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Prosthetic rehabilitation of the edentulous posterior maxilla with implant-supported prostheses frequently presents a challenge for the oral surgeon because of the lack of bone due to alveolar ridge resorption or maxillary sinus pneumatization. To overcome these problems, different solutions were proposed over the years. Maxillary sinus membrane elevation is a common surgical technique for increasing bone height in the posterior maxilla prior to dental implant placement. However, the biological nature of bone regeneration in maxillary sinus membrane remains largely unidentified. The authors present a clinical case and literature review to understand the fundamental of bone formation in osteotomy sinus floor elevation

Background: With an ageing population, an increase of more challenging implant treatments is expected. In this thesis, we evaluate the outcome of two faster implant protocols, in patients with compromised alveolar bone. We examine the bone integrating abilities of two new synthetic bone substitute materials and in another paper, we discuss the effects of nonsteroidal anti-inflammatory drugs (NSAID) on bone healing. Aim: In paper I we investigate implant survival and effect of reduced implant-tooth distance. In paper II we evaluate the long-term implant survival and function of immediately loaded implants. In paper III & IV, we analyse if added NSAID reduce postoperative pain and if it has a reduced effect on new bone formation in a rabbit sinus lift model. We also investigate if a ceramic compound (CPC, granules) and hydrogel (HABP.CaP) result in a similar or larger bone amount, in comparison with bovine bone mineral. In Paper V we assess new bone formation adjacent to a hollow CPC implant. Material & Methods: Paper I present a clinical and radiological follow-up, performed on subjects that previously received 3.0-3.3 mm diameter implants in the aesthetic area. In paper II, clinical and radiographic examinations were performed on subjects that had received six implants each with immediate loading in the maxilla 8-11-year ago. For paper III-IV, pain was assessed by clinical examination and scoring of facial expressions from photos. Histomorphometry and histology evaluations were performed. In paper V, a critical radius defect was created and either replaced by particulate autologous bone (AB) or a CPC implant. Qualitative and quantitative radiographic and histology evaluations were performed. Results: In paper I, an implant survival of 97.2% up to 124 months was shown with a tooth-implant distance in many cases of <1.5 mm. Discoloration and recession of the buccal gingiva was the most frequent patient concern. In paper II a cumulative implant survival ra

Background: With an ageing population, an increase of more challenging implant treatments is expected. In this thesis, we evaluate the outcome of two faster implant protocols, in patients with compromised alveolar bone. We examine the bone integrating abilities of two new synthetic bone substitute materials and in another paper, we discuss the effects of nonsteroidal anti-inflammatory drugs (NSAID) on bone healing. Aim: In paper I we investigate implant survival and effect of reduced implant-tooth distance. In paper II we evaluate the long-term implant survival and function of immediately loaded implants. In paper III & IV, we analyse if added NSAID reduce postoperative pain and if it has a reduced effect on new bone formation in a rabbit sinus lift model. We also investigate if a ceramic compound (CPC, granules) and hydrogel (HABP.CaP) result in a similar or larger bone amount, in comparison with bovine bone mineral. In Paper V we assess new bone formation adjacent to a hollow CPC implant. Material & Methods: Paper I present a clinical and radiological follow-up, performed on subjects that previously received 3.0-3.3 mm diameter implants in the aesthetic area. In paper II, clinical and radiographic examinations were performed on subjects that had received six implants each with immediate loading in the maxilla 8-11-year ago. For paper III-IV, pain was assessed by clinical examination and scoring of facial expressions from photos. Histomorphometry and histology evaluations were performed. In paper V, a critical radius defect was created and either replaced by particulate autologous bone (AB) or a CPC implant. Qualitative and quantitative radiographic and histology evaluations were performed. Results: In paper I, an implant survival of 97.2% up to 124 months was shown with a tooth-implant distance in many cases of <1.5 mm. Discoloration and recession of the buccal gingiva was the most frequent patient concern. In paper II a cumulative implant survival ra

