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Context: Several materials have been used for maxillary sinus augmentation for subsequent implant-supported prosthetic rehabilitation. No perfect material has been identified for the purpose. Aims: The aim of the study is to clinically and radiographically evaluate the use of Sterile Demineralized bone matrix (Osseograft™) for maxillary sinus augmentation and subsequent implant-supported prosthetic rehabilitation. Subject and Methods: Sinus augmentation and implant placement were carried out in twenty patients with Osseograft™. Using intraoral periapical radiographs, radiographic implant length (rIL), residual bone height at the mesial (mRBH) and residual bone height at the distal (dRBH) aspects of the implant, and height of the graft apically (aGH) were measured. Residual bone height (RBH) = Mean of mRBH and dRBH, implant penetration (IP) =difference between rIL and RBH, Extent of the sinus lift (SL) = sum of IP and aGH were calculated and a qualitative assessment of maturation was performed using the Sinus Grafting Remodeling Index (SGRI). Statistical Analysis Used: Descriptive statistics. Results: The mean residual bone height immediately after surgery was 6.81 mm. The mean IP length was 5.45 mm. The mean aGH was 3.21 mm. The mean extent of the SL was 8.89 mm. At 3 months and 6 months, the mean aGH was 2.68 mm and 2.57 mm. The mean SL at 3 months and 6 months was 7.84 mm and 7.73 mm. The SGRI was 1 in all cases immediately postsurgery; between 1 and 2 at the end of 3 months; 2 in 15 cases and 1 in 4 cases at the end of 6 months. Conclusion: Osseograft™ can be used as an effective material for sinus augmentation with minimal complications and morbidity to the patient.

Aims and Objectives: The aim of this prospective clinical study was to evaluate the success of one-stage direct (lateral) sinus lift procedure in severely atrophic posterior maxilla. Materials and Methods: One-stage direct (lateral) sinus lift procedure was carried out at 15 sites in 13 patients. All patients included in the study presented with partially edentulous posterior maxilla with one or more missing teeth and residual bone height less than 5 mm. Three months after surgery, patients were evaluated to access increase in residual bone height, density of new bone formed and implant stability. Patients were also evaluated after 3 months of prosthetic placement for the success of implant-supported prosthesis. Results: At 3 months post-operatively, increase in residual bone height was 8.31 ± 1.63 mm and the mean density of the newly formed bone around the implants was 417 ± 66.61 HU. All implants were stable and successfully osseointegrated, except one implant that was lost. The success rate of implant stability was 96.3% during the study period. Conclusion: Single-stage direct (lateral) maxillary sinus floor augmentation is a good treatment option with predictable outcome for patients with deficient alveolar bone in posterior maxilla.

Background: The posterior maxilla is always a challenge for dental implant restoration. The presence of maxillary sinus and reduced subantral bone height are the limitations for implant insertion. The need of the hour is to make the surgical procedures simple, minimally invasive, andpredictable. Can we perform the sinus lift and simultaneous implant insertion by minimally invasive,simple, cost-effective, and less time-consuming technique? With this in consideration, the author carriedout this study for graftless crestal hydraulic sinus lift (CHSL) and simultaneous implant insertion in partially edentulous posterior maxilla for 26 implants. The aim is to evaluate the clinical and radiological success of graftless CHSL with simultaneous implant insertion. Material and Method: The sample size was 17 patients and 26 implants were inserted. The clinical as well as radiological follow-up was done for 1 year. The outcome variables were the gain in bone height and implant survival. Result: Mean Bone height Gain is 5.6 mm; Mean torque used 32 nm, Mean age of the patient was 53 years. The literature shows a success of graftless lateral and osteotome-mediated sinus lift. The concept is the blood filling the gap around the implant in tented sinus lining can eventually result in the ossification to form bone. Until now, no study has demonstrated the bone formation in the peri-implant area of CHSL with simultaneous implant insertion. CHSL, a minimally invasive sinus lift surgery is very encouraging, easy to master, and predictive. The simultaneous implant insertion acts to retain the elevated sinus lining by tenting. It also reduces treatment time. After a sinus lifting procedure, the compartment around the implants under the sinus mucosal lining in the sinus floor is filled with a blood clot from surrounding bleeding. Blood clot can be considered autologous osteogenic graft material, to which osteoprogenitors can migrate, differentiate, and regenerate bone. Conclusion: The graftless CHSL is predictable and safe for the sinus lift. The gain of up to 5–6 mm of subantral bone is possible.

