Instalação de implante em região posterior de maxila através da técnica de Summers e osseodensificação: relato de caso / Implant installation in posterior maxilla using the Summers technique and osseodensification: a case report / Instalación de implantes en la región posterior del maxilar utilizando la técnica de Summers y la oseodensificación: informe de un caso

Este trabalho tem por objetivo relatar um caso em que foi realizada a técnica de Summers para elevação do seio maxilar, associada à realização de osseodensificação. Paciente do gênero masculino, 53 anos, apresentando ausência do dente 17, com altura reduzida na área edêntula. Foi realizada a elevação do seio maxilar pela técnica de Summers associada à osseodensificação da região para uma melhora da qualidade óssea. Foi instalado um implante cone morse SIN de 3.8 x 8.5 com torque de 45 newtons. No acompanhamento pós-operatório não houve qualquer sinal ou sintoma de complicação e o paciente foi reabilitada com uma prótese parafusada sobre implante.

This study aims to report a case in which the Summers technique was performed for maxillary sinus elevation, associated with osseodensification. Male patient, 53 years old, with missing tooth 17, with reduced height in the edentulous area. Maxillary sinus elevation was performed using the Summers technique associated with osseodensification of the region for an improvement in bone quality. A 3.8 x 8.5 SIN morse taper implant with a torque of 45 newtons was installed. In the postoperative follow-up, there were no signs or symptoms of complications and the patient was rehabilitated with a screw-retained implant prosthesis.

Este trabajo tiene como objetivo informar de un caso en el que se realizó la técnica de Summers para la elevación del seno maxilar, asociada a la osteodensificación. Paciente varón, de 53 años, que presenta ausencia del diente 17, con altura reducida en la zona edéntula. Se elevó el seno maxilar mediante la técnica de Summers asociada a la osteodensificación de la región para mejorar la calidad ósea. Se instaló un implante morse cónico de 3,8 x 8,5 SIN con un par de 45 newtons. En el seguimiento postoperatorio no hubo signos ni síntomas de complicación y el paciente fue rehabilitado con una prótesis atornillada sobre un implante.

Minimally invasive techniques for lateral maxillary sinus floor elevation: small lateral window and one-stage surgery-a 2-5-year retrospective study / 国际口腔科学杂志·英文版

This study aimed to introduce a minimally invasive technique for maxillary sinus floor elevation using the lateral approach (lSFE) and to determine the factors that influence the stability of the grafted area in the sinus cavity. Thirty patients (30 implants) treated with lSFE using minimally invasive techniques from 2015 to 2019 were included in the study. Five aspects of the implant (central, mesial, distal, buccal, and palatal bone heights [BHs]) were measured using cone-beam computed tomography (CBCT) before implant surgery, immediately after surgery (T0), 6 months after surgery (T1), and at the last follow-up visit (T2). Patients' characteristics were collected. A small bone window (height, (4.40 ± 0.74) mm; length, (6.26 ± 1.03) mm) was prepared. No implant failed during the follow-up period (3.67 ± 1.75) years. Three of the 30 implants exhibited perforations. Changes in BH of the five aspects of implants showed strong correlations with each other and BH decreased dramatically before second-stage surgery. Residual bone height (RBH) did not significantly influence BH changes, whereas smoking status and type of bone graft materials were the potentially influential factors. During the approximate three-year observation period, lSFE with a minimally invasive technique demonstrated high implant survival rate and limited bone reduction in grafted area. In conclusion, lSFE using minimally invasive techniques was a viable treatment option. Patients who were nonsmokers and whose sinus cavity was filled with deproteinized bovine bone mineral (DBBM) had significantly limited bone resorption in grafted area.

Elevación de seno maxilar sin injerto y colocación simultánea de implante dental / Graftless maxillary sinus lift with simultaneous dental implant placement

Introducción: La elevación de seno maxilar con implante dental simultáneo, sin el uso de substitutos óseos, ha retomado la teoría del potencial de neoformación ósea, que el coágulo de sangre alojado bajo la membrana de Schneider por sí solo presenta. Excluyendo así la necesidad de materiales exógenos. Objetivo: Exponer la efectividad de la elevación de seno maxilar con implante dental simultáneo, sin el uso de injerto, mediante la evaluación de la cantidad de ganancia ósea vertical. Presentación de casos: Caso 1: Paciente de 62 años, género femenino, que fue sometida a una elevación de seno maxilar sin injerto e implante dental simultáneo, con técnica de ventana lateral debido a altura ósea reducida de 5,24 mm. Luego del período de seguimiento tomográfico de 12 meses, después de la carga protésica, se logró una altura ósea vertical de 10,2 mm, lo que dio como resultado una ganancia ósea vertical de 4,96 mm. Caso 2: Paciente de 48 años, género femenino, que fue sometida a una elevación de seno maxilar sin injerto e implante dental simultáneo, con técnica transalveolar, mediante el uso de piezoeléctrico debido a una altura ósea reducida de 8,33 mm. Luego del período de seguimiento radiográfico de 4 meses, antes de la carga protésica, se logró una altura ósea vertical de 11,55 mm, lo que dio como resultado una ganancia ósea vertical de 3,19 mm. Conclusiones: Con base en estos 2 informes de casos, la elevación de seno maxilar e implante dental simultáneo sin injerto se asocian con la reducción de la morbilidad quirúrgica, menor probabilidad de procesos infecciosos y menor costo de la cirugía. Por lo tanto, puede considerarse una alternativa quirúrgica para la colocación de implantes en el maxilar posterior superior debido a deficiencias óseas verticales, independientemente de la técnica (lateral o transalveolar(AU)

