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ABSTRACT Aim Materials and Methods Results Conclusion Technology improvement and a better understanding of sinus anatomy and wound healing in the past decade have allowed the development of minimally invasive surgical techniques. This systematic review focused on identifying and describing these techniques for vertical and lateral sinus augmentation (VSA and LSA).Electronic and hand search were conducted to screen the literature published from January 2003 to May 2024. The selected studies had to include detailed techniques for minimally invasive SA. Data extraction included the study types, sample size, technique/instrument details, and outcome measurements.A total of 36 articles (27 VSA, 8 LSA with an additional 1 article included both procedures) with 2732 sinus augmentation met the inclusion criteria. Minimally invasive VSA includes the use of modified rotary instruments with stopper, balloon, hydraulic pressure, digital planning, endoscope, and operating microscope. These techniques aim for conservative flap reflection, precise sinus window preparation, and/or controlled sinus membrane elevation. Most of the selected studies (n = 15) did not report the incidence of sinus membrane perforation.Within the limitations of this review, minimally invasive VSA and LSA achieved sufficient sinus augmentation and implant success with the potential advantages of reduced surgical complications and morbidity. Comparative studies with defined outcomes are encouraged to further validate these useful minimally invasive techniques for SA. [ABSTRACT FROM AUTHOR]

The article provides an evidence-based review of different bone grafting materials used in sinus floor elevation procedures, including autologous bone, bovine bone, and allografts. It discusses the clinical outcomes and recommendations based on systematic reviews and meta-analyses. The text emphasizes the importance of biomaterial selection and formulation for optimal outcomes in dental implant treatment. It also covers topics such as the use of platelet-rich fibrin and the impact of residual bone height on implant placement in the sinus area. This comprehensive review offers valuable insights for dental professionals and researchers in the field of oral implantology. [Extracted from the article]

Introduction: Different protocols and procedures for sinus lift and implant placement are available, generally involving the use of grafts to increase the tissue volume and/or prevent the Schneiderian membrane from collapsing. Among xenografts, deproteinised bovine bone graft (DBBP) is frequently used in sinus lift procedures. Leaving an ungrafted space following membrane elevation has proven to have a bony regenerative potential as well. This study aimed to compare the clinical and histological features of sinus lift surgery performed with or without biomaterials. Methods: Patients with severe maxillary posterior atrophy (residual bone height 2–6 mm and residual crest thickness ≥4 mm), and in need of sinus lift surgery to allow the placement of three implants were enrolled and randomly divided into two groups. They underwent sinus lifts with DBBP (control) or with a graftless technique (test) and immediate placement of two implants (a mesial and distal one). After 6 months, a bone sample was retrieved from the area between the previously inserted fixtures, and a third, central implant was placed. The collected bone samples were analyzed morphologically and histomorphometrically. The patients were provided with prosthetic restorations after 6 months and followed up for 5–12 years. Results: Ten patients were enrolled in the test and nine in the control group. The 6‐month follow‐up showed in the control group an average augmentation of 10.31 mm (±2.12), while in the test group it was 8.5 mm (±1.41) and a success rate of 96.3% in the control and 86.7% in the test group (p > 0.05). The histological analysis evidenced the presence of new bone tissue surrounded by immature osteoid matrix in the test group, and a variable number of DBBP particles surrounded by an immature woven bone matrix in the control group. Conclusion: The results of the present trial indicate that, with residual bone height of 2–6 mm and residual crest thickness ≥4 mm, sinus lift surgery with or without biomaterials followed by implant restoration, produces similar clinical and histological outcomes. [ABSTRACT FROM AUTHOR]

Objectives: A mucous retention cyst is a common, asymptomatic lesion that may cause complications during or after the sinus lift procedure. The goal of this study is to assess the effectiveness of the Croco Eye Technique (CET), which allows simultaneous excision of the cyst and sinus floor elevation. Methods: The technique was thoroughly described in two versions, and the group of 33 patients was analyzed. Patients who qualified for this procedure had insufficient alveolar ridge height, and their CBCT showed radiological images typical for retention cysts. Analyzed parameters included the version of CET, demographic data, anatomical parameters, intraoperative complications, recurrence of the cyst, success rate of the sinus lift and implants, and the follow-up period. Results: Out of the 33 cases, 9 were of the primary version (27.27%) and 24 of the final version (72.73%). The average height of a retention cyst was 24.05 mm, with the average alveolar ridge height of 1.86 mm. In three cases (9.09%), implants were placed immediately. The prevalence of uncontrolled Schneiderian membrane perforation was reduced from 55.56% to 4.17% between the primary and final versions. The cyst's recurrence rate was 3.13%. The implant survival rate was 100%. The mean follow-up period was 48.625 months (max 110 months). Conclusions: The Croco Eye Technique, despite the perforation of the Schneiderian membrane, enables successful sinus lift and implantation with a success rate of 100%. Excision of the retention cyst, which is the cause of perforation, allows for limiting the risk of the cyst's recurrence. [ABSTRACT FROM AUTHOR]

Maxillary lateral sinus floor elevation, or external sinus lift, is a widespread surgical intervention in the dental field. Insertion of implants in the posterior region of the maxilla often requires reconstruction of the remaining native bone that has insufficient volume. Background and aims. Much of the research published involves using artificial products, like xenografts and resorbable collagen membranes, after a prior Cone Beam Computer Tomography (CBCT) investigation. Nowadays, more accessible access, less financial costs, a biological approach, and faster healing are objectives that surround this procedure. Leucocytes and platelets rich in Fibrin (L-PRF) are a natural component with a high concentration of growth factors. Due to its regenerative properties and lack of complications, it is used in several medical fields, like orthopedics, dermatology, and oral surgery. This retrospective study aims to compare results in bone height and volume obtained through external sinus lift, either by using xenografts or autologous plasma rich in fibrin, by evaluating the quantity of new bone formation from a radiological point of view. Methods. Fifty-eight Caucasian patients were included in this retrospective study; 48 were submitted to xenograft procedure, and 10 were selected for L-PRF grafting material with simultaneous implant placement. Lack of clinical and histological studies performed on patients with L-PRF surgeries limited us in choosing a larger group for the radiological analysis. CBCT evaluation was performed before surgery and 6 months after. All patients selected for the study presented good general and oral health, acute oral and sinus infections excluded; smoking and periodontal disease were also criteria of exclusion. Two operators performed the measurements in pre-established landmarks in different time frames. The two independent groups were compared with the Wilcoxon rank-sum test for quantitative data. Qualitative characteristics were described as counts and percentages. All analyses were performed in an R environment for statistical computing and graphics. Results. Mean bone height gain in the xenograft group in the regions was as follows: 7.44 for the anterior landmark, 12.14 for the median and 8.28 for the distal. The mean group height gained for the L-PRF group was 0.1 anteriorly, -0.18 for the median measurement, and 0.23 distally. We obtained excellent overall reliability for all the height measurements between the two operators. Conclusions. Further studies must be conducted to establish new sets of surgical protocols in case L-PRF alone is found to be a reliable, stable, biological alternative to the welldocumented xenografts in external sinus lifts. Radiological results, although promising, must be further applied in long term clinical survival of the implants in the grafted sites. Also, studies combining L-PRF in conjunction with xenograft might bring improved clinical results in terms of reduced postoperative complications and accelerated healing. [ABSTRACT FROM AUTHOR]

