Histologic findings in sinus augmentation with autogenous bone chips versus a bovine bone substitute

PURPOSE: The aim of this study was to compare a bovine bone substitute (Bio-Oss) to autogenous bone with respect to its value as a material for sinus augmentation. MATERIALS AND METHODS: In 10 beagle dogs 12 months of age, the 3 maxillary premolars were extracted on both sides. Six weeks later, 2 cavities of predefined size were produced in the region of the nasal cavity. The antral window was 25 mm long and had a vertical extension of 7 mm. Two Frialit-2 implants (3 x 8 mm) were placed in each bone defect (n = 20). Every implant was primarily stable because of fixation in native bone. In each maxilla, 1 bone defect was filled with autogenous bone harvested from the mandible and 1 was filled with Bio-Oss (material selected at random). The animals were sacrificed at 90 and 180 days, and histologic specimens were examined and the results subjected to statistical analysis by the Wilcoxon test for paired observations. RESULTS: No healing problems were observed. Histologically, after 90 days the volume of the augmentation showed a reduction of 14.6 +/- 4.4% within the Bio-Oss group and 3.8 +/- 2.5% in the group with autogenous bone. Bone-implant contact of 52.16 +/- 13.15% in the Bio-Oss group and 60.21 +/- 11.46% in the autogenous bone group was observed. At 180 days, the Bio-Oss group showed bony ingrowth of the substitute, whereas in the autogenous group a differentiation from original bone could no longer be made. The volume reduction was 16.5 +/- 8.67% in the Bio-Oss group and 39.8 +/- 16.14% in the autogenous group. Bone-implant contact of 63.43 +/- 19.56% in the Bio-Oss group and 42.22 +/- 12.80% in the autogenous bone group was measured. DISCUSSION AND CONCLUSION: The results indicated that because of the nonresorptive properties of the bone substitute Bio-Oss, regeneration of the defects is achievable. It was demonstrated that the bone substitute seemed to behave as a permanent implant. The volume of the area augmented by autogenous bone decreased over the observation period.     

Histologic and clinical evaluation for maxillary sinus augmentation using macroporous biphasic calcium phosphate in human

Objectives: This study evaluated both the clinical and histological aspects of bone formation in maxillary sinus augmentation using MBCP as the bone-grafting material.
Material and methods: MBCP was used as a primary bone substitute for maxillary sinus augmentation. Fifty-two patients were selected after a medical and dental examination, and were divided into the following three groups: those augmented with MBCP only; MBCP combined with irradiated cancellous bone; and MBCP combined with intraoral autogenous bone. After a healing period (average 6.78 months after surgery), bone cores were harvested for a histological evaluation and the implant fixtures were installed. These bone cores were evaluated via light microscope and implants were followed up for at least six months after loading.
Results: Four to ten months after surgery, new vital bone surrounding the MBCP particles was observed in 18 bone biopsies. Two out of the 130 implants installed were explanted due to a failure of osseointegration before the prosthetic procedure. All the remaining implants were functioning for 6 to 27 months (average 12.96 months). The cumulative survival rate of the implants was 98.46%.
Conclusion: These results show that MBCP can be used as a grafting material for sinus floor augmentation, whether combined with other bone graft materials or not, and lead to a predictable prognosis for dental implants in the posterior maxillary area where there is insufficient vertical height for fixture installation.     

A clinical and histologic evaluation of implant integration in the posterior maxilla after sinus floor augmentation with autogenous bone,bovine hydroxyapatite,or a 20:80 mixture

