Sinus floor elevation using a new bovine bone grafting material: case report and bone grafting materials update / Actualización en materiales de relleno óseo: reporte de un caso clínico de elevamiento del piso del seno maxilar usando un nuevo material de relleno óseo bovino

Bone grafting is important to preserve the alveolar bone ridge height and volume for dental implant placement. Even though implant-supported overdentures present highly successful outcomes, it seems that a great number of edentulous individuals have not pursued implant-based rehabilitation. The cost of the treatment is one of the reasons of discrepancy between highly successful therapy and its acceptance. Therefore, the development of biomaterials for bone grafting with comparable characteristics and biological effects than those renowned internationally, is necessary. In addition, domestic manufacture would reduce the high costs in public health arising from the application of these biomaterials in the dental feld. The purpose of this clinical case report is to provide preliminary clinical evidence of the efficacy of a new bovine bone graft in the bone healing process when used for sinus floor elevation. (AU)

El uso de injertos óseos es importante para preservar la altura y el volumen de la cresta alveolar para la colocación de implantes dentales. Si bien las sobredentaduras implanto-soportadas presentan resultados altamente exitosos, la mayoría de las personas desdentadas no han sido rehabilitadas mediante implantes dentales. Uno de los principales motivos por los cuales los pacientes no aceptan este tipo de tratamiento, altamente exitoso, es el elevado costo del mismo. Por ello, es necesario el desarrollo de biomateriales de injerto óseo con características y efectos biológicos comparables a los reconocidos internacionalmente. Asimismo, la fabricación nacional reduciría los altos costos en Salud Pública derivados de la aplicación de estos biomateriales en el campo dental. El objetivo de esta comunicación es presentar un caso clínico a fin de proporcionar evidencia preliminar acerca de la eficacia de un nuevo injerto de hueso bovino en el proceso de cicatrización ósea en el levantamiento del piso del seno maxilar. (AU)

A clinical study of dental implantation simultaneously with maxillary sinus augmentation in the presents of antral pseudocyst / 实用口腔医学杂志

17 patients with maxillary antral pseudocyst underwent side wall fenestration with simultaneous implantation of 38 implants and the upper denture repair, follow-up observation was conducted after repair for 6 to 24 months (an average of 11. 4 months) . Good osseointegration was observed in all cases. No implant shedding or bone resorption occurred during the follow-up period, and the antrol pseudo cyst disappeared or decreased. Dental implantation simulataneously with maxillary sinus augmentation is effective in the management of maxillary implantation for the cases with antrol pseudocyst.

Anatomic variations and lesions of the maxillary sinus observed by CBCT before sinus augmentation in 666 sinuses of 589 patients / 实用口腔医学杂志

Objective: To observe the anatomic variations and lesions of maxillary sinus by CBCT before sinus augmentation in Chinese patients with edentulous posterior maxilla. Methods: 589 participants with 666 sinuses were enrolled in this study. The anatomic variations and lesions of maxillary sinus were examined by CBCT prior to sinus augmentation surgery. Results: In all 666 sinuses, the prevalence of septa was 30. 48％, membrane thickness ≤2 mm was 60. 36％, the average thickness of the lateral wall was (1. 38 ± 0. 05) mm, the prevalence of posterior superior alveolar artery in the sinus was 66. 52％, the average diameter of the artery was (0. 98 ± 0. 03) mm, the discontinuity of the sinus floor was 4. 35％, the mean width of maxillary sinus was (14. 20 ± 0. 19) mm, and the prevalence of cyst was 11. 41％. Conclusion: CBCT can reveal the sinus diversity and provide the information for the safe and effective sinus augmentation.

Schematic of mean thickness distribution on the lateral aspect of the canine frontal sinus as an experimental model of sinus surgery / 대한해부학회지

The dog frontal sinus may represent an alternative model dental implant research; its topographical resemblance to the maxillary sinus renders it a potentially favorable experimental environment. The aim of this study was thus to elucidate the anatomical configuration of the canine frontal sinus and histological characteristics, and to determine whether it could be a new canine experimental model for dental implant research. Twenty-four sides of canine frontal bones were harvested. The distance from the nasion to the emerging point of the lateral aspect of the canine frontal sinus was measured with the aid of Lucion software. The thicknesses of the canine frontal sinus wall were measured, and the two specimens stained with hematoxylin and eosin. The mean distance from the nasion to the emerging point of the lateral aspect of the canine frontal sinus was 16.0 mm. The mean thicknesses of the canine frontal bone at 3, 6, 9, 12, and 15 mm lateral to the midsagittal plane were 2.3, 2.7, 3.2, 3.8, and 3.7 mm, respectively. The canine frontal sinus was lined with pseudostratified ciliated columnar epithelium. These data suggest that the canine frontal sinus is a suitable alternative to the canine maxillary sinus as a model for studying various sinus augmentation protocols.