Background: With an ageing population, an increase of more challenging implant treatments is expected. In this thesis, we evaluate the outcome of two faster implant protocols, in patients with compromised alveolar bone. We examine the bone integrating abilities of two new synthetic bone substitute materials and in another paper, we discuss the effects of nonsteroidal anti-inflammatory drugs (NSAID) on bone healing. Aim: In paper I we investigate implant survival and effect of reduced implant-tooth distance. In paper II we evaluate the long-term implant survival and function of immediately loaded implants. In paper III & IV, we analyse if added NSAID reduce postoperative pain and if it has a reduced effect on new bone formation in a rabbit sinus lift model. We also investigate if a ceramic compound (CPC, granules) and hydrogel (HABP.CaP) result in a similar or larger bone amount, in comparison with bovine bone mineral. In Paper V we assess new bone formation adjacent to a hollow CPC implant. Material & Methods: Paper I present a clinical and radiological follow-up, performed on subjects that previously received 3.0-3.3 mm diameter implants in the aesthetic area. In paper II, clinical and radiographic examinations were performed on subjects that had received six implants each with immediate loading in the maxilla 8-11-year ago. For paper III-IV, pain was assessed by clinical examination and scoring of facial expressions from photos. Histomorphometry and histology evaluations were performed. In paper V, a critical radius defect was created and either replaced by particulate autologous bone (AB) or a CPC implant. Qualitative and quantitative radiographic and histology evaluations were performed. Results: In paper I, an implant survival of 97.2% up to 124 months was shown with a tooth-implant distance in many cases of <1.5 mm. Discoloration and recession of the buccal gingiva was the most frequent patient concern. In paper II a cumulative implant survival ra

Background: With an ageing population, an increase of more challenging implant treatments is expected. In this thesis, we evaluate the outcome of two faster implant protocols, in patients with compromised alveolar bone. We examine the bone integrating abilities of two new synthetic bone substitute materials and in another paper, we discuss the effects of nonsteroidal anti-inflammatory drugs (NSAID) on bone healing. Aim: In paper I we investigate implant survival and effect of reduced implant-tooth distance. In paper II we evaluate the long-term implant survival and function of immediately loaded implants. In paper III & IV, we analyse if added NSAID reduce postoperative pain and if it has a reduced effect on new bone formation in a rabbit sinus lift model. We also investigate if a ceramic compound (CPC, granules) and hydrogel (HABP.CaP) result in a similar or larger bone amount, in comparison with bovine bone mineral. In Paper V we assess new bone formation adjacent to a hollow CPC implant. Material & Methods: Paper I present a clinical and radiological follow-up, performed on subjects that previously received 3.0-3.3 mm diameter implants in the aesthetic area. In paper II, clinical and radiographic examinations were performed on subjects that had received six implants each with immediate loading in the maxilla 8-11-year ago. For paper III-IV, pain was assessed by clinical examination and scoring of facial expressions from photos. Histomorphometry and histology evaluations were performed. In paper V, a critical radius defect was created and either replaced by particulate autologous bone (AB) or a CPC implant. Qualitative and quantitative radiographic and histology evaluations were performed. Results: In paper I, an implant survival of 97.2% up to 124 months was shown with a tooth-implant distance in many cases of <1.5 mm. Discoloration and recession of the buccal gingiva was the most frequent patient concern. In paper II a cumulative implant survival ra