PURPOSE: This study was designed to clinically and histologically evaluate the integration of titanium implants in different grafting materials used for maxillary sinus augmentation procedures. MATERIALS AND METHODS: A total of 21 patients and 36 maxillary sinuses were augmented with (1) autogenous particulated bone from the mandibular ramus, (2) bovine hydroxyapatite (BH) with membrane coverage, or (3) an 80/20 mixture of BH and autogenous bone. The grafts were allowed to heal for 6 to 9 months prior to placement of microimplants for histology and standard implants for prosthetic rehabilitation. After another 6 months of healing, when abutments were connected, the microimplants were retrieved for histologic and morphometric analyses. The outcome of the standard implants was clinically evaluated after 1 year of loading. RESULTS: The mean bone-implant contact was 34.6 +/- 9.5%, 54.3 +/- 33.1%, and 31.6 +/- 19.1% for autogenous bone, mixture of 20% autogenous bone/80% BH, and 100% BH, respectively. The corresponding values for the bone area parameter were 37.7 +/- 31.3%, 39.9 +/- 8%, and 41.7 +/- 26.6%. The BH area was found to be 12.3 +/- 8.5% and 11.8 +/- 3.6% for 20% autogenous bone/80% BH and 100% BH, respectively. There were no statistically significant differences for any parameter between any of the groups. After 1 year of loading, 6 of the 33 implants placed in autogenous bone grafts, 2 of the 35 implants placed in the BH/autogenous bone mixture, and 2 of 43 implants placed in BH were lost. There were no statistically significant differences between any of the groups. DISCUSSION: The histomorphometric analysis showed no differences between the 3 groups, indicating that autogenous bone graft can be substituted with bovine hydroxyapatite to 80% or 100% when used for maxillary sinus floor augmentation. The effect of adding autogenous bone remains unclear but may allow for a reduction of the healing time. CONCLUSION: The results from this clinical and histologic study indicate that similar short-term results can be expected when using autogenous bone, BH, or a mixture of them for maxillary sinus floor augmentation and delayed placement of dental implants.     

Maxillary sinus augmentation using xenogenic bone substitute material Bio-Oss in combination with venous blood. A histologic and histomorphometric study in humans

The aim of the present study was to evaluate bone formation following maxillary sinus augmentation using bovine bone substitute material Bio‐Oss^® in combination with venous blood by means of histologic and histomorphometric examination of human biopsies. This involved a total of 15 sinus floor elevation procedures being carried out on 11 patients (average age of 49.6 years) according to the technique described by Tatum (1986). The subantral sinus cavity was augmented using bovine apatite combined with venous blood. After an average healing phase of 6.8 months, trephine burrs were used to take 22 bone biopsies from the augmented sinus region. Then 38 Brånemark^® implants were inserted in both the osteotomies resulting from bone sampling and in regular sites in the augmented posterior maxilla. Histomorphometric analysis of ground sections from the bone biopsies prepared according to the standard method of Donath & Breuner (1982) produced an average percentage of newly‐formed bone of 14.7% (±5.0%) and a proportion of residual xenogenic bone substitute material of 29.7% (±7.8%). Some 29.1% (±8.1%) of the surface of the Bio‐Oss^® granulate was in direct contact with newly‐formed bone. Histologically, newly‐developed bone became evident, partly invaginating the particles of apatite and forming bridges in the form of trabeculae between the individual Bio‐Oss^® particles. Despite the absence of osteoclastic activity, the inward growth of bone indicates slow resorption of the xenogenic bone graft material. When the implants were uncovered, after an average healing phase of 6 months, 4 of the 38 implants had become loose. Of these 4 implants, 1 had to be subsequently explanted, while the others remained as “sleeping implants” and were not included in the implants superstructure. Thus, the resulting clinical survival rate, prior to prosthetic loading, was 89.5%.     

Bio-Oss骨粉在上颌窦提升牙种植术中的临床应用

目的：评价上颌窦提升，植Bio-Oss骨粉在上颌后牙种植的方法和效果。方法：对11例牙槽骨高度不足的上颌后牙种植进行上颌窦提升，植Bio-Oss骨粉，同期种植7例，延期种植4例。结果：6个月后，X线片显示Bio-Oss骨粉改建形成了新骨，增加了牙槽骨高度，满足了种植要求，7例同期种植可见种植体与Bio-Oss诱导的新骨形成紧密的骨性结合，种植体植入9个月后进行二期修复。结论：Bio-Oss骨粉植入提升上颌窦增加了上颌后牙区的牙槽骨高度，拓展了种植的适应证，免疫除了自体取骨手术，方法简单，值得临床推广。     

Histomorphometric analysis of natural bone mineral for maxillary sinus augmentation

PURPOSE: Lack of bone height in the posterior maxilla often necessitates augmentation prior to or simultaneously with dental implant placement. The purpose of this clinical study was to evaluate the use of the natural bone mineral Bio-Oss alone or in combination with autogenous bone in sinus floor elevations performed as 1- or 2-step procedures. MATERIALS AND METHODS: Thirty-eight patients required sinus augmentation. Natural bone mineral alone was used in sinus floor augmentation in 21 patients. In 13 patients, a mixture of the bone substitute and autogenous bone was used, and in 4 patients autogenous bone alone was used. In all of the patients, samples were taken for biopsy 3 to 8 months postoperatively, and bone regeneration was evaluated histologically and histomorphometrically. RESULTS: In all patients, the amount of new bone significantly increased over the observation time, while marrow areas decreased. There was no statistically significant difference in the amount of new bone formation between the Bio-Oss group (new bone 29.52% +/- 7.43%) and the Bio-Oss/autogenous bone group (new bone 32.23% +/- 6.86%). In the 4 patients treated with autogenous bone alone, a greater amount of newly formed bone was found; however, in these cases the area volume filled was smaller than in the other 2 groups. DISCUSSION: The data showed that new bone formation takes place up to 8 months after sinus floor elevation and that there is no difference in the amount of bone formation between procedures done with the bone substitute alone or with the mixture of the substitute and autogenous bone. CONCLUSION: These data suggest that predictable bone formation can be achieved with the use of Bio-Oss.     

