Assessment of the osteogenic effect after maxillary sinus floor elevation and simultaneous implantation with or without bone grafts by analyzing trabecular bone parameters: a retrospective study

Abstract Objective: The aim of this population-based retrospective study was to compare the osteogenic effect of newly formed bone after maxillary sinus floor elevation (MSFE) and simultaneous implantation with or without bone grafts by quantitatively analyzing trabecular bone parameters. Methodology: A total of 100 patients with missing posterior maxillary teeth who required MSFE and implantation were included in this study. Patients were divided into two groups: the non-graft group (n=50) and the graft group (n=50). Radiographic parameters were measured using cone beam computed tomography (CBCT), and the quality of newly formed bone was analyzed by assessing trabecular bone parameters using CTAn (CTAnalyzer, SkyScan, Antwerp, Belgium) software. Results: In the selected regions of interest, the non-graft group showed greater bone volume/total volume (BV/TV), bone surface/total volume (BS/TV), trabecular number (Tb. N), and trabecular thickness (Tb. Th) than the graft group (p<0.001). The non-graft group showed lower trabecular separation (Tb. Sp) than the graft group (p<0.001). The incidence of perforation and bleeding was higher in the graft group than in the non-graft group (p<0.001), but infection did not significantly differ between groups (p>0.05). Compared to the graft group, the non-graft group showed lower postoperative bone height, gained bone height and apical bone height (p<0.001). Conclusion: MSFE with and without bone grafts can significantly improve bone formation. In MSFE, the use of bone grafts hinders the formation of good quality bone, whereas the absence of bone grafts can generate good bone quality and limited bone mass.

Techniques of Maxillary Sinus Floor Elevation

Posterior maxillary region is often limited for standard implant placement because of reduced residual vertical bone height. An elevation of the maxillary sinus floor is one option in solving this problem. This article describes the various surgical techniques that can be used to enter the sinus cavity, elevating the sinus membrane and placing the bone grafts for placement of dental implants in the resorbed posterior maxillary region.

Expert consensus on the bone augmentation surgery for alveolar bone defects / 口腔疾病防治

@#Alveolar bone is an important anatomic basis for implant-supported denture restoration, and its different degrees of defects determine the choices of bone augmentation surgeries. Therefore, the reconstruction of alveolar bone defects is an important technology in the clinical practice of implant restoration. However, the final reconstructive effect of bone quality, bone quantity and bone morphology is affected by many factors. Clinicians need to master the standardized diagnosis and treatment principles and methods to improve the treatment effect and achieve the goal of both aesthetic and functional reconstruction of both jaws. Based on the current clinical experience of domestic experts and the relevant academic guidelines of foreign counterparts, this expert consensus systematically and comprehensively summarized the augmentation strategies of alveolar bone defects from two aspects: the classification of alveolar bone defects and the appropriate selection of bone augmentation surgeries. The following consensus are reached: alveolar bone defects can be divided into five types (Ⅰ-0, Ⅰ-Ⅰ, Ⅱ-0, Ⅱ-Ⅰ and Ⅱ-Ⅱ) according to the relationship between alveolar bone defects and the expected position of dental implants. A typeⅠ-0 bone defect is a bone defect on one side of the alveolar bone that does not exceed 50% of the expected implant length, and there is no obvious defect on the other side; guided bone regeneration with simultaneous implant implantation is preferred. Type Ⅰ-Ⅰ bone defects refer to bone defects on both sides of alveolar bone those do not exceed 50% of the expected implant length; the first choice is autologous bone block onlay grafting for bone increments with staged implant placement or transcrestal sinus floor elevation with simultaneous implant implantation. Type Ⅱ-0 bone defects show that the bone defect on one side of alveolar bone exceeds 50% of the expected implant length, and there’s no obvious defect on the other side; autologous bone block onlay grafting (thickness ≤ 4 mm) or alveolar ridge splitting (thickness > 4 mm) is preferred for bone augmentation with staged implant placement. Type Ⅱ-Ⅰ bone defects indicate that the bone plate defect on one side exceeds 50% of the expected implant length and the bone defect on the other side does not exceed 50% of the expected implant length; autologous bone block onlay grafting or tenting techniques is preferred for bone increments with staged implant implantation. Type Ⅱ-Ⅱ bone defects are bone plates on both sides of alveolar bone those exceed 50% of the expected implant length; guided bone regeneration with rigid mesh or maxillary sinus floor elevation or cortical autologous bone tenting is preferred for bone increments with staged implant implantation. This consensus will provide clinical physicians with appropriate augmentation strategies for alveolar bone defects.