Introduction: Maxillary sinus lift with simultaneous dental implantation without using bone substitutes, reapproaches the theory about the bone neoformation potential of the blood clot housed under the Schneider membrane, all by itself, thus excluding the need to use exogenous materials. Objective: Discuss the effectiveness of graftless maxillary sinus lift with simultaneous dental implant placement through an evaluation of the amount of vertical bone gain. Case presentation: Case 1: Female 62-year-old patient undergoing graftless maxillary sinus lift with simultaneous dental implantation by lateral window technique due to a reduced bone height of 5.24 mm. After a 12-month tomographic follow-up period subsequent to prosthetic loading, a 10.2 mm vertical bone height was achieved, resulting in 4.96 mm vertical bone gain. Case 2: Female 48-year-old patient undergoing graftless maxillary sinus lift with simultaneous dental implantation by transalveolar technique using a piezoelectric generator due to a reduced bone height of 8.33 mm. After a 4-month radiographic follow-up period, before prosthetic loading, an 11.55 mm vertical bone height was achieved, resulting in 3.19 mm vertical bone gain. Conclusions: According to these two case reports, graftless maxillary sinus lifting with simultaneous dental implantation is associated to reduced surgical morbidity, a lesser probability of infectious processes and lower surgical costs. It may therefore be considered to be a surgical alternative for implant placement in the posterior maxilla due to vertical bone deficiencies, regardless of the technique used (lateral or transalveolar(AU)

Endoscopic analysis of alterations in sinus floor elevation approaching the summers technique and immediate implant: a clinical trial with 10 years follow-up / Análise endoscópica das alterações na elevação do assoalho do seio maxilar com abordagem da técnica de Summer e implante imediato: um ensaio clínico com 10 anos de acompanhamento

The goal of this study was to evaluate by endoscopy, possible intercurrences during the sinus floor lifting employing the Summers technique, besides verify the implants' survival rate after 10 years. Six patients (12 sinus) were included in this study. The same surgeon performed the procedures, under local anesthesia and venous sedation in the hospital. All participants underwent sinus lift and implant placement in only one procedure, as previously planned, using endoscopic analysis (Stortz®). All cases received bovine bone graft (Bio-Oss®) before the implant placement. After 10 years, the patients were recalled for follow-up. Two intercurrences (16.66%) were detected using the endoscope, one simple rupture, and another perforation with the leaking of the graft within the sinus. Both were reverted and corrected immediately. There was one implant loss (8.33%), therefore this patient did not undergo any intercurrence in transoperative, and the membrane was elevated lesser than 5 mm. The survival rate reached was 91.66%. The osteotome technique constitutes a reliable method with a long-term of 10 years presenting a high implant survival rate, suggesting an elevation up to 5.5 mm in healthy patients. The occurrences in transoperative were only detected by the endoscopic analysis which must be stimulated to guarantee more secure visibility. Otherwise, the association the atraumatic technique and endoscope was tough, increased the costs, limiting the use routinely.

O objetivo deste estudo foi avaliar através de endoscopia as possíveis intercorrências durante levantamento de seio maxilar fechado, além de verificar a taxa de sobrevivência dos implantes após 10 anos. Seis pacientes (12 seios maxilares) foram incluídos neste estudo com idades entre 26 e 74 anos. O mesmo cirurgião realizou os procedimentos, sob anestesia local e sedação venosa em ambiente hospitalar. Todos os participantes foram submetidos à elevação do seio nasal e colocação do implante em apenas um procedimento, conforme planejado anteriormente, por acompanhamento transcirúrgico da endoscopia (Stortz®). Todos os casos receberam enxerto ósseo bovino (Bio-Oss®) antes da colocação do implante. Após 10 anos, os pacientes foram chamados para acompanhamento. Foram detectadas duas intercorrências (16,66%) com o endoscópio, uma ruptura simples e outra perfuração com extravasamento do enxerto para dentro do seio. Ambos foram revertidos e corrigidos imediatamente. Houve perda de um implante (8,33%), portanto esse paciente não apresentou intercorrência no transoperatório e a membrana estava elevada menos de 5 mm. A taxa de sobrevivência alcançada foi de 91,66%. A técnica do osteótomo constitui um método confiável em longo prazo (10 anos) apresentando uma alta taxa de sobrevivência do implante, sugerindo que uma elevação de até 5,5 mm em pacientes saudáveis é possível. Assim, verificou-se que as ocorrências no transoperatório foram detectadas apenas pela análise endoscópica que deve ser estimulada para garantir uma visibilidade mais segura. Por outro lado, a associação da técnica fechada com o endoscópio foi difícil, aumentou os custos, limitando seu uso como rotina

Elevación unilateral de piso de seno maxilar con ventana lateral utilizando xenoinjerto: reporte de caso / Unilateral elevation of maxillary sinus floor with lateral window using xenografts: report of a case

