Patterns of tissue remodeling after placement of ITI dental implants using an osteotome technique: a longitudinal radiographic case cohort study

The aim of this prospective study was to document radiographically tissue remodeling patterns around ITI implants placed according to an osteotome technique. In 19 consecutive patients from a private practice, 25 implants of the ITI Dental Implant System were placed subjacent to the sinus floor. Implant beds were pre-prepared with pilot drills and/or using the Summers Osteotome Kit. Bio Oss particles were mixed with autologous bone and inserted into the apex area. Implants were placed self-tapping. The sinus floors were thereby pushed up with attempts not to sever the Schneiderian membrane. Healing occurred submerged or semi-submerged and was uneventful in 24/25 implants. At 1 year, all implants had been restored with crowns or short fixed partial dentures. One implant was lost in the first 3 weeks, but was replaced 6 months later in a second attempt. Intraoral radiographs were obtained presurgically and postsurgically at 3 and 12 months. The mean preoperative distance between the sinus floor and the crest was 7.0 mm (range 2.3-10.3 mm). The mean distances between the implant apex and the initial sinus floor were: 3.66 +/- 1.74 mm mesially and 4.44 +/- 1.62 mm distally. The mean height of the new bone reaching apically and mesially to the implants was 1.52 +/- 2.48 mm at surgery, but was reduced significantly to 1.24 +/- 1.30 mm at 3 months and 0.29 +/- 1.91 mm after 12 months (Hotelling's test P< or =0.01). Similar values were obtained at the disto-apical aspects. In an attempt to assess periapical bone/graft remodeling, a novel index was applied: 0=no bone/graft visible, 1=cloudy appearance of new bone/graft, 2=clearly visible new bone/graft disappearing structures of original sinus floor, 3=new bone/graft with new cortical plate and the former boundary of the sinus floor disappearing. This index increased statistically significantly from baseline to 12 months (Hotelling's test P< or =0.02). In conclusion, this study shows that in areas with reduced bone height subjacent to the sinus, an osteotome technique may provide a minimally invasive way to obtain implant abutments predictably. The grafted area apical to the implants undergoes shrinkage and remodeling. The original boundary of the sinus is eventually consolidated and replaced by a new cortical plate. In addition to the linear measurements, the novel index may assist in assessing periapical remodeling at implants placed with an osteotome technique.     

Osteotome sinus floor elevation without grafting material: a 1-year prospective pilot study with ITI implants

OBJECTIVE: The aim of the present pilot study was to evaluate: (1) the predictability of an osteotome sinus floor elevation procedure with ITI-SLA implants without placing a bone grafting material, and (2) the possibility to gain bone height without filling the created space with a bone grafting material. MATERIAL AND METHODS: Seventeen patients received 25 implants protruding in the sinus. Most implants (21/25) were 10 mm long, eight were inserted in type 2 bone, 12 in type 3 and five in type 4 bone. At implant placement, the mean residual bone height (RBH) under the maxillary sinus was 5.4+/-2.3 mm; it was 5.7+/-2.6 mm on the mesial side and 5.1+/-1.9 mm on the distal side. Nineteen implants had less than 6 mm of bone on at least one side and six implants had less than 6 mm on both sides. A healing period of 3-4 months was allowed before abutment tightening at 35 Ncm. The percentage of stable implants at abutment tightening and at the 1-year control was calculated. The endo-sinus bone gain and the crestal bone loss (CBL) at the mesial and distal sides were measured. RESULTS: Abutments were tightened after 3.1+/-0.4 months. All implants but one (96%) resisted the applied 35 Ncm torque. At the 1-year control, all implants were clinically stable and supported the definitive prosthesis. All showed endo-sinus bone gain; the mean gain was 2.5+/-1.2 mm. The mean CBL was 1.2+/-0.7 mm. Endo-sinus bone gain and RBH showed a strong negative correlation (r=-0.78 on the mesial side and -0.80 on the distal side). A good correlation (r=0.73) was found between implant penetration in the sinus and endo-sinus bone gain. CONCLUSION: Elevation of the sinus membrane alone without addition of bone grafting material can lead to bone formation beyond the original limits of the sinus floor. Despite a limited RBH at implant placement, a healing period of 3 months was sufficient to resist a torque of 35 N cm and to lead to a predictable implant function at the 1-year control.     

