A Pilot Investigation Generating an Alternative Therapeutic Strategy Combining Deproteinized Bovine Bone and Gelatin Sponge for a Novel Implant Material in Sinus Floor Elevation Operation.

BACKGROUND Implant placement in the posterior maxilla is typically complicated by a shortage of bone. Gelatin sponge could be combined with an appropriate material to enhance mechanical strength and maintain stability of an implant. This study aimed to evaluate the clinical application of bone grafting with bovine bone mixed with gelatin sponge. MATERIAL AND METHODS Fifty-four patients were divided into a control group (deproteinized bovine bone, n=26) and a test group (deproteinized bovine bone combined with gelatin sponge, n=28). Implants were placed in patients simultaneously after surgery (operation). Cone-beam computed tomography examination was carried out immediately and 6 months after surgery. Space with grafting materials was measured with Mimics software (version 16.0). RESULTS No remarkable differences were found for simultaneous placement, height of residual bone, delayed placement, width of residual bone, graft volume immediately after surgery (V1), graft volume 6 months after surgery (V2), or volumetric change rate between the test group and the control group (P>0.05). Graft volume V2 was remarkably decreased compared with V1 in the control and test groups (P=0.01). There were no significant differences for bone height immediately after surgery (H1) and bone height at 6 months after surgery (H2) between the 2 groups. Bone height H2 was markedly decreased compared with H1 (P<0.05). At 1 year after implantation, there was 1 implant loss in the control group and 2 in the test group. The implant survival rate in the control group was 97.62% and 95.24% in the test group. CONCLUSIONS Absorbable gelatin sponge combined with bovine bone particles was an effective and economical material for use in routine sinus floor elevation surgery.

Comparison of 4 sinus augmentation techniques for implant placement with residual alveolar bone height ≤3 mm.

This study compared implant outcomes following maxillary sinus floor augmentation (MSFA) in edentulous patients with a residual alveolar bone height ≤3 mm. Four techniques were evaluated: 1-stage bone-added osteotome sinus floor elevation procedure (BAOSFE) with simultaneous implant placement; 2-stage BAOSFE with delayed implant placement; 1-stage lateral window sinus floor elevation with simultaneous implant placement; and 2-stage lateral window sinus floor elevation with delayed implant placement. Patients were followed for 18 to 72 months (mean: 52.5 months) after prosthesis placement. Data were analyzed with cone-beam computed tomography. A total of 96 implants from 71 patients were analyzed; pretreatment, there were no significant differences between patients. Total implant survival was 98.9%. The mean residual bone height was significantly higher in the 1-stage BAOSFE group than the other groups (P < .01); 1 implant in this group failed at 3 months. There was no significant difference in total bone height gain between groups. However, the bone height gain of 1st sinus lifting with 2-stage BAOSFE was significantly lower than the 2-stage lateral window procedure (P < .01). There was no prosthesis failure. The favorable implant outcomes suggest these 1-stage and 2-stage MSFA procedures should be considered as alternative treatment options for patients with extremely atrophic posterior maxilla.

Sinus Augmentation with Simultaneous, Non-Submerged, Implant Placement Using a Minimally Invasive Hydraulic Technique.

Background and objectives: To evaluate whether sinus augmentation, using a minimally invasive implant device, via a non-submerged surgical approach, might negatively influence the outcome. Materials and Methods: A retrospective cohort study was conducted by evaluating patients' files, classifying them into two groups. Fifty patients (22 men 28 women) were included in the study, 25 in each group. The use of an implant device based on residual alveolar ridge height for sinus augmentation, radiographic evaluation, insertion torque, membrane perforation, post-operative healing, and a minimum of 12 months follow-up were evaluated. Results: The mean residual alveolar ridge height was 5.4 mm for the non-submerged group and 4.2 mm for the submerged group. There were no intraoperative or postoperative complications (including membrane perforations). The mean insertion torque was 45 N/cm for the study group and 20 N/cm for the control group. Complete soft tissue healing was observed within three weeks. Mean bone gain height was 8 mm for the study and 9.3 mm for the control group. All implants osseointegrated after 6-9 months of healing time. Mean follow-up was 17.5 months, range 12-36 months. Marginal bone loss at last follow-up was not statistically significantly different: 1 mm in the non-submerged vs. 1.2 mm in the submerged group. Conclusions: Submerged and non-submerged healing following maxillary sinus augmentation was comparable provided residual alveolar ridge height >5 mm and insertion torque >25 N/cm.

