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Purpose The aim of our studdy is clinical evaluation of Platform switch hybrid zygoma implants. Materials and Methods 117 zygomatic implants were followed up during this time. They included 55 Brånemark System zygoma implants, 38 Noris implants, and 24 novel iRES hybrid implants with platform switch. Results Bone quality and quantity are the prerequisite for successful implant treatment. Zygomatic implants are intended for patients with severely resorbed maxilla that cannot accommodate conventional implants without prior extensive bone grafting. Such regenerative procedures, like sinus lifts, prolong implant rehabilitation to several months (12–18). Furthermore, extensive grafts are less predictable showing varying degrees of graft resorption. Zygoma implants enable full, often immediate, reconstruction of the upper dental arch without the need for sinus lift treatment. The original zygoma protocol runs the implants through the sinus, requires general anesthesia, and positions the prosthetic platform of the implants on the palate, which makes prosthesis cumbersome. It also induces risk for post‐op sinusitis. Extra‐sinus approach with novel zygoma hybrid implants bypasses sinuses and positions the implant prosthetic platform on the crest allowing for same good prosthetics as on conventional dental implants. Furthermore, crestal threads and a platform‐switch, of the novel zygoma design, increase implant anchorage and minimize marginal bone loss. The study presents evolution of zygoma implant rehabilitation protocol and zygoma implant design in our clinical practice over 15 years (2004‐2019). Conclusion Extra‐sinus zygomatic implant placement lowers the risk of post‐op sinusitis and makes procedure possible to be done in local anesthesia.

Background Ongoing marginal bone loss is a threat to the longevity of implant-supported prostheses. Aim The aim of the present study was to retrospectively evaluate the survival rate and factors affecting marginal bone levels at a hydrophilic implant design after 5 years in function. Materials and methods The study group consisted of 51 consecutive patients previously treated with 159 hydrophilic implants (Neoss Straight Proactive implants) and scheduled for annual check-ups with clinical and radiographic examinations during 5 years. Data were compiled for the entire study population as well as for two subgroups: one where guided bone regeneration (GBR) was performed (91 implants) and the other where no GBR procedures (68 implants) were performed. Marginal bone levels were measured from peri-apical radiographs taken at placement and annual follow-ups. Statistical analyses were applied to evaluate the effect of different factors on marginal bone remodeling. Results Two implant failures, one from each subgroup, occurred during the first year of function resulting in an overall cumulative survival rate (CSR) of 98.7% after 5 years of loading. The mean marginal bone loss amounted to 0.7 ± 0.7 mm after 1 year and 0.8 ± 0.6 mm after 5 years. No implants showed more than 3 mm bone loss after 5 years. Age, gender, implant position, biotype, implant diameter, implant length, indication, surgical/loading protocol, and ISQ at prosthesis delivery were found to affect bone remodeling. No significant differences or correlations were seen for smoking, jaw, bone quantity, bone quality, GBR, sinus lift, and ISQ at implant placement. Conclusions The present implant design performed well with few failures and minimal marginal bone loss after 5 years of loading. Marginal bone remodeling at implants is a complex phenomenon, which is affected by many patient-, procedure-, and implant-related factors that need to be further investigated.

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.

OBJECTIVE The aim of this study is to evaluate the analytical difference between the use of xenograft (control group) and graftless tenting (test group) technique after sinus lift procedure with simultaneous implant placement. MATERIALS AND METHODS Seventeen patients and 20 sinuses where operated for sinus lift procedures using lateral window approach with simultaneous implant placement. Deproteinized bovine bone (Xenograft) was used as a filling material in control group while nongrafted sinus lifting was performed in the test group. Multislice CT was obtained preoperatively and CBCT were obtained immediately postoperative and 6 months after operation. Osstell readings were taken at the time of implant placement and implant exposure (6 months) RESULTS: Mean bone height gain in the xenograft group was 8.59 ± 0.74 while that of the tenting group was 4.85 ± 0.5 and it was statistically significant (P

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

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.

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.

Purpose The aim of the present 1-year clinical and radiographic study was to evaluate a hydrophilic dental implant when used in everyday cases in one clinic. The purpose was also to compare augmented with nonaugmented sites. Materials and Methods The study group consisted of 50 consecutive patients treated with 159 dental implants (Proactive, Neoss Ltd, Harrogate, UK) in both mandibles and maxillae. Ninety-two implants were placed with adjunct bone augmentation procedures, whereas 40 implants were placed in augmented maxillary sinus sites. A two-stage procedure was used for 84 implants and a one-stage procedure for 47 implants. Twenty-eight implants were immediately loaded. Implant stability was measured with resonance frequency analysis (RFA) at placement and at prosthesis delivery. The patients were scheduled for checkups after 6 and 12 months in function with clinical and radiographic examinations. Marginal bone level measurements were performed in baseline and follow-up intraoral radiographs. Results Two implant failures in two patients were experienced after 1 year of loading, giving a survival rate of 98.7%. One implant in nonaugmented sites and one implant in conjunction with an augmentation procedure (sinus lift), giving a survival rate of 98.5% and 98.9% for healed and augmented sites, respectively (NS). RFA measurements showed 70.2 ± 9.5 ISQ at placement and 76.5 ± 5.9 ISQ (p ≤ 0.001) after a mean healing time of 5.6 ± 1.6 months. The marginal bone loss amounted to 0.7 ± 0.7 mm after 1 year of loading. Frequency distribution showed bone gain or less than 1 mm bone loss for the majority of implants (69.3%), whereas 25.7% showed 1.1 to 2 mm, 5.0% more than 2 mm and no implants more than 3 mm of bone loss. Conclusions The use of Neoss Proactive implants for prosthetic rehabilitation of consecutive patients resulted in predictable clinical and radiographic outcomes after 1 year of loading with no differences between augmented and nonaugmented sites.

