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.     

Comparison of Efficacy of Mandible and Iliac Bone as Autogenous Bone Graft for Orbital Floor Reconstruction

Objective

This study evaluated and compared the efficacy of mandible and iliac bone as autogenous bone graft for correction of orbital floor fractures.

Patients and Methods

Twenty patients who suffered orbital floor fractures took part in the study. The subjects enrolled in the study sustained both isolated orbital floor fracture and orbital floor fracture associated with fracture of zygomatico-maxillary complex. Each inferior orbital wall was reconstructed using either a mandible bone graft or an iliac graft. Mandibular symphysis was opted as a donor site for graft harvest from mandible and anterior iliac crest for the iliac group. CT scans were taken before the operation. Inclusion criteria consisted of at least 2 months postsurgical follow-up, pre- and post-surgical photographic documentation, and complete medical records regarding inpatient and outpatient data. To describe the distribution of complications and facilitate statistical analysis, we categorized our findings into diplopia, enophthalmos, and restriction of ocular movements before and after treatment. We also considered the time required for the harvest of the grafts and the donor site complications. A comparative study was carried out using Chi square test and student t test. We considered P value <0.05 to be statistically significant.

Results

Ten iliac crest grafts and ten mandible bone grafts were placed. The mean age of the patients was 33.1 years. 80 % of the patients were males. The most common complication of orbital floor fracture was diplopia, followed by enophthalmos and restriction of ocular movements. The post operative results were compared after 2 months of the surgery. In iliac crest group, diplopia got corrected in six out of seven patients (85 %), enophthalmos in four out of five patients (80 %) and restricted ocular movement showed 100 % correction. While in mandible group, diplopia and ocular movement showed 100 % correction and enophthalmos got corrected in five out of six patients (83 %). No statistically significant differences were found between the two groups on comparing these variables. On the other hand the mean time required for the harvest of iliac graft and mandible graft was 30.2 ± 3.52 min and 16.8 ± 1.75 min respectively. The difference was statistically significant.

Conclusion

There is no difference in the ability of mandible and anterior iliac crest bone grafts to correct post-traumatic diplopia, enophthalmos and restricted ocular movements. But the time and ease of harvest of the graft from mandible was comparatively less and easy especially when the treating doctor was an oral and maxillofacial surgeon. Secondly the post-operative morbidity was low and the quality and contour of the bone graft was very adaptable for the reconstruction of the orbital floor.     

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.     

上颌窦底外提升植骨术49例牙种植的临床分析

目的:观察比较上颌窦底外提升植骨术同期或延期牙种植的临床效果.方法:对2003-04-2009-12在烟台市口腔医院种植中心就诊的49例行上颌窦底外提升植骨术,同期或延期牙种植的患者进行临床效果评价,随访观察时间为1～7年,采用寿命表法及x2检验进行统计学分析.结果:49例患者无1人失访,上颌窦底外提升植骨术同期牙种植...     

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。     

Bone Graft Healing in Reconstruction of Maxillary Atrophy

Purpose: Evaluate correlations between volume change for iliac crest bone grafts in maxillary reconstruction (graft volume change [GVC]) and bone mineral density (BMD), bone volume fraction (BVF), hematologic bone metabolic factors (I), and identify indicators of implant failure (II). Material and Methods: Forty‐six consecutive patients had their edentulous atrophic maxilla reconstructed with free autogenous bone grafts from anterior iliac crest. Endosteal implants were placed 6 months after graft healing. Computer tomography was performed after 3 weeks and 6 months after grafting. Bone biopsies were taken from the internal table of donor site for calculation (BVF), and blood samples were collected. Implant stability was measured at placement with resonance frequency analysis and expressed as implant stability quotient (ISQ). Implant failure was registered. Results: GVC in onlay bone graft was 37%. The BVF in iliac crest biopsies was 32%. Serum‐IGFBP3 differed with 79% of the samples over normal range. Fifteen patients had one or more implant failures prior to loading (early failures). Forty‐two patients were followed for a minimum of 3 years after implant loading and, in addition, 6/42 patients had one or more implants removed during the follow‐up (late failures). GVC correlated to decreased BMD of lumbar vertebrae L2‐L4 (Kruskal–Wallis test, p = .017). No correlation was found between GVC and hematologic factors (Pearson correlation test) or between GVC and BVF (Kruskal–Wallis test). No correlation was found between ISQ and GVC (Pearson correlation test, p = .865). The association between implant failures and the described factors were evaluated, and no significant correlations were found (unconditional logistic regression). Conclusion: Onlay bone grafts decrease 37% during initial healing period, which correlate to BMD of lumbar vertebrae L2‐L4. No other evaluated parameters could explain GVC. The evaluated factors could not explain implant failure.     