Aim The purpose of the present retrospective investigation was to evaluate the survivability and success of implants placed simultaneously during direct sinus lifts with allograft forms of bone with a follow up from one to four years. Materials and methods 110 patients were included in this study. A radiological evaluation was done before the surgical treatment by a OPG and intraoral radiographs. A cone beam CT was done when it was indicated. All patients received a sinus lift surgery with a contemporary implant placement. Success and failure rate was recorded in a follow up from one year to four years since the implant placement. Results Maxillary sinus surgery is a reliable and predictable treatment option for the prosthetic rehabilitation of the atrophic maxilla. A correct surgery planning is a way to avoid post-operative complications and to an adequate prosthetic rehabilitation. Implant success, in this retrospective study is 97.7% at 1 year follow up and 96.9% at 2 years follow up. Prosthetic success at a 4 year follow up (115 prosthetic treatment in 108 patients) has been 98%. Conclusions A complete pre surgical planning and careful patient selections can produce a predictable results for implant prosthesis treatment.

Edentulism is one of the common dental problems in the aging population. Implant therapy has emerged as one the valid and effective solutions to this problem. However in the maxilla, posterior part presents with several anatomic obstacles in the form of bone quality, quantity, size of maxillary antrum and poor accessibility. There are various options like sinus lift with graft and pterygomaxillary implant options available. Option like ptergomaxillary implants requires lot of skill of technic sensitivity and skill of the surgeon and also is proven to be statistically superior. Case reports of pterygomaxillary implants for both partially edentulous and fully edentulous conditions are hereby described in the article.

Context: An essential precondition for successful implant therapy is the presence of an adequate quantity and quality of bone. Aims: The purpose of this study was to radiographically evaluate the bone formation around the dental implants which were placed at different depths into the maxillary sinus by intentional perforation of maxillary sinus floor during implant placement and its effect on implant survival rate. Settings and Design: A total of 86 implants of varying dimensions were placed in maxillary premolar and molar region by intentional perforation of the maxillary sinus floor during implant placement in 57 patients. Subjects and Methods: They were divided into three groups G1, G2, and G3 based on the depth of penetration into the maxillary sinus (region by [IS] compartment) (IS-G1-1 mm; G2-2 mm; G3-3 mm). The following parameters were evaluated-torque, bone density, and bone fill after 6 months of implant placement. Statistical Analysis Used: The comparison among groups for repeated measures data was made by ANOVA repeated measures test. The correlation between two parameters, i.e., torque and bone fill was done by Karl Pearson's correlation test Results: No significant differences were observed among the three groups for torque, bone fill, and bone density from baseline to 6 months. The correlation between torque and bone fill revealed R = 0.198, P = 0.293 which was statistically insignificant Conclusions: There were minimal failure rates and complications observed at the end of the study period. The survival rate of implants was not influenced either by torque or by the depth of penetration of implant into the maxillary sinus.

Aim The present study was aimed to evaluate the efficacy of hybrid implants in replacement of missing teeth in either jaw. Materials and methods Twenty hybrid implants were placed in maxilla and mandible and the implants were assessed for pain,implant exposure, mobility, infection and wound dehiscence at first, third and sixth month postoperatively. Results According to our study the statistical data showed that all the parameters which were seen clinically were nonsignificant. Conclusion Hybrid implants being a new option in this field, our study provides a platform for further research with larger sample size with longer follow ups to be judgemental on their efficacy.