Background and Purpose Sinus lift (SL) using cultured autogenous periosteal cells (CAPCs) combined with autogenous bone and platelet-rich plasma (PRP) was performed to evaluate the effect of cell administration on bone regeneration, by using high-resolution three-dimensional computed tomography (CT). Materials and Methods SL with autogenous bone and PRP plus CAPC [CAPC(+)SL] was performed in 23 patients. A piece of periosteum taken from the mandible was cultured in M199 medium with 10% fetal bovine serum (FBS) for 6 weeks. As control, 16 patients received SL with autogenous bone and PRP [CAPC(−)SL]. Three-dimensional CT imaging was performed before and 4 months and 1 year after SL, and stratification was performed based on CT numbers (HUs) corresponding to soft tissue and cancellous or cortical bone. Results The augmented bone in CAPC(+)SL revealed an increase in HUs corresponding to cancellous bone as well as a decrease in HUs corresponding to grafted cortical bone. In addition, HUs corresponding to cancellous bone in the graft bed were increased in CAPC(+)SL but were decreased in CAPC(−)SL. Insertion torque during implant placement was significantly higher in CAPC(+)SL. Conclusion By promoting bone anabolic activity both in augmented bone and graft bed, CAPCs are expected to aid primary fixation and osseointegration of implants in clinical applications.

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.

Background Maxillary sinus elevation is a predictable procedure to vertically enhance bone volume in the posterior maxilla for successful implant placement. It is speculated that graft bone resorption and remodeling which require angiogenesis may be affected by the dimensions of maxillary sinus cavity. Purpose The aim of this study is to investigate the effect of sinus width (SW) on the outcomes of transcrestal sinus lift with simultaneous implant placement based on cone beam CT (CBCT). Materials and Methods A total of 57 elevated sites in 33 patients were included in this study. All the patients were treated with transcrestal sinus lift procedure associated with simultaneous implant placement using a composite graft material of autogenous bone and Bio-Oss. For each patient, CBCT scans were performed preoperatively, immediately after surgery and 6 months after surgery. Measurements of the linear parameters were conducted on the preoperative and postoperative CBCT images. The correlation of SW with graft resorption (GR) was analyzed using Pearson's correlation test with or without the classification of residual bone height. Results The average width of maxillary sinus was 13.68 ± 2.66 mm. The mean height of apical graft bone decreased from 2.85 mm immediately after surgery to 1.38 mm after 6 months. A positive association between SW and GR (r = 0.323, p = .014) was found in general. Conclusion The findings show that graft bone resorption in elevated sinus has a positive correlation with the SW.

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.

Background There is a lack of evidence regarding success of implants placed in atrophic premaxilla using the nasal floor elevation technique. Purpose This study aimed to compare implants placed in augmented bone in the anterior maxilla using the nasal floor elevation technique with implants placed in the maxillary sinus region using the sinus lift technique. Materials and Methods A within-patient controlled clinical trial was performed on 14 patients receiving 78 implants. The implants were assigned to one of two study groups on the basis of implant location. A total of 37 implants were placed in the nasal fossa region (NF group), and 41 implants were placed in the maxillary sinus region (MS group). Patients were followed up for 4.5 ± 2.2 years, with comparable follow-up times for implants in NF and MS groups (4.7 ± 2.1 and 4.9 ± 2.1 years, respectively; p > .05). Treatment outcomes were assessed and statistically analyzed. Results Implant success rate was 89.2% in the NF group and 95.0% in the MS group, with no statistically significant difference between them (p > .05). No nasal or sinus membrane perforation or other complications were reported within the follow-up period. Significant differences were found between the two groups in terms of residual bone height, augmented bone height, and implant diameter. Conclusions Nasal floor elevation is an effective and safe procedure that can be used for implant placement in atrophic premaxilla with success rates that are comparable to those of implants placed in the maxillary sinus.

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 ProQuest 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.

Purpose The aim of this prospective clinical study was to evaluate the clinical and histomorphometric data of newly formed bone tissue from fresh frozen human allograft in sinus lift surgery. Patients and Methods Thirty-three sinus lift procedures were performed in 20 patients, divided into two groups. The control group (n = 8) received autogenous bone from the mandibular ramus, and the experimental group (n = 12) received fresh frozen bone (FFB) allograft in chips. After 6 months, 52 implants were placed and 50 biopsies were collected for histomorphometric analysis. Cone beam computed tomography scans were performed at preoperative, immediate postoperative, and delayed postoperative time intervals to assess the degree of graft volume loss. Results There was no statistically significant difference between groups as regards degree of graft volume loss (p = .983), total bone area (p = .191), remaining particles (p = .348), and proportion of active osteoblasts (p = .867). There was a statistically significant difference in the vitality rate between the groups (p = .043). In both groups, all implants were clinically osseointegrated after 4 months. Conclusion FFB allograft was shown to be a feasible substitute for autogenous bone graft in sinus lift surgery.