Background: With an ageing population, an increase of more challenging implant treatments is expected. In this thesis, we evaluate the outcome of two faster implant protocols, in patients with compromised alveolar bone. We examine the bone integrating abilities of two new synthetic bone substitute materials and in another paper, we discuss the effects of nonsteroidal anti-inflammatory drugs (NSAID) on bone healing. Aim: In paper I we investigate implant survival and effect of reduced implant-tooth distance. In paper II we evaluate the long-term implant survival and function of immediately loaded implants. In paper III & IV, we analyse if added NSAID reduce postoperative pain and if it has a reduced effect on new bone formation in a rabbit sinus lift model. We also investigate if a ceramic compound (CPC, granules) and hydrogel (HABP.CaP) result in a similar or larger bone amount, in comparison with bovine bone mineral. In Paper V we assess new bone formation adjacent to a hollow CPC implant. Material & Methods: Paper I present a clinical and radiological follow-up, performed on subjects that previously received 3.0-3.3 mm diameter implants in the aesthetic area. In paper II, clinical and radiographic examinations were performed on subjects that had received six implants each with immediate loading in the maxilla 8-11-year ago. For paper III-IV, pain was assessed by clinical examination and scoring of facial expressions from photos. Histomorphometry and histology evaluations were performed. In paper V, a critical radius defect was created and either replaced by particulate autologous bone (AB) or a CPC implant. Qualitative and quantitative radiographic and histology evaluations were performed. Results: In paper I, an implant survival of 97.2% up to 124 months was shown with a tooth-implant distance in many cases of <1.5 mm. Discoloration and recession of the buccal gingiva was the most frequent patient concern. In paper II a cumulative implant survival ra

Background: Sinuslift is meanwhile an established method of bone augmentation in the posterior maxilla. Aim of the study was to evaluate the significance of intraoperative Schneiderian membrane perforations during maxillary sinus floor elevation surgery using autogenous bone harvested from two different donor sites using a Safescraper device on the success rate, graft survival and implant integration.Methods: The investigators conducted a retrospective cohort study at the Department of Oral and Maxillofacial Surgery of Military Hospital Ulm composed of patients with severe maxillary atrophy who underwent sinus augmentation from January 2011 until December 2011. Ninety-nine consecutive patients (89 men, 10 women) with a mean age of 43.1 years underwent sinus graft procedures in a 2-stage procedure using the lateral wall approach, as described by Tatum (1986). Data on patient age, smoking status, donor site and surgical complications were recorded and the relationship between Schneiderian membrane perforation and complication rate was evaluated. Dental implants were inserted 4 months after grafting.Results: A total of 105 sinus lift procedures were performed in 99 patients. Sixty-one patients (61.6%) underwent sinus elevation with autogenous bone from the buccal sinus wall, while 38 patients (38.4%) bone harvesting from the iliac crest. Intraoperative perforation of the Schneiderian membrane was observed in 11 of the 105 sinuses (10.4%). These perforations resulted in 4 (36.3%) of the cases in major postoperative complications accompanied by swelling and wound infection. Membrane perforations were slightly associated with the appearance of postoperative complications (p=0.0762). In 2.4% of all cases, regarding 2 patients the final rehabilitation with dental implants was not possible because of extensive bone resorption. Conclusion: Intraoperative complications performing sinus augmentation may lead to postoperative complications. With careful clinical and radiographic, Hintergrund: Die Sinusbodenelevation ist mittlerweile eine etablierte Methode zur Knochenaugmentation im seitlichen Oberkiefer. Ziel der Arbeit war die Evaluation der Auswirkungen von intraoperativ aufgetretenen Perforationen der Schneider'schen Membran bei Sinusbodenelevationen mit autogenen Knochentransplantaten, gewonnen mit Safescraper von zwei verschiedenen Donorseiten, auf den klinischen Erfolg, die Transplantats-Überlebensrate und die Implantatosseointegration. Methoden: In einer retrospektiven Kohortenstudie an der Abteilung für Mund-, Kiefer- und Gesichtschirurgie des Bundeswehrkrankenhauses Ulm wurden die Daten von Patienten mit ausgeprägter Oberkiefer-Atrophie untersucht, bei denen zwischen Januar 2011 und Dezember 2011 Sinusbodenelevationen durchgeführt wurden. Bei 99 Patienten (89 Männer, 10 Frauen) mit einem mittleren Alter von 43,1 Jahren wurden 105 Sinusbodenelevationen in einem zweizeitigen Vorgehen mit der Technik des lateralen Zugangs nach Tatum (1986) unternommen. Patientenparameter wie Alter, Rauchen, Spenderegion und chirurgische Komplikationen wurden erhoben und die Korrelation zwischen Sinusmembranenperforation und postoperativer Komplikationsrate wurde ausgewertet. Die Implantation erfolgte 4 Monate nach Sinusaugmentation.Ergebnisse: Es wurden insgesamt 105 Sinusbodenelevationen bei 99 Patienten durchgeführt. Bei 61 Patienten (61,6%) wurde eine Augmentation mit autologen Knochenspänen von der lateralen Sinuswand und bei 38 Patienten (38,4%) von dem anterioren Beckenkammrand durchgeführt. Eine intraoperative Perforation der Schneider'schen Membran trat bei 11 der Fälle (10,4%) auf. Davon haben sich bei 4 (36,3%) der Fälle postoperativ schwerere Komplikationen wie Wundinfektionen und Abszesse entwickelt. Es wurde eine leichte signifikante Korrelation zwischen intraoperativer Membranperforation und Auftreten von postoperativen Komplikationen festgestellt (p=0,0762). Bei 2 Patienten (2,4%) war aufgrund der ausgeprägten Transplantatresorption kei

