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...
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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. 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)
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Patient (N)
Gender/age)
Retrieval location
BV/TV (%)
BS/TV (mm2/mm3)
Tb.Th (μm)
...
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T0
T1
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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.
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
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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.
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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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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. 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)
...
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T0
T1
Increase
...
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T1
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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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Received: 22 May 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...
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
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. 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
Accepted: 03 January 2018
Publish...
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.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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.
Not applicable.
Huda M Asmael declares that she had no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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...