الملخص
Introducción: La elevación de seno maxilar con implante dental simultáneo, sin el uso de substitutos óseos, ha retomado la teoría del potencial de neoformación ósea, que el coágulo de sangre alojado bajo la membrana de Schneider por sí solo presenta. Excluyendo así la necesidad de materiales exógenos. Objetivo: Exponer la efectividad de la elevación de seno maxilar con implante dental simultáneo, sin el uso de injerto, mediante la evaluación de la cantidad de ganancia ósea vertical. Presentación de casos: Caso 1: Paciente de 62 años, género femenino, que fue sometida a una elevación de seno maxilar sin injerto e implante dental simultáneo, con técnica de ventana lateral debido a altura ósea reducida de 5,24 mm. Luego del período de seguimiento tomográfico de 12 meses, después de la carga protésica, se logró una altura ósea vertical de 10,2 mm, lo que dio como resultado una ganancia ósea vertical de 4,96 mm. Caso 2: Paciente de 48 años, género femenino, que fue sometida a una elevación de seno maxilar sin injerto e implante dental simultáneo, con técnica transalveolar, mediante el uso de piezoeléctrico debido a una altura ósea reducida de 8,33 mm. Luego del período de seguimiento radiográfico de 4 meses, antes de la carga protésica, se logró una altura ósea vertical de 11,55 mm, lo que dio como resultado una ganancia ósea vertical de 3,19 mm. Conclusiones: Con base en estos 2 informes de casos, la elevación de seno maxilar e implante dental simultáneo sin injerto se asocian con la reducción de la morbilidad quirúrgica, menor probabilidad de procesos infecciosos y menor costo de la cirugía. Por lo tanto, puede considerarse una alternativa quirúrgica para la colocación de implantes en el maxilar posterior superior debido a deficiencias óseas verticales, independientemente de la técnica (lateral o transalveolar(AU)
Introduction: Maxillary sinus lift with simultaneous dental implantation without using bone substitutes, reapproaches the theory about the bone neoformation potential of the blood clot housed under the Schneider membrane, all by itself, thus excluding the need to use exogenous materials. Objective: Discuss the effectiveness of graftless maxillary sinus lift with simultaneous dental implant placement through an evaluation of the amount of vertical bone gain. Case presentation: Case 1: Female 62-year-old patient undergoing graftless maxillary sinus lift with simultaneous dental implantation by lateral window technique due to a reduced bone height of 5.24 mm. After a 12-month tomographic follow-up period subsequent to prosthetic loading, a 10.2 mm vertical bone height was achieved, resulting in 4.96 mm vertical bone gain. Case 2: Female 48-year-old patient undergoing graftless maxillary sinus lift with simultaneous dental implantation by transalveolar technique using a piezoelectric generator due to a reduced bone height of 8.33 mm. After a 4-month radiographic follow-up period, before prosthetic loading, an 11.55 mm vertical bone height was achieved, resulting in 3.19 mm vertical bone gain. Conclusions: According to these two case reports, graftless maxillary sinus lifting with simultaneous dental implantation is associated to reduced surgical morbidity, a lesser probability of infectious processes and lower surgical costs. It may therefore be considered to be a surgical alternative for implant placement in the posterior maxilla due to vertical bone deficiencies, regardless of the technique used (lateral or transalveolar(AU)
الموضوعات
Humans , Female , Middle Aged , Dental Implantation/methods , Sinus Floor Augmentation/methods , Aftercare , Costs and Cost Analysisالملخص
En maxilares atróficos la elevación de piso de seno es una práctica de alta predictibilidad. El adve- nimiento de materiales osteoconductores que generan andamiaje para la formación ósea propor- cionaron un aumento en la tasa de éxito de los implantes endoóseos. El presente artículo reporta un caso clínico en el cual se llevo a cabo un aumento del nivel de altura del piso de seno unila- teralmente por medio de la técnica de Cadwell- Luck modificada por Tatum, técnica con ventana lateral, donde se utilizó xenoinjerto óseo (OstiumMAX, implante de matriz ósea bovina, Laboratorio Bioxen) y membrana reabsorbible de colágeno( Laboratorio Bioxen) en el primer tiempo quirúrgi- co y seis meses después, en el segundo acto quirúrgico se colocaron tres implantes endoóseos (Sistema de implante dental TRP, Laboratorio Tormicron S.R.L.). Los resultados obtenidos fueron controlados en forma mediata y a distancia a través de radiografías panorámicas y tomografías computadas tipo Cone Beam, donde se midió la altura ósea generada post injerto. Pudo consta- tarse el éxito del procedimiento, basándonos en criterios clínico radiograficos de oseointegración (AU)
الموضوعات
Humans , Female , Middle Aged , Bone Substitutes , Dental Implantation, Endosseous/methods , Sinus Floor Augmentation/methods , Heterografts , Patient Care Planning , Alveolar Bone Loss/rehabilitation , Oral Surgical Procedures/methodsالملخص
Objective: the present equivalence two-arm parallel randomized controlled trial aimed to compare survival and marginal bone loss (MBL) of short implants (≤6 mm) and standard implants (≥8.5 mm) associated with sinus floor elevation (SFE). Methods: adult patients with partial edentulism with occlusal stability in the sinus area and intermediate bone height were selected in this double-blind trial (patient and outcome assessment). Patients were randomly allocated into two groups: standard length implants with SFE (control) or short implants (test). Clinical and radiographic assessments were made at the time of implant placement, 6 months, and annually thereafter up to 2 years after loading. The inter-examiner agreement was analyzed using intraclass correlation coefficient (ICC). One-way ANOVA, Kaplan-Meier, and Log-rank tests were used to compare implant survival (primary outcome) and MBL (secondary outcome) (P<0.05). Results: eight short implants and six standard implants were placed (mean age of patients was 47 ±12.5 years). The implant survival rates were 87.5% for short (one 5 mm implant failed at 7 months) and 100% for standard implants with no statistically significant difference between groups (P=0.4). The mean MBL after 1 year was 0.30 ±0.62 mm for short and 0.21 ±0.36 mm for standard implants (P=0.123). The inter-examiner agreement was set in 0.831. Conclusion: survival of short implants and standard implants associated with SFE was similar after two years of clinical service. Trial registration: Registered on 27-03-2018 at ClinicalTrials.gov (NCT03479333). Funding: This study was partially funded by Capes Finance Code 001 and #88881.187933/2018-01. TPC is partially funded by National Council for Scientific and Technological Development (CNPq - Brazil). The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.(AU)