Purpose Provide a comprehensive overview on the clinical use and the efficacy of growth factors in different reconstructive procedures in the oral maxillofacial area. Materials and Methods A systematic review of the literature on the clinical use of human and human recombinant growth factors in oral maxillofacial reconstruction has been performed. Results The use of autogenous growth factors in platelet concentrates (PCs) has shown to be beneficial in the treatment of intrabony pockets at a reasonable level of evidence by improving probing depth and clinical attachment levels as well as linear bone fill within the limits of the observation periods. The application in conjunction with non-autogenous graft materials has been superior to the use of PCs only or grafting materials alone. No benefits have been shown for the use of PCs in recession treatment. When used in furcation treatment, probing depth, clinical attachment level and linear bone fill have been reported to improve significantly, however, without clinical benefit. No benefit for the final outcome could be shown for the use of PCs neither in sinus lift procedures nor in lateral / vertical crest augmentations. The use of human recombinant growth factors has been so far limited almost exclusively to rhPDGF-BB and rhBMPs (BMP-2, BMP-7 and GDF-5). The use of rhPDGF in the treatment of intrabony pockets has shown a reliable increase in linear bone fill but weaker evidence for permanent improvements of clinical attachment level. So far there is no evidence to support the use in recession treatment, sinus lift procedures and socket healing as well as lateral / vertical augmentations of the alveolar crest. rhBMPs have shown to be effective in enhancing bone formation in socket healing (rhBMP-2) and sinus lift procedures (rhBMP-2 and GDF-5). No controlled studies are available for the use in mandibular segmental repair. Successful reports on this application appear to be limited to primary reconstruction after ablative surgery for benign pathology with preservation of the periosteum. Conclusion Evidence of clinical efficacy of growth factors in reconstructive procedures in the oral and maxillofacial area is limited.

Background It is unknown whether autogenous bone impacts the grafts' stability when added to biphasic calcium phosphate (BCP) within the first six months of maxillary sinus augmentation (MSA). Purpose To investigate the volume stability of BCP alone and in mixtures with autogenous bone for MSA. Materials and Methods Bilateral maxillary sinus augmentation was performed in eight patients in a split-mouth design using BCP at the control site and adding particulated autologous bone at the test site (BCPAB). Based on 16 computed tomography (CT) the volumetric changes were evaluated using the Voxim® software (version 6.3, IVS Technology GmbH, Chemnitz, Germany) by comparing the graft volumes within two weeks of the sinus lift procedure with CT data obtained six months later. Changes of the graft volumes were calculated and statistically significant differences between the two groups were evaluated. Results Overall, the volumes decreased by 15% for BCP and 18% for BCPAB. The time-dependent decreases were statistically significant in both groups. Differences between the two groups were not statistically significant (p = .065). Conclusions An evident decrease of graft volume over the first 6 months of healing has to be expected irrespective of bone graft composite. Autogenous bone seems to have no evident impact on the volume decrease when added to BCP.

Purpose The aim of the present systematic review was to estimate the implant survival rate in different types of techniques for the rehabilitation of posterior atrophic maxilla, after at least 3 years of follow-up. Materials and Methods MEDLINE database was searched using a combination of specific terms. A hand searching of the relevant journals and of the reference lists of systematic reviews was also performed. All retrospective and prospective studies evaluating short implants in posterior maxilla, osteotome sinus floor elevation and lateral approach sinus floor elevation, and having a follow-up of at least 3 years, were included. Results Forty-four articles were included in the review. In four studies reporting on a total of 901 short implants, the implant survival rate varied from 86.5% to 98.2% with up to 5 years follow-up. For the osteotome technique, 1,208 implants in eight studies were considered, showing a survival rate varying from 95.4% to 100% after 3-year follow-up. Twenty-nine studies, accounting for 6,940 implants placed in 2,707 sinuses augmented through lateral technique were considered. Implant survival rate varied from 75.57% to 100%. Only three comparative studies were found that showed no significant difference in clinical outcomes between lateral approach and osteotome technique. Conclusions Sinus floor elevation with the lateral approach and with the osteotome technique is an effective and well-documented therapeutic option for the rehabilitation of atrophic posterior maxilla. The use of short implants is promising but needs further investigation to be considered as effective as the other techniques in the long term. However, the indication for the three different techniques is not perfectly equivalent and the treatment choice should be based on a careful evaluation of the individual case, in particular on the available residual bone.