The endoscopically controlled osteotome sinus floor elevation: a preliminary prospective study

PURPOSE: It was the aim of the present prospective study to quantify the gain in height of implant sites by endoscopically controlled osteotome sinus floor elevations (ECOSFE) with simultaneous implant placement and to report the number of sinus membrane perforations. MATERIALS AND METHODS: From October 1999 to December 2000, of 92 sinus floor elevations, 18 were carried out endoscopically controlled with an osteotome technique. As augmentation material, beta-tricalcium phosphate (beta-TCP) or autogenous bone was used; 22 implants were placed. RESULTS: The residual height of the alveolar crest in the posterior maxilla was 6.8 +/- 1.6 mm on average. The implant lengths ranged from 10 to 16 mm (mean implant length 12.2 +/- 1.4 mm). They were significantly larger than the residual height of the alveolar crests (P < .0005). Elevation of the sinus floor with an osteotome had to be supported by conventional sinus floor elevation instruments after a mean elevation of 3.0 +/- 0.8 mm to prevent perforation of the sinus membrane. However, 1 perforation occurred, which was repaired with a periosteal patch. At stage 2 surgery, 2 implants were removed because of mobility. Endoscopic control revealed one case in which beta-TCP could be found within the sinus; another case showed areas of polypoid mucosa on the sinus floor. DISCUSSION: With the ECOSFE, perforations of the sinus membrane can be visualized; however, they cannot be avoided. Although this technique is less invasive than the lateral window technique, it cannot be recommended as a standard procedure in the posterior maxilla because of the large amount of additional equipment needed and the technically demanding procedure. CONCLUSION: The use of the ECOSFE should be confined to scientific trials.     

上颌窦区骨量不足3mm植骨后同期种植临床效果分析

目的:探讨在上颌窦区骨量不足3 mm的情况下,进行上颌窦底提升术并植骨同期将种植体植入的临床效果.方法:选择复旦大学附属中山医院和静安区牙病防治所2012年4月1日-2015年12月31日上颌后牙缺失患者56例,剩余牙槽骨高度均小于3 mm,术中行上颌窦底提升术并植骨,同期将种植体植入.术后3、6、12个月定期随访,分析及评估术后愈合效果及骨结合情况.结果:56例患者共植入72颗种植体,随访期间,种植体与周围骨组织结合良好,种植体稳定.术后6个月行种植修复,均能正常行使咀嚼功能,牙龈无形态、色泽异常,无并发症发生,手术成功率为100％.结论:对于上颌窦底骨量不足3 mm的患者,术中行上颌窦底提升术并植骨同期将种植体植入,也能取得良好的治疗效果.     

自体植骨上颌窦底提升同期种植体植入术近期疗效观察

目的:评价自体骨开窗式上颌窦提升术对上颌后牙区牙槽骨高度严重不足(高度4～6mm)的患者种植治疗的近期疗效。方法:对4例上颌后牙骨量不足(高度4～6mm)而需种植修复的病例,实施自体植骨的开窗式上颌窦提升术,并同期植入种植体共9枚。自体移植骨来自种植窝制备时中空钻取骨,在需做牙槽嵴修整处的牙槽骨棘取骨,如不够再用刮骨器取骨或从颏部手术取骨,将所取之骨碾碎备用。结果:术后7个月拍片,均显示骨性愈合;冠修复后行使功能18～24个月效果理想。结论:自体取骨植骨用于上颌窦提升,可扩大种植手术适应证,降低种植成本。     

