Fig. 8. Photomicrographs of decalcified sections. a Untreated site. Woven bone formed from the sinus walls after 1 week of healing. b Treated site. After 8 weeks, woven bone was still found forming ridges towards residues of provisional matrix, showing that the healing was not completed yet. Scarlet-acid fuchsine and toluidine blue stain. a × 100 magnification. b × 20 magnification
...
Fig. 7. Box-plot representing the new bone percentage and standard deviations (whiskers) found in the various regions evaluated after 8 weeks of healing. (*), a statistical significant difference
Fig. 7. Box-plot representing the new bone percentage and standard deviations (whiskers) found in the various regions evaluated after 8 weeks of healing. (*), a statistical significant difference
Fig. 6. Photomicrographs of decalcified sections illustrating the healing after 8 weeks. a Treated site. Most of the antrostomies presented remaining defects in the outer contour. b, c Untreated sites. Two antrostomies of the treated sites and four of the untreated sites appeared not closed with corticalized bone and presented connective tissue interposed between the edges of the antrostomy. S...
Fig. 5. Photomicrographs of decalcified sections illustrating the healing after 8 weeks. Both at the treated (a) and untreated (b) sites, the antrostomy was closed in most cases, presenting residual defects of various dimensions in the outer side. New bone was connecting the lateral and medial sinus walls. The middle and sub-mucosa regions were not healed completely yet. Scarlet-acid fuchsine ...
Fig. 4. Photomicrographs of ground sections. a) Treated site. Bone residues (examples in yellow asterisks) included in soft tissue containing fibroblast-like cells and inflammatory cells. b) Untreated site. Xenograft residues (examples in red asterisks) surrounded by soft tissue rich in fibroblast-like cells. Scarlet-acid fuchsine and toluidine blue stain. a) 200 x magnification.; b) 100 x magni...
Fig. 3. Photomicrographs of decalcified sections illustrating the healing after 1 week. a Treated site. Bone strips occupying the antrostomy and the subjacent area (close-to-window region). b Untreated site. Note the new bone-forming from the sinus bone walls. Scarlet-acid fuchsine and toluidine blue stain. Images grabbed at × 20 magnification
Fig. 3. Photomicrographs of decalcified sect...
Fig. 2. The various regions evaluated at the histomorphometric analyses. Bone walls (red arrow); middle (white arrow); sub-mucosa (yellow arrow); close-to-window (orange arrow). The antrostomy region was also evaluated at the medial and lateral edges (dark green arrows) and in the middle aspect (light green arrow)
Fig. 2. The various regions evaluated at the histomorphometric analyses. Bone w...
Fig. 1. Clinical view of the surgical procedures. a Tibial bone exposed for autogenous bone harvesting using a bone scraper. b Antrostomies prepared. c Autogenous bone particles placed in the antrostomy. d Xenograft and bone particles (red arrow) at the antrostomies. e Collagen membranes placed on the antrostomies. f Wounds closed with sutures
Fig. 1. Clinical view of the surgical procedures....
AntrostomySinus regions EdgesCenterTotalClose-to-windowMiddleSub-mucosaBone wallsTotalNew boneTreated sites40.3 ± 21.337.8 (27.0;56.0)24.3 ± 23.222.0 (3.4;42.2)35.5 ± 20.927.7 (23.3;52.0)25.8* ± 16.122.9 (15.2;39.7)19.5 ± 16.711.7 (10.1;22.3)22.5 ± 11.620.4 (12.6;31.3)38.0 ± 15.044.8 (31.8;47.5)27.9 ± 12.930.1 (19.6;34.5)Untreated sites32.2 ± 22....
AntrostomySinus regions EdgesCenterTotalClose-to-windowMiddleSub-mucosaBone wallsTotalNew boneTreated sites9.2 ± 10.6 4.6 (3.2;12.5)5.2 ± 13.90.0 (0.0;0.5)7.7 ± 11.22.7 (1.9;7.9)0.6 ± 1.00.0 (0.0;0.7)0.0 ± 0.00.0 (0.0;0.0)1.4 ± 1.80.8 (0.0;2.2)7.7 ± 6.38.2 (1.3;11.1)2.8 ± 2.62.2 (0.7;4.0)Untreated sites8.9 ± 8.5 6.2 (4.0;10.8)1.0 ± 2.70.0 (0....
Favero, G., Viña-Almunia, J., Carda, C. et al. Influence of the use of autogenous bone particles to close the access window after maxillary sinus floor augmentation: an experimental study in rabbits.
Int J Implant Dent 6, 9 (2020). https://doi.org/10.1186/s40729-020-0206-2
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Received: 20 October 2019
Accepted: 21 January 2020
Published: 04 March 2020
DOI:...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
The present research was approved by the Ethics Committee of Valencia University, Spain. Reference number: A1434714637496.
Not applicable.
Daniele Botticelli declares to be the co-owner of Ariminum Odontologica. Giacomo Favero, Jose Viña-Almunia, Carmen Carda, José Javier Martín de Llano, Berta García-Mira, David Soto-Peñaloza, Daniele Botticelli, and Miguel Peñarrocha-Diago declare that t...
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GF participated in the concept/design, data analysis/interpretation, drafting of the article and surgical procedures. JV-A performed the surgical procedures, made the follow up of the animals, participated in the manuscript revision and ethical committee redaction and approval. BG-M and DS-P performed the surgi...
Private practice, London, UK
Giacomo Favero
Oral Surgery Unit. Department of Stomatology, Faculty of Medicine and Dentistry, Clinica Odontológica, University of Valencia, Valencia, Spain
Jose Viña-Almunia, Berta García-Mira, David Soto-Peñaloza & Miguel Peñarrocha-Diago
Department of Pathology and Health Research Institute of the Hospital Clínico (INCLIVA), Faculty of Medicine and De...
Funds from the present have been provided by ARDEC Academy, by Ariminum Odontologica s.r.l., Rimini, Italy and Tecnoss srl, Giaveno, Italy. The biomaterials use were provided free of charge by Tecnoss srl, Giaveno, Italy.
Favero V, Lang NP, Canullo L, Urbizo Velez J, Bengazi F, Botticelli D. Sinus floor elevation outcomes following perforation of the Schneiderian membrane. An experimental study in sheep. Clin Oral Implants Res. 2016;27(2):233–40.
Scala A, Lang NP, Velez JU, Favero R, Bengazi F, Botticelli D. Effects of a collagen membrane positioned between augmentation material and the sinus mucosa in the eleva...
Kawakami S, Lang NP, Ferri M, Apaza Alccayhuaman KA, Botticelli D. Influence of the height of the antrostomy in sinus floor elevation assessed by cone beam computed tomography- a randomized clinical trial. Int J Oral Maxillofac Implants. 2019;34(1):223–32.
Kawakami S, Lang NP, Iida T, Ferri M, Apaza Alccayhuaman KA, Botticelli D. Influence of the position of the antrostomy in sinus floor elevat...
Tatum, H., Jr. Maxillary sinus grafting for endosseous implants. Lecture presented at the Annual Meeting of the Alabama Implant Study Group (1977); cited in Smiler, D.G., Johnson, P.W., Lozada, J.L., Misch, C., Rosenlicht, J.L., Tatum, O.H. Jr. & Wagner J.R. Sinus lift grafts and endosseous implants. Treatment of the atrophic posterior maxilla. Dental clinics of North America. 1992;36:151–186.
...
Animal Research Reporting In Vivo Experiments
Cone beam computed tomography
Deproteinized bovine bone mineral
Tricalcium phosphate
The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.
The lower phylogenetic level of the animals compared to humans was the main limitation of the present study. An increased number of animals might allow reaching a statistical difference in favor of the treated sites also in the antrostomy region. Nevertheless, the outcomes obtained, allow to performing studies in humans that might demonstrate the advantages of applying autologous bone on the antro...
In both studies presented above on sinus floor elevation in sheep, all the lateral windows were prepared using a piezoelectric device. In an experiment in rabbits [21], the antrostomies were done with either a sonic instrument or drills to evaluate differences in bone formation in the antrostomy. Elevated space is filled with a collagenated porcine bone similar that used in the present experiment,...
The present experiment aimed to study the influence on the healing after the placement of autogenous bone on the antrostomy and in the subjacent region after maxillary sinus elevation. After 8 weeks of healing, in the antrostomy region, a trend of higher bone formation in the treated compared to the untreated sites was observed. No statistically significant difference was found. In the subjacent ...
After 1 week of healing (Table 1), in the close-to-window region, the proportions of xenograft were 21.3 ± 14.7% and 55.9 ± 19.0 (p = 0.012) in the treated and untreated sites, respectively. After 8 weeks of healing (Table 2), these values decreased to a similar percentage (15.5 ± 14.4% and to 15.5 ± 14.2%; p = 0.917, respectively).
After 1 week of healing (Table...
Biopsies could be harvested from all animals. However, histological sections could not be obtained from one rabbit of the 8 weeks group; therefore, eight and seven were achieved for the 1-week and 8-week periods, respectively.
After 1 week of healing, at the treated sites, the antrostomy and close-to-windows regions were occupied by a high proportion of residues of autogenous bone (Fig. 3a),...
Overlapping calibrated digital images of the tissues were recorded with Leica Applications Suite version 4.4.0 software from a bright field Leica DM4000 B microscope (Leica Microsystems GmbH, Wëtzlar, Germany) equipped with a 5× lens and DFC420 digital camera. Single images were pasted and merged to compose each elevated sinus using the program Photoshop (Adobe Photoshop CC 2015.0.0).
The histo...
Afterward, a trichotomy was performed in the nasal dorsum and, after disinfection of the experimental region using Betadine (MEDA Pharma®, Madrid, Spain), a sagittal incision was carried out. The skin and the periosteum were dissected and shifted laterally to expose the nasal bone. Antrostomies, 4 × 4 mm in dimensions, located about 3–4 mm laterally to the midline and about 10 mm in f...
Prior to the experiment, the protocol was approved by the Ethics Committee of Valencia University, Spain (A1434714637496). The guidelines indicated by the Council Directive of the European Union (53/2013; February 1, 2013) for animal experimentation and the ethical rules proposed by Royal Decree 223, March 14 and October 13, 1988, were fulfilled. The study was reported following the ARRIVE guideli...
Hence, the present experiment aimed to study the influence on healing, of the autogenous bone particle placement in the antrostomy and in the subjacent region after maxillary sinus elevation.
Maxillary sinus floor elevation through lateral access was first proposed in 1977 [1], while the technique was published in 1984 [2]. Several modifications in the surgical approach and the biomaterials used have been introduced over time [3,4,5]. In a systematic review with meta-analysis, it was concluded that the best survival rate was observed when implants with rough surface and membrane to cov...
To study the influence on the healing of the placement of particulate autogenous bone in the antrostomy and in the subjacent region after maxillary sinus elevation.
Sixteen New Zealand rabbits were undergone to bilateral maxillary sinus floor augmentation with 4 × 4 mm antrostomy dimension. The sinus mucosa was elevated, and the space obtained was filled with xenograft. In the test site (tr...
Fig. 6. Graph representing new bone and composite bone percentages within the elevated area
Fig. 6. Graph representing new bone and composite bone percentages within the elevated area
Fig. 5. Graph representing the tissue percentages within the elevated area. No statistically significant differences were found
Fig. 5. Graph representing the tissue percentages within the elevated area. No statistically significant differences were found
Fig. 4. Photomicrographs of ground sections after 4 months of healing. a Bone formed from the base of the sinus. b Bone plate connected by bridges of the new bone to the close-to-window region. c Particle of the graft surrounded by new bone. d Overexposed image to show the new bone ingrowth within the granules of biomaterial
Fig. 4. Photomicrographs of ground sections after 4 months of he...
Fig. 3. a The elevated area was divided into four regions for morphometric analysis. RED: submucosa; GREEN: middle; YELLOW: base; PURPLE: close-to-window. INC: top of the infraorbital nerve canal
Fig. 3. a The elevated area was divided into four regions for morphometric analysis. RED: submucosa; GREEN: middle; YELLOW: base; PURPLE: close-to-window. INC: top of the infraorbital nerve canal
Fig. 2. Clinical view at a bone plate site. a The bone window was removed. b The sinus mucosa was carefully elevated, and a twisted wire was placed. c The elevated sinus was grafted. d The access bony window was repositioned and secured with cyanoacrylate
Fig. 2. Clinical view at a bone plate site. a The bone window was removed. b The sinus mucosa was carefully elevated, and a twisted wire wa...
Fig. 1. Clinical view at a membrane site. a Skin and periosteum were separately elevated, and the facial sinus wall exposed. b A 12 × 8-mm window was cut and removed. c The Schneiderian membrane was carefully elevated. d A twisted wire was inserted in the middle of the long side of the window and the elevated sinus was grafted. e At the control site, a resorbable membrane was placed and secured...
BoneSoft tissuePure graftInterpenetrated graftComposite boneReplaced windowCenter61.5 ± 46.982.5 (22.2; 96.9)21.7 ± 22.6*17.5 (3.1; 34.4)2.3 ± 4.3*0.0 (0.0; 2.3)7.9 ± 19.30.0 (0.0; 0.0)69.3 ± 38.582.5 (57.6; 96.9)Edge37.2 ± 37.021.6 (16.8; 55.8)41.0 ± 39.833.6 (9.2; 64.9)5.3 ± 7.31.6 (0.0; 9.1)13.8 ± 19.0*6.7 (0.0; 19.7)54.8 ± 34.162.9 (37.5; 69.7)MembraneCenter5.8 ± 2.1 (P = 0.116)5....
New boneSoft tissuePure graftInterpenetrated graftComposite boneReplaced windowTotal16.4 ± 5.618.8 (13.8; 20.3)32.9 ± 8.031.2 (27.7; 37.0)13.6 ± 4.212.0 (10.8; 16.2)37.1 ± 7.534.4 (31.7; 43.4)53.5 ± 7.652.4 (50.8; 57.8)Base15.0 ± 7.216.4 (10.1; 20.1)38.6 ± 14.334.5 (28.9; 47.1)13.4 ± 6.415.3 (13.1; 17.0)33.1 ± 11.133.1 (26.8; 40.0)48.0 ± 18.149.9 (36.9; 59.7)Middle16.9 ± 7.318.1 (11.2...
Perini, A., Ferrante, G., Sivolella, S. et al. Bone plate repositioned over the antrostomy after sinus floor elevation: an experimental study in sheep. Int J Implant Dent 6, 11 (2020). https://doi.org/10.1186/s40729-020-0207-1
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Received: 01 October 2019
Accepted: 04 February 2020
Published: 18 March 2020
DOI: https://doi.org/10.1186/s40729-020-0207-1
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
The research protocol was submitted to and approved by the Ethical Committee of the University of Medical Sciences, School of Dentistry, Havana, Cuba (prot. 013/2013).
All the authors consent to publication.
Alessandro Perini, Giada Ferrante, Stefano Sivolella, Joaquín Urbizo Velez, Franco Bengazi, and Daniele Botticelli declare that they have no competing interests.
Correspondence to Alessandro Perini.
Department of Neuroscience, Division of Dentistry, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
Alessandro Perini, Giada Ferrante & Stefano Sivolella
Faculty of Dentistry, University of Medical Science, Havana, Cuba
Joaquín Urbizo Velez & Franco Bengazi
ARDEC Academy, Ariminum Odontologica, Rimini, Italy
Daniele Botticelli
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This study was funded by ARDEC Academy, Ariminum Odontologica s.r.l., Rimini, Italy.
Degradable Solutions AG, a Sunstar Group Company, CH-8952 Schlieren ZH, Switzerland, provided free of charge the biomaterials used.
Iida T. Carneiro Martins Neto E, Botticelli D, Apaza Alccayhuaman KA, Lang NP, Xavier SP. Influence of a collagen membrane positioned subjacent the sinus mucosa following the elevation of the maxillary sinus: a histomorphometric study in rabbits. Clin Oral Implants Res. 2017 Dec;28(12):1567–76.
Inal S, Yilmaz N, Nisbet C, Güvenç T. Biochemical and histopathological findings of N-butyl-2-cyano...
Russell WMS, Burch RL. The principles of human experimental technique. London: Methuen; 1959.
Schroeder HE, Münzel-Pedrazzoli S. Correlated morphometric and biochemical analysis of gingival tissue: morphometric model, tissue sampling and test of stereologic procedures. J Microsc. 1973 Dec;99(3):301–29.
Sohn DS, Kim WS, An KM, Song KJ, Lee JM, Mun YS. Comparative histomorphometric analysis of ...
Nosaka Y, Nosaka H, Arai Y. Complications of postoperative swelling of the maxillary sinus membrane after sinus floor augmentation. J Oral Sci Rehab. 2015;1:26–33.
Tawil G, Tawil P, Khairallah A. Sinus floor elevation using the lateral approach and bone window repositioning I: clinical and radiographic results in 102 consecutively treated patients followed from 1 to 5 years. Int J Oral Maxillof...
Tatum H Jr. Maxillary sinus grafting for endosseous implants. Lecture presented at the Annual Meeting of the Alabama Implant Study Group (1977); cited in Smiler DG, Johnson PW, Lozada JL, Misch C, Rosenlicht JL, Tatum OH Jr., Wagner JR. Sinus lift grafts and endosseous implants. Treatment of the atrophic posterior maxilla. Dent Clin North Am. 1992;36:151–86.
Boyne PJ, James RA. Grafting of the ...
Biphasic calcium phosphate
Deproteinized Bovine Bone Mineral
Hydroxyapatite
Infraorbital nerve canal
Standard deviation
Beta-tricalcium phosphate
All data and materials are available for control and consultation contacting the first author (alexperini@studioschweiger.it).
In conclusion, the repositioning of the bone window after sinus floor elevation in sheep, compared with the use of a resorbable membrane, improved the closure of the antrostomy and led to a greater amount of the newly formed bone in the close-to-window zone of the grafted area. The bone window appeared partially bonded to the newly formed bone. Bridges of new bone from the edges of the antrostomy ...
In the present study, a lesser amount of bone was registered subjacent to the sinus mucosa compared with the other regions. This is in agreement with another experiment, in which a similar material was used for sinus augmentation in sheep [24]. A similar outcome was also reported in another study [27] that used DBBM xenograft for sinus augmentation in sheep. In that study, a collagen membrane was ...
In another similar experiment in sheep, the sinuses were augmented using a similar biphasic calcium phosphate (60% HA, 40% β-TCP) [24], the biomaterial used in the present study. The perforation of the sinus mucosa was performed at the test sites and a collagen membrane was placed to protect the perforation, while at control sites the elevated mucosa was left unprotected. After 12 weeks of heal...
The aim of the present study was to compare the healing of the augmented sinus in large animals, where the antrostomy was covered by a polylactic membrane or a repositioned bone plate, both secured with cyanoacrylate.
No statistically significant differences were found between test and control sites in the bone formation within the augmented space. This outcome is in agreement with a similar stud...
In the centre of the window area, at the test sites, in the analysed histological sections, the bone plate was still visible in five out of six sheep. It appeared partly remodelled and connected by the new bone formed in the sub-window area. Out of the five bone plates still present, three were bridged to the edges of the antrostomy, while in the two cases no contact was achieved in the observed s...
During surgery, one sheep showed acute sinusitis at the test site. The sinus mucosa was perforated to allow sinus drainage and surgery was completed. During the healing period, no evident clinical complications were observed.
At the histomorphometric analysis, one sinus of the control group and one of the test group (corresponding to the sinusitis case) appeared to have lost almost all biomateria...
The percentages of the new mineralised bone, soft or connective tissue, pure graft, graft interpenetrated by bone, and remnants of cyanoacrylate were evaluated. The total tissue percentages in the elevated space that included submucosa, middle, base, and sub-window regions were also calculated.
Mean values and standard deviations (SDs) as well as the 25th, 50th (median), and 75th percentiles were...
After 4 months, the animals were anaesthetised and then euthanised with an overdose of pentobarbital sodium and subsequently perfused with 10% formalin. The maxilla was retrieved en bloc, trimmed, and immersed in formalin solution.
All histological procedures were performed in the Laboratorio de Histologıa de la Facultad de Odontologıa de la Universidad de Ciencia Medica in Havana, Cuba. Bila...
Through an extra-oral approach, an oblique incision was made bilaterally along the sagittal axis between the facial tuberosity and the inferior orbital rim. The skin and periosteum were elevated separately, and the bony facial sinus wall was exposed on both sides of the maxilla (Fig. 1a).
A 12-mm large and 8-mm high antrostomy was prepared using a burr (H254E Komet Dental, Trophagener Weg 25, L...
The research protocol was submitted to and approved by the Ethical Committee of the University of Medical Sciences, School of Dentistry, Havana, Cuba (prot. 013/2013).
Eight female Pelibuey sheep, with a mean body weight of approximately 35 kg and a mean age of approximately 3 years, were provided by the Centro Nacional para la Producción de Animales de Laboratorio (CENPALAB) in Havana, Cuba...
To prevent the movement of the bony plate and to gain adequate stability, cyanoacrylate has been suggested to glue the plate to the bony edges of the antrostomy [17]. Cyanoacrylates (as methyl 2-cyanoacrylate or ethyl 2-cyanoacrylate) are widely used in surgery and have shown good compatibility [18] and biomechanical strength for fixation of grafts [19]. In an experiment in rabbits [17], the antro...
Sinus floor elevation is a commonly used technique to increase bone volume in the posterior maxilla prior to implant placement. This procedure was first developed by Tatum in 1977 [1], modified by Boyne and James in 1980 [2], and further modified over time. In this well-described technique, a bony window is created on the lateral wall of the sinus with a round burr, and the membrane elevated. Diff...
The objective of this study was to compare the healing of the augmented sinus at which the antrostomy was covered with a membrane or the repositioned bone plate.
Eight sheep underwent bilateral maxillary sinus floor augmentation. The control site was covered with a resorbable membrane, while at the experimental site the bone plate was repositioned, and both were secured with cyanoacrylate. Animal...
Fig. 8. Photomicrographs of decalcified sections. a Untreated site. Woven bone formed from the sinus walls after 1 week of healing. b Treated site. After 8 weeks, woven bone was still found forming ridges towards residues of provisional matrix, showing that the healing was not completed yet. Scarlet-acid fuchsine and toluidine blue stain. a × 100 magnification. b × 20 magnification
...
Fig. 7. Box-plot representing the new bone percentage and standard deviations (whiskers) found in the various regions evaluated after 8 weeks of healing. (*), a statistical significant difference
Fig. 7. Box-plot representing the new bone percentage and standard deviations (whiskers) found in the various regions evaluated after 8 weeks of healing. (*), a statistical significant difference
Fig. 6. Photomicrographs of decalcified sections illustrating the healing after 8 weeks. a Treated site. Most of the antrostomies presented remaining defects in the outer contour. b, c Untreated sites. Two antrostomies of the treated sites and four of the untreated sites appeared not closed with corticalized bone and presented connective tissue interposed between the edges of the antrostomy. S...
Fig. 5. Photomicrographs of decalcified sections illustrating the healing after 8 weeks. Both at the treated (a) and untreated (b) sites, the antrostomy was closed in most cases, presenting residual defects of various dimensions in the outer side. New bone was connecting the lateral and medial sinus walls. The middle and sub-mucosa regions were not healed completely yet. Scarlet-acid fuchsine ...
Fig. 4. Photomicrographs of ground sections. a) Treated site. Bone residues (examples in yellow asterisks) included in soft tissue containing fibroblast-like cells and inflammatory cells. b) Untreated site. Xenograft residues (examples in red asterisks) surrounded by soft tissue rich in fibroblast-like cells. Scarlet-acid fuchsine and toluidine blue stain. a) 200 x magnification.; b) 100 x magni...
Fig. 3. Photomicrographs of decalcified sections illustrating the healing after 1 week. a Treated site. Bone strips occupying the antrostomy and the subjacent area (close-to-window region). b Untreated site. Note the new bone-forming from the sinus bone walls. Scarlet-acid fuchsine and toluidine blue stain. Images grabbed at × 20 magnification
Fig. 3. Photomicrographs of decalcified sect...
Fig. 2. The various regions evaluated at the histomorphometric analyses. Bone walls (red arrow); middle (white arrow); sub-mucosa (yellow arrow); close-to-window (orange arrow). The antrostomy region was also evaluated at the medial and lateral edges (dark green arrows) and in the middle aspect (light green arrow)
Fig. 2. The various regions evaluated at the histomorphometric analyses. Bone w...
Fig. 1. Clinical view of the surgical procedures. a Tibial bone exposed for autogenous bone harvesting using a bone scraper. b Antrostomies prepared. c Autogenous bone particles placed in the antrostomy. d Xenograft and bone particles (red arrow) at the antrostomies. e Collagen membranes placed on the antrostomies. f Wounds closed with sutures
Fig. 1. Clinical view of the surgical procedures....
AntrostomySinus regions EdgesCenterTotalClose-to-windowMiddleSub-mucosaBone wallsTotalNew boneTreated sites40.3 ± 21.337.8 (27.0;56.0)24.3 ± 23.222.0 (3.4;42.2)35.5 ± 20.927.7 (23.3;52.0)25.8* ± 16.122.9 (15.2;39.7)19.5 ± 16.711.7 (10.1;22.3)22.5 ± 11.620.4 (12.6;31.3)38.0 ± 15.044.8 (31.8;47.5)27.9 ± 12.930.1 (19.6;34.5)Untreated sites32.2 ± 22....
AntrostomySinus regions EdgesCenterTotalClose-to-windowMiddleSub-mucosaBone wallsTotalNew boneTreated sites9.2 ± 10.6 4.6 (3.2;12.5)5.2 ± 13.90.0 (0.0;0.5)7.7 ± 11.22.7 (1.9;7.9)0.6 ± 1.00.0 (0.0;0.7)0.0 ± 0.00.0 (0.0;0.0)1.4 ± 1.80.8 (0.0;2.2)7.7 ± 6.38.2 (1.3;11.1)2.8 ± 2.62.2 (0.7;4.0)Untreated sites8.9 ± 8.5 6.2 (4.0;10.8)1.0 ± 2.70.0 (0....
Favero, G., Viña-Almunia, J., Carda, C. et al. Influence of the use of autogenous bone particles to close the access window after maxillary sinus floor augmentation: an experimental study in rabbits.
Int J Implant Dent 6, 9 (2020). https://doi.org/10.1186/s40729-020-0206-2
Download citation
Received: 20 October 2019
Accepted: 21 January 2020
Published: 04 March 2020
DOI:...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
The present research was approved by the Ethics Committee of Valencia University, Spain. Reference number: A1434714637496.
Not applicable.
Daniele Botticelli declares to be the co-owner of Ariminum Odontologica. Giacomo Favero, Jose Viña-Almunia, Carmen Carda, José Javier Martín de Llano, Berta García-Mira, David Soto-Peñaloza, Daniele Botticelli, and Miguel Peñarrocha-Diago declare that t...
You can also search for this author in
PubMed Google Scholar
GF participated in the concept/design, data analysis/interpretation, drafting of the article and surgical procedures. JV-A performed the surgical procedures, made the follow up of the animals, participated in the manuscript revision and ethical committee redaction and approval. BG-M and DS-P performed the surgi...
Private practice, London, UK
Giacomo Favero
Oral Surgery Unit. Department of Stomatology, Faculty of Medicine and Dentistry, Clinica Odontológica, University of Valencia, Valencia, Spain
Jose Viña-Almunia, Berta García-Mira, David Soto-Peñaloza & Miguel Peñarrocha-Diago
Department of Pathology and Health Research Institute of the Hospital Clínico (INCLIVA), Faculty of Medicine and De...
Funds from the present have been provided by ARDEC Academy, by Ariminum Odontologica s.r.l., Rimini, Italy and Tecnoss srl, Giaveno, Italy. The biomaterials use were provided free of charge by Tecnoss srl, Giaveno, Italy.
Favero V, Lang NP, Canullo L, Urbizo Velez J, Bengazi F, Botticelli D. Sinus floor elevation outcomes following perforation of the Schneiderian membrane. An experimental study in sheep. Clin Oral Implants Res. 2016;27(2):233–40.
Scala A, Lang NP, Velez JU, Favero R, Bengazi F, Botticelli D. Effects of a collagen membrane positioned between augmentation material and the sinus mucosa in the eleva...
Kawakami S, Lang NP, Ferri M, Apaza Alccayhuaman KA, Botticelli D. Influence of the height of the antrostomy in sinus floor elevation assessed by cone beam computed tomography- a randomized clinical trial. Int J Oral Maxillofac Implants. 2019;34(1):223–32.
Kawakami S, Lang NP, Iida T, Ferri M, Apaza Alccayhuaman KA, Botticelli D. Influence of the position of the antrostomy in sinus floor elevat...