Conventional RPD Patients with severely resorbed alveolar ridge always having problems with their conventional dentures that may be related to reduced load bearing capacity of the supporting structures with decreased biting force and poor masticatory action in addition to weakened oral sensory function related to prosthetic coverage The rehabilitation of edentulous posterior maxilla with implant supported prosthesis may be complicated by insufficient bone volume caused by continuous ridge resorption and increased maxillary sinus pneumatization. Bone augmentation of atrophic ridges is a commonly used method to place implants in compromised posterior maxillary ridges. Several techniques have been proposed, such as guided bone regeneration, sinus augmentation, block grafts and distraction osteogenesis before or during placement of the dental implant. Maxillary sinus floor elevation either by trans-alveolar or lateral window approach is considered the gold standard in augmentation of atrophic posterior maxilla where bone can be gained on the expense of the pneumatized sinus. However, the technique is associated with several problems such as increased surgical trauma, postoperative swelling, bleeding, infection and inflammation of maxillary sinus, graft resorption, and tearing or perforation of Schneiderian membrane. [ABSTRACT FROM AUTHOR]

Objective: Nursing comprises the care of sick or well people, including health promotion, maintenance, or recovery. As stated in Article 7 of the Saudi Law of Health Jobs, the stated monthly working hours are 176 hours. When they exceed 8 hours in outpatient departments, 12 hours in inpatient departments, or 176 monthly hours, they are considered overloaded. Providers seek to provide cost-free qualified care. Many countries have developed new techniques to combat the rising costs, which may lower quality. This study is concerned with the nurse shortage and the growing burden of healthcare. Materials and Methods: A self-structured survey was distributed among different departments in five hospitals. The study was conducted in November and December, 2021. Results: 21.5% of males and 78.5% of females, with an average age of 44.3 years, contributed. 77.8% have a bachelor's, 79% are trained in patient safety, and 84% had no patient safety problems. A Likert scale-based scoresheet was distributed to measure patient safety practice, and higher scores were found in expert nurses, nurses working in isolation departments, and those who had received patient safety training. It also showed lower scores as the working hours increased. Using a t-test and an ANOVA provides insignificant results. Conclusion and Recommendation: Average working hours improve quality and safety. This distinguishes decision-making from action-taking. What care to offer and how to provide and allocate time are interwoven practice decisions. Due to schedules, policies, and workflows, nurses may not be able to make timely decisions. [ABSTRACT FROM AUTHOR]

Introduction. The presence of bone septum in the maxillary sinus is one of the most common anatomical findings. So-called Underwood septa (US) are an atypical bone formation in the maxillary sinuses. Mostly they are quite easily found in CBCT studies and have major importance in sinus lift procedures in dental surgery. Furthermore, the shape, location, and size of the bony septa are important in each maxillary sinus surgery. Material and methods. A retrospective study of 120CBCT scans from the authors' own database was conducted. Results. Approximately 37.5% of each CBCT was associated with the occurrence of US, while just 25% had a full septum, and a total of only 14 patients had a half septa. More females have US, while healthy pneumatized maxillary sinus is most commonly found (82.22%). There is no correlation between the occurrence of silent sinus syndrome (p = 0.174), mucosal thickening (p = 0.325), or retention cyst formation (p = 0.272). Most sinuses are without any opacification in CBCT evaluation (91.11%), while other syndromes are not statistically relevant. Conclusions. It seems that the occurrence of Underwood septa is not statistically related to any clinical, radiological, or pathological condition within the sinus (p > 0.05). Furthermore, a more full or partial appearance of US was found in female patients. [ABSTRACT FROM AUTHOR]

(1) Background: The demands of patients for aesthetic and functional rehabilitation of edentulous areas led to the use of dental implants as therapeutic means on an increasingly large scale. This aspect determined the appearance of some infectious pathologies with a peri-implant starting point that can be complicated by various sinus diseases. The purpose of this review article is to synthesize the existing information in the specialized literature regarding the existing correlations between peri-implant and maxillary sinusitis. (2) Methods: The articles published in five databases were researched using different combinations of search terms. We selected 12 articles from the 250 found, by applying the inclusion and exclusion criteria and removing duplicates. (3) Results: We analyzed the included studies and we found that all of them reported a positive correlation between maxillary sinusitis and peri-implant infectious diseases. There are also reported other pathologies with a peri-implant infectious disease as a starting point such as abscesses, oro-antral communications, or foreign body reactions due to implant or bone graft materials migration. (4) Conclusions: This scoping review highlighted the existence of correlations between peri-implant and sinus pathology and the importance of preventing peri-implant diseases of an infectious nature to avoid the occurrence of these complications. [ABSTRACT FROM AUTHOR]

Oral maxillofacial rehabilitation of the atrophic maxilla with or without pneumatization of the maxillary sinuses routinely presents limited bone availability. This indicates the need for vertical and horizontal bone augmentation. The standard and most used technique is maxillary sinus augmentation using distinct techniques. These techniques may or may not rupture the sinus membrane. Rupture of the sinus membrane increases the risk of acute or chronic contamination of the graft, implant, and maxillary sinus. The surgical procedure for maxillary sinus autograft involves two stages: removal of the autograft and preparation of the bone site for the graft. A third stage is often added to place the osseointegrated implants. This is because it was not possible to do this at the same time as the graft surgery. A new bioactive kinetic screw (BKS) bone implant model is presented that simplifies and effectively performs autogenous grafting, sinus augmentation, and implant fixation in a single step. In the absence of a minimum vertical bone height of 4 mm in the region to be implanted, an additional surgical procedure is performed to harvest bone from the retro-molar trigone region of the mandible to provide additional bone. The feasibility and simplicity of the proposed technique were demonstrated in experimental studies in synthetic maxillary bone and sinus. A digital torque meter was used to measure MIT and MRT during implant insertion and removal. The amount of bone graft was determined by weighing the bone material collected by the new BKS implant. The technique proposed here demonstrated the benefits and limitations of the new BKS implant for maxillary sinus augmentation and installation of dental implants simultaneously. [ABSTRACT FROM AUTHOR]

Background and objectives: The aim of this systematic review with meta-analysis was to assess the performance of short implants in comparison with standard implants and sinus floor elevation in atrophic posterior maxilla. Materials and methods: The protocol of the study was registered in the PROSPERO database (CRD42022375320). An electronic search on three databases (PubMed, Scopus, Web of Science) was performed to find randomized clinical trials (RCTs) with ≥5 years' follow-up, published until December 2022. Risk of bias (ROB) was calculated using Cochrane ROB. A meta-analysis was performed for primary (implant survival rate, ISR) and secondary outcomes (marginal bone loss, MBL; biological and prosthetic complications). Results: Of 1619 articles, 5 RCTs met the inclusion criteria. The ISR showed a risk ratio (RR) of 0.97 [0.94, 1.00] (CI 95%), p = 0.07. The MBL indicated a WMD of −0.29 [−0.49, −0.09] (CI 95%), p = 0.005. Biological complications showed a RR of 0.46 [0.23, 0.91] (CI 95%), p = 0.03. Prosthetic complications showed a RR of 1.51 [0.64, 3.55] (CI 95%), p = 0.34. Conclusions: The available evidence suggests that short implants might be used as an alternative to standard implants and sinus floor elevation. After 5 years, in terms of ISR, standard implants and sinus floor elevation showed a higher survival rate comparted to short implants, although statistical significance was not achieved. Future RCTs with long-term follow-up are needed to draw a clear conclusion on the advantages of one method over another. [ABSTRACT FROM AUTHOR]