开窗植骨与闭合冲压上颌窦底提升同期种植的临床研究

目的:研究比较上后牙缺失牙槽嵴高度不足患者,根据上颌窦底牙槽嵴骨高度不同,选用开窗植骨或闭合冲压提升上颌窦底,同期种植牙的治疗效果。方法:43例(55侧)上后牙缺失患者,其中34例(40侧)窦底牙槽嵴骨高6~10 mm者行闭合冲压上颌窦底提升术,其余9例(15侧)骨高2~5 mm者行开窗植骨上颌窦底提升手术,均同期完成一期种植体植入手术。结果:所有患者术后未出现上颌窦炎症,9例行开窗植骨上颌窦底提升手术的患者,无窦膜穿孔,平均提升窦底高度5.8 mm,26颗种植体平均负载30个月,种植体稳定,骨结合状况良好。34例行闭合冲压上颌窦底提升术的患者,平均提升窦底高度4.3 mm,手术操作中有3颗发生可察觉窦膜破孔,发生率为4.1%(3/73),在73颗种植体中,有2颗种植体失败,71颗种植体平均负载23个月,种植体稳定,未见明显骨吸收,成功率97.3%(71/73)。结论:闭合冲压上颌窦底提升术是一种微创、简单、可靠用于上颌后牙上颌窦底牙槽嵴骨高度不足的种植临床技术,临床上应根据上颌窦底牙槽嵴骨高度不同,选用开窗植骨或闭合冲压提升上颌窦底。     

上颌窦内提升术用于严重骨萎缩患者种植修复3年疗效观察

目的：研究单纯上颌窦内提升术用于严重骨萎缩患者种植修复的临床疗效。方法：对2008～2009年上颌后牙缺失伴缺牙处余留骨高度不足5 mm的22例患者行单纯上颌窦内提升术,同期植入Straumann？？ SLA种植体32颗。术后6、12、24、36个月复查并行X线片检查。结果：所有种植体均于术后3~6个月成功负载,其中1颗种植体在负载12个月时脱落,其余种植体稳固,无相关并发症出现。种植体在36个月时的存留率为96.88%。术后6、12、24、36个月的根尖片显示,上颌窦内种植体周围骨高度持续稳定增加,36个月时骨高度增加 （3.41±0.42） mm,边缘骨丧失（1.21±0.46） mm。结论：单纯上颌窦内提升同期植入种植体,能有效解决上颌后牙区严重骨萎缩时的牙种植修复问题。     

Influence of abutment connections and plaque control on the initial healing of prematurely exposed implants: an experimental study in dogs

BACKGROUND: Spontaneous early implant exposure is believed to be harmful, resulting in early crestal bone loss around submerged implants. The purpose of this study was to examine the influence of abutment connections and plaque control on the initial healing of prematurely exposed implants in the canine mandible. METHODS: Bilateral, edentulated, flat alveolar ridges were created in the mandible of 10 mongrel dogs. After 3 months of healing, two implants were placed on each side of the mandible following a commonly used two-stage surgical protocol. Implants on each side were randomly assigned to one of two procedures: 1) connection of a cover screw to the implant and removal of the gingiva to expose the cover screw; and 2) connection of a healing abutment to the implant so that the coronal portion of the abutment remained exposed to the oral cavity. In five dogs (plaque control group), meticulous plaque control was performed. In the other five dogs (no plaque control group), plaque was allowed to accumulate. At 8 weeks post-implantation, microcomputed tomography was performed at the implantation site to measure bone height in the peri-implant bone. RESULTS: The plaque control group had greater vertical alveolar ridge height (9.7 +/- 0.5 mm) than the group without plaque control (7.4 +/- 0.7 mm; P <0.05). In the plaque control group, the average bone height was greater with the abutment-connected implant (10.1 +/- 0.5 mm) than with the partially exposed implant (9.3 +/- 0.5 mm; P <0.05). In the group without plaque control, the average bone height was greater with the partially exposed implant (8.2 +/- 0.6 mm) than with the abutment-connected implant (6.5 +/- 0.7 mm; P <0.05). CONCLUSION: These results suggest that the placement of healing abutments and meticulous plaque control may limit bone loss around submerged implants when implants are partially exposed.     