Tatum, H., Jr. Maxillary sinus grafting for endosseous implants. Lecture presented at the Annual Meeting of the Alabama Implant Study Group (1977); cited in Smiler, D.G., Johnson, P.W., Lozada, J.L., Misch, C., Rosenlicht, J.L., Tatum, O.H. Jr. & Wagner J.R. Sinus lift grafts and endosseous implants. Treatment of the atrophic posterior maxilla. Dental clinics of North America. 1992;36:151–186.
...
Animal Research Reporting In Vivo Experiments
Cone beam computed tomography
Deproteinized bovine bone mineral
Tricalcium phosphate
The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.
The lower phylogenetic level of the animals compared to humans was the main limitation of the present study. An increased number of animals might allow reaching a statistical difference in favor of the treated sites also in the antrostomy region. Nevertheless, the outcomes obtained, allow to performing studies in humans that might demonstrate the advantages of applying autologous bone on the antro...
In both studies presented above on sinus floor elevation in sheep, all the lateral windows were prepared using a piezoelectric device. In an experiment in rabbits [21], the antrostomies were done with either a sonic instrument or drills to evaluate differences in bone formation in the antrostomy. Elevated space is filled with a collagenated porcine bone similar that used in the present experiment,...
The present experiment aimed to study the influence on the healing after the placement of autogenous bone on the antrostomy and in the subjacent region after maxillary sinus elevation. After 8 weeks of healing, in the antrostomy region, a trend of higher bone formation in the treated compared to the untreated sites was observed. No statistically significant difference was found. In the subjacent ...
After 1 week of healing (Table 1), in the close-to-window region, the proportions of xenograft were 21.3 ± 14.7% and 55.9 ± 19.0 (p = 0.012) in the treated and untreated sites, respectively. After 8 weeks of healing (Table 2), these values decreased to a similar percentage (15.5 ± 14.4% and to 15.5 ± 14.2%; p = 0.917, respectively).
After 1 week of healing (Table...
Biopsies could be harvested from all animals. However, histological sections could not be obtained from one rabbit of the 8 weeks group; therefore, eight and seven were achieved for the 1-week and 8-week periods, respectively.
After 1 week of healing, at the treated sites, the antrostomy and close-to-windows regions were occupied by a high proportion of residues of autogenous bone (Fig. 3a),...
Overlapping calibrated digital images of the tissues were recorded with Leica Applications Suite version 4.4.0 software from a bright field Leica DM4000 B microscope (Leica Microsystems GmbH, Wëtzlar, Germany) equipped with a 5× lens and DFC420 digital camera. Single images were pasted and merged to compose each elevated sinus using the program Photoshop (Adobe Photoshop CC 2015.0.0).
The histo...
Afterward, a trichotomy was performed in the nasal dorsum and, after disinfection of the experimental region using Betadine (MEDA Pharma®, Madrid, Spain), a sagittal incision was carried out. The skin and the periosteum were dissected and shifted laterally to expose the nasal bone. Antrostomies, 4 × 4 mm in dimensions, located about 3–4 mm laterally to the midline and about 10 mm in f...
Prior to the experiment, the protocol was approved by the Ethics Committee of Valencia University, Spain (A1434714637496). The guidelines indicated by the Council Directive of the European Union (53/2013; February 1, 2013) for animal experimentation and the ethical rules proposed by Royal Decree 223, March 14 and October 13, 1988, were fulfilled. The study was reported following the ARRIVE guideli...
Hence, the present experiment aimed to study the influence on healing, of the autogenous bone particle placement in the antrostomy and in the subjacent region after maxillary sinus elevation.
Maxillary sinus floor elevation through lateral access was first proposed in 1977 [1], while the technique was published in 1984 [2]. Several modifications in the surgical approach and the biomaterials used have been introduced over time [3,4,5]. In a systematic review with meta-analysis, it was concluded that the best survival rate was observed when implants with rough surface and membrane to cov...
To study the influence on the healing of the placement of particulate autogenous bone in the antrostomy and in the subjacent region after maxillary sinus elevation.
Sixteen New Zealand rabbits were undergone to bilateral maxillary sinus floor augmentation with 4 × 4 mm antrostomy dimension. The sinus mucosa was elevated, and the space obtained was filled with xenograft. In the test site (tr...
Fig. 6. Graph representing new bone and composite bone percentages within the elevated area
Fig. 6. Graph representing new bone and composite bone percentages within the elevated area
Fig. 5. Graph representing the tissue percentages within the elevated area. No statistically significant differences were found
Fig. 5. Graph representing the tissue percentages within the elevated area. No statistically significant differences were found
Fig. 4. Photomicrographs of ground sections after 4 months of healing. a Bone formed from the base of the sinus. b Bone plate connected by bridges of the new bone to the close-to-window region. c Particle of the graft surrounded by new bone. d Overexposed image to show the new bone ingrowth within the granules of biomaterial
Fig. 4. Photomicrographs of ground sections after 4 months of he...
Fig. 3. a The elevated area was divided into four regions for morphometric analysis. RED: submucosa; GREEN: middle; YELLOW: base; PURPLE: close-to-window. INC: top of the infraorbital nerve canal
Fig. 3. a The elevated area was divided into four regions for morphometric analysis. RED: submucosa; GREEN: middle; YELLOW: base; PURPLE: close-to-window. INC: top of the infraorbital nerve canal
Fig. 2. Clinical view at a bone plate site. a The bone window was removed. b The sinus mucosa was carefully elevated, and a twisted wire was placed. c The elevated sinus was grafted. d The access bony window was repositioned and secured with cyanoacrylate
Fig. 2. Clinical view at a bone plate site. a The bone window was removed. b The sinus mucosa was carefully elevated, and a twisted wire wa...
Fig. 1. Clinical view at a membrane site. a Skin and periosteum were separately elevated, and the facial sinus wall exposed. b A 12 × 8-mm window was cut and removed. c The Schneiderian membrane was carefully elevated. d A twisted wire was inserted in the middle of the long side of the window and the elevated sinus was grafted. e At the control site, a resorbable membrane was placed and secured...
BoneSoft tissuePure graftInterpenetrated graftComposite boneReplaced windowCenter61.5 ± 46.982.5 (22.2; 96.9)21.7 ± 22.6*17.5 (3.1; 34.4)2.3 ± 4.3*0.0 (0.0; 2.3)7.9 ± 19.30.0 (0.0; 0.0)69.3 ± 38.582.5 (57.6; 96.9)Edge37.2 ± 37.021.6 (16.8; 55.8)41.0 ± 39.833.6 (9.2; 64.9)5.3 ± 7.31.6 (0.0; 9.1)13.8 ± 19.0*6.7 (0.0; 19.7)54.8 ± 34.162.9 (37.5; 69.7)MembraneCenter5.8 ± 2.1 (P = 0.116)5....
New boneSoft tissuePure graftInterpenetrated graftComposite boneReplaced windowTotal16.4 ± 5.618.8 (13.8; 20.3)32.9 ± 8.031.2 (27.7; 37.0)13.6 ± 4.212.0 (10.8; 16.2)37.1 ± 7.534.4 (31.7; 43.4)53.5 ± 7.652.4 (50.8; 57.8)Base15.0 ± 7.216.4 (10.1; 20.1)38.6 ± 14.334.5 (28.9; 47.1)13.4 ± 6.415.3 (13.1; 17.0)33.1 ± 11.133.1 (26.8; 40.0)48.0 ± 18.149.9 (36.9; 59.7)Middle16.9 ± 7.318.1 (11.2...
Perini, A., Ferrante, G., Sivolella, S. et al. Bone plate repositioned over the antrostomy after sinus floor elevation: an experimental study in sheep.
Int J Implant Dent 6, 11 (2020). https://doi.org/10.1186/s40729-020-0207-1
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Received: 01 October 2019
Accepted: 04 February 2020
Published: 18 March 2020
DOI: https://doi.org/10.1186/s40729-020-0207-1
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
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The research protocol was submitted to and approved by the Ethical Committee of the University of Medical Sciences, School of Dentistry, Havana, Cuba (prot. 013/2013).
All the authors consent to publication.
Alessandro Perini, Giada Ferrante, Stefano Sivolella, Joaquín Urbizo Velez, Franco Bengazi, and Daniele Botticelli declare that they have no competing interests.
Correspondence to
Alessandro Perini.
Department of Neuroscience, Division of Dentistry, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
Alessandro Perini, Giada Ferrante & Stefano Sivolella
Faculty of Dentistry, University of Medical Science, Havana, Cuba
Joaquín Urbizo Velez & Franco Bengazi
ARDEC Academy, Ariminum Odontologica, Rimini, Italy
Daniele Botticelli
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This study was funded by ARDEC Academy, Ariminum Odontologica s.r.l., Rimini, Italy.
Degradable Solutions AG, a Sunstar Group Company, CH-8952 Schlieren ZH, Switzerland, provided free of charge the biomaterials used.
Iida T. Carneiro Martins Neto E, Botticelli D, Apaza Alccayhuaman KA, Lang NP, Xavier SP. Influence of a collagen membrane positioned subjacent the sinus mucosa following the elevation of the maxillary sinus: a histomorphometric study in rabbits. Clin Oral Implants Res. 2017 Dec;28(12):1567–76.
Inal S, Yilmaz N, Nisbet C, Güvenç T. Biochemical and histopathological findings of N-butyl-2-cyano...
Russell WMS, Burch RL. The principles of human experimental technique. London: Methuen; 1959.
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Sohn DS, Kim WS, An KM, Song KJ, Lee JM, Mun YS. Comparative histomorphometric analysis of ...
Nosaka Y, Nosaka H, Arai Y. Complications of postoperative swelling of the maxillary sinus membrane after sinus floor augmentation. J Oral Sci Rehab. 2015;1:26–33.
Tawil G, Tawil P, Khairallah A. Sinus floor elevation using the lateral approach and bone window repositioning I: clinical and radiographic results in 102 consecutively treated patients followed from 1 to 5 years. Int J Oral Maxillof...
Tatum H Jr. Maxillary sinus grafting for endosseous implants. Lecture presented at the Annual Meeting of the Alabama Implant Study Group (1977); cited in Smiler DG, Johnson PW, Lozada JL, Misch C, Rosenlicht JL, Tatum OH Jr., Wagner JR. Sinus lift grafts and endosseous implants. Treatment of the atrophic posterior maxilla. Dent Clin North Am. 1992;36:151–86.
Boyne PJ, James RA. Grafting of the ...
Biphasic calcium phosphate
Deproteinized Bovine Bone Mineral
Hydroxyapatite
Infraorbital nerve canal
Standard deviation
Beta-tricalcium phosphate
All data and materials are available for control and consultation contacting the first author (alexperini@studioschweiger.it).
In conclusion, the repositioning of the bone window after sinus floor elevation in sheep, compared with the use of a resorbable membrane, improved the closure of the antrostomy and led to a greater amount of the newly formed bone in the close-to-window zone of the grafted area. The bone window appeared partially bonded to the newly formed bone. Bridges of new bone from the edges of the antrostomy ...
In the present study, a lesser amount of bone was registered subjacent to the sinus mucosa compared with the other regions. This is in agreement with another experiment, in which a similar material was used for sinus augmentation in sheep [24]. A similar outcome was also reported in another study [27] that used DBBM xenograft for sinus augmentation in sheep. In that study, a collagen membrane was ...
In another similar experiment in sheep, the sinuses were augmented using a similar biphasic calcium phosphate (60% HA, 40% β-TCP) [24], the biomaterial used in the present study. The perforation of the sinus mucosa was performed at the test sites and a collagen membrane was placed to protect the perforation, while at control sites the elevated mucosa was left unprotected. After 12 weeks of heal...
The aim of the present study was to compare the healing of the augmented sinus in large animals, where the antrostomy was covered by a polylactic membrane or a repositioned bone plate, both secured with cyanoacrylate.
No statistically significant differences were found between test and control sites in the bone formation within the augmented space. This outcome is in agreement with a similar stud...
In the centre of the window area, at the test sites, in the analysed histological sections, the bone plate was still visible in five out of six sheep. It appeared partly remodelled and connected by the new bone formed in the sub-window area. Out of the five bone plates still present, three were bridged to the edges of the antrostomy, while in the two cases no contact was achieved in the observed s...
During surgery, one sheep showed acute sinusitis at the test site. The sinus mucosa was perforated to allow sinus drainage and surgery was completed. During the healing period, no evident clinical complications were observed.
At the histomorphometric analysis, one sinus of the control group and one of the test group (corresponding to the sinusitis case) appeared to have lost almost all biomateria...
The percentages of the new mineralised bone, soft or connective tissue, pure graft, graft interpenetrated by bone, and remnants of cyanoacrylate were evaluated. The total tissue percentages in the elevated space that included submucosa, middle, base, and sub-window regions were also calculated.
Mean values and standard deviations (SDs) as well as the 25th, 50th (median), and 75th percentiles were...
After 4 months, the animals were anaesthetised and then euthanised with an overdose of pentobarbital sodium and subsequently perfused with 10% formalin. The maxilla was retrieved en bloc, trimmed, and immersed in formalin solution.
All histological procedures were performed in the Laboratorio de Histologıa de la Facultad de Odontologıa de la Universidad de Ciencia Medica in Havana, Cuba. Bila...
Through an extra-oral approach, an oblique incision was made bilaterally along the sagittal axis between the facial tuberosity and the inferior orbital rim. The skin and periosteum were elevated separately, and the bony facial sinus wall was exposed on both sides of the maxilla (Fig. 1a).
A 12-mm large and 8-mm high antrostomy was prepared using a burr (H254E Komet Dental, Trophagener Weg 25, L...
The research protocol was submitted to and approved by the Ethical Committee of the University of Medical Sciences, School of Dentistry, Havana, Cuba (prot. 013/2013).
Eight female Pelibuey sheep, with a mean body weight of approximately 35 kg and a mean age of approximately 3 years, were provided by the Centro Nacional para la Producción de Animales de Laboratorio (CENPALAB) in Havana, Cuba...
To prevent the movement of the bony plate and to gain adequate stability, cyanoacrylate has been suggested to glue the plate to the bony edges of the antrostomy [17]. Cyanoacrylates (as methyl 2-cyanoacrylate or ethyl 2-cyanoacrylate) are widely used in surgery and have shown good compatibility [18] and biomechanical strength for fixation of grafts [19]. In an experiment in rabbits [17], the antro...
Sinus floor elevation is a commonly used technique to increase bone volume in the posterior maxilla prior to implant placement. This procedure was first developed by Tatum in 1977 [1], modified by Boyne and James in 1980 [2], and further modified over time. In this well-described technique, a bony window is created on the lateral wall of the sinus with a round burr, and the membrane elevated. Diff...
The objective of this study was to compare the healing of the augmented sinus at which the antrostomy was covered with a membrane or the repositioned bone plate.
Eight sheep underwent bilateral maxillary sinus floor augmentation. The control site was covered with a resorbable membrane, while at the experimental site the bone plate was repositioned, and both were secured with cyanoacrylate. Animal...
Fig. 3. Postoperative radiograph of the resected dental implant in the right anterior maxilla
Fig. 3. Postoperative radiograph of the resected dental implant in the right anterior maxilla
Fig. 2. On radiological examination, it was confirmed that the dental implant had perforated the cortical bone of the right nasal floor
Fig. 2. On radiological examination, it was confirmed that the dental implant had perforated the cortical bone of the right nasal floor
Fig. 1. On anterior rhinoscopy, the apical part of the titanium dental implant in the right anterior maxilla was seen in the nasal floor close to the nasal septum
Fig. 1. On anterior rhinoscopy, the apical part of the titanium dental implant in the right anterior maxilla was seen in the nasal floor close to the nasal septum
Wolff, J., Karagozoglu, K.H., Bretschneider, J.H. et al. Altered nasal airflow: an unusual complication following implant surgery in the anterior maxilla.
Int J Implant Dent 2, 6 (2016). https://doi.org/10.1186/s40729-016-0045-3
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Received: 24 August 2015
Accepted: 23 March 2016
Published: 29 March 2016
DOI: https://doi.org/10.1186/s40729-016-0045-3
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Jan Wolff, Hakki Karagozoglu, Jochen Bretschneider, Tymour Forouzanfar, and Engelbert Schulten declare that they have no competing interests.
JW gave substantial contributions to the conception or design of the work, drafted the work, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately i...
Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
Jan Wolff, K. Hakki Karagozoglu, Tymour Forouzanfar & Engelbert A. J. M. Schulten
Department of Otorhinolaryngology-Head and Neck Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
Jochen H...
Esposito M, Grusovin MG, Kwan S, et al. Interventions for replacing missing teeth: bone augmentation techniques for dental implant treatment. Cochrane Database Syst Rev. 2008;16:CD003607.
Raghoebar GM, van Weissenbruch R, Vissink A. Rhino-sinusitis related to endosseous implants extending into the nasal cavity. A case report. Int J Oral Maxillofac Surg. 2004;33:312–4.
Zimbler MS, Lebowitz RA, ...
Since this is a case report, no approval of the Institutional Review Board was necessary.
Written informed consent was obtained from the patient for publication of this Case report and any accompanying images
In conclusion, dental implants protruding into the nasal cavity can cause alterations to the airflow. Dental implants partially residing in the nasal cavity can be minimal invasively treated by sectioning the apical part of the implant using a transnasal approach.
No complications were apparent during the surgical procedure. Postoperative clinical and radiological examinations demonstrated an intact nasal mucosa and an adequate resection of the dental implant to the level of the nasal floor (Fig. 3). The patient had an uneventful recovery and at 2-, 6-, and 12-month follow-up, she reported having no altered nasal airflow.
Insertion of endosseous dental im...
A 50-year-old female patient was referred to the Department of Oral and Maxillofacial Surgery of the VU University Medical Center in Amsterdam with complaints of a long ongoing unpleasant altered nasal airflow after the placement of eight dental implants in the maxilla. Four months prior to implant surgery, a bony augmentation of the atrophic edentulous alveolar crest and a bilateral maxillary sin...
Endosseous dental implants are commonly used to rehabilitate fully or partially edentulous patients [1]. The insertion of such implants can in some cases cause complications, especially in the edentulous atrophic maxilla [2–4]. In this paper, an unusual complication of altered nasal airflow after the placement of an endosseous dental implant in the maxilla is presented. Subsequent treatment of t...
Dental implants have been in routine clinical use for over three decades and are a predictable treatment modality. However, as with all other aspects of dentistry, complications occur. A 50-year-old female patient with complaints of a long ongoing unpleasant altered nasal airflow presented herself at the VU University Medical Center Amsterdam. Visual inspection of the right nasal cavity revealed t...
Fig. 6. Radiographic examination: The relationship between changes in the maxillary sinus floor associated with a reduction in the grafted bone and the implant tip (a immediately after surgery, b 5 years after surgery)
Fig. 6. Radiographic examination: The relationship between changes in the maxillary sinus floor associated with a reduction in the grafted bone and the implant tip (a immediat...
Fig. 5. Radiographic examination (long-term changes in bone height surrounding the implant) n = 20 Number of implants. A total of 5 CBCT scans were taken prior to surgery, immediately after surgery, 6 months after surgery, 1–2 years after surgery, and 3–5 years after surgery
Fig. 5. Radiographic examination (long-term changes in bone height surrounding the implant) n = 20 Numbe...
Fig. 4. Clinical findings of the second surgery on biopsy at 6 months. The degree of residual grafting materials varied depending on the patient. a most of the β-TCP remained. b Replacement of the β-TCP by new bone had progressed
Fig. 4. Clinical findings of the second surgery on biopsy at 6 months. The degree of residual grafting materials varied depending on the patient. a most of the ...
Fig. 3. Radiographic examination of the height of the bone surrounding the implant (BH): Measurement of changes in the height of the implant tip to the bone fixation part over time in the frontal plane: the distance measured from the intersecting point of the long axis of the implant and the maxillary sinus floor to the implant tip: +maxillary side, −alveolar crest side. The liner valuables: r...
Fig. 2. Radiographic examination of the volume of the bone graft (BV): Calculation of area on the frontal plane prior to and immediately after surgery using polygon tool. The polygon tool is included in the CT device, which was dragged around the perimeter of the target site to measure area. Graft volume calculation method (sum of the area and calculation of volume). Volume cm3 = area cm2 ...
Fig. 1. Treatment protocol for the present study. Postoperative CBCT was performed a minimum of three times, i.e., immediately, 6 months, and 2.5 years after implant placement
Fig. 1. Treatment protocol for the present study. Postoperative CBCT was performed a minimum of three times, i.e., immediately, 6 months, and 2.5 years after implant placement
Coefficient
Standard error
95 % CI
P value
Time (months)
−0.087
...
Parameter
Mean (mm)
SD (mm)
RBH
4.48
1.51
...
NoneTable 6 Radiographic examination of BH (changes in bone height surrounding the implant)
BV
Mean
Reduction rate
Immediately after surgery (n = 30)
1206 ...
CBCT examination (year)
Number of patients
0–1
0
1–2
14
...
Implant site
Number of implants
4
6
5
16
6
24
7
12
Total: 58 implants
Table 3 The number of implants according to site
Observation period (months)
Number of patients
12–18
11
19–24
4
...
Age group (years)
Number of patients
40–49
7
50–59
10
...
Okada, T., Kanai, T., Tachikawa, N. et al. Long-term radiographic assessment of maxillary sinus floor augmentation using beta-tricalcium phosphate: analysis by cone-beam computed tomography.
Int J Implant Dent 2, 8 (2016). https://doi.org/10.1186/s40729-016-0042-6
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Received: 25 November 2015
Accepted: 23 March 2016
Published: 01 April 2016
DOI: https://do...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Tsuneji Okada, Toru Kanai, Noriko Tachikawa, Motohiro Munakata, and Shohei Kasugai declare that they have no competing interests.
TO performed the data acquisition, both of surgical and prosthodontic treatments, the data analysis, statistical analysis, and wrote the manuscript. TK performed the treatment plan, making of pictures, and collecting of references. NT and MM performed the data acquisit...
Clinic for Implant Dentistry, Dental Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
Tsuneji Okada, Toru Kanai & Noriko Tachikawa
Oral Implantology Department of Prosthodontic Dentistry for Function of TMJ and Occlusion, Kanagawa Dental University, 82, Inaokachou, Yokosuka-shi, 238-8580, Kanagawa, Japan
Motohiro Munakata
Oral Implantology and...
The bone grafting agent, β-TCP (OSferion), was kindly supplied by Olympus Terumo Biomaterials Corp.
Boyne PJ, James RA. Grafting of the maxillary sinus floor with autogenous marrow and bone. J Oral Maxillofac Surg. 1980;38:613–6.
Jensen OT, Shulman LB, Block MS, et al. Report of the sinus consensus conference of 1996. Int J Oral Maxillofac Implants. 1998;13:11–45.
Artzi Z, Weinreb M, Givol N, et al. Biomaterial resorption rate and healing site morphology of inorganic bovine bone and β-tri...
Chanavaz M. Maxillary sinus: anatomy, physiology, surgery, and bone grafting related to implantology: eleven years of surgical experience (1979–1990). J Oral Implantol. 1990;16:199–209.
Misch CE. Maxillary sinus lift and elevation with subantral augmentation. In: Misch CE, editor. Contemporary implant dentistry. St. Louis, MO: Mosby; 1993. p. 545–74.
Sharan A, Madjar D. Maxillary sinus pne...
Maxillary sinus graft augmentation using β-TCP is clinically effective.
Analysis by CBCT provides superior spatial resolution and allows for extremely accurate postoperative evaluation of maxillary sinus floor augmentation and bone volume measurements.
On the basis of CBCT examinations, although maxillary sinus pneumatization continues to progress ≥1 year after surgery, it stabilizes 3 year...
During the observation period, there was no clinical implant failure and the suvival rate for implantation and maxillary sinus floor augmentation was 100 %. Histological examination in a previous report on maxillary sinus augmentation using β-TCP (Cerasorb®), Szabo et al. compared bilateral maxillary sinus augmentation in the same patients using β-TCP and iliac bone at 6 months after surgery ...
As grafting materials for maxillary sinus floor augmentation, autogenous bone, which is considered as the gold standard and reported first by Boyne et al. using iliac bone graft, has been used as the first-choice material. In terms of osteogenic, osteoinductive, and osteoconductive properties, autogenous bone is considered ideal; however, the use of autogenous bone places great physical stress on ...
Change in height of bone surrounding the implant (height from the maxillary sinus floor to the implant tip): Immediately after surgery, all patients had grafted bone between the implant tip and the maxillary sinus floor, with a mean of 2.00 ± 1.51 mm. This height decreased to 0.73 ± 1.33 mm at 6 months after surgery and −0.72 ± 1.11 mm at 2.5 years after surgery (Fig. 5). 41...
The mean age of the 30 patients was 57.4 (40–75) years, and the male/female ratio was 4:26. The mean postoperative observation period was 3 years and 8 months (the maximum period was 5 years and 0 months; the minimum period was 2 years and 2 months). Total of 58 implants were placed at premolar and molar region. There were no dropouts, such as participants not visiting the clinic, during t...
Residual bone height (RBH): existing bone height to the maxillary sinus at the implant site
Implant length (IL): the length of the part of the implant that projects into the maxillary sinus
Width of sinus (SW): the width of the maxillary sinus from lateral wall to medial wall at the height of the center of the IL
In the present study, the radiographic examinations were statistically analyzed fo...
In the present study, we used the superior spatial resolution of CBCT to measure changes over time in (a) the volume of the bone graft (BV) and (b) the height of the bone surrounding the implant (BH).
The method of calculating the volume of the implant site is shown below (Fig. 2).
The slice thickness (voxel value) was resized (0.146 mm → 1 mm) to derive the volume of the grafting agent...
This study is a prospective observational study. The subjects included patients who had undergone maxillary sinus floor augmentation using β-TCP and implant placement at the Clinic for Implant Dentistry, Dental Hospital, Tokyo Medical and Dental University during the 3-year period from January 2009 to December 2011. All patients underwent maxillary sinus floor augmentation at the same time as imp...
Radiographic examinations to determine changes in bone mass in maxillary sinus floor augmentation have been conducted primarily using panoramic radiography [8–12], which allows for the assessment of the height of the maxillary sinus in only two dimensions. In addition, it does not allow for detailed examination or measurement of the interior of the maxillary sinus without factoring in magnificat...
The maxillary sinus gradually expands after birth and becomes fully pneumatized with the eruption of all permanent teeth. Although the physiological cause and maxillary sinus pneumatization are largely unknown, it is believed that genetics, atmospheric pressure, and hormones are involved in it. This sinus is closely related to the root apex of the premolar and molar teeth, and it is either separat...
The long-term stability of maxillary sinus floor augmentation with β-TCP remains largely unknown. We report the long-term assessment of volumetric changes in maxillary sinus floor augmentation with β-TCP by cone-beam computed tomography (CBCT).
The subjects included 30 patients who underwent maxillary sinus floor augmentation using β-TCP and 58 implant placement for unilateral maxillary defect...
Implant
Author Year Reference
Study type
Patients
Primary disease in BP patients (n)
...
Topic
Identified (n)
Included (n)
Outcome osteonecrosis risk. ST (bisphosphonate OR denosumab) AND osteonecrosis jaw AND
...
Walter, C., Al-Nawas, B., Wolff, T. et al. Dental implants in patients treated with antiresorptive medication – a systematic literature review. Int J Implant Dent 2, 9 (2016). https://doi.org/10.1186/s40729-016-0041-7
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Received: 26 September 2015
Accepted: 23 March 2016
Published: 04 April 2016
DOI: https://doi.org/10.1186/s40729-016-0041-7
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
The authors Christian Walter, Bilal Al-Nawas, Tim Wolff, Eik Schiegnitz, and Knut A. Grötz declare that they have no competing interests.
All authors designed the review. TW made the primary literature acquisition that was evaluated by the other others. All authors interpreted the data. CW drafted the manuscript that was revised by the other authors. All authors read and approved the final manus...
Department of Oral and Maxillofacial Surgery – Plastic Surgery of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131, Mainz, Germany
Christian Walter, Bilal Al-Nawas & Eik Schiegnitz
Department of Oral and Maxillofacial Surgery of the Dr. Horst Schmidt Clinic, Ludwig-Erhard-Str. 100, 65199, Wiesbaden, Germany
Tim Wolff & Knut A. Grötz
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Krimmel M, Ripperger J, Hairass M, Hoefert S, Kluba S, Reinert S. Does dental and oral health influence the development and course of bisphosphonate-related osteonecrosis of the jaws (BRONJ)? Oral Maxillofac Surg. 2014;18(2):213–8. doi:10.1007/s10006-013-0408-3.
Tsao C, Darby I, Ebeling PR, Walsh K, O'Brien-Simpson N, Reynolds E, et al. Oral health risk factors for bisphosphonate-associated jaw...
DeBaz C, Hahn J, Lang L, Palomo L. Dental Implant Supported Restorations Improve Quality of Life in Osteoporotic Women. Int J Dent. 2015;2015:451923. doi:10.1155/2015/451923.