The Buccofacial Wall of Maxillary Sinus: An Anatomical Consideration for Sinus Augmentation

Purpose: This study aimed to quantify the thickness of the buccofacial wall of the maxillary sinus where sinus augmentations are often performed.
Materials and Methods: Fourteen sites located 15 and 20 mm superior to the anatomical cervical line (named as groups H15 and H20, respectively) and along the long axes of the mid and the interproximal of two premolars and two molars were measured from 74 Korean hemiface cadavers.
Results: The buccofacial wall of the maxillary sinus was thinnest at the area between the maxillary second premolar and first molar in groups H15 and H20. The lowest mean thickness was 1.2 mm in both groups. The walls were thicker in males than in females, with statistically significant gender differences found at four and two sites on the anterior horizontal reference in groups H15 and H20, respectively. However, the thickness did not differ significantly with age or laterality. Incomplete septa were found in seven of the 74 specimens, and they were present in the area between the first and second molars in six (86%) of these cases.
Conclusions: These observations indicate that anatomical characteristics of the buccofacial wall thickness of the maxillary sinus need to be considered when performing a window opening procedure for sinus augmentation.     

保守治疗上颌窦前壁骨折的疗效观察

目的 :观察保守治疗治疗上颌窦骨折的疗效。方法 :将24例上颌窦骨折患者中严重移位的上颌窦前壁骨片初步复位,严密缝合关闭软组织伤口。结果:24例患者,软组织伤口均一期愈合。愈合面部外形基本满意,双侧基本对称,局部无明显凹陷。X线片显示:上颌窦前壁在6个月后恢复连续,外形接近正常侧。结论:上颌窦前壁骨折常可不予固定,仅在复位固定其他部位骨折时将内陷、错位严重的骨折片初步复位,与周围骨折断端接触,软组织严密覆盖,即可提供骨修复条件。     

自体髂骨游离移植同期种植体植入修复骨量不足区牙缺失的动物实验研究

目的:利用自体髂骨游离移植一期植入种植体的动物实验研究,揭示自体髂骨游离移植同期植入种植体的愈合过程,为临床工作提供理论依据和借鉴。方法:选择16只健康成年雄性日本大耳白兔,在双侧髂骨制备髂骨缺损模型,游离移植自体髂骨,并同期分别在双侧髂骨植骨区及非植骨区植入自制圆柱状羟基磷灰石种植体。随机分成4组,每组4只。术后2周、4周、8周、12周各处死一组动物,切取标本。进行大体标本观察,放射线、组织学(脱钙HE染色)、扫描电镜检查、力学测试。结果:大体标本观察见各组种植体和髂骨结合紧密。肉眼见种植体和髂骨之间多为骨性结合,仅2周标本及4周实验组标本一些区域可见一薄层纤维样组织。放射线检查:2周标本可见有放射线透射区,实验组密度稍低于对照组密度;余各组种植体周围均未见明显的放射线透射区;4周标本实验组密度稍低于对照组;8周标本、12周标本实验组密度与对照组密度基本无差别。组织学及扫描电镜检查实验组与对照组种植体均与骨质形成不同程度的骨结合;对照组种植体比实验组形成更好的骨结合;各组种植体4周、8周、12周依次形成更好的骨结合。力学测试(反向推出实验)显示2周、4周、8周、12周骨结合实验组最大负荷分别是66.3N/cm2、143.9N/cm2、194.6N/cm2、248.3N/cm2。对照组最大负荷分别是108.6N/cm2、229.2N/cm2、307.1N/cm2、377.6N/cm2。结论:自体髂骨游离移植同期种植修复骨量不足区牙缺失是切实可行的修复方法。     

Cholesterol Granuloma of the Maxillary Sinus Encountered during Floor Augmentation Procedure: A Case Report

Background: Cholesterol granuloma (CG) is a foreign‐body reaction to the deposition of cholesterol crystals. Its occurrence in the paranasal sinuses is very rare. Purpose: This report describes a new case of maxillary sinus CG discovered incidentally during sinus‐floor augmentation for dental implant placement in a 60‐year‐old female patient. Materials and Methods: The preoperative clinical and radiological examinations revealed a normal maxillary antrum with no evidence of sinus pathology. After lateral osteotomy, a dark‐green, viscous soft tissue mass appeared through the thin mucous membrane inside the sinus. Enucleation and curettage of the sinus contents including the sinus membrane were performed for histopathologic analysis. The augmentation and implant placement procedures were postponed. Results: Histopathologic analysis showed several fragments of granulation tissue containing diffuse cholesterol clefts surrounded by mixed chronic inflammatory cell infiltrate including plasma cells and lymphocytes. These features were compatible with the diagnosis of CG. The patient was followed up for 3 months after the first procedure, and a second attempt of sinus augmentation and dental implant insertion was then carried out. The inserted dental implants were followed up for 6 months without any complications. Conclusions: CG of maxillary sinus can be an incidental finding. For this reason, the final diagnosis can only be achieved after examination of the material under the microscope.     