A study of the maxillary sinus lateral wall thickness using cone-beam CT / 口腔疾病防治

Objective@#To investigate the relationship between the thickness of the lateral wall of the maxillary sinus and patient age and sex at different tooth sites to provide a reference for sinus floor elevations.@*Methods @#Cone-beam CT（CBCT） imaging data were collected from 222 patients admitted to the Department of Stomatology, the First Hospital of Shanxi Medical University, from March 2020 to October 2020. The thicknesses of the maxillary sinus lateral wall of the first premolar, second premolar, first molar and second molar were observed and measured on the coronal plane of CBCT images, and the relationship between the maxillary sinus lateral wall thickness and patient sex was analyzed. The patients were divided into the following groups according to their age: ①the young group (18~29 years old), ②the middle-aged group (30~59 years old), and ③the elderly group (≥ 60 years old). The difference in the maxillary sinus lateral wall thickness was compared among these three age groups@*Results@#The mean thicknesses of the maxillary sinus lateral wall at the first premolar, second premolar, first molar and second molar were （1.61 ± 0.58） mm, （1.68 ± 0.66） mm, （2.00 ± 0.76） mm and （1.71 ± 0.71） mm, respectively. The maximum thickness of the lateral wall was located at the first molar (P< 0.05). The thickness of the maxillary sinus lateral wall in the young group was significantly thicker than that in the middle-aged group and the elderly group at the first premolar and first molar (P < 0.05). The thickness of the maxillary sinus lateral wall in males was significantly thicker than that in females at the second molar [(1.78 ± 0.80) mm vs. (1.63 ± 0.62) mm, P=0.029].@*Conclusion@#The mean thickness of the lateral wall changes at different reference points. The maxillary sinus lateral wall is the thickest at M1. The thickness of the maxillary sinus lateral wall decreased with age, and the thickness of the lateral wall was higher in males than in females.

Retrospective study on the merits of bone grafts and the influence of implant protrusion length after osteotome sinus elevation surgery / 华西口腔医学杂志

OBJECTIVES@#This study aims to evaluate the endo-sinus bone remodeling of dental implants placed via osteotome sinus floor elevation (OSFE) after 6 months and using different implant protrusion lengths and bone grafts through cone beam computed tomography (CBCT).@*METHODS@#Ninety-six patients with 124 implants were included and assigned into four groups. Group 1: implant protrusion length4 mm with bone graft; group 3: implant protrusion length4 mm without bone graft. Apical bone gain (ABG), cortical bone gain (CBG), bone density gain (BDG), and marginal bone loss (MBL) were observed and analyzed at baseline and 6 months after implant surgery.@*RESULTS@#The CBG in grafted groups 1 and 2 was higher than that in non-grafted groups. The ABG and BDG were higher in non-grafted groups 3 and 4 than in grafted groups, and the levels in group 3 were higher than those in group 4. The CBG in grafted group 2 was higher than that in group 1. No significant difference was observed in MBL analysis.@*CONCLUSIONS@#The BDG of IPL4 mm implant when bone grafts were not applied. No relevance was observed between IPL and CBG. Bone grafts can accelerate endo-sinus bone remodeling by increasing CBG and dissipating the influence of IPL on BDG.

Effect of anatomical parameters of maxillary sinus on the outcomes of transcrestal sinus lift / 华西口腔医学杂志

OBJECTIVE@#To investigate the effect of three anatomical parameters (maxillary sinus width, maxillary sinus angle, and residual bone height) on the outcomes of transcrestal sinus lift with simultaneous implant placement.@*METHODS@#A total of 60 maxillary sinuses in 42 patients were included in this study. All patients were treated with transcrestal sinus lift procedure associated with simultaneous implant placement using a composite graft material of autogenous bone and Bio-Oss. For each patient, beam computed tomography (CBCT) scans were performed preoperatively, immediately after surgery, and 6 months after surgery. The parameters were measured on the preoperative and postoperative CBCT images. The correlation of three anatomical parameters with graft resorption was analyzed using Pearson's correlation test.@*RESULTS@#The average residual bone height was (4.46±1.55) mm. The average width of maxillary sinus was (13.86±2.71) mm. The average sinus angle was 78.09°±10.27°. A significant positive correlation was observed between maxillary sinus width and graft resorption (P<0.01). A positive association was also found between sinus angle and graft resorption (P<0.01).@*CONCLUSIONS@#The findings show that graft bone resorption in elevated sinus has a positive correlation with the sinus width and sinus angle.