Grötz KA, Al-Nawas B. Persisting alveolar sockets-a radiologic symptom of BP-ONJ? J Oral Maxillofac Surg. 2006;64(10):1571–2. doi:10.1016/j.joms.2006.05.041.
Hutchinson M, O'Ryan F, Chavez V, Lathon PV, Sanchez G, Hatche...
Carmagnola D, Celestino S, Abati S. Dental and periodontal history of oncologic patients on parenteral bisphosphonates with or without osteonecrosis of the jaws: a pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106(6):e10–5. doi:10.1016/j.tripleo.2008.07.011.
Jabbour Z, El-Hakim M, Mesbah-Ardakani P, Henderson JE, Albuquerque Jr R. The outcomes of conservative and surgical ...
Marx RE, Sawatari Y, Fortin M, Broumand V. Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg. 2005;63(11):1567–75. doi:10.1016/j.joms.2005.07.010.
Al-Sabbagh M, Robinson FG, Romanos G, Thomas MV. Osteoporosis and bisphosphonate-related osteonecrosis in a dental school implant patient popula...
Javed F, Almas K. Osseointegration of dental implants in patients undergoing bisphosphonate treatment: a literature review. J Periodontol. 2010;81(4):479–84. doi:10.1902/jop.2009.090587.
Bedogni A, Bettini G, Totola A, Saia G, Nocini PF. Oral bisphosphonate-associated osteonecrosis of the jaw after implant surgery: a case report and literature review. J Oral Maxillofac Surg. 2010;68(7):1662–6...
Grötz KA, Piesold JU, Al-Nawas B. Bisphosphonat-assoziierte Kiefernekrose (BP-ONJ) und andere Medikamenten-assoziierte Kiefernekrosen. 2012. AWMF online.
Walter C, Al-Nawas B, Frickhofen N, Gamm H, Beck J, Reinsch L, et al. Prevalence of bisphosphonate associated osteonecrosis of the jaws in multiple myeloma patients. Head Face Med. 2010;6:11. doi:10.1186/1746-160X-6-11.
Walter C, Sagheb K, Bit...
bisphosphonate
bisphosphonate-associated osteonecrosis of the jaws
C-terminal telopeptide of the type I collagen
patients intervention control outcome
preferred reporting items for systematic reviews and meta-analyses protocols
quality of life
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temporomandibular joint
Successful implant therapy is feasible in patients receiving antiresorptive therapy. The risk of osteonecrosis development needs to be explained to the patient. An individual risk assessment is essential, taking the primary disease with the medication and further wound-healing-compromising diseases and medications into account. If possible, bone augmentations should be avoided, and a perioperative...
The use of bone markers is discussed controversially in the literature, and no clear recommendation can be given at the moment [1, 8]. In these cases, where an implant is planned, a perioperative antimicrobial prophylaxis should be administered, similar to the prophylaxis suggested in other surgical procedures performed in these patients, since this seems to be a tool to decrease BP-ONJ frequency ...
Dental implants can improve the Qol in patients with antiresorptive therapy (bisphosphonate/denosumab) [44] analogous to patients without antiresorptive therapy [48]. A recently performed systematic review on masticatory performance, bite force, nutritional state and patient’s satisfaction showed that implant-supported dentures were associated with high patient satisfaction regarding denture com...
Even latest guidelines and statements dealing with medication associated osteonecrosis of the jaws such as the American [7, 8], Scottish [47], Swiss [6] or German [1] do not address implant therapy in these patients in detail. Due to this lack of data a systematic literature review was performed to fill this gap. Unfortunately the literature dealing with this topic is very sparse and consists main...
No articles could be found regarding the prognosis of the remaining dentition depending on implant therapy, neither for patients with bisphosphonate nor denosumab treatment.
There are no reliable parameters indicating the success of implants in patients with anti-resorptive therapy. The risk of osteonecrosis development has already been described in the chapter referring to the osteonecrosis risk...
The literature dealing with this topic can be separated into two groups:
BP-ONJ case series for which varying amounts are caused by dentures in patients with malignant and benign diseases [2, 33–42] and
studies performed on BP patients with dentures analyzing the frequency of BP-ONJ [15, 43].
Here as well, no imbalance regarding the dignity of the primary disease could be found. Jabbour descr...
Out of 606 articles 556 articles were excluded because they were either duplicates, case reports, narrative reviews, case series with less than 5 cases or were not associated with the topic at all (Table 1 and Fig. 1). Some of the articles analyzed more than one outcome and are referred to several times. Since the available literature is very inhomogeneous with a low level of evidence a statisti...
A table was generated and used to collect the relevant information.
A systematic review was performed in accordance with the preferred reporting items for systematic reviews and meta-analyses protocols (PRISMA-P),
The review was performed using the PICO design.
Patients: For which subclientel of patients with antiresorptive therapy
Intervention: do dental implants have a benefit
Control: compared to forgoing dental implants
Outcome: in regards to oral rehabil...
A similar scenario is well known in patients with radiation of the jaws. Initially, radiation therapy was seen as a contraindication for implant insertion [14] because of osteoradionecrosis. In Germany meanwhile, implants are covered by the health insurance by law in some of these patients (§28 SGB V Sozialgesetzbuch). Due to xerostomia sufficient fixation of a denture is rather complicated, and ...
Bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is a well-known side effect in patients receiving bisphosphonates (BP) due to e.g. osteoporosis, multiple myeloma or malignant diseases with metastases to the bone; prevalences range between 0.1% for patients with primary osteoporosis to 1% in patients with secondary osteoporosis and up to about 20% for special high risk subpopulations o...
Bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is triggered by inflammatory processes. Typical trigger factors are periodontal disease, denture pressure sores, and surgical interventions such as tooth extractions. Unfortunately there is only little data on how to proceed with implant therapy in patients with bisphosphonate treatment. This topic is not addressed in the German guidelin...
Fig. 8. Postoperative panoramic radiograph taken about 3 years after implant loading
Fig. 8. Postoperative panoramic radiograph taken about 3 years after implant loading
Fig. 7. Radiographic findings on panoramic computed tomography after nongrafted sinus lift with simultaneous implant placement. a Immediately. b At 6 months. c At 42 months
Fig. 7. Radiographic findings on panoramic computed tomography after nongrafted sinus lift with simultaneous implant placement. a Immediately. b At 6 months. c At 42 months
Fig. 6. Radiographic findings on cross-sectional computed tomography in the right second molar region after nongrafted sinus lift with simultaneous implant placement. a Immediately. b At 6 months. c At 42 months
Fig. 6. Radiographic findings on cross-sectional computed tomography in the right second molar region after nongrafted sinus lift with simultaneous implant placement. a Immediately....
Fig. 5. Clinical view of the repositioned bone window with the HA/PLLA mesh plate device
Fig. 5. Clinical view of the repositioned bone window with the HA/PLLA mesh plate device
Fig. 4. a Front view of the bone window with the HA/PLLA mesh plate device fixed by a screw. b Lower view of the bone window with the HA/PLLA mesh plate device fixed by a screw
Fig. 4. a Front view of the bone window with the HA/PLLA mesh plate device fixed by a screw. b Lower view of the bone window with the HA/PLLA mesh plate device fixed by a screw
Fig. 3. After the removal of the bone window, the membrane was lifted upward, and the dental implants were placed without grafting materials
Fig. 3. After the removal of the bone window, the membrane was lifted upward, and the dental implants were placed without grafting materials
Kaneko, T., Nakamura, S., Hino, S. et al. Continuous intra-sinus bone regeneration after nongrafted sinus lift with a PLLA mesh plate device and dental implant placement in an atrophic posterior maxilla: a case report. Int J Implant Dent 2, 16 (2016). https://doi.org/10.1186/s40729-016-0049-z
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Received: 18 March 2016
Accepted: 01 June 2016
Published: 06 June 2016
DOI: https:/...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
Takahiro Kaneko, Satoshi Nakamura, Shunsuke Hino, Norio Horie, and Tetsuo Shimoyama declare that they have no competing interests.
TK, SN, and SH were involved with the literature review and performance of the surgery. NH and TS suggested the treatment planning and were also involved with the surgeries. All authors read and approved the final manuscript.
Department of Oral and Maxillofacial Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
Takahiro Kaneko, Satoshi Nakamura, Shunsuke Hino, Norio Horie & Tetsuo Shimoyama
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Atef M, Hakam MM, EIFaramawey MI, Abou EIFetouh A, Ekram M. Nongrafted sinus floor elevation with a space-maintaining titanium mesh: case-series study on four patients. Clin Oral Implants Res. 2011;23:100–5.
Kaneko T, Masuda I, Horie N, Shimoyama T. New bone formation in nongrafted sinus lifting with space-maintaining management: a novel technique using a titanium bone fixation device. J Oral M...
Pjetursson BE, Tan WC, Zwahlen M, Lang NP. A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation. J Clin Periodontol. 2008;35:216–40.
Tan WC, Lang NP, Zwahlen M, Pjetursson BE. A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation. P...
computed tomography
bioresorbable unsintered hydroxyapatite combined with poly l-lactide
Written informed consent was obtained from the patient for publication of this report and all accompanying images.
This nongrafted sinus-lifting procedure using an HA/PLLA mesh plate device helps to attain predictable bone formation. Stable membrane elevation by the HA/PLLA device for the long term could contribute to predictable bone formation in the sinus. The source of cell supply could possibly be the Schneiderian membrane, reflecting its osteogenic potential.
In nongrafted sinus-lifting procedure, several devices such as titanium [12–14], hollow hydroxyapatite [15], and bioresorbable materials [16] have been used for space retention to maintain the lifted sinus membrane and the results of predictable bone formation have been reported in addition to histological examination. In this case, a mesh plate device consisting of HA/PLLA materials was applied...
A 60-year-old healthy female, who desired dental implant therapy in the right molar region of the maxilla, was referred to the Department of Oral and Maxillofacial Surgery. Clinical examination revealed an edentulous maxilla from the right first premolar to the second molar region. Panoramic radiography showed atrophy of the maxillary alveolar ridge in the same site (Fig. 1), and the need for sin...
Maxillary sinus lift is a bone augmentation procedure in the sinus that improves the alveolar crest height in atrophic posterior maxilla by forming new bone in the space created under the elevated sinus membrane. To date, numerous grafting materials have been used as a scaffold for new bone regeneration, including autogenous bone, bone graft substitutes, or their combination [1, 2]. Autogenous bon...
Sinus lift is a bone augmentation procedure that improves the alveolar crest height in an atrophic posterior maxilla. However, the regenerated bone volume can vary and generally has a tendency to decrease after sinus operation. This article describes nongrafted maxillary sinus lift using a bioresorbable unsintered hydroxyapatite combined with poly l-lactide (HA/PLLA) mesh plate device and dental i...
Fig. 2. Figure illustrating the proposed mucosal thickening index. A ≤1 mm, indicating no thickening; B >1 mm but ≤2 mm, indicating minimal thickening; C >2 mm but ≤5 mm, indicating moderate thickening; D >5 mm, indicating severe thickening
Fig. 2. Figure illustrating the proposed mucosal thickening index. A ≤1 mm, indicating no thickening; B >1 mm but ≤2 mm, indicating min...
Fig. 1. Figure illustrating the reference points of the CBCT measurements. A: most posterior point of the sinus wall; B: most anterior point of the sinus wall; C: mid-point between A and B; C1: measurement of mucosal thickening perpendicular to A–B line at point C; D: mid-point between A and C; D1: measurement of mucosal thickening perpendicular to A–B line at point D; E: mid-point between B...
Gender
Respiratory diseases
Cardio-vascular diseases
Diabetes mellitus
Smoking
Hist...
Patient
Anterior
(E1-floor of the sinus)
Middle
(C1-floor of the sinus)
Posterior
(D1-floor of the sinus)
...
Maska, B., Lin, GH., Othman, A. et al. Dental implants and grafting success remain high despite large variations in maxillary sinus mucosal thickening.
Int J Implant Dent 3, 1 (2017). https://doi.org/10.1186/s40729-017-0064-8
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Received: 18 October 2016
Accepted: 13 January 2017
Published: 18 January 2017
DOI: https://doi.org/10.1186/s40729-017-0064-8
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
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Correspondence to
Yvonne Kapila.
Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, 1011 N University Ave, Ann Arbor, MI, USA
Bartosz Maska, Guo-Hao Lin, Abdullah Othman, Shabnam Behdin, Suncica Travan, Erika Benavides & Yvonne Kapila
Department of Surgical Sciences, School of Dentistry, Marquette University, 1801 W Wisconsin Ave, Milwaukee, WI, USA
Guo-Hao Lin
Department of Peri...
The authors thank Ms. Victoria Zakrzewski for her help with the figure generation and preparation.
Co-primary author BM contributed to the CBCT measurement and preparation of the manuscript. Co-primary author G-HL contributed to the data analysis and preparation of the manuscript. Second author AO contributed to the protocol preparation, case review, case selection, and preparation of the manuscr...
Romanos GE, Froum S, Costa-Martins S, Meitner S, Tarnow DP. Implant periapical lesions: etiology and treatment options. J Oral Implantol. 2011;37:53–63.
Acharya A, Hao J, Mattheos N, Chau A, Shirke P, Lang NP. Residual ridge dimensions at edentulous maxillary first molar sites and periodontal bone loss among two ethnic cohorts seeking tooth replacement. Clin Oral Implants Res. 2014;25:1386–94...
Pazera P, Bornstein MM, Pazera A, Sendi P, Katsaros C. Incidental maxillary sinus findings in orthodontic patients: a radiographic analysis using cone-beam computed tomography (CBCT). Orthod Craniofac Res. 2011;14:17–24.
Ritter L, Lutz J, Neugebauer J, et al. Prevalence of pathologic findings in the maxillary sinus in cone-beam computerized tomography. Oral Surg Oral Med Oral Pathol Oral Radiol...
Gardner DG. Pseudocysts and retention cysts of the maxillary sinus. Oral Surg Oral Med Oral Pathol. 1984;58:561–7.
Chiapasco M, Palombo D. Sinus grafting and simultaneous removal of large antral pseudocysts of the maxillary sinus with a micro-invasive intraoral access. Int J Oral Maxillofac Surg. 2015;44:1499–505.
Cano J, Campo J, Alobera MA, Baca R. Surgical ciliated cyst of the maxilla. Cl...
Beretta M, Poli PP, Grossi GB, Pieroni S, Maiorana C. Long-term survival rate of implants placed in conjunction with 246 sinus floor elevation procedures: results of a 15-year retrospective study. J Dent. 2015;43:78–86.
Del Fabbro M, Corbella S, Weinstein T, Ceresoli V, Taschieri S. Implant survival rates after osteotome-mediated maxillary sinus augmentation: a systematic review. Clin Implant D...
Cone-beam computed tomographic
Protected Health Information
Sinus floor elevation
Our study found that the largest tissue thickening was present in the middle section of the maxillary sinus. This tissue thickening did not vary based on gender, age, or smoking status, nor did it relate to the underlying alveolar ridge height. However, patients with a history of periodontal diseases demonstrated a significant association with mucosal thickening. A mucosal thickening index was pro...
Although residual alveolar ridge height has been associated with sinus mucosal thickening [36], our study did not find a significant association between these two parameters. Acharya et al. [36] reported that lower available bone height in the subsinus region was related to thickened sinus membranes within an Asian-Indian and Hong Kong-based Chinese population. Differences in the ethnic compositio...
Based on the findings of the current study, a history of periodontal disease is the only identified parameter significantly associated with sinus mucosal thickening. This finding indicates that clinicians should expect some degree of mucosal thickening when performing sinus augmentation procedures in a previously periodontally involved site. This finding is consistent with several previously publi...
CBCT imaging has been recognized as a more sensitive imaging modality for identifying sinus thickening and pathoses in the posterior maxilla compared to panoramic radiography [21, 22]. This could explain why the current study identified a higher prevalence of mucosal thickening compared to earlier studies [23]. However, compared to other similar CBCT studies [21, 24, 25], the prevalence reported i...
Twenty-nine CBCT images (11 females and 18 males) were included in this study. All the implants placed in these included cases survived, representing a 100% implant survival rate. With regards to measurements of mucosal thickening, the intra-examiner reproducibility revealed an exact intra-examiner correlation of 99%, with a p value of 0.40 for a t test for independent samples, indicating a high r...
The sites that were measured are specified in the image below (Fig. 1). The most posterior and anterior aspects of the visible maxillary sinus were measured. The ½ point along with the ¼ and ¾ points were then selected, and the measurements of the mucosal thickening were then completed at these three sites. The thickest portion of the mucosa was also measured if it did not coincide with one of...
The study required access to University of Michigan Protected Health Information (PHI). PHI was necessary in order to track and coordinate the CBCT data and dental and medical history for each subject. Corresponding subject charts and electronic records were reviewed for retrieval of relevant implant placement and restorative history, medical history, and demographic information, including gender ...
Our study hypothesis was that mucosal thickening of more than 2 mm and up to 1/3 of the volume of the sinus would not alter the predictability for SFE and dental implant placement. The primary outcome was to determine the success rate of dental implant placement in augmented maxillary sinus areas with mucosal thickening. A secondary outcome was to evaluate the effect of gender, age, and smoking o...
Despite the high survival rate of dental implants inserted in maxillary sinuses that have undergone sinus floor elevation (SFE) with bone grafting, complications still occur [1–3]. Sinus membrane perforation is reported to be the most common complication [4, 5]. Postoperative maxillary sinusitis is less common (0–22%) [6, 7]; nevertheless, it could potentially compromise the outcome of SFE and...
Although mucosal thickening is the most common radiographic finding observed regarding sinus pathology, the knowledge regarding its clinical significance on the outcomes of dental implants and grafting in the maxillary sinuses is still limited. We hypothesized that mucosal thickening would not alter the predictability for sinus floor augmentation and dental implant placement. The purpose of this r...
Fig. 7. Orthopantomograph 2 years after implant placement
Fig. 6. Clinical picture 2 years after implant placement
Fig. 6. Clinical picture 2 years after implant placement
Fig. 5. Occlusal view of implants after vertical repositioning of the dental alveolus segment showing proper mesiodistal space and buccolingual spacing
Fig. 5. Occlusal view of implants after vertical repositioning of the dental alveolus segment showing proper mesiodistal space and buccolingual spacing
Fig. 4. Vertical repositioning of dental alveolus segment with placement of dental implants
Fig. 4. Vertical repositioning of dental alveolus segment with placement of dental implants
Fig. 3. Direct sinus lift with implant osteotomy preparation
Fig. 3. Direct sinus lift with implant osteotomy preparation
Fig. 2. Marked incision site for surgical access
Fig. 2. Marked incision site for surgical access
Fig. 1. Edentulous site with supra-eruption of opposing dentition
Fig. 1. Edentulous site with supra-eruption of opposing dentition
Tsegga, T., Wright, T. Maxillary segmental osteoperiosteal flap with simultaneous placement of dental implants: case report of a novel technique. Int J Implant Dent 3, 2 (2017). https://doi.org/10.1186/s40729-017-0067-5
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Received: 06 December 2016
Accepted: 13 January 2017
Published: 19 January 2017
DOI: https://doi.org/10.1186/s40729-017-0067-5
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
Department of Oral & Maxillofacial Surgery, San Antonio Military Medical Center, 3551 Roger Brooke Dr., Ft. Sam Houston, 78234, TX, USA
Tibebu Tsegga & Thomas Wright
Department of Oral & Maxilofacial Surgery, Wilford Hall Ambulatory Surgical Center, 2200 Bergquist Dr, Suite 1, Lackland AFB, TX, 78236, USA
Tibebu Tsegga & Thomas Wright
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Irinakis T. Efficacy of injectable demineralized bone matrix as graft material during sinus elevation surgery with simultaneous implant placement in the posterior maxilla: clinical evaluation of 49 sinuses. J Oral and Maxillofac Surg. 2011;69:134–41.
Chiapasoo M, Casentini P, Zaniboni M. Bone augmentation procedures in implant dentistry. Int J Oral Maxillofac Implants. 2009;24:237–69.
Jenson...
This case highlights the evolving variations in dentoalveolar augmentation with an emphasis on concomitant implant placement. In the most traditional sense, a vertical osteoperiosteal flap technique would be bound with a stable basal bone that can be used to anchor simultaneous dental implant placement. Further refinement should consider minimizing crestal reflection and overall labial bone resorp...
A critical appraisal of the gingival architecture in the final end point of this case demonstrates some radiolucency through the soft tissue outlining the platform of the Nobel Biocare TiUnite implant. This would lead us to believe that either the transmucosal bone level placement attempt was inaccurate or excessive reflection of the labial tissue has caused some degree of resorption. This is anot...
A suitable alternative surgical management of this particular case might have been to simply perform an alveoloplasty to produce the desired inter-occlusal clearance and proceed with placement of implant and simultaneous direct sinus lift. That would have left more of the apical portion of the implant within the grafted sinus and possibly modified the location of keratinized band of tissue. The lo...
A 35-year-old female with a 10-year history of partial acquired edentulism at site numbers 3 and 4 presented to our clinic for dental implant evaluation. Preoperative clinical examination revealed a reproducible intercuspation, well-delineated band of keratinized tissue, and decreased inter-occlusal clearance to allow for optimal dimension of prosthetic crowns (Fig. 1). Radiographs demonstrated e...
Obtaining proper occlusal clearance to allow for a single unit crown restoration is a fundamental prerequisite for dental implant restoration. Long-standing edentulous sites are often fraught with disuse atrophy and unopposed supra-eruption of the opposing dentition. In the posterior maxillae/mandible, there are vital structures that have to be mobilized in order to allow space for either bone tra...
Dental restorative space from the opposing dentition requires adequate distance for restorative material for an acceptable restoration. Typically, long-standing edentulous alveolar ridges will have vertical and or horizontal defects that require alveolar ridge augmentation for ideal dental implant restorations. Along with these defects, one will see the opposing dentition supra erupt which can obl...
Fig. 5. Total score for physical and psychological disabilities before (gray) and after (hatched) sinus augmentation according to indications
Fig. 5. Total score for physical and psychological disabilities before (gray) and after (hatched) sinus augmentation according to indications
Fig. 4. Total score for functional limitations before (gray) and after (hatched) sinus augmentation according to indications
Fig. 4. Total score for functional limitations before (gray) and after (hatched) sinus augmentation according to indications
Fig. 3. Total score for complaints due to surgical procedure pre-operative, post-operative, and recently
Fig. 3. Total score for complaints due to surgical procedure pre-operative, post-operative, and recently
Fig. 2. Cumulative survival rate according to Kaplan–Meier and sinus augmentation procedure
Fig. 2. Cumulative survival rate according to Kaplan–Meier and sinus augmentation procedure
Fig. 1. Flow chart of patients included in the study
Fig. 1. Flow chart of patients included in the study
Item
Mean ± SD pre-operative
Mean ± SD post-operative
Mean ± SD in the last time
Have you felt pain in your mouth?
...
Item
Mean ± SD before sinus lift
Mean ± SD after sinus lift
p value
Have you felt tense because of problems with your teeth, mouth or dentures?
...
Item
Mean ± SD before sinus lift
Mean ± SD after sinus lift
p value
Have you had difficulty chewing any foods?
...
Schiegnitz, E., Kämmerer, P.W., Sagheb, K. et al. Impact of maxillary sinus augmentation on oral health-related quality of life. Int J Implant Dent 3, 10 (2017). https://doi.org/10.1186/s40729-017-0072-8
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Received: 20 November 2016
Accepted: 12 March 2017
Published: 28 March 2017
DOI: https://doi.org/10.1186/s40729-017-0072-8
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre of the Johannes Gutenberg-University, Augustusplatz 2, 55131, Mainz, Germany
E. Schiegnitz, K. Sagheb, A. Pabst, B. Al-Nawas & M. O. Klein
Department of Oral and Maxillofacial Surgery, Plastic Surgery, University of Rostock, Rostock, Germany
P. W. Kämmerer
Department of Prosthodontics, University of ...
Stellingsma K, Bouma J, Stegenga B, Meijer HJ, Raghoebar GM. Satisfaction and psychosocial aspects of patients with an extremely resorbed mandible treated with implant-retained overdentures. A prospective, comparative study. Clin Oral Implants Res. 2003;14(2):166–72.
Heydecke G, Locker D, Awad MA, Lund JP, Feine JS. Oral and general health-related quality of life with conventional and implant d...
Locker D. Self-esteem and socioeconomic disparities in self-perceived oral health. J Public Health Dent. 2009 Winter;69(1):1-8.
Allen PF, McMillan AS, Walshaw D. A patient-based assessment of implant-stabilized and conventional complete dentures. J Prosthet Dent. 2001;85(2):141–7.
Ohrn K, Jonsson B. A comparison of two questionnaires measuring oral health-related quality of life before and aft...
Al-Nawas B, Schiegnitz E. Augmentation procedures using bone substitute materials or autogenous bone—a systematic review and meta-analysis. Eur J Oral Implantol. 2014 Summer;7 Suppl 2:S219-34.
Derks J, Hakansson J, Wennstrom JL, Tomasi C, Larsson M, Berglundh T. Effectiveness of implant therapy analyzed in a Swedish population: early and late implant loss. J Dent Res. 2015;94(3 Suppl):44S–51S...
Within the limitations of this study, the results demonstrated a high long-term survival for sinus augmentation procedures and significant improvement of OHRQoL after this procedure. Therefore, sinus augmentation procedures are highly valuable treatment options in implant dentistry.
In order to measure OHRQoL in the present study, a specific and shortened questionnaire based on the validated and reliable OHIP score was developed to consider representative impairments of maxillary sinus augmentation like sinusitis and to relieve the clinical application. In a cross sectional study, Allen et McMillan proofed that a shortened OHIP-14 version showed a similar ability to assess OH...
The clinical and radiological outcomes of sinus augmentation procedures have been published in several studies [1, 3, 6, 7]. However, little data on the physical and psychological impact of this procedure on the patient is available yet. The present study evaluated pre-operative and post-treatment OHRQoL self-assessment scores of patients treated with dental implants after sinus augmentation proce...
Concerning functional limitations, all posed questions showed significant better values for OHRQoL after sinus augmentation procedure than before the treatment (p
After an average time in situ of 41.2 ± 27 months (3.4 years; range 0–96 months), 40 of the 863 implants were lost. These results indicated an in situ rate of 95.4%. One-year and five-year survival rate according to Kaplan–Meier were 95.4 and 94.4%. In patients receiving an external sinus lift an in situ rate of 95.1% and in patients with an internal sinus lift an in situ rate of 96.4%...
The Kaplan–Meier survival function was applied for the description of survival rates. To examine the statistical difference between survival rates, a log-rank test was used. Implant-related data were calculated. For statistical comparison of the paired questions and the total scores, a Wilcoxon test was applied. The intention of this study was descriptive, exploratory without a primary hypothesi...
This retrospective study addresses the oral health-related quality of life after maxillary sinus augmentation. Therefore, all patients that received an implantation after maxillary sinus augmentation in the Department of Oral and Maxillofacial Surgery of the University Medical Centre Mainz, Germany, between July 2002 and December 2007 were included in this study. There were no specific exclusion c...
In conclusion, little information is available about patient’s perception of sinus augmentation procedures. The aim of the present study was to assess whether sinus augmentation procedures together with implant placement and prosthetic rehabilitation improve quality of life in dental patients using a modified German OHIP and to examine the survival rates after this procedure.
Rehabilitation of completely and partial edentulous patients with dental implants has proved to be a safe and predictable procedure [1–3]. However, reduced bone height and the proximity of the maxillary sinus are challenging limitations for dental implant placement in the posterior maxilla [3]. Besides the use of short and tilted implants [4], one of the most frequently used surgical techniques ...
The aim of this study was to measure the oral health-related quality of life (OHRQoL) after maxillary sinus augmentation to determine the physical and psychological impact of this procedure for the patient.
Three hundred sixteen patients treated with an external or internal maxillary sinus augmentation and a total of 863 implants in the Department of Oral and Maxillofacial Surgery, Johannes Guten...
Fig. 2. a Panoramic radiography with area of interest (maxillary sinus) and b, c examples of corresponding images in cone beam computed tomography
Fig. 2. a Panoramic radiography with area of interest (maxillary sinus) and b, c examples of corresponding images in cone beam computed tomography
Fig. 1.
Fig. 1. a Panoramic radiography with area of interest (maxillary sinus) and b, c examples of corresponding images in cone beam computed tomography
Question
General practitioner (n = 2)
Junior maxillofacial surgeon (n = 2)
Senior maxillofacial surgeon (n = 3)
p value*
...
Additional incidental findings in panoramic radiography
Relative incidence (%) in relation to total number of therapy affecting findings
Retained third molar/follicular cyst
22
...
Number of cases
General practitioner (n = 2)
Junior maxillofacial surgeon (n = 2)
Senior maxillofacial surgeon (n = 3)
p value*
...
Question
General practitioner (n = 2)
Junior maxillofacial surgeon (n = 2)
Senior maxillofacial surgeon (n = 3)
p value*
...
