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Background/purpose Graft bone maturation and remodeling in the maxillary sinus require adequate angiogenesis and osteoprogenitor cells migration from the surrounding bony walls and Schneiderian membrane. This study aimed to evaluate the influence of anatomical factors related to maxillary sinus on the outcomes of transcrestal sinus floor elevation using cone-beam computed tomography (CBCT). Materials and methods Forty-five patients (63 elevated sites) were included in this study. CBCT were obtained preoperatively, immediately and 6 months after surgery. The anatomical features of residual bone height, maxillary sinus width, maxillary sinus angle and Schneiderian membrane thickness were measured on preoperative CBCT. Descriptive statistics and correlation analysis were conducted to evaluate the influence of anatomical factors on outcome parameters, including sinus lift height, graft bone resorption and marginal bone loss. Results The results showed that there was a positive correlation between sinus width and graft bone resorption. A significantly positive correlation between sinus angle and graft bone resorption was also found. Conclusion Our findings indicate that the anatomical factors of maxillary sinus (sinus width and sinus angle) have influence on the linear change of bone grafts after transcrestal sinus floor elevation.

The aim of this systematic review was to evaluate survival rate of short dental implants placed in the posterior area of the maxilla. The electronic literature search of studies published between January 1, 2010 and February 29, 2020 was performed using specific word combinations. The outcome was to meta-analyse the implant survival rate (ISR). The search generated 238 potential studies. After screening procedures, only nine randomized controlled trials fulfilled the inclusion criteria and were selected for qualitative and quantitative analysis. ISR of short implants ranged from 91.9% to 100%, while standard-length implants ISR ranged from 82.9% to 100% with a follow-up from 1 to 5 years in function. The risk ratio difference was 1.24 (95% confidence interval: 0.63-2.45, P=0.52) for short dental implants failure when compared with standard dental implants, and was not statistically significant. Based on the evidence of the included studies, short implants (≤6mm) reported high survival rates over short to medium follow-up in posterior maxilla, but the long-term success is as yet not demonstrated.

Oligodontia demands multidisciplinary management due to its repercussions on dentofacial growth. To place implants to realize implant-borne fixed denture, preimplant surgery may be necessary if bone volumes are insufficient. Our aim was to assess bone increase following autogenic bone grafting and to discuss prosthetic options. Twenty patients followed for oligodontia, who underwent bone grafting, were treated from 2008 to 2019. Transversal and vertical bone levels were measured pre- and postoperatively to assess alveolar ridge augmentation. Mean horizontal grafting increase was 4.60 mm [standard deviation (SD) 0.79 mm], mean sinus lift increase was 9.95 mm (SD 2.35 mm). Mean implants placed per patient was 9, mean implants placed on grafted site was 5 per patient. Overall implant survival rate was 100%. All patients benefited from prosthetic procedures when it was planned to perform implant-borne fixed dentures. Within the framework of a complete treatment plan (involving paediatric dentistry, dentofacial orthopaedics, oral and maxillofacial surgery, and prosthodontics), autologous bone grafting combined or not with orthognathic surgery is fully adapted to patients with oligodontia. It allows reconstruction of favourable bone volumes for placement of implants to realize implant-borne fixed dentures, with high implant survival rates and great improvements to quality of life.

Background: The development of techniques in biomaterials design and production added to advanced surgical procedures which enabled better and more predictable clinical out-comes. Maxillary sinus floor augmentation (MSFA) is among the more studied bone-guided regeneration procedure in the literature. The MSFA could be considered the gold standard procedure for bone-guided regeneration as it provides suitable functional and aesthetic solutions to alveolar ridge atrophy due to tooth loss. Purpose: This study aimed to conduct a detailed histomorphometric evaluation of collagen production in SFAs bone-guided regeneration, using nano-hydroxyapatite/beta-tricalcium phos-phate (nano-HA/beta-TCP) composite. Patients and Methods: A 52-year-old female had the left upper second premolar con-demned due to periodontal disease, then a tooth implant replacement was planned. Due to maxillary sinus pneumatization, the MSFA had to be done before implant placement. Nano-HA/beta-TCP composite (2g) was used in the MSFA procedure. After nine months of the healing process, during the Cone Morse implant installation process, bone samples were collected for histologic analysis (sirius red, hematoxylin/eosin, polarized microscopy). Six months after implant installation, a ceramic crown was installed according to the patient's request. Results: Proper masticatory function and aesthetics were re-established. The histomorpho-metric evaluation indicated that nano-HA/beta-TCP composite did not show any area devoid of cellular activity in sirius red or hematoxylin/eosin staining and the percentage (%) of new bone collagen fibers was achieved using polarization technique evaluation. Conclusion: According to these results, nano-HA/beta-TCP composite presented clinical and histomorphometric properties suit to be used as bone-guided regeneration biomaterial in MSFA. Furthermore, nano-HA/beta-TCP composite provided a favorable nano-environment to bone cells, enhancing bone matrix production.

Introduction Maxillary sinus augmentation is a common and predictable procedure utilized to gain vertical alveolar bone height to allow for successful placement of dental implants in the deficient posterior maxilla. The surgical techniques, however, may be associated with intraoperative complications, the most common of which is Schneiderian membrane perforation and, less commonly, bleeding and the loss of an implant into the sinus cavity. Case presentation In the current report, we present two cases with unique complications. A large perforation which was discovered after the graft material had been placed was successfully managed by carefully removing the graft material from both sides of the perforation and sealing the perforation with a resorbable membrane and a tack fixation. The second case involved a patient who presented with an implant that had migrated into the sinus during an unsuccessful transcrestal sinus lift. The case was successfully treated by locating and removing the implant through an intentional membrane perforation, repairing the perforation, and placing a new implant with simultaneous grafting. Conclusion Management and repair of maxillary sinus membrane perforations that are either intentionally or iatrogenically created can be predictable procedures with favorable outcomes if thoughtful evaluation and treatment are provided. Managing such complications at the time of occurrence avoids unnecessary additional surgical procedures that might prove to be even more complicated.

Magnetic mallet was introduced in dentistry by Bonwill in 1873. It was introduced with the aim of increasing the efficacy of hammered gold fillings. Magnetic mallet is a magnetodynamical handpiece with an ergonomical design. It comprises central control with force adjustment, sterilizable handpiece with different replaceable tips, and pedal control. It comes with an entire range of bone expanders/osteotomes, cutter, and other instruments. It is applicable for procedures such as tooth and root extraction, impacted tooth removal, delayed implant placement, bone manipulating and sinus lifting procedures, root apex resection, removal of crowns, bridges, and implant part. The use of magnetic mallet is said to provide with better clinical advantage.