Histomorphometric study of rabbit's maxillary sinus augmentation with various graft materials / 대한해부학회지

The purpose of this animal study is to evaluate, by histomorphometric analysis, bone regeneration in rabbit's maxillary sinuses with blood clots alone, Bio-Oss, β-tricalcium phosphate (β-TCP), and demineralized tooth dentin (DTD) grafting. Bilateral sinus augmentation procedures were performed in 18 adult male rabbits. Rectangular replaceable bony windows were made with a piezoelectric thin saw insert. In the group 1, blood clots were filled; group 2, anorganic bovine graft (Bio-Oss) was grafted; group 3, β-TCP was grafted; group 4, DTD was grafted, and covered by replaceable bony windows. Animals were sacrificed at 2, 4, and 8 weeks after surgical procedure. The augmented sinuses were evaluated by histomorphometric analysis using hematoxylin and eosin and Masson's trichrome stains. Histologically, new bone formation was revealed along the elevated sinus membrane and all graft materials. The new bone area of the group 2 was significantly greater than the group 1, and of the group 3 was significantly greater than the group 2, and of the group 4 was significantly greater than the group 3 at 8 weeks with P < 0.05. The bone marrow area of group 1 was significantly greater than other groups at 8 weeks. The DTD area was significantly lesser than Bio-Oss or β-TCP particles area at 8 weeks. This present study suggests that DTD can be effective graft materials for bone regeneration of the maxillary sinus augmentation.

Biomateriales en levantamiento de seno maxilar para implantes dentales / Biomaterials in maxillary sinus lift for dental implants

RESUMEN: Objetivos El objetivo principal es describir las técnicas y condiciones en que se usan los diferentes biomateriales para los procedimientos de aumento del seno maxilar en implantes oseointegrados inmediatos o diferidos. Método Se realizó una búsqueda electrónica de textos completos desde el año 2010 hasta el 15 de agosto del 2014, y que respondieran la pregunta de investigación, utilizando diferentes buscadores y una manual en las revistas científicas de periodoncia. Se determinó el nivel de evidencia, calidad de reporte, sesgos de la literatura analizada y aspectos éticos. Resultados Se seleccionaron 17 estudios, 4 revisiones sistemáticas y 13 ensayos clínicos aleatorizados. Diez estudios comparaban los diferentes biomateriales disponibles entre sí, y no encontraron diferencias estadísticamente significativas en la nueva formación ósea. Un estudio examinaba la opción de no utilizar un biomaterial en el aumento de senos maxilares. Seis estudios indicaban que el uso de biomateriales adicionales no era significativo. Tres estudios concluyeron que no existían diferencias significativas entre uno o 2 tiempos quirúrgicos para realizar los procedimientos. Tres estudios comparaban la técnica quirúrgica de ventana lateral con la técnica indirecta, sin encontrar diferencias estadísticamente significativas, pero sí se asocia a un menor número de complicaciones a la técnica indirecta, especialmente al estar acompañada de la instalación de implantes cortos. Conclusiones No se describen diferencias entre los diferentes biomateriales utilizados en procedimientos de aumento de senos maxilares. El uso de biomateriales adicionales pareciera no ofrecer beneficios medibles al tratamiento. La técnica quirúrgica indirecta puede ser asociada a un menor número de complicaciones. Son necesarios más estudios de ensayos clínicos aleatorizados, con tamaños de muestra mayores, variables controladas y seguimientos a largo plazo para establecer conclusiones.

ABSTRACT: Objectives The main objective is to describe the techniques and conditions in which the various biomaterials are used for sinus augmentation procedures for immediate or delayed osseointegrated implants. Method An electronic search was conducted looking for papers published from 2010 to 15 August 2014 to answer the research question. Several search engines were used as well as a manual on scientific journals of periodontics. The level of evidence, quality reporting, biases of the analysed literature, and ethical aspects were determined. Results A total of 17 studies were selected, of which 4 were systematic reviews, and 13 were randomised trials. Ten different trials compared the available biomaterials with each other, and found no statistically significant differences in new bone formation. One study examined the option of not using biomaterials in the procedures. Six studies indicated that the use of additional biomaterials was not significant. Three studies concluded that there were no significant differences between 1 and 2 surgical times. Three studies compared the surgical technique of lateral window with the indirect technique, with no statistically significant differences, but the indirect technique was associated with fewer complications, especially when accompanied by the installation of short implants. Conclusions No differences between different biomaterials used in augmentation procedures for maxillary sinuses were described. The use of additional biomaterials does not seem to offer measurable benefits to the treatment. The indirect surgical technique may be associated with fewer complications. Further studies of randomised clinical trials, with larger sample sizes, controlled variables, and long term monitoring are needed to draw stronger conclusions.