Question
General practitioner (n = 2)
Junior maxillofacial surgeon (n = 2)
Senior maxillofacial surgeon (n = 3)
p value*
...
Dau, M., Marciak, P., Al-Nawas, B. et al. Evaluation of symptomatic maxillary sinus pathologies using panoramic radiography and cone beam computed tomography—influence of professional training.
Int J Implant Dent 3, 13 (2017). https://doi.org/10.1186/s40729-017-0075-5
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Received: 10 December 2016
Accepted: 12 March 2017
Published: 05 April 2017
DOI: http...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
Department of Oral, Maxillofacial and Plastic Surgery, University Medical Center, Schillingallee 35, 18057, Rostock, Germany
Michael Dau, Bernhard Frerich & Peer Wolfgang Kämmerer
Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre, Mainz, Germany
Paul Marciak & Bial Al-Nawas
Private Dental Praxis Dr. Rossa, Ludwigshafen, Germany
Henning Staedt
Depa...
Quintero JC, et al. Craniofacial imaging in orthodontics: historical perspective, current status, and future developments. Angle Orthod. 1999;69(6):491–506.
Tadinada A, et al. Radiographic evaluation of the maxillary sinus prior to dental implant therapy: a comparison between two-dimensional and three-dimensional radiographic imaging. Imaging Sci Dent. 2015;45(3):169–74.
Ritter L, et al. Pre...
Rivis M, Valeanu AN. Giant maxillary cyst with intrasinusal evolution. Rom J Morphol Embryol. 2013;54(3 Suppl):889–92.
Yilmaz SY, Misirlioglu M, Adisen MZ. A diagnosis of maxillary sinus fracture with cone-beam CT: case report and literature review. Craniomaxillofac Trauma Reconstr. 2014;7(2):85–91.
Lana JP, et al. Anatomic variations and lesions of the maxillary sinus detected in cone beam ...
Gang TI, et al. The effect of radiographic imaging modalities and the observer’s experience on postoperative maxillary cyst assessment. Imaging Sci Dent. 2014;44(4):301–5.
Batra PS, et al. Computed tomography imaging practice patterns in adult chronic rhinosinusitis: survey of the American Academy of Otolaryngology-Head and Neck Surgery and American Rhinologic Society Membership. Int Forum Al...
Dragan E, et al. Maxillary sinus anatomic and pathologic CT findings in edentulous patients scheduled for sinus augmentation. Rev Med Chir Soc Med Nat Iasi. 2014;118(4):1114–21.
Raghav M, et al. Prevalence of incidental maxillary sinus pathologies in dental patients on cone-beam computed tomographic images. Contemp Clin Dent. 2014;5(3):361–5.
Lyros I, et al. An incidental finding on a diagno...
Depending on the observers’ clinical and radiological experience, PAN alone may not be sufficient for evaluation of pathologies of the maxillary sinus. On the contrary, significant benefits of sFOV-CBCT for diagnosing symptomatic maxillary sinus pathologies were reported. Having sFOV-CBCT seems to have added additional information and confidence in comparison to PAN alone. Nonetheless, also with...
The influence of clinical experience of evaluation of PAN [34] as well as the clinical experience and routine analysis of 3D radiographs (as assumed for maxillofacial surgeons when compared to those for general practitioners) strongly influence the diagnostic value of additional three-dimensional imaging. The number of incidental findings in CBCT in addition to those seen in PAN was not of major d...
In dentistry, PAN is a widely available, useful, and important diagnostic tool for diagnosis and general preoperative planning [32] with less radiation exposure then CBCT [21]. While most dentists have used it routinely successful for years and gained significant experience in doing so [33], there are certain limitations in dependence of the region to be examined [10]. The high number of “not vi...
This study focused on three different aspects in our analysis—PAN, PAN and CBCT, as well as the influence of the different clinical and radiological experience (examples in Figs. 1 and 2).
Panoramic radiography (PAN)
When assessing PAN, the ratings were significantly lower at “good visible and can be evaluated” (9.9%) compared to “visible but cannot be evaluated” (39.5%; p
The first question for PAN addressed the imaging quality in the clinical relevant area of interest (clinical data were given). Three answers were possible: 1 = good visibility and can be evaluated, 2 = visible but cannot be evaluated, and 3 = not visible. The second question asked for an additional need for CBCT scans. Three answers were possible: 1 = required, 2 = reasonable, and 3 = not required...
In an experimental diagnostic comparison, radiographic images of 15 female and 13 male patients were assessed. Patients’ radiographs were selected from the Department of Oral, Maxillofacial and Facial Plastic Surgery of the University Medical Centre of Mainz and Rostock, Germany. All patients have had referrals to the hospitals with symptomatic maxillary sinus pathologies and received PAN (Ortho...
In order to justify CBCT use for clinical examination and diagnosis of the maxillary sinus, the aim of this study was to compare the subjective quality rating of PAN and PAN together with a small field of view (sFOV) CBCT to evaluate symptomatic maxillary sinus by clinicians with different training and clinical experience.
Non-symptomatic abnormalities of the maxillary sinus such as mucosal thickening, retention cysts, and opacification are reported to occur in up to 74% of all cases [1–6]. For diagnosis of symptomatic pathologies of the maxillary sinus like retention cysts, polyps, and tumors, panoramic radiographies (PAN) are commonly used and widely available. In PAN, not every area of interest is accurately de...
A comparison of panoramic radiography (PAN) alone and PAN together with small field of view cone beam computed tomography (sFOV-CBCT) for diagnosis of symptomatic pathologies of the maxillary sinus was carried out by clinicians of different experience.
Corresponding radiographic images (PAN/sFOV-CBCT) of 28 patients with symptomatic maxillary sinus pathologies were chosen and analyzed by two gene...
Fig. 6. Histomorphometric evaluation results (considering six sections for each biopsy), for newly formed bone, soft tissues, and others
Fig. 6. Histomorphometric evaluation results (considering six sections for each biopsy), for newly formed bone, soft tissues, and others
Fig. 5. Histomicrograph of a biopsy from the BC + EMD group, showing an aspect of newly formed bone. Section stained with picrosirius-hematoxylin and digitalized with bright-field (d) and linearly polarized light (e and f). e, f Results of near 45° section rotation (between axes B–B’ and C–C’) to compensate some of the orientation-related effects associated with linearly polarized l...
Fig. 4. Histomicrograph of a biopsy from the BC group, showing an aspect of newly formed bone. Section stained with picrosirius-hematoxylin and digitalized with bright-field (a) and linearly polarized light (b and c). b, c Results of near 45° section rotation (between axes B–B’ and C–C’) to compensate some of the orientation-related effects associated with linearly polarized light. In a...
Fig. 3. Histomicrograph of a biopsy from the BC + EMD group. Overview—×25 magnification; b ×30 magnification; c ×60 magnification. Areas corresponding to BC + EMD removed during histological processing (square) surrounded by newly formed bone (asterisk), with large numbers of osteocytes and soft tissue (arrow) can be observed. There is direct contact between the BC reminiscent, soft...
Fig. 2. Histomicrograph of a biopsy from the BC group. a Overview—×25 magnification; b ×30 magnification; c ×60 magnification. Areas corresponding to BC removed during histological processing (square) in direct contact with newly formed bone (asterisk), containing a large number of osteocytes, and with soft tissue (arrow) can be observed (hematoxylin-eosin stain)
Fig. 2. Histomicrograph ...
Fig. 1. Histomicrograph illustrating the various tissue areas measured on the sections: newly formed bone (green mask), soft tissues (purple mask), and “others”, including residual bone substitute particles and empty spaces either due to removal of the bone substitute particles during to the decalcification processing or due to artifacts (white mask)
Fig. 1. Histomicrograph illustrating t...
Nery, J.C., Pereira, L.A.V.D., Guimarães, G.F. et al. β-TCP/HA with or without enamel matrix proteins for maxillary sinus floor augmentation: a histomorphometric analysis of human biopsies.
Int J Implant Dent 3, 18 (2017). https://doi.org/10.1186/s40729-017-0080-8
Download citation
Received: 08 December 2016
Accepted: 22 April 2017
Published: 04 May 2017
DOI: https://do...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
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Correspondence to
James Carlos Nery.
Department of Implantology, São Leopoldo Mandic Research Center, Brasília, DF, Brazil
James Carlos Nery, George Furtado Guimarães & Fabiana Mantovani Gomes França
Department of Biochemistry and Tissue Biology, UNICAMP – State University of Campinas, Institute of Biology, Campinas, São Paulo, Brazil
Luís Antônio Violin Dias Pereira
Department of Periodontology, UNESP – Univ. Estad...
Wikesjo UM, Sorensen RG, Kinoshita A, Wozney JM. RhBMP-2/alphaBSM induces significant vertical alveolar ridge augmentation and dental implant osseointegration. Clin Implant Dent Relat Res. 2002;4:174–82.
Carinci F, Brunelli G, Franco M, Viscioni A, Rigo L, Guidi R, et al. A retrospective study on 287 implants installed in resorbed maxillae grafted with fresh frozen allogenous bone. Clin Implant...
Miron RJ, Sculean A, Cochran DL, Froum S, Zucchelli G, Nemcovsky C, et al. Twenty years of enamel matrix derivative: the past, the present and the future. J Clin Periodontol. 2016;43:668–83.
Sculean A, Nikolidakis D, Nikou G, Ivanovic A, Chapple IL, Stavropoulos A. Biomaterials for promoting periodontal regeneration in human intrabony defects: a systematic review. Periodontol 2000. 2015;68:182...
Esposito M, Felice P, Worthington HV. Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus. Cochrane Database Syst Rev. 2014;17:CD008397.
Jungner M, Cricchio G, Salata LA, Sennerby L, Lundqvist C, Hultcrantz M, et al. On the early mechanisms of bone formation after maxillary sinus membrane elevation: an experimental histological and immunohistochemical study. ...
The present study showed that maxillary sinus floor augmentation with BC resulted in adequate amounts of new bone formation allowing successful implant installation, while adding EMD did not have a significant effect.
Nevertheless, the amount of bone generated with BC or BC + EMD herein was adequate to support successful implant placement and osseointegration of implants. In fact, more or less similar amounts of bone formation have been reported in studies evaluating human sinus biopsies after grafting with a variety of biomaterials (bone formation ranging approximately from 30 to 50%) [19]. On the other ha...
The present study compared the histological and histomorphometrical outcome of healing after maxillary sinus floor augmentation with BC with or without EMD, based on human biopsies. The results showed that addition of EMD did not enhance the outcome of healing, neither in terms of quality nor quantity of new bone. Nevertheless, the amount of bone generated after maxillary sinus floor augmentation ...
All ten patients showed uneventful healing after the sinus floor augmentation procedure as well as after dental implant placement, with no overt postoperative inflammation or infection. Consistently, in all ten patients, no significant jiggling of the drill was noticed during biopsy harvesting, while subjective drilling resistance during implant placement was similar in both groups and all implant...
The data for each tissue component from the three histological sections were averaged to represent the biopsy. Commercially available software (GraphPad Prism 5.0 for Windows, GraphPad Software Inc., USA) was utilized for statistical comparisons between groups and for drawing the graphics. The assumption of normality was checked using D’Agostino & Pearson omnibus test. The data for each evaluate...
Six months after grafting, another CBCT examination was carried out for implant planning. In the sequence, following the previously described antiseptic and anesthetic procedures, two implants with a sand-blasted and acid etching surface were installed in each of the grafted sinuses, i.e., 40 implants in total (32—Neoporous, Neodent, Curitiba, Paraná, Brazil; 8—SLA, Straumann, Basel, Switzerl...
This research project was approved by the Ethics Committee of the School of Dentistry and Dental Research Center São Leopoldo Mandic, Brazil, under the protocol 2010/0360.
Ten consecutive patients (age range 35–75 years) with the need of bilateral maxillary sinus floor augmentation prior to the placement of four dental implants (two in each side of posterior maxilla) were selected for the stu...
The aim of the present study was to compare histomorphometrically the outcome of maxillary sinus floor augmentation with β-TCP/HA with or without enamel matrix proteins (BC + EMD and EMD, respectively) in humans.
Reconstruction of the edentulous and severely atrophied posterior maxilla is often performed by means of maxillary sinus floor augmentation in combination with dental implants [1, 2]. Various bone graft materials are typically used for enhancing bone formation within the sinus cavity; autogenous bone (AB) is considered as the gold standard due to its osteogenic, osteoinductive, and osteoconductive...
It is still unclear whether enamel matrix proteins (EMD) as adjunct to bone grafting enhance bone healing. This study compared histomorphometrically maxillary sinus floor augmentation (MSFA) with β-TCP/HA in combination with or without EMD in humans.
In ten systemically healthy patients needing bilateral MSFA, one side was randomly treated using β-TCP/HA mixed with EMD (BC + EMD) and the ot...
Fig. 6. Histomorphometric evaluation results (considering six sections for each biopsy), for newly formed bone, soft tissues, and others
Fig. 6. Histomorphometric evaluation results (considering six sections for each biopsy), for newly formed bone, soft tissues, and others
Fig. 5. Histomicrograph of a biopsy from the BC + EMD group, showing an aspect of newly formed bone. Section stained with picrosirius-hematoxylin and digitalized with bright-field (d) and linearly polarized light (e and f). e, f Results of near 45° section rotation (between axes B–B’ and C–C’) to compensate some of the orientation-related effects associated with linearly polarized l...
Fig. 4. Histomicrograph of a biopsy from the BC group, showing an aspect of newly formed bone. Section stained with picrosirius-hematoxylin and digitalized with bright-field (a) and linearly polarized light (b and c). b, c Results of near 45° section rotation (between axes B–B’ and C–C’) to compensate some of the orientation-related effects associated with linearly polarized light. In a...
Fig. 3. Histomicrograph of a biopsy from the BC + EMD group. Overview—×25 magnification; b ×30 magnification; c ×60 magnification. Areas corresponding to BC + EMD removed during histological processing (square) surrounded by newly formed bone (asterisk), with large numbers of osteocytes and soft tissue (arrow) can be observed. There is direct contact between the BC reminiscent, soft...
Fig. 2. Histomicrograph of a biopsy from the BC group. a Overview—×25 magnification; b ×30 magnification; c ×60 magnification. Areas corresponding to BC removed during histological processing (square) in direct contact with newly formed bone (asterisk), containing a large number of osteocytes, and with soft tissue (arrow) can be observed (hematoxylin-eosin stain)
Fig. 2. Histomicrograph ...
Fig. 1. Histomicrograph illustrating the various tissue areas measured on the sections: newly formed bone (green mask), soft tissues (purple mask), and “others”, including residual bone substitute particles and empty spaces either due to removal of the bone substitute particles during to the decalcification processing or due to artifacts (white mask)
Fig. 1. Histomicrograph illustrating t...
Nery, J.C., Pereira, L.A.V.D., Guimarães, G.F. et al. β-TCP/HA with or without enamel matrix proteins for maxillary sinus floor augmentation: a histomorphometric analysis of human biopsies.
Int J Implant Dent 3, 18 (2017). https://doi.org/10.1186/s40729-017-0080-8
Download citation
Received: 08 December 2016
Accepted: 22 April 2017
Published: 04 May 2017
DOI: https://do...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
You can also search for this author in
PubMed Google Scholar
Correspondence to
James Carlos Nery.
Department of Implantology, São Leopoldo Mandic Research Center, Brasília, DF, Brazil
James Carlos Nery, George Furtado Guimarães & Fabiana Mantovani Gomes França
Department of Biochemistry and Tissue Biology, UNICAMP – State University of Campinas, Institute of Biology, Campinas, São Paulo, Brazil
Luís Antônio Violin Dias Pereira
Department of Periodontology, UNESP – Univ. Estad...
Wikesjo UM, Sorensen RG, Kinoshita A, Wozney JM. RhBMP-2/alphaBSM induces significant vertical alveolar ridge augmentation and dental implant osseointegration. Clin Implant Dent Relat Res. 2002;4:174–82.
Carinci F, Brunelli G, Franco M, Viscioni A, Rigo L, Guidi R, et al. A retrospective study on 287 implants installed in resorbed maxillae grafted with fresh frozen allogenous bone. Clin Implant...
Miron RJ, Sculean A, Cochran DL, Froum S, Zucchelli G, Nemcovsky C, et al. Twenty years of enamel matrix derivative: the past, the present and the future. J Clin Periodontol. 2016;43:668–83.
Sculean A, Nikolidakis D, Nikou G, Ivanovic A, Chapple IL, Stavropoulos A. Biomaterials for promoting periodontal regeneration in human intrabony defects: a systematic review. Periodontol 2000. 2015;68:182...
Esposito M, Felice P, Worthington HV. Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus. Cochrane Database Syst Rev. 2014;17:CD008397.
Jungner M, Cricchio G, Salata LA, Sennerby L, Lundqvist C, Hultcrantz M, et al. On the early mechanisms of bone formation after maxillary sinus membrane elevation: an experimental histological and immunohistochemical study. ...
The present study showed that maxillary sinus floor augmentation with BC resulted in adequate amounts of new bone formation allowing successful implant installation, while adding EMD did not have a significant effect.
Nevertheless, the amount of bone generated with BC or BC + EMD herein was adequate to support successful implant placement and osseointegration of implants. In fact, more or less similar amounts of bone formation have been reported in studies evaluating human sinus biopsies after grafting with a variety of biomaterials (bone formation ranging approximately from 30 to 50%) [19]. On the other ha...
The present study compared the histological and histomorphometrical outcome of healing after maxillary sinus floor augmentation with BC with or without EMD, based on human biopsies. The results showed that addition of EMD did not enhance the outcome of healing, neither in terms of quality nor quantity of new bone. Nevertheless, the amount of bone generated after maxillary sinus floor augmentation ...
All ten patients showed uneventful healing after the sinus floor augmentation procedure as well as after dental implant placement, with no overt postoperative inflammation or infection. Consistently, in all ten patients, no significant jiggling of the drill was noticed during biopsy harvesting, while subjective drilling resistance during implant placement was similar in both groups and all implant...
The data for each tissue component from the three histological sections were averaged to represent the biopsy. Commercially available software (GraphPad Prism 5.0 for Windows, GraphPad Software Inc., USA) was utilized for statistical comparisons between groups and for drawing the graphics. The assumption of normality was checked using D’Agostino & Pearson omnibus test. The data for each evaluate...
Six months after grafting, another CBCT examination was carried out for implant planning. In the sequence, following the previously described antiseptic and anesthetic procedures, two implants with a sand-blasted and acid etching surface were installed in each of the grafted sinuses, i.e., 40 implants in total (32—Neoporous, Neodent, Curitiba, Paraná, Brazil; 8—SLA, Straumann, Basel, Switzerl...
This research project was approved by the Ethics Committee of the School of Dentistry and Dental Research Center São Leopoldo Mandic, Brazil, under the protocol 2010/0360.
Ten consecutive patients (age range 35–75 years) with the need of bilateral maxillary sinus floor augmentation prior to the placement of four dental implants (two in each side of posterior maxilla) were selected for the stu...
The aim of the present study was to compare histomorphometrically the outcome of maxillary sinus floor augmentation with β-TCP/HA with or without enamel matrix proteins (BC + EMD and EMD, respectively) in humans.
Reconstruction of the edentulous and severely atrophied posterior maxilla is often performed by means of maxillary sinus floor augmentation in combination with dental implants [1, 2]. Various bone graft materials are typically used for enhancing bone formation within the sinus cavity; autogenous bone (AB) is considered as the gold standard due to its osteogenic, osteoinductive, and osteoconductive...
It is still unclear whether enamel matrix proteins (EMD) as adjunct to bone grafting enhance bone healing. This study compared histomorphometrically maxillary sinus floor augmentation (MSFA) with β-TCP/HA in combination with or without EMD in humans.
In ten systemically healthy patients needing bilateral MSFA, one side was randomly treated using β-TCP/HA mixed with EMD (BC + EMD) and the ot...
Fig. 6. Patient # 1 (12-month healing time): increased bone formation following the shape of the grafted particles that are still present (magnification ×100)
Fig. 6. Patient # 1 (12-month healing time): increased bone formation following the shape of the grafted particles that are still present (magnification ×100)
Fig. 5. Patient # 4 (9-month healing time): increased bone formation following the shape of the grafted particles stained with Goldner trichrome staining (magnification ×100)
Fig. 5. Patient # 4 (9-month healing time): increased bone formation following the shape of the grafted particles stained with Goldner trichrome staining (magnification ×100)
Fig. 4. Patient # 1 (12-month healing time): overview of a typical example of a bone biopsy stained with Goldner trichrome staining (magnification ×10)
Fig. 4. Patient # 1 (12-month healing time): overview of a typical example of a bone biopsy stained with Goldner trichrome staining (magnification ×10)
Fig. 3. Alveolar tissue height (in true mm) over a 5-year period in the 12-month group
Fig. 3. Alveolar tissue height (in true mm) over a 5-year period in the 12-month group
Fig. 2. Aveolar tissue height (in true mm) over a 5-year period in the 9-month group
Fig. 2. Aveolar tissue height (in true mm) over a 5-year period in the 9-month group
Fig. 1. Images of patient # 5 (9-month healing time). a. Radiograph of the left maxillary sinus: situation 9 months after the maxillary sinus floor elevation procedure. b. With a trephine drill, the implant osteotomy is made and the biopsy is obtained. c. Clinical situation after placing two Straumann® SLA implants in the left posterior maxilla. d. Radiograph of two Straumann® SLA implants in...
Patient (N)
Gender/age
Retrieval location
BV/TV (%)
BS/TV (mm2/mm3)
Tb.Th (μm)
...
Patient (N)
Gender/age)
Retrieval location
BV/TV (%)
BS/TV (mm2/mm3)
Tb.Th (μm)
...
Patient
Gender/age
Implant site
T0
T1
Increase
...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Authors W.F. Bouwman, N. Bravenboer, J.W.F.H. Frenken, C.M. ten Bruggenkate and E.A.J.M. Schulten state that there are no conflicts of interest, either directly or indirectly.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Correspondence to
E. A. J. M. Schulten.
Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
W. F. Bouwman, C. M. ten Bruggenkate & E. A. J. M. Schulten
Department of Clinical Chemistry, VU University Medical Center, Amsterdam, The Netherlands
N. Bravenboer
Department of Oral and Maxillofacial Su...
Groeneveld EH, van den Bergh JP, Holzmann P, ten Bruggenkate CM, Tuinzing DB, Burger EH. Mineralization processes in demineralized bone matrix grafts in human maxillary sinus floor elevations. J Biomed Mater Res. 1999;48:393–402.
Schulten EAJM, Prins HJ, Overman JR, Helder MN, ten Bruggenkate CM, Klein-Nulend JA. Novel approach revealing the effect of collagenous membrane on osteoconduction in ...
Schopper C, Ziya-Ghazvini F, Goriwoda W, Moser D, Wanschitz F, Spassova E, Lagogiannis G, Auterith A, Ewers R. HA/TCP compounding of a porous CaP biomaterial improves bone formation and scaffold degradation—a long-term histological study. J Biomed Mater Res B Appl Biomater. 2005;74:458–67.
Frenken JW, Bouwman WF, Bravenboer N, Zijderveld SA, Schulten EA, ten Bruggenkate CM. The use of Strauma...
Beirne JC, Barry HJ, Brady FA, Morris VB. Donor site morbidity of the anterior iliac crest following cancellous bone harvest. Int J Oral Maxillofac Surg. 1996;25:268–71.
Vermeeren JIJF, Wismeijer D, van Waas MAJ. One-step reconstruction of the severely resorbed mandible with onlay bone grafts and endosteal implants: a 5-year follow-up. Int J Oral Maxillofac Surg. 1996;2:112–5.
Nkenke E, Stel...
Boyne PJ, James RA. Grafting of the maxillary sinus floor with autogenous marrow and bone. J Oral Surg. 1980;38:613–6.
Tatum H Jr. Maxillary and sinus implant reconstructions. Dent Clin N Am. 1986;30:207–29.
Del Fabbro M, Rosano G, Taschieri S. Implant survival rates after maxillary sinus augmentation. Eur J Oral Sci. 2008;116:497–506.
Pjetursson BE, Tan WC, Zwahlen M, Lang NP. A systemat...
Based on clinical, radiological, histological, and histomorphometric analysis, this study confirms the suitability of BCP for vertical augmentation of the posterior maxilla by means of an MSFE procedure, allowing dental implant placement after 9 and 12 months healing times. Yet, complete degradation of the BCP particles does not occur within a 12-month healing time. From a histological and histom...
In the cranial part of the biopsy, some osteoid islands with osteogenic activity were detected, possibly caused by osteoinductive properties from the lifted bony trap-door. In the present study, histomorphometric analyses revealed that the vital bone volume was higher in the 9-month healing time group than in the 12-month healing time group, while one would expect to find more newly formed bone in...
This study presents the clinical, radiological, histological and histomorphometric results on the use of a biphasic calcium phosphate (Straumann® bone ceramic) in a MSFE procedure with healing times of 9 and 12 months. During the clinical evaluation, it appeared that both 9-month and 12-month healing times resulted in integration of the grafted BCP with the original maxillary bone (sinus floor),...
Histological observations did not show inflammatory cells in the tissue adjacent to the bone substitute particles. Bone marrow-like tissue, which included blood vessels, was observed in between the bone trabeculae (Fig. 4). Reinforcement by lamellar bone was shown in some areas after 9 and 12 months (Figs. 5 and 6). No Howship’s lacunae could be detected on the characteristic outlines of the su...
None of the 10 patients showed postoperative inflammation or infection after the MSFE procedure nor during surgical re-entry for dental implant placement. When opening the area for dental implant insertion, the grafted area proved to be well vascularized and the tissue at the site of the former trap-door location was slightly flexible and had a fibrous aspect. Between the periosteum and the bone g...
Parameters evaluating vital bone mass/bone structure:
1: Vital bone volume (BV): percentage of the grafted section that is vital bone tissue (%)
2: Bone surface (BS): BS expressed as a fraction of the total vital bone volume (mm2/mm3)
3: Thickness of bone trabeculae (Tb.Th) (μm)
Parameters evaluating bone turnover:
1: Osteoid volume (OV): fraction of the vital bone tissue section that is ost...
All 22 inserted dental implants were clinically tested for good primary stability. Osseointegration at abutment connection was tested with a 35-Ncm torque. One experienced oral and maxillofacial surgeon (CB) carried out all follow-up examinations.
Panoramic radiographs were made at patient’s intake (T0); immediately after the MSFE procedure (T1); immediately after dental implant placement (T2);...
A midcrestal incision was made with vertical release incisions at the canine and tuberosity region. A full-thickness mucoperiosteal flap was elevated. The lateral maxillary sinus wall was prepared using a diamond burr with copious irrigation with sterile isotonic saline, regarding the contour of the maxillary sinus as observed on the preoperative panoramic radiograph. A bony top-hinge trap-door wa...
In this study, 10 consecutive healthy patients were selected for a unilateral MSFE procedure. Five patients received dental implants 9 months after MSFE and five patients underwent dental implant surgery 12 months after MSFE. In the 9-month group (three men and two women), the average age was 56.6 years (range 40 to 64 years); in the 12-month group (one man and four women), the average age was...
β-TCP is a biocompatible osteoconductive calcium phosphate that may provide a scaffold for potential bony ingrowth [24]. β-TCP resorbs rather quickly but not necessarily at the same rate as new bone formation [25,26,27]. Most research focused on either using the relative unresorbable HA as a scaffold or β-TCP as a degradable component [19, 24,25,26, 28, 29]. Zerbo et al. [30] concluded that due...
Maxillary sinus floor elevation (MSFE) is a surgical procedure to enhance the bone height in the posterior maxilla with graft material, allowing dental implant placement (later or at the same time) [1, 2]. This pre-implant procedure is predictable and results in a dental implant survival of more than 93.8% 3 years after dental implant placement [3]. According to Pjetursson [4] in his systematic r...
This study evaluates the clinical, radiological, histological, and histomorphometric aspects of a fully synthetic biphasic calcium phosphate (BCP) (60% hydroxyapatite and 40% ß-tricalcium phosphate), used in a human maxillary sinus floor elevation (MSFE) procedure with 9- and 12-month healing time.
A unilateral MSFE procedure, using 100% BCP, was performed in two series of five patients with hea...
Fig. 6. The hydraulic lifter stabilized in the osteotomy before injecting the saline
Fig. 6. The hydraulic lifter stabilized in the osteotomy before injecting the saline
Fig. 5. se conical shape. b The hydraulic lifter
Fig. 5. a The CAS drill has four blades and an inverse conical shape. b The hydraulic lifter
Fig. 4. The inflated balloon while elevating the sinus membrane (The balloon is seen from the medial.)
Fig. 4. The inflated balloon while elevating the sinus membrane (The balloon is seen from the medial.)
Fig. 3.