The three-dimensional printing has been used since very long ago in the field of medicine as well as in dentistry. The evolution of 3-dimensional imaging and modelling in dentistry is progressing towards a more efficient and cost-effective workflow using state-of-the-art technology. The practicability of this technique is expanding in several dental fields such as prosthodontics, oral and maxillofacial surgery and prosthesis, and production of surgical guides or physical models in dental implant treatment. The key of success in this technique depends on the usage of various materials such as, metal, resin, plastic etc. which is most commonly used in dentistry. With introduction of this recent advanced technology, it is used in various surgical procedures such as ridge augmentation, sinus lift and guided implant surgery, implant fixtures, preparation of customized scaffold with or without stem cell therapy, education models as well as in drug delivery technology. The 3-dimensional printing technology is becoming more economical technique and able to produce replica of dental models with a high resolution and accuracy. Keywords : Printing, Guided bone regeneration, Scaffold, Bioprinting, Stereolithography, Tissue engineering.

Dental implants are considered the first choice to replace lost or non-restorable teeth. However, the posterior maxilla remains a challenge in its management because of the quality of bone in the posterior maxilla. Osseo densification (OD) concept has been proposed in the literature to improve primary implant stability, which is an important aspect of osseointegration. Densah bur is novel drills specially designed to enhance a bone density by Osseo densification, which in turn increases primary stability. This present study was conducted to assess crestal sinus floor elevation by osteotome in comparison to Densah bur in the posterior atrophic maxilla. This was a randomized controlled clinical trial conducted on 20 patients to evaluate available crestal bone height loss, implant stability after implant placement in healed posterior maxillary alveolar ridge, whole bone height, Schneiderian membrane trauma, and post-operative complication.

Este estudo teve como objetivo, apresentar por meio de um relato de caso a interação entre odontologia restauradora e prótese dentária, orientando ao clínico uma opção de conduta clínica minimamente invasiva no tratamento de reabilitação oral. Paciente do sexo masculino, 49 anos, com queixa principal de mobilidade nos dentes anteriores superiores que sustentavam uma prótese fixa e insatisfação estética do sorriso. O exame clínico foi realizado e constatou-se situação periodontal comprometida de todos os dentes superiores, periodontite com grau 2 de mobilidade e reabsorção óssea vertical severa nos dentes 31, 32, 37 e 42, ausência dos elementos 36 e 41 e mobilidade grau 2 nos demais dentes inferiores em função da má oclusão. Foi planejada extração dentária dos dentes superiores, seguida de levantamento de seio bilateral e instalação de seis implantes para prótese do tipo protocolo de Banemärk. No arco inferior, raspagem e alisamento radicular, extração dos dentes 31, 32, 37 42, instalação de implantes nas regiões dos dentes 32, 36 e 42 e instalação de prótese implantosuportada. Considerando a necessidade de reestabelecer a oclusão, a condição periodontal comprometida dos dentes inferiores posteriores e a necessidade de melhorias estéticas, foi optado pela realização de restaurações em resina composta do tipo BulkFill® através da técnica do carimbo modificado, reproduzindo a anatomia oclusal dos elementos. Dessa forma, podemos concluir que a interação da odontologia restauradora e a prótese dentária pode ser uma alternativa interessante para casos em que há necessidade de tratamento reabilitador conservador, visando obter resultado de excelência na reabilitação oral

Aim To present a technical note on intra-sinusal bone ring concomitant with Le Fort 1 osteotomy. Material and method A 57-year-old man was referred to our Department for full-mouth rehabilitation. Oral examination identified: uncompensated multiple tooth loss and a class 3 skeletal malocclusion. The treatment plan consisted in a Le Fort 1 osteotomy and short-arch dental implant rehabilitation. Intra-sinusal bone ring technique associated with Le Fort 1 osteotomy were carried out under general anaesthesia. Result High primary retention was clinically observed of both the implant and the bone graft. Radiographic follow-up demonstrated satisfactory healing of the graft and implant osseointegration. Conclusion Bone ring technique concomitant with Le Fort 1 osteotomy seems to be appropriate to correct jaw discrepancy associated to a single tooth loss of the upper molar region with residual bone height of at least 3 mm to ensure implant primary stability.

Background: The Oro-antral fistulae (OAF) compromises the oral mucosa and the alveolar bone integrity, depleting its capacity to receive dental implants.Purpose: This clinical study aims to assess the clinical outcomes and the radiographic vertical bone gain of an innovative technique that combines the (OAF) closure, bone grafting, and sinus lift. Patients and methods: The study represents a case series conducted on thirteen patients with large (OAF), closed by sliding the buccal advancement flap combined with a distant palatal releasing incision after inverting and elevating the fistulous epithelial tract to set, elevate and conceal the floor of the maxillary sinus from the underlying bone graft. Meanwhile, evaluating the clinical outcomes and justifying a radiographic linear bone height comparison between the sinus floor height preoperatively and three months after. Results: The healing went uneventful, with neither shallowing of the vestibular depth nor obliterating the sinus cavity. The bony sinus floor was admirably elevated, and the grafted defects demonstrated appropriate bone width and height. The mean baseline bone height recorded (9.28 ±2.4 mm) versus ( 17.54 ± 1.6 mm ) for the three months postoperative. The vertical bone gain ranged from (4 to 12.5 mm), with a mean of ( 8.26 ± 2.6 mm), computing a statistically significant linear gain increase ( p < 0.00001). Conclusion: The novel approach provided comprehensive coverage of the oral defect, an appropriate primary elevation of the maxillary sinus with consolidated alveolar graft, cutting short the routine treatment time with the conduction of significant linear bone height gain values.

The purpose of this study was to investigate the effect of posterior maxillary ridge augmentation using mineralized plasmatic matrix versus autogenous bone graft on implant body stability in a randomized clinical trial. Twenty implants were placed in eight sinuses with a defective edentulous posterior maxillary ridge. After diagnosis of each case clinically and radio graphically, patients were randomly assigned into two equal groups of 3 patients each. After implant placement, the ridges assigned to the study group received MPM – prepared by centrifugation of patient’s blood- mixed with autogenous bone graft; while ridges in the control group received the gold standard of particulate autogenous bone graft. Implant stability was assessed in ISQ unit by Osstell, and Vertical bone height was assessed by CBCT at 4, 9 months. All demographic data and ISQ scores and CBCT measurements were collected and statistically analyzed. Results showed that, there was a statistically significant increase in implant stability, and vertical bone height after 4 months in both groups (P 0.05). The mean Osstell gain, bone height in the study group was significantly higher than those in the control group (P < 0.05).

