APCs in sinus floor augmentation.

After tooth loss in the posterior area of the maxilla, sinus floor elevation is often required to compensate the vertical bone loss due to sinus pneumatization. This narrative review reports on the potential benefits of autologous platelet concentrates (APCs) during this procedure. As for transcrestal approach, APCs have been used as "sole" substitute/graft. However, because of the low number of clinical trials available with PRGF, and even none for PRP, no definitive conclusions can be made regarding their efficacy. The number of studies on the use of L-PRF were outnumbered indicating good feasibility for vertical bone gain, with a high implant survival rate and a low degree of complications. PRP and PRGF have not been studied as a "single/sole" substitute for a one-stage lateral window approach, probably because of the weak physical characteristics of the membranes. L-PRF alone appears to be a predictable grafting material for lateral maxillary sinus grafting and a reduced RBH should not be considered as a risk factor. Compared to a "standard" bone substitute L-PRF shows slightly less vertical bone gain (consider enough membrane application and use of bony window as new sinus floor roof over the implant apices), enhanced early resorption (first 6 months after application), but a similar stable bone gain afterward. For a two-stage lateral window approach, APCs "alone" cannot be recommended, due to their weak withstand to the sinus pneumatization forces. APCs combined with bone substitutes seem to accelerate bone formation, without any additional benefits on the long-term new bone gain. The use of L-PRF membranes for the treatment of perforations appears to be an effective treatment option, but further clinical studies are needed to confirm this. Even though the abovementioned statements are based on large numbers of studies, additional RCTs comparing APCs with different types of grafting procedures for sinus elevation are needed.

Implant stability and clinical outcome between implant placement using internal sinus floor elevation with alloplastic bone material grafting and without grafting: A 1-year randomized clinical trial.

OBJECTIVE: To compare implant stability and clinical outcome in implant placement between osteotome sinus floor elevation (OSFE) with biphasic calcium phosphate (BCP) which consisted of 30% of hydroxyapatite (HA) and 70% of beta-tricalcium phosphate (ß -TCP) grafting material and OSFE without using bone grafting material. The research questions is whether the BCP provides any benefit in OSFE or not. MATERIALS AND METHODS: Thirty patients (30 implants) with a single edentulous area of upper premolar or molar were randomly separated into OSFE with BCP (n = 15) and OSFE without grafting (n = 15). The patients were reevaluated 3, 6, 9, and 12 months after implant loading. The clinical assessments (implant stability quotient (ISQ), implant survival-failure rate, and surgical complication) were analyzed. Together with radiographic assessments in 2D (endo-sinus bone gain (ESBG), mean marginal bone change (MMBC)) and 3D (endo-sinus bone gain in CBCT (ESBG-CT)) were evaluated, with a mean follow-up time of at least 12 months of functional loading and prosthetic complication. RESULTS: 20 remaining implants (OSFE with BCP, n = 10; OSFE without grafting, n = 10) were analyzed. Mean ISQ was 79.18 ± 3.43 in 1-year follow-up (ISQ; OSFE with BCP = 78.72 ± 3.46, OSFE without grafting = 79.65 ± 3.52). ISQ in both groups increased steadily without significant differences in each follow-up. (p = 0.56). In radiographic evaluation, at 6-, 9-, and 12-month, OSFE without grafting group showed statistically significant lower MMBC (p < 0.05). The 1-year clinical results showed that 2 implants failed in OSFE with BCP, and 1 implant failed in OSFE without grafting. CONCLUSIONS: Graft material "BCP" (HA30:TCP70) coupled with OSFE presents no extraordinary benefit in implant stability, clinical and radiographic outcome in 1-year follow-up. CLINICAL RELEVANCE: Clinically, OSFE with grafting materials provides no additional benefit. CLINICAL TRIAL REGISTRATION NUMBER: TCTR20210517008 (date of registration: May 17, 2021).

Guided Lateral Window Osteotomy Using Dynamic Navigation for Maxillary Sinus Augmentation: A Novel Technique.