Clinical guidelines for maxillary sinus floor elevation with sinus membrane lesions / 口腔疾病防治

@#Maxillary sinus membrane lesions have been broadly detected before implant surgery in the posterior maxilla region, resulting in uncertainty regarding maxillary sinus floor elevation surgery. In this context, we composed this commentary article based on the current literature and the clinical experience of our department. We discuss the common lesion types shown by CBCT including membrane pathological thickening, polyps/cystic lesions and air-liquid level in the sinus. Maxillary sinus floor elevation surgery can be conducted in patients with membrane thickening of 2-5 mm or with polyps/cysts of less than half of the sinus height (because the above symptoms have little influence on the outcome of surgery). Membrane thickening of more than 5 mm with ostium obstruction, antrochoanalpolyps, mucoceles and cysts of more than half of the sinus height should be carefully treated. Different treatments can be performed such as conducting elevation surgery while retaining the cyst, removing the cyst before surgery or removing the cyst during surgery based on the cyst type and size, inflammation, patency of the ostium, etc. Antibiotics-anti-inflammatory-aspiration, surgical debridement and oral lesions eliminations are generally used for treating post-operative sinusitis. Presurgical radiographic evaluation is the key to diagnosing and treating these membrane lesions. We highly advocate collaboration between our dentists and otolaryngologists on this issue.

The role of the membrane of the maxillary sinus in space osteogenesis under the sinus floor after elevation of the sinus floor / 口腔疾病防治

@#With the continuous development of maxillary sinus floor elevation technology, the osteogenesis mechanism of maxillary sinus floor elevation has always been a concern of scholars. The membrane of the maxillary sinus is an indispensable physiological structure in the process of space osteogenesis under the sinus floor after elevation of the sinus floor. In recent years, the role of the maxillary sinus floor mucosa in sinus floor space osteogenesis has been a research hotspot. Recent studies have found that the maxillary sinus floor membrane plays a role as a natural biological barrier membrane in the process of sinus floor space osteogenesis after maxillary sinus floor elevation; in addition, it has the ability to undergo osteogenesis. It has also been found that maxillary sinus membrane stem cells (MSMSCs) derived from the maxillary sinus floor membrane have characteristics of mesenchymal stem cells, which can differentiate into osteoblasts and participate in sinus floor space osteogenesis after maxillary sinus floor elevation. New studies have also found that small RNAs such as microRNAs, long noncoding RNAs and circular RNAs can regulate the osteogenic differentiation of MSMSCs, which may be important biological targets for promoting osteogenesis in the sinus floor space. In this paper, the relationship between the maxillary sinus floor mucosa and bone formation after maxillary sinus floor elevation, the barrier and osteogenic function of the maxillary sinus floor mucosa, the sources of osteoblasts involved in osteogenesis of the sinus floor space, and the molecular regulatory mechanisms of stem cells derived from maxillary sinus mucosa will be elucidated step by step.

Research progress in maxillary sinus mucosal disease associated with maxillary sinus floor lifting / 中华口腔医学杂志

Maxillary sinus augmentation is an effective procedure to gain bone height for implant placement in an atrophic posterior maxilla. But maxillary sinus diseases are prevalent in patients scheduled for sinus lift procedures. The presence of these diseases may increase the difficulties in performing the surgery and the risk of developing postoperative complications. This paper summarizes and introduces the common maxillary sinus mucosa diseases related to maxillary sinus augmentation.

Clinical evaluation of two transalveolar methods for sinus augmentation with placing 1 204 implants immediately / 中华口腔医学杂志