AIM:The aim of the study was to evaluate the stability of the implants placed simultaneously after graftless sinus floor elevation using titanium mesh and to investigate whether sinus membrane elevation using titanium mesh with simultaneous implant placement)one-stage technique(without grafting materials constitute a valid technique for bone augmentation of sinus floor.Material and methods: The study group comprised 12 patients in whom a total of 17 implants are inserted simultaneously in 12 sinuses.Only blood clots occurring from bleeding due to the surgical procedure filled the secluded compartment space beneath the lifted sinus membrane, where the stable titanium mesh allowing for stable blood clot formation.Results:All implants achieved adequate primary and secondary stability except one implant showed insufficient second implant stability, six months at the stage of prosthesis fabrication, its secondary stability was inadequate to receive the final restoration and postponed for more and longer follow up (later on, this failed implant was lost and replaced). Overall, measurements taken for all placed implant increased over time, 16 implants achieved adequate secondary stability (ISQ2) and was sufficient for satisfactory loading. It was observed that the larger implant diameter improve the initial implant stability while the length did not had any effect on the initial stability.Conclusion:Open graftless sinus lift with simultaneous implant placement resulted in bone formation over a period of 6 months and showed high implant survival rates. The treatment time is shorter and decrease the patient discomfort due to reducing the risks of morbidity related to the harvesting of bone grafts.

Objective: Aim of this study was to evaluate the effect of using Nanobone & PRF with or without simvastatin on sinus lift and one stage implant placement. Material & Methods: 20 patients need sinus lift for implant placement in atrophied posterior maxilla were divided in two groups (group I: maxillary sinus left made by using synthetic bone substitute (NanoBone) & PRF Without simvastatin, while in group II using NanoBone & PRF with simvastatin. Results: Six months after surgery the mean of bone height gain in group I was 11.349 mm and the mean bone density was 297.8 Hounsfield units, while in group II the new bone height was 11.889 mm and the mean bone density was 314.3 Hounsfield units. During and after surgery there were no major complication and no implant failure. For endo sinus bone gain results were statistically significant in favour of group II (P

Objectives : The purpose of the study was to assess the occurrence, location, and dimensions of the intraosseous vascular canal in the lateral wall of the maxillary antrum using cone-beam computed tomography (CBCT). Materials and Methods In this retrospective study, we examined 400 CBCT scans from our archive of patients who had earlier reported to a dental teaching hospital in the United Arab Emirates. The prevalence, location, and dimensions of the lateral antral intraosseous canal (LAIC) in the maxillary antrum were evaluated by 2 examiners using standardised methods. A third examiner was consulted in cases of disagreement. Results The prevalence of LAIC was 62.3% (249 maxillary antra) among the study population. The mean distance between the most inferior point of the alveolar bone and the inferior border of the LAIC in the posterior maxillary region was 19.83±3.12 mm. There was a significant difference (P=0.05) between the maxillary molar and premolar regions in mean distance from the most inferior point of the alveolar bone and the inferior border of the LAIC. There was no statistically significant difference in mean distance between the most inferior point of the alveolar bone and the inferior border of the LAIC between dentulous and edentulous areas (P=0.1). The G3-intrasinusal type canal less than 1mm in diameter was the most common type of LAIC. Conclusion This study established the approximate location of the LAIC in a United Arab Emirates cohort, which will assist the oral surgeon in selecting the appropriate site for sinus lift procedures with reduced risk of surgical hemorrhage.

A demanding procedure in the rehabilitation of atrophied edentulous jaws is implant insertion. Various bone augmentation procedures like ridge augmentation, sinus lift are possible today, which increases the risk and cost of dental implant treatment as well as the number of necessary operations. Patients with severely atrophied jaw bones paradoxically receive little or no treatment. Basal implants are helpful in avoiding the risky and expensive bone augmentation procedures. The basal bone is, which usually remains free from the infection and less prone to resorption, gives support to basal implants. In this article, we shall review the basal implantology. Keywords: Basal implants, Basal osseointegrated implants (BOI), Bone multicellular unit(BMU), Osseoadaptation.

The posterior maxilla is indubitably the site reported with highest failures in implant literature so far as the bone availability beneath the sinus poses a major challenge for surgeons. Sinus lift both by direct and various indirect accesses were hitherto utilized to counter the compromising situation. But the risk of implant failure if the implant was simultaneously placed besides the parasthesia, perforation and morbidity were experienced more with more the cases documented. The osseodensification(OD), a relatively new technique provides a minimally invasive approach along with feasibility where the above-mentioned other modalities are contraindicated. The present article presents the novel case of indirect sinus lift with OD concept and simultaneous implant placement using an adjunct PRF (Platelet-rich fibrin). Keywords: Osseodensification, Crestal Sinus Lift, Sinus Membrane, Bone Graft, Osseointegration

Aim of this study is to investigate.Hybrid implant has got satisfactory results in our previous study in various edentulous areas with inadequate bone for endosseous implant placement .The credibility of the implant in the areas of posterior maxilla needed to be evaluated.Objectives•     To evaluate the hybrid implant postoperatively 18 months for gingival status, pain, peri-implantitis and mobility, so that it can be applied in posterior maxillary edentulous spaces with inadequate bone as an alternative to conventional implant.Materials and methods15 patients were rehabilitated in the posterior edentulous areas with hybrid implant. we intended to study the rehabilitation of posterior maxillary edentulous space i.e. Maxillary- premolar, 1st molar and 2nd molar area with hybrid implant and evaluate the hybrid implant post operatively for 18months (1stmonth, 3rd month, 6th month ,12 th month,18thmonth).Results•     During the study period the implant system presented with no gingivitis, peri-implantitis, and pain.•     The periotest test values show the implant system to be very much stable.•     Also proves to be safe, economical and clinician and patient friendly compared to other implant systems.Conclusion•     Hybrid implant system proves to be very effective in rehabilitating the posterior maxillary regions with inadequate bone.•     Also proves to be safe, economical and clinician and patient friendly compared to other implant systems.  Â