Aim: The aim of this pilot study was to assess the performance of autologous tooth matrix, used as a graft material for maxillary sinus augmentation, after at least 1-year of follow-up. Settings and Design: The patients included in this prospective case series study were treated in four clinical centers using standardized clinical procedures. Materials and Methods: Patients with atrophic posterior maxilla in need of sinus augmentation before rehabilitation with implant-supported prostheses, and with compromised teeth to be extracted, were included. The extracted tooth was cleaned and processed by a recently introduced automated device, which allows fragmentation and partial demineralization of the tooth matrix, and used as a graft material for sinus augmentation. A covering membrane was used to protect the graft. Implants were placed after 6 months of healing. Five bone biopsies of the grafted sites were taken at the time of implant surgery, for histological analysis. Implants were followed for at least 1 year after placement. Cone-beam computed tomography and/or standardized periapical radiographs were used to assess the ridge height before and after grafting, up to 1-year postimplantation. Statistical Analysis: Descriptive statistics were used to synthesize the results, using mean values and standard deviations. Results: Twenty-three patients (9 males, mean age at surgery 57.1 ± 9.4 years) were treated and 40 implants were placed in grafted sites. Residual ridge height was 5.22 ± 2.04 mm and increased to 14.72 ± 2.83 mm after grafting. One implant failed during healing phase. Cumulative implant survival rate was 97.5% after 19.1 ± 8.0 months of follow-up (range 12.3–44.1 months). After 6 months of healing, the graft height appeared stable. No signs of sinus infection were present. The histologic analysis revealed neither inflammatory nor infective reaction against tooth graft. Granules appeared surrounded by newly formed bone and partially resorbed, indicating ongoing remodeling. Conclusion: Autologous human tooth matrix can be successfully used as graft material in sinus augmentation procedure.

Primary stability in dental implants is an essential factor for achieving successful osseointegration. Surgical procedure and bone quality are among the most common factors that affect primary stability. It is also crucial to achieve high-insertion torque which is important for obtaining primary stability. Maintaining sufficient bone bulk and density is essential to achieve necessary bone-to-implant contact for obtaining a biomechanically stable implant. A new concept for osteotomy called osseodensification (OD) has been at the forefront of changes in surgical site preparation in implantology. This relatively new concept with universally compatible drills has been proposed to help in better osteotomy preparation, bone densification, and indirect sinus lift and also achieve bone expansion at different sites of varying bone densities. This procedure has also shown improvement in achieving better implant primary stability and better osteotomy than conventional implant drills. A systematic review was undertaken to analyze if OD procedure had any advantages over conventional osteotomy on bone density and primary stability. An electronic database search was conducted in PubMed using keywords such as "OD," "implant primary stability," "implant bone density," and "implant osteotomy." A total of 195 articles were collected and subjected to screening using inclusion and exclusion criteria. A literature review was done, following which it was seen that the use of versah drills for bone OD resulted in undersized osteotomy compared to conventional drills. It also resulted in improved bone density and increase in percentage bone volume and bone-to-implant contact, thereby improving implant stability.

The rehabilitation of patients affected by posterior maxillary atrophy by the aid of implant-supported fixed prosthesis presents a challenge in many cases. The available residual alveolar ridge is insufficient for the placement of dental implants because of alveolar bone resorption, pneumatization of the maxillary sinus, or their combination. Maxillary sinus floor augmentation is the treatment of choice in such cases. Sinus lift procedure can be carried with or without simultaneous implant placement. Recently, various newer techniques have been introduced for sinus floor elevation such as antral membrane balloon elevation, water lift technique, and piezosurgery. Furthermore, short implants and zygomatic implants can also be done in severe posterior atrophied maxilla.

