Sinus Floor Elevation Technique Research Articles

An Animal Ex Vivo Model Comparing Two Different Methods of Sinus Floor Elevation with Great Elevation Heights: Macroscopic, Microscopic and Radiological Analysis

Introduction: Maxillary sinus pneumatization increases with age and tooth loss, leading to a reduction in the maxillary alveolar ridge, which often results in insufficient bone height for the proper placement of dental implants. This study focused on performing maxillary sinus elevations in ex vivo bisected pig heads using novel access and elevation devices, comparing these with the osteotome sinus floor elevation (OSFE) technique. Materials and Methods:An experimental study was conducted using 20 ex vivo adult pig heads. The sinus elevations were divided into two groups: 10 heads were treated using the osteotome technique, and 10 heads were treated using a new device, which consists of a syringe with latex and saline solution, as well as a burr system for membrane access and control. Results: In the osteotome technique, perforations of the Schneiderian membrane were observed, whereas the inflatable balloon device did not cause any lacerations. Conclusions: OSFE resulted in sinus membrane perforations at greater elevation heights, while the new balloon device successfully elevated the membrane without tearing it. Within the limitations of this study, maxillary sinus lifts using the new balloon technique proved to be minimally invasive procedures.

Reamer-scraping and implant-pushing technique for transcrestal sinus floor elevation.

Transcrestal maxillary sinus floor elevation is an effective method to solve the problem of insufficient bone height in the posterior maxillary region. However, current methods, such as osteotome sinus floor elevation, cushioned grind-out technique, Smart Drill technique, etc., require specialized surgical tool boxes. In this article, we introduce a new method of transcrestal maxillary sinus elevation that uses built-in reamers of various implant systems to scrap residual bone at the sinus floor and uses the implant to push the sinus membrane during implant placement. This technique is easy to operate and time saving and has a low rate of sinus membrane perforation. After a one-year follow-up observation of 146 people and 175 implants, the endo-sinus bone gains were 5.00 (4.70, 5.30) mm and 2.10 (1.40, 2.70) mm in the group of 3 mm≤residual bone height (RBH)<5 mm and the group of 5 mm≤RBH<8 mm, respectively, which can meet the clinical requirements of implant stability. This technique is suitable in generalizing dental implantation.

Minimally invasive techniques for sinus floor elevation using dental implants among Indians.

It is of interest to compare conventional lateral window technique, trans-alveolar technique with minimally invasive technique like modified trephine technique and antral membrane balloon elevation technique for sinus floor elevation in placement of dental implants. The current study included 140 participants (191 dental implants) who had maxillary posterior edentulous regions and had low sinuses and insufficient alveolar ridges but had chosen an implant-retained prosthesis. The minimally invasive techniques of sinus augmentation can be suitable alternative to conventional traumatic techniques due to low incidence of pain, gingival swelling. Moreover, the success rate of implants and increase in total bone height was almost same in minimally invasive techniques of sinus augmentation as compared to conventional traumatic techniques.

Osseodensification versus lateral window technique for sinus floor elevation with simultaneous implant placement: A randomized clinical trial on patient-reported outcome measures.

To compare patient-reported outcome measures and additional surgical outcomes after sinus floor elevation (SFE) with osseodensification (OD) versus lateral window (LW), both with simultaneous implant placement. Twenty participants requiring single-implant rehabilitation with residual bone height (RBH) ≤4 mm were enrolled. Pain experience, quality of life (QoL) via the Oral Health Impact Profile-14 (OHIP-14), analgesics intake, and other symptoms were self-reported for a week on a daily basis. Surgery duration, complications, and implant stability quotient at baseline (ISQ T0 ) and after 6 months (ISQ T6 ) were registered. Participants were followed up for 1 year. From Day 0 (day of surgery) to Day 3, pain experience was significantly lower (p < 0.05) in the OD group. OHIP-14 score was significantly lower (p < 0.05) in the OD group on all postoperative days, except on Day 5. Average analgesics intake was significantly lower (p < 0.001) in the OD group. Surgery mean duration was significantly higher (p < 0.001) in LW compared to OD (71.1 ± 10.4 vs. 32.9 ± 5.3 min). After osseointegration period, all implants were successfully restored with screw-retained crowns. Within the limitations of this study, it can be concluded that OD and LW techniques were similarly effective in SFE with simultaneous implant placement when RBH ≤ 4 mm. However, OD significantly outperformed LW in pain experience, impact on self-perceived QoL, surgery duration, postoperative edema, and analgesics intake.