The aim of this study was to evaluate the effect of closed sinus lift surgery on dental vitality and periodontal sensitivity of teeth adjacent to the surgery area. Thirty patients undergoing closed sinus lift surgery by osteotomes were evaluated for dental vitality and periodontal sensitivity of adjacent teeth. Dental vitality and sensitivity were evaluated using the electric pulp tester (EPT) and cold spray once before surgery and one week, one month, and six months after surgery. In order to increase the validity of the study, one contralateral tooth in each patient was considered the control. In the test group, the number of teeth that did not respond to EPT and cold stimuli increased from baseline to six months after surgery and showed a significant difference between the four time intervals (P = 0.015 for EPT; P = 0.007 for cold stimuli). Thus, the vitality of teeth adjacent to the closed sinus lift area was lost over time. There was no significant difference between the two groups at any time for either stimuli. According to this research, tooth sensitivity to EPT and cold stimuli was not significantly different between test subjects and controls. For both cold and electrical stimulation, the number of teeth that did not respond was highest at one week after surgery and significantly different from baseline. However, after six months postsurgery, this number decreased, indicating recovery. However, some teeth were considered necrotic in the sixth month. It can be concluded that closed sinus lift surgery may cause necrosis in adjacent teeth, but more studies are required.

According to the literature, maxillary mucous retention cysts are a common finding in screening studies. They are incidentally found in 12.4—22% of people with CT examinations of the maxillary and are often asymptomatic. There is still no consensus on the symptomatology of maxillary mucous retention cysts. Objectives — identification of maxillary mucous retention cysts in patients at the initial visit: 1) study the clinical manifestations and radiological features of the maxillary mucous retention cysts depending on the size of the cysts; 2) identify the symptoms of retention cysts depending on the size of the cysts; 3) analyze the size of the cysts, age and gender prevalence, multiplicity and loneliness of retention cysts; 4) study the likelihood of recurrence of retention cysts after their removal; 5) study the effect of cysts on the sinus lift. Materials and methods. Clinical and screening studies were performed in 940 patients who came to the clinic in 2019. Thus, 1880 maxilla sinuses were examined. Patients underwent X-ray examinations and anamnesis. Results and conclusions. The results of the study allow us to conclude that there is no significant symptoms in the presence of maxillary mucous retention cysts. Retention cysts, as a rule, are an accidental finding on CBCT when examining the dento-maxillary system and planning a sinus lift. It is very important to take anamnesis for the prognosis of the postoperative course after the sinus lift. In cases of small cysts (up to 1/3 of the size of the maxilla sinus) detachment and elevation of the Schneiderian membrane together with the retention cyst is possible. There is no need to remove small retention cysts, since the contents of the cyst are sterile. The presence of a retention cyst does not affect the postoperative course and the results of the sinus lift. In cases of large cysts (from 1/2 the volume of the maxilla sinus and more), the operating surgeon must decide to remove the cyst during the operation in order to prevent obstruction of the anastomosis after sinus lift.

Background The replacement of maxillary posterior teeth often challenges the clinician due to bone resorption after dental exodontia and low bone quality. Currently, attempts are being made to shorten treatment times by placing implants simultaneously to sinus lift procedures in borderline cases, which can lead to complications such as displacement of implants into the maxillary sinus. Clinical case A 54-year-old patient who was planned for complete rehabilitation of the maxilla through a fixed implant-supported prosthesis on 6 implants. At the level of the 3rd sextant, a sinus lift was performed with a lateral window approach (Caldwell-Luc type) and the simultaneous placement of two implants, one of which migrated into the sinus. The implant was displaced after 4 months when the second stage (uncovering) implant surgery was performed for the connection of the healing abutments. The implant was removed a week after the migration, since it had moved to the tuberosity area in the sinus and the lateral window had been performed in a more mesial position, so the patient was recommended to sleep on the right side to achieve the displacement of the implant to a more favourable area, removing it after a week through the same approach. Discussion Surgical strategies for the removal of a migrated implant are essentially divided into two main approaches: endoscopic transoral and endoscopic transnasal (and combined). Conclusions In case of intra-operative migration of the implant into the sinus, it is recommended to remove it as soon as possible to avoid a possible sinus pathology of iatrogenic origin. Key words:Dental implant complications, dental implant, dental implant displacement, maxillary sinus, case report.

Background The present study aimed to evaluate and compare the postoperative effects of the piezoelectric device and conventional rotary instruments in Schneider’s membrane sinus lifting procedure. Material and Methods Twenty patients requiring bilateral maxillary bone graft augmentation in the posterior maxillary region were selected. Piezoelectric surgery was performed on one side and conventional surgery with a rotary diamond bur on the other. Postoperative pain, swelling, edema, and mouth opening were evaluated at one hour and two and seven days after the procedures. All variables were submitted to Friedman or Wilcoxon tests at a 5% significance level. Results The comparison between groups showed that postoperative pain after one hour and two days was significantly lower (p< 0.05) in the piezoelectric device group. Regarding the edema, the results of both techniques were similar at all times assessed (p> 0.05). Piezosurgery was statistically associated (p< 0.05) with greater mouth opening only at the 48-hour evaluation. Conclusions Osteotomy with a piezoelectric device causes less pain and greater mouth opening postoperatively compared with the conventional technique. Key words:Piezosurgery, sinus lift, edema, pain, rotative instruments.

Aim of the study: The aim of this study is to compare the effect of PRF versus xenograft on implant primary stability after closed sinus elevation in the maxillary posterior area . MATERIAL AND METHODS: Patients were divided in to two equal groups: Group A: closed sinus lifting by Osteotome using PRF as grafting material with implant placement in 8 partially edentulous patients. Group B: Closed sinus lifting by osteotome using xenograft as a grafting material with implant placement in 8 partially edentulous patients. After implant placement, Smart peg was placed on implant and Ostell is used to record ISQ. Implant stability was measured intraoperative and at week 2, 4, 6, 8 and 10 for both groups. The collected results were tabulated and statistically analyzed. Results: The study results showed that there was no statistically significant difference between (PRF) and (Xenograft) groups in ISQ reading. Conclusion: Maxillary sinus elevation by osteotome technique and using PRF or xenograft as a grafting material is a predictable and effective procedure for correcting limited bone resorption in posterior areas of the maxilla.

