RESUMO
Maxillary sinus floor elevation, via the lateral approach, is one of the most predictable bone augmentation procedures performed in implant dentistry. but both intra- and postoperative complications can occur, and some of them are severe. Our aim is as follows: To review the pertinent literature on the topic, especially assessing the risk factors related to complications. To give clinical recommendations to minimize intra- and postoperative complications with the ultimate scope of improving the standard of clinical care and patient safety.
Assuntos
Levantamento do Assoalho do Seio Maxilar , Humanos , Levantamento do Assoalho do Seio Maxilar/efeitos adversos , Levantamento do Assoalho do Seio Maxilar/métodos , Seio Maxilar/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/cirurgia , Fatores de Risco , Implantação Dentária Endóssea/efeitos adversos , Implantação Dentária Endóssea/métodosRESUMO
BACKGROUND: The effects of horizontal platelet-rich fibrin (H-PRF) bone block on the healing and immune response during sinus augmentation have not been fully investigated histologically at early time points. METHODS: Eighteenth male New Zealand white rabbits underwent bilateral sinus augmentation and were divided into two groups: deproteinized bovine bone mineral (DBBM) alone and H-PRF + DBBM (H-PRF bone block) group. Maxilla samples were collected at 3, 7 and 14 days post sinus augmentation procedures and analyzed using histological staining for the number of inflammatory cells, new blood vessels and evidence for early osteoclast bone turnover/remodeling. Furthermore, the effects of H-PRF bone blocks on the migration of osteoblasts and THP-1 macrophages were evaluated using a Transwell assay in vitro. RESULTS: A higher number of immune cells were found in the H-PRF bone block group at 3 and 7 days post-surgery when compared to the DBBM alone group,most notably in the regions close to the mucosal lining and bone plates. Furthermore, a significantly greater number of new blood vessel formations and early signs of osteoclast development were found in the H-PRF bone block group at 14 days. The in vitro transwell assay further confirmed that culture medium from H-PRF bone block markedly promote the migration of osteoblasts and THP-1 macrophages. CONCLUSIONS: The findings from this study have shown that H-PRF bone block is capable of increasing early immune cell infiltration leading to the acceleration of neovascularization and speeding the process of bone metabolism in vivo following maxillary sinus grafting with DBBM.
Assuntos
Produtos Biológicos , Fibrina Rica em Plaquetas , Masculino , Animais , Bovinos , Coelhos , Seio Maxilar/cirurgia , Maxila/cirurgiaRESUMO
AIM: To compare the effectiveness of two xenografts for maxillary sinus floor augmentation in terms of clinical, radiographical, histologic, and molecular outcomes. MATERIALS AND METHODS: A split-mouth randomized clinical trial was conducted at the University of Granada. Ten consecutive patients in need of bilateral two-staged maxillary sinus floor augmentation were included. Each patient received both biomaterials (porcine bone mineral and anorganic bovine bone), which were randomly assigned for bilateral sinus augmentation. The maxillary autogenous bone scraped from the sinus access window was mixed with each xenograft at a 20:80 ratio. After a healing period of 6 months, bone biopsies were collected with a trephine during the implant placement in the regenerated area. Histologic, histomorphometrical, immunohistochemical, and molecular outcomes were analyzed. Clinical and radiographical data throughout the treatment phases were also evaluated. RESULTS: The resulting anatomic features were similar between both groups. After six months of graft consolidation, the graft resorption rates were similar between both biomaterials. The histologic, histomorphometrical, and immunohistochemical results showed no statistical differences between groups. CONCLUSION: Anorganic bovine bone and porcine bone mineral combined with maxillary autogenous cortical bone show similar biologic and radiologic features in terms of biomaterial resorption, osteoconduction, and osteogenesis when used for maxillary sinus floor augmentation.