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.

Minimally invasive techniques for lateral maxillary sinus floor elevation: small lateral window and one-stage surgery—a 2–5-year retrospective study

This study aimed to introduce a minimally invasive technique for maxillary sinus floor elevation using the lateral approach (lSFE) and to determine the factors that influence the stability of the grafted area in the sinus cavity. Thirty patients (30 implants) treated with lSFE using minimally invasive techniques from 2015 to 2019 were included in the study. Five aspects of the implant (central, mesial, distal, buccal, and palatal bone heights [BHs]) were measured using cone-beam computed tomography (CBCT) before implant surgery, immediately after surgery (T0), 6 months after surgery (T1), and at the last follow-up visit (T2). Patients’ characteristics were collected. A small bone window (height, (4.40 ± 0.74) mm; length, (6.26 ± 1.03) mm) was prepared. No implant failed during the follow-up period (3.67 ± 1.75) years. Three of the 30 implants exhibited perforations. Changes in BH of the five aspects of implants showed strong correlations with each other and BH decreased dramatically before second-stage surgery. Residual bone height (RBH) did not significantly influence BH changes, whereas smoking status and type of bone graft materials were the potentially influential factors. During the approximate three-year observation period, lSFE with a minimally invasive technique demonstrated high implant survival rate and limited bone reduction in grafted area. In conclusion, lSFE using minimally invasive techniques was a viable treatment option. Patients who were nonsmokers and whose sinus cavity was filled with deproteinized bovine bone mineral (DBBM) had significantly limited bone resorption in grafted area.

The Impact of Sinus Floor Elevation Techniques on Sinus Membrane Perforation: A Systematic Review and Network Meta-analysis.

Purpose: To compare the risk of sinus membrane perforation (SMP) among lateral window sinus floor elevation (LSFE) and transcrestal sinus floor elevation (TSFE) techniques in prospective and retrospective studies for patients who underwent sinus augmentation for dental implant placement. Materials and Methods: A database search was conducted to screen the literature published from January 1960 to August 2021. The associations between SMP and surgical techniques as well as other clinical factors were evaluated via network meta-analysis. The impact of SMP on vertical ridge gain and implant survival was also evaluated. Results: Eighty-five studies with 5,551 SFE procedures were included. In LSFE techniques, using rotary burs showed the highest risk of SMP (surface under the cumulative ranking area [SUCRA] = 0.0745). In TSFE techniques, using reamers had the lowest risk of SMP (SUCRA = 0.9444). Increased SMP prevalence was significantly associated with reduced implant survival rate (odds ratio [OR] = 0.45 per 10% increase of SMP rate [95% credible interval (CreI): 0.21, 0.71], P < .001). Conclusions: With the inherent limitations, this network meta-analysis suggested that some techniques within either the LSFE or TSFE group may reduce SMP risk. Additional randomized controlled trials and better assessment of SMP are required to directly compare the risk of SMP between LSFE and TSFE.

Less Invasive Window Repositioning Technique for Sinus Floor Elevation: A Clinical and Radiographic Study

To determine whether a less invasive window repositioning technique could provide a feasible, safe, and reliable lateral sinus augmentation. The less-invasive window repositioning technique using a piezoelectric saw was performed on adult patient candidates for lateral sinus floor elevation. The augmented bone height (primary outcome variable), bone length, and posthealing outcome variables were evaluated to determine the augmentation adequacy, safety, and reliability of this technique overall and in one- and two-implant groups with different window dimensions. Data were analyzed using descriptive statistics, chi-square test, and Pearson correlation analysis. P < .05 was considered significant. A total of 50 consecutive sinus floor elevations with simultaneous placement of 66 implants (one-implant: 34, two-implant: 16) were performed on 44 subjects (72% men) with a mean age of 46.7 ± 10.3 years and followed for a mean of 13.28 ± 3.5 months. The overall, one-implant, and two-implant group mean window sizes were 31.38 ± 6.78 mm2, 28.38 ± 4.2 mm2, and 37.75 ± 6.88 mm2, respectively. The mean overall augmented bone height and length were 12.3 ± 1.04 mm and 19.67 ± 2.01 mm, respectively. The mean window size was significantly smaller in the one-implant group versus the two-implant group (P < .001). However, there was no correlation between window size and augmented bone height (r = -0.9, P = .54) and length (r = 0.05, P = .68). The posthealing outcome variables showed perfect window integration without soft tissue ingrowth. Six sinus perforations (12%) during membrane elevation that were not related to window osteotomy were observed and were appropriately managed. The less-invasive window repositioning technique is feasible, safe, and reliable for appropriate sinus augmentation in height and length. The reduction of window dimension does not influence the feasibility, augmentation adequacy, and surgical safety and does not increase surgical risks or membrane perforation. The repositioned window showed proper integration. Also, sinus floor elevation through this technique is an experience-based surgery that requires delicate instruments.