Modified Disk-Up Sinus Reamer for Sinus Floor Elevation and Simultaneous Implant Placement: An Animal Study with Miniature Pigs.

Objective: The disk-up sinus reamer (DSR) is a modified instrument used to elevate the maxillary sinus floor. This study aimed to compare the effects of modified DSR sinus floor elevation (DSFE) with osteotome sinus floor elevation (OSFE), both with simultaneous implant placement. Methods: Twelve miniature pigs were treated with DSFE on one side and OSFE on the other. Implants 9 mm in length were placed in six pigs without grafting, while implants 11 mm in length were placed in the other six pigs with grafting. After submerged healing for 3 months, vertical bone gain (VBG), general and histological observation, and bone contact ratio (BCR) were analyzed. Results: The mean maxillary residual bone height (RBH) when implants were placed was 6.45 ± 0.36 mm. In the no-grafting group, DSFE and OSFE had a similar VBG after 3 months. The grafting group with DSFE recorded a significantly higher VBG (VBG0: 7.83 ± 0.44 mm, VBG1: 7.54 ± 0.40 mm) than the graft group with OSFE (VBG0: 5.45 ± 0.56 mm, VBG1: 4.34 ± 2.15 mm) (p < 0.05). One implant became loose and the sinus mucosa of three pigs appeared metallic in color on the control side (OSFE). Conclusions: The effect of OSFE and DSFE is similar when there is no need for grafting. DSFE seems a better alternative method for sinus floor elevation with grafting when more VBG is needed.

Osteogenic Potential of Porous Titanium. An Experimental Study in Sheep.

The search for osteoinductive as well as osteoconductive materials has led to the novel idea of using titanium in bone augmentations of the alveolar crest. Due to its excellent biocompatibility and favorable osteogenic properties, highly porous TiO2 granules has been proposed as a promising material for non-resorbable synthetic bone grafts in the restoration of large bone defects, and for bone augmentation in dental applications. OBJECTIVES: The aim of this study was to investigate the osteoconductive properties and biological performance of porous titanium granules used in osseous defects adjacent to the maxillary sinus in sheep. The experimental animal study involved 15 yearling sheep with a focus on the osteogenic potential of porous titanium used for subantral augmentation. MATERIAL AND METHODS: Calibrated defects were prepared in the subantral region of sheep. The defects were randomized into tests and control group. The test defects were grafted with porous titanium granules (PTG), whereas control defects were left empty (sham). Defects were left for healing for 30, 60, and 90 days. After healing, the grafted areas were removed and finally osteoconductivity was analyzed by an orthopantograph (OPG} and histology. RESULTS: Significantly more new bone formed in PTG grafted defects compared with sham. The control group showed significantly less expression of key inflammation cells, but with no significant difference in key inflammation cells compared with the experimental groups. CONCLUSION: Porous titanium can offer as an effective alternative to calcium phosphate and bone collagen-based materials used for subantral augmentation of the maxillary bone in cases of dental implantation.

Clinical evaluation of modified transalveolar sinus floor elevation and osteotome sinus floor elevation in posterior maxillae: study protocol for a randomized controlled trial.