Purpose Less morbidity is the major advantage to a one-stage crestal approach to maxillary sinus elevation. However, the ability to ensure high primary implant stability in a severely atrophied ridge is of chief concern. The purpose of this study is to measure and compare the success rate of implants placed at the time of crestal approach sinus lift in patients with ≤4 mm of residual alveolar bone (RAB) and >4 mm of RAB. Materials and Methods In this three-site multicenter study, one hundred two patients, 53 males and 49 females, (23–89 years old; mean = 56.2) were evaluated. Three experienced surgeons (>15 years) performed the crestal approach sinus lift microsurgeries with simultaneous implant placement. At baseline and at the follow-up appointments, calibrated examiners measured radiographic interproximal bone level using ImageJ for Windows after calibration of the radiographs. References for the bone level measurements were the platform, first and second threads of the implants. Statistical analyses, using STATA version 12, stratified patients according to RAB height (group 1: RAB of ≤4 mm; n = 35 and group 2: RAB > 4 mm; n = 67), age, gender, and treatment center. Results The success rate was 100% for group 1 and 98.51% for group 2 at 6 to 100 months postprosthetic loading (mean = 29.7 months). The peri-implant bone loss averaged 0.55 mm (interquartile range [IQR] = 0.5 [0–1]) in group 1 and 0.07 mm (IQR = 0 [0–0]) in group 2. There was no statistically significant difference between the two groups. Clinical outcomes were independent of age, gender, and treatment center. Conclusions The RAB height did not increase crestal bone loss or reduce the success rate of the implants and associated prostheses. The crestal approach should be considered a viable technique for use in patients with residual bone height of ≤4 mm and merits further evaluation.

Author(s): Pozzi, A; Moy, PK | Abstract: Purpose: This study describes a new procedure for sinus elevation using computer-guided planning and guided surgical approach through the use of computer-aided design (CAD)/computer-aided manufacturing (CAM)-generated surgical template in combination with expander-condensing osteotomes thus providing a minimally invasive surgical technique. Materials and Methods: Sixty-six consecutive patients were treated with 136 implants placed by transcrestal-guided sinus floor elevation technique and the patients were followed for at least 3years in function. The drilling protocol is customized based on the bone density of each implant site to achieve an insertion torque ranging between 45 and 55Ncm. Titanium temporary abutments were connected to the implants with prosthetic screws tightened to 35Ncm and an acrylic resin provisional restoration was adapted and delivered immediately. Six months after initial loading, a definitive CAD/CAM-generated restoration was delivered. Outcome measurements assessed were implant and prosthesis survival rate, biological or biomechanical complications, marginal bone level changes, total alveolar ridge bone height before and after procedure, periodontal parameters measured as well as patient's perception of pain levels during recovery period. Results: Mean follow-up was 43.96 (range from 36 to 52) months. Cumulative implant survival rate was 98.53% at 3 years. No biological or mechanical complications were encountered and no prosthetic failures occurred during the entire follow-up period. Mean marginal bone loss (MBL) during the first year of function was 0.33±0.36mm, while at the 3-year follow-up, the mean MBL was 0.51±0.29mm. The mean residual bone height of the alveolar crest prior to grafting was of 6.7±1.6mm (range 5.1-9.2mm), while, the mean bone height gained was 6.4±1.6mm (range 3.2-8.1mm). All patients reported low levels of pain and found to have normal periodontal parameters. Conclusion: This proof-of-concept study suggests that the use of guided surgery to perform transcrestal maxillary sinus floor elevation for alveolar ridge height augmentation is a successful minimally invasive technique for the short- to medium-term follow-up, thus avoiding the extended treatment time and morbidities associated with maxillary sinus floor augmentation. © 2013 Wiley Periodicals, Inc.

Purpose In cases of advanced maxillary sinus atrophy of the bone (pneumatization), the sinus floor has to be augmented in order to obtain acceptable bone volume for implantation. The objective of the present study is to evaluate a new procedure and device, designed as a closed sinus lift using a dedicated dental implant that allows for Schneiderian membrane elevation and the placement of a flowable bone replacement graft. Materials and Methods Eighteen patients (8 males, 10 females) underwent 23 procedures. All procedures were completed successfully, with elevation of the sinus membrane and insertion of bone graft and the dental implant at the planned site. No membrane tears were noted. No intraoperative or postoperative adverse events were observed in any of the cases. There were no postprocedural emergency or distress calls. Results The patients' average age was 52 (range 38–72). The mean residual alveolar ridge height was 5.5 mm (range 4.0–7.0). The average bone gain was 11.2 mm (range 9–13) after an average healing period of 8.7 months (range 6.7–13.1). All implants achieved clinical stability and prosthetic rehabilitation was uneventful. Conclusions A closed sinus floor elevation procedure can be accomplished using a dedicated dental implant that allows for hydraulic elevation of the Schneiderian membrane and placement of a flowable bone replacement graft and dental implant placement all at the same time with minimal patient discomfort.

