Search

Background Maxillary sinus floor elevation with a lateral approach (LSFE) represents the most predictable surgical procedure to vertically enhance the available bone in the edentulous posterior maxilla. Intra-operative complications and post-operative patient morbidity are the main issues of concern for patients and clinicians. Aim/HypothesisThe aim of this study is to evaluate the patient-reported outcomes and complication rates in 50 patients after augmentation of maxillary sinus.Material and Methods50 consecutive patients with residual bone height less than 5 mm were treated between 2018 and 2019 in 3 different private centers. All patient underwent to LSFE procedure (T0) before implant placement (T1) and restoration (T2) using a bovine bone graft (Bio-Ossu00ae; Geistlich Pharma, AG, Wolhusen, Switzerland).Patient-reported outcomes were assessed using a 100-mm visual analog scale (VAS) to evaluate the post-operative pain experienced in the first week following surgery and visual rating scales (VRS) to evaluate discomfort level, swelling level, and willingness to undergo the same surgery. Analgesics intake, onset and duration of swelling and ecchymosis were also evaluated. Finally, all complications were recorded and divided into: surgical complications (venous or arterial bleeding, sinusal membrane perforation, or buccal flap laceration) and healing complications (wound dehiscence, infection / fistula, or sinusitis).ResultsAll 50 patients were completely evaluated according to the study protocol. Pain level showed moderate values in the first (median: 50; IR: 60-46.2) and second day (median: 50; IR: 60-40) with a tendency to decrease over the third (median: 30; IR: 50-20) and fourth day (median: 14; IR: 28.25u20137.75), showing median values of 0 from the fifth day. Average analgesics intake during the week following the surgery was 4.1u00b12.8. Discomfort level was low (median: 1; IR: 1-0), while willingness to undergo the same surgery was very high (98% of patients; median: 0; IR: 0-0). Swelling and ecchymosis were experienced by 100% and 56% of patients respectively with a mean duration of 4u00b10.9 and 4.2u00b10.9 days respectively. Surgical complications included only 3 membrane perforations (6%), while no healing complications were observed (0%). Conclusion and Clinical implicationsThis study confirmed that LSFE is a safe and predictable procedure because of moderate patient morbidity and very low complication rates. High level of willingness to undergo the same surgery should encourage clinicians to choose LSFE for bone augmentation in posterior maxilla.

Background One of the most recent innovations in bone augmentation surgery is represented by computer-aided-design/computer-aided-manufacturing (CAD/CAM) customized titanium meshes, which can be used to restore vertical bone defects before implant-prosthetic rehabilitations. The aim of this study was to evaluate the effectiveness/reliability of this technique in a consecutive series of cases. Methods Ten patients in need of bone augmentation before implant therapy were treated using CAD/CAM customized titanium meshes. A digital workflow was adopted to design virtual meshes on 3D bone models. Then, Direct Metal Laser Sintering (DMLS) technology was used to produce the titanium meshes, and vertical ridge augmentation was performed according to an established surgical protocol. Surgical complications, healing complications, vertical bone gain (VBG), planned bone volume (PBV), lacking bone volume (LBV), regenerated bone volume (RBV), average regeneration rate (RR) and implant success rate were evaluated. Results All augmented sites were successfully restored with definitive implant-supported fixed partial dentures. Measurements showed an average VBG of 4.5 ± 1.8 mm at surgical re-entry. Surgical and healing complications occurred in 30% and 10% of cases, respectively. Mean values of PBV, LBV, and RBV were 984, 92, and 892 mm3, respectively. The average RR achieved was 89%. All 26 implants were successfully in function after 1 year of follow-up. Conclusions The results of this study suggest that the bone augmentation by means of DMLS custom-made titanium meshes can be considered a reliable and effective technique in restoring vertical bone defects.