Context: The present study was undertaken to do a comparative evaluation of the role of cone-beam computed tomography (CBCT) imaging and orthopantomography (OPG) for preoperative implant planning in combination with sinus grafting procedures to assess sinus anatomy and morphology and the existing bone height in three-dimensions (3D). Aim: The aim of the present study was to assess sinus anatomy and morphology and the existing bone height in all the 3D. Materials and Methods: Pre- and postoperative assessment of maxillary sinuses was done in 17 patients who underwent implant therapy in combination with sinus augmentation procedures using CBCT and OPG. These patients were subjected to orthopantomographs and CBCT imaging both preoperatively and postoperatively. CBCT imaging helped decide the type of sinus augmentation procedure best suited for the patients as per the individual needs and depending on the residual alveolar bone height, timing of implant placement, sinus morphology, anticipation of complication, and comparative analysis between pre- and postprocedural gain in vertical alveolar bone height and increase in bone density. Statistical Analysis Used: The results were tabulated and statistically analyzed using paired and unpaired t-tests. Results: In the majority of cases, there was a concordance between the treatment types based on pre- and postoperative CBCT scans. The assessment of sinus morphology revealed a significantly higher detection rate of aberrations in the form of sinus mucosal hypertrophy and septae on CBCT which were imperceptible on routine radiographs. The most appealing result was that vertical alveolar bone height could be measured precisely, and there was a significant increase in surgical confidence and a significantly better prediction of complications when using CBCT imaging. Conclusions: A preoperative planning based on CBCT imaging seems to improve sinus diagnostics and helps execute a better treatment plan. Furthermore, it is a good tool for the comparison of vertical alveolar bone height pre- and postoperatively following sinus augmentation procedures using various graft materials.

Primary stability in implant placement is one of the most critical factors determining the outcome of implant therapy. The factors mainly involved in enhancing implant primary stability are bone density,surgical protocol,and implant thread type, and geometry. The mechanical friction between implant surface and bone walls of the osteotomy site provides primary implant stability. The insertion torque peak was demonstrated to be directly related to implant primary stability and host bone density5; high insertion torque could significantly increase the initial bone-to-implant contact percentage (%bic) with respect to implant inserted with low insertion torque values.osseodensification is a novel biomechanical bone preparation performed for dental implant placement. It causes low plastic deformation of bone created by rolling and sliding contact with a densifying bur that is fluted to densify the bone as it drills with minimal heat elevation. Osseodensification (od), a bone nonextraction technique, was developed by huwais in 20138 and made possible with specially designed burs (densahtmburs) to increase bone density as they expand an osteotomy.the new burs allow bone preservation and condensation through compaction autografting during osteotomy preparation, increasing the periimplant bone density.. This paper describes a case of indirect sinus lift with compaction autografting done in posterior maxilla along with simultaneous implant placement.

Replacement of missing teeth in the posterior maxilla is always a challenge for the treating implant surgeon as the posterior maxilla has several obstacles in the form of quality, quantity, the anatomy of the maxillary sinus, and inaccessibility. To overcome these deficiencies, several surgical procedures such as sinus lift, bone augmentation, tilted implants, short implants, and zygomatic implants were tried. Since these procedures have their own limitations, pterygomaxillary region provides us an excellent place for placement of implant and rehabilitation of posterior maxilla. This case report describes the usage of the pterygomaxillary region for placement of the implant to restore atrophic posterior maxilla, without any additional surgical procedures.

The posterior maxillary segment frequently exhibits insufficient bone mass to support dental implants. Sinus floor augmentation enables implant placement in the posterior maxilla. This case series included ten sites, in which sinus floor elevation was done using sinus lift balloon system followed by augmentation utilizing irradiated cancellous bone allograft. Postoperative radiographic assessment of vertical bone gain was done at 3 and 6 months follow-up period. The mean initial and final bone height were 6.16 and 10.50 mm, respectively, with a mean increase of 4.34 mm at 6 months being observed with nil complication. The presented technique might represent a viable alternative for sinus elevation in posterior atrophied maxilla. Irradiated cancellous bone allograft can be advocated as an ideal bone graft material for sinus augmentation procedures.

Implant placement into the posterior maxilla often creates a challenge due to inadequate bone height because of close sinus proximity. This article presents a case report of indirect sinus lift technique involving hydraulic pressure to elevate the floor of the maxillary sinus.

