Sinus Augmentation Research Articles

A Novel Application of Dynamic Navigation System in Dental Implant with Simultaneous Sinus Lifting by Lateral Window Approach over Molars Area: A Case Series

A Novel Application of Dynamic Navigation System in Dental Implant with Simultaneous Sinus Lifting by Lateral Window Approach over Molars Area: A Case Series

Adjacent tooth migration after maxillary first molar loss in patients with sinus augmentation: A retrospective research.

The objectives of this study are to: (1) investigate the extent of antagonistic and distal neighboring tooth migration in the maxillary posterior single tooth-missing site during the healing period of bone augmentation and implant surgery; (2) identify factors associated with tooth migration. One hundred and forty-three cases that lost the maxillary first molar were included, and their CBCT data during the edentulous period were obtained. Dentition models were reconstructed from CBCT, and superimpositions were performed, followed by measuring migration distances and calculating migration rates of antagonistic and distal neighboring teeth. Factors were analyzed using multivariate generalized estimating equations (GEE). The mean migration distances were 208 ± 137 μm and 403 ± 605 μm for antagonistic teeth and distal teeth, and the mean migration rates were 26.8 ± 21.2 μm/month and 48.5 ± 76.7 μm/month, respectively. One hundred and nineteen out of 143 distal neighboring teeth migrated toward the edentulous site, and all antagonistic teeth migrated occlusally. Occlusal contact loss and chronic apical periodontitis both significantly accelerated antagonistic tooth migration (p < 0.05), the latter also accelerated distal tooth migration (p < 0.05). Besides, the displacement of the distal teeth was somewhat accelerated by the impacted adjacent third molar and root protrusion into the sinus. The neighboring teeth tend to migrate toward the edentulous gap in the maxillary posterior region. Occlusal contact loss and chronic apical periodontitis are two significant risk factors for accelerating antagonistic tooth migration, and for distal teeth, chronic apical periodontitis is the risk factor. The impacted adjacent third molar and root protrusion into the sinus are also potential risk factors for accelerating the migration of the maxillary distal tooth. Thus, to prevent maxillary edentulous gap reduction, the factors mentioned above should be taken into consideration when planning treatment flow.

The Effectiveness of the Addition of Platelet-Rich Fibrin to Bovine Xenografts in Sinus and Bone Ridge Augmentation: A Systematic Review.

Dental implants sometimes need bone augmentation to recreate an adequate bone height and volume. Numerous bone augmentation techniques have been described, and, currently, the most commonly used bone graft procedure is xenografts with deproteinized bovine bone mineral (DBBM). The addition of platelet-rich fibrin (PRF) to DBBM has already shown better performance than DBBM alone in restoring intrabony periodontal defects, but the role of PRF in preimplantation bone grafts is still not clear. The objective of this systematic review was to evaluate the efficacy of the adjunction of PRF or L-PRF to DBBM in bone ridge augmentation procedures. Clinical randomized controlled studies using PRF associated with DBBM were included. In April 2023, three electronic databases (PubMed, Cochrane, and Web of Science) were searched. The search strategy was performed according to PRISMA guidelines. The risk of bias assessments were performed using the Cochrane Collaboration tool. A total of seven articles were included and analyzed. The results show no statistically significant effect of PRF added to DBBM compared to DBBM alone in the sinus lift procedure but do show an effect in the reduction in bone graft resorption in one study of mandibular guided bone regeneration.

Analog-digital workflow for complex rehabilitation of severe maxillary atrophy with zygomatic implants: a clinical case

Patients with a complete lack of teeth, severe maxillary atrophy and midface deformity create the most unfavorable conditions for their rehabilitation according to traditional protocols, including bone grafting, sinus lifting and implantation, which forms a complex clinical challenge. Today, zygomatic implants are successfully used as an alternative option for rehabilitation of patients with severe upper jaw atrophy, allowing to reduce the volume of surgical interventions, as well as to shorten the rehabilitation period. Until now, the question of finding an optimal treatment protocol with the use of zygomatic implants remains relevant.&#x0D; We proposed an integrated protocol of rehabilitation of patients with severe maxillary atrophy, based on the use of analogue-digital diagnostic tools and treatment outcome planning, as well as including the stages of surgical and prosthetic treatment using the developed technology of zygomatic implant placement and immediate loading with prosthetic jaw prosthesis constructions.&#x0D; This work presents a clinical case of the patient (62 years old), whose rehabilitation was performed in accordance with her own protocol: preoperative digital planning according to computer tomography data (Blue Sky Bio Plan., USA), virtual modeling and manufacturing of surgical template for positioning four zygomatic implants (Nobel Biocare, USA), installation of zygomatic implants and immediate fixation of temporary dental prosthesis. Based on the results of follow-up examinations, including X-ray assessment of the zygomatic bones over a period of 6 years no complications were detected.