Objective@#To compare the clinical outcomes of posterior maxillary implant surgery when using the regular transalveolar approach or with the crestal approach-sinus (CAS-KIT), a device for maxillary sinus membrane elevation by the crestal approach using a special drilling system and hydraulic pressure.@*Methods@#In this retrospective study 887 patients during Jan 2012 to July 2015 in Hangzhou Dental Hospital with underwent either regular transalveolar approach or CAS-KIT approach for maxillary augmentation; whereas 11 patients dropped out for the reason of serious membrane perforations. Totally, 876 patients with 1 204 plants, placed immediately after transalveolar maxillary augmentation, were included in this study. The data analysis was performed by radiological measures to assess the changes in height of maxillary sinus floor after the transalveolar augmentation at different time points. In addition, the complications after surgery, failure rates, osseointegration condition and the performance of rehabilitation were evaluated as well.@*Results@#Five hundred and three patients were experienced with regular transalveolar approach, and 7 patients were drop out for the serious membrane perforations. Thus, 496 patients received 653 implants in this group; the average lifted range in maxillary sinus floor height changes was (4.08±3.45) mm. The complications were minor membrane perforations during procedure in 64 patients, postoperative maxillary sinus infection happening in 2 patients and 13 patients experienced rehabilitation failure. Three hundred and eighty-four patients had CAS-KIT approach with 4 patients dropped out. Three hundred and eighty patients get 551 implants with the mean lifted range of (8.36±4.07) mm in maxillary sinus floor height changes. Minor membrane perforations during procedure occurred in 31 people and 2 got postoperative maxillary sinus infection. The 4 year overall survival rate of 1 204 implants was 97.26%, with four implants fell off after 3 months of rehabilitation and one implant occurred after one year of rehabilitation.@*Conclusions@#The regular transalveolar sinus lift technique is easier and time saving, but the compromised lifting range in maxillary sinus floor height and the comparatively high occurrence of intraoperative membrane perforations should be concerned. Using CAS-KIT could be an alternative method to perform maxillary sinus augmentation with a reduced incidence of complications. There was no statistically difference in implant failure rates and incidence of postoperative maxillary sinus infection between two groups.

The complications, prevention and treatment of sinus floor elevation through lateral window approach / 中华口腔医学杂志

Several systematic reviews and many clinical articles have shown that maxillary sinus floor elevation through lateral window approach (LSFE) is a predictable and reliable procedure, which has been routinely performed for more than 30 years. The complication rate is low, but some cases may require additional surgery, and the outcome of implant may be affected if not treated properly. The survival rates of implants are still high after early diagnosis and proper early treatments. The purpose of this article is to discuss the intraoperative and postoperative complications of LSFE, including perforation, bleeding, postoperative infection and implant displacement into sinus with special attention to prevalence rate, prevention and treatment.

Short-term and mid-term follow-up study of 34 cases of maxillary posterior teeth deletion treated by orthotopic implantation combined with maxillary sinus floor elevation at the same time / 中国基层医药

Objective To investigate the application value and short-term and mid-term prognosis of orthotopic implantation combined with maxillary sinus floor elevation in the treatment of patients with maxillary posterior teeth deletion at the same time.Methods A total of 68 patients with maxillary posterior teeth deletion in the Integrated Traditional Chinese and Western Medicine Hospital of Shanxi Province from June 2014 to June 2016 were selected and randomly divided into the control group(n=34)and the study group(n=34)according to the digital table.The control group was treated with dental implant technology to repair,and the study group was treated with implanted orthotopic implantation combined with maxillary sinus floor elevation at the same time.The follow-up was continued for 3-12 months after operation.The degree of postoperative pain,the incidence of complications,the satisfaction of the treatment,and the prognosis of the two groups after 12 months of operation(the exfoliation of implant and the loosening of the implant)were statistically analyzed.Results The good rate of pain in the study group was 97.06％(33/34),which was higher than that of the control group [76.47％(26/34)](P<0.05).There was no statistically significant difference in the incidence rate of complications between the study group [5.88％(2/34)]and control group[8.82％(3/34)](P>0.05).The treatment satisfaction of the study group [97.06％(33/34)] was higher than that of the control group [70.59％(24/34)](χ2 =8.758,P<0.05).The incidence rate of poor prognosis of the study group[2.94％(1/34)]was lower than that of the control group [23.53％(8/34)](χ2 =4.610,P <0.05).Conclusion Orthotopic implantation combined with maxillary sinus floor elevation in the treatment of patients with maxillary posterior teeth deletion at the same time has less postoperative pain and high treatment satisfaction.And the complications and incidence of exfoliation and loosening of implants are low after 12 months of operation.