BACKGROUND: Implant placement in the posterior maxilla is often complicated by the insufficient bone volume. While transalveolar sinus floor elevation (TSFE) has been proven as a predictable surgical procedure to increase the bone height in the posterior maxilla, questions in regard to the necessity of the bone grafting during the sinus lift and the question of whether TSFE could be performed when the residual bone height is below 5 mm are still debated. Furthermore, high-quality evidence comparing the clinical outcome of transalveolar sinus floor elevation with osteotome and modified sinus floor elevation with crestal non-cutting drills is limited. METHODS/DESIGN: One hundred twenty adult patients who fit the inclusion criteria are being recruited from the Peking University Hospital of Stomatology First Clinical Division (Beijing, China). All patients are assigned to one of four groups according to a table of random numbers. Participants will receive (1) TSFE using osteotomes with bone grafting, (2) TSFE using osteotomes without bone grafting, (3) modified TSFE with bone grafting, or (4) modified TSFE without bone grafting. In a one-year follow-up period, implant survival rates, complications, implant stability, bone remodeling around the implant, and patient-reported outcome (visual analog scale for intraoperative discomfort and postoperative pain) will be observed and documented. The implant stability will be gauged by the resonance frequency analysis six times (at baseline and weeks 6, 8, 12, 16, and 26), and the bone remodeling will be observed and compared via radiographic examinations. DISCUSSION: The result of the trial will potentially contribute to better decision making in atrophic posterior maxilla when implant placement is needed. Therefore, if the outcome is deemed favorable, the use of the modified TSFE would achieve an outcome equivalent to that of the traditional TSFE while introducing less trauma and postoperative discomforts. Separately, whether the bone graft procedure is necessary for the TSFE will also be discussed. TRIAL REGISTRATION: The study has been registered in ClinicalTrials.gov under the identifier number NCT03445039 . Registered on 26 February 2018.

Analysis of Forces Applied During Transalveolar Sinus Lift: A Preliminary Clinical Study.

PURPOSE: To introduce a novel modality that enables the measurement of forces applied during a transalveolar sinus floor elevation (tSFE) and to investigate the influence of anatomical and surgical factors on the necessitated force in sinus membrane detachment. MATERIAL AND METHODS: A new endosinus probe, innovated with a calibrated load cell, was used to test the forces needed to perforate ten maxillary sinuses in 5 human cadavers. The same probe was also used to detach the Schneiderian membrane from the bony floor of 21 human subjects undergoing tSFE. RESULTS: The force needed to cause membrane perforation in the cadaver sample was on average 3.46 ± 1.04 N. The maximum force applied in vivo to a sinus membrane without perforation was 2.01 ± 0.67 N on average. Regression analysis showed that smoking (P < 0.001), as well as 3.0 mm osteotomy (P < 0.001), was significantly correlated to increased forces during membrane detachment. CONCLUSIONS: The maximum force needed to detach the membrane was found to be, on average, lower than the membrane breaking load in cadavers. Furthermore, because of smoking and a 3.0-mm osteotomy diameter demonstrating a high association with increased forces during membrane detachment, they may be considered as risk factors of membrane perforation.

Maxillary Sinus Membrane Elevation Using a Special Drilling System and Hydraulic Pressure: A 2-Year Prospective Cohort Study.

The purpose of this study was to evaluate clinical and radiologic outcomes using a newly developed device for maxillary sinus membrane elevation. Patients with a residual bone height of at least 3 mm were enrolled. Crestal sinus lift elevation and sinus graft were performed using the crestal approach sinus (CAS) kit. Graft was avoided if the residual bone crest was ≤ 2 mm less than the length of the planned implant. Outcome measures were implant and prosthesis failure, any biologic or technical complications, and marginal bone loss (MBL). A total of 35 consecutive patients underwent 49 crestal elevations of the sinus membrane. All the implants were followed for at least 2 years after placement (mean follow-up 37.3 months; range 24 to 54 months). No implants or prostheses failed during follow-up, and no membrane tears or other intraoperative or postoperative adverse events were observed. At the 2-year follow-up, mean MBL was 0.33 ± 0.24 mm (95% confidence interval: 0.08 to 0.30 mm). A total of 32 implants were placed after filling the sinus with anorganic bovine bone, while 17 implants were placed without grafting the sinus. Post-hoc analysis was performed using the sinus grafting remodeling index (SGRI) to evaluate radiographically the tissue remodeling patterns. The SGRI was statistically significantly higher when the sinus was grafted (P = .000). The CAS kit may provide a new option for minimally invasive crestal sinus surgery. Long-term randomized controlled trials with larger sample size are needed to confirm these preliminary results.

Crestal Sinus Augmentation in the Presence of Severe Sinus Mucosal Thickening: A Report of 3 Cases.