En maxilares atróficos la elevación de piso de seno es una práctica de alta predictibilidad. El adve- nimiento de materiales osteoconductores que generan andamiaje para la formación ósea propor- cionaron un aumento en la tasa de éxito de los implantes endoóseos. El presente artículo reporta un caso clínico en el cual se llevo a cabo un aumento del nivel de altura del piso de seno unila- teralmente por medio de la técnica de Cadwell- Luck modificada por Tatum, técnica con ventana lateral, donde se utilizó xenoinjerto óseo (OstiumMAX, implante de matriz ósea bovina, Laboratorio Bioxen) y membrana reabsorbible de colágeno( Laboratorio Bioxen) en el primer tiempo quirúrgi- co y seis meses después, en el segundo acto quirúrgico se colocaron tres implantes endoóseos (Sistema de implante dental TRP, Laboratorio Tormicron S.R.L.). Los resultados obtenidos fueron controlados en forma mediata y a distancia a través de radiografías panorámicas y tomografías computadas tipo Cone Beam, donde se midió la altura ósea generada post injerto. Pudo consta- tarse el éxito del procedimiento, basándonos en criterios clínico radiograficos de oseointegración (AU)

Transcrestal sinus lift with simultaneous implant placement using osseodensification in posterior maxilla with residual bone height of 4-6 mm / Elevação de seio maxilar via crista do rebordo com instalação simultânea de implante utilizando osseodensificador em região posterior de maxila com altura do remanescente ósseo de 4 a 6 mm

Objective: The aim of this study was to evaluate the transcrestal sinus lift using Osseodensification technique with simultaneous implant placement. Material and Methods: In this case series 7 patients who needed implant placement in the atrophic posterior maxilla were enrolled. In all the cases the residual bone height between the sinus floor and the alveolar crest was 4-6 mm. Transcrestal sinus lift was performed using Osseodensification with simultaneous implant placement. Cone-beam computed tomography (CBCT) were obtained immediately postoperative and 6 months after operation. Implant stability using Osstell® were assessed at the time of implant placement and implant exposure (6 months). Results: The results showed that the mean bone height gain was 5.33±0.83mm at 6 months postoperatively. Mean bone density value was 818.43±109.63 HU. Mean ISQ value was 80.00±3.11 at 6 months postoperatively. The duration of surgical procedure (minutes) ranged between 25-38 minutes with an average of 30.86±4.10 minutes. Conclusion: The crestal maxillary sinus floor elevation using Osseodensification technique with simultaneous implant placement provide superior results regarding bone density and implant stability and less duration of surgical procedure. (AU)

Objetivo: O objetivo deste estudo foi avaliar a elevação de seio maxilar via crista do rebordo com a técnica de Osseodensificação com instalação simultânea de implante. Material e Métodos: Nesta série de casos, participaram 7 pacientes que necessitavam de implantes em região posterior de maxila atrófica. Em todos os casos a altura de remanescente ósseo entre o soalho do seio e a crista alveolar estava entre 4 a 6 mm. A elevação de seio maxilar via crista do rebordo foi realizada com osseodensificação com instalação simultânea de implante. As Tomografias Computadorizadas Cone Beam (TCCB) foram obtidas imediatamente após a cirurgia e 6 meses depois. A estabilidade dos implantes utilizando Osstell® foi avaliada no momento da instalação do implante e no momento da reabertura (6 meses). Resultados: Os resultados mostraram que a média de ganho de altura óssea foi de 5.33±0.83mm após 6 meses da cirurgia. A média da densidade óssea foi de 818.43±109.63 HU. A média de ISQ foi de 80.00±3.11 após 6 meses da cirurgia. A duração do procedimento cirúrgico (minutos) foi entre 25 a 38 minutos com uma média de 30.86±4.10 minutos. Conclusão: A elevação do soalho de seio maxilar via crista do rebordo com instalação simultânea de implante utilizando osseodensificador promove resultados superiores em relação à densidade óssea, estabilidade do implante e menor duração do tempo cirúrgico (AU)

Posterior rehabilitation using 3D-printed dental implants and synthetic regenerative biomaterials / Reabilitação posterior com implantes impressos e biomateriais sintéticos

Aim: To describe through a clinical case report the surgical sequence of rehabilitation with 3D-printed implants associated with maxillary sinus floor lift with synthetic regenerative materials, including biphasic bioceramic. Case Report: Patient had an agenesis of the upper left premolars (#12 and #13), a vertical bone deficiency caused by maxillary sinus' pneumatization, and a horizontal alveolar resorption around the missing teeth area. During the surgical procedures, incisions, detachment, and osteotomy were performed in the lateral region of the maxillary sinus. The sinus membrane was detached and lifted 10 mm. Then, a thick poly(dioxanone)-based synthetic resorbable membrane (Plenum) was inserted and adapted inside the sinus to protect the sinus membrane. After the osteotomies with sub-instrumentation, 3D-printed implants (Plenum) were installed in the #12 area (3.5mm x 11.5 mm; 30N) and #13 area (4.0mm x 10mm; 20N). The maxillary sinus was entirely filled with a biphasic bioceramic, HA/ß-TCP (70:30) 500-1000 µm (Plenum) and covered by the same synthetic resorbable membrane. Connective tissue graft from the palatal area was positioned internally to the flap and stabilized with sutures to improve the vestibular tissue architecture. The entire surgical wound was sutured, and the tissues stabilized. No complications occurred in the postoperative period. Conclusion: The use of synthetic regenerative memberane and 3D-printed implants seems to be a promising option in areas of deficient bone remnants (AU)