Surgeons' Performance Determining the Amount of Graft Material for Sinus Floor Augmentation Using Tomography

Abstract This study aimed to assess the performance of surgeons in determining the amount of graft material required for maxillary sinus floor augmentation in a preoperative analysis using cone-beam computed tomography images. A convenience sample of 10 retrospective CBCT exams (i-CAT®) was selected. Scans of the posterior maxilla area with an absence of at least one tooth and residual alveolar bone with an up to 5 mm height were used. Templates (n=20) contained images of representative cross-sections in multiplanar view. Ten expert surgeons voluntarily participated as appraisers of the templates for grafting surgical planning of a 10 mm long implant. Appraisers could choose a better amount of graft material using scores: 0) when considered grafting unnecessary, 1) for 0.25 g in graft material, 2) for 0.50 g, 3) for 1.00 g and 4) for 1.50 g or more. Reliability of the response pattern was analyzed using Cronbach's a. Wilcoxon and Mann-Whitney tests were performed to compare scores. Regression analysis was performed to evaluate whether the volume of sinuses (mm3) influenced the choose of scores. In the reliability analysis, all values were low and the score distribution was independent of the volume of the maxillary sinuses (p>0.05), which did not influence choosing the amount of graft material. Surgeons were unreliable to determine the best amount of graft material for the maxillary sinus floor augmentation using only CBCT images. Surgeons require auxiliary diagnostic tools to measure the volume associated to CBCT exams in order to perform better.

Resumo O objetivo deste estudo foi avaliar o desempenho dos cirurgiões na determinação da quantidade de material de enxerto necessária para a elevação do assoalho do seio maxilar em uma análise pré-operatória, utilizando imagens de tomografia computadorizada de feixe cônico. Foi selecionada uma amostra de conveniência de 10 exames retrospectivos CBCT (i-CAT®). Os exames foram da área da maxila posterior que possuíam ausência de pelo menos um dente e com osso alveolar residual de altura igual ou inferior a 5 mm. Os templates (n=20) continham imagens de secções transversais representativas numa vista multiplanar. Dez experientes cirurgiões voluntariamente participaram como avaliadores dos templates para o planejamento cirúrgico de enxerto para um implante de 10 mm de comprimento. Os avaliadores escolheram a melhor quantidade de material de enxerto usando os escores: 0) quando o enxerto era desnecessário, 1) para 0,25 g de enxerto, 2) para 0,50 g, 3) para 1,00 g, e 4) para 1,50 g ou mais. A confiabilidade do padrão de resposta foi analisada utilizando a a de Cronbach. Os testes de Wilcoxon e Mann-Whitney foram utilizados para comparar os escores. A análise de regressão foi realizada para avaliar se o volume dos seios (mm3) influenciou a escolha dos escores. Na análise de confiabilidade, todos os valores foram baixos e a distribuição dos escores foi independente do volume dos seios maxilares (p>0,05), o que não influenciou a escolha da quantidade de material de enxerto. Os cirurgiões apresentaram falta de confiabilidade ao determinar a melhor quantidade de material de enxerto para o aumento do assoalho do seio maxilar utilizando somente as imagens de TCFC. Assim, os cirurgiões necessitam de ferramentas de diagnóstico auxiliares para mensuração de volume associada à TCFC para um melhor desempenho.

Maxillary sinus floor elevation / 口腔疾病防治

@#Maxillary sinus floor elevation is a common method to increase the bone height in posterior maxilla. Maxillary sinus floor elevation can be divided into 2 types: sinus floor elevation with lateral window approach and sinus floor elevation with trans-alveolar approach. The present article reported the anatomy, antibiotics choice, indications, grafting, growth factors, complications and the influence of tobacco on maxillary sinus floor elevation.

Comparative experiments of stripping sheep maxillary sinus mucosal with new-type stripper and umbrella detacher / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To compare the stripping length obtained through the model of 0.012 and 0.014 of the nickel-titanium dual-stage maxillary sinus mucosa stripper, and the umbrella detacher.</p><p><b>METHODS</b>Twenty-four goats (1.5-2 years old) were chosen, randomly divided into A, B, C groups, each group of eight. Group A was 0.012 model group, group B was 0.014 model group, group C was umbrella detacher group. Animal model was established, and maxillary sinus mucosa was stripped to the left and right sides of the bottom of the sinus in three groups. The data was measured when stripping to the limit or being perforated.</p><p><b>RESULTS</b>The average length of group A was 12.41 mm±4.35 mm, two cases perforated. The average length of group B was 23.38 mm±4.84 mm, one case perforated. The average length of group C was 2.61 mm±0.30 mm. The population mean of stripping length in three groups was not all the same calculated by analysis of variance (P<0.01). There were significant differences in the stripping length of the three groups by the SNK test (P<0.05).</p><p><b>CONCLUSIONS</b>The nickel-titanium dual-stage maxillary sinus mucosa stripper can achieve a larger mucosal stripping range. The stripper with a model of 0.014 has a moderate flexibility and safety, and it can strip a large area of sinus mucosa.
.</p>

