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Background In locations where the alveolar bone height is low, such as at the maxillary molars, implant placement can be difficult, or even impossible, without procedures aimed at generating new bone, such as sinus lifts. Various types of bone graft materials are used after a sinus lift. In our study, a three-dimensional image analysis using a volume analyzer was performed to measure and compare the volume of demineralized bovine bone mineral (Bio-Oss®) and carbonate apatite (Cytrans®) after a sinus lift, as well as the amount of bone graft material resorption. Patient data were collected from cone-beam computed tomography images taken before, immediately following, and 6 months after the sinus lift. Using these images, both the volume and amount of resorption of each bone graft material were measured using a three-dimensional image analysis system. Results The amount of bone resorption in the Bio-Oss®-treated group was 25.2%, whereas that of the Cytrans®-treated group was 14.2%. A significant difference was found between the two groups (P < 0.001). Conclusions Our findings indicate that the volume of bone resorption was smaller in the Cytrans®-treated group than in the Bio-Oss®-treated group, suggesting that Cytrans® is more promising for successful implant treatments requiring a sinus lift.

BackgroundAnorganic bovine bone (Bio-Oss®) has been extensively used for reconstruction of posterior area of maxilla in sinus lift procedure; however, a new graft material (Lumina-Bone Porous®), that has a different manufacturing process, has not been yet compared in clinical and histological terms. The manufacturing process of bovine bone graft is related to size and porosity of the particles, and this can change osteoconductive property of the material and bone formation. The use of Lumina-Porus® could improve bone formation, reduce the remaining particles of the biomaterial using a low-cost material. The aim of this research was to compare the clinical, radiological, and histomorphometrical results from maxillary sinus lift with two different anorganic bovine bone substitutes Bio-Oss® (control) and Lumina-Bone Porous® (test).ResultsA split-mouth study was performed with 13 volunteers. The mean bone ridge height in the deepest portion of maxillary sinuses floor was 3.11 ± 0.83 mm in the Bio-Oss® and 2.38 ± 0.75 mm in the Lumina-Bone Porous®. After sinus lift, the Bio-Oss® group shows bone ridge height of 11.56 ± 2.03 mm and Lumina-Bone® of 10.62 ± 1.93 mm. The increase in alveolar bone height scores was significant between pre-augmentation and 6 months after SL in both groups (p< 0.001). No statistical significant difference in newly formed bone in the Bio-Oss® group (20.4 ± 5.4%), and Lumina-Bone Porous® (22.8 ± 8.5%) was histomorphological observed (p> 0.05). On the other hand, the residual graft particles showed significant difference between the Bio-Oss® group (19.9 ± 8.6%) and Lumina-Bone Porous® (14.6 ± 5.6%) (p< 0.05). The survival rate of dental implants for augmented area with Lumina Bone Porous® was 88.88%, while for Bio-Oss® group was 100%.ConclusionBoth materials Bio-Oss® and Lumina-Bone Porous® can be used in the maxillary sinus floor augmentation with good predictability in clinical, radiographical, and histological point of view.

Background Osteotome sinus floor elevation (OSFE) is used to increase the bone volume at the site of the maxillary sinus through the transalveolar approach. However, there is uncertainty regarding the necessity of the use of grafting material in order to maintain the space for new bone formation. Objective This study aimed to evaluate new bone formation 6 months after osteotome sinus floor elevation without grafting and to evaluate the correlations between residual bone height (RBH), implant protrusion length (IPL), and endo-sinus bone gain (ESBG). Material and methods Thirty-one implants (27 patients) from area 14–17 and 24–27 were included in the study. All implants had a history of OSFE without grafting, with cone beam computed tomography (CBCT) taken prior to the surgery. The clinical examination and radiographic examination using CBCT were performed again 6 months after implantation. The RBH, new bone level, ESBG, and IPL were measured. Paired sample t test and Pearson correlation were used to analyze the data. Results The average RBH before surgery was 7.14 ± 1.07 mm and 6 months after surgery was 8.95 ± 1.17 mm. There was a significant increase in new bone formation in the 6 months following surgery (p < 0.05). The average ESBG and IPL were 1.8 ± 0.79 mm and 2.02 ± 0.73 mm, respectively. There was a significant positive correlation between the IPL and ESBG (p < 0.05) while there was a negative correlation between RBH and ESBG. This study also demonstrates a decrease in the percentage of bone formation in relation to IPL as the IPL increases. The survival rate of the implant was 100%. Conclusion Significant new bone formation can be detected around the implant site 6 months after implantation using OSFE technique without grafting. There is a negative correlation between the RBH and ESBG. While IPL is correlated to ESBG and appears to be the influencing factors of bone formation changes in the maxillary sinus. The preliminary radiographic results suggest that OSFE technique without grafting in combination with optimal IPL can provide sufficient bone height for implant support with a 100% implant survival rate. Electronic supplementary material The online version of this article (10.1186/s40729-019-0181-7) contains supplementary material, which is available to authorized users.