Comparative evaluation of dental implants in posterior maxilla placed using unicortical and bicortical anchorage-A split-mouth prospective study.

The use of dental implants has become a very predictive method of rehabilitation for patients with partial or complete edentulism. It is more challenging to treat the posterior quadrants of the maxillary ridges using dental implants due to their anatomical and physiological characteristics. So to overcome the limitations of other techniques, short implants were introduced recently as a new approach to simplify implant placement in compromised alveolar bone and to prevent possible damage to vital structures. This study aims to compare the clinical outcomes of dental implants placed using the osteotomized sinus floor elevation (OSFE) technique side engaging the bony floor of the maxillary sinus (bicortical anchorage) on one side and the conventional technique by split mouth on the other side. This study included 15 patients. Study participants had dental implants placed on both sides of the mouth at the same time, so one side was implanted according to the test method, while the other side used the control method. Randomization determined which side would be implanted. The OSFE technique provides greater stability to the implant via bicortical anchorage than conventional techniques, which only provide unicortical anchorage.

Indirect Sinus Lift in Maxillary Posterior Region using BAOSFE Technique

Implant placement in edentulous posterior maxilla along the maxillary sinuses poses difficulties following tooth extraction due to ridge resorption and pneumatization of sinuses resulting in inadequate vertical bone height. The maxillary sinus lying close to the posterior maxillary edentulous ridge can be augmented by various methods such as lateral window sinus floor elevation, crestal approach, and grafting procedures. Summers introduced the less invasive approach for the sinus floor elevation known as osteotome sinus floor elevation technique in which the vertical bone height was attained by retaining and relocating existing bone using different graded osteotomes. He further modified this technique by addition of bone graft to the osteotomy site before sinus elevation known as bone added osteotome mediated sinus floor elevation (BAOSFE). This case report shows placement of implant in atrophic maxillary region using BAOSFE technique.

Short and Ultra-Short Implants, in Association with Simultaneous Internal Sinus Lift in the Atrophic Posterior Maxilla: A Five-Year Retrospective Study.

Recent short-term studies suggested the use of short and ultra-short implants in association with a modified osteotome sinus floor elevation (internal sinus lift) technique for the treatment of edentulous resorbed posterior maxilla. The aim of this retrospective study was to investigate this hypothesis in locking-taper implants with a mid-term follow-up of 5 years. Overall, 155 implants (32, 100, and 23 of, respectively, 5.0 mm, 6.0 mm, and 8.0 mm length) were positioned in the atrophic upper maxilla of 79 patients, and 151 implants were loaded with single crowns. Overall implant survival after 5 years was 94.84%. Implant survival for each length group was 93.75%, 94%, and 100% for 5.0, 6.0, and 8.0 mm length, respectively. Preoperative residual crestal bone height of 4.45 (1.3) mm increased to 9.25 (2.13) mm after implant placement and settled at 6.35 (1.73) mm after loading and at 5.25 (1.68) mm at follow-up. Elevation of the Schneiderian membrane was 4.8 (2.46) mm after implant placement, 3.06 (1.3) mm after loading, and 1.46 (1.06) mm at follow-up. Mean variations of peri-implant crestal bone loss and first bone-to-implant contact point were, respectively, -0.36 (1.3) mm and -0.62 (1.15) mm. It can be confirmed that internal sinus lift procedure revealed stable bone gain and negligible resorption at mid-term follow-up for atrophic upper crests with reduced height.

Sinus floor elevation techniques- A review

Long term edentulism in the maxillary posterior region presents with complications that compromise the quality and quantity of the residual ridge, making the implant placement impossible. Despite of these challenges, prosthetically driven dental implants tend to restore function using various sinus membrane elevation and augmentation techniques. Over the past few years, these techniques have undergone several advancements aiming to overcome the short comings of the conventional techniques and assuring a successful outcome.