The alveolar antral artery resides lateral to the maxillary sinus and can lead to complications in sinus lift surgery. Traditional approaches that decrease intraoperative bleeding into the surgical field include vessel preservation using multiple bony windows or neutralizing the vessel at the surgical site. Unfortunately, these methods are technique sensitive, time intensive, and may lead to hemosinus and graft loss. The variable distance from the crest of the alveolar ridge and vessel diameter further complicates pre-operative planning. This paper discusses the anatomical features of the alveolar antral artery, techniques for clinical assessment, and current management strategies. We then describe a novel protocol to manage the alveolar antral artery in sinus lift procedures via tamponade of the vessel at a proximal site. This method is faster than those described in the literature, does not require any additional equipment or expertise, and aims to improve long-term graft predictability by decreasing the risk of sinus membrane perforation. The alveolar antral artery is an under-reported source of surgical complications and warrants further research.

Patients with highly atrophied jaws pose a serious clinical problem for construction of removal denture or surgical placement of implant. They sometime are in need of undergoing delicate surgical interventions for gaining vertical bone height with/without sinus lift. It requires expensive bone graft substitutes and barrier membranes in the hand of an expert. A long period of time for bone healing is an additional enigma. After the jaws are made ready, the implants are surgically inserted into the bone and a period of another 4-6 months waiting is inevitable. The long waiting period and the expenses for adjuvant surgical treatments are not appreciated by the patients. The present article deals with a patient with highly atrophied jaws for full mouth rehabilitation with basal and cortical implants. Keywords: Jaw atrophy, Bone augmentation, Cortical implants, Full mouth rehabilitation, Strategic implantology.

In the present paper, the authors present a case report of premolar edentulism in the upper jaw treated through a guided flapless oral implant surgery with contextual crestal sinus lift, performed with a system of manual screw-tapered bone expanders (B&B Dental, San Benedetto, BO, Italy). The surgery was planned by means of dedicated software, through which the data obtained from the CBCT and from intraoral scanner impression were matched, with consequent production of a surgical template. The proposed surgical procedure is minimally invasive, very simple, and fast and ensures good comfort for the patient by avoiding the elevation of mucoperiosteal flaps and uncomfortable malleting maneuvers. In addition, the presented method shows a good degree of correspondence between the ideal position of the implant in the planning phase and the actual one detectable after the surgery.

Objectives This literature review was performed to assess the risk of bleeding in dental implantation procedures in patients taking antiplatelet drugs (APs), oral anticoagulants (OACs) and direct oral anticoagulants (DOACs). Study Design MEDLINE and SCOPUS databases were searched for English language publications through October 2019, using the keywords “dental implants,” “dental implantation,” “anticoagulants,” “platelet aggregation inhibitors,” and “hemorrhage.” Reference lists of relevant articles were also hand searched. Collected data regarding dental implantation procedures, type of medications (APs, OACs and DOAC), and postoperative bleeding episodes were analyzed. Results Nine studies were included in the review. Postoperative bleeding occurred in 10 (2.2%) of 456 of cases involving dental implant placements; in all of those cases, bleeding was controlled with the use of local hemostatic agents. The bleeding incidence in patients on antiplatelet medications was 0.4% (range 1 of 253 to 1 of 261). Among those taking oral anticoagulants, the bleeding incidence was 5.7% (range 6 of 105 to 6 of 113), and among those on direct oral anticoagulants, the bleeding incidence was 3.3% (3 of 90). The numbers of more extensive surgical procedures (i.e., sinus lift and bone augmentation procedures) were small, and additional information regarding the surgery, the specific antithrombotic used, or bleeding was often not provided, so further analysis was not possible. Conclusions Evidence supports continuing OACs, DOACs, or APs during dental implant surgery.

Aim To report a case involving transantral palatal root piezoelectric surgery followed by a sinus floor augmentation procedure with the purpose of minimizing and managing complications associated with sinus lining perforations and optimizing bone regeneration at the site of the surgical defect. Summary An asymptomatic 28-year-old male patient with the diagnosis of chronic apical periodontitis on a previously root filled right maxillary first molar (FDI tooth 16) and second premolar (No. 15) was managed by transantral apical surgery. Cone-beam computerized tomography (CBCT) revealed the position of the palatal root of the first molar within the maxillary sinus. The case highlights the management of the palatal root and the handling of a perforation of the Schneiderian membrane through a combination of piezosurgery and a sinus lift grafting procedure involving a second-generation of platelet concentrates. No postoperative complications were observed. Sinus bone augmentation after a 26-month recall period was confirmed by CBCT in the clinically asymptomatic teeth. Key learning points The selective bone tissue cutting and enhanced visibility obtained by piezoelectric surgery in comparison with current rotary techniques make this technology the preferred tool for apical surgery when the mucosal lining of the maxillary sinus could be compromised. The wound healing and physical properties of the platelet-rich fibrin membranes in combination with an allograft material can be considered as sinus bone graft options when a transantral approach is performed on a palatal root of a maxillary molar. A preoperative tomographic examination is essential for apical surgery using a transantral approach with sinus bone augmentation, because of the information obtained from the axial and coronal views on the CBCT scan.

Pre-prosthetic surgery is part of the oral and maxillofacial surgery, which concerns restoration of facial form and oral function. Pre-prosthetic surgery is a surgery done to obtain a better anatomic environment and to provide proper supporting structures for denture construction. The aim of this study was to analyse the various pre-prosthetic surgeries performed in a private dental institution. In this retrospective study, digital case records of all patients who underwent pre-prosthetic surgeries in Saveetha Dental College and Hospital from June 2019 to March 2020 were reviewed. Demographic details of patients and types of pre-prosthetic surgeries performed were recorded from digital case records. Retrieved data was analysed using IBM SPSS Software Version 23.0. Descriptive statistics and tests of association for categorical variables by Chi square tests were done and results were obtained. P value

As the COVID-19 has become a pandemic across the globe, the knowledge of healthcare workers (HCWs) about the diseases and its management is very vital to have a better control over the infection This study was carried out to assess the knowledge of HCWs of the 5 south Indian states with higher rates of COVID-19 infection An online survey with 25 validated questions about COVID-19 was administered to 385 HCWs across the study region Prior to the administration, the questionnaire was validated for various standard param-eters using Cronbach’s alpha score greater than 0 7 The responses were analyzed using descriptive statistics and statistical significance was assessed using one-way ANOVA p value of less than 0 05 was considered to be statis-tically significant The overall knowledge about COVID-19 was found to be greater among the medical doctors, pharmacists and nurses from higher to lower scores with a mean value of78 81±13 45 compared to the other health-care workers 63 6±24 3 The one-way ANOVA revealed that the difference in the knowledge levels among the HCWs significantly differed (p=0 0012) The answers to few of the questions were found to be highly dynamic as the advi-sory guidelines are highly dynamic The present knowledge level of HCWs in south India about COVID-19 is relatively high However, there is a need for continuous education about COVID-19 to the HCWs and the national organizations and authorities should provide a structured and reliable information to the HCWs in order to have a better control over the COVID-19 infection © 2020, J K Welfare and Pharmascope Foundation All rights reserved