Assuntos
Substitutos Ósseos , Levantamento do Assoalho do Seio Maxilar , Animais , Materiais Biocompatíveis , Substitutos Ósseos/farmacologia , Substitutos Ósseos/uso terapêutico , Transplante Ósseo/métodos , Bovinos , Implantação Dentária Endóssea , Xenoenxertos , Humanos , Seio Maxilar/cirurgia , Minerais/uso terapêutico , Boca , Levantamento do Assoalho do Seio Maxilar/métodos , SuínosRESUMO
One common complication with dental implants placed in the atrophic posterior maxilla, especially with simultaneous transcrestal sinus augmentation, is the implant protruding into the sinus without apical bone support. Frequently, apically exposed implants contribute to various sinus pathologies that may lead to implant failure. Treatment options include (1) managing asymptomatic sinus pathology; (2) regrafting the apically exposed portion of the implant(s); and (3) removing the implant and placing a new implant with simultaneous grafting. The purpose of this case report is to present 4 clinical cases of apically exposed implants in the maxillary sinus. The report will cover: (1) exposed implants with asymptomatic sinus pathologies and (2) show successful management of protruding implants and pathologies using maxillary sinus floor augmentation. Various methods of implant surface detoxification, mechanical and chemical, are described for predictable bone remodeling around existing implants as well as newly installed implants. After 6 months of healing, osseointegration was well achieved for all implants and sinonasal complications were not observed. Clinical photographs and 3-dimensional imaging of surgical sites were used to validate clinical assessments.
Assuntos
Implantes Dentários , Levantamento do Assoalho do Seio Maxilar , Humanos , Levantamento do Assoalho do Seio Maxilar/métodos , Implantação Dentária Endóssea/métodos , Seio Maxilar/cirurgia , Maxila/cirurgiaRESUMO
OBJECTIVE: The present study was designed to explore endurable pressure intensity of different paranasal sinus mucosa in goats. METHOD: Mucosa commonly involved in maxillary sinus augmentation, including mucosa from maxillary sinus crest, maxillary sinus floor, and frontal sinus, were harvested in a computed tomography-guided manner. The obtained mucosa was then sectioned into square and irregular ones for maximum endurable pressure intensity determination and morphological observation, respectively. RESULTS: Thickness of paranasal sinus mucosa, as determined under morphological staining by an optical microscope with a graduated eyepiece, were calculated. And the results showed that the average thickness of maxillary sinus crest mucosa, floor mucosa, and frontal sinus mucosa in goats were 410.03 ± 65.97 µm, 461.33 ± 91.37 µm and 216.90 ± 46.47 µm, respectively. Significant differences between maxillary sinus crest and frontal sinus, maxillary sinus floor, and frontal sinus were observed (P < 0.05). Maximum endurable pressure intensity was determined by utilizing a self-made clamp device and the results revealed maximum endurable pressure intensity of maxillary sinus crest mucosa, floor mucosa and frontal sinus mucosa in goats were 260.08 ± 80.12Kpa, 306.90 ± 94.37Kpa and 121.72 ± 31.72Kpa, respectively. Also, a statistically significant difference was observed when comparing the endurable pressure intensity between maxillary sinus crest and frontal sinus, maxillary sinus floor, and frontal sinus (P < 0.05). Further correlation analysis also revealed a positive correlation between the thickness of mucosa of the maxillary sinus and frontal sinus and maximum endurable pressure intensity (P < 0.05). CONCLUSION: Mucosal thickness and maximum endurable pressure intensity of maxillary sinus crest and floor were larger than that of frontal sinus mucosa and a positive correlation between the thickness of mucosa and endurable pressure intensity was observed. Our results thus might provide an experimental basis and guidance for mucosa-related problems involved maxillary sinus augmentation.
Assuntos
Levantamento do Assoalho do Seio Maxilar , Animais , Cabras , Humanos , Maxila , Seio Maxilar/anatomia & histologia , Seio Maxilar/diagnóstico por imagem , Mucosa , Levantamento do Assoalho do Seio Maxilar/métodosRESUMO
The cause and pathogenicity of grafting voids following lateral maxillary sinus augmentation (MSA) have not yet been elucidated. The first purpose of this case series is to introduce an unusually large grafting void that radiologically resembles a surgical ciliated cyst (SCC) at the sinus augmented site; the second is to observe the histological findings of these grafting voids. In four patients, MSA was performed using the lateral window technique. An unusually large grafting void appeared on cone-beam-computed tomography (CBCT) taken one week after surgery and except for one patient, there were no clinical symptoms. On CBCT taken six months after surgery, the grafting voids were slightly smaller in size but showed radiographic findings similar to those of SCC. During uncovering, grafting voids were removed through the lateral window site. Histologically, the grafting void was empty or filled with dense connective tissue, and no ciliated columnar epithelium or inflammatory cells were observed. Within the limitations of this case series, the large grafting voids generated after MSA was not converted to SCCs. Rather, they remained scar tissue, which could infringe the sinus bone graft and affect the apical bone support of the implant.