Objetivo: o presente ensaio clínico randomizado de dois braços de equivalência comparou a taxa de sobrevivência e a perda óssea marginal de implantes curtos (≤ 6 mm) e implantes convencionais (≥ 8.5 mm) associados à elevação do seio maxilar. Métodos: edêntulos parciais adultos, com estabilidade oclusal e altura óssea intermediária na região do seio maxilar, foram selecionados neste estudo duplo-cego e alocados randomicamente em dois grupos: implante de comprimento convencional associado à elevação do seio maxilar (controle) ou implante curto (teste). Avaliações clínicas e radiográficas foram realizadas logo após a instalação do implante, seis meses e anualmente por até dois anos. A concordância interexaminador foi avaliada através do coeficiente de correlação intraclasse. Os testes ANOVA de uma via, Kaplan-Meier e Log-rank foram utilizados para comparar a sobrevivência do implante e a perda óssea marginal (P<0.05). Resultados: oito implantes curtos e seis implantes de comprimento convencional foram instalados em onze pacientes (média de idade dos pacientes: 47 ± 12.5 anos). As taxas de sobrevivência dos implantes foram de 87,5% para implantes curtos (um implante de 5 mm falhou aos sete meses), e 100% para implantes convencionais, sem diferença estatisticamente significativa entre os grupos (P=0.4). A perda óssea marginal média após um ano foi de 0.30 ±0.62 mm para implantes curtos e 0.21 ±0.36 mm para implantes convencionais (P=0.123). A concordância interexaminador foi de 0.831. Conclusão: a taxa de sobrevivência de implantes curtos e convencionais associados ao seio maxilar foi semelhante após dois anos de acompanhamento. Registro do estudo: Registrado em 27-03-2018 no ClinicalTrials.gov (NCT03479333).(AU)
الموضوعات
Humans , Male , Female , Adult , Middle Aged , Dental Implantation, Endosseous/methods , Sinus Floor Augmentation/methods , Time Factors , Analysis of Variance , Treatment Outcome , Dental Restoration Failure , Kaplan-Meier Estimateالملخص
Bone grafting is important to preserve the alveolar bone ridge height and volume for dental implant placement. Even though implant-supported overdentures present highly successful outcomes, it seems that a great number of edentulous individuals have not pursued implant-based rehabilitation. The cost of the treatment is one of the reasons of discrepancy between highly successful therapy and its acceptance. Therefore, the development of biomaterials for bone grafting with comparable characteristics and biological effects than those renowned internationally, is necessary. In addition, domestic manufacture would reduce the high costs in public health arising from the application of these biomaterials in the dental feld. The purpose of this clinical case report is to provide preliminary clinical evidence of the efficacy of a new bovine bone graft in the bone healing process when used for sinus floor elevation. (AU)
El uso de injertos óseos es importante para preservar la altura y el volumen de la cresta alveolar para la colocación de implantes dentales. Si bien las sobredentaduras implanto-soportadas presentan resultados altamente exitosos, la mayoría de las personas desdentadas no han sido rehabilitadas mediante implantes dentales. Uno de los principales motivos por los cuales los pacientes no aceptan este tipo de tratamiento, altamente exitoso, es el elevado costo del mismo. Por ello, es necesario el desarrollo de biomateriales de injerto óseo con características y efectos biológicos comparables a los reconocidos internacionalmente. Asimismo, la fabricación nacional reduciría los altos costos en Salud Pública derivados de la aplicación de estos biomateriales en el campo dental. El objetivo de esta comunicación es presentar un caso clínico a fin de proporcionar evidencia preliminar acerca de la eficacia de un nuevo injerto de hueso bovino en el proceso de cicatrización ósea en el levantamiento del piso del seno maxilar. (AU)
الموضوعات
Humans , Animals , Female , Middle Aged , Cattle , Rats , Bone Transplantation/methods , Jaw, Edentulous, Partially/rehabilitation , Sinus Floor Augmentation/methods , Osteogenesis , Argentina , Biocompatible Materials , Cattle/physiology , Carticaine/administration & dosage , Chlorhexidine/administration & dosage , Naproxen/administration & dosage , Public Health/economics , Osseointegration , Dentures , Bone Transplantation/trends , Jaw, Edentulous, Partially/pathology , Jaw, Edentulous, Partially/therapy , Durapatite/therapeutic use , Amoxicillin-Potassium Clavulanate Combination/administration & dosage , Dental Implantation, Endosseous/methods , Sinus Floor Augmentation/trends , Allografts/immunology , Allografts/transplantationالملخص
Objetivo: avaliar a eficácia do levantamento do seio maxilar atraumático sem enxerto ósseo e a taxa de sobrevivência da instalação de implantes imediatos. Material e métodos: realizou-se uma estratégia de busca nas bases de dados Pubmed, Web of Science e Science Direct, obtendo 103 artigos, sendo selecionados 07 estudos publicados entre 2008 até 2019. Resultados: foram registrados 576 pacientes com idades entre 19 e 85 anos de idade, de ambos os sexos e 1,113 implantes instalados. Verificou-se uma taxa de sucesso e sobrevivência dos implantes de 96,6%, após um seguimento de 1 a 3 anos e houve um ganho ósseo de aproximadamente 3mm. Considerações finais: o levantamento de seio maxilar atraumático sem enxerto ósseo é eficaz para reabilitação de áreas edêntulas e mostra um bom resultado ao longo do tempo, com uma taxa média de sobrevivência dos implantes de 96,3%. Ainda faltam estudos para determinar qual tipo de implante é melhor para este tipo de técnica. (AU)
