Sinus Lift Operations Research Articles

Elimination of defects in the Schneiderian membrane during sinus lift operations

Evaluation of the effectiveness of a new method of plasty of an extensive defect in the mucous membrane of the Schneiderian membrane, which occurs during the sinus lift operation, using an artificial collagen membrane and a developed method for fixing it. A total of 188 patients took part in the study, all of these patients underwent an open sinus lift operation with simultaneous or delayed implantation. Operations were performed under balanced anesthesia. Six months after the operation, according to computed tomography, the height of the formed bone regenerate was estimated. In the area of each missing tooth, the initial bone height and the resulting bone grafting were assessed. Then we compared the average values before and after the operation, the average height difference before and after the operation. In 19 patients during the sinus lift there was an accidental extensive rupture of the mucous membrane of the maxillary sinus. Elimination of the mucosal defect was carried out according to our patented method. All 188 patients were diagnosed with partial loss of teeth with bone tissue deficiency in the distal maxillary sinus. The height of the alveolar process in the projection of missing teeth ranged from 0.5 mm to 5 mm. Delayed dental implantation was performed when the height of the alveolar bone was less than 3 mm, direct when the presence of 3-5 mm. After 6 months, dental implants were installed in the reconstruction zone, after another 6 months - rational prosthetics. The proposed method of plastic surgery has the following advantages. Firstly, it allows to eliminate the defect of the mucous membrane together with an increase in the height of the alveolar ridge. Secondly, after this method, the integrity of the mucous membrane will be restored. Thirdly, with an alveolar bone height of 3 mm or more, dental implants should also be installed.

Influence of Schneiderian Membrane Perforations on the Prognosis and Outcomes of Lateral Window Sinus Lift Operations: A Retrospective Case Series Study

Introduction: This study analyzed the influence of Schneiderian membrane perforations covered with collagen membranes on the success of augmentation and implantation as well as the influences of smoking, radiation and chemotherapy. Patients and Methods: 182 consecutive operated patients with a total of 298 augmented sinuses and 833 inserted implants were analyzed retrospectively. Success rates of sinus augmentations with perforated and unperforated Schneiderian membranes were compared. Results: Perforations of the Schneiderian membrane occurred in 23.2% (p< 0.001). Success rate decreased from 89.4% (p< 0,001) at unperforated sinuses to 80.0% (p=0.005) at perforated sinuses for the irradiated patients and from 95.6% (p< 0,001) at unperforated sinuses to 89.8% (p< 0.001) at perforated sinuses for patients not treated with radiation therapy. Similar results were found for the implant loss rate, which was highest for perforated sinuses at irradiated patients – 43.9% (p=0.023) – and lowest for unperforated sinuses at not irradiated patients – 4.5% (p< 0.001). Comparing membrane perforation to lost implants and failure rate a statistically significant difference could be detected (p=0,029). Conclusions: Although Schneiderian membrane was covered with collagen membranes in all cases, perforations still have a negative impact on success rates of augmentation and implant survival. Possible improvements of this method should be investigated in following studies. Keywords: Radiation therapy; Smoking; Chemotherapy; Sinus augmentation; Implant loss; Implant survival;