Assuntos
Cistos , Seio Maxilar , Transplante Ósseo/métodos , Tomografia Computadorizada de Feixe Cônico/métodos , Cistos/cirurgia , Humanos , Maxila/cirurgia , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/cirurgiaRESUMO
Mucociliary clearance (MCC) allows ventilation of graft particles that are displaced through a perforated Schneiderian membrane during maxillary sinus augmentation (MSA). However, it is very rarely confirmed by cone-beam computed tomographic (CBCT) images. It is not yet known how long the dislodged bone graft particles remain in the maxillary sinus or how quickly they are ventilated after MSA. The purpose of these case reports is to introduce tomographic imaging of ventilation of bone graft particles displaced through a perforated Schneiderian membrane after MSA. Four patients, who needed implant placement in the posterior maxilla, received MSA, during which the Schneiderian membrane was perforated but was not repaired. Therefore, some bone graft particles were dislocated into the sinus cavity. The sizes of the perforated membranes were measured and recorded. CBCT scans were taken at multiple time points after the surgery to visualize and trace the ejected material. In addition, the time from when the bone graft substitute was delivered to the sinus until the CBCT scans were taken was recorded. The expelled bone graft particles migrated to the ostium along the sinus wall immediately after MSA on CBCT images taken immediately after the surgery. No displaced graft particles were observed in the maxillary sinus on CBCT scans after 1 week. The CBCT scans at 6 months showed no unusual radiographic images. Within the limitations of the case reports, tomographic imaging revealed an MCC system that allows displaced graft particles to be ventilated into the ostium very early during MSA healing and not stagnate in the maxillary sinus.
Assuntos
Substitutos Ósseos , Seio Maxilar , Substitutos Ósseos/uso terapêutico , Transplante Ósseo/métodos , Tomografia Computadorizada de Feixe Cônico/métodos , Humanos , Maxila/cirurgia , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/cirurgia , Depuração MucociliarRESUMO
OBJECTIVES: To analyze a modified biphasic phycogenic biomaterial in comparison with anorganic bovine bone in maxillary sinus floor elevation in humans. MATERIAL AND METHODS: Eight male patients in need of bilateral two-stage sinus floor elevation were consecutively recruited for this randomized split-mouth study. A combination of autogenous cortical bone (ACB, 20%) and anorganic bovine bone (ABB, 80%) (ACB + ABB group) or ACB (20%) and modified biphasic phycogenic material (BP, 80%) (ACB + BP group) were randomly assigned to graft each sinus. Patients were followed up for 6 months post-surgery when bone samples were collected for analysis. RESULTS: Radiographically, bone height gain was statistically higher in the ACB + ABB versus the ACB + BP group. While the analysis of the biological compartments showed differences in non-mineralized tissue (39.15 ± 20.97% vs. 65.87 ± 28.59%, ACB + ABB vs. ACB + BP respectively; p = .018) and remnant biomaterial particles (22.62 ± 17.01% vs. 7.96 ± 8.57%, respectively; p = .028), the percentage of mineralized tissue (38.23 ± 17.55% vs. 24.14 ± 24.66%, respectively; p = .398) showed no statistically significant difference. In contrast, ACB + ABB biopsies showed higher Musashi-1-positive cells per mm2 compared to ACB + BP biopsies (811.49 ± 875.30 vs. 236.90 ± 280.81; p < .018), where the fusiform cells corresponded mainly with fibroblasts, as demonstrated by ultrastructural analysis. CONCLUSION: Both combinations of materials exhibited bone formation after 6 months of healing in the maxillary sinus cavity. However, the combination with biphasic phycogenic biomaterial induced a higher radiographical vertical resorption and graft collapse in comparison with the combination with anorganic bovine bone, possibly due to a higher remodeling of the graft.