Objective: To assess the efficacy of atraumatic maxillary sinus augmentation without bone grafting and the survival rate of the immediate implant installation. Material and methods: A search strategy was performed the in Pubmed, Web of Science, and Science Direct databases, resulting in 103 articles from which seven studies published between 2008 and 2019 were selected. Results: 576 patients of both sexes, aged between 19 and 85 years, were registered, as well as 1,113 implants installed. There was a success rate and survival of implants of 96.6% after a follow-up of 1 to 3 years and there was a bone gain of approximately 3 mm. Final considerations: The atraumatic maxillary sinus augmentation without bone graft is effective to rehabilitate edentulous areas and shows a good outcome over time, with an average rate of implant survival 96.3%. Further studies are still required to determine which type of implant is best for this type of technique.(AU)
الموضوعات
Humans , Male , Female , Dental Implantation, Endosseous/methods , Sinus Floor Augmentation/methods , Alveolar Bone Loss/therapy , Jaw, Edentulous/therapy , Maxillary Sinusالملخص
Introducción: pseudoquistes y quistes verdaderos de los maxilares son contraindicaciones para cirugías de aumento de volumen óseo en la región posterior de la maxila. Objetivo: describir dos casos de pacientes con transtornos en los senos maxilares (pseudoquiste y quiste verdadero del maxilar) en senos maxilares neumatizados que necesitaban reconstrucción ósea, para posterior rehabilitacion con implantes oseointegrados. Presentación de casos: se presentan dos casos clínicos en que la planificación quirúrgica consistió en la remoción de la lesión y simultánea elevación del suelo del seno maxilar. En el primer caso, pseudoquiste antral, se procedió a la aspiración del contenido quístico previamente a la elevación de la membrana de Schneider. En el segundo caso, quiste verdadero del seno maxilar, se realizó la remoción completa de la lesión quística. En ambos casos no hubo perforación de la membrana, y el hueso bovino inorgánico fue utilizado como material de relleno. La instalación de los implantes fueron después de 7 meses de la cirugía de elevación de seno. Los controles clínicos y tomográficos mostraron adecuada oseointegración de los implantes y ausencia de recidiva y/o restos de la lesión. Conclusiones: el quiste verdadero del seno maxilar causa la destrucción de las paredes óseas y debe ser removido previamente a las cirugías de elevación sinusal. Ningún tratamiento es indicado para el pseudoquiste antral, teniendo claro que la lesión no representa necesariamente una contraindicación para la elevación de la membrana sinusal y colocación de injerto óseo para implantes. Mientras tanto, la aspiración previa de contenido líquido del pseudoquiste evita posibles complicaciones infecciosas posoperatorias(AU)
Introduction: maxillary pseudocysts and true cysts are contraindications for bone volume augmentation surgery in the posterior maxillary region. Objective: describe two cases of patients with maxillary sinus disorders (pseudocyst and true cyst) in pneumatized maxillary sinuses requiring bone reconstruction with a view to eventual rehabilitation with osseointegrated implants. Case presentation: two clinical cases are presented in which surgical planning consisted in lesion removal and simultaneous maxillary sinus floor elevation. In the first case, antral pseudocyst, aspiration was performed of the cystic content before elevation of the Schneiderian membrane. In the second case, true cyst of the maxillary sinus, total removal of the cystic lesion was performed. Membrane perforation did not occur in either case. Inorganic bovine bone was used as filler in both. Implantation was performed 7 months after sinus lifting surgery. Clinical and tomographic examination showed adequate implant osseointegration and absence of recurrence and/or lesion remnants. Conclusions: true maxillary sinus cysts cause bone wall destruction, and should be removed before performing sinus lifting surgery. No treatment is indicated for antral pseudocyst, for the lesion does not necessarily constitute a contraindication for sinus membrane lifting and bone graft placement for implantation. On the other hand, previous aspiration of the liquid content of the pseudocyst prevents possible postoperative infectious complications(AU)
الموضوعات
Humans , Female , Middle Aged , Sinus Floor Augmentation/methods , Mucocele/surgery , Dental Implants/adverse effects , Bone Transplantation/methodsالملخص
Introducción: Las elevaciones del seno maxilar traen consigo modificaciones anatómicas, que pueden influir en su funcionabilidad. Objetivo: Caracterizar clínica y anatómicamente las elevaciones sinusales realizadas y su repercusión en el éxito de los implantes posicionados. Material y Método: Se realizó un estudio descriptivo, prospectivo en 56 pacientes sometidos a elevaciones sinusales en el período comprendido desde enero 2013-enero 2015 con criterios de inclusión debidamente establecidos, en la Facultad de Estomatología Raúl González Sánchez. Cada paciente se sometió a interrogatorio, examen clínico y al análisis ortopantomográfico previo al tratamiento, y a los 6, 12, 18 y 24 meses de la intervención. Se analizaron las variables edad, sexo, distribución topográfica, técnica quirúrgica implementada, material de relleno, altura sinusal, nivel óseo y complicaciones. Resultados: Predominaron pacientes del sexo femenino (60,7 por ciento), con edades comprendidas entre 30-39 años (60,7 por ciento). La tasa total de éxito a 2 años de implantación dental fue 92,1 por ciento. La reducción final en altura sinusal promedio en técnica de ventana lateral fue la mayor (10,1 mm). La mejor relación altura injerto-longitud de implante se obtuvo con beta fosfato tricálcico (1,66). La perforación de membrana menor de 5mm fue la complicación transoperatoria más registrada (28,6 por ciento). Conclusiones: La técnica de ventana lateral exhibe mejores resultados en la reducción de la altura sinusal. El relleno con betafosfato tricálcico muestra mejor relación altura de injerto-longitud del implante. Los resultados de reducción en altura se mantienen estables tras 12 meses y la perforación de membrana sinusal es la complicación más usual(AU)
