Maxillary sinus augmentation using sinus membrane elevation and peripheral venous blood for implant-supported rehabilitation of the atrophic posterior maxilla: case series

Background Dental implants need appropriate bone volume for adequate stability in the rehabilitation after tooth loss. In the severely atrophic posterior maxilla, the clinical success of implant treatment sometimes requires a vertical ridge augmentation in the maxillary sinus floor. Purpose The purpose of this investigation was to evaluate a maxillary sinus floor augmentation technique using a replaceable bone window, elevation of the membrane, placement of implants, and injection of the patient’s own venous blood to fill the voids. Materials and Methods Six patients with need of maxillary sinus floor augmentation participated in the study. After preparation of a replaceable bone window in the lateral aspect of the sinus and careful elevation of the Schneiderian membrane, a total of 14 Brånemark implants (TiUnite, MK III, Nobel Biocare AB, Göteborg, Sweden) were installed in the residual bone penetrating into the sinus cavity. The sinus cavity was then filled with peripheral venous blood and the bone window replaced and stabilized with a medical tissue glue (Aron Alpha A, Sankyo, Inc., Tokyo, Japan) to prevent blood leakage from the created compartment in the maxillary sinus. Results After a healing period of a minimum of 6 months, new bone was successfully generated in all 14 implant sites as judged from radiographs. One of the 14 implants failed, corresponding to a survival rate of 92.9% after a follow‐up period ranging 12 to 34 months. Conclusions The present case series demonstrate that the creation of a secluded space in the maxillary sinus and filling with venous blood results in bone formation at simultaneously installed dental implants over a 6‐month period.     

Histological Outcomes on the Development of New Space‐making Devices for Maxillary Sinus Floor Augmentation

Background: Previous studies have pointed out that the mere elevation of the maxillary sinus membrane promotes bone formation without the use of augmentation materials. Purpose: This experimental study aimed at evaluating if the two‐stage procedure for sinus floor augmentation could benefit from the use of a space‐making device in order to increase the bone volume to enable later implant installation with good primary stability. Materials and Methods: Six male tufted capuchin primates (Cebus apella) were subjected to extraction of the three premolars and the first molar on both sides of the maxilla to create an edentulous area. The sinuses were opened using the lateral bone‐wall window technique, and the membrane was elevated. One resorbable space‐making device was inserted in each maxillary sinus, and the bone window was returned in place. The animals were euthanatized after 6 months, and biopsy blocks containing the whole maxillary sinus and surrounding soft tissues were prepared for ground sections. Results: The histological examination of the specimens showed bone formation in contact with both the schneiderian membrane and the device in most cases even when the device was displaced. The process of bone formation indicates that this technique is potentially useful for two‐stage sinus floor augmentation. The lack of stabilization of the device within the sinus demands further improvement of space‐makers for predictable bone augmentation. Conclusions: It is concluded that (1) the device used in this study did not trigger any important inflammatory reaction; (2) when the sinus membrane was elevated, bone formation was a constant finding; and (3) an ideal space‐making device should be stable and elevate the membrane to ensure a maintained connection between the membrane and the secluded space.     

Relationship among Schneiderian Membrane,Underwood's Septa,and the Maxillary Sinus Inferior Border

Background: Osseo‐integrated implants are increasingly being used to restore functional dentition; however, in the posterior region, implant placement can be problematic because of inadequate bone height. In this condition, maxillary sinus floor elevation surgery has become the treatment of choice. The presence of anatomic variations within the maxillary sinus such as Underwood's septa and thin schneiderian membrane decreases the success of the sinus floor elevation. Purpose: In this study, we tried to determine the relationship between the anatomic variations of the maxillary sinus: Underwood's septa, schneiderian membrane thickness, and the cortical thickness of the inferior border of the maxillary sinus. Material and Methods: The left and right maxillary sinus images of 74 patients were obtained by using dental computed tomography (CT). The schneiderian membrane and the cortical thickness of the inferior border of the maxillary sinus were measured on the coronal images of dental CT scans at the deepest portion of the sinus cavity. The presence of Underwood's septa was identified on the axial images. The correlations between these variables were assessed. Results: We found that there was only a negative correlation between the schneiderian membrane thickness and the presence of Underwood's septa (r = –0.168 p = .042). Conclusion: It is suggested that Underwood's septa may be the reason for the thinness of the schneiderian membrane. However, future studies among larger groups are necessary for confirming the finding by using well‐designed clinical studies.     