Objetivo: Descrever por meio de um relato de caso clínico a sequência cirúrgica de reabilitação com implantes obtidos por impressão 3D associados à elevação do assoalho do seio maxilar com materiais regenerativos sintéticos, incluindo uma biocerâmica bifásica. Relato de Caso: Paciente apresentava agenesia dos pré-molares superiores esquerdos (24 e 25), deficiência óssea vertical causada pela pneumatização do seio maxilar e reabsorção alveolar horizontal ao redor da área dos dentes ausentes. Durante os procedimentos cirúrgicos foram realizados incisões, descolamento e osteotomia na região lateral do seio maxilar. A membrana sinusal foi descolada e elevada 10 mm. Em seguida, uma membrana reabsorvível sintética à base de poli(dioxanona) espessa (Plenum) foi inserida e adaptada dentro do seio para proteger a membrana do seio. Após as osteotomias com subinstrumentação, implantes impressos em 3D (Plenum) foram instalados na área do 24 (3,5mm x 11,5mm; 30N) e na área do 25 (4,0mm x 10mm; 20N). O seio maxilar foi inteiramente preenchido com biocerâmica bifásica, HA/ß-TCP (70:30)500-1000 µm (Plenum) e recoberto pela mesma membrana sintética reabsorvível. O tecido conjuntivo da região palatina foi posicionado internamente ao retalho e estabilizado com suturas para melhorar a arquitetura do tecido vestibular. Toda a ferida cirúrgica foi suturada e os tecidos estabilizados. Não ocorreram complicações no pós-operatório. Conclusão:A utilização de biomateriais regenerativos sintéticos e implantes impressos parece ser uma opção promissora em áreas de remanescentes ósseos deficientes.(AU)

Short vs standard implants associated with sinus floor elevation: a randomized controlled trial / Implantes curtos versus implantes convencionais associados à elevação do seixo maxilar: um ensaio clínico randomizado

Objective: the present equivalence two-arm parallel randomized controlled trial aimed to compare survival and marginal bone loss (MBL) of short implants (≤6 mm) and standard implants (≥8.5 mm) associated with sinus floor elevation (SFE). Methods: adult patients with partial edentulism with occlusal stability in the sinus area and intermediate bone height were selected in this double-blind trial (patient and outcome assessment). Patients were randomly allocated into two groups: standard length implants with SFE (control) or short implants (test). Clinical and radiographic assessments were made at the time of implant placement, 6 months, and annually thereafter up to 2 years after loading. The inter-examiner agreement was analyzed using intraclass correlation coefficient (ICC). One-way ANOVA, Kaplan-Meier, and Log-rank tests were used to compare implant survival (primary outcome) and MBL (secondary outcome) (P<0.05). Results: eight short implants and six standard implants were placed (mean age of patients was 47 ±12.5 years). The implant survival rates were 87.5% for short (one 5 mm implant failed at 7 months) and 100% for standard implants with no statistically significant difference between groups (P=0.4). The mean MBL after 1 year was 0.30 ±0.62 mm for short and 0.21 ±0.36 mm for standard implants (P=0.123). The inter-examiner agreement was set in 0.831. Conclusion: survival of short implants and standard implants associated with SFE was similar after two years of clinical service. Trial registration: Registered on 27-03-2018 at ClinicalTrials.gov (NCT03479333). Funding: This study was partially funded by Capes Finance Code 001 and #88881.187933/2018-01. TPC is partially funded by National Council for Scientific and Technological Development (CNPq - Brazil). The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.(AU)

Objetivo: o presente ensaio clínico randomizado de dois braços de equivalência comparou a taxa de sobrevivência e a perda óssea marginal de implantes curtos (≤ 6 mm) e implantes convencionais (≥ 8.5 mm) associados à elevação do seio maxilar. Métodos: edêntulos parciais adultos, com estabilidade oclusal e altura óssea intermediária na região do seio maxilar, foram selecionados neste estudo duplo-cego e alocados randomicamente em dois grupos: implante de comprimento convencional associado à elevação do seio maxilar (controle) ou implante curto (teste). Avaliações clínicas e radiográficas foram realizadas logo após a instalação do implante, seis meses e anualmente por até dois anos. A concordância interexaminador foi avaliada através do coeficiente de correlação intraclasse. Os testes ANOVA de uma via, Kaplan-Meier e Log-rank foram utilizados para comparar a sobrevivência do implante e a perda óssea marginal (P<0.05). Resultados: oito implantes curtos e seis implantes de comprimento convencional foram instalados em onze pacientes (média de idade dos pacientes: 47 ± 12.5 anos). As taxas de sobrevivência dos implantes foram de 87,5% para implantes curtos (um implante de 5 mm falhou aos sete meses), e 100% para implantes convencionais, sem diferença estatisticamente significativa entre os grupos (P=0.4). A perda óssea marginal média após um ano foi de 0.30 ±0.62 mm para implantes curtos e 0.21 ±0.36 mm para implantes convencionais (P=0.123). A concordância interexaminador foi de 0.831. Conclusão: a taxa de sobrevivência de implantes curtos e convencionais associados ao seio maxilar foi semelhante após dois anos de acompanhamento. Registro do estudo: Registrado em 27-03-2018 no ClinicalTrials.gov (NCT03479333).(AU)

Avaliação do reparo ósseo com Bio-Oss® associado ao raloxifeno em levantamento de seio maxilar de coelhos / Evaluation of bone repair with Bio-Oss® associated with raloxifene in rabbit maxillary sinus lifting