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 named the procedure: Tilted Implant Expansion Osteotomy (TIEO). Fifteen patients (10 females and 5 males, mean age 47.8±8.15 years) with distal edentulous maxillae were enrolled in this study. For each edentulous site 2 implants were placed, the anterior implant in the area of the most anterior missing tooth while, the posterior implant, immediately in front of the maxillary sinus, with an inclined position. Adopting the aforesaid procedure, 34 cylindrical two-piece implants were placed, 17 of which were placed in tilted position, in order to by-pass the maxillary sinus. After a healing period of 4-6 months, the second stage surgery was performed. The cases were finalized by metal-ceramic cementable restorations with a variable number of elements, from 2 to 4, without any cantilever element. The post finalization follow-up was at 12 months. Survival rate was 100% since no 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. TIEO is a promising surgical procedure for oral rehabilitation of maxillary edentulous sites and represents a therapeutic alternative to sinus lift techniques.

Objectives: Placing implants in the posterior maxillary area has the drawback of working with scarce, poor quality bone in a significant percentage of cases. Numerous advanced surgical techniques have been developed to overcome the difficulties associated with these limitations. Subsequent to reports on the elevation of the maxillary sinus through the lateral approach, there were reports on the use of the crestal approach, which is less aggressive but requires a minimal amount of bone. Furthermore, it is more sensitive to operator technique, as the integrity of the sinus membrane is checked indirectly. The aim of this paper is to review the technical literature on minimally invasive sinus lift and compare the advantages of different techniques with Intralift™, a new technique. Study design: The present study is a review of techniques used to perform minimally invasive sinus lift published in Cochrane, Embase and Medline over the past ten years and the description of the crestal sinus lift technique based on minimally invasive piezosurgery, with the example of a case report. Results: Only eight articles were found on minimally invasive techniques for sinus lift. The main advantage of this new technique, Intralift, is that it does not require a minimum amount of crestal bone (indeed, the smaller the width of the crestal bone, the better this technique is performed). The possibility of damage to the sinus membrane is minimised by using ultrasound based hydrodynamic pressure to lift it, while applying a very non-aggressive crestal approach. Conclusions: We believe that this technique is an advance in the search for less traumatic and aggressive techniques, which is the hallmark of current surgery.

Objectives: Placing implants in the posterior maxillary area has the drawback of working with scarce, poor quality bone in a significant percentage of cases. Numerous advanced surgical techniques have been developed to overcome the difficulties associated with these limitations. Subsequent to reports on the elevation of the maxillary sinus through the lateral approach, there were reports on the use of the crestal approach, which is less aggressive but requires a minimal amount of bone. Furthermore, it is more sensitive to operator technique, as the integrity of the sinus membrane is checked indirectly. The aim of this paper is to review the technical literature on minimally invasive sinus lift and compare the advantages of different techniques with Intralift™, a new technique. Study design: The present study is a review of techniques used to perform minimally invasive sinus lift published in Cochrane, Embase and Medline over the past ten years and the description of the crestal sinus lift technique based on minimally invasive piezosurgery, with the example of a case report. Results: Only eight articles were found on minimally invasive techniques for sinus lift. The main advantage of this new technique, Intralift, is that it does not require a minimum amount of crestal bone (indeed, the smaller the width of the crestal bone, the better this technique is performed). The possibility of damage to the sinus membrane is minimised by using ultrasound based hydrodynamic pressure to lift it, while applying a very non-aggressive crestal approach. Conclusions: We believe that this technique is an advance in the search for less traumatic and aggressive techniques, which is the hallmark of current surgery.