The size and the position of the sinus antrostomy play a key role in making sinus grafting surgery more predictable and effective with less complications. A cone beam computed tomography and intraoral scan of the maxilla were taken for a patient who is missing maxillary first molar tooth with limited residual bone. Data were exported to the dynamic navigation (DN) system software. Sinus lateral window osteotomy position and dimensions were determined and planned using four 1.5 mm diameter implants placed on the maxillary sinus lateral wall. The osteotomy was initiated following the planned four 1.5 mm implants in a parallel motion to the bone surface using dynamic navigation guidance; thus, creating an outline for the lateral sinus window. Afterword's, the lateral sinus window was greenstick fractured and the membrane was lifted; first molar implant osteotomy done, implant placed, and bone graft material was placed. The flap was sutured, and post-operative instructions and medications were given. No post-operative complications noticed. The outline of the lateral window osteotomy along with implant osteotomy can be accurately planned and executed using DN technology, which may potentially reduce complications and insure accurate placement of the implant and the graft.

3D assessment after maxillary sinus grafting with a porcine, a bovine and a synthetical bone substitute material. A randomized controlled clinical trial.

AIM: This randomized controlled clinical study focused on graft volume alterations after sinus floor augmentation with a deproteinized bovine bone mineral (DBBM, Geistlich Bio-Oss®), deproteinized porcine bone mineral (DPBM, THE GRAFT®) or a biphasic calcium phosphate (BCP, OSOPIA®). MATERIAL AND METHODS: 28 patients with edentulous situations in the posterior maxilla with less or equal to 5 mm of residual bone height received a two- staged external sinus grafting procedure with DBBM, DPBM or BCP. CBCT scans were performed prior surgery (CBCT1), directly after surgery (CBCT2) and after a healing period of 4-6 months prior implant placement (CBCT3). CBCT scans were used to analyze volumetric alterations of the sinus grafts by virtual 3D model matching of CBCT1- CBCT2 (situation after sinus grafting) and CBCT1 and CBCT2 (situation prior implant placement). RESULTS: The volume of the bone graft in the maxillary sinus (volume (VOL%) directly after grafting rated as 100%) was stable after the healing period in the DBBM (VOL%: 103±4%) and the PBBM groups (VOL%: 112± 23) with no statistically significant differences concerning 3D measurements. In the BCP group, the grafted volume declined to 66± 25% (VOL%), statistically inferior to the DBBM and DPBM groups. CONCLUSION: Concerning bone graft stability/ 25 volume DBBM and DPBM show comparable outcomes. Due to resorption, BCP showed inferior bone graft volume after healing (statistically significant) compared to DBBM and DPBM.

Long-term crestal bone changes in implants placed in augmented sinuses with minimal or moderate remaining alveolar bone: A 10-year retrospective case-series study.

OBJECTIVES: To evaluate long-term clinical and radiographic outcomes of dental implants placed after lateral window sinus augmentation utilizing the sagittal sandwich technique. MATERIALS AND METHODS: Patients treated with sinus augmentation were included in this retrospective case-series study. The surgical procedure was performed with particulate autogenous bone- and anorganic bovine bone-derived mineral (3:7 ratio). Implants were grouped based on baseline residual alveolar ridge height: group S (residual alveolar ridge height of 0.1-3.5 mm), group M (height of 3.5-7mm), and group C (native bone). Radiographs were taken at baseline (abutment installation) and annually throughout the 10-year follow-up. RESULTS: A total of 86 patients (92 sinus lifts) and 209 implants were included. Ten sinus membrane perforations were recorded (11% incidence), and graft infections occurred in 3 cases (3.2% incidence). During the 10-year follow-up, 3 implants (1.4%) failed. No significant differences in the mean implant marginal bone loss (MBL) between the three groups were found after 1-, 2-, and 5-year follow-up (p > .05). At 10 years, group C exhibited more MBL than group M with a mean difference of -0.53 mm (p = .01). After 10 years, MK III implants displayed significantly more bone loss in native bone than those in augmented bone with a mean difference of 0.48 mm (p = .02). Five patients and 7 implants developed peri-implantitis with no significant differences between the groups (p = .570). CONCLUSION: Implant placement after two-stage sinus grafting utilizing the sagittal sandwich technique is a relatively safe and predictable procedure with minimal complications and MBL after 10-year follow-up.

Long-term outcomes of osteotome sinus floor elevation with or without bone grafting: The 10-year results of a randomized controlled trial.

