Sinus Augmentation Research Articles

Implant failure rate and the prevalence of associated risk factors: a 6-year retrospective observational survey

Introduction:The purpose of this monocentric retrospective observational investigation is to evaluate the implant failure rate observed in an oral surgery department and analyze the risk factors associated with them. Preventative measures will be suggested to reduce the incidence of implant failure.Material and method:All implants removed between 2014 and 2020 were analyzed. The main criterion assessed was the overall failure rate over 6 years of activity;the secondary criteria were the risk factors associated with implant failure.Results:12 out of 376 implants placed between 2014 and 2019 in 11 patients (mean age: 55.5 ±11.5 years);sex ratio M/F=5/6) were removed, for an overall failure rate of 3.11%. The majority, 83% (10/12) of the lost implants, were in the maxilla, while only 17% (2/12) were placed in the mandible. The main risk factors identified were: a III−IV bone type density (75%, 9/12), pre-implant sinus lift surgery (42%, 5/12) smoking (8.3%, 1/12), surgical site infection (8.3%, 1/12) and rheumatoid arthritis (8.3%, 1/12).Conclusion:The failure rate observed in this oral surgery unit is consistent with the other international studies, confirming the compliance with good clinical practices of the healthcare team. Pre-implant bone surgery is the major risk factor to consider before implant surgery.

Rehabilitation of atrophic posterior partial edentulous maxilla with TTPHIL ALL TILT® technique: 3 year follow-up case report

Maxillary sinus pneumatisation pose a grave clinical challenge for implant fixed rehabilitation in posteriormaxilla owing to diminished bone volume. This necessitates sinus lift and grafting which increase the durationand cost and possible surgical complications. Pterygoid implant has a greater short term osseointegration and isa proven treatment method for rehabilitation of highly resorbed posterior maxilla. To overcome the limitationsof sinus grafting techniques, the current case report describes the use of flapless, tilted and pterygoid implantfor restoration of partially edentulous atrophic maxilla eliminating grafting. KEYWORDSDental Implants; Immediate Dental Implant Loading; Jaw Edentulous Partially; Surgery Computer-Assisted;Case Reports.

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.

Piezosurgery - Safe and Reliable Method for Direct Sinus Lift

Piezosurgery is an alternative technique over conventional oral surgical procedure which is gained popularity in the field of dentistry. It offers a minimally invasive technique that reduces the risk of damage to soft tissues and important structures such as nerves, blood vessels, and the mucosa. This device is being used in osteotomies, periodontology and implantology, oral surgical procedures and in sinus augmentation procedures. The most important features of Piezosurgery include the selective cutting of bone depending on bone mineralization, without damaging the adjacent soft tissue (e.g. vessels, nerves or mucosa), providing a clear visibility in the operating field, and cutting with sensitivity without the generation of heat. This case report illustrates its use in the direct sinus lift procedure.

口腔インプラント治療による上顎洞炎の治療

Two hypotheses have been proposed for the pathogenesis of maxillary sinusitis caused by dental implant placement and/or maxillary sinus augmentation surgery.

Long-Term Human Histologic Evaluation of Sinus Bone Augmentation and Simultaneous Implant Placement.

This study aimed to histologically and histomorphometrically evaluate osseointegration following simultaneous implant placement and maxillary sinus augmentation. Three retrospective human cases are described in which implants were placed at the maxillary sinus site augmented with deproteinized bovine bone mineral (DBBM) and later retrieved due to implant fracture after 5 to 8 years of occlusal loading. The removed implants with bone were processed for histologic evaluation, and bone-to-implant contact (BIC), bone area (BA), and mirror-image bone area (MIBA) were measured. Mature lamella bone was mainly observed, and some unabsorbed grafted bone particles remained in all cases. The measured values of BIC, BA, and MIBA in the three consecutive threads with the highest values were 86.0% to 91.2%, 65.8% to 91.9%, and 73.0% to 90.4%, respectively, and there were no signs of inflammation. Within the limits of this study, these cases demonstrate successful bone formation after maxillary sinus bone augmentation with DBBM and simultaneous implant placement.

