A new sinus lift technique in conjunction with placement of 265 implants: a 6-year retrospective study

Evaluation of the effectiveness of a water lift system in the sinus membrane-lifting operation as a sinus surgical instrument

PURPOSE

The effectiveness of a Water Lift System in the sinus membrane-lifting operation was examined. This investigation focused on the capability of this equipment to reduce the risk of Schneiderian membrane perforation.

MATERIALS AND METHODS

A preliminary clinical study on the use of the Water Lift System in sinus membrane elevation to place implants through the sinus floor was conducted. A total of 70 sinus membrane-lifting operations were performed on patients with various bone heights ranging from 1.2 to 9.9 mm (most commonly in the range of 4-6 mm) through the lateral approach (four cases) or the crestal approach (66 cases).

RESULTS

In all of the cases performed using the lateral approach, sinus membrane perforation did not occur. In the 66 cases performed using the crestal approach, Schneiderian membrane tearing occurred in two cases. The membrane tearing occurred during elevation of the Schneiderian membrane but not when a hole was drilled to access the Schneiderian membrane. One case of membrane tearing resulted from previous inflammation in the maxillary sinus, and the other case of membrane tearing was caused by application of excessive hydraulic pressure. In addition, similar outcomes were obtained and no microbial infections were observed in a total of 68 successful cases.

CONCLUSIONS

In this study, the Water Lift System was confirmed to effectively reduce the risk of Schneiderian membrane perforation during the sinus membrane-lifting operation. We conclude that the Water Lift System deserves to be considered as a sinus surgical instrument, which ensures safety in the sinus membrane-lifting operation.

Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus

BACKGROUND

Insufficient bone volume is a common problem encountered in the rehabilitation of the edentulous posterior maxillae with implant-supported prostheses. Bone volume is limited by the presence of the maxillary sinus together with loss of alveolar bone height. Sinus lift procedures increase bone volume by augmenting the sinus cavity with autogenous bone and/or commercially available biomaterials.

OBJECTIVES

To determine whether and when augmentation of the maxillary sinus are necessary and which are the most effective augmentation techniques for rehabilitating patients with implant-supported prostheses.

SEARCH STRATEGY

The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched on 7th January 2010. Several dental journals were handsearched. The bibliographies of review articles were checked, and personal references were searched. More than 55 implant manufacturing companies were also contacted.

SELECTION CRITERIA

Randomised controlled trials (RCTs) of different techniques and materials for augmenting the maxillary sinus for rehabilitation with dental implants reporting the outcome of implant success/failure at least to abutment connection.

DATA COLLECTION AND ANALYSIS

Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted independently and in duplicate. Authors were contacted for any missing information. Results were expressed as random-effects models using mean differences for continuous outcomes and odds ratios for dichotomous outcomes with 95% confidence intervals. The statistical unit of the analysis was the patient.

MAIN RESULTS

Ten RCTs out of 29 met the inclusion criteria. One trial of 15 patients evaluated implants 5 mm long with 6 mm diameter as an alternative to sinus lift in bone with a residual height of 4 to 6 mm. Nine trials with 235 patients compared different sinus lift techniques; of these four trials (114 patients) evaluated the efficacy of platelet-rich plasma (PRP). Due to the variety of techniques evaluated, meta-analysis was only possible of use of PRP for implant failure (two trials) and complications (three trials). No statistically significant difference was observed.

AUTHORS' CONCLUSIONS

Conclusions are based on few small trials, with short follow-up, and judged to be at high risk of bias. Therefore conclusions should be viewed as preliminary and interpreted with great caution. It is still unclear when sinus lift procedures are needed. 5 mm short implants can be successfully loaded in maxillary bone with a residual height of 4 to 6 mm but their long-term prognosis is unknown. Elevating the sinus lining in presence of 1 to 5 mm of residual bone height without the addition of a bone graft may be sufficient to regenerate new bone to allow rehabilitation with implant-supported prostheses. Bone substitutes might be successfully used as replacements for autogenous bone. If the residual alveolar bone height is 3 to 6 mm a crestal approach to lift the sinus lining, to place 8 mm implants may lead to fewer complications than a lateral window approach, to place implants at least 10 mm long. There is no evidence that PRP treatment improves the clinical outcome of sinus lift procedures with autogenous bone or bone substitutes.