AIMS: To assess the long-term clinical and radiographic results of implants placed using osteotome sinus floor elevation (OSFE) with or without bone grafting. MATERIALS AND METHODS: Forty-five patients were randomly assigned into two groups: Group 1 (OSFE with deproteinized bovine bone mineral) and Group 2 (OSFE without grafting). The patients were recalled at 1, 3, 5 and 10 years after surgery. The implant survival, endo-sinus bone gain (ESBG), marginal bone loss (MBL), peri-implant bone height (PBH, distance from the most coronal level to the most apical level of bone-to-implant contact), prosthesis survival and hardware complications, and peri-implant soft tissue conditions were assessed. RESULTS: Forty patients attended the 10-year examination. Mean residual bone height was 4.58 ± 1.28 mm. The 10-year cumulative survival rate was 90.7% for Group 1 and 95.0% for Group 2. The PBH was 5.89 ± 1.24 mm for Group 1 and 5.74 ± 1.43 mm for Group 2 at 10 years. The ESBG of both groups remained stable after 3 years. Two-thirds of the implants were free of hardware complications. No significant differences in MBL and peri-implant tissue parameters were found. CONCLUSION: OSFE with or without grafting both yielded predictable clinical outcomes with similar PBH (ClinicalTrials.gov. NCT01619956).

Randomized controlled multicentre study comparing short dental implants (6 mm) versus longer dental implants (11-15 mm) in combination with sinus floor elevation procedures: 5-Year data.

AIM: To compare the implant survival rate between short dental implants and standard length implants placed in combination with bone grafting at 5 years of loading. METHODS: This multicentre study enrolled 101 patients (137 implants) with a posterior maxillary bone height of 5-7 mm. Patients randomly received either short implants (6 mm; GS) or long implants (11-15 mm) with sinus grafting (GG). Six months later, implants were loaded with single crowns and patients re-examined at 1, 3 and 5 years of loading. Outcomes included: implant survival, marginal bone levels (MBLs), biological and technical parameters and patient-reported outcome measures (OHIP-49 = Oral Health Impact Profile). Statistical analysis was performed using a non-parametric approach. RESULTS: At 5 years, 90 patients (124 implants; GS: 60; GG: 64) were re-examined (drop-out rate 10%). Patient-level implant survival rates were 98.5% (GS; 1 implant failure) and 100% (GG; p = 0.49). Mean MBLs were 0.54 mm ± 0.87 (GS) and 0.46 mm ± 1.00 (GG; p = 0.34). Biological and technical parameters were not significantly different (p > 0.05). Median overall OHIP-49 scores improved significantly up to 5 years in both groups (GS: p = 0.03; GG: p = 0.00; intergroup comparison p = 0.11). CONCLUSIONS: Both treatment modalities were suitable for implant therapy in the atrophied posterior maxilla revealing no differences in terms of survival rates, marginal bone levels (changes), patient-reported outcomes and technical/biological complications.

Variation in bucco-palatal maxillary sinus width does not permit a meaningful sinus classification.

OBJECTIVES: The bucco-palatal sinus width (SW) appears as relevant factor for graft consolidation after maxillary sinus (MS) floor augmentation. The present study aimed to assess (a) SW at different height levels of posterior teeth, (b) possible factors influencing SW, and (c) whether a simple/meaningful sinus classification based on SW is possible. METHODS: The following parameters were recorded on computed tomographies of 76 edentulous and 86 partially edentulous maxillary quadrants displaying 383 tooth sites in total: (a) alveolar ridge height, (b) -area, (c) -width 2 mm apical to the alveolar crest, (d) -width at the sinus floor, and (e) SW and sinus area at a level 2, 4, 6, 8, and 10 mm above the sinus floor. The possible influence of gender, tooth position [i.e., premolar (PM); molar (M)], tooth-gap extent, and residual alveolar ridge dimensions on SW was assessed. Further, based on percentiles of average values or on the frequency distribution of SW <10, 10-15, or >15 mm, it was attempted to classify the sinus at each given site into narrow, average, or wide. RESULTS: Gender and tooth-gap extent presented no relevant impact on MS dimensions; however, significant differences were observed among the various tooth positions regarding all evaluated parameters. The lower the residual alveolar ridge, the wider the MS at 4-10 mm height, while the wider the residual alveolar ridge, the wider the MS. Large variation in SW classes among the different height levels within the same tooth position and among tooth positions within the same person was observed, irrespective of the threshold applied. Further, at a MS height of 10 mm at PM1, PM2, M1, and M2, SW was <10 mm in 68%, 33%, 0%, and 7% of the cases, respectively, while in 3%, 21%, 65%, and 57%, respectively, SW was >15 mm. CONCLUSIONS: There is a large variation in SW depending on the height level within the sinus and on tooth position, which does not permit a simple/meaningful classification of each sinus as "narrow," "average," or "wide." Nevertheless, narrow sinuses (<10 mm) are rather prevalent in the premolar region, while wide sinuses (>15 mm) in the molar region; further, a wider and shorter residual alveolar ridge is associated with a wider SW.