PURPOSE: In the presence of severe sinus mucosal thickening, the ostium can be blocked when the sinus membrane is lifted, causing drainage disturbances and sinusitis. Here, we present 3 cases in which maxillary sinus floor elevation was performed using a crestal approach in the presence of severe sinus mucosal thickening (>10 mm). MATERIALS AND METHODS: The effects of maxillary sinus floor elevation using the crestal approach technique on sinus mucosal thickening and bone formation in the sinus were evaluated using cone beam computed tomography. RESULTS: None of the patients exhibited an increase in sinus membrane thickness. No complications were encountered during the follow-up periods, and bone formation was observed around the implants at the sinus floor. All implants were functioning successfully. CONCLUSIONS: Maxillary sinus floor elevation using the crestal approach technique in the presence of severe sinus mucosal thickening allows for minimally invasive sinus grafting and simultaneous implant placement and does not increase sinus membrane thickness.

Fabrication of a Surgical Guide for Lateral Sinus Augmentation.

Cone-beam computed tomography (CBCT) scans are used in planning implant treatment to help determine volume of available bone and identify anatomical structures. This enhances planning, particularly when inadequate bone is present in the posterior maxilla due to proximity of the inferior aspect of the maxillary sinus to the crestal bone. To place dental implants into this area, sinus augmentation is often needed to provide sufficient bone volume to support implants and allow prosthetic loading with predictable long-term results. Use of surgical guides for implant placement and sinus augmentation aids the practitioner in providing precision treatment. This article will discuss a method for fabrication of a surgical guide to transfer CBCT information intraorally to enable creation of a precisely placed lateral sinus window.

Bioresorbable versus titanium space-maintaining mesh in maxillary sinus floor elevation: a split-mouth study.

Maxillary sinus pneumatization limits implant placement in the edentulous posterior maxilla. Grafted sinus floor augmentation through Schneiderian membrane elevation and space obliteration with autogenous bone grafts, bone substitutes, or a combination of the two has often been used to resolve this problem. More recently, non-grafted sinus floor elevation has been established. This is based on the concept of membrane elevation and support either by tenting technique or using space-maintaining mesh. The aim of this study was to evaluate the predictability of new bone formation after sinus floor elevation using space-maintaining mesh without graft material and to illustrate the difference between the use of bioresorbable and titanium meshes. Eight patients with bilateral sinus pneumatization were selected for implant placement in the edentulous posterior maxilla. Pneumatized sinuses were approached through the lateral window technique; these were elevated and maintained with resorbable or titanium meshes. All patients were evaluated clinically and radiographically immediately and at 6 months postoperative. At 6 months, a core bone biopsy was obtained from the planned implant position using a trephine drill, and the bone formed was examined histologically. Healing was uneventful in all patients, and radiographic, clinical, and histological evidence of new bone formation was seen in both groups. Titanium and resorbable meshes were found to be reliable and predictable as space-maintaining devices.

Bone Scrapers Versus Piezoelectric Surgery in the Lateral Antrostomy for Sinus Floor Elevation.

The purpose of this investigation is to evaluate 2 different methods for reducing cortical wall thickness in sinus floor augmentation surgery. A manual bone scraper was compared in terms of efficacy, speed, and safety to an ultrasonic insert for osteoplasty, in a randomized controlled clinical trial with a split-mouth design. Twenty-five patients with severe posterior maxillary atrophy were treated with bilateral sinus floor elevation with lateral approach. Antrostomies were randomly performed by eroding the cortical wall with a manual bone scraper (test site) or with an ultrasonic insert (control site) until the membrane was visible under a thin layer of bone, before outlining the window with a piezoelectric device. Occurrence of membrane perforation, laceration of vascular branches, and surgical time were recorded. Mean surgical time of the antrostomy in the test sites was 9'18", while in the control sites was 9'47". No significant differences were found in terms of surgical time, incidence of membrane perforation during antrostomy (4.3% in both groups), or other intraoperative complications between the 2 techniques. Both surgical approaches represent effective options for performing lateral antrostomies during sinus floor elevation procedures in a safe and predictable way.

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.