Re-evaluating the induction of bone formation in primates

The molecular cloning of the osteogenic proteins of the transforming growth factor-β (TGF-β) supergene family and the results of numerous pre-clinical studies in several mammalian species including non-human primates, have prematurely convinced molecular biologists, tissue engineers and skeletal reconstructionists alike to believe that single recombinant human bone morphogenetic/osteogenic proteins (hBMPs/OPs) would result in tissue induction when translated in clinical contexts. This theoretical potential has not been translated to acceptable clinical results. Clinical trials in craniofacial and orthopedic applications such as mandibular reconstruction and sinus-lift operations have indicated that supra physiological doses of a single recombinant human protein are needed to induce unacceptable tissue regeneration whilst incurring significant costs without achieving equivalence to autogenous bone grafts. The acid test for clinically relevant bone tissue engineering should now become the concept of clinically significant osteoinduction, whereby the regenerated bone is readily identifiable on radiographic examination by virtue of its opacity and trabecular architecture. The need for alternatives to the hBMPs/OPs is now felt more acutely following reported complications and performance failure associated with the clinical use of hBMP-2 and hOP-1 (BMP-7). Because of the often substandard regeneration of clinical defects implanted with hBMPs/OPs, we now need to finally deal with the provocative question: are the hBMPs/OPs the only initiators of the induction of bone formation in pre-clinical and clinical contexts? The rapid induction of bone formation by the hTGF-β3 isoform in heteropic intramuscular sites of the Chacma baboon Papio ursinus together with TGF-β1, TGF-β3, BMP-2, BMP-3, OP-1, RUNX-2 and Osteocalcin up-regulation and expression, hyper cellular osteoblastic activity, osteoid synthesis, angiogenesis and capillary sprouting are the molecular and morphological foundation for the induction of bone formation in clinical contexts. The induction of bone as initiated by hTGF-β3 when implanted in the rectus abdominis muscle of P. ursinus is via the BMPs/OPs pathway with hTGF-β3 controlling the induction of bone formation by regulating the expression of BMPs/OPs via Noggin expression, eliciting the induction of bone formation by up-regulating endogenous BMPs/OPs and it is blocked by hNoggin, providing insights into performance failure of hBMPs/OPs in clinical contexts. Physiological expression of BMPs/OPs genes upon implantation of hTGF-β3 may escape the antagonist expression of Noggin and other inhibitors, whereas direct application of hBMPs/OPs, representing a later by-product step of the bone induction cascade as set by the TGF-β3 master gene in primates, sets into motion Noggin' antagonist action, as shown by the limited effectiveness of hBMPs/OPs in clinical contexts. The unprecedented induction of bone formation by 250 μg hTGF-β3 when combined with coral-derived macroporous constructs is the novel molecular and morphological frontier for the induction of bone formation in man. The induction of bone by hTGF-β3 has been thus translated in clinical contexts to treat a large mandibular defect in a pediatric patient; 30 months after implantation of 250 μg hTGF-β3 per gram of human demineralized bone matrix, radiographic analyses show the reconstruction of the avulsed large mandibular segment including the induction of the avulsed coronoid process.

Pre- and Postoperative Long-Term Assessment of Sinus Floor Augmentation Site Using Cone Beam Computed Tomography

Abstract Introduction. Sinus lift operations are planned in atrophic maxillary residual alveolar bone. There is little evidence how the quality and quantity of residual bone influence the dimension of sinus lifts. Aim of the Study. To evaluate relationship between amount of residual alveolar bone and sinus lift dimension. Materials and Methods. 73 sinuses of 54 patients were included in to the study. Preoperative and postoperative cone beam computed tomography scan of sinus lift operation site was performed. The measurement of atrophic alveolar bone height, width and radiodensity in planned sinus lift area was done. Postoperatively sinus lift height, width and length were measured. The sinus volume difference from both scans was calculated. Amount of bone substitute materials used was registered. Results. Residual alveolar bone mean height was 3.84 mm SD±2.28, width 7.15 mm SD±2.27, radiodensity 142.74 HU SD±155.38. Postoperatively mean sinus lift height was 15.81 mm SD±2.91, length 18.73 mm SD±5.21, width 12.70 mm SD±2.49. The mean sinus volume difference was 2422.70 mm3 SD± 3415.92. Mean amount of biomaterials used was 1.29 g SD±0.67. Conclusions. The less bone radiodensity was found in alveolar bone with more dimensions. The less quantity of atrophic alveolar bone leads to increase size of sinus lift.

Evaluation of maxillary bone quality before and after sinus lift operations using immunohistochemistry and computer tomography

Introduction: Bone quality and quantity is most important issue for successful dental implantology. Using bone radiological and morphological investigation is possible to evaluate bone quality before implantation and during bone regeneration.

Outcome of 47 Consecutive Sinus Lift Operations Using Aragonitic Calcium Carbonate Associated With Autologous Platelet-Rich Plasma