Platelet-rich fibrin (PRF) is a fibrin meshwork, in which platelet cytokines, growth factors, and cells are entrapped and discharged after a period and can serve as a resorbable film. PRF is the next generation of platelet concentrates equipped to improve arrangement without biochemical blood handling; PRF is an evolution of the fibrin adhesive, which is widely used in the oral surgery. The guidelines of this innovation depend on concentrating platelets and growth factors in a plasma medium, and initiating them in a fibrin gel, keeping in mind the end goal to enhance the healing of wounds. Maxillary bone loss requires numerous regenerative techniques: as a supplement to the procedures of tissue regeneration, a platelet concentrate called PRF was tested for the 1st time in France by Dr. Choukroun. This article enriches the benefits and role of plasma-rich fibrin in oral surgery. Platelet-concentrate fibrin is an evolution of the fibrin glue, which is widely used in the oral surgery.

The aim of this paper is to introduce an alternative technique for the treatment of oroantral communication (OAC). Closure of OAC, reconstruction of the posterior maxilla by sinus‑lifting procedure with a particulate xenograft, and implant insertion were performed in the same operation. A lateral antral approach was used in the sinus elevations. The sinus membranes were elevated gently around the perforation area, and then a barrier membrane was used to close the perforation. Care was taken not to extend the perforation. Next, the maxillary sinus was filled with a particulate xenograft, and an implant was inserted simultaneously. Forty‑seven and 40 months of clinical and radiographic follows‑up revealed healthy and functional implants in the teeth area.Keywords: Immediate implant, membrane perforation, oroantral communication, sinus‑lift

Aims: Implant placement in the posterior region of the maxilla might be problematic due to poor regional bone quality. The aim of this study was to clinically and radiologically evaluate implants which were placed in the posterior region of the maxilla (with insufficient bone height) with osteotome sinus lift technique after 19-month follow-up. Materials and Methods: Twenty-four patients with posterior maxillary alveolar height ranging from 5 to 8 mm were chosen for this prospective study. After breaking of the cortical bony sinus floor, sufficient bone substitute was placed, and sinus floor was elevated. In this way, a new sinus floor was created, which was designated for further implants placement. Fifty implants were placed immediately after osteotomy sinus lift technique. The mean clinical and radiological follow-up period was 19 months (with a range of 14–24 months). Success factors such as the absence of mobility, pain, infection, and the amount of crestal bone loss were determined in this study. For data analyzing, Kruskal–Wallis and Mann–Whitney tests were used. Results: After 19 months, results showed 96% success rate. Two out of fifty implants failed due to mobility. The mean depth of implants in sinus, mean height of residual crestal bone before surgery, and the mean rate of crestal bone loss were 3.8, 7.9, and 0.71 mm, respectively. Conclusion: Osteotome sinus lift technique is a noninvasive surgical method for enhancing a desired length. Furthermore, implants insertion was successful after osteotome sinus lift technique in cases with insufficient bone height.

Insufficient bone volume is a common problem encountered in the rehabilitation of the edentulous posterior maxilla with implant-supported prostheses. The bone available for implant placement may be limited by the presence of the maxillary sinus together with loss of alveolar bone height and it may be increased by augmentation. This case report presents the rehabilitation of the right maxillary molar region using direct sinus lift followed by immediate placement of the implant. It helps in reducing the treatment time and increases the patient comfort.

Maxillary sinus septum is an anatomical variation in the maxillary sinus. Sinus septum is also an important anatomical structure that complicates sinus lift procedure. Aim of the Study : This study evaluated the prevalence of maxillary sinus septa in the edentulous and dentate maxilla using digital orthopantomogram. Materials and Method: This study was based on the analysis of digital orthopantomogram images for posterior maxilla that were obtained from patients who visited a Private Hospital. A retrospective analysis of 921 pairs of nonpathological maxillary sinuses was done. Patients who had pathological findings were excluded from the study. Results: Sinus septum was present in 217 (23.6%) of the 921 pair of maxillary sinuses. Totally, 704 (76.4%) patients did not have maxillary sinus septum. Also, out of 527 male patients, 125 patients had the septum and out of 394 female patients, 92 patients had sinus septum. Conclusion: This study gives an idea about the prevalence of sinus septum that would help a surgeon prevent a few possible complications during sinus lifting