Introduction: Elevations of the maxillary sinus lead to anatomical modifications, which can influence on its function. Objective: To characterize sinus elevations from the clinical and anatomical point of view, and comment on their impact on the success of positioned implants. Material and Method: A descriptive prospective study was conducted in 56 patients who underwent sinus elevations with very well established inclusion criteria in Raúl González Sánchez Faculty of Odontology from January 2013 to January 2015. Each patient was interviewed, and submitted to a clinical exam. Also, an orthopantomography analysis was made before treatment, and 6, 12, 18, and 24 months after the intervention. Variables such as age, sex, topographic distribution, implemented surgical technique, padding material, sinus height, bone level, and complications were analyzed. Results:Female patients predominated (60,7 percent), aging from 30-39 years (60,7 percent). The overall success rate at 2 years following implantation was 92,1 percent. The final reduction of average sinus height with the lateral window technique was the highest (10,1 mm). The best relationship in terms of height and length of graft was obtained with beta-tricalcium phosphate (1,66). Membrane perforation smaller than 5mm was the most recorded intraoperative complication (28,6 percent). Conclusions: The lateral window technique exhibits better results in the reduction of sinus height. Padding with beta-tricalcium phosphate shows a better relationship in terms of height and length of graft. The results in height reduction are stable after 12 months, and sinus membrane perforation is the most common complication(AU)
الموضوعات
Humans , Adult , Middle Aged , Dental Implantation/methods , Sinus Floor Augmentation/methods , Epidemiology, Descriptive , Prospective Studies , Longitudinal Studiesالملخص
Abstract This study compared the survival rate of dental implants, amount of marginal bone loss, and rates of complications (biological and prosthetic) between short implants and long implants placed after maxillary sinus augmentation. This systematic review has been registered at PROSPERO under the number (CRD42017073929). Two reviewers searched the PubMed/MEDLINE, Embase, LILACS, and Cochrane Library databases. Eligibility criteria included randomized controlled trials, comparisons between short implants and long implants placed after maxillary sinus augmentation in the same study, and follow-up for >6 months. The Cochrane Collaboration's tool for assessing the risk of bias in randomized trials was used to assess the quality and risk of bias of the included studies. The search identified 1366 references. After applying the inclusion criteria, 11 trials including 420 patients who received 911 dental implants were considered eligible. No significant difference was observed in the survival rate [p = 0.86; risk ratio (RR): 1.08; 95% confidence interval (CI): 0.46-2.52] or in the amount of marginal bone loss (p = 0.08; RR: −0.05; 95%CI: −0.10 to 0.01). However, higher rates of biological complications for long implants associated with maxillary sinus augmentation were observed (p < 0.00001; RR: 0.21; 95%CI: 0.10-0.41), whereas a higher prosthetic complication rate for short implants was noted (p = 0.010; RR: 3.15; 95%CI: 1.32-7.51). Short implant placement is an effective alternative because of fewer biological complications and similar survival and marginal bone loss than long implant placement with maxillary sinus augmentation. However, the risk of mechanical complications associated with the prostheses fitted on short implants should be considered.
الموضوعات
Humans , Dental Implants/adverse effects , Dental Implantation/methods , Sinus Floor Augmentation/methods , Maxillary Sinus/surgery , Postoperative Complications , Bias , Risk Factors , Alveolar Bone Loss/etiology , Treatment Outcome , Dental Prosthesis Design , Dental Restoration Failure , Dental Implantation/adverse effects , Sinus Floor Augmentation/adverse effectsالملخص
Abstract Objective The aim of this study was to compare the bone resorption rate, histomorphometry and immunohistochemical findings of bioactive glass (Biogran; Biomet, Warsaw, IN, USA) mixed with autogenous bone grafts (1:1) and autogenous bone graft isolate in maxillary sinus elevation surgery. Material and Methods A total of 9 maxillary sinuses were grafted with Biogran with autogenous bone graft (group 1) and 12 were mixed with autogenous bone graft (group 2). Postoperative cone beam computed tomography (CBCT) was used to measure the initial graft volume after 15 days (T1), and 6 months later, another CBCT scan was performed to evaluate the final graft volume (T2) and determine the graft resorption rate. The resorption outcomes were 37.9%±18.9% in group 1 and 45.7%±18.5% in group 2 (P=0.82). After 6 months, biopsies were obtained concurrent with the placement of dental implants; these implants were subjected to histomorphometric analysis and immunohistochemical analysis for tartrate-resistant acid phosphatase (TRAP). Results The average bone formation in group 1 was 36.6%±12.9 in the pristine bone region, 33.2%±13.3 in the intermediate region, and 45.8%±13.8 in the apical region; in group 2, the values were 34.4%±14.4, 35.0%±13.9, and 42.0%±16.6 of new bone formation in the pristine bone, intermediate, and apical regions, respectively. Immunostaining for TRAP showed poor clastic activity in both groups, which can indicate that those were in the remodeling phase. Conclusions The similarity between the groups in the formation and maintenance of the graft volume after 6 months suggests that the bioactive glass mixed with autogenous bone (1:1) can be used safely as a bone substitute for the maxillary sinus lift.
الموضوعات
Humans , Alveolar Bone Loss/pathology , Bone Transplantation , Bone Substitutes/therapeutic use , Bone Substitutes/chemistry , Sinus Floor Augmentation/methods , Glass/chemistry , Maxillary Sinus/surgery , Osteogenesis/physiology , Time Factors , Transplantation, Autologous/methods , Bone Regeneration/physiology , Immunohistochemistry , Prospective Studies , Reproducibility of Results , Treatment Outcome , Statistics, Nonparametric , Cone-Beam Computed Tomography , Maxillary Sinus/pathologyالملخص
RESUMEN: La colocación de implantes en la zona posterior maxilar resulta en numerosos desafíos para la rehabilitación fija implanto-soportada debido a la falta de reborde residual. La disponibilidad ósea de la región posterior del maxilar se ve reducida por varios factores, entre ellos, la pérdida prematura de dientes, presencia de enfermedad periodontal, o hiperneumatización de las cavidades sinusales, posterior a exodoncias de la zona posterior. El presente artículo reporta un caso de una paciente femenina de 51 años, con disminución de altura del reborde alveolar en la zona de premolares, describiendo la técnica de elevación de piso de seno maxilar por medio de la realización de una ventana lateral y la colocación simultánea de 2 implantes.