Assuntos
Substitutos Ósseos , Levantamento do Assoalho do Seio Maxilar , Animais , Materiais Biocompatíveis , Transplante Ósseo , Bovinos , Durapatita , Humanos , Masculino , Seio Maxilar , BocaRESUMO
The anatomical variations of the maxillary sinus septa, greater palatine artery, and posterior superior alveolar arteries might cause unexpected complications when they are damaged. Dentists who know these structures well might hope to learn more practical knowledge to avoid and assess injury preoperatively. Therefore, this review paper aimed to review the reported anatomy and variations of the maxillary sinus septa, greater palatine artery/nerve, and posterior superior alveolar artery, and to discuss what has to be assessed preoperatively to avoid iatrogenic injury. To assess the risk of injury of surgically significant anatomical structures in the maxillary sinus and hard palate, the operator should have preoperative three-dimensional images in their mind based on anatomical knowledge and palpation. Additionally, knowledge of the average measurement results from previous studies is important.
Assuntos
Variação Anatômica , Implantação Dentária Endóssea/efeitos adversos , Complicações Intraoperatórias/prevenção & controle , Seio Maxilar/anormalidades , Tomografia Computadorizada de Feixe Cônico , Implantação Dentária Endóssea/métodos , Gengiva/transplante , Humanos , Imageamento Tridimensional , Complicações Intraoperatórias/etiologia , Artéria Maxilar/anatomia & histologia , Artéria Maxilar/diagnóstico por imagem , Artéria Maxilar/lesões , Nervo Maxilar/anatomia & histologia , Nervo Maxilar/diagnóstico por imagem , Nervo Maxilar/lesões , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/cirurgia , Osteotomia de Le Fort/efeitos adversos , Palato Duro/irrigação sanguínea , Palato Duro/diagnóstico por imagem , Palato Duro/inervação , Fatores de Risco , Levantamento do Assoalho do Seio Maxilar/efeitos adversos , Coleta de Tecidos e Órgãos/efeitos adversosRESUMO
OBJECTIVES: The aim of this study was to evaluate and compare the morphometric components and the histological properties of pristine bone and bone grafted with a biphasic ß-tricalcium phosphate in humans using the maxillary sinus model. Reparative mesenchymal stem cells in the pristine bone and graft were also evaluated. MATERIALS AND METHODS: For this prospective case series, sinus augmentation was performed using a biphasic ß-tricalcium phosphate. After 6 months of healing, a core of remnant native alveolar bone and grafted bone was collected with a trephine. Histological, histomorphometrical, and immunohistochemical techniques were performed. Radiological analysis through cone beam computerized tomography was also conducted. RESULTS: A total of 10 patients were enrolled in this study. Radiologically, patients showed an average increase of crestal bone of 8.03 ± 1.72 mm. Morphologically, the grafted area was composed by 34.93 ± 14.68% of new mineralized tissue, 9.82 ± 11.42% of remnant biomaterial particles, and 55.23 ± 11.03% non-mineralized tissue. Histologically, we found no differences in the number of osteocytes per mm2 (p = 0.674), osteoblasts (p = 0.893), and blood vessels (p = 0.894) in the grafted area compared to the pristine bone. Differences were found on the number of osteoclasts (15.57 ± 27.50 vs. 5.37 ± 16.12, p = 0.027). The number of Musashi-1 positive mesenchymal cells (239.61 ± 177.4 vs. 42.11 ± 52.82, p = 0.027) was also significantly higher in the grafted area than in the pristine bone. CONCLUSION: Biphasic ß-tricalcium phosphate is a suitable biomaterial to be used in the formation of new bone in sinus floor elevation procedures in humans, not only from the histomorphometrical point of view, but also regarding the cellular and vascular quality of the regenerated bone.
