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     

经牙槽嵴顶上颌窦底提升术植骨与否的研究进展

上颌后牙区常因骨量不足而成为种植的难点区域,常用的解决办法为上颌窦侧壁开窗窦底提升术和经牙槽嵴顶上颌窦底提升术。经牙槽嵴顶上颌窦底提升术因为手术操作简单、创伤小、愈合时间短、术后不适感少等优点逐步得到广泛应用。该技术早期应用常伴有同期植骨,但由于骨替代材料存在感染、低吸收率及引发上颌窦再气化等风险,近些年来临床上开始主张经牙槽嵴顶上颌窦底提升时不再植骨。目前对经牙槽嵴顶上颌窦底提升术中植骨与不植骨的愈合状况和临床疗效等方面都有较多的研究报道。本文就经牙槽嵴顶上颌窦底提升术是否需要同期植骨的研究进展做如下综述。     

An animal model for sinus floor elevation with great elevation heights. Macroscopic,microscopic, radiological and micro‐CT analysis: ex vivo

Objectives: Different animal models are used for research and training concerning sinus floor elevation. However, there is little information regarding an animal model for elevation heights of approximately 10 mm. The aim of this study was to explore the anatomical aspects of the maxillary sinus of adult pigs and to investigate the suitability of this animal as a model for sinus floor elevation training and research with great elevation heights. Material and methods: Thirty‐four bisected heads of adult domestic pigs were examined 6 h postmortem. Direct sinus floor elevation was performed with an elevation height of 10 mm. Localization, diameters, volume and septa of the maxillary sinus were recorded on lateral X‐rays and macroscopically. The thickness and structure of the maxillary sinus were investigated microscopically. The osseous microstructure of the lateral sinus wall was assessed microscopically and via micro‐CT. Results: The maxillary sinus of the adult pig exhibits an average length of 51±6.2 mm, a height of 31±4.1 mm, a width of 19±1.6 mm and a volume of 31±7.6 cm³. At least one septum could be observed on the floor of each sinus. The mucosal thickness amounted to a mean of 1692±138 μm, and the lateral bony wall of the sinus to a mean of 3±0.3 mm. A laceration of the Schneiderian membrane occurred in 25% during the elevation process. Conclusion: The maxillary sinus of adult domestic pigs is a suitable model for sinus floor elevation training and research with greater elevation heights of up to 10 mm. To cite this article:
Stelzle F, Benner K‐U. An animal model for sinus floor elevation with great elevation heights. Macroscopic, microscopic, radiological and micro‐CT analysis: ex vivo.
Clin. Oral Impl. Res. 21 , 2010; 1370–1378.
doi: 10.1111/j.1600‐0501.2010.01958.x     

上颌窦内提升技术在口腔种植修复中的应用

目的:研究上颌窦内提升技术在上颌后牙区种植修复中应用及临床效果.方法:2005年7月至2009年7月共完成32例、54枚种植体的上颌窦内提升种植修复病例.随访3年以上4例、2年以上12例、1年以上10例、1年以内6例.观察方法为临床检查和X线检查.患者上颌后牙区牙槽嵴顶至上颌窦底之间剩余骨高度在7--11mm之间,无法...     

Maxillary sinus floor elevation and grafting with deproteinized bovine bone mineral: a clinical and histomorphometric study

Objectives: This study evaluated the histomorphometric and clinical outcomes of maxillary sinus floor elevation using deproteinized bovine bone mineral (DBBM). Material and methods: Maxillary sinuses with a residual vertical height of <5 mm were augmented with DBBM alone before implant placement 9 months later. At the time of implant surgery, trephine samples were removed and histological and histomorphometric analyses were performed to examine the percentage of bone and residual graft using point counting and software‐aided analysis. Patients were recalled for clinical and radiographic examination up to 3 years later. Results: Twenty‐five patient specimens were analysed. The percentages of regenerated bone and residual graft material were 19% and 40%, respectively. Software‐aided analysis was comparable to point counting. Twelve patients attended for clinical follow‐up. Implants placed into this regenerated bone exhibited success and survival rates of 100% after an average follow‐up of 3 years. The average vertical height gained was 7.9 mm. Conclusions: The use of DBBM alone in maxillary sinus floor elevation is a predictable method to gain vertical bone height in the posterior maxilla. To cite this article :
Lee DZ, Chen ST, Darby IB. Maxillary sinus floor elevation and grafting with deproteinized bovine bone mineral: a clinical and histomorphometric study.
Clin. Oral Impl. Res. 23 , 2012; 918–924
doi: 10.1111/j.1600‐0501.2011.02239.x     