ABSTRACT: The edentulous posterior maxillary implant presents numerous challenges that are unique to this region. The bone availability of the posterior maxilla is reduced, among other things, because of the premature loss of teeth, presence of periodontal disease, or hiperpneumatization of the sinus cavities after extractions of posterior teeth. This article presents a case report of a 51 years old female patient with the alveolar ridge diminished at premolars zone, describing the surgical technique of sinus floor elevation with a lateral window and the simultaneous colocation of 2 dental implants.
الموضوعات
Humans , Female , Middle Aged , Dental Implantation, Endosseous/methods , Sinus Floor Augmentation/methods , Maxillary Sinus/pathology , Osteotomyالملخص
Abstract This study aimed to assess the performance of surgeons in determining the amount of graft material required for maxillary sinus floor augmentation in a preoperative analysis using cone-beam computed tomography images. A convenience sample of 10 retrospective CBCT exams (i-CAT®) was selected. Scans of the posterior maxilla area with an absence of at least one tooth and residual alveolar bone with an up to 5 mm height were used. Templates (n=20) contained images of representative cross-sections in multiplanar view. Ten expert surgeons voluntarily participated as appraisers of the templates for grafting surgical planning of a 10 mm long implant. Appraisers could choose a better amount of graft material using scores: 0) when considered grafting unnecessary, 1) for 0.25 g in graft material, 2) for 0.50 g, 3) for 1.00 g and 4) for 1.50 g or more. Reliability of the response pattern was analyzed using Cronbach's a. Wilcoxon and Mann-Whitney tests were performed to compare scores. Regression analysis was performed to evaluate whether the volume of sinuses (mm3) influenced the choose of scores. In the reliability analysis, all values were low and the score distribution was independent of the volume of the maxillary sinuses (p>0.05), which did not influence choosing the amount of graft material. Surgeons were unreliable to determine the best amount of graft material for the maxillary sinus floor augmentation using only CBCT images. Surgeons require auxiliary diagnostic tools to measure the volume associated to CBCT exams in order to perform better.
Resumo O objetivo deste estudo foi avaliar o desempenho dos cirurgiões na determinação da quantidade de material de enxerto necessária para a elevação do assoalho do seio maxilar em uma análise pré-operatória, utilizando imagens de tomografia computadorizada de feixe cônico. Foi selecionada uma amostra de conveniência de 10 exames retrospectivos CBCT (i-CAT®). Os exames foram da área da maxila posterior que possuíam ausência de pelo menos um dente e com osso alveolar residual de altura igual ou inferior a 5 mm. Os templates (n=20) continham imagens de secções transversais representativas numa vista multiplanar. Dez experientes cirurgiões voluntariamente participaram como avaliadores dos templates para o planejamento cirúrgico de enxerto para um implante de 10 mm de comprimento. Os avaliadores escolheram a melhor quantidade de material de enxerto usando os escores: 0) quando o enxerto era desnecessário, 1) para 0,25 g de enxerto, 2) para 0,50 g, 3) para 1,00 g, e 4) para 1,50 g ou mais. A confiabilidade do padrão de resposta foi analisada utilizando a a de Cronbach. Os testes de Wilcoxon e Mann-Whitney foram utilizados para comparar os escores. A análise de regressão foi realizada para avaliar se o volume dos seios (mm3) influenciou a escolha dos escores. Na análise de confiabilidade, todos os valores foram baixos e a distribuição dos escores foi independente do volume dos seios maxilares (p>0,05), o que não influenciou a escolha da quantidade de material de enxerto. Os cirurgiões apresentaram falta de confiabilidade ao determinar a melhor quantidade de material de enxerto para o aumento do assoalho do seio maxilar utilizando somente as imagens de TCFC. Assim, os cirurgiões necessitam de ferramentas de diagnóstico auxiliares para mensuração de volume associada à TCFC para um melhor desempenho.
الموضوعات
Humans , Adult , Middle Aged , Clinical Competence , Cone-Beam Computed Tomography/methods , Orthognathic Surgical Procedures/methods , Sinus Floor Augmentation/methods , Surgery, Oral , Maxillary Sinus/diagnostic imaging , Maxillary Sinus/surgery , Reproducibility of Results , Retrospective Studiesالملخص
A elevação de seio via crista do rebordo maxilar é uma técnica bastante utilizada no aumento ósseo da maxila posterior, e a utilização de osteótomos de Summers com martelo é a modalidade mais conhecida. Esta técnica é denominada "técnica de elevação de seio atraumática", o que se trata de uma designação equivocada, uma vez que as marteladas utilizadas para elevar o assoalho do seio maxilar, dependendo do nível de densidade óssea, são bastante incômodas aos pacientes e não são raras as manifestações de desconforto pelos mesmos. Além do desconforto, devido às marteladas sobre os osteótomos, pode ocorrer a vertigem posicional paroxicística benigna (VPPB). Nos últimos anos, a Implantodontia vem buscando técnicas menos traumáticas para a elevação de seio maxilar, destacando-se aquelas que se utilizam de instrumentos rotatórios. Neste trabalho, foi apresentada uma técnica de elevação de seio via crista, que se caracteriza por ser minimamente invasiva e pouco traumática, utilizando instrumentos rotatórios (kit SCA Neobiotech, Coreia), associada à técnica hidrodinâmica (Aqua Lift System, IM3 Neobiotech, Coreia) para descolamento e elevação da membrana, enxertia com Cerasorb (Curasan, Alemanha) e instalação de implante concomitantemente (SW SIN, Brasil).
The transcrestal maxillary sinus lift is a technique widely used in bone enhancement of the posterior maxilla and the use of Summers osteotomes with hammer is the best known modality. This technique is termed an atraumatic sinus elevation technique, which is probably a misnomer, since hammers used to raise the floor of the maxillary sinus, depending on the level of bone density, are very uncomfortable for patients and manifestations of discomfort are not uncommon. In addition to discomfort, due to the hammering of the osteotomes, benign paroxysmal positional vertigo (BPPV) can occur as a complication. In recent years, Implantology has been seeking less traumatic techniques for maxillary sinus elevation. Among them, stand out those that use rotary instruments. In this work, a technique of sinus elevation via crest is presented, which is characterized by being minimally invasive and not very traumatic, using rotary instruments (kit SCA Neobiotech, Korea), associated to the hydrodynamic technique (Aqua Lift System, IM3 Neobiotech, Korea) for membrane detachment and elevation, grafting with Cerasorb (Curasan, Germany) and concomitant implant installation (SW SIN, Brazil).
