Comparison of 4 sinus augmentation techniques for implant placement with residual alveolar bone height ≤3 mm.

This study compared implant outcomes following maxillary sinus floor augmentation (MSFA) in edentulous patients with a residual alveolar bone height ≤3 mm. Four techniques were evaluated: 1-stage bone-added osteotome sinus floor elevation procedure (BAOSFE) with simultaneous implant placement; 2-stage BAOSFE with delayed implant placement; 1-stage lateral window sinus floor elevation with simultaneous implant placement; and 2-stage lateral window sinus floor elevation with delayed implant placement. Patients were followed for 18 to 72 months (mean: 52.5 months) after prosthesis placement. Data were analyzed with cone-beam computed tomography. A total of 96 implants from 71 patients were analyzed; pretreatment, there were no significant differences between patients. Total implant survival was 98.9%. The mean residual bone height was significantly higher in the 1-stage BAOSFE group than the other groups (P < .01); 1 implant in this group failed at 3 months. There was no significant difference in total bone height gain between groups. However, the bone height gain of 1st sinus lifting with 2-stage BAOSFE was significantly lower than the 2-stage lateral window procedure (P < .01). There was no prosthesis failure. The favorable implant outcomes suggest these 1-stage and 2-stage MSFA procedures should be considered as alternative treatment options for patients with extremely atrophic posterior maxilla.

Sinus Augmentation with Simultaneous, Non-Submerged, Implant Placement Using a Minimally Invasive Hydraulic Technique.

Background and objectives: To evaluate whether sinus augmentation, using a minimally invasive implant device, via a non-submerged surgical approach, might negatively influence the outcome. Materials and Methods: A retrospective cohort study was conducted by evaluating patients' files, classifying them into two groups. Fifty patients (22 men 28 women) were included in the study, 25 in each group. The use of an implant device based on residual alveolar ridge height for sinus augmentation, radiographic evaluation, insertion torque, membrane perforation, post-operative healing, and a minimum of 12 months follow-up were evaluated. Results: The mean residual alveolar ridge height was 5.4 mm for the non-submerged group and 4.2 mm for the submerged group. There were no intraoperative or postoperative complications (including membrane perforations). The mean insertion torque was 45 N/cm for the study group and 20 N/cm for the control group. Complete soft tissue healing was observed within three weeks. Mean bone gain height was 8 mm for the study and 9.3 mm for the control group. All implants osseointegrated after 6-9 months of healing time. Mean follow-up was 17.5 months, range 12-36 months. Marginal bone loss at last follow-up was not statistically significantly different: 1 mm in the non-submerged vs. 1.2 mm in the submerged group. Conclusions: Submerged and non-submerged healing following maxillary sinus augmentation was comparable provided residual alveolar ridge height >5 mm and insertion torque >25 N/cm.

Histologic and Histomorphometric Comparison between Sintered Nanohydroxyapatite and Anorganic Bovine Xenograft in Maxillary Sinus Grafting: A Split-Mouth Randomized Controlled Clinical Trial.

The presence of vital bone after maxillary sinus augmentation is crucial to enhance the quality of bone-implant interface, ensuring predictable long-term results. The aims of this RCT with split-mouth design were the histologic and histomorphometric comparison of two different biomaterials in sinus elevation after 6 months of healing and the evaluation of the clinical outcomes of implants inserted in the augmented areas after 12 months of prosthetic loading. Twenty-eight patients (10 females, 18 males) were treated with bilateral sinus floor elevation with lateral approach. Pure sintered nanohydroxyapatite (NHA) and anorganic bovine bone (ABB) were used as test and active control, respectively. After six months, 52 bone biopsies were harvested from 26 patients, and 107 implants were inserted in the augmented areas. Histomorphometry showed that, in the two groups, vital bone percentages were 34.9 ± 15% (NHA) and 38.5 ± 17% (ABB) (p = 0.428), marrow spaces percentages were 44.5 ± 18% (NHA) and 43.5 ± 23% (ABB) (p = 0.866), and residual graft percentages were 20.6 ± 13% (NHA) and 22.3 ± 12% (ABB) (p = 0.638). After 6 months of healing, no statistically significant difference was present in histomorphometric outcomes between NHA and ABB groups. Implant survival rate in NHA group after 12 months of loading was 96.4%, showing no statistically significant differences with ABB group.

Long-Term Implant Survival After 100 Maxillary Sinus Augmentations Using Plasma Rich in Growth Factors.