Rehabilitation of the long-standing edentulous posterior maxilla with dental implant poses a unique challenge. This is due to mainly two reasons – pneumatization of the maxillary sinus and atrophy of the alveolar bone. The challenge is intensified when the native bone is around 2–3 mm. This requires vertical bone augmentation in the form of direct sinus lift/lateral wall sinus lift procedure. The most common complication associated with this procedure is the sinus membrane perforation resulting in unfavorable stabilization of the graft and associated bone regeneration. Simultaneous implant placement becomes all the more difficult in such situations. As a result, of which implant placement has to be deferred resulting in extended treatment duration and multiple surgical appointments. The present case report represents two such sinus membrane perforation repair cases associated with lateral wall osteotomy approach for sinus augmentation with simultaneous implant placement in the posterior maxilla.

The purpose of this article was to present a guided lateral window sinus lift procedure with the aid of a fully digital workflow using surgical templates for window osteotomy preparation and implant placement. A 22-year-old patient with insufficient residual bone height in the posterior maxilla was treated with a maxillary sinus augmentation procedure with a lateral window technique and simultaneous implant installation using 3-dimensionally printed surgical guides. The surgical guides, used for the preparation of both the lateral window and the implant site according to the optimal prosthodontic and anatomic position, were based on a fully digital workflow and virtual pre-planning with modified implant-planning software. Successful functional and esthetic rehabilitation of the patient was accomplished using standard surgical techniques and instruments but an innovative method for the production and application of surgical templates ensured a precise and safe approach for the lateral window osteotomy preparation. This guided lateral window sinus lift technique may reduce the incidence of surgical complications and failures and enhance patient-related outcomes.

Surgical ciliated cysts (SCC) are rare entities that were first described in the Japanese literature after treatment for chronic maxillary sinusitis. Classically associated with surgery to the maxillary sinus, they have also been reported in association with orthognathic surgery, bone grafting, and trauma. These lesions can develop from a few months up to several years after the surgical procedure. The authors report 2 new cases of SCC after a LeFort I osteotomy for class III dentofacial deformity correction. One of them presented with bilateral lesions and suffered from a recurrence after 5 years, 2 rare events associated with SCC.A review of the literature of the past 5 years was undertaken, in order to ascertain the reported time of follow-up and recurrence. A PubMed search retrieved a total of 15 articles with 17 cases reported. Nine cases were associated with orthognathic surgery, 4 with Caldwell-Luc procedures, 2 with sinus lift and 2 with trauma. The mean follow-up after removal of the SCC was of 8.6 months. Four cases did not specify the follow up time; 1 case was lost to follow-up. No relapses were reported.Like what happens with the primary lesion, a recurrence can take place several years after removal. It is the authors' opinion that adequate long-term follow-up must be granted for a timely diagnosis and treatment of relapsed SCC.

Typically, the greater the atrophy of the process, the more extensive and invasive the sinus floor elevation procedure is. This case of a 39-year-old man demonstrates a minimally invasive hydrostatic sinus lift from 1.7-mm height process in the site of lost tooth No. 16. Using a small flap, safe drills for a crestal approach diameter of 2.8 mm, 2 mL of saline solution under pressure of a syringe plunger, and 1 g of particulated bovine xenograft, a 14-mm height and 12-mm width sinus floor elevation was obtained. The implant was placed with a torque of 30 Ncm, and a healing cap was attached. Despite the very difficult conditions, the presented method not only resulted in a very good therapeutic effect but also reduced the number of procedures and time necessary for complete rehabilitation of the patient. The total treatment time to the final crown delivery was 6 months.

Aim of the study: to compare clinically, radigraphically and histologically the application of PRF and grafless lateral sinus lift with simulatanous implant placement. Material and methods: ten patients with missing maxillary posterior teeth to receive 20 implants underwent this lateral sinus lift technique performed using an SLA KIT. Patients divided equally into two groups. Group A; included 10 implants combined with application of PRF at the osteotomy site surface while group B; included 10 implants without PRF application. The residual bone height was 3-5 mm at least. Immediately after the implant placement, implant stability test was performed using the Osstell Monitor, Patients were recalled for follow up at 6 months. Radiographic and clinical and histological examinations were conducted . Result: All implants were considered successful after 6 months from implantation. No significant difference in bone quality or quantity and implant stability in group A and group B . Conclusion: There is no difference between application of PRF and graftless sinus lift in new bone formation and implant stability at 6 month from implantation.

Introdução: A infecção do enxerto sinusal com consequente rinossinusite bacteriana aguda (ABRS) é uma complicação que pode ocorrer durante o período pós-operatório de cirurgia de aumento sinusal. Um pequeno grupo de bactérias parece predominar no ABRS, e essas bactérias são empiricamente suscetíveis aos antibióticos da tetraciclina, impedindo a presença de cepas resistentes. Historicamente, os clínicos misturam tetraciclina com vários biomateriais ou biomateriais hidratados em uma solução diluída de tetraciclina no tratamento da doença periodontal e para indicações de preservação / aumento da crista. Apresentação do caso: No presente caso, um homem afro-americano de 39 anos de idade com infecção do enxerto sinusal e sinais e sintomas consistentes com o ABRS foi tratado com sucesso removendo o material inicial do enxerto, desbridando e irrigando completamente o antro e colocando um osso liofilizado aloenxerto hidratado em uma solução aquosa de tetraciclina. Conclusão: Dadas as bactérias típicas presentes no ABRS, a tetraciclina aplicada localmente pode ser útil profilaticamente na cirurgia de elevação do seio ou como adjuvante no tratamento da infecção pós-operatória do enxerto sinusal.