Fig. 3. a The balloon in a resting position. b The inflated balloon [12]
Fig. 2. The exposed mesial aspect of the sinus
Fig. 2. The exposed mesial aspect of the sinus
Fig. 1. Determination of the remaining bone height (RBH) on the CBCT image
Fig. 1. Determination of the remaining bone height (RBH) on the CBCT image
Methods
BAOFSE
BALLOON
CAS kit
Number of cases
12
12
...
BAOSFE
BALLOON
CAS kit
Total
Stats
p value
Occurrence of perforation
...
Yassin Alsabbagh, A., Alsabbagh, M.M., Darjazini Nahas, B. et al. Comparison of three different methods of internal sinus lifting for elevation heights of 7 mm: an ex vivo study.
Int J Implant Dent 3, 40 (2017). https://doi.org/10.1186/s40729-017-0103-5
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Received: 13 March 2017
Accepted: 29 August 2017
Published: 04 September 2017
DOI: https://doi.org/10...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Aghiad Yassin Alsabbagh, Mohammed Monzer Alsabbagh, Batol Darjazini Nahas, and Salam Rajih declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Department of Periodontology, Damascus University Dental School, Damascus, Syrian Arab Republic
Aghiad Yassin Alsabbagh & Mohammed Monzer Alsabbagh
Department of Orthodontics, Damascus University Dental School, Damascus, Syrian Arab Republic
Batol Darjazini Nahas
Temple university, Philadelphia, USA
Salam Rajih
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Toffler M, Toscano N, Holtzclaw D. Osteotome-mediated sinus floor elevation using only platelet-rich fibrin: an early report on 110 patients. Implant Dent. 2010;19(5):447–56.
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Zitzmann NU, Scharer P. Sinus elevation procedures in the resorbed posterior maxilla. Comparison of the crestal and lateral approaches. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85(1):8–17.
Esposito M, Felice P, Worthington HV. Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus. The Cochrane database of systematic reviews 2014(5):CD008397.
Sc...
Seong WJ, Barczak M, Jung J, Basu S, Olin PS, Conrad HJ. Prevalence of sinus augmentation associated with maxillary posterior implants. The Journal of oral implantology. 2013;39(6):680–8.
Cawood JI, Howell RA. A classification of the edentulous jaws. Int J Oral Maxillofac Surg. 1988;17(4):232–6.
Tan WC, Lang NP, Zwahlen M, Pjetursson BE. A systematic review of the success of sinus floor elev...
An amendment to this paper has been published and can be accessed via the original article.
Within the limitation of this study and that of an ex vivo study, we can accept our hypotheses that the balloon is better than the BAOSFE in elevating the membrane mucosa and the CAS kit is better than the BAOSFE in preparing the osteotomy and breaking the sinus floor for elevation heights of 7 mm. Further, in vivo studies need to be taken to prove these findings.
The BAOSFE technique caused perforations in the membrane in 7 out of 12 cases with a percentage of 58.4. This result is consistent with many previous studies which state that this technique has a high rate of perforations when the RBH is less than 5 mm [2, 7, 26]. Also, all the perforations happened during the elevation process; however, this percentage is different than that reported by Steltzle...
Using a reamer instead of the osteotomes for breaking the sinus floor has the advantage of creating a thin bone shell that prevents direct contact between the drill and the Schneiderian membrane [24]. Moreover, using a reamer has been shown to cause less discomfort and nausea when compared to the osteotome technique as a result of the constant tapping of the osteotomes [25]. As a result, the CAS k...
Although the lateral sinus floor elevation is a proven clinically successful technique [14], the indirect SFE approach is favorable among clinicians because it does not require a second surgery site and hence cause less trauma and discomfort for the patient [14,15,16]. However, this method has its drawbacks, such as a higher risk of membrane perforation, a decreased space for using surgical instru...
For the entire sample, the mean perforation length was (0.711 mm, SD = 1.4) and the mean time required to perform the procedure was (5.65 min, SD = 2.26), and out of the entire sample (N = 36), perforations happened in nine cases for a percentage of 25%.
Chi-square test showed a significant association between method used and the occurrence of perforation (chi-square statistic = 8.585, ...
This approach starts like BAOSFE. The osteotomy is enlarged to 5.0 mm before the balloon (Zimmer Sinus Lift Balloon, Zimmer Dental Inc., California, USA) is inserted (Fig. 3). The sinus floor was broken with the 5 mm osteotome after the addition of bone. The sleeve of the balloon was inserted 1 mm beyond the sinus floor. The saline was injected slowly from the syringe into the balloon, so the ...
To achieve our purposes, an experimental ex vivo study was carried. This research project was approved by the University of Damascus Local Research Ethics Committee (UDDS-3045PG.) and was funded by the Damascus University Postgraduate Research Budget (97687027834DEN). The sinus floor elevations were done on 18 bisected heads of lambs aged between 6 and 12 months that were slaughtered in a maximum...
Therefore, the two working hypotheses of our study were “the CAS-Kit is safer than BAOSFE in breaking the sinus floor and the balloon is safer than BAOSFE in elevating the Schneiderian membrane” for elevation heights of 7 mm.
More than half of the implants placed in the posterior maxilla require sinus floor elevation (SFE) [1]. The need for this procedure is explained by continuous ridge resorption in an apical direction after tooth extraction combined with progressive sinus pneumatization in addition to poor bone quality that is frequently seen in the maxilla [2].
Sinus membrane perforation is considered the most com...
Various techniques are available for elevating the sinus membrane. The aim of this study is to evaluate three methods of indirect sinus floor elevation regarding elevation heights of 7 mm on the outcomes of membrane perforation, length of perforation, and time required to perform the procedure.
Three different methods for indirect sinus lifting, bone added osteotome sinus floor elevation (BAOS...
Fig. 2. Figure illustrating the proposed mucosal thickening index. A ≤1 mm, indicating no thickening; B >1 mm but ≤2 mm, indicating minimal thickening; C >2 mm but ≤5 mm, indicating moderate thickening; D >5 mm, indicating severe thickening
Fig. 2. Figure illustrating the proposed mucosal thickening index. A ≤1 mm, indicating no thickening; B >1 mm but ≤2 mm, indicating min...
Fig. 1. Figure illustrating the reference points of the CBCT measurements. A: most posterior point of the sinus wall; B: most anterior point of the sinus wall; C: mid-point between A and B; C1: measurement of mucosal thickening perpendicular to A–B line at point C; D: mid-point between A and C; D1: measurement of mucosal thickening perpendicular to A–B line at point D; E: mid-point between B...
Gender
Respiratory diseases
Cardio-vascular diseases
Diabetes mellitus
Smoking
Hist...
Patient
Anterior
(E1-floor of the sinus)
Middle
(C1-floor of the sinus)
Posterior
(D1-floor of the sinus)
...
Maska, B., Lin, GH., Othman, A. et al. Dental implants and grafting success remain high despite large variations in maxillary sinus mucosal thickening.
Int J Implant Dent 3, 1 (2017). https://doi.org/10.1186/s40729-017-0064-8
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Received: 18 October 2016
Accepted: 13 January 2017
Published: 18 January 2017
DOI: https://doi.org/10.1186/s40729-017-0064-8
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
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Yvonne Kapila.
Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, 1011 N University Ave, Ann Arbor, MI, USA
Bartosz Maska, Guo-Hao Lin, Abdullah Othman, Shabnam Behdin, Suncica Travan, Erika Benavides & Yvonne Kapila
Department of Surgical Sciences, School of Dentistry, Marquette University, 1801 W Wisconsin Ave, Milwaukee, WI, USA
Guo-Hao Lin
Department of Peri...
The authors thank Ms. Victoria Zakrzewski for her help with the figure generation and preparation.
Co-primary author BM contributed to the CBCT measurement and preparation of the manuscript. Co-primary author G-HL contributed to the data analysis and preparation of the manuscript. Second author AO contributed to the protocol preparation, case review, case selection, and preparation of the manuscr...
Romanos GE, Froum S, Costa-Martins S, Meitner S, Tarnow DP. Implant periapical lesions: etiology and treatment options. J Oral Implantol. 2011;37:53–63.
Acharya A, Hao J, Mattheos N, Chau A, Shirke P, Lang NP. Residual ridge dimensions at edentulous maxillary first molar sites and periodontal bone loss among two ethnic cohorts seeking tooth replacement. Clin Oral Implants Res. 2014;25:1386–94...
Pazera P, Bornstein MM, Pazera A, Sendi P, Katsaros C. Incidental maxillary sinus findings in orthodontic patients: a radiographic analysis using cone-beam computed tomography (CBCT). Orthod Craniofac Res. 2011;14:17–24.
Ritter L, Lutz J, Neugebauer J, et al. Prevalence of pathologic findings in the maxillary sinus in cone-beam computerized tomography. Oral Surg Oral Med Oral Pathol Oral Radiol...
Gardner DG. Pseudocysts and retention cysts of the maxillary sinus. Oral Surg Oral Med Oral Pathol. 1984;58:561–7.
Chiapasco M, Palombo D. Sinus grafting and simultaneous removal of large antral pseudocysts of the maxillary sinus with a micro-invasive intraoral access. Int J Oral Maxillofac Surg. 2015;44:1499–505.
Cano J, Campo J, Alobera MA, Baca R. Surgical ciliated cyst of the maxilla. Cl...
Beretta M, Poli PP, Grossi GB, Pieroni S, Maiorana C. Long-term survival rate of implants placed in conjunction with 246 sinus floor elevation procedures: results of a 15-year retrospective study. J Dent. 2015;43:78–86.
Del Fabbro M, Corbella S, Weinstein T, Ceresoli V, Taschieri S. Implant survival rates after osteotome-mediated maxillary sinus augmentation: a systematic review. Clin Implant D...
Cone-beam computed tomographic
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Sinus floor elevation
Our study found that the largest tissue thickening was present in the middle section of the maxillary sinus. This tissue thickening did not vary based on gender, age, or smoking status, nor did it relate to the underlying alveolar ridge height. However, patients with a history of periodontal diseases demonstrated a significant association with mucosal thickening. A mucosal thickening index was pro...
Although residual alveolar ridge height has been associated with sinus mucosal thickening [36], our study did not find a significant association between these two parameters. Acharya et al. [36] reported that lower available bone height in the subsinus region was related to thickened sinus membranes within an Asian-Indian and Hong Kong-based Chinese population. Differences in the ethnic compositio...
Based on the findings of the current study, a history of periodontal disease is the only identified parameter significantly associated with sinus mucosal thickening. This finding indicates that clinicians should expect some degree of mucosal thickening when performing sinus augmentation procedures in a previously periodontally involved site. This finding is consistent with several previously publi...
CBCT imaging has been recognized as a more sensitive imaging modality for identifying sinus thickening and pathoses in the posterior maxilla compared to panoramic radiography [21, 22]. This could explain why the current study identified a higher prevalence of mucosal thickening compared to earlier studies [23]. However, compared to other similar CBCT studies [21, 24, 25], the prevalence reported i...
Twenty-nine CBCT images (11 females and 18 males) were included in this study. All the implants placed in these included cases survived, representing a 100% implant survival rate. With regards to measurements of mucosal thickening, the intra-examiner reproducibility revealed an exact intra-examiner correlation of 99%, with a p value of 0.40 for a t test for independent samples, indicating a high r...
The sites that were measured are specified in the image below (Fig. 1). The most posterior and anterior aspects of the visible maxillary sinus were measured. The ½ point along with the ¼ and ¾ points were then selected, and the measurements of the mucosal thickening were then completed at these three sites. The thickest portion of the mucosa was also measured if it did not coincide with one of...
The study required access to University of Michigan Protected Health Information (PHI). PHI was necessary in order to track and coordinate the CBCT data and dental and medical history for each subject. Corresponding subject charts and electronic records were reviewed for retrieval of relevant implant placement and restorative history, medical history, and demographic information, including gender ...
Our study hypothesis was that mucosal thickening of more than 2 mm and up to 1/3 of the volume of the sinus would not alter the predictability for SFE and dental implant placement. The primary outcome was to determine the success rate of dental implant placement in augmented maxillary sinus areas with mucosal thickening. A secondary outcome was to evaluate the effect of gender, age, and smoking o...
Despite the high survival rate of dental implants inserted in maxillary sinuses that have undergone sinus floor elevation (SFE) with bone grafting, complications still occur [1–3]. Sinus membrane perforation is reported to be the most common complication [4, 5]. Postoperative maxillary sinusitis is less common (0–22%) [6, 7]; nevertheless, it could potentially compromise the outcome of SFE and...
Although mucosal thickening is the most common radiographic finding observed regarding sinus pathology, the knowledge regarding its clinical significance on the outcomes of dental implants and grafting in the maxillary sinuses is still limited. We hypothesized that mucosal thickening would not alter the predictability for sinus floor augmentation and dental implant placement. The purpose of this r...
Tsegga, T., Wright, T. Maxillary segmental osteoperiosteal flap with simultaneous placement of dental implants: case report of a novel technique.
Int J Implant Dent 3, 2 (2017). https://doi.org/10.1186/s40729-017-0067-5
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Received: 06 December 2016
Accepted: 13 January 2017
Published: 19 January 2017
DOI: https://doi.org/10.1186/s40729-017-0067-5
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Department of Oral & Maxillofacial Surgery, San Antonio Military Medical Center, 3551 Roger Brooke Dr., Ft. Sam Houston, 78234, TX, USA
Tibebu Tsegga & Thomas Wright
Department of Oral & Maxilofacial Surgery, Wilford Hall Ambulatory Surgical Center, 2200 Bergquist Dr, Suite 1, Lackland AFB, TX, 78236, USA
Tibebu Tsegga & Thomas Wright
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Irinakis T. Efficacy of injectable demineralized bone matrix as graft material during sinus elevation surgery with simultaneous implant placement in the posterior maxilla: clinical evaluation of 49 sinuses. J Oral and Maxillofac Surg. 2011;69:134–41.
Chiapasoo M, Casentini P, Zaniboni M. Bone augmentation procedures in implant dentistry. Int J Oral Maxillofac Implants. 2009;24:237–69.
Jenson...
This case highlights the evolving variations in dentoalveolar augmentation with an emphasis on concomitant implant placement. In the most traditional sense, a vertical osteoperiosteal flap technique would be bound with a stable basal bone that can be used to anchor simultaneous dental implant placement. Further refinement should consider minimizing crestal reflection and overall labial bone resorp...
A critical appraisal of the gingival architecture in the final end point of this case demonstrates some radiolucency through the soft tissue outlining the platform of the Nobel Biocare TiUnite implant. This would lead us to believe that either the transmucosal bone level placement attempt was inaccurate or excessive reflection of the labial tissue has caused some degree of resorption. This is anot...
A suitable alternative surgical management of this particular case might have been to simply perform an alveoloplasty to produce the desired inter-occlusal clearance and proceed with placement of implant and simultaneous direct sinus lift. That would have left more of the apical portion of the implant within the grafted sinus and possibly modified the location of keratinized band of tissue. The lo...
A 35-year-old female with a 10-year history of partial acquired edentulism at site numbers 3 and 4 presented to our clinic for dental implant evaluation. Preoperative clinical examination revealed a reproducible intercuspation, well-delineated band of keratinized tissue, and decreased inter-occlusal clearance to allow for optimal dimension of prosthetic crowns (Fig. 1). Radiographs demonstrated e...
Obtaining proper occlusal clearance to allow for a single unit crown restoration is a fundamental prerequisite for dental implant restoration. Long-standing edentulous sites are often fraught with disuse atrophy and unopposed supra-eruption of the opposing dentition. In the posterior maxillae/mandible, there are vital structures that have to be mobilized in order to allow space for either bone tra...
Dental restorative space from the opposing dentition requires adequate distance for restorative material for an acceptable restoration. Typically, long-standing edentulous alveolar ridges will have vertical and or horizontal defects that require alveolar ridge augmentation for ideal dental implant restorations. Along with these defects, one will see the opposing dentition supra erupt which can obl...
Fig. 2. xillary sinus) and b, c examples of corresponding images in cone beam computed tomography
Fig. 2. a Panoramic radiography with area of interest (maxillary sinus) and b, c examples of corresponding images in cone beam computed tomography
Fig. 1. maxillary sinus) and b, c examples of corresponding images in cone beam computed tomography
Fig. 1. a Panoramic radiography with area of interest (maxillary sinus) and b, c examples of corresponding images in cone beam computed tomography
Question
General practitioner (n = 2)
Junior maxillofacial surgeon (n = 2)
Senior maxillofacial surgeon (n = 3)
p value*
...
Additional incidental findings in panoramic radiography
Relative incidence (%) in relation to total number of therapy affecting findings
Retained third molar/follicular cyst
22
...
Number of cases
General practitioner (n = 2)
Junior maxillofacial surgeon (n = 2)
Senior maxillofacial surgeon (n = 3)
p value*
...
Question
General practitioner (n = 2)
Junior maxillofacial surgeon (n = 2)
Senior maxillofacial surgeon (n = 3)
p value*
...
Question
General practitioner (n = 2)
Junior maxillofacial surgeon (n = 2)
Senior maxillofacial surgeon (n = 3)
p value*
...
Dau, M., Marciak, P., Al-Nawas, B. et al. Evaluation of symptomatic maxillary sinus pathologies using panoramic radiography and cone beam computed tomography—influence of professional training.
Int J Implant Dent 3, 13 (2017). https://doi.org/10.1186/s40729-017-0075-5
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Received: 10 December 2016
Accepted: 12 March 2017
Published: 05 April 2017
DOI: http...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Department of Oral, Maxillofacial and Plastic Surgery, University Medical Center, Schillingallee 35, 18057, Rostock, Germany
Michael Dau, Bernhard Frerich & Peer Wolfgang Kämmerer
Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre, Mainz, Germany
Paul Marciak & Bial Al-Nawas
Private Dental Praxis Dr. Rossa, Ludwigshafen, Germany
Henning Staedt
Depa...
Quintero JC, et al. Craniofacial imaging in orthodontics: historical perspective, current status, and future developments. Angle Orthod. 1999;69(6):491–506.
Tadinada A, et al. Radiographic evaluation of the maxillary sinus prior to dental implant therapy: a comparison between two-dimensional and three-dimensional radiographic imaging. Imaging Sci Dent. 2015;45(3):169–74.
Ritter L, et al. Pre...
Rivis M, Valeanu AN. Giant maxillary cyst with intrasinusal evolution. Rom J Morphol Embryol. 2013;54(3 Suppl):889–92.
Yilmaz SY, Misirlioglu M, Adisen MZ. A diagnosis of maxillary sinus fracture with cone-beam CT: case report and literature review. Craniomaxillofac Trauma Reconstr. 2014;7(2):85–91.
Lana JP, et al. Anatomic variations and lesions of the maxillary sinus detected in cone beam ...
Gang TI, et al. The effect of radiographic imaging modalities and the observer’s experience on postoperative maxillary cyst assessment. Imaging Sci Dent. 2014;44(4):301–5.
Batra PS, et al. Computed tomography imaging practice patterns in adult chronic rhinosinusitis: survey of the American Academy of Otolaryngology-Head and Neck Surgery and American Rhinologic Society Membership. Int Forum Al...
Dragan E, et al. Maxillary sinus anatomic and pathologic CT findings in edentulous patients scheduled for sinus augmentation. Rev Med Chir Soc Med Nat Iasi. 2014;118(4):1114–21.
Raghav M, et al. Prevalence of incidental maxillary sinus pathologies in dental patients on cone-beam computed tomographic images. Contemp Clin Dent. 2014;5(3):361–5.
Lyros I, et al. An incidental finding on a diagno...
Depending on the observers’ clinical and radiological experience, PAN alone may not be sufficient for evaluation of pathologies of the maxillary sinus. On the contrary, significant benefits of sFOV-CBCT for diagnosing symptomatic maxillary sinus pathologies were reported. Having sFOV-CBCT seems to have added additional information and confidence in comparison to PAN alone. Nonetheless, also with...
The influence of clinical experience of evaluation of PAN [34] as well as the clinical experience and routine analysis of 3D radiographs (as assumed for maxillofacial surgeons when compared to those for general practitioners) strongly influence the diagnostic value of additional three-dimensional imaging. The number of incidental findings in CBCT in addition to those seen in PAN was not of major d...
In dentistry, PAN is a widely available, useful, and important diagnostic tool for diagnosis and general preoperative planning [32] with less radiation exposure then CBCT [21]. While most dentists have used it routinely successful for years and gained significant experience in doing so [33], there are certain limitations in dependence of the region to be examined [10]. The high number of “not vi...
This study focused on three different aspects in our analysis—PAN, PAN and CBCT, as well as the influence of the different clinical and radiological experience (examples in Figs. 1 and 2).
Panoramic radiography (PAN)
When assessing PAN, the ratings were significantly lower at “good visible and can be evaluated” (9.9%) compared to “visible but cannot be evaluated” (39.5%; p
The first question for PAN addressed the imaging quality in the clinical relevant area of interest (clinical data were given). Three answers were possible: 1 = good visibility and can be evaluated, 2 = visible but cannot be evaluated, and 3 = not visible. The second question asked for an additional need for CBCT scans. Three answers were possible: 1 = required, 2 = reasonable, and 3 = not required...
In an experimental diagnostic comparison, radiographic images of 15 female and 13 male patients were assessed. Patients’ radiographs were selected from the Department of Oral, Maxillofacial and Facial Plastic Surgery of the University Medical Centre of Mainz and Rostock, Germany. All patients have had referrals to the hospitals with symptomatic maxillary sinus pathologies and received PAN (Ortho...
In order to justify CBCT use for clinical examination and diagnosis of the maxillary sinus, the aim of this study was to compare the subjective quality rating of PAN and PAN together with a small field of view (sFOV) CBCT to evaluate symptomatic maxillary sinus by clinicians with different training and clinical experience.
Non-symptomatic abnormalities of the maxillary sinus such as mucosal thickening, retention cysts, and opacification are reported to occur in up to 74% of all cases [1–6]. For diagnosis of symptomatic pathologies of the maxillary sinus like retention cysts, polyps, and tumors, panoramic radiographies (PAN) are commonly used and widely available. In PAN, not every area of interest is accurately de...
A comparison of panoramic radiography (PAN) alone and PAN together with small field of view cone beam computed tomography (sFOV-CBCT) for diagnosis of symptomatic pathologies of the maxillary sinus was carried out by clinicians of different experience.
Corresponding radiographic images (PAN/sFOV-CBCT) of 28 patients with symptomatic maxillary sinus pathologies were chosen and analyzed by two gene...
Nery, J.C., Pereira, L.A.V.D., Guimarães, G.F. et al. β-TCP/HA with or without enamel matrix proteins for maxillary sinus floor augmentation: a histomorphometric analysis of human biopsies.
Int J Implant Dent 3, 18 (2017). https://doi.org/10.1186/s40729-017-0080-8
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Received: 08 December 2016
Accepted: 22 April 2017
Published: 04 May 2017
DOI: https://do...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
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Correspondence to
James Carlos Nery.
Department of Implantology, São Leopoldo Mandic Research Center, Brasília, DF, Brazil
James Carlos Nery, George Furtado Guimarães & Fabiana Mantovani Gomes França
Department of Biochemistry and Tissue Biology, UNICAMP – State University of Campinas, Institute of Biology, Campinas, São Paulo, Brazil
Luís Antônio Violin Dias Pereira
Department of Periodontology, UNESP – Univ. Estad...
Wikesjo UM, Sorensen RG, Kinoshita A, Wozney JM. RhBMP-2/alphaBSM induces significant vertical alveolar ridge augmentation and dental implant osseointegration. Clin Implant Dent Relat Res. 2002;4:174–82.
Carinci F, Brunelli G, Franco M, Viscioni A, Rigo L, Guidi R, et al. A retrospective study on 287 implants installed in resorbed maxillae grafted with fresh frozen allogenous bone. Clin Implant...
Miron RJ, Sculean A, Cochran DL, Froum S, Zucchelli G, Nemcovsky C, et al. Twenty years of enamel matrix derivative: the past, the present and the future. J Clin Periodontol. 2016;43:668–83.
Sculean A, Nikolidakis D, Nikou G, Ivanovic A, Chapple IL, Stavropoulos A. Biomaterials for promoting periodontal regeneration in human intrabony defects: a systematic review. Periodontol 2000. 2015;68:182...
Esposito M, Felice P, Worthington HV. Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus. Cochrane Database Syst Rev. 2014;17:CD008397.
Jungner M, Cricchio G, Salata LA, Sennerby L, Lundqvist C, Hultcrantz M, et al. On the early mechanisms of bone formation after maxillary sinus membrane elevation: an experimental histological and immunohistochemical study. ...
The present study showed that maxillary sinus floor augmentation with BC resulted in adequate amounts of new bone formation allowing successful implant installation, while adding EMD did not have a significant effect.
Nevertheless, the amount of bone generated with BC or BC + EMD herein was adequate to support successful implant placement and osseointegration of implants. In fact, more or less similar amounts of bone formation have been reported in studies evaluating human sinus biopsies after grafting with a variety of biomaterials (bone formation ranging approximately from 30 to 50%) [19]. On the other ha...
The present study compared the histological and histomorphometrical outcome of healing after maxillary sinus floor augmentation with BC with or without EMD, based on human biopsies. The results showed that addition of EMD did not enhance the outcome of healing, neither in terms of quality nor quantity of new bone. Nevertheless, the amount of bone generated after maxillary sinus floor augmentation ...
All ten patients showed uneventful healing after the sinus floor augmentation procedure as well as after dental implant placement, with no overt postoperative inflammation or infection. Consistently, in all ten patients, no significant jiggling of the drill was noticed during biopsy harvesting, while subjective drilling resistance during implant placement was similar in both groups and all implant...
The data for each tissue component from the three histological sections were averaged to represent the biopsy. Commercially available software (GraphPad Prism 5.0 for Windows, GraphPad Software Inc., USA) was utilized for statistical comparisons between groups and for drawing the graphics. The assumption of normality was checked using D’Agostino & Pearson omnibus test. The data for each evaluate...
Six months after grafting, another CBCT examination was carried out for implant planning. In the sequence, following the previously described antiseptic and anesthetic procedures, two implants with a sand-blasted and acid etching surface were installed in each of the grafted sinuses, i.e., 40 implants in total (32—Neoporous, Neodent, Curitiba, Paraná, Brazil; 8—SLA, Straumann, Basel, Switzerl...
This research project was approved by the Ethics Committee of the School of Dentistry and Dental Research Center São Leopoldo Mandic, Brazil, under the protocol 2010/0360.
Ten consecutive patients (age range 35–75 years) with the need of bilateral maxillary sinus floor augmentation prior to the placement of four dental implants (two in each side of posterior maxilla) were selected for the stu...
The aim of the present study was to compare histomorphometrically the outcome of maxillary sinus floor augmentation with β-TCP/HA with or without enamel matrix proteins (BC + EMD and EMD, respectively) in humans.
Reconstruction of the edentulous and severely atrophied posterior maxilla is often performed by means of maxillary sinus floor augmentation in combination with dental implants [1, 2]. Various bone graft materials are typically used for enhancing bone formation within the sinus cavity; autogenous bone (AB) is considered as the gold standard due to its osteogenic, osteoinductive, and osteoconductive...
It is still unclear whether enamel matrix proteins (EMD) as adjunct to bone grafting enhance bone healing. This study compared histomorphometrically maxillary sinus floor augmentation (MSFA) with β-TCP/HA in combination with or without EMD in humans.
In ten systemically healthy patients needing bilateral MSFA, one side was randomly treated using β-TCP/HA mixed with EMD (BC + EMD) and the ot...
Fig. 6. Patient # 1 (12-month healing time): increased bone formation following the shape of the grafted particles that are still present (magnification ×100)
Fig. 6. Patient # 1 (12-month healing time): increased bone formation following the shape of the grafted particles that are still present (magnification ×100)
Fig. 5. Patient # 4 (9-month healing time): increased bone formation following the shape of the grafted particles stained with Goldner trichrome staining (magnification ×100)
Fig. 5. Patient # 4 (9-month healing time): increased bone formation following the shape of the grafted particles stained with Goldner trichrome staining (magnification ×100)
Fig. 4. Patient # 1 (12-month healing time): overview of a typical example of a bone biopsy stained with Goldner trichrome staining (magnification ×10)
Fig. 4. Patient # 1 (12-month healing time): overview of a typical example of a bone biopsy stained with Goldner trichrome staining (magnification ×10)
Fig. 3. Alveolar tissue height (in true mm) over a 5-year period in the 12-month group
Fig. 3. Alveolar tissue height (in true mm) over a 5-year period in the 12-month group
Fig. 2. Aveolar tissue height (in true mm) over a 5-year period in the 9-month group
Fig. 2. Aveolar tissue height (in true mm) over a 5-year period in the 9-month group
Fig. 1. Images of patient # 5 (9-month healing time). a. Radiograph of the left maxillary sinus: situation 9 months after the maxillary sinus floor elevation procedure. b. With a trephine drill, the implant osteotomy is made and the biopsy is obtained. c. Clinical situation after placing two Straumann® SLA implants in the left posterior maxilla. d. Radiograph of two Straumann® SLA implants in...
