The effects of sinus membrane pathology on bone augmentation and procedural outcome using minimal invasive antral membrane balloon elevation.

Membrane pathology tends to complicate the postprocedural course of open sinus lift by ostio-meatal complex (OMC) obstruction and consequent acute sinusitis. The objective of this study was to evaluate the outcome of subjects with considerable sinus membrane pathology undergoing maxillary sinus floor augmentation and simultaneous implant placement using the minimal invasive antral membrane balloon elevation (MIAMBE) method. This study was a retrospective chart review of MIAMBE procedures performed in the presence of significant sinus membrane pathology. Sixteen patients with maxillary sinus membrane thickening in well-ventilated OMC as determined by dental computerized tomography underwent sinus augmentation and simultaneous implant placement using the MIAMBE technique. All 16 procedures were successfully concluded without significant procedural or postprocedural complications or implant failure. Post MIAMBE membrane pathology regressed or disappeared in 8 patients (50%) or remained unchanged in 6 patients (37.5%), while in 2 patients the sinus membrane pathology was limited to evaluation by periapical X rays. Sinus augmentation using the MIAMBE technique can be performed safely in asymptomatic patients in the presence of sinus membrane pathology if the OMC is not obstructed. In a significant proportion of these cases, complete resolution of the membrane pathology after MIAMBE is observed. When compared to open sinus lift, OMC obstruction is less likely to occur when employing the MIAMBE method.

Minimally invasive subnasal elevation and antral membrane balloon elevation along with bone augmentation and implants placement.

Atrophic edentulous anterior maxilla is a challenging site for implant placement and has been successfully treated surgically by anterior maxillary osteoplasty. This procedure is associated with considerable discomfort, morbidity, and cost-and consequently reduced patient acceptance. The efficacy and safety of minimally invasive bone augmentation of the posterior maxilla has not been extended thus far to the anterior subnasal maxilla. We present 2 representative cases in which minimally invasive subnasal floor elevation was performed along with minimally invasive antral membrane balloon elevation. Both segments underwent bone grafting and implant placement during the same sitting. Minimally invasive anterior maxilla bone augmentation appears to be feasible. Designated instruments for alveolar ridge splitting and nasal mucosa elevation are likely to further enhance this initial favorable experience.

Flapless approach to maxillary sinus augmentation using minimally invasive antral membrane balloon elevation.

In the atrophic posterior maxilla, successful implant placement is often complicated by the lack of quality and volume of available bone. In these cases, sinus floor augmentation is recommended to gain sufficient bone around the implants. Sinus elevation can be performed by either an open lateral window approach or by a closed osteotome approach depending on available bone height. This case series demonstrates the feasibility and safety of minimally invasive antral membrane balloon elevation, followed by bone augmentation and implant fixation in 20 patients with a residual bone height of 2 to 6 mm below the sinus floor. The surgical procedure was performed using a flapless approach. At 18 months follow-up, the implant survival rate was 100%. Absence of patient morbidity and satisfactory bone augmentation with this minimally invasive procedure suggests that minimally invasive antral membrane balloon elevation should be considered as an alternative to some of the currently used methods of maxillary bone augmentation.

Minimally invasive antral membrane balloon elevation in the presence of antral septa: a report of 26 procedures.

Antral septa of the maxillary sinus occurs in approximately one third of patients undergoing posterior maxillary bone augmentation and is considered a relative contraindication for lateral maxillary window ("hinge osteotomy"). We present the results of 26 consecutive cases of patients with septated maxillary sinus who underwent minimally invasive antral membrane balloon elevation (MIAMBE) followed by bone augmentation and implant fixation. After undergoing preprocedural assessment and signing an informed consent, 57 consecutive patients were referred for posterior maxillary bone augmentation. Alveolar crest exposure (via 3-mm osteotomies), MIAMBE, and bone augmentation were followed by implant placement and primary closure (executed at the same sitting). Implant loading was done 6-9 months later. Twenty-six out of 57 (45.6%) patients had significant septa (detected on computed tomography) in the designated augmentation region. Twenty-four (92%) concluded the initial procedure successfully. Two patients had membrane tear requiring procedure abortion. Mean procedure time was 48 +/- 23 minutes. Incremental bone height consistently exceeded 10 mm, and implant survival of 95.2% was observed at 6-9 months. MIAMBE can be applied to patients in need of posterior maxilla bone augmentation in the presence of septated maxillary sinus with high procedural success, low complication rate, and satisfactory bone augmentation and implant survival. MIAMBE should be an alternative to the currently employed methods of maxillary bone augmentation, especially in the presence of septated maxilla.

Minimally invasive antral membrane balloon elevation: report of 36 procedures.

BACKGROUND: The posterior maxillary segment frequently has insufficient bone mass to support dental implants. This registry evaluated the feasibility and safety of minimally invasive antral membrane balloon elevation (MIAMBE), followed by bone augmentation and implant fixation. METHODS: Thirty-six consecutive patients referred for posterior maxillary bone augmentation underwent alveolar crest exposure and implant osteotomy followed by MIAMBE (> 10 mm). Fibrin and bone particles were injected beneath the antral membrane, implants were placed into the osteotomies, and primary closure was executed at the same sitting. RESULTS: All 36 patients successfully concluded the procedure with no significant procedural complications or discomfort. Procedure time was 48 +/- 15 minutes. Incremental bone height consistently exceeded 8 mm, and implant survival of 97% was observed at 6 to 8 months. CONCLUSIONS: MIAMBE resulted in high procedural success and satisfactory bone augmentation implant survival and complication rates. Because it is minimally invasive, this procedure may be an alternative to the currently used surgical methods.

Immediate bone augmentation after infected tooth extraction using titanium membranes.