Short dental implants (6 mm) versus long dental implants (11-15 mm) in combination with sinus floor elevation procedures: 3-year results from a multicentre, randomized, controlled clinical trial.

AIM: To test whether the use of short dental implants (6 mm) results in an implant survival rate similar to that with longer implants (11-15 mm) in combination with sinus grafting. METHODS: This multicentre study enrolled 101 patients with partial edentulism in the posterior maxilla and a remaining bone height of 5-7 mm. Included patients were randomly assigned to receive short implants (6 mm; GS/group short) or long implants (11-15 mm) simultaneously with sinus grafting (GG/group graft). Six months after implant placement (IP), implants were loaded with single crowns (PR) and patients were re-examined yearly thereafter. Assessed outcomes included: implant survival, marginal bone level changes (MBL), probing pocket depth (PPD), bleeding on probing (BoP) and plaque accumulation (PCR) during 3 years of loading as well as recording of any adverse effects. In addition to descriptive statistics, statistical analysis has been performed for the two treatment modalities using a non-parametric approach. RESULTS: In 101 patients, 137 implants were placed. At the 3-year follow-up (FU-3), 94 patients with 129 implants were re-examined. The implant survival rate was 100% in both groups. MBL at FU-3 was 0.45 mm (GG) and 0.44 mm (GS) (p > 0.05). A statistically significant loss of MBL was observed in both GG (-0.43 ± 0.58 mm) and GS (-0.44 ± 0.56 mm) from IP to FU-3, and from PR to FU-3 in GG (-0.25 ± 0.58 mm) but not in GS (-0.1 ± 0.54 mm). PCR and BoP at FU-3 did not show any difference between the groups but for PPD (p = 0.035). CONCLUSIONS: Within the limitations of this study, implants with a length of 6 mm as well as longer implants in combination with a lateral sinus lift may be considered as a treatment option provided a residual ridge height of 5-7 mm in the atrophied posterior maxilla is present.

Randomized controlled multicenter study comparing short dental implants (6 mm) versus longer dental implants (11-15 mm) in combination with sinus floor elevation procedures. Part 2: clinical and radiographic outcomes at 1 year of loading.

AIM: To compare, clinically and radiographically, short dental implants (6 mm) to long implants (11-15 mm) placed with sinus grafting. METHODS: Participants with 5-7 mm of bone height in the posterior maxilla were randomly allocated to receive short implants (GS) or long implants with sinus grafting (GG). Implants were loaded with single crowns 6 months after placement (PR). Patients were re-evaluated 12 months after loading (FU-1). Outcome variables included: Implant survival rate (CSR), marginal bone level alteration (MBL), periodontal probing depth (PPD), bleeding on probing (BoP), plaque control record (PCR) and crown-to-implant ratios (C/I). Statistical analysis was performed using parametric tests. RESULTS: In 97 subjects, 132 implants were re-evaluated at FU-1. The CSR was 100%. The MBL from implant placement (IP) to (PR) was -0.22 ± 0.4 mm for GG and -0.3 ± 0.45 mm for GS (p < 0.001). MBL from IP to FU-1 was -0.37 ± 0.59 mm for GG and -0.22 ± 0.3 mm for GS (p < 0.001). Intergroup comparisons showed non-significant differences for MBL (p > 0.05), PPD (p = 1) and PCR (p = 0.09). BoP was higher in the GS (p = 0.04). The C/I was 0.99 ± 0.17 for GG and 1.86 ± 0.23 for GS (p < 0.001). No correlation was observed between C/I and MBL, (GG: p = 0.13; GS: p = 0.38). CONCLUSIONS: Both treatment modalities provided similar outcomes.

Randomized controlled multicentre study comparing short dental implants (6 mm) versus longer dental implants (11-15 mm) in combination with sinus floor elevation procedures. Part 1: demographics and patient-reported outcomes at 1 year of loading.