Purpose If less than 4 mm of residual bone is remained in posterior maxilla, two-stage operation is recommended for implant installation. However, if primary stability could be obtained using tapered designed implants, one-stage surgery could be performed with reliable success rate in severely resorbed maxilla. The purpose of this prospective study was to evaluate survival and success rates of the implants simultaneously placed into grafted sinus using rough-surfaced implant. Materials and Methods A total of two hundred seventeen consecutive sinus lifting through lateral approach and four hundred sixty-two simultaneous implants were installed from November 2003 for 5.5 years. Xenogenic bone was used solely for bone graft materials. Second surgery was performed around 6 months after operation and porcelain fused metal or gold crown was used for definitive restorations. Cumulative survival and success rates were evaluated according to residual alveolar bone height (RABH), smoking status, and Schneiderian membrane perforation. Results The mean follow-up was 57.1 ± 15.6 (36–98) months. Of the four hundred sixty-two implants, two hundred sixty-two implants (56.7%: group 1) were installed in posterior maxilla less than 4-mm RABH and two hundred implants (43.3%: group 2) were placed in over 5-mm RABH. The cumulative survival and success rates were 98.91% and 96.54%. There was no statistically significant difference in success rate between group 1 and group 2 (p = .3135). Perforation of the membrane was not related to success (p = .7162), but smoking status is significantly related with implant failure (p = .0003). Conclusions Sinus lifting with simultaneous implant placement could be used to treat atrophic maxilla in patients with minimal RABH when initial stability could be obtained by using taper designed implants with surgical techniques. Smoking is a possible factor for implant failure. Membrane perforation did not have an adverse effect on implant success if the membrane was repaired with absorbable membrane and fibrin glue.

Background Implant stability is one of the key factors for a successful osseointegration. At present, several techniques are available to regenerate bone tissue, but it is not clear whether implants placed in grafted bone are as stable as implants in native bone over time. Purpose The aim of the present study was to compare, by means of resonance frequency analysis (RFA), the stability of implants placed in sinus-grafted and -nongrafted sites during 12-month follow-up. Methods Twenty-five patients received a total of 38 implants. Nineteen implants were placed in maxillary native bone (group A) and 19 implants following maxillary sinus floor augmentation using anorganic bovine bone and autogenous bone (group B) in a 50:50 ratio. Group B was divided into groups B1 and B2 depending on the timing of implant insertion, that is, B1 simultaneously and B2 6 months after sinus lift. The implants were inserted according to a two-stage procedure. RFA values were collected at baseline, 6 and 12 months after implant placement. Results Between the tested groups, no statistically significant difference was found in RFA values of implants placed in sinus-grafted and -nongrafted sites after the surgery as well as at 6 and 12 months, while a significant difference was recorded in group B1 (p = .0297) when RFA values were compared over time. Conclusions The results of the present study suggest that regenerated bone can offer good stability for dental implants.

Purpose: The purpose of this longitudinal study was to evaluate the success of bovine bone and calcium sulfate (CaSO4) as sinus augmentation material with osteotome maxillary sinus lift. Materials and Methods: Thirty-one osteotome sinus lift procedures were performed for 18 healthy patients (7 males and 11 females). A mixture of bovine bone and CaSO4 (ratio, 4:1) was used as sinus augmentation material with simultaneous implant placement. Implants were loaded 4 to 5 months postimplant surgery. Cases were followed for an average of 23.4 months postloading (range, 12–60 months). Results: The mean age of the study group was 49.7 ± 10.66 years. The residual height of the alveolar ridge ranged from 5.5 to 11 mm (mean, 8.16 ± 1.52 mm). Four to 5 months after implant placement, the x-ray showed a 1.5 to 5 mm apical shift of the sinus floor (mean, 3.47 ± 0.97 mm), which was maintained to the end of the evaluation period. At 12 months postloading, crestal bone loss ranged from 0.5 to 1.5 mm (mean, 0.87 ± 0.26 mm), and pocket depth ranged from 2 to 4 mm (mean, 2.9 ± 0.67 mm). No significant change in crestal bone loss or pocket depth was noticed afterward. Conclusion: Bovine bone plus CaSO4 can be used successfully as a sinus augmentation material with osteotome sinus elevation. The use of CaSO4 significantly improved the handling properties of bovine bone and helped to stabilize the bone graft particles during healing.

Purpose: The aim of the present study was to systematically evaluate the implant survival rate after osteotome-mediated maxillary sinus augmentation with or without using grafting materials. Materials and methods: MEDLINE database was searched using a combination of specific search terms. Furthermore, a hand searching of the relevant journals and of the bibliographies of reviews was performed. Prospective and retrospective clinical studies with at least 20 patients treated by osteotome-mediated sinus floor elevation were included. Results: Nineteen studies were selected for data analysis. A total of 1,822 patients, accounting for 3,131 implants were considered. Mean weighted cumulative implant survival at 1, 2, 3, and 5 years was estimated as 98.12%, 97.40%, 96.75%, and 95.81%, respectively. No significant difference was found in relation to the use of grafting material nor in relation to implant length. Overall implant survival was 92.7% for 331 implants placed in

Background: Immediate loading of full-arch restorations yields good results in selected cases, but long-term follow-up and the outcome in compromised bone are scarcely evaluated. Purpose: To evaluate immediately loaded Osseotite implants (Biomet 3i, Palm Beach, FL, USA) installed in healed or grafted bone, with regard to implant survival and peri-implant bone loss up to 7 years in function. Materials and Methods: Information was retrospectively retrieved from 83 patients' records with 749 Osseotite implants supporting immediately loaded semipermanent full-arch acrylic restorations. Five hundred sixty-eight (75.8%) implants were placed in healed bone and 181 (24.2%) in augmented bone, regenerated with sinus lifting and/or onlay/inlay grafts with/without biomaterials and membranes. Implant survival and success based on radiological peri-implant bone loss were registered. Wilcoxon rank sum tests evaluated peri-implant bone loss in compromised versus healed bone or between jaws or time intervals with p