The success of dental implants lies in their strong and lasting integration into the patient's receiving bone. The first biological interactions at the implant surface determine the subsequent evolution of the integration process. In this study we set our objective to analyze the mechanistic interaction of the early regenerative matrix at implant surfaces modified with calcium ions (Ca) as compared to standard implant surfaces (NoCa). We put the surfaces in a Quartz Crystal Microbalance with Dissipation (QCM-D) to monitor the frequency shift (f) and the viscoelastic properties of the adsorbed biofilms and used Scanning Electron Microscopy (SEM) to visualize the resulting interfaces. Upon the addition of human blood plasma, Ca surfaces formed an adsorbed three-dimensional film attached to the surface (∆f = −40 Hz), while with NoCa, the biofilm formed but was not attached to the surface (∆f = 0 Hz). After 20 min in blood, two representative commercial implants with Ca and NoCa surfaces showed also distinct interfaces: Ca implants formed a visible clot attached to the implant which was composed mainly of platelets (Surface Coverage: 40 ± 20%) and some red blood cells (SC: 9 ± 3%) entrapped within a fibrin network (SC: 93 ± 5%). The NoCa implants were largely populated by red blood cells (SC: 67 ± 12%) with scarce fibrin remnants (SC: 3 ± 2%), and the implants showed no clot on their surfaces macroscopically. The pre-clinical and clinical results discussed in this work encourage the modification of titanium implant surfaces with calcium ions to improve the bone regenerative process. Taken together, these results add more information about the roles of Ca ions in bridging the formation of the provisional matrix at implant surfaces and their effects on implant osseointegration. [ABSTRACT FROM AUTHOR]

With the spread of oral implant therapy, serious medical complications related to implant surgery are becoming a social problem. Although the number of complications after implant surgery in the edentulous jaw is decreasing in Japan, maxillary-sinus-related complications (MSRCs) have reached the highest number since 2012. It is essential to identify and eliminate possible predisposing risk factors for MSRCs at an early stage to prevent MSRCs. In this review article, we highlight the causal factors of postoperative complications with or without sinus augmentation for the maxillary molar region to achieve optimal treatment outcomes and reduce complications. In particular, we focus on anatomical variations that can cause the impairment of maxillary sinus drainage. Furthermore, we emphasize that the paradigm for personalized medicine for patients with a maxillary edentulous jaw by ENT specialist and dentist cooperation is shifting from the traditional assessment of maxillary sinus pathologies alone to the new assessment of anatomic variations that can cause the impairment of maxillary sinus drainage in addition to maxillary sinus pathologies. [ABSTRACT FROM AUTHOR]

The purpose of this systematic review was to analyze sinus lifting procedures and to compare the efficiency of this treatment associated with the second generation of platelet-rich fibrin related to its effects on bone gain and to clarify the regenerative efficacy in sinus lift procedure, whether alone or as a coadjutant to other bone graft materials. The PICOT question was, "In clinical studies with patients needing a maxillary sinus lift (P), does the use of PRF either alone (I) or in conjunction with other biomaterials (C) improve the clinical outcome associated with bone gain and density (O), with at least three months of follow-up (T)?" An electronic search was conducted in the MEDLINE (PubMed), Science Direct, and Scopus databases through a search strategy. A total of 443 articles were obtained from the electronic database search. Sixteen articles met all criteria and were included in this review. Within the limitation of this study and interpreting the results carefully, it was suggested that a higher risk for implant failure after a sinus elevation might be seen in patients with residual bone ≤4 mm, and PRF application was effective, suggesting reducing the time needed for new bone formation. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: Dental implant placement in the posterior maxilla is challenging due to poor bone quality and volume. Displacement of implants into the sinus is a common complication. This study was conducted to evaluate the risk of displacement in relation to various factors. Materials and Methods: A retrospective observational study was conducted on 21 patients with 22 implants accidentally displaced into the maxillary sinus during a period of three years (November 2017-October 2002) The following data are collected: patient information, medical condition and smoking habit, geometry and size of the implant and anatomical region of displacement, time of displacement and removal after placement, available bone height and the associated sinus lift procedure. The surgical technique and type of anaesthesia for implant removal were also recorded. Results: The mean age of patients was 43±9 years with male to female ratio of 2:1. About 67% of patients were smokers and score II ASA (American Society of Anaesthesia). More than half of patients had oroantral communication and 1/4th had sinusitis. Most implants were in the first molar region (68%) followed by the second molar (18%). The displaced implants accompanied by closed sinus lift were 82%, in addition, 82% of cases dislodged intraoperatively. The height and diameter of implants were 8-10 mm (59%) and 4-5 mm (73%) respectively, 82% were tapered and 64% were associated with 2-4 mm of residual bone height. Conclusion and Recommendation: Dental implant displacement into the maxillary sinus should be expected when placing implant in the posterior maxilla with deficient bone volume and poor quality. The patient should be informed of this complication in the informed consent. [ABSTRACT FROM AUTHOR]

In this article, the authors want to present the possibilities of solving some difficult cases, treated in a conventional surgical and implant manner and which were a failure, as well as the possibilities of avoiding these failures using Strategic Implant® technology. In the first case presented, the patient goes through bone augmentation procedures, without reaching the time of implant insertion and prosthesis, with the loss of bone addition on one side of the mandible, the case being later completed with corticobasal implants in immediate prosthetic loading. The second case in which the patient successively loses the inserted two stage implants, without reaching their functional load, resorts to the treatment with corticobasal implants in immediate loading and the fixed prosthetic restoration of the mandible in 3 days postimplantation. The last case in which the patient comes for the removal of a maxillary prosthetic work fixed on 4 two stage implants with bone addition and unilateral sinuslift, with mobility, and in which the treatment with corticobasal implants and fixed prosthetic work in 3 days was the optimal way of treatment. These cases as well as the feedback of the treatment after a number of years show us that the treatment with corticobasal implants can be made much easier using only the native bone of the patient using implants that adapt to the morphology of the existing bone and a immediate loading protocol to allow the optimal functioning of prosthetic works; knowledge of surgical and prosthetic protocols of Strategic Implant® technology lead to predictable prosthetic results with minimally invasive surgery, without sinus lift and bone addition, in a short time of 3 days from the surgical step until the final oral rehabilitation. [ABSTRACT FROM AUTHOR]

Aim: To investigate risk factors causing sinus membrane perforation during sinus floor elevation (SFE) performed with lateral window technique and to evaluate the sinus membrane health after SFE via Cone-Beam Computed Tomography (CBCT). Materials and Methods: CBCT images of 33 patients with sinus membrane perforation during SFE and 33 patients without perforation during SFE as a control and a total of 80 CBCTs were evaluated. Patient-related factors (age, sex, smoking) and maxillary sinusrelated factors (preoperative membrane thickness, residual bone thickness, postoperative membrane thickness, and postoperative total bone thickness, type of sinus membrane morphology, and presence of septa) were assessed. Results: Preoperative sinus membrane thickness of the perforated group (4.38 ± 6.02 mm) was significantly higher than the nonperforated group (1.74 ± 2.81 mm) (p = 0.02). No significant difference was found between preoperative and postoperative membrane thicknesses of the non-perforated and perforated group (p = 0.135 and p = 0.106, respectively). The perforation rate was highest (83.3%) in the group of mucosal thickness ≥4 mm. Membrane perforation was observed in 100% of circumferential and complete type sinus membrane morphology, 80% of polyp type morphology, and 85.7% in irregular type morphology. A relationship was found between the presence of septa and membrane perforation (p = 0.01). Conclusion: The study results show that the presence of septa, age of >55 years, and a sinus membrane thickness of >4 mm are associated with an increased risk of sinus membrane perforation. Perforation did not affect postoperative sinus membrane thickness. [ABSTRACT FROM AUTHOR]