Assuntos
Substitutos Ósseos , Levantamento do Assoalho do Seio Maxilar , Materiais Biocompatíveis , Fosfatos de Cálcio , Durapatita , Humanos , Seio Maxilar , Estudos ProspectivosRESUMO
OBJECTIVES: To evaluate the effect of leukocyte and platelet-rich fibrin (L-PRF) in combination with deproteinized bovine bone mineral (DBBM) on bone regeneration in maxillary sinus augmentation. MATERIAL AND METHODS: Thirteen patients (nine males and four females, mean age ± SD; 49.92 ± 10.37) were enrolled to the study. 26 maxillary sinus augmentation procedures were randomly performed using DBBM and L-PRF mixture (test) or DBBM alone (control) in a split-mouth design. The same surgical procedures were performed in both groups, and bone biopsies were harvested from the implant sites 6 months postoperatively for histological and histomorphometric evaluations as the primary outcome of the study. Implants were placed and then loaded in the augmented sites after 6 months. The secondary outcomes included clinical and radiographic data and were obtained pre- and postoperatively. RESULTS: There was no qualitative difference in histological analyses among the groups. In all samples, a newly formed bone was in direct contact with the residual material. The percentages of newly formed bone (test; 21.38 ± 8.78% and control; 21.25 ± 5.59%), residual bone graft (test; 25.95 ± 9.54% and control; 32.79 ± 5.89%), bone graft in contact with the newly formed bone (test; 47.33 ± 12.33% and control; 54.04 ± 8.36%), and soft tissue (test; 52.67 ± 12.53% and control; 45.96 ± 8.36%) were similar among the groups (p < .05). Similar radiographic bone height in the augmented area was observed, and implant survival rate was 100% for both groups. CONCLUSIONS: Both techniques were effective for maxillary sinus augmentation, and after 6 months of healing, the addition of L-PRF in DBBM did not improve the amount of regenerated bone or the amount of the graft integrated into the newly formed bone under histological and histomorphometric evaluation.
Assuntos
Regeneração Óssea , Substitutos Ósseos , Seio Maxilar/anatomia & histologia , Minerais , Fibrina Rica em Plaquetas , Levantamento do Assoalho do Seio Maxilar/métodos , Adulto , Animais , Bovinos , Feminino , Humanos , Leucócitos , Masculino , Seio Maxilar/cirurgia , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To compare the clinical and histologic outcomes of two different grafting materials (allograft and xenograft) when combined with autogenous bone and covered with a collagen membrane for sinus augmentation. MATERIAL AND METHODS: A parallel case series of fourteen patients in need of a unilateral sinus augmentation was evaluated in this study. Seven patients received a graft composed by autologous cortical bone (ACB) and anorganic bovine bone in a ratio of 1:1; the other seven patients received ACB mixed with an allograft in the same ratio. Bone biopsies were obtained 6 months after sinus augmentation at the time of implant placement. Comparative histomorphometrical, histopathological, and immunohistochemical analyses were conducted and statistically analyzed. RESULTS: After 12 months of functional loading, all implants in both groups were clinical and radiographically successful. Histomorphometrically, although the initial bone formation was not significantly different between groups (new mineralized tissue: 41.03(12.87)% vs. 34.50(13.18)%, p = .620; allograft vs. xenograft groups), the graft resorbed faster in the allograft group (remnant graft particles: 9.83[7.77]% vs. 21.71[17.88]%; p = .026; allograft vs. xenograft groups). Non-mineralized tissue did not statistically differ either (49.00[14.32]% vs. 43.79[19.90]%; p = .710; allograft vs. xenograft groups). The histologic analyses revealed higher cellular content, four times more osteoid lines, and higher vascularization in the xenograft group. Musashi-1 (mesenchymal stromal cell marker) was also more intensively expressed in the xenograft group (p = .019). CONCLUSIONS: Both composite grafts generate adequate substratum to receive dental implants after healing. Compared with the xenograft composite, allograft composite shows faster turnover and a quicker decrease in biological action after 6 months.
Assuntos
Transplante Ósseo/métodos , Levantamento do Assoalho do Seio Maxilar/métodos , Idoso , Aloenxertos , Processo Alveolar/patologia , Animais , Bovinos , Implantação Dentária Endóssea/métodos , Feminino , Xenoenxertos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVES: The objective of this study was to determine the validity of a graft-free sinus floor elevation (SFE) procedure with simultaneous placement of recombinant morphogenetic protein-2 (rhBMP-2)-coated implants compared to uncoated control implants. METHODS: In 10 rabbits, SFE was performed on both sides. Dental implants were randomly placed in the sinus filled with a blood clot. Test implants were coated with rhBMP-2, whereas in the control group, implants were uncoated. Micro-computed tomographic and histomophometric analyses were performed at 4 and 8 weeks, including measurement for newly formed bone height (NBHm). RESULTS: Bone formation was evident along the implant surfaces up to the apex in test, but limited in control implants at 4 weeks. NBHm amounted to 5.1 mm (Q1 = 4.1; Q3 = 5.3) for test implants and to 3.4 mm (2.6; 3.7) for control implants at 4 weeks. NBHm then decreased to 8 weeks (3.4 mm (3.3; 3.7)) for test implants, whereas in control sites, NBHm increased slightly to 4.4 mm (4.1; 4.5) (p = 0.1250; p = 0.6250). CONCLUSIONS: Implants coated with rhBMP-2 presented a strong osteogenic reaction at 4 weeks with more favorable outcomes in terms of bone formation along the implant surface up to the apex compared to uncoated control implants. Remodeling and resorption process between 4 and 8 weeks did not further improve the outcomes in the test, but in the control group. CLINICAL RELEVANCE: The use of rhBMP-2-coated implants in a graft-free SFE might show an advantage in early implant stability to prevent collapse of membrane. However, a potential clinical benefit still needs to be proven.