PURPOSE: To identify determinants of long-term implant survival after sinus augmentation procedure (SAP) using a combination of plasma rich in growth factors (PRGF) and graft material. MATERIALS AND METHODS: Patients were included in this retrospective study if they underwent SAP through a lateral wall approach using PRGF in combination with mainly xenograft, and received implants restored for at least 1 year. Sociodemographic, behavioral and implant characteristics (clinical factors, implant details, surgical details, prosthesis details, and complications) were analyzed. RESULTS: Sixty-seven patients received 217 implants in 100 augmented sinuses. The mean follow-up was 7.2 years. Overall, 22 implants failed in 15 patients (90% cumulative implant survival). Multivariable models showed greater implant survival with implants placed with ≥5 mm of residual crestal bone height (RBH) compared with those placed with <3 mm of RBH. There was also an improvement in survival comparing implant lengths. In addition, immediate loading of implants significantly increased the risk of implant failure. CONCLUSION: The use of PRGFs for maxillary sinus grafting may be an effective and safe treatment option for the rehabilitation of atrophic edentulous posterior maxillae. However, randomized clinical trials are needed to confirm these findings.

Evaluación de la arteria alveolo-antral mediante tomografía volumétrica en población mexicana y su relación con levantamiento del piso del seno maxilar / CBCT evaluation of the alveolar antral artery in a mexican cohort and its relationship to maxillary sinus floor lifting

Introducción: El conocimiento de la anatomía de la región maxilar debe ser esencial para el cirujano antes de realizar levantamiento del seno maxilar para evitar complicaciones. La arteria alveolo antral forma una anastomosis intraósea con la arteria infraorbitaria a nivel de la pared antero lateral del seno maxilar, aproximadamente a una distancia de entre 18.9 y 19.6 mm desde el reborde alveolar maxilar. La arteria alveolo antral es la encargada de dar vascularidad a la membrana mucosa del seno maxilar, pared antero lateral del seno y tejido perióstico subyacente.Objetivo: Describir y establecer la frecuencia, diámetro y localización dela anastomosis entre la arteria infraorbitaria y la arteria alveolar posterior superior, llamada arteria alveolo antral y su relación con la cresta ósea alveolar en una población mexicana. Material y métodos: Se realizaun protocolo de estudio observacional, descriptivo y transversal en una población de 1,116 pacientes derecho habientes del Instituto de Seguridad Social y Servicios para los Trabajadores del Estado (ISSSTE), en el oriente de la Ciudad de México, mediante la revisión de estudios de tomografía volumétrica computarizada. Resultados: Se encuentra la anastomosis arterial en el 90 por ciento de los estudios revisados, correspondiente a 1,005 estudios de tomografía.

Introduction: In order to avoid complications, it is essential for surgeonsto have a detailed knowledge of the anatomy of the superior maxillarybone prior to performing any sinus lift procedure. The alveolarantral artery forms an intraosseous anastomosis with the infraorbitalartery at the level of the anterolateral wall of the maxillary antrum at anapproximate distance of between 18.9 and 19.6 mm from the maxillaryalveolar ridge. The alveolar antral artery is responsible for providingvascularity to the mucous membrane of the maxillary sinus, the anteriorlateral wall of the sinus, and the underlying periosteal tissue. Objective:To analyze and establish the frequency, diameter, and locationof the anastomosis between the infraorbital artery and the posteriorsuperior alveolar artery known as the alveolar antral artery, and itsrelationship to the alveolar bone crest in a Mexican cohort. Materialand methods. We conducted a cross-sectional observational descriptivestudy involving a cohort comprised of 1,116 patients of the Institute forSocial Security and Services for State Workers (ISSSTE) on the eastside of Mexico City. The study consisted of a review of CBCT studies.Results: The arterial anastomosis was found in 90% of the 1,005 CBCTstudies reviewed, based on which the following values were determinedfor the distance between the alveolar ridge and the canal of the alveolarantral artery: for the fi rst premolar, 18.24 mm; second premolar,17.35 mm; fi rst molar, 16.96 mm, and for the second molar, 18.75 mm.Conclusions: We established the average measurements for the locationof the vascular bundle in question and the measurements neededto safeguard it along its course, which is important for the preservationand osseointegration of bone grafts placed during maxillary sinus liftprocedures, thus providing a margin of safety not previously reportedin the literature for a Mexican cohort.