冲压式上颌窦底提升术同期种植临床分析

目的:探讨上颌后牙区采用冲压式上颌窦底提升术植骨与不植骨同期种植的效果。方法:2001年1月—2007年12月,共完成冲压式上颌窦底提升种植修复病例91例,男35例,女56例,随机分为2组,植骨组47例,植入57颗种植体;不植骨组44例,植入种植体51颗,共植入108颗种植体。上颌窦底剩余牙槽骨高度为5～11mm,提升幅度为2～6mm。平均随访56.8个月。35例患者(41颗种植体)于后期随访中行锥形束CT(CBCT)和根尖片,观察种植体新骨形成量和种植体突出窦底高度,应用SPSS17.0软件包对数据进行方差分析和t检验。结果:植骨组7颗种植体脱落,存留率为87.7%;不植骨组3颗种植体脱落,存留率为94.1%。CBCT扫描显示,提升幅度为2～4mm时,植骨组新骨形成高度为(2.7±1.3)mm,不植骨组为(2.4±1.5)mm,2组间无统计学差异;提升幅度为4～6mm时,植骨组新骨形成高度为(3.5±1.3)mm,不植骨组为(1.3±0.4)mm,植骨组比不植骨组新骨形成高度显著增加。结论:在上颌后牙缺失区采用冲压式上颌窦底提升、不植骨同期种植是安全可行的,植骨材料对于促进新骨形成并非必须,然而提升幅度较大时,植骨能获得更多的骨量。     

Influence of Sinus Floor Configuration on Grafted Bone Remodeling After Osteotome Sinus Floor Elevation

Background: This study investigates influence of the sinus floor configuration on dimensional stability of grafted bone height after the osteotome sinus grafting procedure. Methods: Forty single‐tooth dental implants inserted after placement of bioglass and/or allograft into the sinus area using an osteotome technique in 37 patients were evaluated in this retrospective study. Periapical radiographs were taken using the long‐cone technique before and after implant placement. Specifically, radiographic measurements of grafted bone height at the mesial and distal side of each implant were taken, and the sinus floor configuration was classified into concave, angle, and flat according to the sinus floor profile at the implant site. Furthermore, the intruding angle, defined as the angle between the implant axis and sinus floor, was measured. Results: All implants were clinically stable during a mean follow‐up period of 39.2 months. Mean initial gain of sinus grafted bone height was 7.0 ± 1.9 mm, and later it was reduced to 4.6 ± 1.9 mm at follow‐up (P <0.001). A greater reduction in grafted bone height was revealed in the flat sinus group compared with the concave group (P <0.001). Results from the linear regression showed larger intruding angles were statistically significantly associated with a greater reduction in grafted bone height (r² = 0.55, P <0.001). Conclusion: All bioglass and/or allograft placed in the maxillary sinus after the osteotome technique underwent remodeling and shrinkage; however, the outcome of the procedure was more predictable in sinuses with a concave floor and small implant‐intruding angles.     

骨挤压器在不开窗上颌窦底提升后种植术中的应用

目的:介绍采用骨挤压器从牙槽嵴顶入路提升上颌窦底后植入种植体,观察该方法窦底提升后种植的临床效果.方法:术前在曲面断层片和种植区牙片上测量牙槽嵴顶到上颌窦底的距离,对40例经测量后预计种植体植入后将超出上颌窦底,但超出窦底距离不多于4mm的接受种植术患者,自牙槽嵴顶制备种植体洞型,在距离上颌窦底约1毫米时停止,换用固定了止停器的骨挤压器轻力敲击加压,穿破上颌窦底骨壁,在不损伤窦底粘膜的情况下植入种植体。结果:用此方法植入的种植体共59枚,种植体初期稳定性良好。术后X光片测量显示,种植体超出上颌窦底最大距离4.5毫米,平均超出2.3毫米。种植后3-6个月进行上部修复。共三枚种植体二期修复前没有骨结合取出,一枚种植体修复后一年半种植体松动拔除。其余种植体观察6个月-4.5年骨结合良好。结论:本方法能有效提高窦底距离1-4毫米,不需要从颊侧开窗进行上颌窦底提升手术,具有创伤小,方法简单可靠的特点,患者易于接受。     