Aim: To report a case involving transantral palatal root piezoelectric surgery followed by a sinus floor augmentation procedure with the purpose of minimizing and managing complications associated with sinus lining perforations and optimizing bone regeneration at the site of the surgical defect. Summary: An asymptomatic 28‐year‐old male patient with the diagnosis of chronic apical periodontitis on a previously root filled right maxillary first molar (FDI tooth 16) and second premolar (No. 15) was managed by transantral apical surgery. Cone‐beam computerized tomography (CBCT) revealed the position of the palatal root of the first molar within the maxillary sinus. The case highlights the management of the palatal root and the handling of a perforation of the Schneiderian membrane through a combination of piezosurgery and a sinus lift grafting procedure involving a second‐generation of platelet concentrates. No postoperative complications were observed. Sinus bone augmentation after a 26‐month recall period was confirmed by CBCT in the clinically asymptomatic teeth. Key learning points: The selective bone tissue cutting and enhanced visibility obtained by piezoelectric surgery in comparison with current rotary techniques make this technology the preferred tool for apical surgery when the mucosal lining of the maxillary sinus could be compromised. The wound healing and physical properties of the platelet‐rich fibrin membranes in combination with an allograft material can be considered as sinus bone graft options when a transantral approach is performed on a palatal root of a maxillary molar. A preoperative tomographic examination is essential for apical surgery using a transantral approach with sinus bone augmentation, because of the information obtained from the axial and coronal views on the CBCT scan. [ABSTRACT FROM AUTHOR]

Objectives: Atrophic resorption of the maxillary alveolar ridge is a complication that makes implantological rehabilitation critical. Our aim was to develop a novel computer aided procedure for the accurate quantitative assessment of maxillary residual ridge resorption including pneumatisation of the maxillary sinus that goes beyond previously described approaches and to apply it to a large dataset. Materials and methods: To develop and refine the method, we performed a retrospective analysis using computed tomography data from 405 patients to generate segmented, three-dimensional models of zygomaticomaxillary bones and maxillary sinuses. Using anatomical landmarks and orientation lines or planes, all models were aligned automatically to subsequently generate cross-sectional images (n = 2835), enabling the classification of atrophy as well as the quantification of volumes and caudal extensions of the maxillary sinuses. Results: We developed and implemented an accurate and reproducible workflow for the semi-automated analysis of volumetric maxillary images. Comprehensive statistical analysis of the large quantitative dataset revealed various correlations of maxillary process heights and sinus volumes with atrophy class, age and region and identified conjectural trends over the patient group. Conclusions: The method was used successfully to process a large dataset to classify atrophy, to measure alveolar height parameters, and to quantify maxillary sinus volume, bottom volume and pneumatisation. Clinical relevance: Apart from the anthropometric value of the generated dataset, the method could be applied to provide additional and more accurate data to assess the necessity of bone augmentation in the context of three-dimensional planning before implantation. [ABSTRACT FROM AUTHOR]

Objectives: Preoperative maxillary sinus imaging findings have been suggested to be associated with complications and outcomes of sinus lift and dental implant procedures; nonetheless the evidence is controversial. The aim of this study was to examine the association between preoperative maxillary sinus imaging findings and outcomes of sinus lift and dental implant procedures in asymptomatic patients. Methods: We included all patients who underwent maxillary sinus lift and dental implant procedures between 2014 and 2017. Maxillary sinus imaging findings were extracted from pre-procedural dental computed tomography scans, and outcomes of the procedures were assessed. Results: A total of 145 procedures were included. No sinonasal symptoms were reported preoperatively. In 46% of cases maxillary sinus imaging was abnormal. The most common imaging finding was peripheral mucosal thickening (38%). Sinus floor cyst/polyp was identified in 13% of the cases, of which 47% occupied more than 50% of the sinus volume. Partial or complete opacification of the maxillary sinus was documented in 3% of cases. The sinus ostium and ostiomeatal complex were obstructed in 7% and 1%, respectively. Mucosal perforation was documented in 22% of cases and was inversely related to mucosal thickening (P = 0.011). Other minor post-operative complications did not correlate with radiological findings. Post-surgical sinusitis was not observed in any of the patients regardless of pre-surgical imaging findings. Conclusions: Incidental maxillary sinus imaging findings such as mucosal swelling, cysts or polyps, regardless of their severity or size, and maxillary ostial obstruction may not need to be addressed prior to sinus augmentation and dental implant procedures in asymptomatic patients. Patients with complete sinus opacification should be referred to an otolaryngologist prior to surgery. Further controlled trials, in larger cohorts, are needed to corroborate our findings. [ABSTRACT FROM AUTHOR]

Maxillary sinus augmentation is the most predictable of the pre-prosthetic surgical procedures. There are, however, known and well-documented complications that can and do occur. The most common are the intraoperative complications of sinus membrane perforation and bleeding, and the postoperative complications of sinus graft infections, sinus infections, and sinusitis. The majority of these complications can be prevented, or their incidence greatly reduced, through a thorough understanding of maxillary sinus anatomy, the multifaceted etiologies of these conditions, and the steps that can be taken to avoid them. This volume of Periodontology 2000 will discuss both the preoperative and intraoperative procedures that will prevent these untoward outcomes and the necessary treatment modalities that will limit their adverse effects. [ABSTRACT FROM AUTHOR]

Background: Natural and synthetic graft materials are used routinely in sinus floor augmentations to help support implants in atrophic maxillary ridges. The aim of the study is to evaluate the amount of bone formation using two different types of bone graft harvested adjacent to the actual surgical site as well as synthetic bone graft, the status of the implant, and the outcome of maxillary sinus lift augmentation in patient undergoing maxillary sinus lift and simultaneous implant placement. [ABSTRACT FROM AUTHOR]

Sinus lift surgery elevation is a procedure that requires radiological maxillary sinus evaluation and procedure planning. The condition of the maxillary sinus before and after sinus lift surgery was assessed. Sixty-five sinuses of 49 patients were included in the study. Preoperative and postoperative cone beam computed tomography (CBCT) scans were performed. The sinuses were analysed radiologically for pathological changes: mucosal thickening, ostia obstruction and accessory opening. The presence of concha bullosa in nasal cavity and septa in the maxillary sinus were recorded. The sinus volume also was measured before and after surgery. Thickened mucosa was found more often in postoperative scans than in preoperative scans (63.1% and 67.7%, respectively). Concha bullosa was found in 30 preoperative scans and in 33 postoperative scans. A correlation between mucosal thickening and ostia obstruction was found. The mean sinus volume decreased after surgery and the changes were statistically significant. In conclusion, changes of the maxillarysinus and nasal cavity can be detected with CBCT. Sinus lift surgery does not excacerebate the existing conditions of the maxillary sinus; however, there is a tendency for pathological features to increase after surgery. Sinus lift surgery is a safe surgery with regard to the maxillary sinus if performed with care. [ABSTRACT FROM AUTHOR]