Objectives: Placing implants in the posterior maxillary area has the drawback of working with scarce, poor quality bone in a significant percentage of cases. Numerous advanced surgical techniques have been developed to overcome the difficulties associated with these limitations. Subsequent to reports on the elevation of the maxillary sinus through the lateral approach, there were reports on the use of the crestal approach, which is less aggressive but requires a minimal amount of bone. Furthermore, it is more sensitive to operator technique, as the integrity of the sinus membrane is checked indirectly. The aim of this paper is to review the technical literature on minimally invasive sinus lift and compare the advantages of different techniques with Intralift™, a new technique. Study design: The present study is a review of techniques used to perform minimally invasive sinus lift published in Cochrane, Embase and Medline over the past ten years and the description of the crestal sinus lift technique based on minimally invasive piezosurgery, with the example of a case report. Results: Only eight articles were found on minimally invasive techniques for sinus lift. The main advantage of this new technique, Intralift, is that it does not require a minimum amount of crestal bone (indeed, the smaller the width of the crestal bone, the better this technique is performed). The possibility of damage to the sinus membrane is minimised by using ultrasound based hydrodynamic pressure to lift it, while applying a very non-aggressive crestal approach. Conclusions: We believe that this technique is an advance in the search for less traumatic and aggressive techniques, which is the hallmark of current surgery.

Objectives: Placing implants in the posterior maxillary area has the drawback of working with scarce, poor quality bone in a significant percentage of cases. Numerous advanced surgical techniques have been developed to overcome the difficulties associated with these limitations. Subsequent to reports on the elevation of the maxillary sinus through the lateral approach, there were reports on the use of the crestal approach, which is less aggressive but requires a minimal amount of bone. Furthermore, it is more sensitive to operator technique, as the integrity of the sinus membrane is checked indirectly. The aim of this paper is to review the technical literature on minimally invasive sinus lift and compare the advantages of different techniques with Intralift™, a new technique. Study design: The present study is a review of techniques used to perform minimally invasive sinus lift published in Cochrane, Embase and Medline over the past ten years and the description of the crestal sinus lift technique based on minimally invasive piezosurgery, with the example of a case report. Results: Only eight articles were found on minimally invasive techniques for sinus lift. The main advantage of this new technique, Intralift, is that it does not require a minimum amount of crestal bone (indeed, the smaller the width of the crestal bone, the better this technique is performed). The possibility of damage to the sinus membrane is minimised by using ultrasound based hydrodynamic pressure to lift it, while applying a very non-aggressive crestal approach. Conclusions: We believe that this technique is an advance in the search for less traumatic and aggressive techniques, which is the hallmark of current surgery.

Background: Presence of the maxillary sinus and low bone density in this area often could create a problem for prosthetic rehabilitation with dental implants. Sinus floor augmentation technique can successfully increase dimensions of the posterior maxilla for implant placement. Objective: To assess quality of newly formed bone for implant insertion after augmentation of the floor of the maxillary sinus using Digora for Windows computer programme. Materials and Methods: 30 patients with indications for sinus lift procedure were involved in this clinical study. Bone density was analyzed by Digora for Windows computer programme. Results: 16 patients completed this clinical study with preoperative and postoperative orthopantomographs. Conclusion: Cases with sufficient density and bone volume in the posterior maxilla require sinus lift technique with adequate bone graft for implant insertion. This is confirmed by pre- and post-operative analysis of radiographic images in Digora for Windows programme.