A Clinical and Histological Case Series Study on Calcium Sulfate for Maxillary Sinus Floor Augmentation and Delayed Placement of Dental Implants

Background: Maxillary sinus floor augmentation is a procedure that is indicated in cases when the volume of the posterior maxillary bone is inadequate. The goal of this treatment is to obtain sufficient amount of bone tissue in order to gain osseointegration of endosseous implants. Purpose: The purpose of this study was to conduct a clinical and histological analysis of calcium sulfate (CaS) as bone graft substitute in sinus floor augmentation. Material and Methods: Ten patients with edentulous maxillas were included in this study. They had moderate to severe atrophy of the posterior maxilla. Surgiplaster (Classimplant®, Rome, Italy) was used as graft material in the maxillary sinus and was covered by BioGide® (Geistlish Pharmaceutical, Wolhusen, Switzerland). After 4 months of graft healing, 40 dental implants were placed and a biopsy for histomorphometry was taken at these occasions. The specimens were viewed by light microscope, and the extent of bone regeneration and remaining graft material was evaluated. Radiographs were taken at the time of sinus augmentation and after 4 months of graft healing. Results: At the time of abutment surgery, one implant was considered as a failure and was consequently removed, giving a survival rate of 97.5% after 1 year of loading. Radiographs showed a mean of 26.5% shrinkage of the augmented area. A significant resorption of CaS was noted with a mean value of 8.8% of remaining graft material after 4 months of healing. The biopsies also revealed new bone formation with a mean value of 21.2% of the total biopsy area. Histology showed signs of an acellular substitution of CaS with bone‐like tissue. Conclusion: The results of this study show that new bone regeneration occurs in the maxillary sinus after augmentation with CaS. This enabled successful placement, integration, and loading of dental implants in the posterior maxilla, as only 1 of 40 implants was lost during 1 year of follow‐up.     

Clinical evaluation of demineralized bone allograft in a hyaluronic acid carrier for sinus lift augmentation in humans: a computed tomography and histomorphometric study

OBJECTIVES: Natural and synthetic graft materials are used routinely in sinus floor augmentations to help support implants in atrophic maxillary ridges. This clinical study was based on the hypothesis that the clinical effectiveness of demineralized freeze-dried bone allograft/demineralized bone matrix (DFDBA/DBM) in sinus lifts varies when used in combination bone graft substitute materials. To test this hypothesis, DFDBA was used together with one of three materials: in saline plus anorganic bone (DFDBA: Bio-Oss; in hyaluronic acid (DFDBA: HY, 32 : 68, w/w; DBX alone; DBX plus Bio-Oss; and DBX plus tricalcium phosphate granules (beta-TCP). MATERIAL AND METHODS: Thirty-two sinus lift procedures, eight per group, were performed on 26 patients. Before surgery and at 8 months post-surgery when implants were placed, ridge heights were visualized by computed tomography (CT) and measured by morphometric analysis. Cores of bone were removed by trephine at the sites of implant placement; these biopsies from the graft sites were used for histomorphometric analysis. RESULTS: All 32 sinus lift elevations were successful when measured by CT, increasing from an average 2.84+/-0.2 mm before treatment to 15.2+/-0.6 mm after treatment. The percent of each biopsy that was occupied by new bone and incorporated bone graft materials varied with each treatment: DFDBA+Bio-Oss, DBX+Bio-Oss, or DBX alone was higher than that for DBX+beta-TCP by approximately 10%. When comparing only newly formed bone, DBX+beta-TCP treatment resulted in 50% less bone than the other three preparations. All grafted sites received implants as per the treatment plan for each patient. CONCLUSIONS: This study confirmed the hypothesis that new bone formation is dependent on the DFDBA formulation used and demonstrated that DBX, alone or in combination with other materials, can be used successfully for sinus floor elevation.     