Aim: To assess the long‐term effectiveness (≥5 years) of maxillary sinus floor augmentation (MSFA) procedures applying the lateral window technique and to determine possible differences in outcome between simultaneous and delayed implant placement, partially and fully edentulous patients and grafting procedures. Materials and methods: MEDLINE (1950–May 2018), EMBASE (1966–May 2018) and Cochrane Central Register of Controlled Trials (1800–May 2018) were searched. Inclusion criteria were prospective studies with follow‐up ≥5 years and a residual bone height ≤6 mm. Outcome measures included implant loss, peri‐implant bone level change, suprastructure survival, patient‐reported outcome measures and overall complications. Data were pooled and analysed using a random effects model. Results: Out of 2,873 selected articles, 11 studies fulfilled all inclusion criteria. Meta‐analysis revealed a weighted annual implant loss of 0.43% (95% CI: 0.37%–0.49%). Meta‐regression analysis did not reveal significant differences in implant loss neither between edentulous and dentate patients nor implants placed simultaneously with or delayed after MSFA, nor implants placed in MSFA using solely autologous bone or bone substitutes. The results of the other outcome measures were favourable, and overall complications were low. Conclusion: MSFA is a reliable procedure in the partially and fully edentulous maxilla for support of dental implants. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate and compare the morphometric components and the histological properties of pristine bone and bone grafted with a biphasic ß‐tricalcium phosphate in humans using the maxillary sinus model. Reparative mesenchymal stem cells in the pristine bone and graft were also evaluated. Materials and Methods: For this prospective case series, sinus augmentation was performed using a biphasic ß‐tricalcium phosphate. After 6 months of healing, a core of remnant native alveolar bone and grafted bone was collected with a trephine. Histological, histomorphometrical, and immunohistochemical techniques were performed. Radiological analysis through cone beam computerized tomography was also conducted. Results: A total of 10 patients were enrolled in this study. Radiologically, patients showed an average increase of crestal bone of 8.03 ± 1.72 mm. Morphologically, the grafted area was composed by 34.93 ± 14.68% of new mineralized tissue, 9.82 ± 11.42% of remnant biomaterial particles, and 55.23 ± 11.03% non‐mineralized tissue. Histologically, we found no differences in the number of osteocytes per mm2 (p = 0.674), osteoblasts (p = 0.893), and blood vessels (p = 0.894) in the grafted area compared to the pristine bone. Differences were found on the number of osteoclasts (15.57 ± 27.50 vs. 5.37 ± 16.12, p = 0.027). The number of Musashi‐1 positive mesenchymal cells (239.61 ± 177.4 vs. 42.11 ± 52.82, p = 0.027) was also significantly higher in the grafted area than in the pristine bone. Conclusion: Biphasic ß‐tricalcium phosphate is a suitable biomaterial to be used in the formation of new bone in sinus floor elevation procedures in humans, not only from the histomorphometrical point of view, but also regarding the cellular and vascular quality of the regenerated bone. [ABSTRACT FROM AUTHOR]

Background: A sinus floor augmentation may be indicated when a lack of hard tissue impedes implant placement. Although clinically successful, evidence supporting the long‐term three‐dimensional stability of the grafted volume is scarce. Second, evidence on the patient's acceptance of this type of treatment is limited. Purpose: First is to evaluate the changes in graft volume after lateral wall sinus lifting based on superimposed cone beam computed tomography (CBCT) images and then to assess patient‐reported outcome measures (PROMs) and clinical outcomes. Materials and Methods: Partially edentulous patients in need of a sinus lift and fixed reconstruction on at least two neighboring implants were selected for a prospective case series. Lateral wall sinus augmentation was performed using deproteinized bovine bone mineral (DBBM) as the only filling material. Volumetric changes were quantified on the basis of a preoperative CBCT and three postoperative CBCTs (at 2 weeks, 3 months, and 2 years). PROMs and clinical parameters were registered. Results: Twenty‐two patients (7 males, 15 females; mean age 59 years) participated of which three patients dropped out during the follow up. Graft volumes amounted to 1418.26 mm3 at 2 weeks, 1201.21 mm3 at 3 months, and 1130.13 mm3 at 2 years postoperative pointing to a relative graft volume stability of 79.7%. Swelling was the leading symptom during the first week. A peak in visual analogue scale scores was observed for pain, swelling, and hematoma the day of surgery and 1 day postoperation with a statistically significant decline between days 3 and 7. Hemorrhage and nose bleeding occurred in 18.2% and 27.3% of the subjects, respectively. About 95.5% of the subjects would undergo the treatment again. All implants integrated successfully and demonstrated healthy clinical conditions. Conclusion: Lateral wall sinus augmentation using DBBM as the only filling material is a viable treatment concept given limited graft resorption, good patients' tolerance, and clinical outcomes. [ABSTRACT FROM AUTHOR]

The process of healing underwent by hard and soft tissues is mediated by a wide range of intracellular as well as extracellular events that are maintained by the help of protein signals. It has been well known that platelets are responsible for the healing process through the formation of a blood clot and release of many growth factors that promote and maintain the process of wound healing. Platelet-rich fibrin (PRF) is a fibrin network in which mediators such as cytokines, essential growth factors, and cells are embedded and released after a certain period of time and serves as resorbable membrane. PRF is considered to be a healing biomaterial. Platelet concentrates have been used to improve healing of surgical wounds. The reason for the review was to discuss various new developments and practical applications of PRF in the field of oral and maxillofacial surgery. [ABSTRACT FROM AUTHOR]

Purpose: Odontogenic sinusitis and sinonasal complications of dental disease or treatment (SCDDT) represent a heterogeneous group of conditions that often require multidisciplinary care. The present study aims to prospectively validate a classification and treatment protocol for SCDDT patients.Methods: One hundred twenty-eight consecutive patients (73 females and 45 males, mean age 52.4 years) affected by SCDDT not responding to dental and medical therapy were classified and surgically treated according to the proposed protocol. The protocol classified patients into three aetiology-based groups (preimplantologic, implantologic, and related to traditional dental diseases and procedures, respectively). The groups were further divided into classes according to the presence of oro-antral communications and/or dislocated dental hardware. Each condition was treated according to the class-related, protocol-defined treatment, by either a transnasal or combined transnasal/transoral approach. All patients were successfully classified according to our protocol. None of the proposed classes were redundant, and no condition fell outside the definitions.Results: The surgical treatment protocol proved to be adequate and effective, in that 125 of the 128 patients completely recovered after surgical treatment.Conclusions: The term SCDDT and the consequent classification proposed by the authors appear, therefore, to be nosologically correct. Furthermore, the protocol-related proposed treatment appears to be clinically sound, with a success rate nearing 98%. [ABSTRACT FROM AUTHOR]

Keywords: Sinus lift; collagen sponge; gelatin sponge; mechanical properties; microstructure EN Sinus lift collagen sponge gelatin sponge mechanical properties microstructure S206 S208 3 11/26/20 20200902 NES 200902 1. Case reports and case series have pointed out successful new bone formation after sinus membrane elevation using reoxidised cellulose (Gray et al. [2]), venous blood clot (Moon et al. [3]) and gelatin sponge (Sohn et al. [4]) as space maintainers. [Extracted from the article]

Purpose There is still debate whether intraoperative Schneiderian membrane (SM) perforation in the maxillary sinus lift causes an increase the risk of implants failure. The aim of this study was to assess an association between SM perforation and implants loss following the maxillary sinus lift. Materials and methods: A systematic review and meta‐analysis of clinical studies assessing association between SM perforation and implants failure based on PRISMA was conducted. Three major databases were used to gather research dating from their respective inception up until March 2018. All clinical studies expressly reported the number of the SM perforation and implants loss that installed in the perforated and nonperforated sinuses were included. The statistical analyses used were Pearson's correlation, simple linear regression, and meta regression. The risk ratio (RR) of implant loss between perforated and nonperforated sites was estimated. Results: A total of 2947 patients with 3884 maxillary sinuses augmentations who received 7358 implants, enrolled in 58 studies were included in this study. There was a significant relationship between the implants' failure and SM perforation according to simple linear regression (P < .001) and meta regression analysis (P = .06). There was a significant decrease (moderate quality evidence) in implant loss in the nonperforated sinuses compared to perforated sunrises (RR = 2.17, CI: 1.52‐3.10, P = .001). There was also no significant association between implant loss in the perforated sinuses and the surgical devices used (piezosurgical or rotary), surgical approach applied (lateral or crestal sinus lift), barrier membrane used and type of bone grafting materials. Conclusion: The results of this study showed that an intraoperative SM perforation could increase the risk of implant failure after the sinus lift surgery. [ABSTRACT FROM AUTHOR]