Transcrestal sinus floor elevation with the presence of pseudocyst:A clinical study / 实用口腔医学杂志

Objective:To evaluate the clinical outcome of transcrestal maxillary sinus floor elevation(TMSFE)in the presence of pseudocyst.Methods:14 cases with pseudocyst were treated by TMSFE.In the operation following osteotome,pseudocyst was not ex-cised and sinus floor membrane was elevated,15 implants were placed for the 14 cases.Definite prosthesis was delivered about 6 months after implant placement.CBCT examination was done before,immediately after and 1-year after surgery,the cyst condition, the gain of vertical bone height and implant stability over time were observed.Results:Pre-operation residual ridge height of the alveo-lar crest was (6.85 ±1.07)mm.The sinus membrane was successfully elevated in all sites without perforation (mean elevation height,6.93 ±2.07)mm.All 15 implants were ossteointegrated.At 1-year revisit the gained bone height was (12.76 ±2.03)mm. Cyst grew bigger in 3 cases,not changed in 3 cases,became smaller in 5 cases and disappeared in 3 cases.Conclusion:Pseudocyst excision is not necessary in TMSFE.

Presencia y distribución de tabiques intrasinusales en el piso del seno maxilar / Prescence and distribution of intrasinusal septa in the maxillary sinus floor

La pérdida de dientes superiores causa reabsorción del proceso alveolar y la neumatización del seno maxilar. La implantología oral ha permitido solucionar la perdida de dientes, sin embargo, cuando existe neumatización del seno maxilar, la disponibilidad ósea se ve disminuida, dificultando el procedimiento implantologico. Para remediar esta situación se efectúa la técnica quirúrgica de levantamiento del piso del seno maxilar, la que puede tener complicaciones por la morfología interna del seno, específicamente por la presencia de septos intrasinusales. El objetivo de este estudio es verificar la presencia y distribución de los septos intrasinusales, debido a su importancia en técnicas quirúrgicas realizadas en implantología oral. Se realizó un estudio descriptivo, basado en el análisis visual de huesos maxilares aislados. De 65 huesos se seleccionaron 51 (42 dentados y 9 edéntulos) que cumplían con determinados criterios de inclusión. La segunda parte del estudio consistió en dividir topográficamente el piso del seno en tres regiones: anterior a la cresta cigomato alveolar, en relación a ella, y posterior a la cresta. La observación de los septos fue realizado por un único examinador, asistido por un dispositivo USB, con 4 leds de alta luminiscencia. De los 51 maxilares analizados se obtuvo: 74,5 por ciento, presentaron al menos un septo intrasinusal, 25,4 por ciento, no presentaron septos visibles. Los maxilares que presentaron un único tabique correspondieron al 33,3 por ciento de la muestra, el 19,6 por ciento de la muestra presento sólo dos tabiques, el 15,7 por ciento presentó tres tabiques, mientras que los maxilares que presentaron más de tres tabiques intrasinusales correspondieron sólo al 5,9 por ciento. Del total de tabiques encontrados (75 tabiques) el 42 por ciento se observó en la región anterior, 21 por ciento en la región de la cresta cigomato alveolar y el 37 por ciento en la región posterior del seno maxilar. De los 42 maxilares en condición...