Retrospective Analysis of Risk Factors Related Implant Loss in Patients with Maxillary Sinus Augmentation and Simultaneous Implant Placement

Retrospective Analysis of Risk Factors Related Implant Loss in Patients with Maxillary Sinus Augmentation and Simultaneous Implant Placement

Two-Year Follow-up Comparison of Three Surgical Techniques for Implant Placement in Posterior Maxilla with Limited Alveolar Bone Height.

The aim of this pilot study was to compare three surgical techniques (bicortical fixation, unicortical fixation, and indirect sinus elevation) for implant placement in the posterior maxilla with limited alveolar bone height. This 2-year follow-up assessment on the implants of a previously published prospective clinical trial compared (1) restoration/implant stability among the three surgical groups, (2) intrasinus bone formation between the bicortical fixation and indirect sinus elevation groups, and (3) implant and prosthetic complications reported among the three groups. For the original prospective study, 38 patients were recruited, exhibiting 7 to 11 mm of alveolar bone coronal to the sinus floor as confirmed by preoperative CBCT, and 45 implants were placed using three randomly assigned surgical techniques. No patient received more than two implants, which were placed in opposite sides of the maxilla and using different surgical techniques. At the 2-year follow-up assessment, 32 patients with 37 implants were evaluated. The 2-year follow-up restoration/implant stability was measured with the Periotest stability measuring device. Intrasinus bone formation was measured from the 2-year follow-up CBCT in comparison to the preoperative CBCT. Clinical examination was also performed to identify loose implants and/or implant crowns and signs of peri-implantitis. Patients were interviewed regarding complications experienced with the study implants/restorations, and electronic charts were thoroughly reviewed to identify records of complications. No significant difference in restoration/implant stability (Periotest value [PTV]) was seen between the bicortical fixation, unicortical fixation, and indirect sinus elevation groups (-1.69 [0.80], -1.76 [0.80], -2.22 [0.60], respectively, P = .76) at the 2-year follow-up. The indirect sinus elevation group showed more intrasinus horizontal (1.99 [0.17] vs 1.47 [0.16] mm, P = .03) and vertical (3.15 [0.43] vs 2.35 [0.38] mm, P = .13) bone gain compared with the bicortical fixation group. Within the limitations of this study, placing implants using a bicortical fixation surgical technique in moderately limited alveolar bone height (7 to 11 mm) was not significantly different from the other two techniques and may be a feasible option with limited risks while allowing longer implant placement and negating the need for indirect sinus augmentation, which is accompanied by additional expense and surgical morbidity to the patient.

Geriatrik Hasta Popülasyonunda Ciddi Atrofik Posterior Maksillaya Dental İmplant Yerleştirmesini Takiben Trombositten Zengin Fibrin ve Allojenik Kemik Grefti Karışımı Kullanılarak Yapılan Sinüs Tabanı Ögmentasyonunun Hacimsel Değerlendirmesi Kohort Araştırması (Retrospektif)

Objective: We aimed to retrospectively evaluate the volume of new bone formed following sinus floor augmentation with simultaneous dental implant placement in severely atrophied residual alveolar ridges using a combination of platelet-rich fibrin and demineralized cortico-cancellous bone allograft in a geriatric population. Material and Methods: The clinical and radiological data of patients who underwent sinus floor augmentation using a combination of platelet-rich fibrin and demineralized cortico-cancellous bone allograft with simultaneous dental implant placement between 01 April 2013 and 01 August 2020 were retrieved from the archives. The main inclusion criteria for the study were age >60 years and a residual ridge height <2 mm. For each patient, cone-beam computed tomography (CBCT) scans were performed preoperatively, and 6 months after surgery. The volume of the maxillary sinus cavity preoperatively and postoperatively was measured using CBCT. The volume of the newly regenerated bone was calculated by subtracting the post-operative total sinus volume from the pre-operative total sinus volume. Residual and postoperative ridge heights were measured on the mid-coronal and mid-sagittal sections of preoperative and postoperative cone beam computed tomography images, respectively. Results: Fourteen patients with 19 sinus augmentations were included in the study. Thirty-two dental implants were placed with simultaneous sinus floor augmentation. All cases showed new bone formation on axial, coronal, and sagittal sections of postoperative CBCT scans. Conclusion: The combination of plateletrich fibrin and demineralized cortico-cancellous bone allograft used in sinus flor augmentation may promote the formation of healthy new bone that supports the simultaneous placement of dental implants in the elderly population with severely atrophic alveolar ridges.