Immediate loading of the grafted maxillary sinus using platelet rich plasma and autogenous bone: a preliminary study with histologic and histomorphometric analysis

OBJECTIVE: The goal of this clinical study was to evaluate dental implant survival rates using the concept of a nonfunctional, immediate loading protocol with nonsplinted dental implants in the grafted maxillary sinus during a 52-week period. Random histomorphological and histomorphometric analysis was completed to evaluate the early healing effect of platelet rich plasma (PRP) and 50% autogenous bone combined with 3 different substitute graft materials. MATERIALS: Four to 8 months after grafting the sinus with PRP sprayed autogenous bone combined with 3 different substitute graft materials in a 50:50 composite ratio, 27 hydroxyapatite- coated dental implants were surgically placed in 41 patients and immediately loaded between 48 hours and 5 days later with custom titanium abutments and acrylic provisional restorations placed out of functional occlusion. Six months later, definitive ceramometal restorations were cemented on to the custom abutments. RESULTS: During a 52-week observation period, no implants were lost. Between 4 and 8 months of graft healing time, histologic and histomorphometric analysis revealed formation of new vital bone in different graft specimens ranging from 77% to 100%. CONCLUSION: The preliminary results of this clinical study indicate that immediate nonfunctional loading using PRP and 50% autogenous bone combined with different substitute graft materials is a predictable protocol in the grafted maxillary sinus as early as 4 months of postgrafting. The high implant survival rate is due to the early formation of large percentages of new vital bone as confirmed by using histologic and histomorphometric analysis.     

A clinical long-term radiographic evaluation of graft height changes after maxillary sinus floor augmentation with a 2:1 autogenous bone/xenograft mixture and simultaneous placement of dental implants

The aim of the present study was to assess long-term changes in sinus-graft height after maxillary sinus floor augmentation and simultaneous placement of implants. A total of 191 patients who underwent maxillary sinus floor augmentation were radiographically followed for up to about 10 years. A 2 : 1 mixture of autogenous bone and bovine xenograft (Bio-Oss) was used as the graft material. Sinus-graft height was measured using 294 panoramic images immediately after augmentation and up to 108 months subsequently. Changes in sinus-graft height were calculated with respect to implant length and original sinus height. Patients were divided into three groups based on the height of the grafted sinus floor relative to the implant apex: Group I, in which the grafted sinus floor was above the implant apex; Group II, in which the implant apex was level with the grafted sinus floor; and Group III, in which the grafted sinus floor was below the implant apex. After augmentation, the grafted sinus floor was consistently located above the implant apex. After 2-3 years, the grafted sinus floor was level with or slightly below the implant apex. This relationship was maintained over the long term. Sinus-graft height decreased significantly and approached original sinus height. The proportion of patients classified as belonging to Group III reached a maximum from year 3 onwards. The clinical survival rate of implants was 94.2%. All implant losses occurred within 3 years after augmentation. We conclude that progressive sinus pneumatization occurs after augmentation with a 2 : 1 autogenous bone/xenograft mixture, and long-term stability of sinus-graft height represents an important factor for implant success.     

Maxillary sinus lift with solely autogenous bone compared to a combination of autogenous bone and growth factors or (solely) bone substitutes. A systematic review

Literature regarding the outcome of maxillary sinus floor elevation to create sufficient bone fraction to enable implant placement was systematically reviewed. Bone fraction and implant survival rate were assessed to determine whether grafting material or applied growth factor affected bone fraction. Trials where sinus floor elevations with autogenous bone (controls) were compared with autogenous bone combined with growth factors or bone substitutes, or solely with bone substitutes (test groups) were identified; 12 of 1124 fulfilled all inclusion criteria. Meta-analyses comparing the bone fraction after applying: autogenous bone; autologous bone with growth factors (platelet rich plasma); or autogenous bone and bone substitutes (bovine hydroxyapatite, bioactive glass, corticocancellous pig bone) revealed no significant differences in bone formation after 5 months. A significantly higher bone fraction was found in the autogenous bone group compared to the sole use of β-tricalciumphosphate (P=0.036). The one-year overall implant survival rate showed no significant difference between implants. Bone substitutes combined with autogenous bone provide a reliable alternative for autogenous bone as sole grafting material to reconstruct maxillary sinus bony deficiencies, for supporting dental implants after 5 months. Adding growth factors (platelet rich plasma) to grafting material and the sole use of β-tricalciumphosphate did not promote bone formation.     