O objetivo deste estudo foi analisar o potencial do Bio-oss® otimizado pelo processamento ultrassônico e associação com o raloxifeno no reparo ósseo em aumento de seio maxilar de coelhos. A associação dos materiais pesquisados foi realizada pelo processamento ultrassônico com 80% de Bio-oss e 20% de Raloxifeno. Para tanto, 8 coelhos (Oryctolagus cunilicus), machos, 6 meses de idade foram submetidos ao levantamento de membrana do seio maxilar bilateralmente, em seguida os seios maxilares foram preenchidos pelos biomateriais, de acordo com o grupo experimetal, sendo 4 animais (8 seios) por grupo: grupo 1 (BS) foi realizada a aplicação do Bio-oss submetido ao processamento ultrassônico sem raloxifeno, nos dois seios. O grupo 2 (BR) foi realizada a aplicação do Bio-oss com processamento ultrassônico juntamente ao raloxifeno, nos dois seios. Foi realizada eutanásia de 2 animais de cada grupo após 2 semanas da enxertia, para análise histométrica de osso neoformado, tecido conjuntivo e material remanescente, e para as reações de imunoistoquímica através do anticorpo primário contra Runx2. Já com 6 semanas, os outros 2 animais de cada grupo foram submetidos a eutanásia para avaliação de parâmetros histométricos (HE) e imunohistoquímicos para OCN, OPG, RANKK-L e TRAP. Os resultados obtidos mostraram superioridade para o grupo BS, que apresentou mais organização tecidual no período de 14 dias, além de maior quantidade de tecido ósseo neoformado aos 14 e 42 dias (p< 0,05). A avaliação imunoistoquímica revelou similaridade entre os escores para ambos os grupos, independente do tempo e proteína analisada. Conclui-se que a adição do raloxifeno, pelo processamento ultrassônico, aumentou reduzindo a quantidade de osso neoformado(AU)

The aim of this study was to analyze the potential of Bio-oss® optimized by the ultrasonic process and association with raloxifene in bone repair in rabbit maxillary sinus augmentation. The association of the researched materials was carried out by the ultrasonic process with 80% Bio-oss and 20% Raloxifene. Eight male rabbits (Oryctolagus cunilicus), six-months of age were subjected to a bilateral maxillary sinus lifting and, they were filled with biomaterials according to two groups, with four animals (eight maxillary sinus) per group: group 1 (BS) Biooss was subjected to ultrasonic process without raloxifene in both sinuses. Group 2 (BR) performed the application of the Bio-osssubjected to ultrasonic process together with raloxifene in both sinuses. The euthanasia of two animals for each group was performed two weeks after grafting, for histometric analysis of newly formed bone, connective tissue, and remaining material, and for immunohistochemical reactions using the primary antibody against Runx2. At 6 weeks, the other two animals for each group were euthanized to evaluate histomorphometric (HE), and immunohistochemical parameters for OCN, OPG, RANK -L, and TRAP. The results obtained showed superiority for the BS group, which presented more tissue organization in the period of 14 days, in addition to a greater amount of new bone tissue at 14-, and 42- days (P< 0.05). The immunohistochemical evaluation revealed a similarity between the scores for both groups, regardless of the time and protein analyzed. It is concluded that the addition of raloxifene, through the ultrasonic process, increases the inflammatory process in the initial period, reducing bone repair(AU)

The new bone formation in human maxillary sinuses using two bone substitutes with different resorption types associated or not with autogenous bone graft: a comparative histomorphometric, immunohistochemical and randomized clinical study

Abstract Objective The aim of this study is to evaluate the new bone and connective tissue formation and the biomaterial remaining after maxillary sinus bone augmentation using 5 different bone substitutes. The osteocalcin immunolabeling was performed to demonstrate their calcification and the possibility of receiving dental implants. Methodology 40 patients underwent maxillary sinus bone augmentation and were divided in 5 groups: Group 1 with 8 maxillary sinuses were grafted with autogenous bone graft (AB); Group 2 with 8 maxillary sinuses grafted with bioactive glass (BG); Group 3 with 8 maxillary sinuses grafted with bioactive glass added to autogenous bone graft (BG + AB) 1:1; Group 4 with 8 maxillary sinuses grafted with Bio-Oss (BO) and Group 5 with 8 maxillary sinuses grafted with Bio-Oss added to autogenous bone graft (BO + AB) 1:1. Results In group AB, 37.8% of bone was formed in the pristine bone region, 38.1% in the intermediate and 44.5% in the apical region. In group BG, 43.6% was formed in the pristine bone, 37% in the intermediate and 49.3% in the apical region. In group BG + AB 1:1, 39.0% was formed in the pristine bone region, 34.8% in the intermediate and 36.8% in apical region. In group BO, 33.4% was formed in the pristine bone, 32.5% in the intermediate and 34.3% in the apical region. In group BO + AB 1:1, 32.8% was formed in the pristine bone, 36.1% in intermediate and 27.8% in the apical regions. The immunolabeling for osteocalcin showed an intensive staining for all groups, which could demonstrate the calcification of the bone formed. Conclusion This study showed that the groups evaluated formed a suitable lamellar bone in the maxillary sinus reconstruction after six months of bone healing, thus being indicated to receive dental implants.

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.