Evaluation of Different Methods of Indirect Sinus Floor Elevation for Elevation Heights of 10 mm: An Experimental Ex Vivo Study

Objective: The aim of this study was to macroscopically and microscopically evaluate different methods of indirect sinus floor elevation regarding elevation heights of 10 mm. Materials and Methods: Four different methods of indirect sinus floor elevation‐osteotome sinus floor elevation (OSFE), bone added osteotome sinus floor elevation (BAOSFE), piezo‐ surgical sinus floor elevation (PSFE), and sinus floor elevation with an inflatable balloon, balloon‐lift‐control system (BLC) – were macroscopically and microscopically investigated ex vivo using 36 bisected pigs’ heads. Results: OSFE and BAOSFE perforated the Schneiderian membrane, whereas the inflatable balloon caused no laceration. PSFE elevated the mucosa without laceration as well, but was technically restricted to an elevation height of 5 mm. BAOSFE, PSFE, and BLC separated the mucosa, leaving the periosteum on the bone. OSFE completely lifted the soft tissue from the bone, including the periosteum. Conclusions: The results of this study indicate that balloon elevation of the sinus floor may extend the indication for indirect sinus floor elevation for elevation heights of up to 10 mm. The histological elevation layer seems to be non‐uniform in the different sinus floor elevation methods. Further in vivo experiments have to prove these findings as well as their relevance regarding the clinical outcome of sinus floor augmentation.     

两种上颌窦底提升术的短期临床效果研究

目的 研究上颌后牙区剩余牙槽骨高度为3～<4 mm时,行经牙槽嵴顶上颌窦底提升或侧壁开窗上颌窦底提升同期种植体植入的短期临床效果。方法 选择2016年1月至2018年12月于西安交通大学口腔医院种植科行经牙槽嵴顶上颌窦底提升和侧壁开窗上颌窦底提升同期种植体植入的患者45例（50侧上颌窦,上颌后牙区剩余牙槽骨高度为3～<4 mm）,于术前、术后当日或术后第2天及术后6～9个月的愈合期后行影像学检查,比较两种术式的上颌窦底新骨形成高度、上颌窦底黏膜穿孔率及种植体早期成功率。结果 采用经牙槽嵴顶上颌窦底提升或侧壁开窗上颌窦底提升同期种植体植入的分别有19例和26例（上颌窦分别为21、29侧）患者;上颌窦底黏膜穿孔率分别为4.76%和0,差异无统计学意义（P> 0.05）。经过6～9个月的愈合期,两种术式上颌窦底新骨形成高度分别为（5.18±0.48）mm和（7.32±0.84）mm,差异有统计学意义（P <0.05）;两种术式种植体早期成功率分别为95.83%和100%,差异无统计学意义（P> 0.05）。结论 当上颌后牙区剩余牙槽骨高度为3～<4 mm时...     

上颌窦冲顶提升术同期种植体植入的临床研究

目的 研究上颌窦冲顶提升术不植骨同期植入种植体的临床效果及种植特点。方法 43例患者,牙槽嵴顶距窦底骨高度为5～10mm。经上颌窦冲顶提升术不植骨植入56颗ITI种植体。结果 术后X片显示上颌窦底抬高(2.50±1.70)mm。所有患者未发生上颌窦炎的并发症,种植体稳固,X线片显示骨结合良好。所有种植体术后3～4个月均完成种植修复,可正常负重;种植体存留率100%。结论 在选择好适应证及良好的手术操作配合下,上颌窦冲顶提升术不植骨同期植入种植体可以获得很好的种植成功率。     

Transalveolar maxillary sinus floor elevation using osteotomes with or without grafting material. Part II: radiographic tissue remodeling