SinusC-Net for automatic classification of surgical plans for maxillary sinus augmentation using a 3D distance-guided network

The objective of this study was to automatically classify surgical plans for maxillary sinus floor augmentation in implant placement at the maxillary posterior edentulous region using a 3D distance-guided network on CBCT images. We applied a modified ABC classification method consisting of five surgical approaches for the deep learning model. The proposed deep learning model (SinusC-Net) consisted of two stages of detection and classification according to the modified classification method. In detection, five landmarks on CBCT images were automatically detected using a volumetric regression network; in classification, the CBCT images were automatically classified as to the five surgical approaches using a 3D distance-guided network. The mean MRE for landmark detection was 0.87 mm, and SDR for 2 mm or lower, 95.47%. The mean accuracy, sensitivity, specificity, and AUC for classification by the SinusC-Net were 0.97, 0.92, 0.98, and 0.95, respectively. The deep learning model using 3D distance-guidance demonstrated accurate detection of 3D anatomical landmarks, and automatic and accurate classification of surgical approaches for sinus floor augmentation in implant placement at the maxillary posterior edentulous region.

Graftless Sinus Augmentation via Crestal Sinus Floor Elevation using Densah Burs with Simultaneous Implant Placement: A Clinical Report after Two Years in Service

Maxillary sinus floor elevation is a reliable surgical procedure to establish oral rehabilitation using implant prostheses in the atrophic maxilla. Both lateral sinus floor elevation (LSFE) and crestal sinus floor elevation (CSFE) are viable to augment inadequate alveolar bone height. Still, the results of post-surgical trauma, complications, and patient-reported outcome measures (PROMs) vary. Furthermore, combining bone grafting for maxillary sinus augmentation (MSA) is suggested to increase the volume of the alveolar ridge, yet more researches have demonstrated outcomes of the graftless method. This clinical report describes a graftless sinus augmentation with simultaneous implant placement utilizing Densah burs implementing CSFE through the osseodensification method.

Risk factors contributing to early implant failure following sinus augmentation: A study of a challenging cohort.

Sinus augmentation has become a more predictable and successful procedure as the knowledge of its indications and complications increased. However, knowledge of risk factors leading to early implant failure (EIF) among challenging systemic and local conditions is insufficient. The present study aims to assess risk factors for EIF following sinus augmentation in a challenging cohort. A retrospective cohort study conducted during a period of 8 years in a tertiary referral centre providing surgical and dental health care. Implant and patient variables including age, ASA (American Society of Anesthesiology) physical status classification, smoking, residual alveolar bone, type of anaesthesia and EIF were collected. Cohort was comprised of 751 implants placed in 271 individuals. EIF rates at the implant and patient level were 6.3% and 12.5%, respectively. EIF was found to be higher among smokers (patient level: χ2 (1) = 8.74, p = .003), ASA 2 physical classification patients (patient level: χ2 (2) = 6.75, p = .03), sinuses augmented under general anaesthesia (patient level: χ2 (1)=8.97, p = .003), higher bone gain (implant level: W = 12 350, p = .004), lower residual alveolar bone height (implant level: W = 13 837, p = .001) and multiple implantations (patient level: W = 3016.5, p = 0.01). However, other variables such as age, gender, collagen membrane and implant's dimensions did not reach significance. Within the limits of the study, we can conclude that smoking, ASA 2 physical status classification, general anaesthesia, low residual alveolar bone height and numerous implants are risk factors for EIF following sinus augmentation in challenging cohorts.

Ngritja e dyshemesë së sinusit maxillar me teknikën e dritares laterale me ndihmën e pajisjes piezoelektrike

Piezo surgical devices are innovations in dental medicine. Their most frequent use is in oral surgery and dental im- plantology procedures. Manufacturers of these devices de- clare that they are minimally invasive and are recommend- ed for interventions where there is a risk of damage to anatomical structures. They are especially practical during maxillary sinus augmentation techniques to minimize pos- sible perforation the Schneider membrane during its ma- nipulation and lifting. The author of the article will describe his practice use the acteon – piezotome cube device.