Radiographic study of the distribution of maxillary intraosseous vascular canal in Koreans / 대한악안면성형재건외과학회지

BACKGROUND: This study aimed to investigate the distribution and prevalence of intraosseous loop (anastomosis between posterior superior alveolar artery and infraorbital artery) in Koreans detected on computed tomography (CT) images taken prior to sinus augmentation surgery. METHODS: From the 177 patients who underwent sinus augmentation with lateral approach at Ewha Womans University Department of Implant Dentistry, 284 CT scans were evaluated. The canal height (CH), ridge height (RH), and canal height from the sinus floor (CHS) were measured on para-axial views at the first premolar, first molar, and second molar. The horizontal positions of the bony canals in the lateral wall were also classified. One-way analysis of variance (ANOVA) and t test were used to estimate the statistical differences (p < 0.05). RESULTS: The intraosseous loops were detected in 92 CT scans (32 %). The mean vertical height of the bony canals from the alveolar crest (CH) was 23.45 +/- 2.81, 15.92 +/- 2.65, and 16.61 +/- 2.92 mm at the second premolar, first molar, and second molar, respectively. In the horizontal positions of the bony canals, intraosseous type was the most predominant. The canal heights more than 15 mm and less than 17 mm were most prevalent (33.7 %) and those under 13 mm were 12.0 %. CONCLUSIONS: The radiographic findings in this study could be used to decide the lateral osteotomy line avoiding potential vascular complication. However, only one third of the canals could be detected in CT scans; a precaution should be taken for the possibility of severe bleeding during lateral osteotomy.

Clinical evaluation of sinus bone graft in patients with mucous retention cyst / 대한악안면성형재건외과학회지

BACKGROUND: Mucous retention cyst refers to a cyst made by expansion due to the blockage of the salivary gland near the maxillary sinus, and it is surrounded by epithelial cells. Most of them are small; therefore, they cannot be found well and are frequently with antral polyp. The aim of this study was to evaluate the clinical prognosis of sinus bone graft in patients with mucous retention cyst. METHODS: This study was performed retrospectively on 23 patients who had sinus bone graft. Group 1 was 8 patients (10 sinuses) who had a mucous retention cyst, and group 2 was 15 patients (17 sinuses) who had no pathologic history about the maxillary sinus. For these patients, sinus bone graft was performed using the lateral approach technique. The total 51 implants were placed 6.22 weeks on the average after sinus bone graft. Sinus membrane perforation during operation, postoperative complications, marginal bone loss after restorative function, implant success rate, and survival rate were analyzed. RESULTS: There was no complication in group 1, and there were three complications in group 2. In group 2, two cases of implants failed. The types of postoperative complications consisted of two minor infections and one wound dehiscence. Two implants of total 51 implants were removed, and the survival rate of implants was 96.08 % (group 1 100 %, group 2 93.5 %). The total success rate of implants was 92.2 % (group 1 95 %, group 2 90.3 %). CONCLUSIONS: The clinical prognosis was not affected by the presence of mucous retention cyst.

Late-term healing in an augmented sinus with different ratios of biphasic calcium phosphate: a pilot study using a rabbit sinus model