Background This systematic review aimed to propose a treatment protocol for repairing intraoperative perforation of the Schneiderian membrane during maxillary sinus floor augmentation (MSFA) procedures with lateral window technique. In turn, to assess subsequent implant survival rates placed below repaired membranes compared with intact membranes and therefore determine whether membrane perforation constitutes a risk factor for implant survival. Material and methods This review was conducted according to PRISMA guidelines. Two independent reviewers conducted an electronic search for articles published between 2008 and April 30, 2020, in four databases: (1) The National Library of Medicine (MEDLINE/PubMed) via Ovid; (2) Web of Science (WOS); (3) SCOPUS; and (4) Cochrane Central Register of Controlled Trials (CENTRAL); also, a complementary handsearch was carried out. The Newcastle-Ottawa Quality Assessment Scale was used to assess the quality of evidence in the studies reviewed. Results Seven articles fulfilled the inclusion criteria and were analyzed. A total of 1598 sinus lift surgeries were included, allowing the placement of 3604 implants. A total of 1115 implants were placed under previously perforated and repaired membranes, obtaining a survival rate of 97.68%, while 2495 implants were placed below sinus membranes that were not damaged during surgery, obtaining a survival rate of 98.88%. The rate of Schneiderian membrane perforation shown in the systematic review was 30.6%. In the articles reviewed, the most widely used technique for repairing perforated membranes was collagen membrane repair. Conclusions Schneiderian membrane perforation during MFSA procedures with lateral approach is not a risk factor for dental implant survival (p=0.229; RR 0.977; 95% CI 0.941-1.015). The knowledge of the exact size of the membrane perforation is essential for deciding on the right treatment plan.

Objectives Maxillary sinus augmentation (MSA) is a successful and predictable intervention with low complication rates. Perforations of the Schneiderian membrane may occur impairing the general success. The aim of this study was to compare the incidence of membrane perforations between conventional rotating instruments and piezoelectric devices in a meta-analysis. Material and methods An electronic research on MEDLINE and PubMed database was performed evaluating the literature from 1980 till 2016. Meta-analysis was performed with the studies matching the inclusion criteria. The incidence of perforations between conventional and piezo during the lateral maxillary sinus floor elevation was determined, and forest plots and a t test for significance analysis were performed. Results The search provided 377 articles of which 69 could be included. Selected non-randomised and non-controlled prospective and retrospective studies were incorporated. Conventional rotary instruments were associated with a perforation rate of 24%, the piezoelectric devices with 8% with statistically significant difference between both modalities (p

Background This study assessed the clinical outcomes of graft success rate and early implant survival rate after preprosthetic alveolar ridge reconstruction with autologous bone grafts. Methods A consecutive retrospective study was conducted on all patients who were treated at the military outpatient clinic of the Department of Oral and Plastic Maxillofacial Surgery at the military hospital in Ulm (Germany) in the years of 2009 until 2011 with autologous bone transplantation prior to secondary implant insertion. Intraoral donor sites (crista zygomatico-alveolaris, ramus mandible, symphysis mandible, and anterior sinus wall) and extraoral donor site (iliac crest) were used. A total of 279 patients underwent after a healing period of 3–5 months routinely computer tomography scans followed by virtual implant planning. The implants were inserted using guided oral implantation as described by Naziri et al. All records of all the consecutive patients were reviewed according to patient age, history of periodontitis, smoking status, jaw area and dental situation, augmentation method, intra- and postoperative surgical complications, and surgeon’s qualifications. Evaluated was the augmentation surgical outcome regarding bone graft loss and early implant loss postoperatively at the time of prosthodontic restauration as well a follow-up period of 2 years after loading. Results A total of 279 patients underwent 456 autologous augmentation procedures in 546 edentulous areas. One hundred thirteen crista zygomatico-alveolaris grafts, 104 ramus mandible grafts, 11 symphysis grafts, 116 grafts from the anterior superior iliac crest, and 112 sinus lift augmentations with bone scrapes from the anterior facial wall had been performed. There was no drop out or loss of follow-up of any case that had been treated in our clinical center in this 3-year period. Four hundred thirty-six (95.6%) of the bone grafts healed successfully, and 20 grafts (4.4%) in 20 patients had been lost. Fourteen out of 20 patients with total graft failure were secondarily re-augmented, and six patients wished no further harvesting procedure. In the six patients, a partial graft resorption was detected at the time of implantation and additional simultaneous augmentation during implant insertion was necessary. No long-term nerve injury occurred. Five hundred twenty-five out of 546 initially planned implants in 259 patients could be inserted into successfully augmented areas, whereas 21 implants in 20 patients due to graft loss could not be inserted. A final rehabilitation as preplanned with dental implants was possible in 273 of the 279 patients. The early implant failure rate was 0.38% concerning two out of the 525 inserted implants which had to be removed before the prosthodontic restoration. Two implants after iliac crest augmentation were lost within a period of 2 years after loading, concerning a total implant survival rate after 2 years of occlusal loading rate of 99.6% after autologous bone augmentation prior to implant insertion. Conclusions This review demonstrates the predictability of autologous bone material in alveolar ridge reconstructions prior to implant insertion, independent from donor and recipient site including even autologous bone chips for sinus elevation. Due to the low harvesting morbidity of autologous bone grafts, the clinical results of our study indicate that autologous bone grafts still remain the “gold standard” in alveolar ridge augmentation prior to oral implantation.