Osteotome-mediated sinus floor elevation: a clinical report

PURPOSE: It was the aim of the present study to clinically evaluate the success of osteotome-mediated sinus floor elevation (OMSFE) using autogenous and xenogenic bone and a variety of screw-type implants. MATERIALS AND METHODS: From August 1995 to February 2003, 276 OMSFE procedures with simultaneous implant placement were completed in 167 patients. RESULTS: The mean residual bone height (RBH) of the alveolar ridge was 7.1 mm (range 3 to 10 mm). The mean increase in height of the implant sites using osteotome techniques was 3.8 mm (range 2 to 7 mm). Of the 276 implants placed, 240 had been loaded for an average of 27.9 months (range 1 to 84 months). There were a total of 18 failures: Ten implants failed to integrate, 3 implants were lost within the first 18 months of loading, 1 implant fractured after 3 years in function, and 4 implants demonstrated excessive bone loss. The overall survival rate was 93.5%. When only sites with an RBH of 4 mm or less were considered, the survival rate dropped to 73.3%. Small tears in the schneiderian membrane were clinically assessed at 13 sites, for a detectable perforation rate of 4.7%. DISCUSSION: The primary determinant in implant survival with OMSFE procedures was the height of the residual alveolar ridge. Implant design, graft material, and the method of sinus floor infracture (direct or bone-cushioned) exerted minimal influence on survival outcome; however, factors such as edentulism, osteoporosis, and an overdenture prosthesis were shown to negatively influence postloading survival of implants placed in areas of limited RBH. CONCLUSION: OMSFE procedures can be used predictably for implant placement at sites with moderate vertical deficiencies in the posterior maxilla.     

Flapless, CBCT-guided osteotome sinus floor elevation with simultaneous implant installation. I: radiographic examination and surgical technique. A prospective 1-year follow-up

Background: Survival rates of implants placed in transalveolar sinus floor augmentation sites are comparable with those placed in non‐augmented sites. Flapless implant surgery can minimize postoperative morbidity, alveolar bone resorption and crestal bone loss. The use of cone beam computerized tomography (CBCT) provides 3D presentations with reduced dose exposure. Objectives: To evaluate a flapless, CBCT‐guided transalveolar sinus floor elevation technique with simultaneous implant installation. Material and methods: Fourteen consecutive patients in need of maxillary sinus floor augmentation were enrolled in this study. Preoperative CBCT with a titanium screwpost as an indicator at the intended implant position was used to visually guide the flapless surgical procedure. Twenty one implants all with a length of 10 mm and a diameter of 4.1 and 4.8 mm were inserted and followed clinically and with CBCT for 3, 6 and 12 months postoperatively. Intraoral radiographs were taken for comparison. All patients were provided with permanent prosthetic constructions 8–12 weeks after implant surgery. Results: Ten (47.6%) implants were inserted in residual bone of 2.6–4.9 mm and 11 (52.3%) implants were inserted in residual bone of 5–8.9 mm. No implants were lost after surgery and follow‐up. There was no marginal bone loss during the follow‐up verified by CBCT. The implants penetrated on average 4.4 mm (SD 2.1 mm) into the sinus cavity and the mean bone gain was 3 mm (SD 2.1 mm). Conclusion: Flapless transalveolar sinus lift procedures visually guided by preoperative CBCT can successfully be used to enable placement, successful healing and loading of one to three implants in residual bone height of 2.6–8.9 mm. There was no marginal bone loss during the 3–12 months follow‐up. To cite this article :
Fornell J, Johansson L‐Å, Bolin A, Isaksson S, Sennerby L. Flapless, CBCT‐guided osteotome sinus floor elevation with simultaneous implant installation. I: radiographic examination and surgical technique. A prospective 1‐year follow‐up.
Clin. Oral Impl. Res. 23 , 2012; 28–34.
doi: 10.1111/j.1600‐0501.2010.02151.x     