Maxillary Sinus Elevation by Crestal Window: Influence of 3D Sinus Size on Bone Regeneration-A Retrospective Clinical and Histologic Evaluation.

This evaluation correlates maxillary sinus 3D morphology with bone regeneration. In 39 patients with crestal bone ≤ 2 mm, mineralized human bone allografts were used to augment the sinus floor through the crestal window sinus elevation approach. CBCT was used to measure the buccopalatal diameter (BPD), mesiodistal diameter (MDD), and hemi-ellipsoidal volume (Vh) in all sinuses. A bone core biopsy sample was taken at implant placement (4 to 5 months after sinus augmentation). Microradiographs of methacrylate-embedded sections were used to evaluate the amounts of bone, residual graft, and soft tissue. All 51 implants placed in the 39 patients successfully osseointegrated. A linear regression analysis showed that as BPD, MMD, and Vh increased, the amount of bone gain decreased and the amount of soft tissue increased (P < .05). The amount of residual graft was little affected by sinus morphology. Microradiographic data were grouped into four different sinus types (from small to great) using BPD and Vh medians. The best amount of bone formation was achieved in the narrow and short sinus type, while no great differences were found in the remaining three sinus types. Understanding of 3D sinus cavity morphology, especially the buccopalatal diameter and mesiodistal dimensions, is fundamental for achieving the best possible sinus augmentation outcomes.

Influence of implant protrusion length and initial bone height on intrasinus bone gain in transalveolar sinus floor elevation without bone graft: a 2-year retrospective study.

This retrospective cohort study was carried out on patients who had reported to the department of oral and maxillofacial surgery at Tishreen University between January 2020 and September 2022. The sample consisted of patients who had a transalveolar sinus lift with simultaneous dental implants placement. TSFE was performed using motorized threaded bone expanders. The IBH, the IPL, and the IBG height were analyzed using CBCT scans that were taken preoperatively and 6 months postoperatively. Statistical analysis was performed to assess the relationship of the IBG with the IPL and the IBH. The P values < 0.05 were considered to be statistically significant. A total of 34 implants were placed using motorized threaded bone expanders in 29 patients who were included in the study. Three membrane perforations were observed out of 34 procedures (8.82%). The survival rate for all implants was 100%. The mean IBH was 6.37±0.85mm, the mean IPL was 2.01±0.55mm, and the mean IBG was 1.69±0.44mm. A strong positive correlation was found between bone gain and IPL. No correlation was found between bone gain and IBH. According to the result of this study, the IPL is a critical factor in TSFE and dental implant placement simultaneously without bone graft procedures.

The Customized Alveolar Ridge-Splitting (CARS) Technique Combined with Guided Bone Regeneration or Sinus Elevation Augmentation in Maxillary Deficient Ridges.

Various techniques have been proposed to regenerate deficient ridges after tooth removal, including guided bone regeneration, block grafting, distraction osteogenesis, and ridge splitting. However, these procedures are technique-sensitive and often present complications which prevent reconstruction of the deficient ridge and implant placement. In an atrophic anterior or posterior maxilla, these techniques often fail to produce satisfactory long-term outcomes due to the poor bone quality, pneumatization of the maxillary sinus, and the highly cosmetic patient demands. The customized alveolar ridge-splitting (CARS) technique was introduced to improve outcomes and minimize the risk of complications. The synergistic combination of this technique with another augmentation procedure-including lateral window sinus augmentation and guided bone regeneration-allows implant placement into ridges with deficient bone volume both vertically and horizontally. This study presents two case reports that were successfully treated with the CARS technique and additional augmentation techniques to treat severely atrophic ridges in the anterior and posterior maxilla.

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.

Alveolar Ridge Preservation: A Review

A number of changes occur in the alveolar ridge following tooth extraction such as remodeling of bone in the alveolar ridge that can lead to loss of alveolar ridge width and height. Studies have shown that most of the changes occur in the first three months following teeth extraction. The goal of alveolar ridge preservation procedures is to maintain the dimensions of the extraction site, reduce significant loss of alveolar ridge and height and maintain adequate bone for dental implant placement. Alveolar ridge preservation also helps prevent the need for additional procedures prior to dental implants such as utilization of block grafting for ridge augmentation and sinus augmentation. It is indicated for both intact extraction sockets and extraction sites with significant damage to its walls. The goal of this article is to present two case reports on patient management for extraction sockets with damaged boney walls using Alveolar ridge preservation.