Patient (N)
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Bouwman, W.F., Bravenboer, N., Frenken, J.W.F.H. et al. The use of a biphasic calcium phosphate in a maxillary sinus floor elevation procedure: a clinical, radiological, histological, and histomorphometric evaluation with 9- and 12-month healing times.
Int J Implant Dent 3, 34 (2017). https://doi.org/10.1186/s40729-017-0099-x
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Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Authors W.F. Bouwman, N. Bravenboer, J.W.F.H. Frenken, C.M. ten Bruggenkate and E.A.J.M. Schulten state that there are no conflicts of interest, either directly or indirectly.
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Correspondence to
E. A. J. M. Schulten.
Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
W. F. Bouwman, C. M. ten Bruggenkate & E. A. J. M. Schulten
Department of Clinical Chemistry, VU University Medical Center, Amsterdam, The Netherlands
N. Bravenboer
Department of Oral and Maxillofacial Su...
Groeneveld EH, van den Bergh JP, Holzmann P, ten Bruggenkate CM, Tuinzing DB, Burger EH. Mineralization processes in demineralized bone matrix grafts in human maxillary sinus floor elevations. J Biomed Mater Res. 1999;48:393–402.
Schulten EAJM, Prins HJ, Overman JR, Helder MN, ten Bruggenkate CM, Klein-Nulend JA. Novel approach revealing the effect of collagenous membrane on osteoconduction in ...
Schopper C, Ziya-Ghazvini F, Goriwoda W, Moser D, Wanschitz F, Spassova E, Lagogiannis G, Auterith A, Ewers R. HA/TCP compounding of a porous CaP biomaterial improves bone formation and scaffold degradation—a long-term histological study. J Biomed Mater Res B Appl Biomater. 2005;74:458–67.
Frenken JW, Bouwman WF, Bravenboer N, Zijderveld SA, Schulten EA, ten Bruggenkate CM. The use of Strauma...
Beirne JC, Barry HJ, Brady FA, Morris VB. Donor site morbidity of the anterior iliac crest following cancellous bone harvest. Int J Oral Maxillofac Surg. 1996;25:268–71.
Vermeeren JIJF, Wismeijer D, van Waas MAJ. One-step reconstruction of the severely resorbed mandible with onlay bone grafts and endosteal implants: a 5-year follow-up. Int J Oral Maxillofac Surg. 1996;2:112–5.
Nkenke E, Stel...
Boyne PJ, James RA. Grafting of the maxillary sinus floor with autogenous marrow and bone. J Oral Surg. 1980;38:613–6.
Tatum H Jr. Maxillary and sinus implant reconstructions. Dent Clin N Am. 1986;30:207–29.
Del Fabbro M, Rosano G, Taschieri S. Implant survival rates after maxillary sinus augmentation. Eur J Oral Sci. 2008;116:497–506.
Pjetursson BE, Tan WC, Zwahlen M, Lang NP. A systemat...
Based on clinical, radiological, histological, and histomorphometric analysis, this study confirms the suitability of BCP for vertical augmentation of the posterior maxilla by means of an MSFE procedure, allowing dental implant placement after 9 and 12 months healing times. Yet, complete degradation of the BCP particles does not occur within a 12-month healing time. From a histological and histom...
In the cranial part of the biopsy, some osteoid islands with osteogenic activity were detected, possibly caused by osteoinductive properties from the lifted bony trap-door. In the present study, histomorphometric analyses revealed that the vital bone volume was higher in the 9-month healing time group than in the 12-month healing time group, while one would expect to find more newly formed bone in...
This study presents the clinical, radiological, histological and histomorphometric results on the use of a biphasic calcium phosphate (Straumann® bone ceramic) in a MSFE procedure with healing times of 9 and 12 months. During the clinical evaluation, it appeared that both 9-month and 12-month healing times resulted in integration of the grafted BCP with the original maxillary bone (sinus floor),...
Histological observations did not show inflammatory cells in the tissue adjacent to the bone substitute particles. Bone marrow-like tissue, which included blood vessels, was observed in between the bone trabeculae (Fig. 4). Reinforcement by lamellar bone was shown in some areas after 9 and 12 months (Figs. 5 and 6). No Howship’s lacunae could be detected on the characteristic outlines of the su...
None of the 10 patients showed postoperative inflammation or infection after the MSFE procedure nor during surgical re-entry for dental implant placement. When opening the area for dental implant insertion, the grafted area proved to be well vascularized and the tissue at the site of the former trap-door location was slightly flexible and had a fibrous aspect. Between the periosteum and the bone g...
Parameters evaluating vital bone mass/bone structure:
1: Vital bone volume (BV): percentage of the grafted section that is vital bone tissue (%)
2: Bone surface (BS): BS expressed as a fraction of the total vital bone volume (mm2/mm3)
3: Thickness of bone trabeculae (Tb.Th) (μm)
Parameters evaluating bone turnover:
1: Osteoid volume (OV): fraction of the vital bone tissue section that is ost...
All 22 inserted dental implants were clinically tested for good primary stability. Osseointegration at abutment connection was tested with a 35-Ncm torque. One experienced oral and maxillofacial surgeon (CB) carried out all follow-up examinations.
Panoramic radiographs were made at patient’s intake (T0); immediately after the MSFE procedure (T1); immediately after dental implant placement (T2);...
A midcrestal incision was made with vertical release incisions at the canine and tuberosity region. A full-thickness mucoperiosteal flap was elevated. The lateral maxillary sinus wall was prepared using a diamond burr with copious irrigation with sterile isotonic saline, regarding the contour of the maxillary sinus as observed on the preoperative panoramic radiograph. A bony top-hinge trap-door wa...
In this study, 10 consecutive healthy patients were selected for a unilateral MSFE procedure. Five patients received dental implants 9 months after MSFE and five patients underwent dental implant surgery 12 months after MSFE. In the 9-month group (three men and two women), the average age was 56.6 years (range 40 to 64 years); in the 12-month group (one man and four women), the average age was...
β-TCP is a biocompatible osteoconductive calcium phosphate that may provide a scaffold for potential bony ingrowth [24]. β-TCP resorbs rather quickly but not necessarily at the same rate as new bone formation [25,26,27]. Most research focused on either using the relative unresorbable HA as a scaffold or β-TCP as a degradable component [19, 24,25,26, 28, 29]. Zerbo et al. [30] concluded that due...
Maxillary sinus floor elevation (MSFE) is a surgical procedure to enhance the bone height in the posterior maxilla with graft material, allowing dental implant placement (later or at the same time) [1, 2]. This pre-implant procedure is predictable and results in a dental implant survival of more than 93.8% 3 years after dental implant placement [3]. According to Pjetursson [4] in his systematic r...
This study evaluates the clinical, radiological, histological, and histomorphometric aspects of a fully synthetic biphasic calcium phosphate (BCP) (60% hydroxyapatite and 40% ß-tricalcium phosphate), used in a human maxillary sinus floor elevation (MSFE) procedure with 9- and 12-month healing time.
A unilateral MSFE procedure, using 100% BCP, was performed in two series of five patients with hea...
Fig. 6. The hydraulic lifter stabilized in the osteotomy before injecting the saline
Fig. 6. The hydraulic lifter stabilized in the osteotomy before injecting the saline
Fig. 5.
Fig. 5. a The CAS drill has four blades and an inverse conical shape. b The hydraulic lifter
Fig. 4. The inflated balloon while elevating the sinus membrane (The balloon is seen from the medial.)
Fig. 4. The inflated balloon while elevating the sinus membrane (The balloon is seen from the medial.)
Fig. 3. 12]
Fig. 3. a The balloon in a resting position. b The inflated balloon [12]
Fig. 2. The exposed mesial aspect of the sinus
Fig. 2. The exposed mesial aspect of the sinus
Fig. 1. Determination of the remaining bone height (RBH) on the CBCT image
Fig. 1. Determination of the remaining bone height (RBH) on the CBCT image
Methods
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12
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Yassin Alsabbagh, A., Alsabbagh, M.M., Darjazini Nahas, B. et al. Comparison of three different methods of internal sinus lifting for elevation heights of 7 mm: an ex vivo study.
Int J Implant Dent 3, 40 (2017). https://doi.org/10.1186/s40729-017-0103-5
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Received: 13 March 2017
Accepted: 29 August 2017
Published: 04 September 2017
DOI: https://doi.org/10...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Aghiad Yassin Alsabbagh, Mohammed Monzer Alsabbagh, Batol Darjazini Nahas, and Salam Rajih declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Department of Periodontology, Damascus University Dental School, Damascus, Syrian Arab Republic
Aghiad Yassin Alsabbagh & Mohammed Monzer Alsabbagh
Department of Orthodontics, Damascus University Dental School, Damascus, Syrian Arab Republic
Batol Darjazini Nahas
Temple university, Philadelphia, USA
Salam Rajih
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Toffler M, Toscano N, Holtzclaw D. Osteotome-mediated sinus floor elevation using only platelet-rich fibrin: an early report on 110 patients. Implant Dent. 2010;19(5):447–56.
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Zitzmann NU, Scharer P. Sinus elevation procedures in the resorbed posterior maxilla. Comparison of the crestal and lateral approaches. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85(1):8–17.
Esposito M, Felice P, Worthington HV. Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus. The Cochrane database of systematic reviews 2014(5):CD008397.
Sc...
Seong WJ, Barczak M, Jung J, Basu S, Olin PS, Conrad HJ. Prevalence of sinus augmentation associated with maxillary posterior implants. The Journal of oral implantology. 2013;39(6):680–8.
Cawood JI, Howell RA. A classification of the edentulous jaws. Int J Oral Maxillofac Surg. 1988;17(4):232–6.
Tan WC, Lang NP, Zwahlen M, Pjetursson BE. A systematic review of the success of sinus floor elev...
An amendment to this paper has been published and can be accessed via the original article.
Within the limitation of this study and that of an ex vivo study, we can accept our hypotheses that the balloon is better than the BAOSFE in elevating the membrane mucosa and the CAS kit is better than the BAOSFE in preparing the osteotomy and breaking the sinus floor for elevation heights of 7 mm. Further, in vivo studies need to be taken to prove these findings.
The BAOSFE technique caused perforations in the membrane in 7 out of 12 cases with a percentage of 58.4. This result is consistent with many previous studies which state that this technique has a high rate of perforations when the RBH is less than 5 mm [2, 7, 26]. Also, all the perforations happened during the elevation process; however, this percentage is different than that reported by Steltzle...
Using a reamer instead of the osteotomes for breaking the sinus floor has the advantage of creating a thin bone shell that prevents direct contact between the drill and the Schneiderian membrane [24]. Moreover, using a reamer has been shown to cause less discomfort and nausea when compared to the osteotome technique as a result of the constant tapping of the osteotomes [25]. As a result, the CAS k...
Although the lateral sinus floor elevation is a proven clinically successful technique [14], the indirect SFE approach is favorable among clinicians because it does not require a second surgery site and hence cause less trauma and discomfort for the patient [14,15,16]. However, this method has its drawbacks, such as a higher risk of membrane perforation, a decreased space for using surgical instru...
For the entire sample, the mean perforation length was (0.711 mm, SD = 1.4) and the mean time required to perform the procedure was (5.65 min, SD = 2.26), and out of the entire sample (N = 36), perforations happened in nine cases for a percentage of 25%.
Chi-square test showed a significant association between method used and the occurrence of perforation (chi-square statistic = 8.585, ...
This approach starts like BAOSFE. The osteotomy is enlarged to 5.0 mm before the balloon (Zimmer Sinus Lift Balloon, Zimmer Dental Inc., California, USA) is inserted (Fig. 3). The sinus floor was broken with the 5 mm osteotome after the addition of bone. The sleeve of the balloon was inserted 1 mm beyond the sinus floor. The saline was injected slowly from the syringe into the balloon, so the ...
To achieve our purposes, an experimental ex vivo study was carried. This research project was approved by the University of Damascus Local Research Ethics Committee (UDDS-3045PG.) and was funded by the Damascus University Postgraduate Research Budget (97687027834DEN). The sinus floor elevations were done on 18 bisected heads of lambs aged between 6 and 12 months that were slaughtered in a maximum...
Therefore, the two working hypotheses of our study were “the CAS-Kit is safer than BAOSFE in breaking the sinus floor and the balloon is safer than BAOSFE in elevating the Schneiderian membrane” for elevation heights of 7 mm.
More than half of the implants placed in the posterior maxilla require sinus floor elevation (SFE) [1]. The need for this procedure is explained by continuous ridge resorption in an apical direction after tooth extraction combined with progressive sinus pneumatization in addition to poor bone quality that is frequently seen in the maxilla [2].
Sinus membrane perforation is considered the most com...
Various techniques are available for elevating the sinus membrane. The aim of this study is to evaluate three methods of indirect sinus floor elevation regarding elevation heights of 7 mm on the outcomes of membrane perforation, length of perforation, and time required to perform the procedure.
Three different methods for indirect sinus lifting, bone added osteotome sinus floor elevation (BAOS...
Fig. 8. The association between mean osseus sinus volume of the maxillary sinus and gender. Men have a statistically significant higher mean osseus volume than women (p = 0.007)
Fig. 8. The association between mean osseus sinus volume of the maxillary sinus and gender. Men have a statistically significant higher mean osseus volume than women (p = 0.007)
Fig. 7. The association between the mean osseus sinus volume and age. No significant association between these parameters was found (p = 0.2)
Fig. 7. The association between the mean osseus sinus volume and age. No significant association between these parameters was found (p = 0.2)
Fig. 6. No statistical significant association between a patient’s age and the presence of obliteration of at least one maxillary sinus was found (p = 0.92). For better visibility, the diagram has been jittered along the y-axis
Fig. 6. No statistical significant association between a patient’s age and the presence of obliteration of at least one maxillary sinus was found (p = 0.92...
Fig. 5. The association between the obliterated volume and sinus pathology. The presence of a pathology significantly increased the obliterated volume of a maxillary sinus (p
Fig. 4. The association between the osseus volume and the dentition. Edentulous, partly edentulous, and dentate patients showed no relevant difference in the size of the osseus sinus volume (p = 0.52)
Fig. 4. The association between the osseus volume and the dentition. Edentulous, partly edentulous, and dentate patients showed no relevant difference in the size of the osseus sinus volume ...
Fig. 3. 3D view of osseus sinus volumes. Surface area (cm2) and volume (cm3) were calculated by the software
Fig. 3. 3D view of osseus sinus volumes. Surface area (cm2) and volume (cm3) were calculated by the software
Fig. 2. View from the coronal plane. The marked curves define the osseus and mucous boundaries of the maxillary sinuses. The hatched surface illustrates the measured remaining pneumatized cavity of an obliterated sinus and the filled (yellow) surface highlights the calculated obliterated volume
Fig. 2. View from the coronal plane. The marked curves define the osseus and mucous boundaries of t...
Fig. 1. Calculation of the sinus body by interpolating 15–25 curves at a distance of 2 mm, depending upon the size of the maxillary cavity
Fig. 1. Calculation of the sinus body by interpolating 15–25 curves at a distance of 2 mm, depending upon the size of the maxillary cavity
Frequency of pathologies
n
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Absence of alteration
73
(57.0)
Mucosal thickening
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SD
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Luz, J., Greutmann, D., Wiedemeier, D. et al. 3D-evaluation of the maxillary sinus in cone-beam computed tomography.
Int J Implant Dent 4, 17 (2018). https://doi.org/10.1186/s40729-018-0128-4
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Received: 30 January 2018
Accepted: 20 March 2018
Published: 05 June 2018
DOI: https://doi.org/10.1186/s40729-018-0128-4
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
JL and CR are residents at the Clinic of Cranio-Maxillofacial and Oral Surgery, University of Zurich, University Hospital Zurich, Switzerland.
DG is a master student at the Center of Dental Medicine, University of Zurich, Zurich, Switzerland.
MR is the Chairman of the Clinic for Cranio-Maxillofacial and Oral Surgery, University of Zurich, University Hospital Zurich, Zurich, Switzerland.
DW is t...
Correspondence to
Julia Luz.
Clinic of Cranio-Maxillofacial and Oral Surgery, University of Zurich, University Hospital Zurich, Zurich, Switzerland
Julia Luz, Dominique Greutmann, Claudio Rostetter, Martin Rücker & Bernd Stadlinger
Statistical Services, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
Daniel Wiedemeier
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Uchida Y, Goto M, Katsuki T, Akiyoshi T. A cadaveric study of maxillary sinus size as an aid in bone grafting of the maxillary sinus floor. J Oral Maxillofac Surg. 1998;56(10):1158–63.
Uchida Y, Goto M, Katsuki T, ...
Lee KC, Lee SJ. Clinical features and treatments of odontogenic sinusitis. Yonsei Med J. 2010;51(6):932–7.
Brook I. Sinusitis of odontogenic origin. Otolaryngology Head Neck Surgery. 2006;135(3):349–55.
Nunes CA, Guedes OA, Alencar AH, Peters OA, Estrela CR, Estrela C. Evaluation of periapical lesions and their association with maxillary sinus abnormalities on cone-beam computed tomographic ...
Mozzo P, Procacci C, Tacconi A, Martini PT, Andreis IAB. A new volumetric CT machine for dental imaging based on the cone-beam technique: preliminary results. Eur Radiol. 1998;8(9):1558–64.
Price JB, Thaw KL, Tyndall DA, Ludlow JB, Padilla RJ. Incidental findings from cone beam computed tomography of the maxillofacial region: a descriptive retrospective study. Clin Oral Implants Res. 2012;23(11...
The present study showed the volume software to be a suitable tool for the measurement of the dimensions of the maxillary sinus. The results show that the osseus volume of the maxillary sinus varies on the base of gender and that the obliterated volume varies on the base of a present pathology. No statistically significant association between the patient’s age and the sinus volume or a present s...
Velasco-Torres et al. [19] showed a larger sinus volume for dentate patients compared to edentulous and partially edentulous patients. This may be explained through the loss of posterior teeth in the maxilla, leading to the reduction of mechanical stimulation of the maxillary sinus. As a consequence, the sinus could expand (pneumatization) due to increased pressure and ostoclastic activity of the ...
The aim of this study was to analyze volume parameters of the maxillary sinus based on CBCT data. Further, neighboring anatomical structures and related pathologies were recorded. Overall, the applied volume software used in this study allowed the calculation of the surface area and volume of maxillary sinuses.
In clinics, the radiographic evaluation of the maxillary sinus is obligatory prior to ...
No relationship was observed between a patient’s age and the presence of partial or complete obliteration of at least one maxillary sinus (Fig. 6, p = 0.92). Patient’s age and the mean osseus sinus volume were also not associated significantly (Fig. 7, p = 0.20). Both maxillary sinuses (osseus borders) of each patient were quite similar in size (mean difference between left and right...
In total, 128 maxillary sinuses were analyzed. The mean surface area was found to be 39.7 cm2 and the mean volume 17.1 cm3. The mean surface area of the remaining pneumatized cavities of obliterated sinuses was found to be 36.4 cm2 and the mean volume 15 cm3 (Table 1). 42.2% of all sinuses showed an obliteration, and the mean volume of the obliterated sinuses was 5.1 cm3. If there was an obl...
Patient-specific variables like gender, date of birth, and date of CBCT were recorded. The date of the CBCT image was further divided into either being in autumn/winter (1 January 2013–19 March 2013; 22 September 2013–31 December 2013) or spring/summer (20 March 2013–21 September 2013). The maxillary sinus was classified into obliterated or nonobliterated. It was also documented if there was...
In the present study, 64 CBCT images (128 maxillary sinuses), taken between 1 January 2013 and 31 December 2013 at the Department of Cranio-Maxillofacial and Oral Surgery at the University of Zurich, were included. The inclusion criterion of each CBCT scan was the presence of two complete maxillary sinuses; the osseus borders of both sinuses had to be entirely visible.
The scans were performed us...
The precise assessment of the maxillary sinus is important in oral and maxillofacial surgery in cases of traumatology, sinusitis, and dental implantology. After the introduction of cone-beam computed tomography (CBCT) in dental medicine in 1998 [1], the number of clinicians using CBCTs increased constantly. Whereas in 2004, there were only three CBCTs registered in Switzerland, the current number ...
There are few studies measuring the dimensions of the maxillary sinus, being mostly based on computed tomography imaging and rarely being based on cone-beam computed tomography (CBCT). The aim of this study was to measure the 3D osseous and soft tissue defined volume and surface area of the maxillary sinus. Further, possible associations with patient-specific and sinus-related variables were evalu...
Fig. 3. Forest plot of random effects meta-analysis of the incidence of Schneiderian membrane perforation using piezoelectric devices. The weighted average for the incidence rate of Schneiderian membrane perforation was 8%
Fig. 3. Forest plot of random effects meta-analysis of the incidence of Schneiderian membrane perforation using piezoelectric devices. The weighted average for the incidenc...
Fig. 2. Forest plot of random effects meta-analysis of the incidence of Schneiderian membrane perforation using conventional rotative instruments. The weighted average for the incidence rate of Schneiderian membrane perforation was 24%
Fig. 2. Forest plot of random effects meta-analysis of the incidence of Schneiderian membrane perforation using conventional rotative instruments. The weighted...
Fig. 1. Result of the search strategy and included and excluded studies
Fig. 1. Result of the search strategy and included and excluded studies
Piezoelectric
Event rate
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p value
...
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Jordi, C., Mukaddam, K., Lambrecht, J.T. et al. Membrane perforation rate in lateral maxillary sinus floor augmentation using conventional rotating instruments and piezoelectric device—a meta-analysis.
Int J Implant Dent 4, 3 (2018). https://doi.org/10.1186/s40729-017-0114-2
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Received: 28 September 2017
Accepted: 20 December 2017
Published: 29 January 20...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
The authors Jordi Corinne, Mukaddam Khaled, Lambrecht Jörg Thomas and Kühl Sebastian state that they have no competing interests.
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Department of Oral Surgery, Oral Radiology and Oral Medicine, University Center for Dental Medicine, University of Basel, Basel, Switzerland
Corinne Jordi, Khaled Mukaddam, Jörg Thomas Lambrecht & Sebastian Kühl
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We would like to express our gratitude to Ms. Irene Mischak for the statistical support.
Delilbasi C, Gurler G. Comparison of piezosurgery and conventional rotative instruments in direct sinus lifting. Implant Dent. 2013;22(6):662–5.
Becker ST, Terheyden H, Steinriede A, Behrens E, Springer I, Wiltfang J. Prospective observation of 41 perforations of the Schneiderian membrane during sinus floor elevation. Clin Oral Implants Res. 2008;19(12):1285–9.
Hernandez-Alfaro F, Torradeflo...
Blus C, Szmukler-Moncler S, Salama M, Salama H, Garber D. Sinus bone grafting procedures using ultrasonic bone surgery: 5-year experience. Int J Periodontics Restorative Dent. 2008;28(3):221–9.
Cortes AR, Cortes DN, Arita ES. Effectiveness of piezoelectric surgery in preparing the lateral window for maxillary sinus augmentation in patients with sinus anatomical variations: a case series. Int J ...
Froum SJ, Khouly I, Favero G, Cho SC. Effect of maxillary sinus membrane perforation on vital bone formation and implant survival: a retrospective study. J Periodontol. 2013;84(8):1094–9.
Stricker A, Voss PJ, Gutwald R, Schramm A, Schmelzeisen R. Maxillary sinus floor augmentation with autogenous bone grafts to enable placement of SLA-surfaced implants: preliminary results after 15-40 months. C...
Wannfors K, Johansson B, Hallman M, Strandkvist T. A prospective randomized study of 1- and 2-stage sinus inlay bone grafts: 1-year follow-up. Int J Oral Maxillofac Implants. 2000;15(5):625–32.
Hallman M, Nordin T. Sinus floor augmentation with bovine hydroxyapatite mixed with fibrin glue and later placement of nonsubmerged implants: a retrospective study in 50 patients. Int J Oral Maxillofac I...
Tawil G, Mawla M. Sinus floor elevation using a bovine bone mineral (Bio-Oss) with or without the concomitant use of a bilayered collagen barrier (Bio-Gide): a clinical report of immediate and delayed implant placement. Int J Oral Maxillofac Implants. 2001;16(5):713–21.
Yilmaz HG, Tozum TF. Are gingival phenotype, residual ridge height, and membrane thickness critical for the perforation of max...
Geminiani A, Tsigarida A, Chochlidakis K, Papaspyridakos PV, Feng C, Ercoli C. A meta-analysis of complications during sinus augmentation procedure. Quintessence Int. 2017;48(3):231–40.
Esposito M, Felice P, Worthington HV. Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus. Cochrane Database Syst Rev. 2014;5:CD008397.
Galindo-Moreno P, Avila G, Fernandez...
Tatum H. Maxillary and sinus implant reconstructions. Dent Clin N Am. 1986;30(2):207–29.
Boyne PJ, James RA. Grafting of the maxillary sinus floor with autogenous marrow and bone. J Oral Surg. 1980;38(8):613–6.
Khoury F. Augmentation of the sinus floor with mandibular bone block and simultaneous implantation: a 6-year clinical investigation. Int J Oral Maxillofac Implants. 1999;14(4):557–6...
The aim of the present study was to resume in a review the literature evaluating the incidence of sinus membrane perforation comparing conventional rotating instruments with piezoelectric devices. Since only scarce studies exist comparing both techniques directly, we decided to additionally include any study on MSA in which information on the applied technique, e.g. conventional or piezosurgery, w...
Atieh [11] found no significant difference in perforation risk. In these studies, occurred in the two groups of the RCTs are almost identical perforations. Maybe due to the fact that they included only one RS, while our study included 22, they see no deviation.
The review of Stacchi [12] also described a lower incidence of membrane perforation during piezosurgery (10.9%) than during conventional ...
Though both techniques exist more than 20 years, only single studies could be found in which the incidence of membrane perforation was focused comparing both operative techniques. This was the rationale for our meta-analysis. Principally, there is a controversy in the literature concerning the use of piezosurgical devices for MSA. Torrella et al. showed a reduced risk for perforations of the sinu...
Finally, a significance analysis was performed between both groups in terms of a t test. The significance level was set at p
The database PubMed and the US National Library of Medicine were screened from January 8, 2012, to January 6, 2016, for potential studies reporting on membrane perforations during MSA from 1980 till 2015. The search was conducted independently and in duplicate by two authors (MK and JC). The following search terms were used:
MeSH Terms:
Piezo-surgery
Ultrasound
Ultrasonic Osteotomy
Maxillary ...
Atieh et al. [11] examined the intra- and postoperative events associated with the use of piezoelectric devices and conventional rotary instruments for lateral MSA in a systematic review. They included four studies with 178 lateral MSA in 120 participants. The meta-analysis did not show any significant difference between the two surgical techniques. Stacchi et al. [12] analysed the occurrence of i...
Maxillary sinus augmentation (MSA) is a successful and predictable procedure to rehabilitate the atrophic edentulous posterior maxilla after postextractional pneumatisation of the sinus and bone loss with dental implants. Different approaches to elevate the maxillary sinus floor have been described and were originally introduced by Tatum [1, 2]. The lateral approach provides drilling a window in t...
Maxillary sinus augmentation (MSA) is a successful and predictable intervention with low complication rates. Perforations of the Schneiderian membrane may occur impairing the general success. The aim of this study was to compare the incidence of membrane perforations between conventional rotating instruments and piezoelectric devices in a meta-analysis.
An electronic research on MEDLINE and PubMe...
Fig. 5. Bone resorption in the follow-up of the control group and the perforation group
Fig. 5. Bone resorption in the follow-up of the control group and the perforation group
Fig. 4. The initial bone level of the control group and the perforation group
Fig. 4. The initial bone level of the control group and the perforation group
Fig. 3. Reasons for perforations
Fig. 3. Reasons for perforations
Fig. 2. Overview of the perforation treatment in the study group
Fig. 2. Overview of the perforation treatment in the study group
Fig. 1. Bone levels after sinus floor elevation
Fig. 1. Bone levels after sinus floor elevation
Peri-implantitis
No peri-implantitis
Perforation group
12
80
Control group
...
One-stage procedure
Two-stage procedure
Perforation group
11
81
Control group
...
Adjusted p values
multiple comparison
Control group
bone level 4 mm
0.0453
Control group
bone level > ...
Bone level preoperatively
Bone level postoperatively
Bone level follow-up
Bone resorption
Perforation group
...
Origin of bone graft
No bone graft
Linea obliqua
Iliac crest
Scapula flap
Perforation...
Implant position
3
4
5
6
7
8...
Beck-Broichsitter, B.E., Westhoff, D., Behrens, E. et al. Impact of surgical management in cases of intraoperative membrane perforation during a sinus lift procedure: a follow-up on bone graft stability and implant success.