Sinus lift surgery is an established and reliable technique because of the low rate of postoperative complications and the success of implants placed in the grafted area. However, as with any surgical procedure, it is not immune from risk. To minimize this risk, the surgery must be carried out by experienced professionals with appropriate planning. The major part of success with implant placement in posterior maxilla by grafting procedure lies in treatment planning. The in-depth knowledge of anatomy of the maxillary sinus is utmost important before actually performing the sinus floor elevation procedure. In this article we will be discussing in detail the various anatomical and clinical considerations in the posterior maxillae for sinus floor elevation procedure to ensure a predictable success with minimum complication. Keywords: Maxillary sinus, Anatomy, Antrum of highmore, Ostium, Schneiderian membrane.

espanolEste estudio busco evaluar la anatomia interna de los senos maxilares y sus septos mediante tomografia computarizada de haz conico (CBCT) en una poblacion Irani. Materiales y Metodos: . La resorcion del hueso alveolar disminuye la altura de la cresta alveolar maxilar. Esta reduccion de altura puede ser tan severa que justifique el aumento de la cresta mediante una elevacion de seno. La manipulacion de los senos maxilares, como en la cirugia de elevacion del seno, requiere un conocimiento adecuado sobre la anatomia del seno Resultado: El tabique del seno maxilar, como una variacion anatomica, puede complicar los procedimientos quirurgicos y aumentar el riesgo de complicaciones como la perforacion de la membrana sinusal. En este estudio retrospectivo, dos radiologos orales evaluaron 366 senos, 190 de mujeres y 176 de hombres, con edades comprendidas entre 10 y 65 anos que se presentaron en el Departamento de Radiologia Oral y Maxilofacial de la Facultad de Odontologia de Hamadan University of Medical Sciences. Se determino la extension de los senos maxilares, la presencia de septos, el numero de septos y su ubicacion. Los datos se analizaron mediante la prueba de chi cuadrado (nivel de significacion p≤0.001). El coeficiente de concordancia entre los dos radiologos orales se calculo en base a Cohen kappa. Los septos estaban presentes en el 40.5% de los senos maxilares, de los cuales, el 31.6% tenia uno, el 7.9% tenia dos y el 1% tenia tres o mas septos; El 38% de los septos eran horizontales, mientras que el 62% tenia una orientacion oblicua. En total, se encontraron 184 septos en 183 pacientes; de los cuales, 91 septos tenian de 2mm a 5mm de largo, mientras que 93 septos tenian mas de 5mm. Conclusion: El conocimiento exhaustivo sobre la anatomia interna tridimensional de los senos maxilares adquiridos por CBCT antes de los procedimientos quirurgicos puede ayudar en gran medida a prevenir complicaciones postoperatorias. EnglishThis study sought to assess the internal anatomy of the maxillary sinuses and their septa using cone-beam computed tomography (CBCT) in an Iranian population. Materials and Methods: Resorption of alveolar bone decreases the height of the maxillary alveolar ridge. This height reduction may be so severe that it warrants ridge augmentation by a sinus lift. Manipulation of the maxillary sinuses, as in sinus lift surgery, requires adequate knowledge about the sinus anatomy. Results: Maxillary sinus septum, as an anatomical variation, may complicate the surgical procedures and increase the risk of complications such as sinus membrane perforation. In this retrospective study, 366 sinuses, 190 from females and 176 from males, aged between 10 and 65 years old presenting to the Oral and Maxillofacial Radiology Department of School of Dentistry at Hamadan University of Medical Sciences were evaluated by two oral radiologists. The extension of the maxillary sinuses, presence of septa, number of septa and their location were determined. Data were analyzed using the chi square test (level of significance p≤0.001). The coefficient of agreement between the two oral radiologists was calculated based on Cohen kappa. Septa were present in 40.5% of the maxillary sinuses, out of which, 31.6% had one, 7.9% had two and 1% had three or more septa; 38% of the septa were horizontal while 62% had an oblique orientation. In total, 184 septa were found in 183 patients; out of which, 91 septa were 2mm to 5mm long while 93 septa were longer than 5mm. Conclusions: Comprehensive knowledge about the three-dimensional internal anatomy of the maxillary sinuses acquired by CBCT prior to surgical procedures can greatly help to prevent postoperative complications.

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.

Xenograft bone substitutes are commonly used to increase bone volume and height in the deficient posterior maxilla. The addition of enamel matrix derivate (Emdogain) could increase the efficiency of the bone healing process. The aim of this prospective randomized, controlled split-mouth design study was to compare the percentage of newly formed bone in sinus floor augmentation with deproteinized bovine bone mineral with or without the addition of enamel matrix derivative after 6 months of healing. Sixteen bilateral sinus floor augmentation procedures were performed. Deproteinized bovine bone mineral combined with enamel matrix derivative (test) and deproteinized bovine bone mineral alone (control) groups were randomly allocated within each patient. Six months after augmentation and concurrent to implant placement, bone biopsies were taken for histomorphometric analysis. Additionally, implant survival and peri-implant bone levels were radiographically assessed at baseline and 24 months after functional loading. Histomorphometric analysis revealed a significantly higher amount of newly formed bone in the test group compared with the control group (22.6% and 15.5%, respectively; P = .033). No significant differences in the amount of remaining graft or connective tissue was found. Enamel matrix derivative added to deproteinized bovine bone mineral particles significantly increased new bone formation in sinus lift procedures in edentulous or partially edentulous patients with deficient bilateral posterior alveolar ridges requiring augmentation for implant placement.

Maxillary sinus is the first paranasal sinuses to develop, which is pyramidal in shape and it completes developing around 20 years of age with the eruption of the maxillary third molars. Pneumatization of the maxillary sinus occurs with time. Tooth loss may lead to loss of bone density, atrophy of bone and further pneumatization of the maxillary sinus leading to insufficient quality and quantity of bone for placing implants. Despite lots of literature and research being done, there is no clarity in obtaining consensus regarding the techniques and materials used in maxillary sinus lift procedures. This article reviews the various techniques and bone graft materials used in maxillary sinus lift procedures. The techniques include lateral window approach, hydraulic sinus lift technique, Piezoelectric Surgery technique, Transcrestal Approach, Osteotome Technique, and Balloon elevation technique. It can be concluded that the balloon antral elevation technique and Hydraulic Sinus Lift technique are more efficient techniques for maxillary sinus lift procedures. These techniques are known to result inless perforations, less chair-side time, comparatively easier, and the need for elaborate instrumentation is minimized. It can also markedly increase the success rates of implants in contrast to the conventional techniques which pose greater risks to the patient, more soft tissue trauma, more chair-side time and can expose patients to infections.