Management of Perioperative Pathologic Conditions Involving Maxillary Sinus for Dental Implant Placement and Sinus Augmentation: Report of Case Series and Literature Review

Management of Perioperative Pathologic Conditions Involving Maxillary Sinus for Dental Implant Placement and Sinus Augmentation: Report of Case Series and Literature Review

A systematic review of sinus floor augmentation complications. Does graft type influence the complications rate?

Background. Sinus floor elevation is considered a safe procedure to properly augment the height of the edentulous crest. Often, complications may arise due to multiple causes and can lead to a poor outcome of the graft and implant’s osseointegration. A careful surgical approach, a good knowledge of possible obstacles, and careful treatment planning can reduce the risks of complications, as well as their impact on the surgical outcome. This study aims to make a literature review of 40 articles, analyzing the incidence and type of complications related to maxillary sinus graft surgeries and graft materials. Material and methods. A total of 40 articles published between 2015 and 2021 were selected for a systematic literature review on maxillary sinus floor complications. The studies were selected from 2 different internet databases: PubMed and Science Direct. The sinus lift complications were counted and their incidence was organized upon the surgical technique and the timing of occurrence (intraoperative, postoperative). It was also analyzed if the graft material influences the complication rate. Results. In a group of 1757 sinus augmentation surgeries performed on 1605 patients, 363 complications were found. Sinus membrane perforation occurred in 242 cases, 29 procedures resulted in partial or total graft loss, there were 26 postoperative cases of sinusitis, 24 sinus infections, 16 wound dehiscence, 6 bleeding complications, 5 lost implants, and 2 oro-antral fistulas. Conclusion. Sinus lift complications are sometimes inherent circumstances of the procedures, but they can also be prevented through an accurate technique and preoperative plan. The type of bone graft does not influence the incidence of surgical complications.

Biomechanical Performance of a Novel Implant Design in Simulated Extraction Sites and Sinuslift Procedures

With increasing experience and in an attempt to shorten overall treatment times, implant placement in combination with tooth extractions and sinus lift procedures has become popular. In both cases, primary stability has to be achieved by either engaging apical and oral regions of trabecular bone or by engaging residual host bone beneath the sinus cavity. Extraction sites were formed by pressing a root analog into homogeneous low density polyurethane foam which was used as bone surrogate while a 3 mm thick sheet of medium density foam was used for mimicking a sinus lift situation. Two types (n = 10) of bone level implants with a conventional tapered design and a cervical back taper (NobelActive; control) and a novel design characterized by a shift in core diameter and thread geometry (AlfaGate; test) were placed in these models following conventional osteotomy preparation. Insertion torque was measured using a surgical motor and primary stability was determined by resonance frequency analysis. Statistical analysis was based on Welch two sample t tests with the level of significance set at α = 0.05. In sinuslifting, NobelActive implants required significantly higher insertion torques as compared to AlfaGate (p = 0.000) but did not achieve greater implant stability (p = 0.076). In extraction sites, AlfaGate implants showed both, significantly higher insertion torques (p = 0.004) and significantly greater implant stability (p = 0.000). The novel implant design allowed for greater primary stability when being placed in simulated extraction sockets and sinuslift situations. While in extraction sockets the position of condensing threads in combination with an increase in core diameter is beneficial, the deep cervical threads of the novel implant lead to superior performance in sinuslift situations.

From Synthesis to Clinical Trial: Novel Bioinductive Calcium Deficient HA/β-TCP Bone Grafting Nanomaterial.

Maxillary sinus augmentation is a commonly used procedure for the placement of dental implants. However, the use of natural and synthetic materials in this procedure has resulted in postoperative complications ranging from 12% to 38%. To address this issue, we developed a novel calcium deficient HA/β-TCP bone grafting nanomaterial using a two-step synthesis method with appropriate structural and chemical parameters for sinus lifting applications. We demonstrated that our nanomaterial exhibits high biocompatibility, enhances cell proliferation, and stimulates collagen expression. Furthermore, the degradation of β-TCP in our nanomaterial promotes blood clot formation, which supports cell aggregation and new bone growth. In a clinical trial involving eight cases, we observed the formation of compact bone tissue 8 months after the operation, allowing for the successful installation of dental implants without any early postoperative complications. Our results suggest that our novel bone grafting nanomaterial has the potential to improve the success rate of maxillary sinus augmentation procedures.