The reconstruction of the maxillary bone frequently represents a real challenge for maxillofacial surgeons especially regarding the best choice of a suitable material to produce the required bone augmentation. In this study, we summarize our clinical experience on 47 sinus lifts with lateral approach using a mixture of aragonitic calcium carbonate and autologous platelet-rich plasma compared with that of a previous published study in which bovine bone (LADDEC) and autologous bone were used in 50 sinus lift operations (Br J Oral Maxillofac Surg 2005;43:309-313). We subjected 34 patients to sinus lift operation, for a total of 47 sinus lifts, using natural coral as osteoconductive material. This material, combined with autologous platelet-rich plasma, was placed onto the maxillary sinus floor, after carefully lifting the endosteum. Cases were clinically, radiographically, and histologically analyzed. Histomorphometrical analysis, tests of microhardness, and x-ray microanalysis were conducted comparing the various sample to controls obtained from the same patients. Histomorphometrical analysis, microhardness test, and x-ray microanalysis demonstrated that the newly formed bone showed morphologic and structural characteristics that were similar for all the grafting materials compared (bovine bone, autologous bone, and coral). Although all the grafting materials did yield good results of maturation of the newly formed bone, best results were achieved using autologous bone.

Assessment of the sinus lift operation by magnetic resonance imaging

Objectives Vertical bone loss in edentulous maxillary alveolar processes may necessitate a sinus lift before the placement of dental implants. We have measured and assessed maxillary sinuses meticulously before the operation and evaluated the postoperative results of the operation with magnetic resonance imaging (MRI). Methods Thirteen edentulous maxillary regions in eight patients were included in the study. The patients were examined 1 week before and 3 months after the sinus lift operations using a 1.5 T superconductive MR imager that gave oblique sagittal T2-weighted images with slices 2 mm thick without a gap. Results The images that were obtained 3 months after the sinus lift operations confirmed that vertical height had increased. Conclusion We obtained high quality images without any artefacts during a short examination period with a high-resolution scanner. The results showed that it is possible to assess the maxillary sinus before the sinus lift and to evaluate the postoperative results using MRI accurately in three dimensions without the risk of radiation. This makes MRI a suitable alternative to computed tomography (CT).

Evaluation of the Success of β-Tricalciumphosphate and Deproteinized Bovine Bone in Maxillary Sinus Augmentation Using Histomorphometry: A Review

Sinus lift operations have become a prerequisite for implantologists in the rehabilitation of atrophic posterior maxilla. Alloplasts and xenografts are the recent innovation in the world of grafting materials and have evolved in such a way as to compensate the need for autografts to be used in conjunction. In order to perfect the grafting materials, histomorphometry is the most often tool used to study the success of the augmentation. This article has tried to commemorate the importance of histomorphometry in maxillary antroplasty and also the success rate of beta-tricalciumphosphate and deproteinized bovine bone as an augmentation material in maxillary augmentation.

The Effect of Cigarette Smoking on Dental Implants and Related Surgery

Cigarette smoking is still considered a common habit. Of smokers, increased plaque accumulation, higher incidence of gingivitis and periodontitis, higher rate of tooth loss, and increased resorption of the alveolar ridge have been found in the oral cavity. Cigarette smoking may adversely affect wound healing, and, thus, jeopardize the success of bone grafting and dental implantation. Bone grafts and sinus lift operations are both common and well-documented procedures before dental implant placement. Heat as well as toxic by-products of cigarette smoking, such as nicotine, carbon monoxide, and hydrogen cyanide, have been implicated as risk factors for impaired healing, and, thus, may affect the success and complications of those surgical procedures. An association among dental implants, grafting procedures (i.e., bone grafts, maxillary sinuses augmentation), and history of smoking has been reported. A higher degree of complication, or implant failure rates, were found in smokers with and without bone grafts. The relationship between cigarette smoking and implant-related surgical procedures, including the incidence of complications associated with these procedures, will be described and discussed based on relevant literature and results of our recent studies.

Smoking increased the risk of major complications of onlay bone graft

Original Article Levin L, Herzberg R, Dolev E, Schwartz-Arad D. Smoking and complications of onlay bone grafts and sinus lift operations. Int J Oral Maxillofac Implants 2004;19:369-73. Level of Evidence 2b Question Does smoking increase the risk of complications of onlay bone graft and sinus lift procedures? Source of Funding Information not available Type of Study/Design Retrospective cohort study

Outcome of 50 consecutive sinus lift operations

We report 50 patients who had sinus lift operations between 1995 and 1999 using different grafting materials [autologous bone, heterologous bone, and hydroxyapatite]. The casenote were analysed clinically (intraoperative and postoperative results and complications), radiographically (amount of augmented bone 6 months postoperatively), and histologically (quality of the new bone 12 months postoperatively). Our aim was to find out if the various bone grafting materials used resulted in different outcomes after adjustment for significant predictors. We found that hydroxyapatite was associated with the lowest rate of loss of grafted material (median, 2.4 mm) followed by the autologous bone from iliac crest (2.8 mm). Bovine bone shown the highest loss (3.3 mm).