Assuntos
Proteína Morfogenética Óssea 2/farmacologia , Implantação Dentária Endóssea/métodos , Implantes Dentários , Osteogênese/efeitos dos fármacos , Levantamento do Assoalho do Seio Maxilar/métodos , Fator de Crescimento Transformador beta/farmacologia , Microtomografia por Raio-X , Animais , Materiais Revestidos Biocompatíveis , Planejamento de Prótese Dentária , Humanos , Implantes Experimentais , Masculino , Coelhos , Proteínas Recombinantes/farmacologiaRESUMO
OBJECTIVE: To assess the impact of a hydrophilic implant surface (SLActive® ) placed into augmented maxillary sinuses on bone-to-implant contact (BIC) and surrounding tissue composition when compared to a hydrophobic surface (SLA® ). MATERIAL AND METHODS: Four sheep underwent bilateral sinus augmentation. Each sinus received anorganic bovine bone mineral + autogenous bone (ABBM + AB). Sixteen implants were subsequently placed 12 weeks postgrafting with each sinus receiving a control (SLA® ) and test implant (SLActive® ). Two animals were sacrificed at 2 weeks and another two animals were sacrificed at 4 weeks postimplantation. The eight sinuses and 16 implants were processed for histomorphometry, which assessed bone-to-implant contact (%BIC) and tissue elements (woven bone - WB, lamellar bone - LB, soft tissue - ST) in the interthread region of implants within the augmented sinus. RESULTS: There was a statistically significant increase in %BIC at week 4 compared to the week 2 animals in both test (P < 0.005) and control (P < 0.005) groups. There was a statistically significant greater %BIC around test implants when compared to control implants in both week 2 (P < 0.05) and week 4 animals (P < 0.05). Greater %WB (11.17% ±6.82) and %LB (11.06% ±3.67) were seen in the test implants when compared to the control implants independent of time. This was only statistically significant for %LB (P < 0.05). A statistically significant reduction of 16.78% (±6.19) in %ST was noted in test implants when compared to control implants (P < 0.05) independent of time. CONCLUSION: Both time and the use of hydrophilic implant surface had a positive impact on %BIC around implants placed into augmented maxillary sinuses. Hydrophilic implant surfaces also had a positive impact on surrounding tissue composition. Larger trials are needed to better assess and detect differences between these two surfaces in augmented maxillary sinuses.
Assuntos
Implantação Dentária Endóssea/métodos , Implantes Dentários , Levantamento do Assoalho do Seio Maxilar/métodos , Animais , Interface Osso-Implante/patologia , Bovinos , Implantação Dentária Endóssea/instrumentação , Osseointegração , Projetos Piloto , OvinosRESUMO
OBJECTIVES: Sinus floor augmentation using transalveolar techniques is a successful and predictable procedure. The aim of the study was to compare the performance of conventional hand instruments using mallets and osteotomes with that of piezoelectric-hydrodynamic devices for maxillary sinus floor elevation. MATERIAL AND METHODS: In 17 undamaged cadaver heads on randomly allocated sites, Schneiderian membrane elevation was carried out transcrestally using piezosurgery and a hydrodynamic device or by conventional hand instrumentation. After simulation of sinus augmentation by the use of a radiopaque impression material, a post-operative CT scan was carried out and volumes were determined. Statistic significant differences between the two methods were evaluated by nonparametric Mann-Whitney U-test with P < 0.05. RESULTS: A mean graft volume of 0.29 ± 0.18 cm(3) (0.07-0.60 cm(3)) was measured for the Summers' technique compared to 0.39 ± 0.32 cm(3) (0.05-1.04 cm(3)) for the Sinus Physiolift(®) technique. There is no statistically significant difference with regard to trauma to the Schneiderian membrane or augmented volume. CONCLUSIONS: Both techniques generate expedient augmentation volume in the posterior atrophic maxilla. The piezoelectric technique can be recommended as an alternative tool to graft the floor of human maxillary sinuses.