AIM: To test whether or not the use of short dental implants (6 mm) results in an implant survival rate similar to long implants (11-15 mm) in combination with sinus grafting. METHODS: This multicentre study enrolled 101 patients with a posterior maxillary bone height of 5-7 mm. Patients randomly received short implants (6 mm) (group short) or long implants (11-15 mm) with sinus grafting (group graft). Six months later, implants were loaded with single crowns and patients re-examined at 1 year of loading. Outcomes included treatment time, price calculations, safety, patient-reported outcome measures (OHIP-49 = Oral Health Impact Profile) and implant survival. Statistical analysis was performed using a non-parametric approach. RESULTS: In 101 patients, 137 implants were placed. Mean surgical time was 52.6 min. (group short) and 74.6 min. (group graft). Mean costs amounted to 941EUR (group short) and 1946EUR (group graft). Mean severity scores between suture removal and baseline revealed a statistically significant decrease for most OHIP dimensions in group graft only. At 1 year, 97 patients with 132 implants were re-examined. The implant survival rate was 100%. CONCLUSIONS: Both treatment modalities can be considered suitable for implant therapy in the atrophied posterior maxilla. Short implants may be more favourable regarding short-term patient morbidity, treatment time and price.

Osteotome sinus floor elevation with and without grafting: an animal study in Labrador dogs.

AIM: To evaluate implant stability and histological outcomes after osteotome sinus floor elevation (OSFE) procedure, and to compare new bone formation and implant osseointegration with and without grafting. MATERIAL AND METHODS: OSFE with simultaneous implant placement was conducted bilaterally on 6 Labrador dogs. Twenty-four implants were placed. The right side sinus (Group 1) was grafted with biphasic calcium phosphate (BCP), whereas the left side (Group 2) was left without any grafting materials. The animals were euthanized 8 and 24 weeks after surgery for histological and histomorphometric assessment. Bone-to-implant contact (BIC%), alveolar bone height (ABH), bone density (BD) and grafting material density (GMD) were measured. The implant stability (ISQ) was assessed using resonance frequency analysis (RFA) at implant placement and 1, 2, 4, 8, 12, 24 weeks after surgery. RESULTS: Endo-sinus new bone with direct contact to implant surface were observed in two groups at both time points. ABH showed no difference between groups at both time points. BIC% and BD in Group 2 (40.05%, 35.90%) was higher than those in Group 1 (23.30%,25.59%) at 24 weeks. Significant shrinkage of grafting material was seen in Group 1. The GMD in Group 1 at 8 weeks was 24.35%, while it dropped to 19.90% at 24 weeks. The changing pattern of ISQ for both groups were similar. CONCLUSIONS: Spontaneous new bone formation and better bone-to-implant contact were found for OSFE without grafting. The grafting material application during OSFE procedure showed no advantages in histological results.

Maxillary sinus opacification after surgery in asymptomatic patients: Transient swelling of the sinus mucosa or graft dispersion into the maxillary sinus. A radiographic report of three cases after a follow-up period of at least 5 years.

Maxillary sinus grafting is a predictable regenerative technique to facilitate maxillary posterior implant placement when there is insufficient vertical bone height inferior to the maxillary sinuses to allow placement of implants of adequate dimensions. It enables an increase in vertical bone height, which makes implant placement easier. Maxillary sinus mucosal membrane perforation is one of the most common intraoperative complications during maxillary sinus grafting and may result in extrusion of graft material into the sinus. When this occurs, the mucociliary function of the maxillary sinus may expel the extruded graft material through its natural ostium, though graft particles may remain in the sinus or possibly occlude the natural ostium. After grafting, transient maxillary sinus mucosal oedema may occur. A postoperative CBCT scan may reveal varying degrees of sinus opacification, namely partial, subtotal or total. Although it is always possible to identify graft material, which may enter the sinus as a result of membrane perforation that might not even be visible to the implantologist during the surgical procedure, it is challenging to assess whether sinus opacification is due to mucosal thickening or mucus accumulation. The aim of the present case series was to offer a pragmatic approach to managing asymptomatic patients whose CBCT scans demonstrated partial, subtotal or total maxillary sinus opacification with bone graft particles that seemed to have been extruded into the sinus.

Histologic and histomorphometric evaluation of a synthetic bone substitute for maxillary sinus grafting in humans.