Prótese e implante sobre enxerto alógeno: análise histológica e acompanhamento clínico: radiográfico por 8 anos / Prosthesis and implant on allogenic graft: histological analysis and clinical: radiographic follow-up for 8 years

Este relato de caso clínico tem como objetivo descrever a utilização de osso alógeno na reconstrução de maxila atrófica para posterior reabilitação com prótese fixa metalocerâmica sobre implantes, fazer uma análise histológica do tecido ósseo enxertado e descrever o acompanhamento clínico e radiográfico por 8 anos. Uma paciente de 54 anos, com edentulismo parcial e atrofia moderada-a-severa na maxila, apresentou-se para tratamento demonstrando muito interesse em receber prótese sobre implantes. Após exame clínico e radiográfico, foi realizada montagem dos modelos de estudo em ASA para enceramento diagnóstico e obtenção de um guia multifuncional (tomográfico/ cirúrgico). A tomografia indicou a necessidade de reconstrução óssea maxilar. Procedeuse então à aposição de blocos de osso alógeno para aumento horizontal nas regiões anterior e posterior da maxila. Um dos blocos foi triturado e utilizado para levantamento do assoalho do seio maxilar no lado esquerdo. Dez meses depois, uma nova tomografia foi solicitada, utilizando o mesmo guia inicial, e os implantes instalados, utilizando o guia multifuncional como guia cirúrgico. Neste momento, material ósseo foi coletado na interface osso enxertado/osso nativo com uma broca trefina. Os resultados histológicos demonstraram viabilidade das células ósseas no enxerto, além da presença de vasos sanguíneos. Após o tempo necessário para osseointegração, procedeu-se com tratamento protético. Nenhuma complicação foi relatada até oito anos de controle. A sequência de tratamento proposta forneceu bons resultados estéticos e funcionais. Concluiu-se, então, que o emprego de osso alógeno é uma alternativa viável para a reconstrução de rebordos alveolares severamente reabsorvidos(AU)

This clinical case report aims to describe the use of allogeneic bone in the atrophic maxilla reconstruction for subsequent rehabilitation with a fixed metal-ceramic prosthesis on implants; to perform a histological analysis of the grafted bone tissue; and to describe the clinical and radiographic monitoring for 8 years. A 54-year-old patient, with partial edentulism and moderate-to-severe atrophy in the maxilla showed great interest in receiving implant prostheses. After c linical and radiographic examination, the ASA study models were assembled for diagnostic waxing and a multifunctional guide (tomographic / surgical) was obtained. Tomography indicated the need for maxillary bone reconstruction. Allogeneic bone blocks were then placed for horizontal enlargement in the anterior and posterior regions of the maxilla. One of the blocks was crushed and used to lift the floor of the maxillary sinus on the left side. Ten months later, a new tomography was requested, using the same initial guide, and the implants installed, using the multifunctional guide as a surgical guide. At this time, bone material was collected at the grafted bone / native bone interface with a trephine drill. Histological results demonstrated viability of bone cells in the graft, besides the presence of blood vessels. After the necessary time for osseointegration, a prosthetic treatment was performed. No complications were reported up to eight years of control. The propose treatment sequence provided good aesthetic and functional results. It was concluded, then, that the use of allogeneic bone is a viable alternative for the reconstruction of severely reabsorbed alveolar edges(AU)

Complicaciones quirúrgicas de la elevación de seno maxilar en implantología / Surgical Complications Associated to Maxillary Sinus Floor Elevation in Implantology

RESUMEN La elevación de piso de seno maxilar ha sido sumamente documentada en implantología como una técnica segura y predecible en el procedimiento de ganancia vertical ósea, en el maxilar posterior atrófico. Sin embargo, conjuntamente se han reportado complicaciones en este procedimiento, las cuales podrían poner en peligro los resultados de la regeneración, y por consiguiente la colocación del implante. El propósito de esta revisión de literatura es exponer y analizar diferentes complicaciones que pueden presentarse en la elevación de piso de seno maxilar.

ABSTRACT Maxillary sinus floor elevation has been extensively documented as a safe and predictable procedure for gaining vertical bone height in the atrophic posterior maxilla. Even though, complications have been reported, which can potentially jeopardize the outcome of the regeneration and implant therapy. Therefore, the purpose of this literature review is to present, debate and analyze the different complications that can occur during a sinus floor elevation.

Manejo multidisciplinario de rinosinusitis bacteriana aguda posterior a elevación de seno maxilar: reporte de caso rehabilitado a tres años de seguimiento / Multidisciplinary management of acute bacterial rhinosinusitis after maxillary sinus lift: three years follow-up: case report

La cirugía de elevación de seno maxilar se considera como la técnica de aumento óseo más predecible. Sin embargo, no está exenta de complicaciones las cuales deben ser manejadas adecuadamente. Se presenta un caso clínico rehabilitado, con un seguimiento de 3 años, en el cual se realizó un manejo multidisciplinario y resolutivo de complicaciones asociadas a la técnica quirúrgica de elevación de membrana sinusal vía ventana lateral. Frente a una infección postoperatoria, como la presentada en el caso, hay que considerar iniciar un tratamiento antibiótico en el momento adecuado para impedir el agravamiento del cuadro clínico o un cambio de esquema en caso de resistencia antimicrobiana.

Maxillary sinus lift surgery is considered the most predictable bone augmentation technique. However, this procedure is not without complications, which must be handled properly. We present a rehabilitated clinical case, with a 3-year follow-up, in which a multidisciplinary and resolutive management of complications associated with the surgical technique of sinus lift procedure, using lateral window approach, was performed. In case of postoperative infection, such as the one presented in this report, it is necessary to consider starting an antibiotic treatment at the adequate moment to prevent the aggravation of the illness or change the pharmacological treatment in case of antimicrobial resistance.