الموضوعات
Humans , Male , Middle Aged , Biocompatible Materials , Bone Substitutes , Dental Implants, Single-Tooth , Sinus Floor Augmentation/methods , Tissue Transplantation , Transplantation, Autologousالملخص
Introdução: regeneração óssea da região posterior da maxila, é um recurso importante para possibilitar a localização correta dos implantes e assim permitir uma adequada reabilitação protética. Várias técnicas cirúrgicas são relatadas, desde a forma de acesso ao seio, elevação da membrana de Schneider e preenchimento da cavidade. Objetivo: abordar os recursos que vem sendo utilizados na cirurgia de regeneração óssea da região posterior da maxila bem como a efetividade dos métodos aplicados. Métodos: foi realizada uma busca eletrônica da literatura, nas bases de dados LILACS, MEDLINE e BBO de estudos publicados na língua inglesa e portuguesa. Como critérios de inclusão foram considerados artigos entre o ano 2000 e 2014, sendo que as palavras chaves que orientaram a busca foram: maxillary bone regeneration, Schneiderian membrane, maxillary sinus lift. Foram obtidos 1 529 artigos, dos quais selecionados 27 artigos relevantes para o estudo em questão. Como critérios de exclusão foram eliminados artigos no qual se encontravam no ano abaixo de 2008 e que fugiam do assunto em questão. Análises e integração da informação : encontrou-se que a técnica tradicional de acesso ao seio maxilar com uso de brocas, elevação da membrana, por meio de curetas, e a regeneração propriamente dita com enxerto ósseo autógeno e/ou heterógeno continuam como as mais utilizadas, no entanto alternativas menos invasivas como tecnologia ultrassônica para fazer acesso, hidrodissecção para elevar a membrana Schneider e biomateriais para preencher a cavidade surgem como opções viáveis e com resultados favoráveis. Conclusões: existe um direcionamento na busca por métodos e materiais que diminuam a morbidade da técnica tradicional e que ofereçam resultados satisfatórios a curto e a longo prazo. A utilização de técnicas cirúrgicas menos invasivas e uso de biomateriais estão entre os avanços para a regeneração da região posterior da maxila(AU)
Introducción: la regeneración ósea de la región posterior del maxilar es un procedimiento importante que permite la correcta colocación de los implantes dentales y una adecuada rehabilitación protésica. Se describen varias técnicas quirúrgicas que van desde la forma de acceder al seno maxilar, el levantamiento de la membrana de Schneider hasta el relleno de la cavidad. Objetivo: abordar los recursos utilizados en la cirugía de regeneración ósea de la zona posterior del maxilar y la efectividad de los métodos aplicados. Métodos: se realizó una revisión bibliográfica en las bases de datos LILACS, MEDLINE y BBO en busca de estudios publicados en inglés y portugués. El criterio de inclusion abarcó los artículos publicados entre los años 2000 y 2014 y las palabras claves que orientaron la búsqueda fueron: regeneración del hueso maxilar, membrana de Schnneider y elevación del seno maxilar. Se encontraron 1 529 artículos de los cuales se seleccionaron 27 con contenido relevante para el estudio en cuestión. En cuanto a los criterios de exclusion, se eliminaron los artículos publicados antes del 2008 y que no se asociaban mucho con el tema referido. Análisis e integración de la información: se halló que la técnica tradicional de acceso al seno maxilar con el uso de brocas, el levantamaiento de la membrana de Schnneider por medio de curetas y la regeneración como tal mediante injertos óseos autógenos y/o heterógenos siguen siendo los procedimientos más utilizados. Por otra parte, alternativas menos invasivas como la tecnología del ultrasonido para lograr acceso, la hidrodisección para levantar la membrana de Schneider y el empleo de biomaterials para rellenar la cavidad emergen como opciones viables con resultados alentadores. Conclusiones: existe una orientación hacia la búsqueda de métodos y materials que disminuyan la morbilidad de las técnicas tradicionales y ofrezcan resultados satisfactorios a corto y a largo plazos. Las técnicas quirúrgicas menos invasivas y el uso de los biomateriales se encuentran entre los avances de hoy día para la regeneración de la zona posterior del maxilar(AU)
Introduction: bone regeneration of the posterior maxilla is an important feature to enable correct placement of implants and thus allow an adequate prosthetic rehabilitation. Several surgical techniques are reported, since the form of access to the sinus, elevation of Schneider membrane and fill the cavity. Objective: to address the resources used in bone regeneration surgery of the posterior maxilla and the effectiveness of the methods applied. Methods: an electronic search of the literature was performed in the databases LILACS, MEDLINE and BBO studies published in English and Portuguese. The inclusion criteria were considered articles between 2000 and 2014, with the key words that guided the search were: maxillary bone regeneration, Schneiderian membrane, maxillary sinus lift. 1 529 articles were obtained, of which 27 selected articles relevant to the study. Exclusion criteria were eliminated in the articles which were in the year below 2008 and fleeing the matter at hand. Data analysis and integration: it was found that the traditional technique of access to the maxillary sinus with the use of drills, lifting the membrane through curettes, and the regeneration itself with autogenous bone graft and/or heterogeneous continue as the most commonly used, however alternative as less invasive ultrasonic technology to access, hydrodissection to raise the Schneider membrane and biomaterials to fill the cavity emerge as viable, with favorable results options. Conclusions: there is a direction in the search for methods and materials that reduce the morbidity of traditional techniques and which offer satisfactory results in the short and long term. The use of surgical techniques less invasive and use of biomaterials are among the advances for the regeneration of the posterior maxilla(AU)
الموضوعات
Humans , Bone Regeneration , Databases, Bibliographic/statistics & numerical data , Dental Implants/statistics & numerical data , Review , Sinus Floor Augmentation/methodsالملخص
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.