上顎洞底挙上術による上顎洞炎の病態と治療

上顎洞底挙上術による上顎洞炎の病態と治療

Subantral sinus augmentation using a hydraulic lift system and alloplastic phosphosilicate putty followed by simultaneous implant placement for the rehabilitation of an atrophic posterior maxilla: A case report

Tooth extraction is generally accompanied by bone remodeling and pneumatization of the maxillary sinus in the posterior region of the maxilla, which can result in a reduction in the height and width of the bone and compromise the placement of the implant. However, this anatomic deficiency can be restored via maxillary sinus elevation. Read more JCTRes.com

Application of a Cone-Beam Computed Tomography-Based Index for Evaluating Surgical Sites Prior to Sinus Lift Procedures-A Pilot Study.

Objectives Radiography-based indices can help surgeons perform detailed examinations of the surgical site and predict the surgical difficulty of cases. We aimed to develop and validate a novel CBCT-based index that can predict the surgical difficulty of sinus-augmentation procedures. Materials and Methods In the first stage, five experienced dental specialists performed a review of the literature and closed group discussions and designed the novel index. In the next stage, the index was validated. CBCT scans of 30 patients scheduled for sinus-augmentation procedures were evaluated and assigned presurgical CBCT evaluation scores (PSCESs) by five examiners. Subsequently, one oral surgeon performed sinus augmentation using the lateral antrostomy technique and assigned surgical difficulty scores (SDSs) to each of the 30 cases along with 2 observers. The PSCESs and SDSs were statistically analysed to determine the interrater reliability and validity of the index. Results The interrater agreement of the PSCES among the five presurgical evaluators was 0.85. The PSCES of the five evaluators had highly significant correlation (P < 0.001, r = 0.68 to 0.76) with the SDS. Regression analysis revealed that for every unit increase in the PSCES, there is 0.46 to 0.57 increase in the SDS value. Conclusion The results of this pilot study revealed that a novel CBCT-based index can be used as a reliable tool for predicting the surgical difficulty of sinus-augmentation procedures. However, the novel index needs to be tested on a larger sample of patients and evaluators for a more concrete validity and reliability.

Maxillary sinus lift using osteotomes: An indirect approach for implant placement in atrophic posterior maxilla

The maxillary posterior edentulous region presents many challenges in implant dentistry. Deficient alveolar ridges often jeopardize the placement of implants in posterior maxilla. This problem mostly occurs when due to ridge resorption, sinus pneumatization is encountered. The procedure of choice is the elevation of the floor of the sinus with the use of the osteotome technique so as to increase the alveolar ridge height for the placement of implant. The purpose of this case report is to demonstrate indirect maxillary sinus lift procedure through alveolar crest using osteotomes to prevent perforation of sinus lining during implant placement and restoring the implants using early loading protocol.

Prevalence and Location of Maxillary Sinus Septum and its Relation to Maxillary Sinusitis

Introduction: Maxillary sinus septum is an anatomical variation in the maxillary sinus. Sinus septum is also an important anatomical structure that complicates sinus lift procedure during dental implant placement. Objectives: To assess the prevalence and location of maxillary sinus septa and its relation to maxillary sinusitis using cone beam computed tomography (CBCT scan). Methods: An analytical cross-sectional study was conducted at the Department of Periodontics and Department of Oral Medicine and Radiology, Kantipur Dental College, Kathmandu, Nepal during July 2019 to June 2020 after ethical clearance. In total, 110 subjects and 220 maxillary sinuses were included in the study for evaluation by convenience sampling. The presence of septa, their location and association with maxillary sinusitis were evaluated. Data was analysed using SPSS software with Statistical level set at P&lt;0.05 for significance. Results: The prevalence of maxillary sinus septa in this study was 54 (49.09%). Statistically significant association was found between sinus septa with maxillary sinusitis (p=0.038) and location of septum in the arch (p=0.001). Conclusion: Presence and distribution of maxillary sinus septa is important in planning sinus surgeries and placement of implant in maxillary posterior region.