The use of autologous venous blood for maxillary sinus floor augmentation in conjunction with sinus membrane elevation: an experimental study

Background: There have been reports of successful bone formation with sinus floor elevation induced by simply elevating the maxillary sinus membrane and filling the sinus cavity with a blood clot. Purpose: We investigated the feasibility of maxillary sinus floor augmentation using the patient's own venous blood in conjunction with a sinus membrane elevation procedure. Materials and methods: An implant that protruded 8 mm into the maxillary sinus after sinus membrane elevation was placed in the maxillary sinus of six adult female mongrel dogs. The resulting space between the membrane and the sinus floor was filled with autologous venous blood retrieved from each dog. The implants were left in place for 6 months. Results: During the experimental period, the created space collapsed and the sinus membrane fell down onto the implant. A small amount of new bone formation occurred in the space created by the collapsed membrane. The average height of newly formed bone around the implants in the sinus was 2.7±0.7 mm on the buccal side and 0.6±0.3 mm on the palatal side. Conclusion: The results of this pilot study indicate that blood clots do not have sufficient integrity to enable the sinus membrane to remain in an elevated position for therapeutically effective periods of time. Accordingly, it is recommended that this method be used only when a small aount of new bone formation is necessary around implants in the maxillary sinus cavity. To cite this article:
Kim H‐R, Choi B‐H, Xuan F, Jeong S‐M. The use of autologous venous blood for maxillary sinus floor augmentation in conjunction with sinus membrane elevation: an experimental study.
Clin. Oral Impl. Res. 21 , 2010; 346–349.
doi: 10.1111/j.1600‐0501.2009.01855.x     

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。     

Maxillary bone grafting for insertion of endosseous implants: results after 12-124 months

Abstract: Insertion of endosseous implants in the atrophic maxilla is often complicated because of lack of supporting bone. Augmentation of the floor of the maxillary sinus with autogenous bone graft has been proven to be a reliable treatment modality, at least in the short term. The long‐term clinical and radiographic outcome with regard to the grafts, the implants and satisfaction of the patients with their implant‐supported overdenture was studied in 99 patients. The sinus floor was augmented with bone grafts derived from the iliac crest (83 subjects, 162 sinuses, 353 implants), the mandibular symphysis (14, 18, 37), or the maxillary tuberosity (2, 2, 2). Before implant installation, the width and height of the alveolar crest were increased in a first stage procedure in 74 patients, while in the other 25 patients augmentation and implant installation could be performed simultaneously (width and height of the alveolar crest >5 mm). Perforation of the sinus membrane occurred in 47 cases, which did not predispose to the development of sinusitis. Loss of bone particles and sequestration were observed in one (diabetic) patient only, in whom a dehiscence of the oral mucosa occurred. A second augmentation procedure was successful in this patient. Symptoms of transient sinusitis were observed in 3 patients. These symptoms were successfully treated with decongestants and antibiotics. 2 other patients developed a purulent sinusitis which resolved after a nasal antrostomy. In all cases, the bone volume was sufficient for implant insertion. 32 of 392 inserted Brånemark implants (8.2%) were lost during the follow‐up. After the healing period of the bone grafts, no sinus pathology was observed. The patients received implant‐supported overdentures (72 patients) or fixed bridges (27 patients). Overall, the patients were very satisfied with the prosthetic construction. We conclude that bone grafting of the floor of the maxillary sinus floor with autogenous bone for the insertion of implants is a reliable treatment modality with good long‐term results.     

Sinusfloor elevation and grafting with autogenous iliac crest bone.