PURPOSE: The aim of this pilot study was to determine the osteoconductivity and dimensional stability of augmented sinuses using different ratios of biphasic calcium phosphate (BCP) in a rabbit sinus model. METHODS: Each sinus of New Zealand white rabbits (2.5-3.5 kg) was assigned to one of two groups: BCP with a hydroxyapatite to beta-tricalcium phosphate (HA:beta-TCP) ratio of 70:30 (group TCP30) and BCP with an HA:beta-TCP ratio of 30:70 (group TCP70). After preparing a window in the antral wall of a sinus, the Schneiderian membrane was elevated, and the applicable material was grafted. A fluorochrome calcein green was injected five days before euthanizing the animals at four months post-surgery. The specimens were analyzed histologically, histomorphometrically, and by using micro-computed tomography (micro-CT). RESULTS: Micro-CT analysis revealed that the total augmented volume and the new bone volume did not differ significantly between the two groups whereas the resorption of materials was greater in the TCP70 group. The trabecular thickness, number, and separation also did not differ significantly between the two groups. Histomorphometrically, the areas of total augmentation, new bone, and residual material, as well as the ratio of new-bone-material contact did not differ significantly between the groups. Histologically, the residual particles were more scattered in the TCP70 group than in the TCP30 group. The fluorescence of the calcein green did not differ notably between the two groups. CONCLUSIONS: The osteoconductivity and dimensional stability of the two BCPs with different ratios tested in this study were comparable after four months of healing. Therefore, we conclude that both BCPs show promise as a bone substitute for sinus augmentation.

Synthetic Bone Substitutes in Combination with Growth Factors for Maxillary Sinus Floor Augmentation: A Mini-review.

Objective: Growth factors have been applied in maxillary sinus augmentation with clinically successful results. The purpose of this article is to evaluate the effectiveness of growth factors in combination with various synthetic scaffolds. Methods and Materials: A systematic review of studies examining the effects of synthetic materials in combination with growth factors were performed. Results: Twelve (1 human and 11 animal) studies were eligible for inclusion. Due to the great heterogeneity of the studies regarding design, materials and outcomes, a meta-analysis was not performed. The majority of the studies show a reduction in healing time and enhancement of bone formation within the subantral environment. Bone Morphogenetic Protein-2 and GDF-5 were the two most common osteoinductive factors studied, showing a significant effect on new bone formation. Moreover, initial outcomes of trials with stem cells genetic transformation, that results in increased production of growth factors, are positive and justify further research. Conclusion: The incorporation of growth factors into the synthetic scaffold may be beneficial regarding the healing process.

Levantamento de seio maxilar por acesso crestal e pressão hidrodinâmica com instalação imediata de implantes / Maxillary sinus lifting with crestal access and hydrodinamic pressure for immediate implant placement

A instalação de implantes dentários na região posterior de maxila pode ser dificultada pela diminuição da quantidade óssea e pelo aumento do seio maxilar. Este artigo relata um caso clínico de instalação de implantes nessa região, com extensa reabsorção óssea e pneumatização do seio maxilar. O paciente foi submetido a um procedimento de elevação da membrana do seio utilizando um sistema de pressão hidrodinâmico, seguido pelo preenchimento com osso xenógeno liofilizado e instalação imediata de implantes. Após um período de seis meses de cicatrização, verificou-se que esse sistema permitiu, de maneira segura e atraumática, a instalação de implantes dentários, preservando o espaço sinusal.

The placement of dental implants in the posterior maxilla may be impaired by the reduced bone quantity and increased maxillary sinus volume. This article reports a case of implant placement with large bone resorption and pneumatization of the maxillary sinus. The patient was submitted to a sinus lifting membrane procedure using a hydrodynamic pressure system followed by filling with lyophilized xenogeneic bone and immediate implant placement. After six months of healing, the clinical results demonstrated that this system provides safe and atraumatic dental implant placement while preserving sinus space.

Delayed Occurrence of Maxillary Sinusitis after Simultaneous Maxillary Sinus Augmentation and Implant: A Case Report and Literature Review

Elevación de piso de seno maxilar: consideraciones anatómicas y clínicas: revisión de la literatura / Maxillary sinus augmentation: anatomic and clinic considerations: literature review

La elevación de piso de seno maxilar es uno de los procedimientos preimplantares másrealizados en la práctica odontológica. El objetivo de este artículo es reportar la evidenciadisponible sobre las implicaciones anatómicas y clínicas del procedimiento de elevación depiso para toma de decisiones clínicas. A partir de una búsqueda en la base Pubmed, se hizouna revisión de literatura de artículos publicados en revistas de odontología y otorrinolaringologíaentre 1980 y el 2011. La literatura encontrada se organizó en los siguientes temas:anatomía del seno maxilar, patología del seno maxilar, técnica de elevación de piso deseno maxilar y complicaciones por elevación de piso de seno maxilar. Con relación a otrosprocedimientos con la misma indicación, la elevación de seno maxilar es el más reportadoy ofrece los resultados más predecibles. Hay pocos estudios que reportan complicacionespor elevación de piso de seno maxilar y su manejo...