USE OF OSTEOPLASTIC MATERIALS TO RESTORE BONE DEFECTS FOLLOWING THE SURGICAL TREATMENT

In recent years, the number of dental surgical operations has been growing rapidly worldwide, and clinicians are facing pressing issue to select and apply osteoplastic materials, which would promote rapid repair of jaw bone defects and relieve symptoms during the post-operative period. With the advancements in the field of dentoalveolar reconstruction, it is of great importance to develop the material for bone restoration, which by its properties would be identical to autologous bone. The aim of this study is to analyze the effectiveness of osteoplastic materials used for the augmentation following sinus lift, tooth socket preservation, osteosynthesis of mandibular fractures and extraction of impacted third molars. 280 people aged from 18 to 55 with partial or complete adentia and atrophy of the alveolar arch of the jaws, with chronic periapical infection, chronic generalized periodontitis, fractures and impacted third molars were examined at the Department of Surgical Dentistry and Maxillofacial Surgery of the Chernivtsi Regional Clinical Hospital. All patients were planned to undergo prosthodontic treatment assisted by dental implants. The study has demonstrated that the patients of subgroups B of all groups of the study, where the augmentation of bone defects was performed using a combination of osteoplastic material «Colapan-L» containing multipotent mesenchymal stem cells of adipose tissue and platelet-rich plasma presented alleviating clinical symptoms including pain, collateral oedema, hyperaemia of the oral mucosa and better bone regeneration at the site of surgery, compared with subgroups A, where the augmentation was performed with osteoplastic material «Colapan-L», and sub-groups B, whose healing followed by blood clot forming. The use of osteoplastic materials containing multipotent mesenchymal stem cells of adipose tissue during dental operations improves the regenerative and reparative properties of bone tissue, facilitates the postoperative period and reduces the duration of inpatient treatment period.

Autologous Tooth Dentin Graft: A Retrospective Study in Humans.

Background and Objectives: The aim of this study is to evaluate the efficacy of an autologous dentin graft, via extracted teeth that are processed into bacteria-free particulate dentin in a Smart dentin grinder and then grafted immediately into alveolus post extraction or into bone deficiencies. Materials and Methods: Ten healthy, partially edentulous patients with some teeth in the mandible were recruited in the study. After their own teeth were grinded, particulate teeth were placed in empty sockets and bone defects after teeth extractions. Furthermore, after three, six, 12 and 24 months, core samples using a 3 mm trephine were obtained. Results: At three months, the particles of grinded tooth were immersed inside a new connective tissue with a small new bone formation (16.3 ± 1.98). At six months, we observed small particles of dentin integrated in new immature bone, without inflammation in the soft tissue (41.1 ± 0.76). At twelve months, we observed a high amount of bone formation surrounding tooth particles (54.5 ± 0.24), and at twenty-four months, new bone, a big structure of bone, was observed with dentin particles (59.4 ± 1.23), statistically different when compared it with at three months. Conclusions: A particulate dentin graft should be considered as an alternative material for sockets’ preservation, split technique, and also for sinus lifting. One of the special characteristics after 24 months of evaluation was the high resorption rate and bone replacement without inflammation. This material could be considered as an acceptable biomaterial for different bone defects due to its osteoinductive and osteoconductive properties

Comparative Efficacy of Osteotome vs CAS Kit Assisted Indirect Maxillary Sinus Lift and Immediate Implant Placement in Posterior Atrophic Maxilla – A Study Protocol