Purpose: The objectives of this radiographic study were to determine to what degree the available residual bone area for implant placement was underestimated on panoramic radiographs (by comparison with multislice computed tomography CT/cone beam CT images combined with planning software) and to what degree the rate of severely resorbed posterior maxillae requiring sinus lift was overestimated on panoramic radiographs (by comparison with planning software in combination with strategic implant placement). Materials and Methods: During a 2-year period, every patient who presented for the placement of implants in the posterior maxilla was examined by three practitioners to discuss the treatment plan. When two to three practitioners indicated a sinus lift with creation of a lateral window, a CT scan was performed and examined using dedicated three-dimensional software by a clinician familiar with the Computer Assisted Design/ Computer Assisted Manufacturing (CAD/CAM) implant placement protocol. For each tooth to be replaced, the presence of anatomical features such as anterior or posterior wall, palatal curvature, and septa were examined in view of the placement of an 8-mm or longer implant. Results: One hundred one patients were studied in this case series for the treatment of 135 edentulous spans accounting for 301 missing teeth. After examination of the CT data on the three-dimensional software, 202 teeth (67.1%) could be replaced using a CAD/CAM procedure; 60.7% of the edentulous spans could be completely repaired by a crown or bridge supported by implants. In addition, 67.3% of edentulism with no teeth posterior to the span could be completely repaired using a fixed prosthesis supported by implants. Conclusion: This radiological study demonstrates that the use of a panoramic exam for oral implant planning in severely resorbed maxillae overestimates the need for a sinus augmentation procedure when compared with the use of both three-dimensional planning software and strategic implant placement on small remaining bone volume.

Background: The aim of this study was to evaluate the clinical outcomes and radiographic data of transcrestal sinus floor elevation (TSFE) of residual alveolar bone ≤3 mm. Methods: Forty-six patients, edentulous in one or both maxillary posterior segments, were enrolled in this study. The residual alveolar ridge was measured. TSFE without bone grafting was performed. Three months after the first surgery procedure, 66 implants were placed without grafting material. A presurgical distance from the alveolar crest to the floor of the maxillary sinus and the amount of new radiopacity between the sinus floor and alveolar crest were measured from the mesial and distal surfaces of each dental implant surface. Results: After a mean follow-up period of 10.43 ± 5.01 years (ranged from 5 to 16 years), a survival rate of 95.45% was reported. Mean bone levels at implant placement were 7.12 ± 0.90 mm and, after 1 year, were 13.28 ± 1.23 mm. They were stable over time, reporting an up to 16 years' value of 13.07 ± 2.63 mm. Conclusions: The results of this retrospective clinical study confirmed the reliability of the TSFE procedure and the maintenance of bone levels without grafting procedures over time.

OBJECTIVES This multicenter prospective study was aimed to clinically evaluate implant behavior inserted in severely resorbed maxillae and restored 3 months after sinus grafting. MATERIALS AND METHODS In three clinical centers, 67 totally rough wide diameter implants were inserted during 30 consecutive sinus lifts. Computed tomography and panoramic analysis were preoperatively requested for each patient. Sinus grafting was performed using a nano-crystalline hydroxyapatite sole bone filler; no membrane was used to cover the buccal window. Preoperative residual bone height ranged between 1-4 mm (mean value: 2.70 mm, standard deviation [SD]: 0.9 mm). Uncovering procedure was carried out following 3 months of healing; 2 weeks later, a definitive restoration was seated using platform switching concept. To monitor stability changes, resonance frequency analysis was performed and implant stability quotient (ISQ) values were collected at the first surgery (baseline, T(0) ), at the abutment connection (T(1) ), and at 2-year follow-up (T(2) ). To measure bone changes, patients underwent panoramic analysis after 2-year follow-up. The image analysis software calculated the grafted bone height changes at level of implant site comparing preoperative and follow-up panoramic films; the software compensated for eventual radiographic distortion. RESULTS Mean ISQ value was 35.7 (SD: 8.8) at baseline, 66.61 (SD: 4.76) at T(1) , and 77.9 (SD: 4.7) at T(2) . Statistically significant differences (p ≤ 0.005) regarding ISQ mean values were found between T(1) and T(0) , as well as between T(1) and T(2) . After 24 months of functional loading, only two implants were lost (cumulative survival rate: 97%). During the same observation period, the mean value of radiographic vertical height of grafted sinus was 13.75 mm (SD = 1.3 mm), with a mean gain of 11 mm. CONCLUSIONS Within the limits of this study, despite preoperative residual bone height ranging 1 to 4 mm and absence of the membrane covering the buccal bone wall, maxillary sinus lift restoration 14 weeks after first surgery seems to be a reliable procedure using totally-rough surfaced implants restored using platform switching concept and nano-structured hydroxyapatite as sole bone filler.