Utilização da fibrina rica em plaquetas na elevação sinusal com instalação imediata de implantes dentários / Use of platelet-rich fibrin in maxillary sinus lift with immediate implant installation

O levantamento de seio maxilar é realizado como forma de obtenção de volume ósseo adequado para a instalação de implantes dentários, por vezes imediatos, em região posterior de maxila. A perfuração da membrana sinusal é um dos acidentes mais comuns associados a este procedimento. Objetivo: Relatar o uso da Fibrina Rica em Plaquetas ­ PRF como uma técnica simples e de baixo custo, que permite a obtenção de coágulos de fibrina e membranas enriquecidas com plaquetas, simulando o processo fisiológico de reparo tecidual, podendo servir como único material de enxertia na elevação sinusal, além de proporcionar o reparo de uma membrana eventualmente perfurada durante o ato cirúrgico. Relato de Caso: Paciente do gênero feminino, faioderma, 57 anos de idade, que por meio de tomografia computadorizada apresentava áreas de pneumatização em região 14 e região 15, exigindo elevação sinusal previamente à instalação de implantes. A perfuração da membrana foi observada durante o descolamento da mesma. O pós-operatório sob exame clínico regular ocorreu sem complicações. Após um período de cicatrização de quatro meses, os implantes foram reabertos para a confecção das coroas. A avaliação da tomografia cone beam pós-cirúrgica comparada à inicial demonstrou que o osso peri-implantar era estável e compacto ao redor dos implantes. Conclusão: Os achados deste relato de caso sugerem que a membrana PRF pode ser uma consideração viável para o reparo da membrana do seio perfurada(AU)

The maxillary sinus lift is performed as a way to obtain adequate bone volume for the installation of dental implants, sometimes immediate, in posterior maxilla. Sinus membrane perforation is one of the most common accidents associated with this procedure. Objective: To report the use of Plateletrich Fibrin ­ PRF as a simple and low cost technique, which allows the allows to obtain fibrin clots and membranes enriched with platelets, simulating the physiological process of tissue repair and can serve as the only grafting material for sinus elevation, besides providing repair of a membrane that may have been perforated during the surgical procedure. Case Report: Female patient, faioderm, 57 years old who, through imaging examinations, had areas of pneumatization in region 14 and region 15, requiring sinusal elevation prior to implant installation. The perforation of the membrane was observed during its detachment. The postoperative period under regular clinical examination occurred without complications. After a healing period of four months, the implants were reopened to make the crowns. The evaluation of the postoperative cone beam tomography compared to the initial one demonstrated that the periimplant bone was stable and compact around the implants. Conclusion: The findings of this case report suggest that the PRF membrane may be a viable consideration for the repair of perforated sinus membrane(AU)

Radiography study on osteotome sinus floor elevation with placed implant simultaneously with no graft augmentation / 北京大学学报(医学版)

OBJECTIVE@#To investigate the change of endo-sinus bone height and bone volume in osteotome sinus floor elevation (OSFE) without bone graft but placing implants simultaneously by using cone beam computed tomography (CBCT) and three dimensional analysis, and to find the impacting factors on endo-sinus bone augmentation.@*METHODS@#OSFE was performed in 38 edentulous patients with missing teeth at posterior maxillary region, and 44 implants were placed and referred for OSFE using no graft materials. CBCT was performed pre-surgery and 9－68 months post-surgery when the patients encountered another implant surgery. The gained bone height at mesial, distal, buccal and palatal sites around the implant in sinus were measured, volumetric measurements of the endo-sinus gained bone volume (ESGBV) in the elevated region were calculated by Mimics software. Univariate analysis and multiple linear regression were performed to investigate the impacting factors on the gained bone height and ESGBV. Marginal bone loss was recorded according to the periapical radiography after implant restoration.@*RESULTS@#The mean residual bone height (RBH) pre-surgery was (3.41±1.23) mm, the mean protruded length (PL) into sinus of implant post-surgery was (3.41±1.28) mm, the mean endo-sinus gained bone height was (2.44±1.23) mm at distal sites, (2.88±1.20) mm at mesial sites, (2.83±1.22) mm at buccal sites and (2.96±1.16) mm at palatal sites, the mean endo-sinus gained bone height at distal sites was significantly lower than the other three sites (P < 0.05). The average endo-sinus gained bone height was (2.78±1.13) mm. The mean ESGBV was (122.15± 73.27) mm3. Univariate analysis showed the more RBH, the less bone height gained in sinus, which existed at buccal, lingual, mesial and distal sites (P < 0.001), and the more RBH, the smaller ESGBV gained (P=0.012). The ESGBV was significantly higher in the subjects whose bone generation period was more than 24 months than those whose bone generation period less than 24 months (P=0.034). The more PL, the more bone height and ESGBV gained (P=0.008). Multivariate analysis showed after adjusting factors of gender, age, smoking, width of sinus floor, thickness of sinus membrane pre-surgery, diameter and length of the implant, PL and bone generation period was positively correlated with mean endo-sinus gained bone height and ESGBV, while RBH negatively correlated with mean endo-sinus gained bone height. During the follow-up, the mean marginal bone loss was 0 (0－1.41) mm and all the implants loaded successfully.@*CONCLUSION@#OSFE without bone graft but with placed implant simultaneously can increase endo-sinus gained bone height and ESGBV. RBH, PL and bone generation period are the significant factors impacting endo-sinus bone augmentation.