Insufficient bone height in the posterior area of the maxilla, due to expansion of the maxillary sinus and atrophic reduction of the alveolar process of the maxilla, represents a contra-indication for insertion of dental implants. This anatomic problem can, in many cases, be solved by augmentation of the floor of the maxillary sinus. This surgical technique was introduced by Tatum. The so-called top hinge door method creates a new floor of the maxillary sinus at a more cranial level. Underneath this new floor the existing space is filled with a bone graft. Implantation in the alveolar process with increased bone height allows insertion of dental implants. This sinus grafting technique was used in the present study. In total, 62 sinusfloor elevations were performed with cancellous iliac bone grafts in 42 patients. In those 62 augmented sinuses, 161 ITI screw type implants were inserted. The follow-up was 1-6 years after implantation. In 2 cases infections occurred. One implant needed an extended integration time. No implants were lost. The ITI solid screw implant appears to be a suitable implant following sinusfloor elevation operations, due to its rough surface, its shape and the size of the thread. The sinusfloor elevation procedure with autogenous cancellous bone graft appears to be a valuable and reliable pre-implantological procedure, provided a proper pre-operative investigation and careful surgery are performed. This procedure allows dental implant placement with a high success rate.     

Maxillary Sinus Floor Augmentation Surgery with Autogenous Bone Grafts as Ceiling: A Pilot Study and Test of Principle

Background: Studies have pointed out that the mere elevation of the maxillary sinus membrane might suffice to allow for bone formation indicating the additional use of augmentation materials to be redundant. Purpose: The purpose of this study was to assess whether elevation of the sinus mucosal lining combined with applying an autologous bone graft as a ceiling and placement of a short implant would allow for bone formation around the implant thus surpassing the need for applying augmentation materials around the installed implants. Materials and Methods: Fourteen consecutive patients were subjected to maxillary sinus floor elevation surgery and simultaneous placement of an implant. Using the lateral bone‐wall window technique, the membrane was exposed and elevated. Next, a bone graft taken from the zygomatic rim was placed as a ceiling above the inserted implant to ensure that the sinus membrane would not collapsed around a significant part of the implant. Finally, the bone window was returned in place. After connecting the healing abutment, the wound was closed. Results: All implants were stable and no implants were lost. There were no complications after harvesting the bone graft. Radiographic evaluation showed a bone gain of 3.2 ± 0.9 mm after 3 months and 3.6 ± 0.9 mm after 1 year. Less than 6% of the implant was not covered by bone after 1 year. Conclusion: Maxillary sinus membrane elevation and simultaneous placement of short endosseous implants with a bone graft as a ceiling on top of the implant result in predictable bone formation around the implant and good osseointegration on radiographs.     

Simultaneous dental implant placement and endoscope-guided internal sinus floor elevation: 2-year post-loading outcomes

Aims: To determine whether endoscope‐guided sinus elevation procedures can be consistently used to create sufficient bone support for stable implant placement and long‐term implant success. Material and methods: Sixty‐two implants were surgically placed into 30 patients (14 men and 16 women) following internal sinus elevation without the use of graft material. Panoramic radiographs were made pre‐, post‐operative and after 24 months in order to evaluate the peri‐implant bone and maxillary sinuses. Resonance frequency analysis (RFA) was used to evaluate implant stability immediately upon placement and just before prosthesis delivery. Results: The average pre‐operative height of the maxillary alveolar bone was 8.4±2.2 mm at the premolar and 7.3±3.1 mm at the molar regions. The average bone gain was 3.5±1.8 and 4.5±1.9 mm in the premolar and molar sites, respectively. Clinical parameters and the RFA (4 and 12 weeks post‐operative) outcomes show sufficient stability (ISQ=60) of the inserted implants. Three implants failed during the healing period of 12 weeks. The overall implant success rate was 94%. After loading, no further implant failure was observed. The overall success rate after beginning of implant loading was 100%. Conclusions: Sinus floor elevation is a well‐established procedure for augmentation of the atrophic maxillary posterior region. The minimally invasive internal sinus floor elevation procedure visually guided by an endoscope helped to prevent, diagnose and manage complications such as sinus membrane perforation. The clinical outcomes of this study show that endoscope‐controlled internal sinus floor elevation combined with implant placement results in low intra operative trauma, good implant stability upon placement, low incidence of post‐operative symptoms and high success rates after 24 months of loading.     