Transsinusoidal lateral nasal floor augmentation for implant placement in the atrophic premaxilla: A within-patient, 5-year, prospective comparative study.

To evaluate the clinical outcome for implants placed with transsinusoidal-lateral nasal cavity augmentation (NA) compared to implants placed in maxillary sinus augmentation (SA). In 28 atrophic edentulous maxillary regions (14 patients bi-maxillary), a lateral window approach was used to perform transsinusoidal-lateral NA (TSLNA) combined with maxillary SA. After healing period of about 6 months, each patient received bimaxillary one anterior implant located in the pre-maxilla having lateral NA and 2-3 implants in the maxillary posterior region with SA. In a prospective follow-up evaluation, clinical implant outcome (survival/success rates) and peri-implant health (mucositis/peri-implantitis) were assessed and compared between implants placed in TSLNA (n = 28) and SA (n = 58). At the year-1, year-3, and year-5 evaluation, neither patient-based nor implant-based comparisons revealed differences for marginal bone level reduction between implants placed in TSLNA (5-year overall: 1.11 ± 0.26 mm) and SA (5-year overall: 1.07 ± 0.30 mm), although with a significant (p < .001) continuous reduction over the observation time. At the year-5 evaluation, all implants (n = 86) and restorations (n = 14) were still in situ (survival 100%) and showed an implant-based incidence of peri-implant mucositis/peri-implantitis of 14.3%/0% in TSLNA and 6.9%/3.4% in SA corresponding to 21.4%/0% and 28.6%/7.1% for implant-based evaluation. In addition, the implant success rate did not differ between NA and SA at implant- (100%/ 98.8%) and patient-based (100%/97.6%) evaluation. The findings obtained show TSLNA as an effective method for implant placement of adequate length and direction in the atrophic premaxilla providing for success rates comparable to those of implants placed in SA.

Retrospective analysis of three different xenografts in maxillary sinus augmentation: histologic and three-dimensional radiologic study.

Low bone density and lack of adequate vertical bone dimension as a result of maxillary sinus pneumatization present some of the most problematic cases for endosseous implant applications in posterior maxillary regions that hinder prosthetic rehabilitation; Objectives: The overall objectives of the study were to assess the histologic, histomorphometric and radiological evaluation of biopsies gathered from maxillary sinuses which were grafted with three different bovine bone particles (Bio-Oss®, Cerabone® and Ti-Oss®) and analyze the volume of the bone graft and the quantity of new bone formation; Methods and materials: Thirty-six patients with <4mm of residual ridge height unilaterally in the posterior maxilla, were equally divided into 3 groups, each of which received different bovine bone particles for maxillary sinus augmentation. Six-months later, biopsies were harvested for histological and histomorphometric evaluations. Volumetric changes in maxillary sinus augmentation were analyzed at 1-week (T-I) and 6-months (T-II) time points following maxillary sinus augmentation surgery; Results: Histomorphometric and histological analysis revealed significant difference between Ti-Oss® group compared with Bio-Oss® and Cerabone® groups (P=0.011). In term of residual graft particles and soft tissue, there were no significant differences between groups. 3-D volumetric reductions between 1-week (baseline) and 6-month time points recorded significant graft volume reduction in all groups (P<0.05). Significantly greater bone resorption and lower new-bone formation were manifested in Ti-Oss® group in comparison to the other groups; Conclusions: Within the limits of this study, histological and radiological results indicated that, Bio-Oss® and Cerabone® could be used efficiently in sinus augmentation procedures, while further prospective studies are needed to evaluate the Ti-Oss® material in maxillary sinus augmentation.

Sinus Augmentation with Simultaneous Implant Placement in Infected Maxillary Sinuses after Cyst Drainage: A Case Report with 2 years Follow-up

Sinus Augmentation with Simultaneous Implant Placement in Infected Maxillary Sinuses after Cyst Drainage: A Case Report with 2 years Follow-up