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Objectives: This study aimed to assess the risk of less than 2 mm keratinized mucosa (KM) width occurrence after free epithelialized graft (FEG) and keratinized mucosa shifting (KMS) procedures using survival analysis. In addition, KM dimensional changes were evaluated. Materials and Methods: This study included 76 implants in 36 patients with insufficient KM (<2 mm). The implants underwent either FEG or KMS procedures. The mid‐buccal KM width was measured from surgery to the end of a one 13‐year follow‐up period. Results: Mean follow‐up durations were 9.2 ± 3.9 years for FEG and 6.3 ± 4.2 years for KMS. Two implants in FEG and nine implants in KMS exhibited a KM width of less than 2 mm during follow‐up. The hazard ratios for KMS compared to FEG were 6.48 (crude) and 6.54 (adjusted), both statistically significant (p <.05). The incidence rate of KMS (4.06%) was higher than that of FEG (0.63%), with an average incidence time of 3.38 years for KMS and 8.82 years for FEG post‐surgery. FEG showed a significant shrinkage within 6 months (33% ± 22%), whereas KMS demonstrated a gradual decrease over 13 years (34% ± 25%). FEG exhibited significantly greater width change than KMS during a 5‐year follow‐up (p <.05). Conclusions: FEG and KMS enhanced PIKM but exhibited different long‐term reduction patterns. FEG demonstrated rapid shrinkage, while KMS displayed gradual and continuous reduction. Moreover, KMS presented a higher risk and incidence of KM width less than 2 mm compared to FEG. [ABSTRACT FROM AUTHOR]

Background: Large antroliths and those located adjacent to the sinus floor can affect clinical interventions and increase the difficulty of implant placement performed simultaneously with osteotome sinus floor elevation surgery. Purpose: This retrospective study investigated the clinical outcomes of implants placed simultaneously with osteotome sinus floor elevation subjacent to maxillary antroliths. Material and methods: Twenty implants inserted subjacent to or intruding into the antrolith after sinus floor elevation were evaluated in 18 patients. Cone‐beam computed tomography (CBCT) was used to measure antrolith size and membrane thickness at sites of osteotome sinus floor elevation. Periapical radiographs were used to assess the height of grafted bone. Generalized estimating equation (GEE) analysis was performed to correlate the occurrence of antroliths with patient background characteristics and dental outcomes, based on a sample population of 239, among whom 33 presented antroliths. Results: The 20 implants remained clinically stable over a mean follow‐up period of 42.4 months. The mean thickness of the sinus membrane at osteotome sites was 5.4 ± 3.3 mm. None of the cases presented sinus membrane perforation or sinus symptoms following osteotome intervention. The mean gain in the height of grafted sinus bone was 4.0 ± 1.4 mm at the last follow‐up. The occurrence of antroliths was higher among females and the elderly (>49 years old). The multivariable GEE analysis showed that the adjusted odds ratio for the occurrence of antroliths with root canal fillings was significantly lower than those without root canal fillings (odds ratio = 0.33; 95% confidence interval = 0.11–0.96). Conclusion: Our findings indicate that osteotome sinus floor elevation is a surgical procedure with a risk <17%. Thorough planning based on CBCT and careful management during surgery can eliminate the negative effects of antroliths on implant performance. [ABSTRACT FROM AUTHOR]

Background: This study investigates influence of the sinus floor configuration on dimensional stability of grafted bone height after the osteotome sinus grafting procedure.Methods: Forty single-tooth dental implants inserted after placement of bioglass and/or allograft into the sinus area using an osteotome technique in 37 patients were evaluated in this retrospective study. Periapical radiographs were taken using the long-cone technique before and after implant placement. Specifically, radiographic measurements of grafted bone height at the mesial and distal side of each implant were taken, and the sinus floor configuration was classified into concave, angle, and flat according to the sinus floor profile at the implant site. Furthermore, the intruding angle, defined as the angle between the implant axis and sinus floor, was measured.Results: All implants were clinically stable during a mean follow-up period of 39.2 months. Mean initial gain of sinus grafted bone height was 7.0 ± 1.9 mm, and later it was reduced to 4.6 ± 1.9 mm at follow-up (P <0.001). A greater reduction in grafted bone height was revealed in the flat sinus group compared with the concave group (P <0.001). Results from the linear regression showed larger intruding angles were statistically significantly associated with a greater reduction in grafted bone height (r2 = 0.55, P <0.001).Conclusion: All bioglass and/or allograft placed in the maxillary sinus after the osteotome technique underwent remodeling and shrinkage; however, the outcome of the procedure was more predictable in sinuses with a concave floor and small implant-intruding angles. [ABSTRACT FROM AUTHOR]