Dental implant treatment with different techniques for sinus floor elevation--a case report

A 60-year-old man with missing maxillary molar teeth received dental implant therapy for reconstruction of occlusion. Sinus floor elevation with autogenous bone graft consisting of iliac bone block and particulate cancellous bone and marrow (PCBM) was performed in the bilateral maxillary sinuses for implant placement. On the right side, bone height in the molar region was less than 2mm. Therefore, a delayed protocol was applied, and 2 implants were placed 4 months after bone grafting. Bone graft resorption occurred during the healing period of 4 months. On the left side, 3 implants were placed simultaneously with sinus floor elevation, as bone height in the molar region was more than 4-5mm. The bone graft was carried out at the same time as implant placement. After implant placement, resorption of the bone graft stopped, and the superstructures were delivered on both sides. The tissues around the implants were clinically healthy at one year after examination. Sinus floor elevation with autogenous bone graft is an acceptable option for implant treatment in the maxillary molar region where there is adequate height of existing bone. In postoperative care, it is important to undertake adequate follow-up to ascertain occurrence of bone graft resorption.     

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??Objective    To evaluate the clinical results of sinus floor elevation technique with simultaneous dental implantation in the posterior maxilla. Methods    A total of 79 patients underwent osteotome sinus floor elevation from 2009 to 2012. Bio-Oss and PRF were used as augmentation material??with simultaneous placement of implants. Results    The implant lengths ranged from 10 to 13 mm. The average height increase of the implant site was 3.8 ??2 to 5.7??. Sinus membrane perforation occurred in 3 cases and the dental implantation was abandoned. Totally 87 implants were placed. At second stage of surgery?? 3 failed implants were removed. Two implants were removed 18 months after prosthetic rehabilitation. One implant was lost due to progressive bone loss. The overall survival rate was 93.1%??81/87??. No clinical complications of the maxillary sinus area were observed during a follow-up period of 12 to 36 months. Conclusion    Osteotome sinus floor elevation with bone graft was a predictable and safe technique. It simplifies the surgical process and can be taken predictably for implant placement with surgical technique.     

Histomorphometric Analysis of Human Maxillary Sinus Lift with a New Bone Substitute Biocomposite: A Preliminary Report

Purpose: To analyze radiographic and histological outcomes of maxillary sinus floor augmentation using a calcium-sulfate based allograft containing demineralized bone matrix particles.
Materials and Methods: Fifteen maxillary sinus lift procedures with simultaneous placement of titanium implants were performed in 12 patients of both genders aged 36–71 years. Each sinus cavity was filled by the biocomposite. After 3 months of healing, all surgical sites were uncovered and bone biopsies were retrieved for undecalcified histology and histomorphometry. The ratio between the original and the grafted sinus height (GSH/OSH) was computed using a panoramic radiography taken immediately after surgery and at 3 months of healing, and the two ratios were compared by Wilcoxon signed-rank test.
Results: By 3 months, all implants were stable without clinical and radiographic signs of infection. Significant changes in GSH/OSH during healing were seen (2.7 ± 0.6 initially vs. 2.6 ± 0.5 after healing; p  = 0.01). Histologic findings showed newly formed bone surrounding the residual grafted particles without inflammation. At 3 months, mean regenerated bone density was 33.8 ± 8.6%; marrow spaces amounted to 32.3 ± 10.3%; residual graft was 33.9 ± 9.0%. Similar histomorphometric and radiographic results were obtained independently from patient age or sex.
Conclusions: The analysed putty seems to be a safe and effective graft material for maxillary sinus floor augmentation by accelerating bone regeneration and thus reducing the healing time.     

Sinus grafting with porous bone mineral (Bio-Oss) for implant placement: a 5-year study on 15 patients

The efficacy of Bio-Oss as a graft material for sinus floor elevation was studied in 15 patients. A total of 20 sinus augmentation procedures was performed, and 6 months later 57 implants were placed into the augmented sinuses. New bone formation was confirmed in biopsies of 3 patients (new bone: 21.08% +/- 7.25% after 6 mo, 27.55% +/- 4.88% after 12 mo; Bio-Oss: 39.17% +/- 4.36% after 6 mo, 27.01% +/- 11.64% after 12 mo). After a mean loading period of 4.0 +/- 0.5 years (range 3.2 to 4.8 y), 56 implants remained in place. This study confirms Bio-Oss's good osteoconductive properties.     