Objectives: To evaluate the pattern of tissue remodeling after maxillary sinus floor elevation using the transalveolar osteotome technique with or without utilizing grafting materials.
Methods: During the period of 2000–2005, 252 Straumann^® dental implants were inserted using the transalveolar sinus floor elevation technique in a group of 181 patients. For 88 or 35% of those implants, deproteinized bovine bone mineral with a particle size of 0.25–1 mm was used as the grafting material, but for the remaining 164 implants, no grafting material was utilized. Periapical radiographs were obtained with a paralleling technique and digitized. Two investigators, who were blinded to whether grafting material was used or not, subsequently evaluated the pattern of tissue remodeling.
Results: The mean residual bone height was 7.5 mm (SD 2.2 mm), ranging from 2 to 12.7 mm. The mean residual bone height for implants placed with grafting material (6.4 mm) was significantly less compared with the implants installed without grafting material (8.1 mm). The implants penetrated on average 3.1 mm (SD 1.7 mm) into the sinus cavity. The measured mean radiographic bone gain using the transalveolar technique without grafting material was significantly less, 1.7 mm (SD 2 mm) compared with a mean bone gain of 4.1 mm (SD 2.4 mm), when grafting material was used. Furthermore, the probability of gaining 2 mm or more of new bone was 39.1% when no grafting material was used. The probability increased to 77.9% when the implants were installed with grafting material.
Conclusion: When the transalveolar sinus floor elevation was performed without utilizing grafting material, only a moderate gain of new bone could be detected mesial and distal to the implants. On the other hand, when grafting material was used, a substantial gain of new bone was usually seen on the radiographs.     

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     

Histological evaluation of healing after transalveolar maxillary sinus augmentation with bioglass and autogenous bone

Objectives: The aim was to evaluate histologically the outcome of a bioglass and autogenous bone (at 1 : 1 ratio) composite implantation for transalveolar sinus augmentation. Methods: In 31 patients, during implant installation ca. 4 months after sinus augmentation, biopsies were harvested through the transalveolar osteotomy by means of a trephine bur and non‐decalcified sections through the long axis of the cylinder were produced. After a strict selection process, taking into account the presurgical residual bone height and biopsy length, 8 and 15 biopsies representing the new tissues formed inside the sinus and the transalveolar osteotomy, respectively, qualified for analysis. The tissue fractions occupied by newly formed bone (mineralized tissue+bone marrow), soft connective tissue, residual biomaterial+empty spaces, and debris inside the sinus cavity or the transalveolar osteotomy were estimated. Results: Bone and connective tissue fraction in the newly formed tissues inside the sinus cavity averaged 23.4 ± 13.2% and 54.1 ± 23.5%, respectively. Residual biomaterial, empty spaces, and debris averaged 1.9 ± 3.5%, 10.5 ± 6.3%, and 8.4 ± 14.5%, respectively. In the transalveolar osteotomy, bone and connective tissue fraction averaged 41.6 ± 14.3% and 46.1 ± 13%, respectively, while the amount of residual biomaterial, empty spaces, and debris was 2.8 ± 5%, 4.7 ± 1.9%, and 3.2 ± 2.6%, respectively. Statistically significant differences between the sinus cavity and the transalveolar osteotomy were found only for bone and empty spaces' values (P=0.02 and 0.04, respectively). Conclusion: Sinus augmentation with a bioglass and autogenous bone composite is compatible with bone formation that, in a short distance from the floor of the sinus, shows similar density as that reported previously for other commonly used bone substitutes. New bone fraction inside the transalveolar osteotomy was almost twice as much as in the sinus cavity, while the amount of residual biomaterial was much less than that inside the sinus. To cite this article :
Stavropoulos A, Sima C, Sima A, Nyengaard J, Karring T, Sculean A. Histological evaluation of healing after transalveolar maxillary sinus augmentation with bioglass and autogenous bone.
Clin. Oral Impl. Res. 23 , 2012; 125–131.
doi: 10.1111/j.1600‐0501.2011.02161.x     