Purpose: The purpose of this study was to evaluate the potential effects of plasma rich in growth factors (PRGF) technology and its autologous formulations in five consecutive patients in which bilateral sinus lift augmentation was carried out. Material and Methods: Five consecutive patients received bilateral sinus floor augmentation. All patients presented a residual bone height of class D (1–3 mm). The effects of PRGF combined with bovine anorganic bone (one side) were compared with the biomaterial alone (contralateral side). The effects of using liquid PRGF to maintain the bone window and autologous fibrin membrane to seal the defect were evaluated. A complete histological and histomorphometrical analysis was performed 5 months after surgery. Results: One patient was excluded from the study as the Schneiderian membrane of the control side was perforated during the surgery. In two patients, the biopsies obtained from the control sides 5 months postsurgery were not acceptable for processing. PRGF technology facilitated the surgical approach of sinus floor elevation. The control area was more inflamed than the area treated with PRGF technology. Patients referred also to an increased sensation of pain in the control area. PRGF-treated samples had more new vital bone than controls. In patient number 1, image processing revealed 21.4% new vital bone in the PRGF area versus 8.4% in the control area, whereas in patient number 2, 28.4% new vital bone was quantified in the PRGF area compared with the 8.2% of the control side. The immunohistochemical processing of the biopsies revealed that the number of blood vessels per square millimeter of connective tissue was 116 vessels in the PRGF sample versus 7 in the control biopsy. Conclusions: These preliminary results suggest that from a practical point of view, PRGF may present a role in reducing tissue inflammation after surgery, increasing new bone formation and promoting the vascularization of bone tissue.

Background: Insufficient alveolar bone height often prevents the placement of standard dental implants in the posterior part of edentulous maxilla. In order to increase adequately the vertical dimension of the reabsorbed alveolar process, a sinus lift procedure is often necessary. The aim of this study was to evaluate histologic results of a prehydrated corticocancellous porcine bone used in maxillary sinus augmentation. Methods: Patients (age 18–70 years) with a residual bone height requiring a maxillary sinus augmentation procedure to place dental implants were eligible for this study. All patients were treated with the same surgical technique consisting of sinus floor augmentation via a lateral approach. The space obtained by elevation of the mucosa wall was grafted with prehydrated and collagenated corticocancellous porcine bone. Biopsies were harvested 6 months after the augmentation procedures. Results: Twenty-four patients were enrolled. The mean percentage of new formed bone was 43.9 ± 18.6% (range 7.5–100%), whereas the mean percentage of residual graft material was 14.2 ± 13.6% (range 0–41.9%). The new bone/residual graft material ratio in the maxillary sinuses was 3.1. The mean soft tissues percentage was 41.8 ± 22.7% (range 0–92.5%). Conclusion: The present study suggested that porcine bone showed excellent osteoconductive properties and could be used successfully for sinus augmentation. Moreover, the porcine bone showed a high percentage of reabsorption after 6 months; this might be because of the presence of collagen and the porosity of the graft material.

Purpose: A lateral approach for sinus elevation using plasma rich in growth factors (PRGF) technology is described. The long-term survival of dental implants installed following a two-stage procedure after sinus elevation using this procedure is reported, using implant loss as the outcome variable. Materials and Methods: A retrospective cohort study design was used. Eighteen patients received 43 implants (BTI implants, Biotechnology Institute, Vitoria, Spain) with sinus floor elevation. All patients presented a residual bone height of class D (1–3 mm). Implants were installed using a low-speed drilling procedure (50 rpm) without irrigation. Finally, the histological and histomorphometric evaluation of eight samples from PRGF grafted sinus involved in the study was carried out 5–6 months posttreatment. Results: The overall survival rate of dental implants was 100%. The mean follow-up period for all implants was 33 ± 7 months ranging from 24 to 44 months. In addition, the histomorphometrical evaluation of the samples evidenced a 25.24 ± 4.62% of vital newly formed bone, 50.31 ± 15.56% of soft connective tissue, and the remaining 24.46 ± 12.79% of bovine anorganic bone. Conclusions: Based on these results, this new approach for sinus elevation and implant installation using PRGF technology can be considered safe, simple, effective, and predictable.

Background: For single-tooth implant replacement in the posterior maxilla, it is often necessary to do an augmentation of the alveolar process because of post-extraction resorption and include part of the maxillary sinus. Purpose: The purpose of this study is to present a technique for a local sinus lift with autogenous bone in a one-stage procedure. Additionally, volume changes of the grafted area were evaluated radiographically up to 2 years. Materials and Methods: Twenty patients, 12 female and 8 males, were included in the study. Single-tooth replacement was made in the second premolar area in 7 cases and in the molar area in 13 cases. Local sinus lift and implant installation were made simultaneously. Abutment connection was made after 6 months of healing. Results: Two years of clinical and radiographic follow-ups have been made in all patients. The survival rate was 100%. The residual bone volume in the actual area was 2–5 mm preoperatively, after sinus lifting in mean 13 mm, after 1 year in mean 11.4 mm, and 2 years postoperatively in mean 10.6 mm. Conclusions: Local sinus lift with simultaneous bone augmentation and single-tooth replacement in the posterior maxilla is a predictable method although a certain bone volume reduction around the implant was evident at the 2-year follow-up.