Minimally Invasive Sinus Augmentation Procedure Using a Dedicated Hydraulic Sinus Lift Implant Device: A Prospective Case Series Study on Clinical, Radiologic, and Patient-Centered Outcomes.

The aim of this study was to evaluate clinical and radiologic outcomes of a novel device that allows simultaneous hydraulic sinus membrane elevation, bone grafting, and implant placement. A sample of 18 consecutive participants with severe atrophy of the posterior maxilla underwent transcrestal elevation of the sinus membrane and implant placement. At the 6-month follow-up, the following parameters were assessed: implant success, any complications, marginal bone loss (MBL), three-dimensional (3D) graft measurements, implant stability quotient (ISQ), and graft density. No implants failed during follow-up (10.8 ± 2.8 months; range: 7-14 months). No membrane tears or other adverse events were observed. Mean residual alveolar ridge height was 4.78 ± 0.88 mm. Six months after the procedure, the mean MBL was 0.18 mm. The mean sinus membrane elevation was 12.78 ± 2.18 mm (range: 10.7-14.23). Along the basic 3D reference planes, the dimensions of grafted bone measured around implants were as follows: axial area = 239.7 ± 57.68 mm2; sagittal area = 257.0 ± 60.83 mm2; coronal area = 143.3 ± 29.46 mm2. The mean volume of the graft was 2.38 ± 0.26 mL at baseline and 2.05 ± 0.24 mL 6 months after graft maturation (difference: 0.33 ± 0.29 mL, P = .0090). Graft density (in Hounsfield units [HU]), improved during healing from 322.0 ± 100.42 HU to 1,062.0 ± 293.7 HU; difference 740.0 ± 295.35 HU (P = .0001). The mean ISQ value was 65.5 at implant placement, and it increased to 74.1 at the 6-month examination (P = .0014). Of 18 patients, 12 experienced no pain (66.6%) and 10 experienced no swelling (55.5%). No severe pain or swelling was reported in any of the cases. The mean number of analgesic tablets consumed was 0.78 ± 0.67. Mean surgical time was 24.0 ± 4.07 minutes. The iRaise Sinus Lift System may provide a new option for minimally invasive transcrestal sinus surgery with minimal patient discomfort. A physiologic contraction of 13.9% of its original volume was experienced during healing. Long-term clinical studies are needed to confirm these preliminary results.

Ex vivo comparative study on three sinus lift tools for transcrestal detaching maxillary sinus mucosa.

The objective of this study was to comparatively evaluate 3 different sinus lift tools, namely umbrella-shaped sinus lift curette YSL-04, our recently designed probe-improved sinus lift curettes, and our newly invented elevator 014, using our previous developed goat ex vivo models for direct visualizing the effectiveness of detaching sinus mucosa in real time. Goat ex vivo models for direct visualizing the effectiveness of detaching sinus mucosa in real time were generated according to our previously developed protocol. The effectiveness for each tool was evaluated through the length of sinus mucosa detached in mesial and distal directions or buccal and palatal directions, and the space volume created by detaching maxillary sinus mucosa in mesial, distal, buccal and palatal directions. The results showed that all 3 sinus lift tools could transcrestally detach the maxillary sinus mucosa and create extra space under the elevated sinus floor on the goat ex vivo sinus models. Moreover, our newly invented elevator 014 had advantages over the other 2 in term of the capability to detach the sinus mucosa. Our newly invented elevator 014 might be a promising tool for detaching maxillary sinus mucosa in transcrestal maxillary sinus floor elevation.

Implants inserted with graftless osteotome sinus floor elevation - A 5-year post-loading retrospective study.