Bone quality after sinus floor augmentation

The problem of insufficient alveolar bone in the edentulous maxilla caused by resorption and pneumatization can be overcome by augmentation of the sinus floor to increase bone volume for the placement of dental implants. The quality of bone which is achieved after sinus floor augmentation is hardly known. This study describes the histologic results obtained three till six months after sinus floor augmentation with autogenous bone from the iliac crest in patients with severe maxillary bone resorption. The bone biopsies taken from the implant sites showed a substantial bone volume with a mature trabecular pattern and active bone growth. It was concluded that with the obtained bone quality, the sinus floor augmentation procedure can be a good treatment modality for the rehabilitation with implants in patients with severe maxillary bone atrophy.     

Sinus floor elevation and grafting with autogenous iliac crest bone

Insufficient bone height in the posterior area of the maxilla, due to expansion of the maxillary sinus and atrophic reduction of the alveolar process of the maxilla, represents a contraindication for insertion of dental implants. This anatomic problem can, in many cases, be solved by augmentation of the floor of the maxillary sinus. This surgical technique was introduced by Tatum. The so‐called top hinge door method creates a new floor of the maxillary sinus at a more cranial level. Underneath this new floor the existing space is filled with a bone graft. Implantation in the alveolar process with increased bone height allows insertion of dental implants. This sinus grafting technique was used in the present study. In total, 62 sinusfloor elevations were performed with cancellous iliac bone grafts in 42 patients. In those 62 augmented sinuses, 161 ITT screw type implants were inserted. The follow‐up was 1–6 years after implantation. In 2 cases infections occurred. One implant needed an extended integration time. No implants were lost. The ITI solid screw implant appears to be a suitable implant following sinusfloor elevation operations, due to its rough surface, its shape and the size of the thread. The sinusfloor elevation procedure with autogenous cancellous bone graft appears to be a valuable and reliable pre-implantological procedure, provided a proper pre‐operative investigation and careful surgery are performed. This procedure allows dental implant placement with a high success rate.     

上颌窦内提升术植骨与不植骨对种植体骨结合的影响

目的探讨上颌窦内提升术植骨与不植骨对种植体骨整合的影响及两者之间的差异。方法将120枚需要进行内提升手术的种植体随机平均分为两组,第一组60枚为实验组,在上颌窦内提升后植入骨材料同期植入种植体;第二组60枚为对照组,上颌窦内提升后不植骨同期植入种植体。对两组种植体进行临床追踪（平均18个月）,观察种植体骨整合、临床检查指标、种植体存留率及影像学变化。结果仅有1例种植体覆盖螺丝暴露,种植体颈部出现骨吸收。所有两组种植体均能完成修复,种植体存留率达到100%,无1例脱落。种植体均能正常行使咀嚼功能,骨整合良好。影像学检查种植体周围均有新骨生长,骨整合良好。结论上颌窦内提升术后不植骨可以取得与植骨同样的效果,可以明显减少患者的种植牙费用,是一种值得推广应用的手术方法。     

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.     

Localized sinus elevation and osteocompression with single-stage tapered dental implants: technical note

In the atrophic posterior maxilla, placement of longer (at least 10 mm) and wider diameter implants may significantly improve long-term results, but sinus grafting is often necessary to provide sufficient bone volume for implant support. The crestal approach to sinus augmentation requires penetration of the sinus floor with surgical instruments that are often difficult to control; there is a high risk of damaging the schneiderian membrane. Fabricating a round cutting rim at the apical end of a single-stage tapered implant can provide a controlled method of gently penetrating the sinus floor prior to grafting and placement of the definitive implant. In soft type 4 bone, the single-stage tapered implant design can help to enhance initial stabilization through lateral osteocondensation of the receptor site. Localized sinus elevation with osteocompression utilizing single-stage tapered implants may offer a simplified approach to the complex clinical challenge of successfully restoring the atrophic posterior maxilla.     