Objective Bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is triggered by inflammatory processes. Typical trigger factors are periodontal disease, denture pressure sores, and surgical interventions such as tooth extractions. Unfortunately there is only little data on how to proceed with implant therapy in patients with bisphosphonate treatment. This topic is not addressed in the German guidelines on medication-associated osteonecrosis. Therefore a systematic literature review was performed. Methods The PICO design was used: (Patients) For which subclientel of patients with antiresorptive therapy (intervention) do dental implants have a benefit (control) compared to forgoing dental implants (outcome) in regards to oral rehabilitation and quality of life without having a substantial risk of BP-ONJ development? A PubMed search was performed including all studies dealing with this topic. Case reports and studies with less than 5 cases were excluded. Results There is only very little data available, mostly retrospective case series. 50 articles were analyzed in detail. BP-ONJ can be triggered by dental implants and by dentures in patients with benign and malignant primary diseases. In most studies, analyzing osteoporosis patients only, no cases of BP-ONJ were observed in patients with implant therapy in the time span observed. There are no studies about implant therapy in patients with malignant diseases. Many case series analyzing the trigger factors for BP-ONJ describe dentures as one of the main causes. Perioperative antimicrobial prophylaxis has a benefit in the prevention of BP-ONJ development. Conclusion Successful implant therapy is possible in patients receiving antiresorptive therapy. The possibility of osteonecrosis development needs to be explained to the patient. An individual risk assessment is essential, taking the primary disease with the medication and further wound-healing-compromising diseases and medications into account. If possible, bone augmentations should be avoided, and a perioperative antimicrobiological prophylaxis is strongly recommended in these patients.

Background Sinus lift is a bone augmentation procedure that improves the alveolar crest height in an atrophic posterior maxilla. However, the regenerated bone volume can vary and generally has a tendency to decrease after sinus operation. This article describes nongrafted maxillary sinus lift using a bioresorbable unsintered hydroxyapatite combined with poly l-lactide (HA/PLLA) mesh plate device and dental implant placement in an atrophic posterior maxilla, after which continuous bone gain was observed around the implant apex during a postoperative follow-up period of 3 years. Case presentation A 60-year-old healthy female was referred to our department for dental implant therapy in the right posterior maxilla. Clinical examination revealed that the maxilla was edentulous from the right first premolar to the second molar region. Radiographically, atrophy of the maxillary alveolar ridge in the same tooth site was observed. Sinus membrane elevation and simultaneous implant placement were performed through the lateral approach. HA/PLLA mesh was utilized to maintain space under the elevated sinus membrane and as a fixation device to replace the bone window. Six months later, new bone was generated in the secluded space maintained under the elevated sinus membrane. When observed 42 months after the implant insertion, bone volume around the implant apex had increased in vertical direction under the HA/PLLA mesh plate device, and there was continuous bone formation in the sinus over time. Conclusion This nongrafted sinus lift procedure using an HA/PLLA mesh device attained predictable bone formation. Stable membrane elevation by an HA/PLLA device might induce long-term, continuous bone formation in the sinus.

Background The aim of this study was to measure the oral health-related quality of life (OHRQoL) after maxillary sinus augmentation to determine the physical and psychological impact of this procedure for the patient. Methods Three hundred sixteen patients treated with an external or internal maxillary sinus augmentation and a total of 863 implants in the Department of Oral and Maxillofacial Surgery, Johannes Gutenberg University, Mainz, Germany, between July 2002 and December 2007 were included in this retrospective study. Total implant survival was assessed. Completion of a modified 26-item version of the Oral Health Impact Profile (OHIP-G) for assessing the oral health-related quality of life before and after the treatment was asked for. Subcategories were (1) functional limitations, (2) physical and psychological disabilities, and (3) complaints due to the surgical procedure. In 53 patients available for clinical follow-up examination, assessment of soft tissue parameters was performed. Results After an average time in situ of 41.2 ± 27 months (3.4 years), the in situ rate was 95.4%. One-year survival rate and five-year survival rate according to Kaplan Meier were 95.4 and 94.4%. Concerning functional limitations, significant better values for OHRQoL after sinus augmentation procedure than before the treatment (p