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.     

Maxillary Sinus Membrane Repair With Amnion–Chorion Barriers: A Retrospective Case Series

Background: Schneiderian membrane perforation is the most common complication of maxillary sinus augmentation procedures and has been associated with a variety of post‐surgical problems. Multiple techniques to repair perforated Schneiderian membranes with materials such as connective tissue, buccal fat pads, and resorbable collagen membranes have been reported in the dental literature. Although these reparative options have proven successful, they are technique sensitive and time consuming. The aim of this case series is to present a simplified method of Schneiderian membrane perforation repair with amnion–chorion membranes and results obtained from nine cases using this technique. Methods: A consecutive retrospective record review was performed of all maxillary sinus augmentation cases performed during the past 5 years by the same board‐certified private practice periodontist (DH). Results: Seventy‐seven cases were identified, with a total of 104 sinus augmentations, in which nine perforations were noted. None of the perforation cases were aborted midprocedure, and all perforations were repaired with amnion–chorion membranes. All cases were augmented with a combination of allograft and xenograft particulate bone. After an average healing time of 4.9 months, dental implants were placed in the grafted sinuses. Conclusions: This retrospective case series shows nine perforations during 104 lateral window maxillary sinus augmentation procedures. A total of 23 dental implants were placed in the augmented sinuses with perforated Schneiderian membranes, and one failure was noted according the Albrektsson success criteria. A total of 158 dental implants were placed in non‐perforated augmented sinuses, with a total of three failures noted.     

Calvarial graft resorption index in the reconstruction of the maxillary sinus in patients with atrophic maxillas: a prospective clinical study

The objective of this study was to assess the resorption index of particulate calvarial grafts in maxillary sinuses of patients undergoing total reconstruction of an atrophic maxilla with residual alveolar bone that was less than, or equal to, 3 mm thick. Twenty-one maxillary sinus floor elevations were carried out using particulate calvarial grafts in 11 individuals with totally edentulous maxillas. All patients had computed tomography (CT) before (T0), and 48 hours (T1) and six months after surgery (T2). For each CT scan, linear measurements were taken of sections of the anterior, medial, and posterior regions of the maxillary sinus. There was a significant increase in the height of the maxillary sinus floor when T0 was compared with T1 (p = 0.001). There was a statistically significant reduction in all maxillary sinus measurements when T1 was compared with T2; the mean height reduction being 2.36 mm (16.87%) in the anterior region, 3.53 mm (22.47%) in the medial region, and 2.21 mm (22.78%) in the posterior region (p = 0.001). Mean resorption was 20.7%. Autogenous calvarial bone used alone is an option for graft material in pneumatised maxillary sinuses and in cases where there is limited alveolar bone.     

自体骨游离移植修复下颌骨缺损的临床疗效观察

目的:观察自体髂骨、肋骨游离移植修复下颌骨缺损的临床疗效。方法:回顾性总结分析49例自体髂骨、肋骨游离移植修复下颌骨缺损病例,经随访0.5～14年,观察移植骨存活、咬合关系与咀嚼功能及颌面部外形恢复情况。结果:45例植骨区伤口一期愈合,占91.8%;47例移植骨完全成活,占95.9%;34例咬合关系与咀嚼功能恢复良好,占69.4%;42例面部外形恢复满意,占85.7%。随访1年时,有39例整体效果满意,满意率为79.6%。颜面外形及咀嚼功能恢复较差者多为大范围缺损行游离肋骨移植病例。结论:单纯自体骨游离移植修复下颌骨缺损术式简单,操作简便,只要严格掌握适应证,修复效果满意,在下颌骨缺损修复中具有较大应用价值。但单纯应用肋骨修复下颌骨体     

上颌窦侧壁开窗提升术中应用CGF的骨增量影像学评价与临床对照研究

目的:探讨CGF在上颌窦底侧壁开窗提升术中的临床疗效和在Minics软件三维重建介导下的影像学变化.方法:收集因上颌后牙区骨量不足(<5 mm)拟行上颌窦侧壁开窗提升术的患者20例分为2组:实验组10例(CGF联合骨替代材料组)和对照组10例(仅使用骨替代材料组).本研究为临床对照研究,通过Minics 19.0软件三...