Indications and Frequency for the Use of Cone Beam Computed Tomography for Implant Treatment Planning in a Specialty Clinic.

PURPOSE: To analyze the indications and frequency for three-dimensional (3D) imaging for implant treatment planning in a pool of patients referred to a specialty clinic over a 3-year period. MATERIALS AND METHODS: All patients who received dental implants between 2008 and 2010 at the Department of Oral Surgery and Stomatology at the University of Bern were included in the study. The influence of age, gender, and time of treatment (2008 to 2010) on the frequency of use of two-dimensional (2D) radiographic imaging modalities alone or in combination with 3D cone beam computed tomography (CBCT) scans was analyzed. Furthermore, the influence of the indication, location, and need for bone augmentation on the frequency of use of 2D imaging modalities alone or in combination with CBCT was evaluated. RESULTS: In all, 1,568 patients (792 women and 776 men) received 2,279 implants. Overall, 633 patients (40.4%) were analyzed with 2D imaging procedures alone. CBCT was performed in 935 patients (59.6%). There was a statistically significant increase in CBCT between 2008 and 2010. Patients older than 55 years received a CBCT scan in addition to 2D radiographic imaging statistically significantly more often. Additional 3D imaging was most frequently performed in the posterior maxilla, whereas 2D radiographs alone exhibited the highest frequency in the anterior mandible. The combination of 2D with CBCT was used predominantly for implant placement with simultaneous or staged guided bone regeneration or sinus elevation. CONCLUSION: Based on these findings from a specialty clinic, the use of additional CBCT imaging for implant treatment planning is influenced by the indication, location, local anatomy (including the need for bone augmentation), and the age of the patient.

Analysis of implant-failure predictors in the posterior maxilla: a retrospective study of 1395 implants.

The aim of this study was to analyze predictors for dental implant failure in the posterior maxilla. A database was created to include patients being treated with dental implants posterior to the maxillary cuspids. Independent variables thought to be predictive of potential implant failure included (1) sinus elevation, (2) implant length, (3) implant diameter, (4) indication, (5) implant region, (6) timepoint of implant placement, (7) one-vs. two-stage augmentation, and (8) healing mode. Cox regression analysis was used to evaluate the influence of predictors 1-3 on implant failure as dependent variable. The predictors 4-9 were analyzed strictly descriptively. The final database included 592 patients with 1395 implants. The overall 1- and 5-year implant survival rates were 94.8% and 88.6%, respectively. The survival rates for sinus elevation vs. placement into native bone were 94.4% and 95.4%, respectively (p = 0.33). The survival rates for the short (<10 mm), the middle (10-13 mm) and the long implants (>13 mm) were 100%, 89% and 76.8%, respectively (middle-vs. long implants p = 0.62). The implant survival rates for the small- (<3.6 mm), the middle- (3.6-4.5 mm) and the wide diameter implants (>4.5 mm) were 92.5%, 87.9% and 89.6%, respectively (p = 0.0425). None of the parameters evaluated were identified as predictor of implant failure in the posterior maxilla.

The predictors of implant failure after maxillary sinus floor augmentation and reconstruction: a retrospective study of 1045 consecutive implants.

OBJECTIVE: To assess the predictors of implant failure after grafted maxillary sinus (GMS). MATERIAL AND METHODS: A total of 1045 implants were inserted in 224 patients/347 GMS during a period of 14 years. Kaplan-Meyer and multivariate log-regression analysis were used to assess the following variates: patient's age, gender, smoker/nonsmoker, American Society of Anesthesiologists (ASA) class, one/two-stage surgery, merged/submerged healing, membrane, antibiotics, auto/allo/xenogenic bone grafts, implant's lengths/surface/diameter, crestal bone atrophy/quality, implant region, prosthetics, opposing dentition, and implant proximity to evaluate the predictors and relative risk (hazard ratio [HR]) of implant failure. RESULTS: Significant implant failure predictors were the graft material (HR = 4.7), with superior results for autogenic bone, residual crestal bone height (HR = 3.51), ASA class (HR = 2.73), surgical technique (HR = 2.56), implant proximity (HR = 2.07), smoker (HR = 1.98), and age (>60/HR=1.39). All other factors were insignificant. Overall survival rate was 93.3%. CONCLUSIONS: GMS is effective when the predictors are considered. Patient selection, including the ASA status, smoking, residual bone height, and the graft material are the predominant predictors. In highly atrophic situations, autogenic bone grafts showed superiority; however, in less atrophic cases, nonautogenic bone-grafts are equivalent.