Assuntos
Osteotomia/instrumentação , Piezocirurgia/métodos , Levantamento do Assoalho do Seio Maxilar/métodos , Cadáver , Humanos , Mucosa Nasal/lesões , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To histomorphometrically compare the use of collagen-stabilized anorganic bovine bone (ABBM-C) (test) to anorganic bovine bone + autogenous bone (ABBM + AB) (control) in maxillary sinus augmentation. MATERIALS AND METHODS: Nine sheep underwent bilateral sinus augmentation. Each sinus was randomized to receive either control or test bone graft. Three animals were sacrificed at 8 weeks, and six animals were sacrificed at 16 weeks post-grafting. The 18 sinuses were processed for histomorphometry, which assessed the area fraction of new bone (%NB), residual graft (%RG) and soft tissue components (% STM), as well as graft particle osseointegration (% OI), within three zones equally distributed from the augmented sinus floor. RESULTS: At week 16, a significant increase in %NB was evident across all three zones in the control group when compared to week 8. A significantly greater %NB was evident in the control group when compared to the test group in zones 2 (P < 0.001) and 3 (P < 0.001). There was a significant increase in %OI in week 16 when compared to week 8 across all three zones in the control group (P < 0.001). %OI in the control group was significantly greater across all three zones when compared to the test group at week 16 (P < 0.001). Zone was found to be a significant main effect (P < 0.001) that was independent of time and treatment with decreasing %OI in distant zones. %RG did not significantly change with time for both groups. There was a significant reduction in %ST in week 16 when compared to week 8 across all three zones in the control group (P < 0.001). %ST in the test group was significantly greater across all zones when compared to the control group at week 16 (P < 0.001). CONCLUSION: Both groups exhibited very similar histomorphometric measurements in the zones proximal to the resident sinus wall. The % NB and % OI were greatest in the zones proximal to resident bony walls and gradually decreased as the distance from the proximal walls increased. There was greater % NB and % OI in the control group when compared to the test group in the distant zone.
Assuntos
Transplante Ósseo/métodos , Colágeno/farmacologia , Seio Maxilar/patologia , Minerais/farmacologia , Levantamento do Assoalho do Seio Maxilar/métodos , Animais , Bovinos , Seio Maxilar/cirurgia , Modelos Animais , OvinosRESUMO
OBJECTIVE: To histomorphometrically compare the use of collagen-stabilized anorganic bovine bone (ABBM-C) (test) to anorganic bovine bone + autogenous bone (ABBM + AB) (control) in maxillary sinus augmentation. MATERIALS AND METHODS: Forty (n = 40 sinuses) patients underwent sinus augmentation and received either control (20 sinuses) or test bone graft (20 sinuses). Bone samples were harvested from the augmented sinuses 5 months postgrafting. The samples were processed for histomorphometry, which assessed within the primary region of interest (ROI-1), the area fraction of new bone (%NB), graft particle osseointegration (% OI), residual graft (%RG), and soft tissue components (% STM). The same analysis was also carried out in a second region of interest (ROI-2) located in a zone 1 mm proximal to the previous maxillary sinus floor. RESULTS: In both ROI-1 and ROI-2, the mean % NB, %RG, and %STM in the control group were similar to mean values in the test group. The % OI was significantly greater in the control group (42.0 +/- 26.8) when compared to the test group (19.6 +/- 27.3) in ROI-2 (P < 0.05). No statistically significant differences were seen when ROI-1 and ROI-2 were compared except for improved %OI in ROI-2 in the control group. The mean proportion of lamellar bone to woven bone in the control group (1.22 ± 1.48) was significantly greater than the test group (0.38 ± 0.29) (P < 0.05). CONCLUSION: ABBM-C exhibited very similar histomorphometric parameters to the composite graft of ABBM + AB. The ABBM + AB group was more mature as indicated by the significantly greater proportion of lamellar bone when compared to the ABBM-C. Improved % OI was seen in the zone proximal to the resident bony floor in the ABBM + AB group. Based on histological assessment, ABBM-C is a suitable bone substitute for the purposes of maxillary sinus augmentation. Its clinical utility may be indicated in cases of sinus membrane perforation and insufficient autogenous bone in the local area.