Sinus floor elevation utilizing the transalveolar approach

A transalveolar approach for sinus floor elevation with subsequent placement of dental implants was first suggested by Tatum in 1986. In 1994, Summers described a different transalveolar approach using a set of tapered osteotomes with increasing diameters. The transalveolar approach of sinus floor elevation, also referred to as ‘osteotome sinus floor elevation’, the ‘Summers technique’ or the ‘Crestal approach’, may be considered as being more conservative and less invasive than the conventional lateral window approach. This is reflected by the fact that more than nine out of 10 patients who experienced the surgical procedure would be willing to undergo it again. The main indication for transalveolar sinus floor elevation is reduced residual bone height, which does not allow standard implant placement. Contraindications for transalveolar sinus floor elevation may be intra‐oral, local or medical. The surgical approach utilized over the last two decades is the technique described by Summers, with or without minor modifications. The surgical care after implant placement using the osteotome technique is similar to the surgical care after standard implant placement. The patients are usually advised to take antibiotic prophylaxis and to utilize antiseptic rinses. The main complications reported after performing a transalveolar sinus floor elevation were perforation of the Schneiderian membrane in 3.8% of patients and postoperative infections in 0.8% of patients. Other complications reported were postoperative hemorrhage, nasal bleeding, blocked nose, hematomas and benign paroxysmal positional vertigo. Whether it is necessary to use grafting material to maintain space for new bone formation after elevating the sinus membrane utilizing the osteotome technique is still controversial. Positive outcomes have been reported with and without using grafting material. A prospective study, evaluating both approaches, concluded that significantly more bone gain was seen when grafting material was used (4.1 mm mean bone gain compared with 1.7 mm when no grafting material was utilized). In a systematic review, including 19 studies reporting on 4388 implants inserted using the transalveolar sinus floor elevation technique, the 3‐year implant survival rate was 92.8% (95% confidence interval: 87.4–96.0%). Furthermore, a subject‐based analysis of the same material revealed an annual failure rate of 3.7%. Hence, one in 10 subjects experienced implant loss over 3 years. Several of the included studies demonstrated that transalveolar sinus floor elevation was most predictable when the residual alveolar bone height was ≥ 5 mm and the sinus floor anatomy was relatively flat.     

Localized Management of Sinus Floor Technique for Implant Placement in Fresh Molar Sockets

Background: The use of osteotome for vertical bone augmentation and localized sinus elevation with minimal surgical trauma represents a suitable procedure to increase the vertical dimension of available bone for implant placement. Purpose: The aim of this study was to report clinical and radiographic results of localized management of sinus floor (LMSF) in fresh molar sockets at 13‐year follow‐up. Materials and Methods: Fifty‐three patients, needing one or two maxillary molar extraction, were enrolled in this study. LMFS procedure was performed and 68 implants were positioned. A presurgical distance from the alveolar crest to the floor of the maxillary sinus and the amount of new radiopacity between the sinus floor and alveolar crest were measured from the mesial and distal surfaces of each dental implant surface. Results: After a mean follow‐up period of 9.76 ± 5.27 years (ranged from 4 to 17 years) a survival rate of 100% was reported. Mean bone height at temporary prosthesis placement was 7.99 ± 1.16 mm. They were stable over time, reporting a mean value of 8.01 ± 1.46 mm at 13‐year follow‐up. Conclusions: The results of this study demonstrated that LMSF procedure in fresh molar sockets allowed to expand the dimensions of resorbed posterior maxillary alveolar bone both vertically and horizontally with a success rate of 100% of implant osseointegration over time.     

Long‐term results after lateral and osteotome technique sinus floor elevation: a retrospective analysis of 2190 implants over a time period of 15 years

Background: During a time period of 15 years (1992–2007), 2190 implants were inserted in 983 patients after sinus floor elevation. Materials and methods: One thousand two hundred and seven implants (461 patients) were placed into sites, in which the sinus was augmented using the lateral approach (LSFE), and 983 implants (522 patients) in sites augmented with the osteotome technique. Bovine bone mineral (n=1217), β‐tricalcium phosphate (n=126), and in some cases, only autogenous bone were used for augmentation in the LSFE. Generally, bone chips that were collected during the preparation of the osteotomy were added to the bone substitutes. No additional augmentation materials were used for augmentation with the osteotome technique. A retrospective analysis of the treatment results was assessed by patients documentations that were recorded in the impDAT(R) – Program and by the evaluation of pre‐, and post‐surgical orthopantomograms. Results: The implant survival analysis according to Kaplan–Meier showed 97.1% after 176 months of loading for both sinus floor elevation techniques. Discussion and conclusion: The evaluation with respect to the augmentation material used did not reveal significant differences in the implant survival rate and in both cases remodelling processes could be observed in the augmented area. To cite this article:
Tetsch J, Tetsch P, Lysek DA. Long‐term results after lateral and osteotome technique sinus floor elevation: a retrospective analysis of 2190 implants over a time period of 15 years.
Clin. Oral Impl. Res. 21 , 2010; 497–503.
doi: 10.1111/j.1600‐0501.2008.01661.x     