Smoking and complications of onlay bone grafts and sinus lift operations

Purpose To compare the incidence of complications related to onlay bone grafts (OBGs) and sinus lift operations (SLOs) among smokers and nonsmokers. Materials and methods Data from 143 operations performed during the years 1995 to 2003 were analyzed. There were 64 OBGs and 79 SLOs. Patients were divided into 3 groups: nonsmokers, mild smokers (up to 10 cigarettes per day), and heavy smokers (more than 10 cigarettes per day). Duration of smoking (less or more than 10 years) was recorded. OBG complications were classified as minor (hematoma, swelling, inflammation, or temporary paresthesia) or major (graft exposure or mobility). For the SLO, perforations of the schneiderian membrane were the main intraoperative complication; postoperative complications mostly consisted of swelling, acute or chronic sinus infection, or bleeding. Results Of smokers having OBG, 50% experienced complications, compared to 23.1% of nonsmokers. Major complications were observed in one third of the smokers, compared to only 7.7% in nonsmokers. There was also a tendency toward complications in former smokers, although this relationship was not statistically significant. There was no relationship between SLO complications and smoking or a past smoking habit. Discussion In the present study, smokers demonstrated significantly higher postoperative complications following OBG operations. Smoking did not influence the results in the SLO group. There was no statistically significant difference between complications and past smoking. This finding indicates that the risk of complications can be reduced up to the normal nonsmoker complication rate when smoking ceases. Conclusions This study established a relationship between OBG complications and smoking in this patient population. A higher incidence of complications was found in the smoking group. There was no significant influence of smoking on SLO complications.— Reprinted with permission of Quintessence Publishing.

Literature Reviews

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Assessment of the sinus lift operation by magnetic resonance imaging

Sinus lift operations are done to increase bone thickness before placement of osseointegrated implants in areas of the maxilla where there is insufficient bone between the lower border of the maxillary sinus mucosa and the oral mucoperiosteum. Full sectional information should be available to the surgeon before the sinus lift operation so that the outcome can be predicted, and to allow for assessment of the volume of bone graft required. It is also useful to assess the success of the procedure before placement of the implant, and to choose the implant length and orientation required for maximum stability. We describe the use of a 0.2 tesla magnetic resonance imaging (MRI) scanner to image a patient before and after sinus lift. MRI gave full sectional information of the bone on both occasions without using ionizing radiation. The quality of the images was good, and should be considered as an alternative to the accepted gold standard of computed tomography (CT), which exposes the patient to a high dose of radiation.

Treatment planning for sinus lift augmentations through use of 3-dimensional milled models derived from computed tomography scans: A report of 3 cases

Objective. Three-dimensional models created by milling machines and stereolithography on the basis of 3-dimensional computed tomography scans have become essential in the diagnosis and therapy planning of oral and maxillofacial disorders. The purpose of this study, based on 3 clinical cases, was to examine the advantages of using 3-dimensional computed tomography scans and 3-dimensional milling models of the maxillary sinus before operative sinus elevation and of developing an operative layout with the aid of 3-dimensional models. Report Design. Three patients with atrophy of the maxillary alveolar ridge received computed tomography scans before operative sinus elevation with iliac bone transplants and simultaneous dental implantation. These computed tomography data were used to create 3-dimensional graphic and plastic reconstructions of the maxillary sinuses. Results. The 3-dimensional milling models enabled the development of an exact preoperative layout that took into consideration the exact shape of the iliac bone and the selection of dental screw implants. Furthermore, the models offered the possibility of producing an acrylic device for precise implant insertion. Precise planning resulted in good success with implantation 2 years after surgery. Conclusion. Three-dimensional diagnosis and treatment layout have become an acknowledged method of operative maxillary sinus floor augmentation combined with simultaneous dental implantation in the upper jaw in difficult cases of sinus lift operations. As far as transplant shape and sinus anatomy are concerned, this has resulted in greater intraoperative precision. A 1-step procedure can thus be performed for augmentation and implantation through use of a well-adapted block transplant and dental screw implants in patients with extensive alveolar ridge atrophy.