Modified transcrestal sinus floor elevation with concomitant implant placement in edentulous posterior maxillae with residual bone height of 5 mm or less: a non-controlled prospective study

The aim of this study was to describe a modified transcrestal sinus floor elevation (mTSFE) technique and to evaluate its clinical effectiveness and reliability when residual bone height is severely reduced. Forty-three maxillary edentulous patients who met the inclusion criteria were enrolled. All patients underwent the mTSFE technique; 66 dental implants were inserted simultaneously. Patient-reported outcomes were assessed 2 weeks after surgery. Prosthetic crowns were placed 6 months after surgery. Radiographic analyses and clinical analyses were conducted to assess the clinical effectiveness and feasibility of mTSFE during a follow-up period of 2–8 years. The mean vertical bone increase after surgery was 8.09 mm, and it decreased to 6.56 mm at 6 months after surgery. Two cases of membrane perforation occurred during surgery and one implant was lost in the third year after surgery; the survival rate at the implant level was 98.48%. No severe postoperative complication was reported and the subjective feeling of patients was acceptable. This mTSFE technique could simplify the operative procedure and might be helpful to reduce intraoperative trauma, as well as to alleviate postoperative discomfort.

Tilted Implants and Sinus Floor Elevation Techniques Compared in Posterior Edentulous Maxilla: A Retrospective Clinical Study over Four Years of Follow-Up

The aim of this study was to evaluate the implant survival rate, marginal bone loss, and surgical and prosthetic complications of implants placed through sinus floor elevation and tilted implants engaged in basal bone to bypass the maxillary sinus. Sixty patients were enrolled for this study. According to the residual bone height of the posterior maxilla, the sample was divided into three groups of 20 patients: Group A (lateral sinus floor elevation), Group B (transcrestal sinus floor elevation), and Group C (tilted implants employed to bypass the sinus floor). Follow-up visits were performed one week after surgery, at three and six months, and then once a year for the next 4 years. The outcomes were the implant survival rate, marginal bone loss, and surgical and prosthetic complications. Although Groups A, B, and C demonstrated implant survival rates of 83.3%, 86.7%, and 98.3%, respectively, the statistical analysis showed no statistically significant difference between groups. Statistically significant differences between groups were also not found concerning marginal bone loss, as recorded by intra-oral X-ray measurements during follow-up examinations. Regarding complications, it was not possible to perform a statistical analysis. To reduce possible surgical risks, implant placement in basal bone could be preferred.

Osteotome technique: literature review

OBJECTIVE: This focus literature review aimed to identify, in a clear and systematic way, the various factors (indications, influence of biomaterials and survival rates of the implants) that a clinician must take into account when addressing the maxillary sinus using trasncrestal maxillary sinus floor elevation techniques. MATERIALS AND METHODS: The papers to include in this focus review were obtained via automatic search and screening of articles published in scientific journals with peer review and indexed in the well-known sources of scientific information e.g. PubMed, ScienceDirect, LILACS, Web of Science, Scielo, Cochrane Library. RESULTS: After screening, 25 papers were included in this focus review. Overall literature results highlight that the osteotome technique is a valid alternative when the remaining bone is &gt;5mm. Also, the most frequent complication is the perforation of the Schneider membrane. Furthermore, different grafts, or no graft at all, can be used with different results, depending on the individual case. Summarizing the results, the average sinus floor elevation was 3,8 mm with variation between 2.6±1.2mm and 5,65±1.93mm. Analyzing the implant survival rate with 5 years follow-up periods, the overall survival rate was 94,3% (varying between 91,9% and 98,3%). The 10 years’ follow-up studies report an average survival rate of 97% (varying between 94% and 100%). CONCLUSIONS: The consensual minimum residual bone height for the indication of osteotome technique is &gt;5mm. Osteotome techniques are predictable, well documented and present a high success rate when correctly carried on.

Survival rate of dental implant placed using various maxillary sinus floor elevation techniques: A systematic review and meta-analysis.

The aim of this systematic review is to evaluate the survival rate of dental implant placed using different maxillary sinus floor elevation techniques. PRISMA guidelines were used for this systematic review and meta-analysis. Relevant articles were searched from Medline, PubMed, Google Scholar, ScienceDirect, and Cochrane trials. Articles published in English language were selected. Hand search was further conducted. For risk of bias, two tools were used, i.e., Cochrane tool for randomized controlled trials (RCTs) and new castle Ottawa quality assessment tool for non-RCTs. For statistical meta-analysis RevMan 5.4 software was used. Seventeen studies were finalized. All studies were included in the meta-analysis to check the implant survival rate. There is no statistical difference between direct and indirect techniques, and forest plot was derived for direct approach (P = 0.688, 95% confidence interval [CI] 0.9691) and for indirect approach (P = 0.686 and 95% CI 0.970). There is no statistically significant difference in the survival rate of implant placed using direct or indirect sinus lift approach procedures. Hence, the technique is selected as per the indications given for each direct and indirect procedure.