上颌窦底提升术

目前,种植手术已成为一种常规的技术应用于临床,随着种植体设计的改进和植入技术的日趋成熟,成功率不断提高,适应证也不断扩大,但是剩余骨高度不足仍是影响上颌后牙区种植手术的主要因素.临床上多采用上颌窦底提升术,主要包括上颌窦侧壁开窗术和冲压式上颌窦底提升术,这2种术式有效解决了上颌后牙区剩余骨高度不足的问题.本文主要介绍上颌窦的解剖结构、底壁分嵴等情况,以及口腔影像学检查方法的应用;归纳总结上颌窦底提升术的基本原则,上颌窦侧壁开窗提升术的切口设计、手术方法,以及3种改良冲压式上颌窦底提升术的比较,骨挤压器和骨冲顶器的应用,初步探讨植骨材料的选择,辅助上颌窦底提升术的特殊器械(超声骨刀和内镜)的特点,伴发上颌窦囊肿和术后并发症的处理方法.     

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.     

The use of Straumann® Bone Ceramic in a maxillary sinus floor elevation procedure: a clinical,radiological, histological and histomorphometric evaluation with a 6‐month healing period

Objectives: In this study, we evaluated the quality and quantity of bone formation in maxillary sinus floor elevation procedure using a new fully synthetic biphasic calcium phosphate (BCP) consisting of a mixture of 60% hydroxyapatite and 40% of β‐tricalcium phosphate (Straumann^® Bone Ceramic). Material and methods: A unilateral maxillary sinus floor elevation procedure was performed in six patients using 100% BCP. Biopsy retrieval for histological and histomorphometric analysis was carried out before implant placement after a 6‐month healing period. Results: In this study, the maxillary sinus floor elevation procedure with the use of BCP showed uneventful healing. Radiological evaluation after 6 months showed maintenance of vertical height gained immediately after surgery. Primary stability was achieved with all Straumann^® SLA dental implants of 4.1 mm diameter and 10 or 12 mm length. The implants appeared to be osseointegrated well after a 3‐month healing period. Histological investigation showed no signs of inflammation. Cranial from the native alveolar bone, newly formed mineralized tissue was observed. Also, osteoid islands as well as connective tissue were seen around the BCP particles, cranial from the front of newly formed mineralized tissue. Close bone‐to‐substitute contact was observed. Histomorphometric analysis showed an average bone volume/total volume (BV/TV) of 27.3% [standard deviation (SD) 4.9], bone surface/total volume (BS/TV) 4.5 mm²/mm³ (SD 1.1), trabecula‐thickness (TbTh) 132.1 μm (SD 38.4), osteoid‐volume/bone volume (OV/BV) 7.5% (SD 4.3), osteoid surface/bone surface (OS/BS) 41.3% (SD 28.5), osteoid thickness (O.Th) 13.3 μm (SD 4.7) and number of osteoclasts/total area (N.Oc/Tar) 4.4 1/mm (SD 5.7). Conclusions: Although a small number of patients were treated, this study provides radiological and histological evidence in humans confirming the suitability of this new BCP for vertical augmentation of the atrophied maxilla by means of a maxillary sinus floor elevation procedure allowing subsequent dental implant placement after a 6‐month healing period. The newly formed bone had a trabecular structure and was in intimate contact with the substitute material, outlining the osteoconductive properties of the BCP material. Bone maturation was evident by the presence of lamellar bone. To cite this article:
Frenken JWFH, Bouwman WF, Bravenboer N, Zijderveld SA, Schulten EAJM, ten Bruggenkate CM. The use of Straumann^® Bone Ceramic in a maxillary sinus floor elevation procedure: a clinical, radiological, histological and histomorphometric evaluation with a 6‐month healing period.
Clin. Oral Impl. Res. 21 , 2010; 201–208.
doi: 10.1111/j.1600‐0501.2009.01821.x     