Estudo clínico prospectivo, randomizado do tipo "Split mouth" do aumento ósseo em enxertos sinusais realizados com o fosfato de cálcio bifásicozado do tipo "Split mouth" do aumento ósseo em enxertos sinusais realizados com o fosfato de cálcio bifásico / Prospective, randomized "split mouth" clinical study of bone augmentation in sinus grafts performed with biphasic calcium phosphate

Objetivos: Avaliar e comparar o comportamento do Fosfato de Cálcio Bifásico (FCB) na forma granulada e em pasta enxertados em seios maxilares de humanos, através da análise histomorfometrica e imunoistoquímica. Metodologia: Este estudo é do tipo Split mouth com radomização controlada, em que 10 pacientes participaram do estudo, 10 seios maxilares foram enxertados com FCB na forma de pasta e 10 com FCB na forma de grânulos. Aos 6 meses após a enxertia, foi colhida a biópsia para as análises histomorfometrica e imunoistoquímica. O teste de normalidade mostrou resultados paramétricos para todas as análises, portanto foi aplicado o teste t. Resultados: A média de quantidade de tecido ósseo foi de 1923705,9 ± 364393 µm2 para o grupo Grânulos e 1532468,7 ± 334892 µm2 para o grupo Pasta (p=0,0223), a média da quantidade de biomaterial foi de 1468571 ± 230879 µm2 para o grupo Grânulos e 1658428 ± 122324 µm2 (38,60%) para o grupo Pasta (p=0,0338) e a média da quantidade de tecido mole foi de 897786 ± 270137,9 µm2 para o grupo Grânulos e 1099166,5 ± 221947,3 µm2 para o grupo Pasta (p=0,0852), as marcações para a osteocalcina foi intenso para ambos os grupos. Conclusão: O FCB em forma de pasta, assim como o FCB em grânulos, pode ser utilizado adequadamente como substituto ósseo para enxerto em seio maxilar de humanos(AU)

Objectives: To evaluate and compare the behavior of Biphasic Calcium Phosphate (BCP) in granulated and paste form grafted on maxillary sinuses of humans, through histometric and immunohistochemical analysis. Metodology: This study is of the Split mouth type with controlled radomization, in which 10 patients participated in the study, 10 maxillary sinuses were grafted with BCP in the form of paste and 10 with BCP in the form of granules. At 6 months after grafting, a biopsy was taken for histometric and immunohistochemical analysis. The normality test showed parametric results for all analyzes, so the t test was applied. Results: The mean amount of bone tissue was 1923705.9 ± 364393 µm2 for the Granules group and 1532468.7 ± 334892 µm2 for the Pasta group (P = 0.0223), the average biomaterial amount was 1468571 ± 230879 µm2 for the Granules group and 1658428 ± 122324 µm2 (38.60%) for the Pasta group (P = 0.0338) and the average amount of soft tissue was 897786 ± 270137.9 µm2 for the Granules group and 1099166.5 ± 221947.3 µm2 for the Pasta group (P = 0.0852), the markings for osteocalcin were intense for both groups. Conclusion: BCP in paste form, like BCP in granules, can be used properly as a bone substitute for grafting in the maxillary sinus of humans(AU)

Development of tilted implant for free end of maxillary posterior teeth / 华西口腔医学杂志

Vertical bone insufficiency in the maxillary posterior teeth is a common clinical situation. At present, the bone insufficiency in the maxillary posterior teeth is mainly overcome by bone grafting through maxillary sinus floor elevation. Compared with traditional axial implantation, tilted implantation can better avoid bone grafting, reduce complications, shorten the treatment cycle, reduce the treatment cost for patients, and gradually be promoted in clinical settings. This article reviews the concept, biomechanics, clinical evaluation, and digital trend of tilted implants of maxillary posterior teeth.

Retrospective study on transcrestal sinus floor elevation with simultaneous implantation of short implants / 华西口腔医学杂志

OBJECTIVE@#To explore the changes in bone height of the maxillary sinus floor at different sinus ridge heights after transcrestal sinus floor elevation (tSFE) with the simultaneous implantation of short implants.@*METHODS@#A total of 74 Bicon short implants were implanted into 37 patients during the same period of maxillary sinus elevation. The residual bone height (RBH)<4 mm group has 43 sites, and the RBH≥4 mm group has 31 sites. After 5 years of follow-up observation, the implant survival rate and the change in bone height achieved in the maxillary sinus over time were measured and analyzed via clinical examination and X-ray imaging.@*RESULTS@#In the 74 implantation sites, the elevation height of the sinus floor was (6.64±1.32) mm and the bone height of the sinus floor was (3.35±1.29) mm 5 years after loading. No statistical difference was observed in the bone resorption of the implant neck between the RBH<4 mm and RBH≥4 mm groups. Meanwhile, a statistical difference was noted in the bone height obtained in the maxillary sinus between the two groups.@*CONCLUSIONS@#When RBH in the maxillary posterior tooth area was <4 mm, the simultaneous implantation of Bicon short implants with tSFE can achieve a high implant survival rate and bone gain in the maxillary sinus, but does not increase the absorption of the alveolar ridge bone.

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.