OBJECTIVE: The present study investigated the efficacy of a biphasic calcium phosphate as a bone grafting material for maxillary sinus augmentation in humans. MATERIALS AND METHODS: Half of the thirty patients selected for sinus augmentation were grafted with biphasic calcium phosphate, whereas the other half were grafted with autogenous bone chips harvested intraorally. After 9 months of healing, bone cores were retrieved from implant sites for histologic and histomorphometric evaluation. RESULTS: The areas augmented with autogenous bone chips showed newly formed bone with a pattern very similar to that of the native area. Histomorphometry demonstrated that the amount of newly formed bone in the autogenous bone group was significantly greater than in the biphasic calcium phosphate group (P < 0.05). In the biphasic calcium phosphate group, less bone formation was observed in the area further away from native bone interface than in the area closer to native bone interface (P < 0.05), whereas no significant differences were observed between both areas in the autogenous group. In both groups, the implant survival rate was 100% with a minimum 1-year follow-up. CONCLUSION: The data presented in this work confirm the osteoconductive properties of biphasic calcium phosphate, as well as its use in association with maxillary sinus floor augmentation procedures with successful outcomes.

Alveolar nerve repositioning with rescue implants for management of previous treatment. A clinical report.

The goal of modern implant dentistry is to return patients to oral health in a rapid and predictable fashion, following a diagnostically driven treatment plan. If only a limited number of implants can be placed, or some fail and the prosthetic phase of implant dentistry is chosen to complete the patient's treatment, the final outcome may result in partial patient satisfaction and is commonly referred to as a "compromise." Previous All-on-4 implant treatment for the patient presented here resulted in a compromise, with an inadequate support system for the mandibular prosthesis and a maxillary complete denture with poor esthetics. The patient was unable to function adequately and also was disappointed with the resulting appearance. Correction of the compromised treatment consisted of bilateral inferior alveolar nerve elevation and repositioning without bone removal for lateral transposition, to gain room for rescue implants for a totally implant-supported and stabilized prosthesis. Treatment time to return the patient to satisfactory comfort, function, facial esthetics, and speech was approximately 2 weeks. The definitive mandibular prosthesis was designed for total implant support and stability with patient retrievability. Adequate space between the mandibular bar system and the soft tissue created a high water bridge effect for self-cleansing. Following a short interim mandibular healing period, the maxillary sinuses were bilaterally grafted to compensate for bone inadequacies and deficiencies for future maxillary implant reconstruction.

A Combination of Platelet-Rich Fibrin and Collagen Membranes for Sinus Membrane Repair: A Case Report (Repair of Sinus Membrane Perforation).

Maxillary sinus lift surgery is applied to compensate for the reduced vertical height in the posterior maxilla to facilitate placing a dental implant of a suitable length. Pathological conditions may be accidentally discovered, which necessitate careful assessment and management to prevent the infection of the maxillofacial complex and eventually bone grafting and dental implant failure. This case report describes an approach for the management of Schneiderian membrane perforation associated with the removal of an antral pseudocyst for successful dental implant therapy. A 70-year-old healthy Caucasian male presented for implant therapy to replace a non-restorable maxillary molar. Initial examination revealed the need for a sinus lift procedure to prepare the site for implant placement. A 3D CBCT evaluation before surgery revealed an incidental finding of a pathological lesion at the surgical site. The histological analysis of a biopsy specimen retrieved during implant site preparation showed findings consistent with antral pseudocyst. The resulting perforation of the sinus membrane was treated, and an adequate period of healing was given. A thickened sinus membrane was detected upon surgical exposure for implant placement. The novel technique illustrated could result in a fibrotic repaired sinus membrane and help shorten the time required for dental implant treatment.

Treatment of Sinusitis Following Dental Implantation: A Systematic Review and Meta-Analysis.

BACKGROUND: Implantological procedures aimed at rehabilitating upper jaw edentulous patients (dental implant placement and/or maxillary sinus grafting) can sporadically result in sinusitis. In these patients, endoscopic sinus surgery is the most commonly employed treatment, but clinical scenarios and comprehensive management strategies are extremely heterogeneous across studies. OBJECTIVE: We sought to systematically define treatment strategies and related success rates for sinusitis following dental implantation, detailing different current treatment choices and concepts. METHODS: Adopting a PRISMA-compliant review framework, systematic searches were performed in multiple databases using criteria designed to include all studies published until November 2020 focusing on the treatment of human sinusitis following dental implantation. We selected all original studies, excluding case reports, specifying treatment modalities with objective treatment success definitions. Following duplicate removal, abstract and full-text selection, and quality assessment, we reviewed eligible articles for treatment modalities and success rates, which were pooled in a random-effects meta-analysis. RESULTS: Among 581 unique citations, eight studies (181 patients) were selected. Seven studies were retrospective case series. All studies relied on endoscopic sinus surgery, often coupled with intraoral accesses, and assessed therapeutic success endoscopically. The pooled treatment success rate was 94.7% (95% confidence interval, 91.5%-98%). Failures were treated in seven of 15 cases with further antibiotic therapies and in another seven cases with surgical revision. A single patient was lost to follow-up. CONCLUSIONS: Endoscopic sinus surgery appears to be the most frequent treatment of choice for sinusitis following dental implantation, with excellent success rates. The protean clinical picture drawn from the selected studies calls for the standardization of diagnostics and definitions in this field to enable direct comparisons between the results of different studies. The role of postoperative antibiotic therapies, which have been employed unevenly across studies, should also be prospectively investigated.