用盘钻经牙槽嵴提升上颌窦底手术的临床效果观察

目的 观察并评估应用盘钻行经牙槽嵴上颌窦底提升同期种植体植入术的临床效果.方法 上颌后牙缺失患者37例,种植区剩余牙槽骨高度为3～8 mm,平均(5.61±1.61) mm,应用盘钻行上颌窦底提升,同期植入种植体51枚,评估手术安全性及舒适度.术后3～6个月行上部结构修复,随访3～24 个月,观察种植体稳定性、骨结合及种植体周围骨量变化情况.结果 本组术中提升上颌窦底高度2～8 mm,平均(4.75±1.55) mm;所有病例均未发生上颌窦黏膜穿孔,患者主观感觉良好,痛苦指数为(2.22±0.98).随访期内,所有病例均未出现上颌窦感染等并发症,骨结合良好,种植体及修复体无松动、脱落,留存率100%.种植体根方骨量于术后6个月趋于稳定,术后1年颈部骨吸收(1.20±0.72) mm.结论 应用盘钻行经牙槽嵴上颌窦底提升同期种植体植入术,近期效果满意.

Abstract：

Objective To evaluate the clinical effect of the disk-up sinus reamer (DSR) applied to transcrestal maxillary sinus floor elevation with simultaneous placement of implants. Methods Thirty-seven patients underwent transcrestal maxillary sinus floor elevation with fifty-one implants placed simultaneously using the DSR. The residual bone height(RBH) was 3 to 8 mm, (5.61±1.61) mm on average. The safety of this technique and the pain index during the operation was evaluated. The final prostheses were restored in 3-6 months postoperatively. The follow-up period was 3 to 24 months. The stability and osseointegration of the implants were clinically evaluated, and the endo-sinus bone gain around the implants were measured. Results The elevation height ranged from 2 to 8 mm, with an average of (4.75±1.55) mm. There was no detectable sinus membrane perforation, no serious suffering or uncomfortable subjective sensation in any patients during operation with a pain index of (2.22±0.98). During the follow-up period, no sinus complication was observed. Favorable osseointegration was obtained. There were no implants or prostheses which were loose or lost. The survival rate was 100%. The radiographic results demonstrated that the endo-sinus bone gain tended to reach stabilization after 6 months and the marginal bone loss was(1.20±0.72) mm after 12 months. Conclusions Transcrestal maxillary sinus floor elevation with simultaneous implant placement by DSR is a safe, invasive and handy technique, with higher elevation height,fewer clinical complications and less pain. It shows satisfactory clinical results in short term and a long-term observation is still needed.     

Dynamics and risk indicators of intrasinus elevation height following transalveolar sinus floor elevation with immediate implant placement: a longitudinal cohort study

Successful intrasinus graft consolidation is essential for the treatment outcome of transalveolar sinus floor elevation (SFE). This study was performed to examine the dynamics and risk indicators related to the elevation height after transalveolar SFE with grafting material and simultaneous implant placement. Fifty-two patients with 55 sites undergoing transalveolar SFE with immediate implant placement were enrolled retrospectively. Cone beam computed tomography (CBCT) images were collected and saved in DICOM format, at the following time-points: pre-surgery (T0), immediately post-surgery (T1), and 6 months post-surgery (T2). Voxel-based CBCT superimposition was performed to measure the sinus width, residual alveolar height, implant protrusion length, total elevation height, and apical graft height. The change in total elevation height from T1 to T2 was defined as the study outcome. Clinical and linear variables were analysed using linear regression. From T1 to T2, the total elevation height showed an average reduction of 1.0 ± 1.1 mm, while 10.9% sites showed an increased elevation height. Univariate regression analysis showed no significant correlation between tested clinical or linear variables and the study outcome. The results suggest that the change in elevation height was not influenced by the alveolar or sinus dimensions, graft materials, implant diameter, implant protrusion length, or the total elevation height at T1.     

Osteotome Sinus Floor Elevation without Bone Grafts – A 3‐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. In 1994, a less‐invasive technique using osteotomes was suggested by Summers. 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. Two implants in edentulous patients were lost at the 1‐year follow‐up, and one more at the 3‐year examination. The remaining 50 implants inserted were in function, giving a 3‐year cumulative survival rate of 94%. Implants used in single‐tooth replacements and in partially edentulous cases had a 100% survival rate. The 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. At the final examination after 3 years, the mean bone level was situated 0.6 ± 0.09 mm below the reference point, indicating a nonsignificant change between 1 year and 3 years. 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.