PURPOSE: To report the outcome of graftless osteotome sinus floor elevation (OSFE) in order to evaluate whether apical bone gain depends on the initial residual bone height and whether the initial residual bone height has an influence on the amount of marginal bone loss. Furthermore the study aimed to assess if perforations of the Schneiderian membrane or residual bone height are potential predictors of implant survival. MATERIALS AND METHODS: In this retrospective study all patients were included who were treated between 2001 and 2010 and received dental implants in combination with OSFE in a private practice. Patients having 1 to 11 mm of residual bone height were subjected to crestal sinus lift elevation. One hundred and thirteen patients with 233 implants were included in this study. The follow-up period was 5-years post-loading for all patients. The average initial bone level height was 5.9 ±â€…1.7 mm. No bone graft or substitute material was used. All implants healed transgingivally and were loaded 3 months after insertion. Outcome measures were prosthetic success, implant success, complications, radiographic crestal bone level changes and apical (sinus floor) bone height. RESULTS: Sixty-three patients dropped out during the 5-year post-loading follow-up. Seven implants in 7 patients failed. Implant survival rate 5 years after loading was 93.8% at patient level. Implants succeeded in 92.7% of all cases. In six patients (5.3%), prostheses failed and had to be remade. Minor complications like small ceramic fractures and loosening of prosthetics were observed in seven patients (6.2%). Average marginal bone loss at 5 years of follow-up was 0.5 ±â€…0.8 mm per patient. No correlation was found between marginal bone loss and initial residual bone height. Average gained bone height was 4.5 ±â€…1.4 mm after 5 years of loading. We found a significantly negative linear correlation for apical bone gain depending on the baseline bone level (P < 0.001). The apical bone gain was higher in cases with less residual bone. CONCLUSIONS: Implants after graftless osteotome sinus floor elevation showed excellent survival and success rates after 5 years of loading. Apical gain of newly formed bone was positively correlated with the initial bone height showing a statistical significance. However, initial residual bone height is also a predictor for implant survival, i.e. survival increases by 1.6 times with every additional millimetre of initial residual bone height. Conflict-of-interest statement: All authors declare that they have neither financial nor non-financial competing interests.

Endoscopically controlled hydraulic sinus lift in combination with rotary instruments: one-year follow-up of a case series.

The aim of this study was to evaluate a sinus lift via crestal approach (SLVCA) case series, performed with rotary instruments and hydraulic pressure, analyzed under endoscopic control. Sixteen patients (11 female, 5 male, mean age 47.13±8.07 years) candidates for SLVCA were enrolled in this study. Twenty-two cylindrical two-piece implants were placed. After a suitable period of time needed for the consolidation of the graft (mean value 5.78±1.49 months), the bone augmentation was assessed by means of intraoral X-ray exams before the surgical procedure of re-entry. After a functional load with temporary acrylic fixed prosthesis, on Peek abutments, for a span of 4 months, the cases were finalized with cemented metal-ceramic prosthesis (10 single crowns, 6 bridges). The post finalization follow-up was at 12 months. During the perforation of the sinus floor via rotary instruments no perforations of the sinus membrane were observed either during the hydraulic detachment or simultaneous filling of the subantral space with the graft material. Survival rate was 94.5% since one fixture was lost, but immediately replaced with a new one. At the one-year follow-up the clinical and radiological appearance of the soft and hard tissues was optimal and no pathological signs were recorded. The SLVCA performed with rotary instruments and hydraulic pressure is a reliable grafting procedure for oral rehabilitation of maxillary edentulous sites.

Incidence of and Factors Associated with Sinus Membrane Perforation During Maxillary Sinus Augmentation Using the Reamer Drilling Approach: A Double-Center Case Series.

Maxillary sinus membrane perforation has been reported as the most common intraoperative complication during sinus augmentation, potentially leading to postoperative infection and consequent loss of graft or even implant failure. Numerous anatomical factors have been demonstrated to affect membrane tearing. However, careful use of proper instrumentation, such as a reamer, seems to play an important role in minimizing the incidence of these complications. Hence, the aim of the present study was to (1) investigate the reliability of reamer drilling for lateral window preparation; (2) examine the incidence of membrane perforation; and (3) study the factors that might influence membrane perforation. Results from this study showed the safety and effectiveness of using a reamer to perform lateral window approach sinus augmentation. The sinus membrane perforation rate was found to be 12.5%. A slightly higher perforation rate was noted in thinner maxillary lateral walls (< 1.25 mm). The authors concluded that reamer drilling is a safe and effective alternate technique for opening the lateral window wall when the lateral wall thickness is ≥ 1.25mm.