Assuntos
Seio Maxilar/patologia , Seio Maxilar/cirurgia , Osseointegração , Levantamento do Assoalho do Seio Maxilar , Animais , Bovinos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Pré-Protéticos Bucais , Estudos Prospectivos , Transplante HeterólogoRESUMO
PURPOSE: To retrospectively assess the changes of the vertical height of the maxillary sinus floor after augmentation with simultaneous and delayed placement of implants. MATERIALS AND METHODS: In total, 38 patients with 76 implants were involved; vertical bone height of the sinus floor was radiographically measured at different stages including preoperation, immediately postsurgery, 6 and 12 months postsurgery, and 6 and 24 months postfunctional loading. RESULTS: Sinus augmentation significantly increased vertical bone height of the sinus floor for both the simultaneous and delayed groups. The survival rate was 100% in the simultaneous group and 95.46% in the delayed group. For simultaneous placement, the vertical bone height of the sinus floor at 6 and 12 months postsurgery was significantly less than that immediately postsurgery. For both groups, augmented bone height of the sinus floor showed significant decrease from 6 months to 24 months postfunctional loading. The mean value of final bone augmentation was 5.85 mm for simultaneous placement and 5.80 mm for delayed placements. CONCLUSION: Sinus augmentation with simultaneous and delayed placement of implants led to similar survival rates and bone augmentation. Resorption of augmentative bone was evident at 24 months postfunctional loading in both cases.
Assuntos
Implantes Dentários , Seio Maxilar , Levantamento do Assoalho do Seio Maxilar , Implantação Dentária Endóssea , Seguimentos , Humanos , MaxilaRESUMO
AIM: The aim of this study was to analyze marginal bone loss (MBL) rates around implants to establish the difference between physiological bone loss and bone loss due to peri-implantitis. MATERIALS AND METHODS: Five hundred and eight implants were placed in the posterior maxilla in 208 patients. Data were gathered on age, gender, bone substratum (grafted or pristine), prosthetic connection, smoking and alcohol habits, and previous periodontitis. MBL was radiographically analyzed in three time frames (5 months post-surgery and at 6 and 18 months post-loading). Nonparametric receiver operating curve (ROC) analysis and mixed linear model analysis were used to determine whether implants could be classified as high or low bone loser type (BLT) and to establish the influence of this factor on MBL rates. RESULTS: Marginal bone loss rates were significantly affected by BLT, connection type, bone substratum, and smoking. Bone loss rates at 18 months were associated with initial bone loss rates: 96% of implants with an MBL of >2 mm at 18 months had lost 0.44 mm or more at 6 months post-loading. CONCLUSION: Implants with increased MBL rates at early stages (healing and immediate post-loading periods) are likely to reach MBL values that compromise their final outcome. Initial (healing, immediate post-loading) MBL rates around an implant of more than 0.44 mm/year are an indication of peri-implant bone loss progression.
Assuntos
Perda do Osso Alveolar/etiologia , Implantação Dentária Endóssea , Implantes Dentários , Peri-Implantite/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda do Osso Alveolar/diagnóstico por imagem , Substitutos Ósseos/uso terapêutico , Feminino , Humanos , Masculino , Maxila/diagnóstico por imagem , Maxila/cirurgia , Pessoa de Meia-Idade , Minerais/uso terapêutico , Peri-Implantite/diagnóstico por imagem , Radiografia Panorâmica , Estudos Retrospectivos , Resultado do TratamentoRESUMO
This article reports a rare case of a horizontally displaced dental implant that migrated into the maxillary sinus 6 months after 3 implants were inserted into the augmented maxillary posterior region. Migration of dental implants into the maxillary sinus usually occurs during surgery and can result in serious complications.