压电超声骨刀在23例上颌窦提升术中的应用

目的:总结压电超声骨刀在上颌窦提升开窗手术中的临床应用,探讨其手术特点及术中注意的问题。方法:对符合上颌窦外提升术标准(种植区骨高度为5～8mm)的23例患者(24侧),进行了上颌窦外提升手术,术中应用压电超声骨刀进行上颌窦开窗手术,黏膜提升,填入人工骨粉,同期植入种植体。结果:24侧上颌窦提升手术,其中1侧由于术中操作不当,出现黏膜穿孔,终止手术;其余23侧均成功地进行了上颌窦提升,黏膜穿孔率仅为4.2%,并同期植入种植体48个,愈合期内(手术后10d拆线时)无感染及创口裂开等并发症。结论:应用压电超声骨刀进行上颌窦外提升手术,快捷、安全、可靠。     

Lack of influence of the Schneiderian membrane in forming new bone apical to implants simultaneously installed with sinus floor elevation: an experimental study in monkeys

Aim: To describe the early healing processes around the implants installed after elevation of the sinus mucosa applying the lateral access technique without the use of grafting material. Material and methods: Immediately after the elevation of the maxillary sinus Schneiderian membrane by the lateral approach in eight monkeys, implants were installed without the use of grafting material. The healing of the tissue around the implants was evaluated after 4, 10, 20 and 30 days. Ground sections were prepared and analyzed histologically. Results: After 4 days of healing, the formation of coagulum and provisional matrix was documented within the elevated area. At 10‐day interval, sprouts of woven bone were in continuity with the parent bone, and partly in contact with the implant surface at the base of the augmented area. While bone‐to‐implant contact increased after 20 and 30 days, the area underneath the Schneiderian membrane appeared reduced in volume and condensed toward the apex of the implants. The sinus mucosa was to some extent collapsed onto the implant surface and on the newly formed bone. Conclusions: The void initially occupied by the coagulum after sinus membrane elevation shrank substantially during the observation period. A lack of influence of the Schneiderian membrane in bone formation apical to implants was documented in the early phase of healing. To cite this article:
Scala A, Botticelli D, Faeda RS, Rangel IG Jr, de Oliveira, JA, Lang NP. Lack of influence of the Schneiderian membrane in forming new bone apical to implants simultaneously installed with sinus floor elevation: an experimental study in monkeys.
Clin. Oral Impl. Res. 23 , 2012; 175–181.
doi: 10.1111/j.1600‐0501.2011.02227.x     

Primary implant stability after maxillary sinus augmentation with autogenous mesenchymal stem cells: a biomechanical evaluation in rabbits

Objectives: To mechanically evaluate the effect of transplantation of precultured preosteoblasts derived from autogenic adult mesenchymal stem cells (aMSC) for experimental sinus floor augmentation on primary dental implant stability in comparison with conventional augmentation procedures in rabbits. Material and methods: After experimental sinus floor augmentation with a synthetic bone substitute, autogenous bone transplantation or osteoblast precursor cells, the primary stability of implants inserted in the edentulous part of the upper jaw of New Zealand White Rabbits was examined. Mechanical evaluation was performed by determination of insertion torque values (Osseocare^?), percussion testing (Periotest^?), resonance frequency analysis (Osstell^? and scanning laser Doppler vibrometer) and measurement of extraction forces. Results: Evaluation of mechanical properties with percussion testing and resonance frequency analysis with Osstell^? revealed slightly higher primary stability of the stem cell group whereas the scanning laser Doppler vibrometer and measurement of pull‐out forces showed no significant difference to the bone substitute group. Transplantation of autogenous bone graft resulted in the highest primary implant stability. Conclusions: The three examination modalities proved suitable for the determination of primary implant stability. The experimental maxillary sinus floor augmentation with precultured osteoblast precursor cells from autogenic stems cells clearly enhanced the primary stability of implants compared with the unaugmented sinus and lead to comparable primary mechanical properties to bone substitutes in rabbits. In comparison with the autogenous bone graft stability enhancement by stem cell transplantation declined. To cite this article:
Riecke B, Heiland M, Hothan A, Morlock M, Amling M, Blake FAS. Primary implant stability after maxillary sinus augmentation with autogenous mesenchymal stem cells – biomechanical evaluation in rabbits.
Clin. Oral Impl. Res. 22 , 2011; 1242–1246.doi: 10.1111/j.1600‐0501.2010.02043.x     