Nasal floor elevation combined with dental implant placement

Objectives: The aim of the present study was to report on the survival of dental implants placed in conjunction with nasal floor elevation. Methods: A retrospective cohort of 32 consecutive patients from two private practices was evaluated. All patients presented with alveolar bone height deficiency in the anterior region, which was not sufficient to place a dental implant according to a computed tomography (CT) scan preformed prior to implantation. Elevation and augmentation of the nasal mucosa was performed simultaneously with dental implant placement. Data collection included demographic information, as well as records of the pre‐operative available bone height, implant dimensions, bone addition following nasal floor augmentation, and survival of the implants at last follow‐up. Results: Overall, 32 patients received 100 implants that were performed in conjunction with nasal floor elevation. The average pre‐operative available bone height according to a CT scan that was preformed prior to implantation was 9.1 ± 0.9 mm and ranged from 7.3 to 11.2 mm. Bone addition following nasal floor augmentation was 3.4 ± 0.9 mm and ranged between1.1 and 5.7 mm. The mean follow‐up time was 27.8 ± 12.4 months, and during that follow‐up period, no implant failure was recorded, resulting in 100% implant survival. Conclusion: Nasal floor elevation might serve as a predictable procedure, which allows implant placement in areas with significant atrophy together with increased implant stability due to the bicortical support.     

Sinus floor elevation using an osteotome technique without grafting materials or membranes

This retrospective study aimed to radiographically assess sinus floor remodeling after using a modified osteotome technique without graft materials or membranes. After pilot drilling, residual bone was fractured and raised with the schneiderian membrane to the final implant length using osteotomes. Self-tapping implants were placed, and restorations were placed 6 months later. Twenty-four patients were available for follow-up after a mean observation period of 17.6 +/- 8.4 months. The implant survival rate at that time was 100%. Bone filling around the implants was measured and compared with baseline digital radiographs. New bone formation was 86.3% +/- 22.1% mesially and 89.7% +/- 13.3% distally. In nine cases, digital volume tomography was used to verify regeneration. Within the limitations of this study, use of the schneiderian membrane led to considerable bone regeneration, and good clinical success was achieved despite the omission of graft materials.     

Maxillary sinus floor augmentation using bioactive glass granules and autogenous bone with simultaneous implant placement. Clinical and histological findings

This clinical study was undertaken to: 1) evaluate the use of bioactive glass Biogran combined with autogenous bone as grafting material for maxillary sinus augmentation with simultaneous implant placement using radiography and histology; and 2) document the short-term post-loading success of implants inserted in sinus cavities augmented with this material. Unilateral or bilateral sinus augmentation was performed in 12 patients with 3-5 mm of alveolar crestal bone height in the posterior maxilla prior to grafting. The sinuses were grafted with bioactive glass mixed in a 4:1 ratio with autogenous bone. Simultaneously, 2-3 threaded titanium implants were inserted into the augmented sinuses. Second stage surgery was carried out 9 to 12 months post implantation. At abutment connection, 10 core biopsy specimens were taken from different grafted sites and evaluated histologically. All 27 implants were clinically stable at second stage surgery. A mean increase in mineralized tissue height of 7.1 +/- 1.6 mm was evident when comparing the pre-surgical CT scans with those performed 9-12 months following the sinus augmentation procedure. Evaluation of the cores yielded a mean of 30.6 +/- 5.7% of bone tissue in the grafted sites. One implant failed during the prosthetic phase while the remaining 26 implants were stable 12 months post loading. This study suggests that Biogran/autogenous bone graft combination used in one-stage sinus augmentation yields sufficient quality and volume of mineralized tissue for predictable simultaneous implant placement in patients with 3-5 mm of bone height prior to grafting.     