Bone is a highly dynamic tissue undergoing constant adaptation to the mechanical and metabolic demands of the body by bone regeneration and repair. In order to facilitate or promote bone healing, bone grafting materials have been placed into bony defects. The advantages of using bone grafts are space maintenance, inhibiting collapse of defect and acting (at least) as osteoconductive scaffold (though they can be osteoinductive or osteogenic also). After their successful use around teeth afflicted by periodontal disease, in ridge augmentations, and in socket preservations, we now look forward to their use around implants during the osseointegration phase. A few questions arise pertaining to the use of bone grafts along with implants are whether these are successful in approximation with implant. Do they accelerate bone regeneration? Are all defects ultimately regenerated with new viable bone? Is the bone graft completely resorbed or integrated in new bone? Does the implant surface characteristic positively affect osseointegration when used with a bone graft? What type of graft and implant surface can be used that will have a positive effect on the healing type and time? Finally, what are the dynamics of bone graft healing around an implant? This review discusses the cellular and molecular mechanisms of bone graft healing in general and in vicinity of another foreign, avascular body, namely the implant surface, and further, the role of bone grafts in osseointegration and/or clinical success of the implants.

Context: Simple low-fidelity process models can be constructed using anatomically similar or analogous materials and can be equivalent to the use of high-fidelity, animal or cadaveric models. Aim s: The objective of the present report is to describe the construction and learning experience of a low-fidelity model for sinus lift procedures. Settings and Design: An anatomic model was constructed using a dried human skull into which, an eggshell membrane (ESM) was affixed to mimic the sinus membrane. Subjects and Methods: Totally, 17 implantology instructors were asked to perform a direct and an indirect sinus lift technique on each of the two halves of the prepared maxilla. Following the procedure, the participants completed a feedback questionnaire to ascertain their impressions on the characteristics of ESM and the suitability and handling of the model. Statistical Analysis Used: Descriptive data were generated and the Mann-Whitney U-test was used to compare the opinions on direct sinus lift versus indirect sinus lift and validity of the model versus ESM behavior respectively. Results: A majority of the participants felt that the model is an effective educational tool for teaching sinus lift procedures. The participants agreed/strongly agreed that ESM showed a strong visual resemblance to sinus membrane and demonstrated excellent tear resistance during surgery. Conclusions: The model can be used for education on the practical aspects of sinus lift surgery and allows residents to learn and practice sinus lift procedures before they take on real patients.

Objectives: The primary aim of this study is to evaluate the success rate of immediately inserted dental implants in sinus lift and the secondary aim is to assess the reliability of performing simultaneous surgery for sinus lift, grafting and implant placement in situations of very low residual bone heights (4 mm).

Purpose: The objective of this paper was to compare histologically and histomorphometrically a hydroxyapatite originated by algae (Algipore) versus demineralized bovine bone (Bio-Oss Geistlich Pharma, Wolhusen, Switzerland) utilised as bone substitutes in maxillary sinus floor elevation with a split-mouth design. Materials and Methods: Five healthy patients underwent a bilateral maxillary sinus floor elevation procedure under local anesthesia. In each case, residual posterior maxillary bone height was between 2 mm and 5 mm. The original bone was augmented with a split-mouth design with 100% Algipore on the test side and 100% Bio-Oss on the contralateral control side. After a healing period of 6-8 months during the re-opening surgery biopsies were retrieved and Xive Implants (Dentsply Implants, Mannheim, Germany) were placed. Results: At microscopic level both Bio-Oss and Algipore blocks resulted well osseointegrated, without inflammatory infiltrate, with an high level of mineralization, without gap between the bone and biomaterial interfaces that resulted indistinguishable. A close contact between the two faces was observed without the presence of slits. Histomorphometrical analysis showed that, on average, the percentage of medullary space was higher for the Bio-Oss compared with Algipore (38.61% ±8.90% vs. 29.23% ±7.89%). In contrast, the mean value of residual particles of biomaterials was higher in Algipore than in Bio-Oss specimens (42.86% ±18.61% vs. 22.30% ±6.40% respectively). Conclusions: The data confirmed that sinus lift carried out with Algipore performed in a similar way of that carried out with Bio-Oss and that this material is safe, predictable and without invasiveness.