上颌窦外提升术在口腔种植术中的应用

目的:探讨上颌窦提升术在口腔种植术中的应用以扩大口腔种植术中的应用范围。方法:25例患者通过上颌窦提升术同期或延期植入种植体31枚,术中患者使用了Bio-Oss胶原质作为骨移植材料,采用非埋入式种植技术。结果:术后6个月,上颌窦底提高4-6mm,所有病例完成修复后,随访6-24各月,x线检查窦底骨质无明显吸收,种植体骨结合良好,无松动脱落,修复效果满意。结论:上颌窦提升术扩大了口腔种植术的应用范围。     

上颌窦底提升同期植入种植体过程中超声骨刀和植骨量的作用

目的:评价应用超声骨刀进行上颌窦底开放式外提升同期植入种植体,以及不同植骨量对种植效果的影响。方法:对21例上颌后牙槽骨高度不足患者随机分成两组,应用超声骨刀进行上颌窦底开放式外提升同期植入种植体,将A组11例患者进行全量骨粉植入,B组10例患者进行半量骨粉植入,6-12个月后检查种植体的稳定性和骨愈合情况。结果:A、B两组25颗种植体与周围组织均形成良好的骨性结合,无上颌窦炎发生,两组间无显著差异。结论:应用超声骨刀行上颌窦底提升术可精确地完成手术,术中半量或全量植骨均能达到较好的临床效果。     

上颌窦底提升同期种植体植入术79例临床分析

目的    观察采用经牙槽嵴入路提升上颌窦底同期植入种植体的临床效果。方法    对2009—2012年南京军区机关医院数字口腔中心接诊的79例上颌后牙缺失患者,行经牙槽嵴顶入路上颌窦底提升,选择性植入人工骨或富血小板纤维蛋白（PRF）,同时植入种植体。结果    79例患者平均提升上颌窦底高度3.8 mm（2.0～5.7 mm）。3例患者因上颌窦黏膜术中发生穿孔,遂关闭创口,未完成种植体植入。其余76例共植入87颗种植体,长度 10～13 mm。Ⅱ期手术时,3颗种植体松动拔除。义齿修复后追踪12～36个月,2颗种植牙松动拔除,1颗有进行性骨吸收,种植体存留率为93.1%（81/87）。所有病例均无上颌窦并发症。结论    经牙槽嵴顶入路上颌窦底提升术较开窗式上颌窦提升创伤小,操作简单,对窦底有适量剩余骨的上颌窦区种植是可行的;但由于窦底黏膜存在穿孔风险,技术要求较高,而且必须有专用的器械。     

Sinus floor augmentation with autogenous iliac bone block grafts: a histological and histomorphometrical report on the two-step surgical technique

In thirteen patients, screw-type endosseous implants were inserted 6 months after sinus floor elevation and augmentation with autogenous iliac bone block grafts. Bone biopsies were harvested at graft positioning (baseline), at implant placement (6 month) and at abutment connection (1 year). Histological evaluation suggested a decrease in the volume of mineralized tissue and in the vitality of the grafts 6 months after graft insertion, followed by an increase at abutment connection. Histomorphometric analysis of the bone specimens showed that, at implant placement, bone content was reduced by 5.2% on average, while 12 months after grafting it had increased by 4.8% compared to the amount of mineralized tissue contained in the graft at baseline. The results suggest that in sinus floor augmentation procedures with autogenous iliac bone blocks, a two-step surgical technique allows implant insertion when graft healing is entering a phase of greater density and vitality.     

Maxillary sinus floor augmention with autogenous bone grafts to enable placement of SLA-surfaced implants: preliminary results after 15-40 months

This study presents preliminary results of placing SLA(R) surfaced ITI(R) implants in conjunction with maxillary sinus floor augmentations using autogenous bone. One hundred and eighty three ITI implants (SLA(R) surface) were inserted after 66 sinus floor elevation procedures in 41 consecutive patients. Forty-eight implants were placed simultaneously and 135 implants in a staged procedure with an average healing time of 4.9 months (148 days) after sinus grafting. Loading of the implants was allowed following an average time of 4.1 months (122 days). The follow-up time was 15-40 months after implant placement. Clinical follow-up consisted of single tooth and panoramic X-rays, and determination of Bleeding On Probing (BOP) and Plaque Index. One implant failed. One hundred and eleven of the inserted implants were used for fixed dentures, 20 for bar constructions, 41 for single crowns, and 11 were loaded provisionally until today. The total 2-year implant survival rate was 99.5%. Keeping the short follow-up period in mind, the encouraging results compared with previous studies, further support the findings of a positive influence of rough surfaces in grafted bone.