Minimally Invasive Lateral Approach through Circular Window with a Diameter of 5 to 6 mm for Maxillary Sinus Floor Elevation with Simultaneous Implant Placement: Retrospective Study

The aims of this study were to propose a minimally invasive lateral approach technique for maxillary sinus floor elevation (MSFE) with simultaneous implant placement and to evaluate the surgical outcome and complications of this technique. This study reviewed 49 surgeries of MSFE with simultaneous implant placement (n = 83) using a minimally invasive lateral approach. A circular shape window with a diameter of 5 to 6 mm and an area of 20–30 mm2 was made on the lateral wall of the maxillary sinus. After elevation of the Schneiderian membrane, the xenograft was used for bone grafting. The MSFE was possible with a minimum-sized window in 47 of 49 cases. For the remaining 2 cases, MSFE with a minimum-sized window was failed. In one case, it was expanded to be more than 30 mm2 to repair the membrane perforation. In another case, MSFE was performed by forming two minimum-sized windows. Post-operative bleeding after MSFE occurred in one anticoagulant-treated patient. There was no failed implant during the follow-up period (mean 22 months). A minimally invasive lateral approach through a small circular window with a diameter of 5 to 6 mm is a feasible and safe technique for MSFE with simultaneous implant placement.

Bone regeneration using deproteinized bovine bone mineral (DBBM) in a crestal sinus elevation technique: a histological and histomorphometrical pilot study

The aim of this study is to evaluate the percentage of new bone formation (NBF) and residual bone substitute following the use of a bovine demineralized xenograft (DBBM) in a sinus floor crestal approach elevation technique. Materials and methods: Nine patients with unilateral or bilateral edentulous sites with less than 2 mm residual bone height under the sinus, were included in this study. Future site development was performed using deproteinized bovine bone mineral (DBBM) as graft material. In the second stage, performed after 6 to 9 months, nine implants were placed after harvesting bone biopsies from the regenerated sites. Histological and histomorphometric analysis were then undertaken to assess the regenerated bone. Results: All the implants were placed successfully after 6 to 9 months following sinus floor elevation technique for future site development without any complications. The average percentage of new bone formation and residual bone substitute were of 24.37 % ± 13.12 % and 5.87 % ± 8.38 %, respectively. Conclusion: Within the validity of this crestal approach in the treatment of the subantral region presenting 2 mm or less residual bone height, the DBBM has proved to be a osteoconductive biomaterials in bone regeneration procedures.

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.

Intraoperative and postoperative outcomes of sinus floor elevation using the lateral window technique versus the hydrodynamic transalveolar approach: a preliminary randomized controlled trial.

To compare the clinical and radiographic outcomes of two sinus floor elevation techniques: the conventional lateral window technique versus the transalveolar approach using a hydrodynamic ultrasonic device. The study was designed as a randomized controlled clinical trial, and participants were randomly allocated to the control group (lateral window: LW) or to the test group (hydrodynamic transalveolar approach: HTA). The intraoperative and postoperative data, including procedure duration and patient-reported outcome measures (PROMs), were collected during the surgery and up to 1 year post-surgery. Additionally, qualitative assessment of gained bone volumes and implant survival rates was recorded. Twenty-two patients were included in the study. The mean surgical time was significantly longer in the HTA compared to the LW group (48.1 ± 11.2 min vs. 35.2 ± 9.1 min, P = 0.0011). Perforation of the Schneiderian membrane occurred in 2/11 and 5/11 patients in the LW and the HTA group, respectively (P = 0.36). Postoperatively, higher morbidity and consumption of nonsteroidal anti-inflammatory drugs (NSAIDs) were associated with the LW group. However, self-reported satisfaction with surgical procedures was similar in the two groups. At 1 year, implant survival rates of 80% in the HTA group and 100% in the LW group were recorded (P = 0.12). Although the new transalveolar approach seems to reduce postoperative morbidity, an increased risk of intraoperative complications compared to the LW approach needs to be considered when choosing a technique. Our results provide new insights regarding clinical and radiographic outcomes of HTA and may help further determine indications for its use. ClinicalTrivals.gov : NCT04499625.