Prevalence of sinus augmentation associated with maxillary posterior implants.

Pneumatization of the maxillary sinus limits the quantity of alveolar bone available for implant placement and may result in a lack of primary stability and difficulty in achieving osseointegration. The purpose of this study was to retrospectively analyze a group of patients who had implants placed in the posterior maxilla, calculate the prevalence of sinus augmentation, and identify factors related to sinus augmentation. With institutional review board approval, dental records from a population of patients who had implants placed in the maxillary posterior region between January 2000 and December 2004 were used to create a database. Independent variables were classified as continuous (age of the patient at stage 1 implant surgery [S1], time between extraction and S1, time between extraction and sinus augmentation, and time between sinus augmentation and S1) and categorical (gender, implant failure, American Society of Anesthesiologists system classification, smoking, osteoporosis, residual crestal bone height, implant position, implant proximity, prostheses type, and implant diameter and length). The dependent variable was the incidence of a sinus augmentation procedure. Simple logistic regression was used to assess the influence of each factor on the presence of sinus augmentation (P < .05). The final database included 502 maxillary posterior implants with an overall survival rate of 93.2% over a mean follow-up period of 35.7 months. Of 502 implants, 272 (54.2%) were associated with a sinus augmentation procedure. Among variables, residual crestal bone height (P < .001), implant position (P < .001), implant proximity (P < .001), prosthesis type (P < .001), implant failure (P < .01), and implant diameter (P < .01), were statistically associated with sinus augmentation. Within the limitations of this retrospective study, the results suggest that more than half (54.2%) of the maxillary posterior implants were involved with a sinus augmentation procedure. The prevalence of sinus augmentation increased with decreased residual crestal bone height, more posterior implant locations, and complete or partial edentulism. Sinus augmentation was significantly associated with implant failure and wide implants.

[Maxillary sinus septa. Prevalence and anatomy]. / Les septums du sinus maxillaire. Prévalence et anatomie au travers d'une revue de la littérature de 1980 à 2009.

BACKGROUND: Maxillary sinus septa may complicate sinus elevation procedures, especially when they are not diagnosed prior to surgery. The authors had for aim to review published data, to analyze the etiology, the prevalence, the localization, and the size of maxillary sinus septa, and to determine what were the best preoperative radiological examinations. PATIENTS AND METHODS: The Medline search was made with keywords such as "maxillary sinus anatomy, maxillary sinus augmentation, maxillary sinus septa, sinus graft/complications, dental implants". The search was limited to studies published in English from 1980 to January 2009. RESULTS: Twenty-two articles were analyzed. The prevalence of maxillary sinus septa ranged between 14.3% and 33.3%. There was no specific geographic distribution within the sinuses. The mean heights of septa ranged between 2.8 and 8.1 mm. DISCUSSION: It is recommended to systematically use preoperative CT or CBCT scan imaging because of the prevalence, the variable anatomy, and the bad contribution of conventional X-rays.

Does a clinician's sex influence treatment decisions?

PURPOSE: As more women are entering health professions, the health care system is becoming more feminized. This investigation evaluated gender differences in clinicians' treatment preferences and decision making in a complex treatment situation. MATERIALS AND METHODS: A questionnaire was developed containing clinical cases and statements to assess practitioners' opinions on treatment of periodontally involved maxillary molars and implant therapy with sinus grafting. Data were analyzed with respect to the clinicians' sex, and an overall logistic regression was performed to further investigate possible influences of age, office location, and specialty. RESULTS: Three hundred forty questionnaires were evaluated (response rate: 35.1%). The mean age of female respondents (37%) was 42 years, and the mean age of male respondents was 46 years. Significantly fewer women reported performing implant placement (35% vs 63%), sinus grafting (16% vs 43%), and periodontal surgery (57% vs 68%). Female practitioners tended to refer more patients to specialists. Participants favored sinus grafting more often for their spouses than for themselves. Apart from a preference for regenerative periodontal surgery among women, no gender differences were observed for treatment decisions or views on general statements related to implant preference, tooth maintenance, or conventional reconstructive therapies. CONCLUSIONS: With similar expert knowledge, treatment decisions were made irrespective of sex. While the majority of male care providers performed complex therapies themselves, female clinicians referred more patients to specialists.