Purpose: Many techniques for maxillary sinus floor elevation have been used prior to implant placement in case of sever sinus pneumatization. Two-stage lateral-window sinus lifting using titanium micromesh without bone grafting was carried out in the present study. The purpose of the study was a trail to solve a question, if it is enough to just increase the height of sub-antral bone or it is also important to elevate the Schneiderian membrane medio-laterally as much as possible to accommodate for dental implants later. Materials and Methods: Seven patients (11 sinuses) were included. A titanium micromesh was shaped in a tick shape and placed into the sinus through a lateral window to maintain the elevated membrane in place. Immediate, 6-months and 9-months postoperative cone beam computed tomography (CBCT) were performed to evaluate the relation between the medio-lateral extension of the mesh and the amount of the gained bone. Results: When the height of the formed bone was related to the depth of the titanium mesh, no significant difference could be observed at either 6 or 9 months. However, when the depth of newly formed bone was compared against the depth of the titanium mesh, a high significant difference was noted at both 6 and 9 months. Conclusion: At least two thirds of the sinus depth must be elevated to obtain adequate bone width for future implantation.

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.

Atrophic resorption of the maxillary alveolar ridge is a complication that makes implantological rehabilitation critical. Our aim was to develop a novel computer aided procedure for the accurate quantitative assessment of maxillary residual ridge resorption including pneumatisation of the maxillary sinus that goes beyond previously described approaches and to apply it to a large dataset. To develop and refine the method, we performed a retrospective analysis using computed tomography data from 405 patients to generate segmented, three-dimensional models of zygomaticomaxillary bones and maxillary sinuses. Using anatomical landmarks and orientation lines or planes, all models were aligned automatically to subsequently generate cross-sectional images (n = 2835), enabling the classification of atrophy as well as the quantification of volumes and caudal extensions of the maxillary sinuses. We developed and implemented an accurate and reproducible workflow for the semi-automated analysis of volumetric maxillary images. Comprehensive statistical analysis of the large quantitative dataset revealed various correlations of maxillary process heights and sinus volumes with atrophy class, age and region and identified conjectural trends over the patient group. The method was used successfully to process a large dataset to classify atrophy, to measure alveolar height parameters, and to quantify maxillary sinus volume, bottom volume and pneumatisation. Apart from the anthropometric value of the generated dataset, the method could be applied to provide additional and more accurate data to assess the necessity of bone augmentation in the context of three-dimensional planning before implantation.

Acemannan, the major polysaccharide extracted from Aloe vera, is biomaterial that has demonstrated osteoinductive effects in vitro and in vivo. However, the effect of acemannan sponges on bone formation in open-type sinus augmentation has not evaluated. Here, we report a case study using radiographic and histological analyses to investigate the effect of acemannan on bone formation after lateral sinus lift surgery. The case was a 57-year-old female patient with an atrophic left posterior maxilla who underwent lateral sinus lift using an acemannan sponge using the two-stage procedure. In the first stage, an acemannan sponge was inserted through the bony window and placed between the antral floor and the elevated sinus membrane. Cone beam computed tomography (CBCT) images were taken immediately as baseline and 6-month postoperation for evaluation. A bone core specimen was also obtained for histological examination at the time of implant placement. The histological results revealed new bone formation, and the CBCT images demonstrated increased alveolar bone height at 6-month postoperation. Our findings suggest that an acemannan sponge could be a biomaterial for inducing bone formation in sinus lift surgery.

In the present retrospective study, we aimed to assess the replicability and reproducibility of a novel digital measurement technique for analyzing the volumes of the left and right maxillary sinuses and the nasal and maxillary sinus airway complex after a sinus lift procedure using the lateral window approach, to provide an accurate measurement technique for easily applying in clinical practice and to allow pre-operative assessment of maxillary sinus lift surgery, avoiding complications and making surgery more predictable. Material and Methods: Thirty patients with partially edentulous posterior maxilla were selected and submitted to bilateral sinus lift using the lateral window approach technique, with grafting materials selected and submitted to cone beam computed tomography (CBCT) scans, both pre- and postoperatively. Then, datasets were uploaded to therapeutic digital planning software to measure the volume of the right and left maxillary sinuses and the nasal and maxillary sinus airway complex. Gage R&amp, R statistical analysis was performed to assess the replicability and reproducibility of the digital measurement technique. Results: The variability attributable to the novel digital measurement technique was 3.4% for replicability and 3.4% for reproducibility of the total variability of the samples. Conclusion: The novel digital method proposed is a replicable and reproducible technique for analyzing the volume of the right and left maxillary sinuses and the nasal and maxillary sinus airway complex after a sinus lift using the lateral window approach technique, allowing an accurate pre-operative assessment of maxillary sinus lift surgery, avoiding complications and making surgery more predictable.

Objective To compare the bone quality histologically and radiologically using two graft materials i.e. demineralized freeze-dried bone allograft (DFDBA) and biphasic calcium phosphate (BCP) along with platelet-rich plasma (PRP) as an adjuvant in both; for bilateral maxillary sinus lift procedures. Material and methods This split mouth pilot study consisted of 5 healthy patients who required bilateral sinus lift procedures in 10 sites. Allocation concealment for site selection was done. Site A was DFDBA with PRP and site B was BCP with PRP. Evaluation of bone density was done as per Misch criteria-preoperatively and 6 months postoperatively with CBCT scans. 6 months after the augmentation procedure, implants were placed and a trephine drill biopsy was taken, for histological evaluation of bone quality. Patients were followed up for 18 months after implant placement. Results Five patients with a mean age of 47 ± 9.27 years (range of 35–60 years) underwent 10 maxillary sinus augmentation procedures. Radiologically, the bone density showed no statistically significant differences between site A: D4 and site B: D5; pre and post operatively. Histologically, the average value calculated for the percentage of marrow spaces was: site A, mean 40.92 ± 2.41 SD; site B mean: 31.48 ± 7.97 SD (t = 2.56, p = 0.03). The architecture of bone formed for all the 5 cases at site A was 100% trabecular pattern of bone, site B had 40% trabecular pattern of bone and 60% compact bone formation. Conclusion Demineralized freeze-dried bone allograft with platelet rich plasma exhibited a superior quality of bone formation and a higher percentage of marrow spaces, it satisfied and met the evaluation parameters for bone quality. Clinical relevance: The conclusive findings of this research could guide clinicians towards utilising the amalgamation of DFDBA and PRP for bone augmentation procedures-as a safe and dependable option.