Maxillary sinus augmentation is one of most commonly performed clinical dental proceduresprevious to implant treatment. The aim of this article is to report the available literatureabout anatomical and clinical implications of the maxillary sinus lift procedure to supportclinical decisions. A literature review of articles published between 1980 and 2011 in dentaland otolaryngology journals was carried out at the Pubmed database. Found referenceswere grouped in the following themes: maxillary sinus anatomy, maxillary sinus pathology,maxillary sinus augmentation technique, and complications for maxillary sinus augmentation.Among other procedures performed for similar conditions, maxillary sinus augmentationis the most reported and the one that provides the most predictable results. Only afew studies report complications and management problems with the maxillary sinus lift...

A Radiographic Evaluation of Graft Height Changes after Maxillary Sinus Augmentation according to Single-unit Implants and Multi-unit Implants / 이화의대지

OBJECTIVES: This study was performed to evaluate whether there is the difference of graft height changes in radiographic evaluation in single implants and multiple implants after maxillary sinus floor augmentation with an auto-xenograft mixture. METHODS: The study group comprised 29 patients (16 men, 13 women; mean age, 56.5+/-12.4 years; range, 27 to 87 years) treated at the implant clinic of the Ewha Womans University Mokdong Hospital. They were treated with the sinus floor augmentation of lateral window technique and simultaneous placement of dental implants. Their implants have been evaluated for 42.4+/-10.5 months. To evaluate the height of grafted material, the real implant length was compared with that of panoramic radiography evaluated by a digital caliper (PACS program), and then the real height of grafted material was assumed. SPSS 19.0 was used in statistical analysis. Wilcoxon singed rank test was utilized for P value and Mann-Whitney for statistical significance in the changes of grafted height between single implants and multiple implants. The level of statistical significance was defined as P0.001). CONCLUSION: There was no statistical significance of radiographic graft height after maxillary sinus floor augmentation between single implants and multiple implants.

Factors Affecting Survival of Maxillary Sinus Augmented Implants

Clinical Evaluation of Simultaneous Implants Placement Following Augmentation of the Maxillary Sinus with Deproteinized Bovine Bone

Maxillary Sinus Augmentation Using Autogenous Teeth: Preliminary Report

New bone formation using fibrin rich block with concentrated growth factors in maxillary sinus augmentation

INTRODUCTION: This study examined the predictability of new bone formation in the pneumatized maxillary sinus using only fibrin-rich blocks with concentrated growth factors as an alternative to bone grafts. MATERIALS AND METHODS: Maxillary sinus augmentation was performed in thirty-three patients with a deficient alveolar bone height (mean 3.9 mm). All patients were treated consecutively with sinus membrane elevation via the lateral window approach and panoramic radiograms and cone-beam computed tomograms were taken to evaluate the remaining bone height and the new bone formation in the maxillary sinus, before and after surgery. Four biopsy specimens were taken at the time of implant consolidation (after an average of five months healing) and were stained by H & E and Trichrome staining. RESULTS: None of the patients had postoperative complications during implant consolidation. After an average of 5 months since sinus augmentation, newly formed bone was observed in all cases by a radiographic evaluation. In 4 biopsy samples, newly formed bone was observed along the floor of the replaced bony window. The osteoblast lining and well distinguished Osteocytes in the lacunas were observed in the newly formed bone. Of the 74 implants (4 different surfaced implants - resorbable blast media-surfaced (RBM), Hydroxyapatite (HA) coated, acid-etched, sintered porous-surfaced implant) placed, one RBM implant failed. The success rate was 98.6% after a mean of 15 months. DISCUSSION: These results suggest that maxillary sinus augmentation using fibrin rich block with concentrated growth factors is a successful and predictable technique.

Radiographic follow-up evaluation of sinus augmentation with deproteinized bovine bone and implant installation after loading.

Computed tomography (CT) has been used in diagnosis and implant treatment, and CT can be used to assess the dimensional stability of graft materials after maxillary sinus augmentation. A 50-year-old male patient was treated for the simultaneous placement of implants with sinus augmentation and two post-operative CT scans were performed after the delivery of the prosthesis at 9 months and 15 months after the operation. There were no significant changes in alveolar bone height and the buccal window seemed to show remodeling over time. The continuity of the defect and the cortication were apparent in the 15-month post-operative CT scan. Implants installed simultaneously with sinus augmentation were well in function and the graft material seemed to be stable in maintaining tissue dimensions after the loading of the implants. The presented results need to be validated in further large case series or case-controlled studies.

Implant Survival Rates of Maxillary Sinus Augmentation: a Literature Review of Graft Materials