Simultaneous implant placement in sinus floor augmentation using iliac bone block grafts in severe maxillary atrophies: case report

The placement of implants requires adequate basic conditions. Insufficient bone height and width in the area of the maxilla, because of expansion of the maxillary sinus and atrophic resorption of the alveolar ridge, represent a common anatomical complication, which can be solved by augmentation of the floor of the maxillary sinus. It is commonly shared that autologous bone graft is the gold standard method in the augmentation of the Higmoro antrum. The reconstruction of atrophies with adequate bone volume and density has become a viable treatment option with high predictability and success rates. The purpose of this study was to present the results obtained with a surgical procedure aimed at reconstructing (rehabilitating) advanced maxillary atrophies. This method includes the use of intramembranous, corticocancellous bone grafts harvested from the iliac crest. These are then fixed to the residual bone by endosseous implants.

A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation

OBJECTIVES

The objectives of this systematic review were to assess the survival rate of grafts and implants placed with sinus floor elevation.

MATERIAL AND METHODS

An electronic search was conducted to identify studies on sinus floor elevation, with a mean follow-up time of at least 1 year after functional loading.

RESULTS

The search provided 839 titles. Full-text analysis was performed for 175 articles resulting in 48 studies that met the inclusion criteria, reporting on 12,020 implants. Meta-analysis indicated an estimated annual failure rate of 3.48% [95% confidence interval (CI): 2.48%-4.88%] translating into a 3-year implant survival of 90.1% (95% CI: 86.4%-92.8%). However, when failure rates was analyzed on the subject level, the estimated annual failure was 6.04% (95% CI: 3.87%-9.43%) translating into 16.6% (95% CI: 10.9%-24.6%) of the subjects experiencing implant loss over 3 years.

CONCLUSION

The insertion of dental implants in combination with maxillary sinus floor elevation is a predictable treatment method showing high implant survival rates and low incidences of surgical complications. The best results (98.3% implant survival after 3 years) were obtained using rough surface implants with membrane coverage of the lateral window.

Particulate inlay nasal graft with immediate dental implant placement in a patient with repaired alveolar cleft: case report

Primary bone grafts in congenital cleft alveolus do not always provide sufficient bulk or height of bone for ideal placement of endosseous implants. Thus, maxillary sinus or nasal floor elevation and inlay bone grafts in previously grafted areas are not exceptions in the daily routine. This case report stresses the need of a detailed treatment plan and careful surgical management of nasal floor elevation with particulate autogenous bone graft to successfully provide the patient with osseointegrated prostheses.

Sinus Floor Elevation Using Osteotomes: A Systematic Review and Meta-Analysis

BACKGROUND

Various techniques of sinus floor elevation (SFE) are described. The elevation with osteotomes (OSFE) from a crestal approach is a relatively new technique. The aim of this systematic review and meta-analysis was to evaluate the clinical outcome of implants placed into the maxillary sinus augmented with an OSFE technique.

METHODS

A systematic online and manual review of the literature identified articles dealing with OSFE. Applying rigid inclusion criteria, screening and data abstraction were performed independently by two reviewers. The follow-up of loaded implants was a minimum of 6 months. The identified articles were analyzed regarding implant outcome and defined surgical aspects. Survival and success rates were estimated by Kaplan-Meier curves.

RESULTS

Eight out of 44 articles dealing with osteotome sinus floor elevation met the inclusion criteria. Five of the studies met established success criteria. The survival and success rates were 95.7% and 96.0% after 24 months and 36 months, respectively. The median and mean follow-up periods were 24 and 18.73 months for the survival rate and 24 and 19.7 months for the success rate. Regarding different surgical elements, i.e., osteotome techniques, implant types, and augmentation materials, the database was multivariate. Thus, no statistical analysis could be performed on these parameters.

CONCLUSIONS

Short-term clinical success/survival (<or years) of implants placed with an osteotome sinus floor elevation technique seems to be similar to that of implants conventionally placed in the partially edentulous maxilla. Controlled prospective clinical studies are needed to evaluate the long-term outcome and various surgical modifications of OSFE.