the use of a hydraulic device and a nanohydroxylapatite paste and to report on 4-year clinical and radiographic outcomes. The sinus floor elevation procedure used a specially designed drill (SinusJet) to start sinus membrane unsticking and a nanohydroxylapatite paste (Ostim) for further sinus membrane elevation and bone augmentation. It was performed as a one-step procedure with immediate implant placement or a two-step procedure with delayed implant placement 9 months later. Implant survival rate, sinus membrane perforation, postoperative complications, and the level of intraoperative and postoperative patient comfort using a visual analog scale were analyzed retrospectively. A nonparametric Wilcoxon matched-pairs test and parametric paired t test were used to identify significant differences. One hundred thirty-six sinus floor elevations were performed in 110 patients at two dental clinics in Belgium with a mean follow-up period of 48 months. In the one-step procedure, the mean 6-month elevation was 8.5 ± 2.7 mm; 194 implants were placed. In the two-step procedure, the mean 9-month elevation was 9.5 ± 2.4 mm; 8 implants were placed. The osteotomy, sinus membrane elevation, and bone grafting typically took less than 3 minutes. Sinus membrane perforation was observed in 2.9% (n = 4/136). The 4-year implant survival rate was 97% (n = 196/202), with six early implant losses. 96.4% of patients reported either no or minimal discomfort. This minimally invasive transcrestal sinus floor elevation procedure that combines a hydraulic device and nanohydroxylapatite paste appears to be safe and predictable. However, further randomized controlled studies are needed to validate the results of this retrospective observational study.

The Potential Influence of Medial Sinus wall Exposure During Lateral Sinus Floor Elevation Procedure on the Blood Supply to the Grafted Material: A Cohort Study

The Potential Influence of Medial Sinus wall Exposure During Lateral Sinus Floor Elevation Procedure on the Blood Supply to the Grafted Material: A Cohort Study

Volumetric analysis of mucous retention cysts in the maxillary sinus: A retrospective study using cone-beam computed tomography.

PurposeThe aim of this study was to evaluate the volumetric characteristics of mucous retention cysts (MRCs) in the maxillary sinus and to analyze potential associations of MRCs with dentoalveolar pathologies.Materials and MethodsCone-beam computed tomography (CBCT) scans exhibiting bilateral maxillary sinuses that were acquired from January 2016 to February 2019 were initially screened. A total of 227 scans (454 sinuses) that fulfilled the inclusion criteria were included. The presence, location, and volumetric characteristics of the diagnosed MRCs were evaluated on CBCT images using the 3D-Slicer software platform. The presence of MRCs was correlated with potential influencing factors including age, sex, and dentoalveolar pathology. For MRCs located on the sinus floor, factors with a potential impact on the volume, surface, and diameter were analyzed.ResultsAn MRC was present in 130 (28.6%) of the 454 sinuses. Most MRCs were located on the sinus walls and floor. The mean MRC volume, surface, and diameter were 551.21±1368.04 mm3, 228.09±437.56 mm2, and 9.63±5.40 mm, respectively. Significantly more sinuses with associated endodontically treated teeth/periapical lesions were diagnosed with an MRC located on the sinus floor. For MRCs located on the sinus floor, endodontic status exhibited a significant association with increased volume, surface, and diameter.ConclusionPeriapical lesions might be a contributing factor associated with the presence and volume of MRCs located on the sinus floor. The 3D-Slicer software platform was found to be a useful tool for clinicians to analyze the size of MRCs before surgical interventions such as sinus floor elevation procedures.

Espesor de la membrana de Schneiderian: análisis de tomografías computadas de haz cónico pre y post procedimientos de elevación de piso sinusal

Objective: To evaluate the thickness of the maxillary sinus mucosa before and after performing the elevation of the maxillary sinus floor in partially and very edentulous patients in the posterior sector using cone beam computed tomography images. Methods: Pre and postsurgical tomographic images of 31 cases were included; 24 of which were a unilateral maxillary sinus floor elevation procedure, while 7 cases involved both pneumatic cavities. Measurements were taken at the sagittal and coronal planes. All of them, perpendicular to the sinus mucosa. A retrospective analysis of cone beam computed tomography was performed and the groups were compared with the Wilcoxon test for related samples and the variables graft size, preoperative membrane thickness, age and gender with multivariate analysis. Setting the level of statistical significance p &lt;0.05. Results: A great variability of the thickness of the sinus membrane was confirmed, both in the pre-operative and in the post-operative. It was observed that the mean values in millimeters obtained in the pre-op were 1.45 and 1.12 in the post-op. The medians showed that the membrane thickness values are more atypical and more extreme in the preoperative values (0.79) than in the postoperative values (0.94), which are more normal and uniform. Conclusion: Under the conditions analyzed, there was an absence of changes in the dimensions of the sinus mucosa in the pre and postoperative period of the tomographic images, highlighting evidence of great inter-individual variability.

Comparison of 4 sinus augmentation techniques for implant placement with residual alveolar bone height ≤3 mm.

This study compared implant outcomes following maxillary sinus floor augmentation (MSFA) in edentulous patients with a residual alveolar bone height ≤3 mm. Four techniques were evaluated: 1-stage bone-added osteotome sinus floor elevation procedure (BAOSFE) with simultaneous implant placement; 2-stage BAOSFE with delayed implant placement; 1-stage lateral window sinus floor elevation with simultaneous implant placement; and 2-stage lateral window sinus floor elevation with delayed implant placement. Patients were followed for 18 to 72 months (mean: 52.5 months) after prosthesis placement. Data were analyzed with cone-beam computed tomography. A total of 96 implants from 71 patients were analyzed; pretreatment, there were no significant differences between patients. Total implant survival was 98.9%. The mean residual bone height was significantly higher in the 1-stage BAOSFE group than the other groups (P < .01); 1 implant in this group failed at 3 months. There was no significant difference in total bone height gain between groups. However, the bone height gain of 1st sinus lifting with 2-stage BAOSFE was significantly lower than the 2-stage lateral window procedure (P < .01). There was no prosthesis failure. The favorable implant outcomes suggest these 1-stage and 2-stage MSFA procedures should be considered as alternative treatment options for patients with extremely atrophic posterior maxilla.