The loss of upper teeth causes alveolar process resorption and maxilary sinus pneumatization. Oral implantology has solved these losses, however, when pneumatization of the maxillary sinus exists, bone availability is diminished, difficulting implantology procedure. To remedy this situation, the surgical technique of lifting the maxillary sinus floor is indicated, which can have complications because of the internal maxillary sinus morphology, specifically the presence of intrasinusal septa. The aim of this study is to verify the presence and distribution of intrasinusal septa, due to its importance in surgical techniques performed in oral implantology. We conducted a descriptive study, based on visual analysis of isolated maxilary bones. Of 65 bones, 51 (42 dentate and 9 edentulous)were selected that met certain inclusion criteria. The second part of the study was, to divide the sinus floor topographically into three regions: anterior to the zygomatic alveolar crest, in relation to it, and posterior to the crest. The observation of the septa was performed by a single examiner, assisted by a USB device with 4 high-luminance LEDs. Of the 51 maxillary analyzed obtained: 74.5 percent had at least one intrasinusal septum, 25.4 percent showed no visible septa. The maxilary bones that had a single septum corresponded to 33.3 percent of the sample, 19.6 percent of the sample had only two septa, 15.7 percent had three septa, while the maxillary bones that had more than three intrasinusal septa corresponded only to 5.9 percent. Of all septa found (75 septa) 42 percent was observed in the anterior region, 21 percent in the region of the zygomatic crest and 37 percent in the posterior region of the maxillary sinus. Of the 42 dentate maxillary bones in 88,1 percent present intrasinusal septa, while the total edentulous maxillary bones (9) only 11 percent present intrasinusal septa. This study establishes that a significant portion of the maxillary bones have...

Osteotome sinus floor elevation without bone grafting and simultaneous implant placement in the atrophic maxilla: A pilot study.

Aims: This study evaluated the clinical and radiographic outcome of implants placed in the posterior maxilla with the osteotome sinus floor elevation (OSFE) technique without graft material. Materials and Methods: Twenty-seven 4.1-mm-diameter dental implants (Straumann AG, Basel, Switzerland) were placed to 17 sinuses with residual bone height of ≤10 mm and ≥5 mm to rehabilitate 23 molar and 4 premolar sites. Implants were simultaneously placed with the OSFE procedure without graft material. Results: All implants were successfully integrated after 8-12 weeks healing time. At the 2-year follow-up, all the implants presented the survival criteria proposed by Buser et al. and Cochran et al. Conclusion: The OSFE technique without grafting material may be predictable because the success rate was 100% in this study. Implants gained endo-sinus bone despite the lack of graft material. More patients and longer follow-up are needed to validate the results of this pilot study.

Maxillary sinus floor elevation using autogenous skin-derived mesenchymal stem cells in miniature pigs

INTRODUCTION: In our previous studies, we isolated porcine skin-derived mesenchymal stem cells (pSDMSCs) from the ears of adult miniature pigs and evaluated the pluripotency of these pSDMSCs based on expressions of transcription factors, such as Oct-4, Sox-2, and Nanog. Moreover, the characteristic of mesenchymal stem cells was revealed by the expression of various mesenchymal stem cell markers, including CD29, CD44, CD90, and vimentin. The aim of this study was to evaluate in vivo osteogenesis after maxillary sinus lift procedures with autogenous pSDMSCs and scaffold. MATERIALS AND METHODS: The autogenous pSDMSCs were isolated from the 4 miniature pigs, and cultured to 3rd passage with same methods of our previous studies. After cell membranes were labeled using a PKH26, 1x10(7) cells/100 microliter of autogenous pSDMSCs were grafted into the maxillary sinus with a demineralized bone matrix (DBM) and fibrin glue scaffold. In the contralateral control side, only a scaffold was grafted, without SDMSCs. After two animals each were euthanized at 2 and 4 weeks after grafting, the in vivo osteogenesis was evaluated with histolomorphometric and osteocalcin immunohistochemical studies. RESULTS: In vivo PKH26 expression was detected in all specimens at 2 and 4 weeks after grafting. Trabecular bone formation and osteocalcin expression were more pronounced around the grafted materials in the autogenous pSDMSCs-grafted group compared to the control group. Newly generated bone was observed growing from the periphery to the center of the grafted material. CONCLUSION: The results of the present study suggest that autogenous skin-derived mesenchymal stem cells grafting with a DBM and fibrin glue scaffold can be a predictable method in the maxillary sinus floor elevation technique for implant surgery.

THE COMPARATIVE EVALUATION USING HATCH REAMER TECHNIQUE AND OSTEOTOME TECHNIQUE IN SINUS FLOOR ELEVATION

0.05). 2. At the total success rate, osteotome group was 92.4% and Hatch reamer group was 94.9%. There was no statistically significant difference between the two groups (P > 0.05). 3. On the discomfort during the operation by using numerical rating scale, osteotome group was 2.87 +/- 0.83 and Hatch reamer group was 1.12 +/- 0.64. There was statistically significant difference between the two groups (P < 0.05). The Hatch reamer group' clinical results was similar to osteotome group and we thought that Hatch reamer technique can overcome the faults of osteotome technique.