Background: Although autografts are the standard procedure for bone grafting, the use of bone regeneration by means of dental pulp stem cell is an alternative that opens a new era in this field. Rigenera Protocol is a new technique able to provide the surgeon autologous pulp micro-grafts. Materials and Methods: At the Department of Oral Surgery, Don Orione Hospital, Bergamo, Italy, one patient underwent sinus lift elevation with pulp stem micro-grafts gentle poured onto collagen sponge. A CT scan control was performed after 4 months and DICOM data were processed with medical imaging software which gives the possibility to use a virtual probe to extract the bone density. Pearson′s Chi-square test was used to investigate difference in bone density (BD) between native and newly formed bone. Results: BD in newly formed bone is about the double of native bone. Conclusion: This report demonstrated that micro-grafts derived from dental pulp poured onto collagen sponge are a useful method for bone regeneration in atrophic maxilla.

Background: There are different techniques for the sinus augmentation; the factors that contribute to the survival rate of sinus augmentation and dental implant placement are still the subject of discussion. So we compare the two different ways of sinus floor elevation: a) Lateral antrostomy as a one or two step procedure as direct method. b) Osteotome technique with a crestal approach as indirect method. Materials and Methods: A total of twenty partially edentulous patients in maxillary posterior region who opted for implant retained prosthesis but had a low sinus and deficient alveolar ridge within the age group of 20-55 years were taken up, 25 implants were placed in combination with bone grafting material for sinus augmentation. The final bone height was measured from Orthopantomogram. Post-operative Clinical Evaluation was based on pain, gingival inflammation status, stability, swelling and bone height. Statistical analysis was done by using Statistical Package for Social Sciences (version 15.0) (SPSS Inc., Chicago, IL, USA). Results: The gain in bone height was significantly greater in direct procedure through lateral antrostomy (mean 8.5 mm) than in indirect method through crestal approach by osteotome technique (mean 4.4 mm). Conclusions: Osteotome technique can be recommended when more than 6 mm of residual bone height is present and an increase of 3-4 mm is expected. In case of more advanced resorption direct method through lateral antrostomy has to be performed. Both sinus elevation techniques did not seem to affect the implant success rate.

Purpose: Aim of the present study was to present the results of a retrospective analysis of maxillary sinus augmentation procedures performed with platelet-rich plasma (PRP) with a mean follow-up of about 5 years. The analysis was focused on implant survival rates and on the dimensional stability of the subantral cavity filling. Materials and Methods: Between 2000 and 2006, 28 patients were recruited for a maxillary sinus augmentation procedure performed with PRP. Two patients did not answer to the calling for the examination at distance, so they were excluded from the sample. The study involved 26 patients, for a total amount of 33 sinus augmentations, with an average follow-up of 65 months. In 26 procedures the grafting material used was a mixture of autologous bone taken from the oral cavity, deproteinized bovine bone Bio-Oss® in a relationship of 1:3 and PRP, while in seven cases, the combination of Bio-Oss and PRP. The dimensional stability of grafting material was investigated through X-ray measurements carried out during X-ray postexaminations. Results: After a mean follow-up time of about 5 years, the implant survival rate registered was 95.9%, while the radiographical variables used to assess the dimensional stability of grafts, showed a mean decrease respectively of 9.38% and 14.61%. Discussion: Very good long-term results were achieved using autologous bone+Bio-Oss+PRP and Bio-Oss+PRP as filling materials in the maxillary sinus augmentation. Dimensional stability of cavity filling seems to represent a very important factor for implant procedures success. It is difficult to estimate the influence of PRP on a long-term basis. Conclusion: The implant survival rate obtained in this study was similar to the expected rate on the areas not subject to bone graft. The method applied showed to be reliable for bone regeneration in subantral cavities, showing a very good dimensional stability and a slight reabsorption over the years.