الموضوعات
Humans , Male , Female , Maxillary Artery/anatomy & histology , Sinus Floor Augmentation/methods , Maxillary Artery , Cone-Beam Computed Tomography/methods , Arteriovenous Anastomosis/anatomy & histology , Cross-Sectional Studies , Epidemiology, Descriptive , Sinus Floor Augmentation/statistics & numerical data , Mexico , Observational Study , Data Interpretation, Statisticalالملخص
La hidroxiapatita (HA) es un componente mineral del hueso. Se ha comercializado la HA sintética o aloplástica en forma porosa o no porosa, densa y reabsorbible o no reabsorbible. Se utiliza como injerto óseo dada sus propiedades osteoconductivas y estimuladoras de proliferación celular generando así condiciones favorables para la regeneración tisular. El objetivo de éste trabajo es evaluar la efectividad del tratamiento con HA en cirugías de implantes dentales e injertos óseos. Se realizó una revisión sistemática. Se revisó ensayos clínicos sobre cicatrización y los injertos de HA sintética en Pubmed, Cochrane Library, Google Académico, Blackwell y Ebsco. Los criterios de selección son pacientes candidatos a tratamientos de defectos periodontales o rehabilitación con implantes dentales, sin alteraciones sistémicas de importancia. La estrategia se resume en los siguientes puntos: Identificación del problema, Identificación de términos de búsqueda, Búsqueda sistemática, Selección de artículos mediante utilización de guías de análisis crítico, Incorporación de la información al REVMAN®, Análisis de sesgos y Meta análisis. Al evaluar el metaanálisis se observa que la HA es efectiva para la cicatrización de injerto óseo. Cuando se omiten los estudios de bajo peso, la medida de resumen se mantiene en la HA. El tratamiento con HA en la cicatrización ósea y de implantes dentales resulta positivo y con una alta tasa de éxito en el largo plazo aunque su rango de efectividad varía con los materiales a los cuales ésta se asocie.
Hydroxyapatite (HA) is a mineral component of bone. Hydroxyapatite has been marketed as synthetic or alloplastic, porous or nonporous, dense and resorbable or non-resorbable form. It is used as bone graft due to its osteoconductive properties and stimulation of cell proliferation, generating favorable conditions for tissue regeneration. The aim of this study is to evaluate the effectiveness of treatment with HA in dental implant surgeries and bone grafts. We conducted a systematic review. Clinical trials on healing and graft of synthetic hydroxyapatite were reviewed in PubMed, Cochrane Library, Google Scholar, Blackwell and Ebsco. The selection criteria was: patient candidates for treatment of periodontal defects or rehabilitation with dental implants without significant systemic abnormalities. The strategy is summarized in the following: Identification of the problem, identifying search terms, systematic search and selection of articles by using critical analysis guides, Incorporating REVMAN ® information, unbiased analysis, and Meta-analysis. Assessing the meta-analysis shows that the HA is effective for healing bone graft. When omitting low weight studies, the summary measure remains in the HA. Treatment with HA in bone healing and dental implants, is positive with a high rate of success in the long term, although its effective range varies according to the materials to which it is associated.
الموضوعات
Humans , Dental Implantation/methods , Durapatite/administration & dosage , Sinus Floor Augmentation/methods , Wound Healing/drug effects , Bone Transplantation/methodsالملخص
The aim of this study is to compare the bone formation in maxillary sinus lift with an autogenous bone graft in histological evaluation at 2 or 6 months. A comparative study was designed where 10 patients with missing teeth bilaterally in the posterior zone of the maxilla were selected. Patients received a particulate autogenous bone graft under the same surgical conditions, selecting a site to collect a biopsy and histological study at two months and another at six months postoperatively. Histomorphometry was performed and were used Kolmogorov-Smirnov test, student's t-test and Spearman's correlation coefficient, considering a value of p<0.05. Differences were observed in inflammatory infiltrate and vascularization characteristics; however, the group analyzed at two months presented 38.12% ± 6.64 % of mineralized tissue, whereas the group studied at 6 months presented an average of 38.45 ± 9.27 %. There were no statistical differences between the groups. It is concluded that the bone formation may be similar in intrasinus particulate autogenous bone grafts in evaluations at two or six months; under these conditions, early installation of implants is viable.
El objetivo de este estudio es comparar la formación ósea en técnicas de elevación de seno maxilar utilizando injerto óseo autógeno en evaluaciónhistológica a las 2 y 6 meses. Un estudio comparativo fue diseñado donde 10 pacientes con dientes perdidos de forma bilateral en el sector posterior de maxila fueron incluidos. Los pacientes recibieron injerto óseo particulado bajo las mismas condiciones quirúrgicas, seleccionando el sitio para tomar la biopsia y el análisis histológico respectivo a los 2 meses en un lado y 6 meses en el lado contralateral. La histomorfometría se realizó y fueron utilizadas la prueba de Kolmogorov-Smirnov, la prueba t de student y la prueba de Spearman, considerando un valor de p<0,05. Fueron observadas diferencias en infiltrado inflamatorio y características de vascularización; sin embargo, los grupos analizados a los dos meses presentaron 38.12% ± 6.64% de tejido mineralizado, mientras que los grupos de estudio a los 6 meses presentaron en promedio 38.45 ± 9.27%. No se observo diferencias significativas entre los grupos. Se concluye que la formación ósea puede ser similar en elevaciones de seno maxila realizada con hueso autógeno particulado a los dos o seis meses; en estas condiciones, la instalación temprana de implantes puede ser viable.