Introduction: One of the most important medical applications of laser is low-level laser therapy (LLLT). In this method, laser radiation penetrates easily into the target tissue. The aim of this study was to investigate whether LLLT can reduce the side effects of advanced implant surgery. Methods: In this triple-blind clinical trial, 30 patients aged 25 to 65 years were selected for implant insertion and divided into two groups. In the laser group, immediately after the surgery, 72 hours and 1 week after the surgery, the surgical site was irradiated with an 830 nm laser. The dose required for the laser therapy was 5 J/cm2. The degree of pain, facial swelling and wound healing were analyzed using statistical methods. Results: Our results showed that at 12, 24, 48, and 72 hours after the surgery, the pain level was reduced in the laser group compared with the placebo group (P < 0.05). Swelling of the face was also significantly reduced 7 days after surgery in the laser group (P < 0.05). The investigation on the recovery conditions of the surgical site showed that on the 3rd, 7th and 14th days after the surgery, higher levels of wound healing have been achieved (P < 0.05). Conclusion: Our results suggest that laser, as a complementary therapy; can be used to reduce the severity and duration of pain. Also, laser can reduce facial swelling and accelerate wound healing. [ABSTRACT FROM AUTHOR]

Purpose: the aim of the computational 3D-finite element study is to evaluate the influence of an augmented sinus lift with additional inserted bone grafting. The bone graft block stabilizes the implant in conjunction with conventional bone augmentation. Two finite element models were applied: the real geometry based bone models and the simplified geometry models. The bone graft block was placed in three different positions. The implants were loaded first with an axial force and then with forces simulating laterotrusion and protrusion. This study examines whether the calculated stress behavior is symmetrical for both models. Having established a symmetry between the primary axis, the laterotrusion and protrusion behavior reduces calculation efforts, by simplifying the model. Material and Methods: a simplified U-shaped 3D finite element model of the molar region of the upper jaw and a more complex anatomical model of the left maxilla with less cortical bone were created. The bone graft block was placed in the maxillary sinus. Then the von Mises stress distribution was calculated and analyzed at three block positions: at contact with the sinus floor, in the middle of the implant helix and in the upper third of the implant. The two finite element models were then compared to simplify the modelling. Results: the position of the bone graft block significantly influences the magnitude of stress distribution. A bone graft block positioned in the upper third or middle of the implant reduces the quantity of stress compared to the reference model without a bone graft block. The low bone graft block position is clearly associated with lower stress distribution in compact bone. We registered no significant differences in stress in compact bone with regard to laterotrusion or protrusion. Conclusions: maximum values of von Mises stresses in compact bone can be reduced significantly by using a bone graft block. The reduction of stress is nearly the same for positions in the upper third and the middle of the implant. It is much more pronounced when the bone graft block is in the lower third of the implant near the sinus floor, which appeared to be the best position in the present study [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate available bone quality and quantity after performing sinus augmentation using simvastatin/β-TCP combination versus β-TCP alone.Materials and Methods: This study included eight sinus lift procedures conducted on six patients. The sinuses were divided into two equal groups. The patients were recalled one, two weeks two, five, nine months post-operatively for post-operative evaluation. Radiographic evaluation involved cone beam computed tomography (CBCT) radiographs taken for every patient one week and nine months post-operatively to evaluate the changes in bone height, while histomorphometric evaluation involved transcortical bone biopsies taken after nine months during the second-stage surgery for implant placement.Results: The histomorphometric results showed that the amount of newly formed bone was higher in the simvastatin group when compared to the β-TCP group nine months after the surgery; the difference between the two groups was statistically significant. On the other hand, the radiographic evaluation showed that the rate of resorption of the simvastatin group was found to be higher than the control group; however, the difference between both groups was statistically insignificant.Conclusion: These results showed that Simvastatin is safe to be used in sinus lift with promising osteoinductive capacity, yet further studies using larger sample size is needed. [ABSTRACT FROM AUTHOR]

The lack of prior information on the presence of Underwood septa is the most common anatomical cause of Schneider's membrane perforation during maxillary sinus floor elevation with lateral access. The objective of this study was to assess the incidence of Underwood septa, their location, type (primary or secondary) and height in Bulgarian patients. Cone beam computed tomography (CBCT) images of 200 patients were examined for the presence of Underwood septa. Presence of at least one septum was found in 144 patients. The non-parametric statistical Mann–WhitneyU-test and Fisher's exact test were used. No statistically significant differences were found between the two genders in terms of the presence of septa. In toothed patients, the location of the septa was behind the distal surface of the second molar in 57% of the cases. In patients with edentulous distal portions of the maxilla, location of the septa in the areas above the first premolar was seen in 54% of the cases. Depending on the presence of teeth, primary complete septa were found in toothed patients, and secondary partial septa were observed in edentulous patients. Prevalence of sagittal primary orientation was found in toothed patients (63%), while axial primary orientation of the septa was found in edentulous patients (58%). The obtained results suggest that precise determination of the septum orientation by CBCT would facilitate the correct choice of surgical approach to minimize the risk of Schneider's membrane perforation. [ABSTRACT FROM PUBLISHER]

Objectives To compare a monophasic (100% ß- TCP) and a biphasic (60% HA and 40% ß- TCP) bone substitute material (BSM) regarding biocompatibility, osteoconductivity and implant stability using histological, radiological and resonance frequency analysis. Material and Methods Sixty-seven sinus floor elevations were performed in 60 patients. One patient group (monophasic bone substitute [MBS], 30 patients, 32 sinuses) was augmented by the use of the monophasic material (Bioresorb®, Sybron Implant Solutions, Bremen, Germany), while the second group (biphasic bone substitute ( BBS), 30 patients, 35 sinuses) received a biphasic material (Maxresorb®, Botiss Biomaterials, Berlin, Germany). Cone beam CT images were taken immediately after augmentation and prior to implant placement after 6 months. Trephines were harvested, while the implant bed was prepared. Resonance frequency analysis was performed immediately after implant placement and 6 months later. Descriptive analysis was performed on all augmented sinus ( n = 67). For statistical comparison of the groups, one sinus of each bilaterally treated patient was randomly excluded, resulting in 30 sinuses grafted with MBS and 30 sinuses grafted with BBS ( n = 60). Results Histomorphometrical analysis of all sinuses displayed comparable results for both groups regarding new bone matrix ( MBS 36.16 ± 19.37%, BBS 38.42 ± 12.61%), residual BSM ( MBS 30.26 ± 11.7%, BBS 32.66 ± 12.57%) and non-mineralized tissue ( MBS 34.29 ± 18.32%, BBS 28.92 ± 15.04) %) ( P > 0.05, respectively). Radiological volume of BBS was significantly more stable (volume loss of 22.2% for MBS, 6.66% for BBS; P < 0.001), and homogeneity of the graft after 6 months was higher for BBS than that for MBS ( P < 0.05). Resonance frequency analysis endorsed a higher implant stability quotient for BBS after 6 months than that for MBS ( MBS 78.31 ± 5.81, BBS 80.42 ± 6.31; P < 0.05, Mann-Whitney U-test, respectively). Conclusion Both monophasic and biphasic materials show good biocompatibility and osteoconductivity with satisfactory support on implant stability. BBS remains more stable in terms of volume maintenance and radiological graft homogeneity after a healing period of 6 months. [ABSTRACT FROM AUTHOR]