三斜磷钙石糊剂封闭牙本质小管的体外研究

体外评价三斜磷钙石糊剂对牙本质小管的封闭作用,为牙本质敏感症的治疗提供新的手段。     

上颌窦内提升不植骨同期种植术——3年临床回顾性研究

目的:评价上颌窦内提升不植骨同期牙种植术的临床效果。方法:收集38例上颌窦区域牙缺失患者,采用上颌窦内提升不植骨同期牙种植手术方式,共植入58颗种植体。在植入后6个月、1年和3年随访,统计种植体的成功率以及拍摄全景片测量上颌窦成骨的高度。结果:1年时,1颗种植体未形成骨结合脱落。3年时,另1颗种植体出现松动取出。其余56颗种植体正常行使功能,3年成功率96.6%。受植区平均牙槽骨高度为(5.8±0.2) mm,术后上颌窦内提升高度为(5.1±0.3)mm。上颌窦内种植体周围见新骨形成,6个月平均成骨2.4 mm,1年平均成骨2.8 mm,3年与1年成骨无明显变化。结论:上颌窦内提升不植骨同期牙种植手术方式是可行的,上颌窦黏膜具有潜在的成骨能力。     

Osteotome sinus floor elevation and simultaneous placement of implants--a 1-year retrospective study with Astra Tech implants

Background: The bone support for implants in the posterior part of the maxilla is often poor. This condition may be treated with augmentation of the maxillary sinus floor. The most common technique used is to elevate the sinus floor by inserting a bone graft through a window opened in the lateral antral wall, although less invasive techniques with osteotomes have been used since 1994. Purpose: The aim of this study was to evaluate the clinical and radiographic outcome of implants placed in the posterior maxilla with the osteotome sinus floor elevation (OSFE) technique without grafting. Materials and Methods: The study population comprised 36 consecutive patients in whom 53 implants were inserted with the OSFE technique. The indication for sinus floor elevation was that the bone height below the maxillary sinus was considered to be 10 mm or less. Results: The mean height of the alveolar process in the intended implant sites was 6.3 ± 0.3 mm, and the mean elevation of the sinus floor was 4.4 ± 0.2 mm. At the 1‐year follow‐up, two implants had been lost, both in edentulous patients. The remaining 51 implants inserted were in function, giving a 1‐year cumulative survival rate of 96%. Implants used in single‐tooth replacements and in partially edentulous cases had a 100% survival rate. The mean marginal bone level at the time of loading of the implants was 0.1 ± 0.04 mm below the reference point. One year later, the corresponding value was 0.5 ± 0.06 mm. The mean bone loss between the two examinations was 0.4 ± 0.05 mm. Conclusions: The OSFE technique, without bone grafts, was found to produce predictable results in the treatment of 36 patients with restricted bone volume in the posterior part of the maxilla.     

Maxillary sinus floor augmentation using a beta-tricalcium phosphate (Cerasorb) alone compared to autogenous bone grafts

PURPOSE: A prospective human clinical study was conducted to determine the clinical and histologic bone formation ability of 2 graft materials, a beta-tricalcium phosphate (Cerasorb; Curasan, Kleinostheim, Germany) and autogenous chin bone, in maxillary sinus floor elevation surgery. MATERIALS AND METHODS: Ten healthy patients underwent a bilateral (n = 6) or unilateral (n = 4) maxillary sinus floor elevation procedure under local anesthesia. In each case, residual posterior maxillary bone height was between 4 and 8 mm. In cases of bilateral sinus floor elevation, the original bone was augmented with a split-mouth design with 100% beta-tricalcium phosphate on the test side and 100% chin bone on the contralateral control side. The unilateral cases were augmented with 100% beta-tricalcium phosphate. After a healing period of 6 months, ITI full body screw-type implants (Straumann, Waldenburg, Switzerland) were placed. At the time of implant surgery, biopsy samples were removed with a 3.5-mm trephine drill. RESULTS: Sixteen sinus floor elevations were performed. Forty-one implants were placed, 26 on the test side and 15 on the control side. The clinical characteristics at the time of implantation differed, especially regarding clinical appearance and drilling resistance. The increase in height was examined radiographically prior to implantation and was found to be sufficient in all cases. After a mean of nearly 1 year of follow-up, no implant losses or failures had occurred. DISCUSSION: The promising clinical results of the present study and the lack of implant failures are probably mainly the result of requiring an original bone height of at least 4 mm at the implant location. CONCLUSION: Although autogenous bone grafting is still the gold standard, according to the clinical results, the preimplantation sinus floor elevation procedure used, which involved a limited volume of beta-tricalcium phosphate, appeared to be a clinically reliable procedure in this patient population.