الموضوعات
Humans , Autografts , Bone Regeneration/physiology , Maxillary Sinus/surgery , Sinus Floor Augmentation/methods , Maxillary Sinus/pathology , Maxillary Sinus/physiology , Time Factorsالملخص
Objetivo: avaliar por meio de revisão sistematizada os fatores relacionados à taxa de sobrevivência dos implantes, na técnica de elevação atraumática do seio maxilar (LASM) e a influência das variáveis: técnica, tamanho dos implantes e altura óssea remanescente (AOR). Material e métodos: realizou-se pesquisa de artigos sobre as técnicas de LASM publicados na base de dados PubMed entre junho de 2008 e julho de 2014, com amostra mínima de dez pacientes e follow-up mínimo de seis meses. Estes foram divididos em três grupos: levantamento do seio maxilar com osteótomos sem enxerto ósseo (LSMO), e com enxerto ósseo (LSMOE) e levantamento do seio maxilar com brocas e enxerto (LSMBr). A sobrevivência do implante foi considerada como desfecho primário. Resultados: dos 92 artigos encontrados, apenas 18 foram selecionados, envolvendo 1.228 pacientes e 1.581 implantes. O comprimento dos implantes foi dividido em quatro grupos: 6 mm a 7 mm (8,03%); 8 mm a 10 mm (57,42%); 11 mm a 12 mm (27,21%) e 13 mm a 15 mm (7,34%). A AOR prévia à instalação dos implantes foi dividida em dois grupos (≤ 5 mm, 33,79% e > 5 mm, 66,2%). A taxa de sobrevivência dos implantes nas diferentes técnicas variou entre 93,6% e 100% (LSMO), 90% e 100% (LSMOE), e 92,7% e 96,3% (LSMBr). Quanto ao uso de biomaterial, o Bio-Oss (Geistlich) foi o mais utilizado. Houve maior perda quando da utilização de implantes curtos. Conclusão: o LASM apresenta-se como uma técnica segura com altas taxas sobrevivência dos implantes. Fatores como a técnica de acesso ao seio, AOR e tamanho dos implantes devem ser levados em consideração na execução da técnica.
Objective: to evaluate through a systematic review factors related to implant survival rates regarding the atraumatic sinus lifting technique (AMSLT) and the influence of variables such: technique, implant length, and the remaining bone height (RBH). Material and methods: an electronic search was made at the PubMed from June 2008 to July 2014, with at least 10 patients and six months of follow-up per study. These were divided into three groups: the osteotome maxillary sinus lifting with no bone graft (OMSL-NG), the same but with bone graft (OMSL-G), and maxillary sinus lifting with burs and grafting (MSL-BG). The implant survival was considered as the primary outcome. Results: from the 92 retrieved articles, only 18 were selected, involving 1228 patients and 1581 dental implants. Implant length was divided into four groups: 6-7 mm (8.03%), 8-10 mm (57.42%), 11-12 mm (27.21%), and 13-15 mm (7.34%). The RBH before implant placement was divided into two groups (≤ 5 mm: 33.79% and > 5 mm: 66.2%). The implant survival rates ranged from 93.6%-100% (MSL-BG), 90%-100% (OMSL-G), and 92.7%-96.3% (MSL-BG). The anorganic bovine bone matrix (Bio-Oss, Geistlich) was the most frequent biomaterial. Most losses occurred for short dental implants. Conclusion: The AMSLT is safe with high implant survival rates. Factors such as sinus access, the RBH, and implant lengths must be taken into account during surgical execution.
الموضوعات
Humans , Bone Transplantation , Dental Implants/statistics & numerical data , Sinus Floor Augmentation/instrumentation , Sinus Floor Augmentation/methodsالملخص
Repor dentes perdidos através de implantes dentários é cotidiano nas clínicas odontológicas. O posicionamento desses implantes em posição ideal nem sempre é possível, devido às perdas ósseas e às limitações anatômicas que o paciente pode apresentar. Na maxila superior posterior a presença do seio maxilar pode ser um fator complicador para fixação dos implantes, além de que com a pneumatização do mesmo, pode evoluir a um osso muito delgado com uma fina camada cortical. Reabilitar esse tipo de paciente através de implantes pode ser impossível sem a utilização de materiais e técnicas capazes de repor parcial ou total a deficiência óssea, e suportar, em função, os implantes dentários. Atualmente, existem diversos materiais que podem ser utilizados isolados ou em conjunto com outros para levantamento do assoalho do seio maxilar, podendo deixar o cirurgião dentista em dúvida de qual material escolher para cada caso. Esta revisão tem como objetivo transcorrer sobre os materiais de enxertia disponíveis no mercado, baseado em evidências científicas, a fim de esclarecer para o cirurgião quais os substitutos ósseos disponíveis para utilização desse tipo de enxertia...
The treatment with dental implants after teeth loss has become a common practice in dentistry. However, the appropriate implant positioning can be compromised by bone resorption and anatomical limitations presented by mandible/maxilla. The presence of maxillary sinus on posterior region of an edentulous maxilla can hinder maxillary implants, mainly when sinus pneumatization occurs, leading to an insufficient volume of healthy bone for implantÆs placement. Oral rehabilitation with dental implants in such cases may not be executed without previous reconstructive surgical techniques associated to materials that will be able to create adequate bone volume for implant sites. Several materials are available and can be used alone or combined for maxillary sinus floor elevation. Thus their indications should be clarified aiming to guide dental surgeons. This literature review aims to discourse about marketed grafting materials, based on scientific evidence, clarifying which materials are the available for bone replacement on sinus lift...
الموضوعات
Humans , Sinus Floor Augmentation/methods , Maxillary Sinus/surgery , Bone Transplantation/methods , Biocompatible Materials/chemistry , Radiography, Panoramic/instrumentationالموضوعات
Humans , Male , Female , Clinical Protocols , Sinus Floor Augmentation/methods , Dental Implantation, Endosseous/statistics & numerical data , Dental Implantation, Endosseous/methods , Sinus Floor Augmentation/statistics & numerical data , Osteotomy/methods , Alveolar Bone Loss/classification , Oral Surgical Procedures/methods , Data Interpretation, Statistical , Maxillary Sinus/physiopathology , Tomography, X-Ray Computed/methods , Bone Transplantation/methodsالملخص
Los senos maxilares son, hoy en día, parte del diagnóstico en odontología, por lo que el conocimiento de los mismos es fundamental a la hora de su observación por parte de las imágenes radiológicas y la clínica. El propósito de este trabajo es mostrar los límites de la radiología convencional en el diagnóstico sinusal y los avances que ofrece la tomografía computada en la visualización de los mismos en sus mínimos detalles, tanto en patologías como en la contemplación de los distintos tipos de rellenos en las técnicas de elevación de piso...