Background: In today’s era implants are mostly used for replacing missing teeth. The greatest challenge for placing an implant is posterior maxillary teeth where the problems arise due to presence of maxillary sinus due which increases the risk of perforating the sinus membrane while implanting. In literature there are many techniques to overcome these problems and place the implant without perforating the sinus membrane. The current study is conducted to check either the traditional technique osteotome or modern technique CAS-Kit is better for placing an implant in posterior maxillary region.&#x0D; Objectives: The aim of these study is to compare and evaluate clinical and radiological outcomes of conventional osteotome technique and CAS kit use for indirect sinus lifting in atrophic posterior maxilla.&#x0D; Methodology: Two groups (study &amp; control) with 20 individuals requiring implant prosthesis in atrophic posterior maxillary region with RBH &lt; 3mm and minimum crestal width of 6mm are considered for the study model. After completion of osteotome and sinus lift procedure, integrity of sinus membrane will be checked by Valsalva manoeuvre. At three months after implant placement a second step surgery will be performed, stability of each implant will be checked. Marginal bone loss and amount of bone generation will be checked on Cone-beam computed tomography systems (CBCT) at 3, 6 &amp; 9 month interval.&#x0D; Expected Results: CAS kit is relatively newer and advanced equipment which is safer in placing implant in posterior atrophic maxilla without perforating sinus membrane with good amount of bone generation and stability of implant. with minimal marginal bone loss.&#x0D; Conclusion: Placement of an implant with CAS-Kit is better option than performing osteotome procedure which is time consumable with high chance of membrane perforation and large amount of marginal bone loss.

Shape-Memory ECM-Mimicking Heparin-Modified Nanofibrous Gelatin Scaffold for Enhanced Bone Regeneration in Sinus Augmentation.

Biomaterials with clinical maneuverability and predictable bone regeneration are needed in the field of maxillary sinus augmentation. Herein, gelatin was chemically modified with heparin that specifically interacted with and stabilized bone morphogenetic protein-2 (BMP-2). We then introduced thermally induced phase separation to form the injectable, shape-memory, highly porous scaffold for bone regeneration in sinus augmentation. The hydrated heparin-modified nanofibrous gelatin scaffolds (NH-GS) were demonstrated with high resilience and shape-memory property, both macroscopically and microscopically, making them injectable scaffolds and expected to be applied in sinus augmentation. This novel scaffold was verified to be biocompatible and an excellent matrix to support cell attachment, proliferation, and infiltration. Further, the growth factor-loaded NH-GS showed sustained release kinetics of BMP-2 through affinity-based scaffold-growth factor interaction, compared with BMP-2 loaded gelatin sponge (GS) and nanofibrous gelatin scaffold (NF). Both in vitro and in vivo experiments demonstrated that the BMP-2-loaded NH-GS exhibited the highest osteogenesis among the other groups. Taken together, this study introduces a new regenerative strategy in maxillary sinus augmentation, which is injectable with a predefined shape and structure and promotes bone regeneration through a more sustained BMP-2 release.

Sinus Mucosa Thinning and Perforations after Sinus Lifting Performed with Different Xenografts: A Histological Analysis in Rabbits

Background: Experimental studies have shown a progressive thinning and perforations of the sinus mucosa associated with sharpened edges and the cutting projections of graft particles used simultaneously for maxillary sinus augmentation. Hence, the aim of the present study was to evaluate the damaging effects of two different bovine grafts on the sinus mucosa after sinus augmentation. Methods: Twenty New Zealand rabbits received a bilateral sinus lifting using, as fillers, two different types of deproteinized bovine bone in granules, one processed at low temperature (low-T group), and the other at high temperature (high-T group). Thinned mucosa sites (<40 µm) and perforations were evaluated in the sinus mucosa that were in contact with graft granules after 2 and 10 weeks, in ten animals per period. Results: After 2 weeks of healing, the number of thinned mucosa sites was 118 in the low-T group, and 149 in the high-T group (p = 0.191). At the 10-week assessment, the thinned sites increased to 237 and 195 sites, respectively. The numbers of sinus mucosa perforations after 2 weeks were eight and three in the low-T and high-T group, respectively. At the 10-week evaluation, the perforations increased to 19 in the low-T group, and to 14 in the high-T group. Conclusions: The contact with bovine xenografts yielded thinning and perforations of the sinus mucosa. Despite the differences in characteristics and dimensions, no differences were found between the two xenografts in the numbers of thinning mucosa sites and perforations. However, a trend of more events was found in the low-T compared to the high-T group.

One- stage indirect sinus augmentation: A Clinical Report

The success of implant therapy depends upon proper case selection, executed with good surgical protocol and proven by radiographic and functional outcome. This clinical report presents successful outcome of one- stage indirect sinus augmentation technique using osteotomes.&#x0D;