Background: Maxillary sinus floor elevation surgery is widely used as a preimplantology method to permit implant insertion. Nevertheless, very few data are available about long-term stability of dental implants inserted in grafted sites. Purpose: The aims of the present study were to evaluate the evolution of resonance frequency analysis (RFA) values at 6 and 12 months from the implant insertion in sinus grafted sites and nongrafted sites. Materials and Methods: In 14 patients, 80 Xive implants (Dentsply Friadent GmbH, Mannheim, Germany) were inserted. Sixty-three implants were inserted in a site previously treated with a sinus lift; 17 implants were inserted in healed or postextraction sites. For each implant diameter, length, bone density, insertion torque, and percentage of implant fixed to a nongrafted bone were recorded. RFA values at implant insertion after 6 and 12 months were recorded. Results: After 6 and 12 months, grafted sites showed higher RFA values than the control sites; after 12 months, the difference was statistically significant (.007). A statistically significant positive correlation was found between resonance frequency values and bone quality after 12 months (.05). No statistically significant correlation between RFA values and all the other variables considered was found. Conclusions: Sites treated with sinus lift can offer good long-term stability. After 6 and 12 months, the geometric characteristics of the implant are no longer important to obtain high RFA values, and the bone–implant interface seems to be determinant.

Aim: This case series is aimed to report a new phenomenon, the “dome phenomenon,” which was observed in infected augmented sinuses over several years. Methods: Five patients are presented in whom sinus lift augmentation resulted in postoperative infection with inflammation and suppuration. The patients received aggressive anti-inflammatory treatment and surgical debridement of the inflamed tissue, including some grafted material performed through the lateral window of the primary procedure. Results: The inflammatory condition was reversed, and the site healed clinically. Radiographically, a dome-shaped, radio-opaque tissue was observed at the superiormost aspect of the grafted sinus. This “dome phenomenon” was further confirmed during dental implant placement, which indicates healing potential adjacent to the maxillary sinus membrane. Conclusions: The current report, as well as other studies and case series, suggests that there is great potential for healing and bone formation in the maxillary sinus membrane. The precise mechanism is not known. Further clinical and histologic studies are needed to understand the regenerative potential of the Schneiderian membrane.

Background Sinus augmentation is a common procedure to increase bone volume and allow for proper implant placement in the atrophic posterior maxilla. Although the patient’s own bone is considered the best grafting material, various synthetic or bovine-derived alternatives are used to simplify the grafting procedure. Purpose The overall objective of this review was to assess the efficacy of different graft materials used in sinus augmentation procedures as demonstrated in animal studies. Materials and Methods A specific and sensitive database was initially created via PUBMED, focusing on studies published in English peer-reviewed journals between 1995 and 2004 and kept updated until 2006. Results Twenty-six articles were available for comparison and discussion; none concerned the use of alloplastic materials; 24 were comparative histomorphometric; and two were biomechanical studies. Because of a great variability in study designs, different implant types, great range in follow-up, and lack of specific integration or loading period, a comparison of the studies and the biomaterials used was difficult. Conclusions In general, autogenous bone is the most predictable material of choice for augmentation procedures, despite a 40% resorption, because it is highly osteoconductive and less dependent on sinus floor endosteal bone migration. The addition of bovine bone mineral to autogenous bone can be beneficial for graft success because it acts as a slowly resorbing space maintainer. Porous hydroxyapatite is suitable when mixed with autogenous bone because it enhances bone formation and bone-to-implant contact in augmented sinuses. Histological evaluation showed that demineralized freeze-dried bone is inferior to other materials. Within the limitation of the animal studies examined in this review and only based on histological examination, the initial osseointegration of implants seems independent of the biomaterial used in grafting procedures.

Little is known about the long-term outcome of implants placed in the atrophic maxilla using osteotome sinus floor elevation (OSFE) without grafting.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.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.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.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.

Background: Prosthetic rehabilitation of the posterior maxilla with dental implants is often difficult because of proximity to the maxillary sinus and insufficient bone height. Maxillary sinus floor augmentation procedures aim to obtain enough bone with an association between biomaterials and autogenous bone. Purpose: The purpose of this study was to evaluate histomorphometrically two grafting materials (calcium phosphate and Ricinus communis polymer) used in maxillary sinus floor augmentation associated with autogenous bone. Materials and Methods: Biopsies were taken from 10 consecutive subjects (mean age 45 years) 10 months after maxillary sinus floor augmentation. The sinus lift was performed with a mixture of autogenous bone and R. communis polymer or calcium phosphate in a 1:2 proportion. Routine histologic processing and staining with hematoxylin and eosin were performed. Results: The histomorphometric analysis indicated satisfactory regenerative results in both groups for a mean of bone tissue in the grafted area (44.24 ± 13.79% for the calcium phosphate group and 38.77 ± 12.85% for the polymer group). Histologic evaluation revealed the presence of an inflammatory infiltrate of mononuclear prevalence that, on average, was nonsignificant. The histologic sections depicted mature bone with compact and cancellous areas in both groups. Conclusion: The results indicated that both graft materials associated with the autogenous bone were biocompatible, although both were still present after 10 months.