During a sinus lift procedure the main requirement in order to position an implant is to have a maxillary sinus floor cortical bone thick enough to guarantee a primary stability in the implant inserted. In this way, the healing process is facilitated and osseointegration of the titanium surface may occur simultaneously, thus reducing the waiting time for the engraftment of the implant into the body. Unfortunately, these conditions are not always present. Hence, the need of developing an alternative approach that could simultaneously allow to perform sinus floor elevation along with an implant placement. Here we present the case of a 62-year-old patient that requires implant-prosthetic rehabilitation from 1.2 to 1.6 at diagnosis. In this study, we reported a novel application derived from the use of a heterologous bone scaffold (SmartBone@) in a sinus lift procedure. We showed the successful implant along with sinus lift with SmartBone@, both at the time of the surgery and after follow-up of the patient at 10 months from the implant. The possibility to perform simultaneously the contextual implant along with sinus lift dramatically reduced the waiting time for the patient of minimum 5-6 months required for osseointegration of the grafted biomaterials, before performing the implant procedure. This surgery represents an advance both in terms of medical technique and as life-benefit for the patient. [ABSTRACT FROM AUTHOR]

Sinus lift elevation restores bone mass at the maxilla in edentulate patients before the placement of dental implants. It consists of opening the lateral side of the sinus and grafting beta-tricalcium phosphate granules (β-TCP) under the olfactory membrane. Bone biopsies were obtained in five patients after 60 weeks. They were embedded undecalcified in poly(methyl methacrylate) (pMMA); blocks were analyzed by nanocomputed tomography (nanoCT); specific areas were studied by Raman microspectroscopy. Remnants of β-TCP were osseointegrated and covered with mineralized bone; osteoid tissue was also filling the inner porosity. Macrophages having engulfed numerous β-TCP grains were observed in marrow spaces. β-TCP was identified by nanoCT as osseointegrated particles and as granules in the cytoplasm of macrophages. Raman microspectroscopy permitted to compare the spectra of β-TCP and bone in different areas. The ratio of the ~820 cm-1 band of pMMA (-CH2 groups) on the ν1 phosphate band at 960 cm-1 reflected tissue hydration because water was substituted by MMA during histological processing. In bone, the ratio of the ~960 cm-1 phosphate to the amide 1 band and the ratio ν2 phosphate band by the 1240-1250 amide III band reflect the mineralization degree. Specific bands of β-TCP were found in osseointegrated β-TCP granules and in the grains phagocytized by the macrophages. The hydration degree was maximal for β-TCP phagocytized by macrophages. Raman microspectroscopy associated with nanoCT is a powerful tool in the analysis of the biomaterial degradation and osseointegration. [ABSTRACT FROM AUTHOR]

Objectives Over 5 years, (i) to evaluate the clinical efficiency of 8-mm implants placed with osteotome sinus floor elevation ( OSFE) in extremely atrophic maxillae and (ii) to compare bone levels around implants placed with and without grafting. Material and methods TE® SLActive® implants (Institut Straumann AG, Basel, Switzerland) were placed in sites with a residual bone height ( RBH) of ≤4 mm. Before surgery, sinuses were randomized to receive anorganic bovine bone (control) or no graft (test). After 10 weeks of healing, implants were functionally loaded with single crowns. Bone levels were measured from standardized peri-apical radiographs. Results Thirty-seven (17 test, 20 control) implants were placed in 12 patients ( RBH: 2.4 ± 0.9 mm). Two early and one late failures occurred. The success rate was 91.9% (94.1% test, 90.0% control). All implants gained endo-sinus bone (3.8 ± 1.0 mm test, 4.8 ± 1.2 mm control; P = 0.004). Mean crestal bone loss ( CBL) was 0.6 ± 1.1 mm, without a significant difference between the groups ( P = 0.527). Mean bone gain and CBL did not change significantly between 1 and 5 years ( P = 0.249 and P = 0.293, respectively). Conclusions Atrophic posterior maxillae can be predictably rehabilitated using OSFE with a simultaneous implant placement. The new bone formed around implants after 1 year was stable after 5 years, irrespective of the presence or the absence of graft. Grafting was unnecessary to achieve an average bone augmentation of 3.8 mm, but more bone was gained with grafting. [ABSTRACT FROM AUTHOR]

The ideal scaffold for bone regeneration is required to be highly porous, non-immunogenic, biostable until the new tissue formation, bioresorbable and osteoconductive. This study aimed at investigating the process of new bone formation in patients treated with granular SmartBone ® for sinus augmentation, providing an extensive histologic analysis. Five biopsies were collected at 4–9 months post SmartBone ® implantation and processed for histochemistry and immunohistochemistry. Histomorphometric analysis was performed. Bone-particle conductivity index (BPCi) was used to assess SmartBone ® osteoconductivity. At 4 months, SmartBone ® (12%) and new bone (43.9%) were both present and surrounded by vascularized connective tissue (37.2%). New bone was grown on SmartBone ® (BPCi = 0.22). At 6 months, SmartBone ® was almost completely resorbed (0.5%) and new bone was massively present (80.8%). At 7 and 9 months, new bone accounted for a large volume fraction (79.3% and 67.4%, respectively) and SmartBone ® was resorbed (0.5% and 0%, respectively). Well-oriented lamellae and bone scars, typical of mature bone, were observed. In all the biopsies, bone matrix biomolecules and active osteoblasts were visible. The absence of inflammatory cells confirmed SmartBone ® biocompatibility and non-immunogenicity. These data indicate that SmartBone ® is osteoconductive, promotes fast bone regeneration, leading to mature bone formation in about 7 months. [ABSTRACT FROM AUTHOR]

Background There is a limited amount of studies evaluating long-term results of the sinus membrane elevation technique for bone formation around implants in the maxillary sinus floor without the use of bone graft material. Purpose To investigate the long-term results of this technique with regard to implant survival and bone gain in the maxillary sinus floor. Materials and Methods A retrospective study was conducted on patients who had undergone the surgical procedure from November 2001 to August 2008. Thirty-six patients with a total of 87 implants ( ASTRA TECH Implant System ™) in 53 sinuses were examined. After a submerged healing period of 6 months and at least 12 months of loading, the patients were examined clinically and radiologically. Implant stability was measured using resonance frequency analysis ( RFA). Results The mean follow-up time was 4.6 years (range 1.5-7 years). Five implants were lost giving a survival rate of 94.3%.Subantral preoperative vertical bone levels were in the range of 1 to 10 mm. The average bone gain at the sinus floor was 6 mm. The 55 fixtures eligible for RFA displayed a mean implant stability quotient of 77 (range 56-85.5). Conclusion The present study illustrates the long-term reliability of the technique. [ABSTRACT FROM AUTHOR]

Background No evidence has been reported yet about dimensional changes in maxillary sinuses grafted with autologous platelet concentrate. Purpose This study aimed to analyze the augmented height alterations around short implants (length ≤ 8.5 mm) placed after transcrestal sinus lift surgery in association with plasma rich in growth factors. Materials and Methods A retrospective design was used. Patients with atrophic posterior maxilla were treated by inserting short implants in combination with transalveolar maxillary sinus floor augmentation. Radiographic bone level alterations over time were assessed on panoramic radiographs. Results Transalveolar sinus augmentation was performed to place 41 implants in 26 patients with a residual bone height of 4.7 ± 1.3 mm. The alveolar bone height was increased by 3.7 ± 1.7 mm and 4.2 ± 2.0 mm after 12 ± 3 months and 35 ± 11 months of surgery, respectively, whereas the apical augmented height (beyond the implant) apex was stable around 34 implants during the follow-up. It was increasing around seven implants that were not covered by the endo-sinus augmented height at the 1-year follow-up. Conclusions Transalveolar sinus floor augmentation in association with plasma rich in growth factors and short implants resulted in a stable augmented height gain after 3 years follow-up. Atrophic posterior maxilla could be treated by transalveolar sinus lift in association with plasma rich in growth factors and the placement of short implants. [ABSTRACT FROM AUTHOR]