The effect of residual bone height and membrane thickness on sinus membrane perforation in crestal sinus grafting: A prospective clinical study.

This study sought to determine the rate of sinus membrane perforation in patients undergoing crestal sinus grafting, as well as the effect of Schneiderian membrane thickness and residual bone height (RBH) on membrane perforation, using cone beam computed tomography. The study included 25 patients undergoing 44 crestal sinus grafting procedures. The sites for crestal sinus grafting were divided into a control group (RBH≥5mm) and a test group (RBH<5mm). All sinus grafting procedures were also categorised based on membrane thickness: group A (<1mm), group B (1-2mm), and group C (≥2mm). The rate of membrane perforation was 18.2%. The median RBH measurement was 5.59mm. No statistically significant difference in membrane perforation rate was found between the test and control groups (P=0.262). The median thickness of the Schneiderian membrane was 1.35mm. There was no statistically significant difference in membrane perforation among the three membrane thickness groups (P=0.431). No significant correlation between RBH and membrane perforation was observed, although clinical observation indicated that there was a tendency for an increased membrane perforation rate in the presence of a RBH<5mm. The perforation rate was found to be at its highest when the membrane was thinner than 1mm.

Biphasic calcium phosphate and polymer-coated bovine bone matrix for sinus grafting in an animal model.

Autogenous bone grafting requires a donor site and may lose substantial volume during remodeling. Several bone replacement materials (BRMs) are under development to overcome these limitations, especially for indications for minimally intervention surgeries. The objective of our study was to assess the potential of an equine collagen cone reinforced with biphasic calcium phosphate (CC-BCP) particles and deproteinized bovine bone matrix (BBM) coated with polylactic acid, and poly-ε-caprolactone copolymer (BBM-PCC) and then to compare the outcomes with a deproteinized BBM and an equine CC without a filler in a sheep sinus grafting model in the Elleven female sheep were selected. Two experimental sites on each side of the animals were prepared using an extraoral approach for maxillary sinus wall. The four treatments were performed in each animal through a standardized 10-mm access window. While the BBM access was covered with a collagen membrane, all other sites were closed with an equine collagen membrane. All animals were euthanized after 16 weeks. New bone (NB), residual graft particles, and connective tissue were measured in undemineralized resin-embedded sections. As a result, one sheep did not survive the surgery. All sites in the remaining 10 sheep healed uneventfully. All CC and BBM-PCC grafts resorbed and failed to augment the sinuses. BBM and CC-BCP, in contrast, showed some histologic evidence of NB and surgical site augmentation. The NB fraction in the latter two groups accounted for 10 ± 9 and 4 ± 5%, respectively (p > 0.05). In conclusion, BBM-PCC and collagen cone performed poorly for sinus floor augmentation, while deproteinised BBM and reinforced collagen cone demonstrated comparable outcomes.

Le Fort I Distraction Osteogenesis of Edentulous Maxillae Combined with Simultaneous Sinus Floor Grafting to Obtain Orthoalveolar Form for Emergence Profile Dental Implant Restorations: Report of Three Patient Treatments Followed for 12 Years.

Three edentulous maxillary patients were treated with 9- to 15-mm advances of the maxilla by Le Fort I distraction osteogenesis combined with simultaneous sinus floor autograft placement. The patients were subsequently treated with 8 implants placed in the molar, bicuspid, and canine regions for complete arch ceramo-metal fixed restorations. Anterior emergence profile esthetics was obtained in 2 patients who had high smile lines. Following final restoration, no maxillary relapse was evident, and no implants were lost. Implant bone levels were stable, although 2 implants had 3 mm of bone loss over the 12-year follow-up period.