Int J Implant Dent 4, 6 (2018). https://doi.org/10.1186/s40729-018-0116-8
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Received: 03 October 2017
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Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
The authors Benedicta Beck-Broichsitter, Dorothea Westhoff, Eleonore Behrens, Jörg Wiltfang, and Stephan T. Becker declare that there are no existing competing interests concerning this collaborative work.
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Correspondence to
Benedicta E. Beck-Broichsitter.
Department of Oral and Maxillofacial Surgery, Charité–University Medical Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
Benedicta E. Beck-Broichsitter
Department of Oral and Maxillofacial Surgery, Schleswig-Holstein University Hospital, Arnold-Heller-Straße 3, Haus 26, 24105, Kiel, Germany
Dorothea Westhoff, Eleonore Behrens, Jörg Wiltfang & Stephan T. Becker
You can al...
This study was not funded.
Shlomi B, Horowitz I, Kahn A, Dobriyan A, Chaushu G. The effect of sinus membrane perforation and repair with Lambone on the outcome of maxillary sinus floor augmentation: a radiographic assessment. Int J Oral Maxillofac Implants. 2004;19(4):559–62.
Moreno Vazquez JC, Gonzalez de Rivera AS, Gil HS, Mifsut RS. Complication rate in 200 consecutive sinus lift procedures: guidelines for prevention ...
Sakkas A, Konstantinidis I, Winter K, Schramm A, Wilde F. Effect of Schneiderian membrane perforation on sinus lift graft outcome using two different donor sites: a retrospective study of 105 maxillary sinus elevation procedures. GMS Interdiscip Plast Reconstr Surg DGPW. 2016;5:Doc11.
Springer IN, Terheyden H, Geiss S, Harle F, Hedderich J, Acil Y. Particulated bone grafts—effectiveness of bone...
Wiltfang J, Schultze-Mosgau S, Nkenke E, Thorwarth M, Neukam FW, Schlegel KA. Onlay augmentation versus sinuslift procedure in the treatment of the severely resorbed maxilla: a 5-year comparative longitudinal study. Int J Oral Maxillofac Surg. 2005;34(8):885–9.
Pikos MA. Maxillary sinus membrane repair: report of a technique for large perforations. Implant Dent. 1999;8(1):29–34.
Cha HS, Kim ...
In conclusion, and within the limits of its retrospective nature, our study implies that in cases of intraoperative perforation of the Schneiderian membrane, a consequent surgical assessment and treatment might avoid complications regarding graft stability and implant survival. Two-stage procedures might be appropriate if primary stability does not seem to be achievable. Augmentation of the sinus ...
The surgical management in cases of a membrane perforation might also influence the overall postoperative outcome and complications. Although the sinus lifting procedure has been established for many years now, there are no evidence-based guidelines for perforation closure or indications to interrupt the procedure. To date, most existing studies recommend sealing smaller sizes of perforations with...
One implant was lost in the perforation group due to early-onset peri-implantitis, whereas all implants in the control group were still in place. As we had previously prospectively reported on the first 6 months after dental implantation in this cohort [11], there was no further impact of membrane perforation on implant loss for at least 12 to 24 months in this retrospective evaluation. The appe...
The aim of this retrospective cohort study was to evaluate the impact of intraoperative perforations of the Schneiderian membrane during sinus floor elevation on the stability of the augmented area and its influence on osseointegration after implant insertion. Therefore, we could re-assess a patient cohort of originally 34 patients with 41 perforations and compare their outcome with a control grou...
The initial bone level differed significantly (p = 0.05) between both groups with a median value of 5.69 mm in the study group and 3.87 mm in the control group (Fig. 4). A Mann-Whitney-U-Wilcoxon test revealed no significant difference between bone level postoperatively (p = 0.7851; median value control group 17.40 mm; median value perforation group 16.91 mm), in follow-up (p = 0....
The mean control interval was 2.69 (± 2.03) years. At the time of the follow-up examination, the average age was 59.95 (± 11.82) years.
In the remaining collective of 31 patients (96.97%; 12 males (37.54%) and 19 females (59.43%)), a total of 92 implants were inserted. The overview of perforation treatment in the study group is given in Fig. 2, and Fig. 3 depicts the reasons for perforati...
One independent oral and maxillofacial surgeon performed the clinical follow-up examinations according to a standardized protocol. A peri-implant probing including probing pocket depths and recessions on four sites of each implant was assessed as was bleeding on probing (BOP) to determine the status of oral hygiene objectively. Signs of gingivitis and pus suppuration were also recorded. The criter...
Three different oral and maxillofacial surgeons performed the sinus lift procedure with an external approach according to comparable surgical standards and inserted all implants examined in this study in a submerged protocol with uncovering after 3–4 months due to the manufacturer’s surgical recommendations. Specifically, a total of 35 external sinus floor elevations were performed through a ...
In accordance with the WMA Declaration of Helsinki—Ethical Principles for Medical Research Involving Human Subjects, approval was given by the local ethics committee of the Christian-Albrechts-University in Kiel (AZ 132/10). All patients gave informed written consent to participate.
A total of 201 sinus floor elevation procedures, which were performed from 2005 to 2006 in the Department of Oral...
Sinus floor elevation procedures have become a predictable and successful treatment, performed when the maxillary alveolar ridge is atrophied and the bone height is not sufficient for primary implantation. If the postoperative course remains uneventful, the outcome is highly predictable [1,2,3]. However, complications may have a negative impact on the overall treatment success. As a common complic...
Until now, sinus floor elevation represents the gold standard procedure in the atrophic maxilla in order to facilitate dental implant insertion. Although the procedure remains highly predictive, the perforation of the Schneiderian membrane might compromise the stability of the augmented bone and implant success due to chronic sinus infection. The aim of this retrospective cohort study was to show ...
Fig. 1. Flow chart showing the search strategy
Fig. 1. Flow chart showing the search strategy
Study
N of patients
Baseline bone height
Total N of implants
Implants survival rate %
N of failed implants
...
Study
Patients
Age
(years)
N of sinus augmentation
Sinus augmentation success rate %
Baseline bone height ...
Asmael, H.M. Is antral membrane balloon elevation truly minimally invasive technique in sinus floor elevation surgery? A systematic review.
Int J Implant Dent 4, 12 (2018). https://doi.org/10.1186/s40729-018-0123-9
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Received: 13 July 2017
Accepted: 08 February 2018
Published: 17 April 2018
DOI: https://doi.org/10.1186/s40729-018-0123-9
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
This is not applicable as this research was a systematic review of the previous studies utilizing the MIMBE technique in the sinus lift surgery.
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Huda M Asmael declares that she had no competing interests.
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Department of Oral & Maxillofacial Surgery, Dental Teaching Hospital, College of Dentistry, University of Baghdad, Bab- Almoadham, P.O.Box 1417, Baghdad, Iraq
Huda Moutaz Asmael
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HMA performed all the aspects of this research which involved writing the research and collecting, interpreting, and analyzing data....
I would like to kindly thank the authors of the original articles who responded instantly upon communication with them to complete the missing data or to clarify the unexplained points in their studies.
This research did not receive any funding from any funding resources.
Asmael HM, Lateef TA. An assessment of the efficacy of sinus balloon technique on transcrestal maxillary sinus floor elevation surgery. J Baghdad Coll Dent. 2016;28:109–13.
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Călin C, Petre A, Drafta S. Osteotome-mediated sinus floor elevation: a systematic review and meta-analysis. Int J Oral Maxillofac Implants. 2014;29:558–76.
Starch-Jensen T, Jensen JD. Maxillary sinus floor augmentation: a review of selected treatment modalities. J Oral Maxillofac Implants. 2017;8:e3.
Wallace SS, Mazor Z, Froum SJ, et al. Schneiderian membrane perforation rate during sinus el...
Ziv mazor. The use of minimally invasive antral membrane balloon elevation to treat the posterior maxilla: Aclinical presentation. J Implant Reconstr Dent. 2010;2:26-31.
Kfir E, Kfir V, Kaluski E, et al. Minimally invasive antral membrane balloon elevation for single-tooth implant placement. Quintessence Int. 2011;42:645–50.
Kfir E, Kfir V, Goldstein M, et al. Minimally invasive subnasal eleva...
Tatum H. Lecture presented to the Alabama Implant Congress 1976.
Summers RB. The osteotome technique: part 3—less invasive methods of elevating the sinus floor. Compendium (Newtown, Pa). 1994;15:698–700.
Muronoi M, Xu H, Shimizu Y, et al. Simplified procedure for augmentation of the sinus floor using a haemostatic nasal balloon. Br J Oral Maxillofac Surg. 2003;41:120–1.
Soltan M, Smiler D...
Autogenous bone particles
Antral membrane balloon elevation
Mean
Male:female numbers
Minimally invasive antral membrane balloon elevation
Number
Not mentioned
Perforation rate
Platelets rich fibrin
Platelets rich plasma
Range
Randomized clinical trial
Sinus floor elevation surgery with balloon is said to be a minimally invasive technique [5], but to date, no systematic review was made to clearly present the study results, authors experience, and surgical outcomes. Results of studies that utilized MIAMBE technique could be discussed under these highlighted points.
There are two critical points in sinus floor elevation surgery which include entr...
The total electronic search results were 5395 articles. The reviewed articles were 400, and the extracted articles which involved utilization of balloon technique in the maxillary sinus floor elevation surgery were 27 articles. Siventen articles were excluded from this study [6,7,8,9,10,11,12,13,14,15,16,17,18,19,20] and only 10 articles met the inclusion criteria.
The results of the selected stu...
This study was executed following the PRISMA criteria for the systematic review. An electronic search including MEDLINE (PubMed) and Cochrane database sites was conducted and supported by manual searching for targeted articles through the related journals and web sites from 1945 to 16 January 2017.
Prospective, retrospective studies and randomized clinical trials.
Articles published in English l...
Several sinus floor elevation techniques had been introduced as a minimally invasive surgical procedure. Among which, minimally invasive antral membrane balloon elevation technique was developed to achieve better results with minimal trauma to the patient also to reduce complications and intra-operative time. Conventionally, sinus augmentation procedure is performed either via lateral approach (mo...
Minimally invasive antral membrane balloon elevation was introduced as a less traumatic technique in sinus floor elevation surgery. This is the first systematic review to assess the results of previous studies utilizing this technique.
The objectives of this study were to assess the bone gain, sinus augmentation success rate, implant survival rate, and complications with minimally invasive antral...
Fig. 7. Box and Whisker plot representing median and range values of membrane thicknesses with different morphologies
Fig. 7. Box and Whisker plot representing median and range values of membrane thicknesses with different morphologies
Fig. 6. Box plot representing mean values of membrane thicknesses for the investigated groups
Fig. 6. Box plot representing mean values of membrane thicknesses for the investigated groups
Fig. 5. Endoscopic view from the crestal osteotomy site showing perforation of the sinus lining under the power of magnification and illumination of the endoscope
Fig. 5. Endoscopic view from the crestal osteotomy site showing perforation of the sinus lining under the power of magnification and illumination of the endoscope
Fig. 4. Schematic drawing showing entrance of the endoscope from the crestal osteotomy site after sinus membrane elevation to assess the integrity of the membrane
Fig. 4. Schematic drawing showing entrance of the endoscope from the crestal osteotomy site after sinus membrane elevation to assess the integrity of the membrane
Fig. 3. Endoscopic view from the lateral sinus wall showing the dome-shape elevation of sinus lining
Fig. 3. Endoscopic view from the lateral sinus wall showing the dome-shape elevation of sinus lining
Fig. 2. Malleting instruments supplied from InnoBioSurg (IBS) Company, Korea. a magic sinus splitter: used to widen and split the crest. b magic sinus lifter: used to lift the available bone with its attached membrane
Fig. 2. Malleting instruments supplied from InnoBioSurg (IBS) Company, Korea. a magic sinus splitter: used to widen and split the crest. b magic sinus lifter: used to lift the a...
Fig. 1. A trephined hole (4 mm bone) in the lateral wall of the maxillary sinus to allow entrance of the endoscope
Fig. 1. A trephined hole (4 mm bone) in the lateral wall of the maxillary sinus to allow entrance of the endoscope
Morphology
No perforation
Perforation
P value
No. (%)
No. (%)
Flat (n = 4)
...
Morphology
Mean ± SD (mm)
Median (range)
P value
Perforation rate (%)
Flat (n = 4)
...
Group
No perforation
Perforation
P value
No. (%)
No. (%)
Group (A)
...
Group
Membrane thickness
Mean ± SD (mm)
Median (range)
Percentage (%) (from total)
Perforation rate (%...
Elian, S., Barakat, K. Crestal endoscopic approach for evaluating sinus membrane elevation technique.
Int J Implant Dent 4, 15 (2018). https://doi.org/10.1186/s40729-018-0126-6
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Received: 08 November 2017
Accepted: 20 March 2018
Published: 17 May 2018
DOI: https://doi.org/10.1186/s40729-018-0126-6
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
Faculty of Dentistry, Minia University ethics committee approved the study. All patients gave the consent to participate in the surgery.
All patients approved for publications.
The authors Samy Elian and Khaled Barakat declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Faculty of Dentistry, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
Samy Elian
Faculty of Dental Surgery, Royal College of Physicians and Surgeons of Glasgow, Glasgow, Scotland
Samy Elian
Dentistry Department, Sohag University Hospital, Sohag, Egypt
Samy Elian
Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Minya University, Minya, Egypt
Khaled Barakat
You c...
We would like to express our gratitude to Ass. Prof. Hamed Gad for his clinical collaboration.
This research was carried out without funding.
The data supporting our findings can be requested for free at any time.
Berengo M, Sivolella S, Majzoub Z, Cordioli G. Endoscopic evaluation of the bone-added osteotome sinus floor elevation procedure. Int J Oral Maxillofac Surg. 2004;33(2):189–94.
Nkenke E, Schlegel A, Schultze-Mosgau S, Neukam FW, Wiltfang J. The endoscopically controlled osteotome sinus floor elevation: a preliminary prospective study. Int J Oral Maxillofac Implants. 2002;17(4):557–66.
Nahlie...
Summers RB. A new concept in maxillary implant surgery: the osteotome technique. Compendium. 1994;15(2):152. 54-6, 58 passim; quiz 62
Zitzmann NU, Scharer P. Sinus elevation procedures in the resorbed posterior maxilla. Comparison of the crestal and lateral approaches. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85(1):8–17.
Ardekian L, Oved-Peleg E, Mactei EE, Peled M. The clinical ...
Crestal sinus lifting technique is a simple less invasive procedure. Nevertheless, it suffers a serious disadvantage of being a blind technique. Thus, perforation can easily occur without being detected which will lead to later implant failure especially when bone graft is added [1, 12,13,14]. We used endoscopic-assisted evaluation as a dependable method to assess the safety of the Schneiderian me...
On the other hand, assessing the effect of membrane morphology pattern on the perforation risk revealed that the polyp type has the lowest risk of perforation, whereas the irregular type represents the most insecure pattern. There was a relation between different membrane morphology and perforation.
All patients tolerated the procedure without major complications. Minor complications included postoperative swelling, edema, and pain that were managed by antibiotic and anti-inflammatory drugs. All implants were successfully osseo-integrated and loaded after about 6 months.
The floor was lifted without perforation in 83.33% of cases. The lifter was able to raise and stretch the sinus membrane ...
After completing the elevation of the Schneiderian membrane, the endoscope (70° lens) was removed from the lateral wall of the maxillary sinus and re-inserted (with 0°) from the crestal osteotomy site of the implant (Fig. 4) to check the integrity of the Schneiderian membrane, as well as to ensure the absence of any undetected minor perforation (Fig. 5). The implant was finally inserted in the...
Twelve patients (4 males and 8 females) ranging in age from 25 to 60 years were included in the study. All patients have bone height ranging 3–5 mm below the sinus membrane. They all performed closed sinus lifting and simultaneous immediate implant insertion.
Under local anesthesia, the flap was elevated and retracted exposing the crestal and buccal bone. A trephine bur 4 mm diameter on hand...
The evolution of closed sinus lift techniques since 1994 [1] was proposed as a less invasive method for management of atrophic posterior maxillae [2]. However, it is a blind technique that lacks the ability to confirm an intact sinus floor elevation without perforation and thus represented a real shortcoming [3]. Various forms of osteotome lifters were designed to guarantee safe elevation of maxil...
Fig. 1. Treatment strategies for OAF closure
Fig. 1. Treatment strategies for OAF closure
Author year
No. of participants
Method
Autogenous soft tissue flaps
Lin et al. 1991
16
...
Parvini, P., Obreja, K., Sader, R. et al. Surgical options in oroantral fistula management: a narrative review.
Int J Implant Dent 4, 40 (2018). https://doi.org/10.1186/s40729-018-0152-4
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Received: 14 August 2018
Accepted: 02 November 2018
Published: 27 December 2018
DOI: https://doi.org/10.1186/s40729-018-0152-4
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
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Puria Parvini, Karina Obreja, Robert Sader, Jürgen Becker, Frank Schwarz, and Loutfi Salti declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Correspondence to
Karina Obreja.
Department of Oral Surgery and Implantology, Carolinum, Johann Wolfgang Goethe-University, Frankfurt, Germany
Puria Parvini, Karina Obreja, Frank Schwarz & Loutfi Salti
Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt am Main, Germany
Robert Sader
Department of Oral Surgery, Universitätsklinikum Düsseldorf,...
Not applicable
No funding to declare.
All data generated or analyzed during this study are included in this published article.
Waldrop TC, Semba SE. Closure of oroantral communication using guided tissue regeneration and an absorbable gelatin membrane. J Periodontol. 1993;64:1061–6.
Götzfried HF, Kaduk B. Okklusion der Mund-Antrum-Verbindung durch eine: alkoholische Prolaminelösung; Tierexperimentelle Studie und erste klinische Erfahrungen. Dtsch Z Mund Kiefer Gesichts Chir. 1985;9:390.
Grzesiak-Janas G, Janas A. Co...
Shaker MA, Hindy AM, Mounir RM, Geaisa KM. Competent closure of chronic oroantral fistula with Zenoderm. Egypt Dent J. 1995;41:1237–42.
Ogunsalu C. A new surgical management for oro-antral communication: the resorbable guided tissue regeneration membrane—bone substitute sandwich technique. West Indian Med J. 2005;54:261–3.
Goldman EH, Stratigos GT, Arthur AL. Treatment of oroantral fistula...
Joshi A, Kostakis GC. An investigation of post-operative morbidity following iliac crest graft harvesting. Br Dent J. 2004;196:167–71.
Misch CM. Harvesting of ramus bone in conjunction with third molar removal for onlay grafting before placement of dental implants. J Oral Maxillofac Surg. 1999;57:1376–9.
Nkenke E, Radespiel-Tröger M, Wiltfang J, Schultze-Mosgau S, Winkler G, Neukam FW. Morb...
El-Hakim IE, El-Fakharany AM. The use of the pedicled buccal fat pad (BFP) and palatal rotating flaps in closure of oroantral communication and palatal defects. J Laryngol Otol. 1999;113:834–8.
Singh J, Prasad K, Lalitha RM, Ranganath K. Buccal pad of fat and its applications in oral and maxillofacial surgery: a review of published literature (February) 2004 to (July) 2009. Oral Surg Oral Med O...
Awang MN. Closure of oroantral fistula. Int J Oral Maxillofac Surg. 1988;17:110–5.
Hynes W. Fistula in the hard palate following cleft surgery. Br J Plast Surg. 1957:377–84.
Genden EM, Lee BB, Urken ML. The palatal island flap for reconstruction of palatal and retromolar trigone defects revisited. Arch Otolaryngol Head Neck Surg. 2001;127(7):837–41.
Salins PC, Kishore SK. Anteriorly based...
Yilmaz T, Suslu AE, Gursel B. Treatment of oroantral fistula: experience with 27 cases. Am J Otolaryngol. 2003;24:221–3.
Borgonovo AE, Berardinelli FV, Favale M, Maiorana C. Surgical options in oroantral fistula treatment. Open Dent J. 2012;6:94–8.
Güven O. A clinical study on oroantral fistulae. J Craniomaxillofac Surg. 1998;26:267–71.
Amaratunga NADES. Oro-antral fistulae- a study of c...
Buccal fat pad
Bone graft transplantation
Connective tissue grafts
Free mucosal graft
Guided tissue regeneration
Oroantral fistula
Platelet-rich fibrin
By reviewing the literature, we can conclude that in selecting the surgical approach to close an oroantral fistula, different parameters have to be taken into account, including location and size of fistula as well as its relationship to the adjacent teeth, height of the alveolar ridge, persistence, sinus inflammation and the general health of the patient.
A small oroantral fistula of less than 5...
Logan and Coates described a procedure that provided closure of OAF in immunocompromised patients [74].
The oroantral fistula was de-epithelialized under local anesthesia, and the patient wore an acrylic surgical splint continuously for an 8-week period. The acrylic surgical splint covered the fistula and the edentulous area including the hard palate. The investigators reported complete healing o...
Use of guided tissue regeneration has been documented by Waldrop and Semba [71]. This method uses an absorbable gelatin membrane, allogenic bone graft material, and a nonresorbable expanded polytetrafluoroethylene (ePTFE) membrane. After flap reflection, an absorbable gelatin membrane is placed over the OAF with its edges on the bony margins of the perforation, which serve as a barrier for the bon...
The use of a bioabsorbable root analog made of β-tricalcium phosphate for closure of oroantral fistulas was proposed by Thoma et al. [68]. The root replicas were fabricated chair side, using a mold of the extracted tooth [10]. The investigators reported that the healing was uneventful. However, fragmentary roots or overly large defects prevent replica fabrication or accurate fitting of the analog...
Polymethylmethacrylate has been introduced as an alternative technique for closing OAFs [64]. After 24 h of immersion in a sterilizing solution, the polymethylmethacrylate plate is placed over the defect. Mucoperiosteal flaps are then replaced without attempting to cover the acrylic plate. The polymethylmethacrylate plate is removed as soon as the edges become exposed. One of the common disadvant...
Various synthetic materials have been used for OAF closures. Use of gold foil and gold plate for the closure of OAFs was reported for the first time by Goldman and Salman, respectively [59, 60]. It is a simplified technique for the closure of oroantral fistulas. The technique consists of elevating the mucoperiosteum to expose the bony margins of the fistula. Then, the opening is covered with an ov...
Multiple techniques have been described for the closure of OAFs using lyophilized fibrin glue of human origin [53]. In this technique, the fibrin glue is prepared and injected into the socket, together with the collagen sheet. Stajčić et al. stressed the importance of inserting the syringe above the floor of the antrum to protect the clot from airflow [53]. The technique is simple with few posto...
An autogenous bone graft and platelet-rich fibrin (PRF) membrane as a treatment strategy for closure of OAF has also been proposed [50]. PRF is a product of centrifuged blood. The biochemical components of PRF are well-known as factors acting synergistically in the healing process. This includes platelet-derived growth factor (PDGF), whose components are the reason why PRF has anti-inflammatory pr...
Recently, auricular cartilage graft has been used for the closure of OAFs. A full-thickness flap is raised at the defect site [47]. A semicircular incision is then made posteriorly over the conchal cartilage. The conchal cartilage with overlying perichondrium is exposed with a blunt dissection. The harvested auricular graft is then adapted on the defect site and sutured with the surrounding tissue...
A retromolar bone graft is a viable procedure for OAF closure. However, harvesting of a retromolar bone can occasionally be combined with removal of the third molar, which may affect acceptance of the procedure by patients [44]. When compared to chin bone grafts, the significant disadvantage of the retromolar donor area is the confined amount of bone available [45]. The incision is made medial to ...
The tongue is an excellent donor site for soft tissue defects of the oral cavity, due to its pliability, position, and abundant vascularity. Tongue flaps can be created from the ventral, dorsal, or lateral part of the tongue [36]. The surgical design of the flap is dictated by the location of the defect. A lateral tongue flap has been described as a suitable method for the closure of large OAF [37...
Free mucosal grafts (FMG) or connective tissue grafts (CTG) are suitable for the closure of small to moderate size defects in the premolar area as well as small to medium size-persistent defects. In contrast to the techniques described so far, the harvested grafts are not directly vascularized. The flap initially receives its nutrients within the first three postoperative days by diffusion alone, ...
The palatal straight advancement flap is of limited use due to the inelastic nature of the palatal tissue, which reduces its lateral mobility. For the same reason, it is suitable for the closure of minor palatal or alveolar defects [17].
The palatal hinged flap has been used successfully to close small fistula of the hard palate, i.e., those less than 2 cm in diameter in a one-stage operation [1...
Môczáir [14] described closing alveolar fistulas by the buccal sliding flap, shifting the flap one tooth distally. This technique produces only a negligible change in the depth of the buccal vestibule. A drawback of this approach is that it requires a large amount of dentogingival detachment in order to facilitate the shift, which may result in gingival recession and periodontal disease.
The fi...
A narrative literature review of articles and case reports for oroantral fistula has been conducted in the PubMed databases of published English literature. Articles published until April 2018 were reviewed. In addition to 262 articles on the closure of oroantral, 4 articles on the closure of antrooral fistula in humans, and 5 articles in animals, citations were referenced to identify further rele...
Radiologically, in the computed tomography (CT) or cone beam computed tomography (CBCT), the oroantral fistula might show as sinus floor discontinuity, opacification of the sinus, or communication between the oral cavity and the sinus. In addition, focal alveolar atrophy and associated periodontal disease may be observed [6]. In chronic OAF, there is generalized mucosal thickening. Recent studies ...
An oroantral fistula (OAF) can be defined as an epithelialized pathological unnatural communication between the oral cavity and the maxillary sinus [1]. The term oroantral fistula is used to indicate a canal lined by epithelium that may be filled with granulation tissue or polyposis of the sinus membrane [2]. They can arise as late sequelae from perforation and last at least 48–72 h. An oroantr...
Authors
Year of study
Method of study
Results
Tos and Mogesen et al.
1979
...
Factor
Difference
95% CI
p value
Age (years)
Gender
Male
Female
Overall
N (%)
N (%)
N (%)
p value
...
Position
1 (AR/AL)
2(BR/BL)
3 (CR/CL)
Overall
N (%)
N (%)
N (%)
...
Sex
Male
Female
Overall
Mean (SD)
Mean (SD)
Mean...
Fig. 3. Demonstration of the method used to measure the angle designated by the buccal and lingual walls of the sinus angle for each of the three fixed points in a given height
Fig. 3. Demonstration of the method used to measure the angle designated by the buccal and lingual walls of the sinus angle for each of the three fixed points in a given height
Fig. 2. Demonstration of the method used to measure the thickness of the Schneiderian membrane in the cross-sectional images for each of the three fixed points
Fig. 2. Demonstration of the method used to measure the thickness of the Schneiderian membrane in the cross-sectional images for each of the three fixed points
Fig. 1. Demonstration of the method used in the panoramic image to divide the sinus in four equal parts and find three fixed points for the measurements. Also, these fixed points in the horizontal plane with and without sections
Fig. 1. Demonstration of the method used in the panoramic image to divide the sinus in four equal parts and find three fixed points for the measurements. Also, these ...
Kalyvas, D., Kapsalas, A., Paikou, S. et al. Thickness of the Schneiderian membrane and its correlation with anatomical structures and demographic parameters using CBCT tomography: a retrospective study.
Int J Implant Dent 4, 32 (2018). https://doi.org/10.1186/s40729-018-0143-5
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Received: 29 January 2018
Accepted: 27 August 2018
Published: 19 October 2018
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Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
Patient recruitment and data collection for this study took place at National and Kapodistrian University of Athens, School of Dentistry, Greece. The research was approved by the Ethics Committee of the National and Kapodistrian University of Athens, Greece, and all activities were conducted in full accordance with ethical principles, including the World Medical Association Declaration of Helsinki...
Department of Oral and Maxillofacial Surgery, School of Dentistry, National and Kapodistrian University of Athens, Greece, Thivon 2 str, 11527, Athens, Greece
Demos Kalyvas, Andreas Kapsalas & Sofia Paikou
Oral Diagnosis & Radiology Clinic, School of Dentistry, National and Kapodistrian University of Athens, Greece, Thivon 2 str, 11527, Athens, Greece
Konstantinos Tsiklakis
You can also sea...
The data will not be shared, but are available upon request.
Wen S-C, Lin Y-H, Yang Y-C, Wang H-L. The influence of sinus membrane thickness upon membrane perforation during transcrestal sinus lift procedure. Clin. Oral Impl. Res. 2015;26:1158–64.
Insua A, Monje-Gil F, García-Caballero L, Caballé-Serrano J, Wang HL, Monje A. Mechanical characteristics of the maxillary sinus Schneiderian membrane ex vivo. Clin Oral Investig. 2017; https://doi.org/10.100...