It is well documented that restoration of posterior atrophied maxilla with implants is a complex entity in itself. Since, implant placement in this area is often accompanied by sinus lift which itself is a morbid procedure with questionable success rate, a new approach of placement of implants in Pterygo maxillary area was explored. The purpose of this article is to present a case report in which Pterygo-maxillary implant has been successfully placed to restore atrophied posterior maxilla without the sinus lift using 3D imaging technique - Cone Beam Computerised Tomography (CBCT). Thus, making it an easy procedure for placement of implants in the areas previously considered to be unapproachable. [ABSTRACT FROM AUTHOR]

Background Little is known about the long-term outcome of implants placed in the atrophic maxilla using osteotome sinus floor elevation ( OSFE) without grafting. Purpose The study aims to evaluate the long-term efficiency of the procedure and stability of the peri-implant bone formed following implant placement without grafting into resorbed posterior maxilla. Materials and Methods Twenty-five implants (≤10 mm in length) were placed in 17 patients using OSFE without grafting. The mean residual bone height was 5.4 ± 2.3 mm. Bone levels were evaluated at 1, 3, 5, and 10 years using periapical radiographs. Results Fifteen patients (23 implants) participated in the 10-year examination. All implants fulfilled the survival criteria. Following surgery, the implant sites gained endo-sinus bone (mean: 3.0 ± 1.4 mm). The mean crestal bone loss ( CBL) was limited to 1.0 ± 0.9 mm. The difference in mean endo-sinus bone gain and CBL was statistically significant between 1 and 10 years, but not between 3 and 5, 3 and 10, and 5 and 10 years. Conclusions At 10 years, the implant survival rate was 100%. Endo-sinus bone was mainly gained during the first year. This study demonstrates the long-term predictability of OSFE without grafting and simultaneous implant placement. [ABSTRACT FROM AUTHOR]

Purpose. In the present paper the use of tapered-screw bone expanders (TSBEs) is proposed, in combination with the placement of tilted implants, in close proximity to the anterior sinus wall, solving the problem of the reduced height of the alveolar bone in the sub-antral area. The Authors present a case series of full-arch rehabilitations performed with this procedure named: Tilted Implant Expansion Osteotomy (TIEO). Materials and methods. 12 patients (5 males and 7 females, average age 58.5 ± 8.1 years) with totally or partially edentulous maxilla were enrolled in this study. For each patient 4 implants were placed, the anterior implants in the area of lateral incisors or canines while, the posterior implants, immediately in front of the maxillary sinus, with an inclined position. Adopting the aforesaid procedure, 48 cylindrical two-piece implants were placed, 24 of which were placed in tilted position, in order to by-pass the maxillary sinus. After a healing period of 6 months, the second stage surgery was performed. The cases were finalized by means of a hybrid metal-acrylic prosthesis. The post finalization follow-up was at 12 months. Results. Survival rate was 100% since none fixtures were lost. At the one-year follow up the clinical and radiological appearance of the soft and hard tissues was optimal and no pathological signs were recorded. Conclusion. TIEO is a promising surgical procedure for full-arch rehabilitation of maxillary edentulous sites and represents a therapeutic alternative to sinus lift techniques. [ABSTRACT FROM AUTHOR]

Background The question whether a minimal maxillary residual bone height ( RBH) allows the predictable use of osteotome sinus floor elevation ( OSFE) remains unresolved. Purpose To evaluate the efficacy of short implants placed with OSFE in an RBH of ≤4 mm and to compare bone levels around implants placed with (control) or without (test) grafting after 3 years. Materials and Methods Eight-millimeter implants were placed by OSFE in sinuses randomized to receive anorganic bovine bone or no grafting material. Healing time before prosthetic rehabilitation was 10 weeks. Peri-implant bone levels were measured on standardized periapical radiographs. Results Thirty-seven implants (17 test, 20 control) were placed at a mean RBH of 2.4 ± 0.9 mm. Three implants failed during the 3-year follow-up. After 3 years, all implants had gained endosinus bone (test: 4.1 ± 1.0 mm; control: 5.1 ± 1.2 mm; p = .001). Mean bone gain was stable between 1 and 3 years in both groups. Conclusions Grafting is unnecessary to achieve bone augmentation of 4.1 mm; however, more bone is gained with grafting. Bone gained over 1 year was retained. Atrophic posterior maxillae can be predictably rehabilitated using OSFE and simultaneous placement of 8-mm implants. [ABSTRACT FROM AUTHOR]

Background Sinus lift procedures are used to allow residual bone to accommodate functional implants in atrophic posterior maxilla. Numerous anatomical and surgical advancements in sinus lift surgery are still inspiring clinicians. Purpose The purpose of this study was to describe the recent trends in sinus lift surgery focusing on implant survival, bone grafting, anatomical and surgical considerations, and their clinical implications on the practice of implant dentistry in atrophic posterior maxilla. Materials and Methods We performed an extensive search in MEDLINE, Embase, Scopus, Web of Science, Trip, Cochrane Oral Health Group's Trials Register, Cochrane Central Register of Controlled Trials, and Pro Quest Dissertations & Theses. Articles were critically reviewed to determine the level of evidence as per the Canadian Task Force on Preventive Health Care. Results Comprehensive assessment of sinus septa, sinus pathology, and bone quality and quantity using three-dimensional cone beam computed tomography radiographs is important before placing implants in posterior maxilla. With a residual bone height of less than 5 mm, the survival rate of implant decreases substantially. Lateral window approach can increase the vertical bone height to greater than 9 mm, while osteotome approach can increase this height from 3 to 9 mm. The perforation of Schneiderian membrane doubles the risk for the incidence of sinusitis or infection. The use of piezoelectric surgery allows adequate sinus lift while protecting soft tissues and minimizing patient discomfort. Conclusions Although both osteotome and lateral window procedures can help clinicians in overcoming the challenges of placing implants in atrophic posterior maxilla, pre-implant residual bone height is crucial in determining the survival of these implants. Future research directions should consider study designs grounded on longitudinal randomized controlled trials of large sample size. [ABSTRACT FROM AUTHOR]

Purpose To assess the influence of complete maxillary sinus volume on the dimensional changes of different grafts used in maxillary sinus lift. Materials and Methods Analysis of 50 surgical procedures of maxillary sinus lift performed on 43 subjects using different grafting materials: fresh frozen allogenic particulated bone (11), hydroxyapatite (Endobon®) (17), 60% hydroxyapatite + 40% beta-tricalcium phosphate (Bone Ceramic®) (12) and Bone Ceramic® + Emdogain® (10). One hundred and fifty multislice tomographic images of the maxillary sinus were obtained using the software Syngo CT 2011 A VOLUME, measuring complete maxillary sinus volume (T0) and dimensional changes of different graft materials during periods of 15 days (T1) and 180 days (T2). The factor studied was the influence of maxillary sinus volume on the dimensional changes of different graft materials used in maxillary sinus lift in patients with posterior edentulism. Data obtained were assessed using the Student's t-test and Pearson's correlation coefficient. Results No correlation ( r 0.112) between the total maxillary sinus volume and the dimensional changes of the different graft materials used in this study was observed ( P > 0.05). Conclusion This study demonstrated that there is no sufficient evidence to support the thesis that the volume of the maxillary sinus influences the contraction of the grafts, at least on sample or the biomaterials evaluated in this cohort study. [ABSTRACT FROM AUTHOR]