Infectious process frequently results in extensive bone resorption and defect, periradicular or periapical lesions, or vertical fracture with infected sinus tract. When tooth extraction is mandated it typically results in additional bone loss in the buccal or lingual cortical plate. Immediate guided bone regeneration (GBR) and implant fixation at an infected site is frequently complicated by soft-tissue dehiscence, membrane exposure, and implant failure. The objective of this research is to assess the feasibility of immediate bone augmentation (IBA) after purulent tooth extraction, employing a dedicated titanium membrane. An intrasulcular incision was made around the tooth to be extracted and extended to 2 adjacent teeth while maintaining the papillae. Vertical releasing incisions were made to mobilize the mucoperiosteal flap. Cautious tooth extraction was executed utilizing conventional measures and was followed by meticulous curettage of the infected and granulated tissue in the socket. Titanium membranes were applied to the socket walls followed by socket filling with autologous platelet-rich fibrin and primary closure. Eight or more weeks later membrane removal and implant placement were performed. Of the 15 patients who underwent this procedure, 7 patients (47%) had early membrane exposure (between weeks 2 and 6), which was treated conservatively. No infection or early membrane removal was reported. All patients achieved sufficient bone augmentation, and 8 patients received implants without any additional GBR. IBA after infected tooth extraction, using titanium membrane application was feasible and safe and yielded adequate bone filling to support implant fixation at > or =8 weeks. Further studies need to evaluate if the titanium membrane helped in any way to inhibit plaque accumulation or resist infection in cases of early membrane exposure.

Minimally invasive guided bone regeneration.

Guided bone regeneration (GBR) is indicated when there is a volume deficiency of the residual ridge that prohibits implantation or optimal implant installation for esthetic and functional needs. Our objective is to describe a new minimally invasive GBR and report its clinical application in several patients. A vertical incision is made mesial to the augmentation zone. The periosteum is initially elevated with a miniature chisel, and then through a series of sequential balloon inflations. This yields a tunnel with adequate space for membrane insertion, decortication, and grafting with substitute bone and platelet rich fibrin (PRF) filling. Primary closure is obtained by 2 or 3 simple interrupted sutures. Vertical and horizontal gains were measured on computerized tomography obtained before and 5 to 6 months after the procedure. Eleven patients were treated with this procedure. There were no significant adverse events. The range of vertical gain was 2.4 to 5.1 mm, while horizontal gain measured 1.3 to 3.9 mm. Implants were successfully placed in 6 patients.

Minimally invasive antral membrane balloon elevation followed by maxillary bone augmentation and implant fixation.

The posterior maxillary segment frequently suffers from insufficient bone mass to support dental implants. Current bone augmentation methods, including the lateral maxillary approach (ie, hinge osteotomy) and sinus elevation by osteotome, have many shortcomings. The objective of our study was to assess the safety and efficacy of minimally invasive antral membrane balloon elevation (MIAMBE) followed by bone augmentation and implant fixation (executed during the same procedure). Alveolar crest exposure and implant osteotomy were followed by sequential balloon inflations yielding > 10 mm MIAMBE. A mix of autologous fibrin and bone particles with bone speckles was injected beneath the antral membrane. Implants were fixated into the osteotomies, and primary closure was performed during the same sitting. A total of 24 patients were enrolled. Successful conclusion of this procedure was accomplished in 91.6% of the initial 12 patients and 100% in the second dozen cases without significant complications. Patient discomfort was minimal. Long-term follow up revealed satisfactory bone formation, resulting in adequate implant stability. We conclude that the protocol of MIAMBE results in an excellent success rate, low complication rate, minimal discomfort, and long-term safety and durability. Because it requires only basic equipment and a short learning curve, this clinical approach should be widely employed.

Minimally invasive antral membrane balloon elevation for single-tooth implant placement.

A single missing tooth in the posterior atrophic maxillary segment poses a therapeutic challenge. Open sinus lift is not often performed because of anatomical restrictions and the need for specific surgical skills. The osteotome approach has considerable efficacy and safety limitations. In many cases, the clinician elects to treat with a three-unit partial denture or discard any rehabilitation plans. Two cases in which minimal invasive antral membrane balloon elevation was performed for single-tooth replacement are presented. This procedure appears to be a relatively simple, highly effective, and safe solution for single-tooth, implant-supported restorations of the posterior atrophic maxilla.

Minimally invasive antral membrane balloon elevation - results of a multicenter registry.

BACKGROUND AND PURPOSE: Frequently, the posterior maxilla lacks sufficient bone mass to support dental implants. This multiphysician registry assessed the feasibility and safety of minimally invasive antral membrane balloon elevation (MIAMBE), followed by bone augmentation and implant fixation. MATERIALS AND METHODS: One hundred twelve consecutive patients were referred for MIAMBE. Following pre-procedural assessment and informed consent, patients underwent alveolar crest exposure, and 3 mm osteotomy followed by MIAMBE. Platelet-rich fibrin and bone substitutes were injected under the antral membrane; implant placement and primary closure were executed at the same sitting. Implant loading was carried out 6 to 9 months later. RESULTS: One hundred nine (97.3%) patients successfully concluded the initial procedure. Three patients had membrane tear requiring procedure abortion. One case of infection was documented at 4 weeks. Procedure time was 58 +/- 23 minutes. Incremental bone height consistently exceeded 10 mm, and implant survival of 95% was observed at 6 to 9 months. CONCLUSION: MIAMBE can be applied to all patients in need of posterior maxilla bone augmentation with high procedural success, low complication rate, and satisfactory bone augmentation and implant survival. As it is minimally invasive and associated with minimal discomfort, MIAMBE should be an alternative to the currently employed methods of maxillary bone augmentation.