Bone reformation with sinus membrane elevation: a new surgical technique for maxillary sinus floor augmentation

Background: Various maxillary sinus floor augmentation techniques using bone grafts and bone substitutes are frequently used to enable placement of dental implants in the posterior maxilla. A previous case report demonstrated the possibility of promoting bone formation in the sinus by lifting the membrane without using a grafting material. However, the predictability of the technique is not known. Purpose: The aim of this study was to investigate whether sinus membrane elevation and the simultaneous insertion of titanium implants without additional grafting material constitute a valid technique for bone augmentation of the maxillary sinus floor. Materials and Methods: The study group comprised 10 patients in whom a total of 12 maxillary sinus floor augmentations were performed. A replaceable bone window was prepared in the lateral sinus wall with a reciprocating saw. The sinus membrane was dissected, elevated superiorly, and sutured to the sinus wall to create and maintain a compartment for blood clot formation. One to three dental implants were inserted through the residual bone and protruded at least 5 mm into the maxillary sinus. The bone window was replaced and secured with the overlying mucosa. Bone height was measured directly at each implant site at the time of insertion. Resonance frequency analysis (RFA) was performed on each implant at the time of initial placement, at abutment surgery, and after 12 months of functional loading. Computed tomography (CT) was performed in the immediate postoperative period and 6 months later, prior to exposure of the implants. Results: A total of 19 implants (Brånemark System®, TiUnite?, Nobel Biocare AB, Gothenburg, Sweden) in lengths of 10 to 15 mm were placed, with an average residual bone height of 7 mm (range, 4–10 mm). All implants remained clinically stable during the study period. Comparisons of pre‐ and postoperative CT radiography clearly demonstrated new bone formation within the compartment created by the sinus membrane elevation procedure. RFA measurements showed mean implant stability quotient values of 65, 66, and 64 at placement, at abutment connection, and after 12 months of loading, respectively. Conclusions: The study showed that there is great potential for healing and bone formation in the maxillary sinus without the use of additional bone grafts or bone substitutes. The secluded compartment created by the elevated sinus membrane, implants, and replaceable bone window allowed bone formation according to the principle of guided tissue regeneration. The precise mechanisms are not known, and further histologic studies are needed. Sinus membrane elevation without the use of additional graft material was found to be a predictable technique for bone augmentation of the maxillary sinus floor.     

闭合式上颌窦挤压提升同期人工牙种植修复45例分析

目的：观察使用Summers骨凿或骨挤压器经牙槽嵴顶闭合式抬高上颌窦底、同期植入种植体的临床效果。方法：对41例45侧后牙缺失患者行上颌窦闭合式提升，必要时植自体骨或人工骨，同时植入种植体。结果：45侧上颌窦剩余牙槽骨平均高度为6．8mm(5～9mm)，用骨凿平均提升上颌窦底高度3．5mm(2～6mm)。2侧上颌窦黏膜被钻穿孔，放弃牙种植。其余43侧上颌窦共植入63颗种植体，长度10～15mm。Ⅱ期手术时，5颗种植体松动拔除。追踪12～48个月，修复后1颗种植牙松动拔除，1颗进行性骨吸收，总成功率达88．9％。所有病例均无上颌窦并发症：结论：上颌窦内提升技术较开窗式上颌窦提升创伤小，操作步骤简单，对有适量剩余牙槽骨的上颌窦区种植可以考虑使用；但由于存在窦底黏膜穿孔风险，技术要求高，同时必须有专用的器械，应慎重使用。在严格控制适应证、掌握种植外科技巧的情况下，开展上颌窦内提升技术是可行的，可以取得较高的成功率。     

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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.