Cagici CA, Yilmazer C, Hurcan C, Ozer C, Ozer F. Appropriate interslice gap for screening coronal paranasal sinus tomography for mucosal thickening. Eur Arch Otorhinolaryngol. 2009;266(4):519–25.
Eggesbø HB. Radiological imaging of inflammatory lesions in the nasal cavity and paranasal sinuses. Eur Radiol. 2006;16:872–88.
Lozano-Carrascal N, Salomó-Coll O, Gehrke SA, Calvo-Guirado JL, Hern...
Testori T. Maxillary sinus surgery: Anatomy and advanced diagnostic imaging. J Implant and Reconstructive Dent. 2011;2:6-14.
Sargi ZB, Casiano RR. Surgical anatomy of the paranasal sinuses. In: Kountakis SE, Onerci TM, editors. Rhinologic and sleep apnea surgical techniques. New York: Springer; 2007. p. 17–26.
Bergh van den JPA, Bruggenkate ten CM, Disch FJM, Tuinzing DB. Anatomical aspects of...
In conclusion, the present study demonstrated that male patients tend to have a thicker membrane than female patients. The angles of the sinus seemed to increase in width from mesial to distal, and they have no significant correlation with any of our parameters. Thickness of the mucosa and width of the maxillary sinus did not seem to correlate. Future studies including larger groups of participant...
In the present study, it was also concluded that the width of the sinus increases from mesial to distal. Male sinuses had higher prevalence of high angle values compared to female sinuses, but the majority of angle values and widths was characterized as moderate.
In an attempt to correlate the membrane biotype regarding thickness with the sinus width, it was proven that there is no correlation be...
Comparing the thickness of the membrane between the two genders, males seem to have thicker membranes than females. Vallo et al. 2010, Janner et al. 2011, Ji-Young Yoo et al. 2011, Cakur et al. 2013, and Jildirim et al. 2017 [9, 11, 12, 16, 17] also come to this conclusion. Our study assumed that this difference is of the order of 40%. On the contrary, Pazera et al. 2010 concluded that there is no...
It is very important to pre-operatively evaluate the thickness of the Schneiderian membrane to plan the surgical procedure in the region that involves the membrane, such as a sinus lift augmentation, which increases the possibility of membrane perforation or other complications.
The present study assumed that the average thickness of the Schneiderian membrane is 1.60 ± 1.20 mm.
There are m...
The mean value of the overall average thickness is 1.60 ± 1.20 mm (males 1.95 ± 1.28 mm and females 1.24 ± 1.02 mm) (Table 1).
The average thickness of the membrane also showed no tendency for differentiation by age group (p = 0.878) (Table 2).
The statistical analysis also shows a clear tendency towards lower values when checking from point AR to point CR and from point ...
These three cross-sectional images, in which the thickness of the Schneiderian membrane was previously measured, were also used for the measurement of the angle of the maxillary sinus. A segment DG (point D is the deepest point of the floor of the maxillary sinus) is created, vertical to the horizontal plane with stable length equal to 9.9 mm. The mean of 9.9 mm was chosen, because of a limitati...
The study sample included 76 patients, of which 39 were females and 37 were males. In total, 120 sinuses (44 both left- and right-sided, 21 right-sided, and 11 left-sided) were evaluated as suitable for the present study and were measured. The total sample was classified in four age groups (below 45 years, 45–54 years, 54–64 years, and over 65 years of age). The mean age value of the sampl...
The maxillary sinus is the largest of the paranasal air-filled spaces, and it develops firstly in utero [1, 2]. Anatomically, the maxillary sinus is a pyramid-shaped cavity located in the facial skull with a mean volume of 12.5 mL (min 5 mL and max 22 mL) [2,3,4,5,6]. The size, the shape, and the wall thickness of every maxillary sinus not only vary among the population, but also between the tw...
The aims of the present study were to determine the thickness of the Schneiderian membrane and identify the width of the maxillary sinus, which is indicated by the buccal and lingual walls of the sinus angle between. Furthermore, to investigate the possibility of a correlation between the aforementioned structures and also other anatomical and demographic parameters using CBCTs for dental implant ...
Fig. 4. Statistical analysis for different variables. a Weighted mean survival rate. b Implant survival rate according to degree of penetration. c Analysis of clinical complications. d Analysis of radiographic complications
Fig. 4. Statistical analysis for different variables. a Weighted mean survival rate. b Implant survival rate according to degree of penetration. c Analysis of clinical com...
Fig. 3. Graphic representation of group 1 ≤ 4 mm penetration and group 2 > 4 mm penetrations
Fig. 3. Graphic representation of group 1 ≤ 4 mm penetration and group 2 > 4 mm penetrations
Fig. 1. Graphic representation of implants intruding sinus perforating or not the Schneiderian membrane
Fig. 1. Graphic representation of implants intruding sinus perforating or not the Schneiderian membrane
Fig. 2. PRISMA flowchart of the screening process
Fig. 2. PRISMA flowchart of the screening process
Reason for exclusion
Investigations
Study design (case series or case report)
Kim et al. (2017), Hatano et al. (2007)
Different grafting techn...
Author (year)
Study design
Follow-up (months)
N of patients
N of implants
Smokers
Le...
Clinical complications
Radiographic complications
Sinusitis
Thickening of Schneiderian membrane
Nasal bleeding, nasal obstruction, nasal secre...
Ragucci, G.M., Elnayef, B., Suárez-López del Amo, F. et al. Influence of exposing dental implants into the sinus cavity on survival and complications rate: a systematic review.
Int J Implant Dent 5, 6 (2019). https://doi.org/10.1186/s40729-019-0157-7
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Received: 09 October 2018
Accepted: 06 January 2019
Published: 05 February 2019
DOI: https://doi.org/10...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
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Gian Maria Ragucci, Basel Elnayef, Fernando Suárez López del Amo, Hom-Lay Wang, Federico Hernández-Alfaro, and Jordi Gargallo-Albiol declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Correspondence to
Basel Elnayef.
Department of Oral and Maxillofacial Surgery, International University of Catalonia, C/Josep Trueta Sn, Sant Cugat del Vallés, C.P 08195, Barcelona, Spain
Gian Maria Ragucci, Basel Elnayef, Federico Hernández-Alfaro & Jordi Gargallo-Albiol
Department of Periodontics, University of Oklahoma Health Sciences Center – College of Dentistry, Oklahoma City, OK, USA
Fernando Suárez-López del ...
The authors want to thank Mr Juan Luis Gómez Martínez for the support in the statistical analysis.
Not applicable
Not applicable
The authors do not have any financial interests, either directly or indirectly, in the products or information listed in the paper.
Schwarz L, Schiebel V, Hof M, Ulm C, Watzek G, Pommer B. Risk factors of membrane perforation and postoperative complications in sinus floor elevation surgery: review of 407 augmentation procedures. J Oral Maxillofac Surg. 2015;73:1275–82.
Jung JA, Choi BH, Zhu SJ, Lee SH, Huh JY, You TM, Lee HJ, Li J. The effects of exposing dental implants to the maxillary sinus cavity on sinus complications....
Ardekian L, Oved-Peleg E, Mactei EE, Peled M. The clinical significance of sinus membrane perforation during augmentation of the maxillary sinus. J Oral Maxillofac Surg. 2006 Feb;64(2):277–82.
Anavi Y, Allon DM, Avishai G, Calderon S. Complications of maxillary sinus augmentations in a selective series of patients. Oral Surg Oral Med Oral Patho Oral RadiolEndod. 2008;106(1):34–8.
Van den Ber...
Curi MM, Cardoso CL, de Ribeiro C. Retrospective study of pterygoid implants in the atrophic posterior maxilla: implant and prosthesis survival rates up to 3 years. Int J Oral Maxillofac Implants. 2015;30(2):378–83.
Boyne PJ, James RA. Grafting of the maxillary sinus floor with autogenous marrow and bone. J Oral Surg. 1980;38(8):613–6.
Tatum H.Jr. Maxillary and sinus implant reconstructions....
Roccuzzo M, Bonino L, Dalmasso P, Aglietta M. Long-term results of a three arms prospective cohort study on implants in periodontally compromised patients: 10-year data around sandblasted and acid-etched (SLA) surface. Clin Oral Implants Res. 2014;25(10):1105–12.
Esposito M, Grusovin MG, Rees J, Karasoulos D, Felice P, Alissa R, Worthington H, Coulthard P. Effectiveness of sinus lift procedures...
The current review showed that the exposure of dental implants in the sinus cavity without the augmentation procedure or graft materials shows a high survival rate of 95.6%, without statistically significant differences according to the level of penetration (lower or higher to 4 mm). Changes in maxillary sinuses in relation to protruding implants within the sinus cavity do not statically affect ...
Consequently, it seems that maxillary sinus changes in relation to protruded implants inside the sinus cavity and does not statically affect to implant survival rate neither to clinical nor radiographic complications.
Several limitations could be described for the present review. Firstly, there is a lack of a control group in the included studies, to compare outcomes and complications, with impla...
Pneumatization of the maxillary sinus and resorption of the residual alveolar ridge following tooth extraction can compromise the dental implant placement. Similarly, extension of the dental implants inside the maxillary sinus cavity is not rare. Some studies have observed some differences in relation to the depth of the implant extension inside the sinus cavity. When the implants penetrate inside...
Seven studies [27,28,29,30,31,32,33] provide information on clinical complications with a global sample of 232 patients. Clinical complications among the different authors range from 0 to 14.3%, being the weighted mean complication rate 3.4% with an IC 95% [0 7.5] (Fig. 4c) Clinical complications analyzed in the studies were sinusitis, nasal bleeding, nasal obstruction, nasal secretion, mucopurul...
An initial screening yielded a total of 3551 publications of which 26 potentially relevant articles were selected after an evaluation of their titles and abstracts. Full text of these articles was obtained and evaluated thoroughly. Of these, eight articles [26,27,28,29,30,31,32,33] (Table 2) fulfilled the inclusion criteria and subsequently were included in the qualitative analysis (Fig. 2). Rea...
Heterogeneity was assessed based on calculation of the I2 statistic (percentage variability of estimated effect that can be attributed to the heterogeneity of the effects) and the null statistic test. Galbraith graphs displayed the degree of heterogeneity. In studies where great heterogeneity was detected, a sensitivity analysis was performed to determine its source. Funnel plots and the Egger tes...
Articles were included in this systematic review if they met the following inclusion criteria: human prospective or retrospective studies, reporting outcomes of implant placed perforating the sinus floor with implant burs, and without regenerative procedure (lateral sinus lift or transalveolar technique) and graft material. The intrusion into the sinus cavity can occur during drilling or implant p...
This systematic review and subsequent meta-analysis follow the guidelines of the PRISMA statement.
The following focus question was developed: Is the intrusion of dental implants into the sinus cavity during implant drilling or implant placement, without regenerative procedure (lateral sinus lift or transalveolar technique) and graft material, has an effect on implant survival or increase clinica...
Intrusion of dental implants into the maxillary sinus perforating through the Schneiderian membrane is considered a cause of undesirable complications [24, 25]. However, this phenomenon has never been properly evaluated and systematically studied. For this reason, the aim of this systematic review was to assess the implant survival and complication rates of implants intruding into the sinus cavity...
The edentulous posterior maxillary region often presents with unique challenging conditions in implant dentistry [1]. Limited bone height secondary to pneumatization of the maxillary sinus and the resorption of the alveolar ridge preclude in many instances the installation of dental implants. To compensate for the lack of bone height, several treatment options have been proposed.
The most conserv...
The overall survival rate of the implants into the sinus cavity was 95.6%, without statistical differences according to the level of penetration. The clinical and radiological complications were 3.4% and 14.8% respectively. The most frequent clinical complication was the epistaxis, and the radiological complication was thickening of the Schneiderian membrane, without reaching statistical significa...
After tooth loss, the posterior maxilla is usually characterized by limited bone height secondary to pneumatization of the maxillary sinus and/or collapse of the alveolar ridge that preclude in many instances the installation of dental implants. In order to compensate for the lack of bone height, several treatment options have been proposed. These treatment alternatives aimed at the installation o...
Item
Mean ± SD pre-operative
Mean ± SD post-operative
Mean ± SD in the last time
Have you felt pain in your mouth?
0.9 ± 1.1
1.2 ± 1.0
0.3 ± 0.6
Have you had difficulties with your mouth opening?
0.2 ± 0.6
0.5 ± 0.9
0.1 ± 1.0
Have you had painful gums?
0.9 ± 1.0
1.0 ± 1.1
0.5 ± 0.8
Have you had a ...
Item
Mean ± SD before sinus lift
Mean ± SD after sinus lift
p value
Have you felt tense because of problems with your teeth, mouth or dentures?
1.8 ± 1.1
0.8 ± 1.0
Item
Mean ± SD before sinus lift
Mean ± SD after sinus lift
p value
Have you had difficulty chewing any foods?
1.6 ± 1.2
0.4 ± 0.7
Figure 5. Total score for physical and psychological disabilities before (gray) and after (hatched) sinus augmentation according to indications
Figure 4. Total score for functional limitations before (gray) and after (hatched) sinus augmentation according to indications
Figure 3. Total score for complaints due to surgical procedure pre-operative, post-operative, and recently
Figure 2. Cumulative survival rate according to Kaplan–Meier and sinus augmentation procedure
Figure 1. Flow chart of patients included in the study
Figure 1. Flow chart of patients included in the study
References
Al-Nawas B, Schiegnitz E. Augmentation procedures using bone substitute materials or autogenous bone—a systematic review and meta-analysis. Eur J Oral Implantol. 2014 Summer;7 Suppl 2:S219-34.
Derks J, Hakansson J, Wennstrom JL, Tomasi C, Larsson M, Berglundh T. Effectiveness of implant therapy analyzed in a Swedish population: early and late implant loss. J Dent Res. 2015;94(...
The authors concluded that in clinical decision-making regarding donor site for bone graft harvesting, patients and clinicians should consider expected decrease in HRQoL if deciding to use extra-oral donor sites. Therefore, the authors recommended to prefer intra-oral donor sites whenever possible. In a recent study of Nickenig et al., OHIP-G 21 was evaluated in 8689 patients with variou...
In this prospective study, health-related quality of life questionnaire was given to 76 patients evaluating patient perception of recovery in the four areas pain, oral function, general activity, and other symptoms. The results showed that average and maximal pain peaked on post-operative day 1 and improved on post-operative days 4 and 5. Difficulty in mouth opening was greatest on pos...
Discussion
The clinical and radiological outcomes of sinus augmentation procedures have been published in several studies. However, little data on the physical and psychological impact of this procedure on the patient is available yet. The present study evaluated pre-operative and post-treatment OHRQoL self-assessment scores of patients treated with dental implants after sinus augmentation ...
In the subcategory physical and psychological disabilities, all questions had significant better values after the sinus lift (p
Results
Survival analysis
After an average time in situ of 41.2 ± 27 months (3.4 years; range 0–96 months), 40 of the 863 implants were lost. These results indicated an in situ rate of 95.4%. One-year and five-year survival rate according to Kaplan–Meier were 95.4 and 94.4%. In patients receiving an external sinus lift an in situ rate of 95.1% and in patients with an internal sinus...
Methods
Study design and subjects
This retrospective study addresses the oral health-related quality of life after maxillary sinus augmentation. Therefore, all patients that received an implantation after maxillary sinus augmentation in the Department of Oral and Maxillofacial Surgery of the University Medical Centre Mainz, Germany, between July 2002 and December 2007 were included in this stu...
Background
Rehabilitation of completely and partial edentulous patients with dental implants has proved to be a safe and predictable procedure. However, reduced bone height and the proximity of the maxillary sinus are challenging limitations for dental implant placement in the posterior maxilla. Besides the use of short and tilted implants, one of the most frequently used surgical techniques fo...
Abstract
Background
The aim of this study was to measure the oral health-related quality of life (OHRQoL) after maxillary sinus augmentation to determine the physical and psychological impact of this procedure for the patient.
Methods
Three hundred sixteen patients treated with an external or internal maxillary sinus augmentation and a total of 863 implants in the Department of Oral and Maxi...
Abbreviations
BP:
bisphosphonate
BP-ONJ:
bisphosphonate-associated osteonecrosis of the jaws
CTX:
C-terminal telopeptide of the type I collagen
PICO:
patients intervention control outcome
PRISMA-P:
preferred reporting items for systematic reviews and meta-analyses protocols
QoL:
quality of life
ST:
search term
TMJ:
temporomandibular joint
...
Next to this, the patients need to be compliant with an appropriate motivation for oral hygiene and the necessary skills to transfer this. Infectious foci should be treated before implant therapy to further reduce the risk of osteonecrosis development. The surgical sites should be followed up clinically (persisting sharp bone edges without any tendency to remodel) and radiologically (e...
Although there are only very few cases in the literature with augmentation of bone/sinus lift, these procedures are linked to a functioning vascular recipient site with working osteoclastic resorption and osteoblastic bone formation, and this is compromised in patients with antiresorptive therapy. Due to the denudation of the bone at the recipient site the vascular situation might be e...
Discussion
Even latest guidelines and statements dealing with medication associated osteonecrosis of the jaws such as the American, Scottish, Swiss or German do not address implant therapy in these patients in detail. Due to this lack of data a systematic literature review was performed to fill this gap. Unfortunately the literature dealing with this topic is very sparse and consists mainl...
Nibbe analyzed 128 patients with IV BP or denosumab separated into 3 groups. In the first group 5 out of 60 patients with no denture had an osteonecrosis (8%), in the 2nd group 5 out of 34 patients with a fixed partial denture had an osteonecrosis 15%, and in the 3rd group 11 out of 34 patients with a removable denture had an osteonecrosis (32%). Kyrgidis determined that dentures increase the ris...
Results
Out of 606 articles 556 articles were excluded because they were either duplicates, case reports, narrative reviews, case series with less than 5 cases or were not associated with the topic at all (Table 1 and Fig. 1). Some of the articles analyzed more than one outcome and are referred to several times. Since the available literature is very inhomogeneous with a low level of evidence a...
Introduction
Bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is a well-known side effect in patients receiving bisphosphonates (BP) due to e.g. osteoporosis, multiple myeloma or malignant diseases with metastases to the bone; prevalences range between 0.1% for patients with primary osteoporosis to 1% in patients with secondary osteoporosis and up to about 20% for special high risk ...
Dental implants in patients treated with antiresorptive medication – a systematic literature review
Abstract
Objective
Bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is triggered by inflammatory processes. Typical trigger factors are periodontal disease, denture pressure sores, and surgical interventions such as tooth extractions. Unfortunately there is only little data on how...
Figure 3. Postoperative radiograph of the resected dental implant in the right anterior maxilla
Figure 2. On radiological examination, it was confirmed that the dental implant had perforated the cortical bone of the right nasal floor
Figure 1. On anterior rhinoscopy, the apical part of the titanium dental implant in the right anterior maxilla was seen in the nasal floor close to the nasal septum
Discussion
Insertion of endosseous dental implants is usually associated with a low incidence of complications and excellent prognosis. However, physiologic changes following tooth loss may complicate or even impede insertion of dental implants in the upper jaw. Furthermore dental implants can only be inserted if there is sufficient bone for adequate stabilization. Therefore, in severely at...
Background
Endosseous dental implants are commonly used to rehabilitate fully or partially edentulous patients. The insertion of such implants can in some cases cause complications, especially in the edentulous atrophic maxilla. In this paper, an unusual complication of altered nasal airflow after the placement of an endosseous dental implant in the maxilla is presented. Subsequent treatmen...
Altered nasal airflow: an unusual complication following implant surgery in the anterior maxilla
Abstract
Dental implants have been in routine clinical use for over three decades and are a predictable treatment modality. However, as with all other aspects of dentistry, complications occur. A 50-year-old female patient with complaints of a long ongoing unpleasant altered nasal airflow presented...
Figure 2. Figure illustrating the proposed mucosal thickening index. A ≤1 mm, indicating no thickening; B >1 mm but ≤2 mm, indicating minimal thickening; C >2 mm but ≤5 mm, indicating moderate thickening; D >5 mm, indicating severe thickening
Table 2 Statistical results after inter-variable adjustment showing the association between recorded parameters and sinus mucosal thickening; p values that showed statistically significant differences are italicized
Gender
Respiratory diseases
Cardio-vascular diseases
Diabetes mellitus
Smoking
History of periodontal diseases
Endodontic treatment
History of orthodontic t...
Table 1 CBCT measurements of sinus mucosal thickening
Patient
Anterior(E1-floor of the sinus)
Middle(C1-floor of the sinus)
Posterior(D1-floor of the sinus)
Thickest(F-floor of the sinus)
1
3.06
0.32
0.76
4.59
2
0.34
0.21
0.20
0.34
3
0.39
0.54
1.38
1.66
4
4.15
3.79
0.61
6.36
5
5.64
1.33
3.73
8.42
6
7.34
0.77
0.86
7.66
7
1.9...
Figure 1. Figure illustrating the reference points of the CBCT measurements. A: most posterior point of the sinus wall; B: most anterior point of the sinus wall; C: mid-point between A and B; C1: measurement of mucosal thickening perpendicular to A–B line at point C; D: mid-point between A and C; D1: measurement of mucosal thickening perpendicular to A–B line at point D...
Shahbazian M, Vandewoude C, Wyatt J, Jacobs R. Comparative assessment of panoramic radiography and CBCT imaging for radiodiagnostics in the posterior maxilla. Clin Oral Investig. 2014;18:293–300.
Logan GM, Brocklebank LM. An audit of occipitomental radiographs. Dentomaxillofac Radiol. 1999;28:158–61.
Pazera P, Bornstein MM, Pazera A, Sendi P, Katsaros C. Incidental maxillary sinus findings...
Shanbhag S, Karnik P, Shirke P, Shanbhag V. Cone-beam computed tomographic analysis of sinus membrane thickness, ostium patency, and residual ridge heights in the posterior maxilla: implications for sinus floor elevation. Clin Oral Implants Res. 2014;25:755–60.
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References
Beretta M, Poli PP, Grossi GB, Pieroni S, Maiorana C. Long-term survival rate of implants placed in conjunction with 246 sinus floor elevation procedures: results of a 15-year retrospective study. J Dent. 2015;43:78–86.
Del Fabbro M, Corbella S, Weinstein T, Ceresoli V, Taschieri S. Implant survival rates after osteotome-mediated maxillary sinus augmentation: a systematic revi...
This study presents new data on maxillary sinus mucosal thickening derived from a carefully defined data set; however, there were some limitations in the study. One limitation was the limited sample size. However, as discussed, our stringent case selection criteria yielded a more uniform data set for analyses. Other limitations were related to the actual measurements of the maxillary sinus. ...
Our study did not find a significant association between endodontically treated teeth and mucosal thickening. Though this finding is consistent with some previously published studies, other studies did report an association. These discrepant findings could be the result of different inclusion criteria in the study design. Since our study did not include any patients with radiographic signs o...
The current study demonstrated that sinus mucosal thickening does not correlate with implant survival. This result is consistent with a previously published report by Jungner et al. In their study, the presence of sinus thickening was not significantly associated with implant failure. Similarly, our study found a 100% implant survival rate for both patients with and without sinus mucosal thi...
Discussion
CBCT imaging has been recognized as a more sensitive imaging modality for identifying sinus thickening and pathoses in the posterior maxilla compared to panoramic radiography. This could explain why the current study identified a higher prevalence of mucosal thickening compared to earlier studies. However, compared to other similar CBCT studies, the prevalence reporte...
Results
Twenty-nine CBCT images (11 females and 18 males) were included in this study. All the implants placed in these included cases survived, representing a 100% implant survival rate. With regards to measurements of mucosal thickening, the intra-examiner reproducibility revealed an exact intra-examiner correlation of 99%, with a p value of 0.40 for a t test for independen...
In order to standardize the measurements for each sinus, each scan was carefully oriented in the axial, coronal, and sagittal plane. In the axial plane, a horizontal line from the right and left zygoma was chosen as the standard. Orienting the hard palate horizontally was the standard in the coronal plane as well as in the sagittal plane. The specific teeth that were to be replaced by implants wer...
Given these specific inclusion and exclusion criteria and the specific purpose of this study, only 29 cases qualified for inclusion from an original screen of approximately 4000 cases. An initial search of our database resulted in a larger number of cases that would theoretically qualify; however, further investigation revealed the need to exclude a great number of cases. The reasons for exclusion...
Methods
Study design
Our study hypothesis was that mucosal thickening of more than 2 mm and up to 1/3 of the volume of the sinus would not alter the predictability for SFE and dental implant placement. The primary outcome was to determine the success rate of dental implant placement in augmented maxillary sinus areas with mucosal thickening. A secondary outcome was to evaluate the effect of g...
Background
Despite the high survival rate of dental implants inserted in maxillary sinuses that have undergone sinus floor elevation (SFE) with bone grafting, complications still occur. Sinus membrane perforation is reported to be the most common complication. Postoperative maxillary sinusitis is less common (0–22%); nevertheless, it could potentially compromise the outcome of...
Dental implants and grafting success remain high despite large variations in maxillary sinus mucosal thickening
Abstract
Background
Although mucosal thickening is the most common radiographic finding observed regarding sinus pathology, the knowledge regarding its clinical significance on the outcomes of dental implants and grafting in the maxillary sinuses is still limited. We hypothesized th...
Reason for exclusion
Investigations
Study design (case series or case report)
Kim et al. (2017), Hatano et al. (2007)
Different grafting technique (lateral sinus lift or transalveolar technique)
Jensen et al. (1994), Winter et al. (2002), Toffler et al. (2004), Chappuis et al. (2009), Soltan et al. (2011), Xiao et al. (2011), Cricchio et al. (2011), Scala et al. (2012), Brus...
Author (year)
Study design
Follow-up (months)
N of patients
N of implants
Smokers
Length and diameter (mm)
Implant system
Shihab 2017
Retrospective
60
35
70
NA
5–12 × 3.0–5.7
IDI FMD Nucleoss
Ghanem 2014
Retrospective
72
10
10
NA
NA
NA
Nooh 2013
Prospective
12
56
63
0
4 × 8 4.3 × 10 5 × 8 5 × 10
Nobel Biocare
...
Clinical complications
Radiographic complications
Sinusitis
Thickening of Schneiderian membrane
Nasal bleeding, nasal obstruction, nasal secretion
Bone reaction to the implants
Headache and pain or tenderness in the region of the sinus
Sinus pathology
Decreased sense of smell
Figure 4. Statistical analysis for different variables. a Weighted mean survival rate. b Implant survival rate according to degree of penetration. c Analysis of clinical complications. d Analysis of radiographic complications
Figure 3. Graphic representation of group 1 ≤ 4 mm penetration and group 2 > 4 mm penetrations
Figure 2. PRISMA flowchart of the screening process
The secondary outcome of this review was the analysis of the clinical and radiological complications related to the penetration of implants in the maxillary sinus. Clinical complication among the different authors ranges from 0 to 14.3%, with a weighted mean complication rate of 3.4%, without finding statistical difference according to the level of implant penetration. The most common clinic...
Figure 1. Graphic representation of implants intruding sinus perforating or not the Schneiderian membrane
Analysis of clinical complications
Seven studies provide information on clinical complications with a global sample of 232 patients. Clinical complications among the different authors range from 0 to 14.3%, being the weighted mean complication rate 3.4% with an IC 95% [0 7.5] (Fig. 4c) Clinical complications analyzed in the studies were sinusitis, nasal bleeding, nasal obstruction, nasal sec...
Results
Study screening
An initial screening yielded a total of 3551 publications of which 26 potentially relevant articles were selected after an evaluation of their titles and abstracts. Full text of these articles was obtained and evaluated thoroughly. Of these, eight articles (Table 2) fulfilled the inclusion criteria and subsequently were included in the qualitative analysis (Fig. 2). Re...
Eligibility criteria
Articles were included in this systematic review if they met the following inclusion criteria: human prospective or retrospective studies, reporting outcomes of implant placed perforating the sinus floor with implant burs, and without regenerative procedure (lateral sinus lift or transalveolar technique) and graft material. The intrusion into the sinus cavity can occur du...
Materials and methods
This systematic review and subsequent meta-analysis follow the guidelines of the PRISMA statement.
Focus question
The following focus question was developed: Is the intrusion of dental implants into the sinus cavity during implant drilling or implant placement, without regenerative procedure (lateral sinus lift or transalveolar technique) and graft material, has an effec...
Introduction
The edentulous posterior maxillary region often presents with unique challenging conditions in implant dentistry. Limited bone height secondary to pneumatization of the maxillary sinus and the resorption of the alveolar ridge preclude in many instances the installation of dental implants. To compensate for the lack of bone height, several treatment options have been proposed.
The ...
Influence of exposing dental implants into the sinus cavity on survival and complications rate: a systematic review
Abstract
Background
After tooth loss, the posterior maxilla is usually characterized by limited bone height secondary to pneumatization of the maxillary sinus and/or collapse of the alveolar ridge that preclude in many instances the installation of dental implants. In order ...