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Wortmann DE, van Minnen B, Delli K, Schortinghuis J, Raghoebar GM, Vissink A. Harvesting anterior iliac crest or calvarial bone grafts to augment severely resorbed edentulous jaws: a systematic review and meta-analysis of patient-reported outcomes. Int J Oral Maxillofac Surg 2023; 52:481-494. [PMID: 36243645 DOI: 10.1016/j.ijom.2022.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/04/2022] [Accepted: 09/09/2022] [Indexed: 01/27/2023]
Abstract
The aim of this systematic review was to compare patient-reported outcomes after harvesting calvarial or anterior iliac crest bone grafts to repair severe jaw defects and enable implant placement. The MEDLINE, Embase, Cochrane Central Register of Controlled Trials databases, and OpenGrey were searched for studies on patient satisfaction, pain, disturbances in daily functioning, sensory alterations, donor site aesthetics, and complication rates. Of the 1946 articles identified, 43 reporting 40 studies fulfilled the inclusion criteria; the studies were one randomized controlled clinical trial, one retrospective controlled clinical trial, and 23 prospective and 15 retrospective cohort studies. A meta-analysis of two studies (74 patients) showed no difference in satisfaction (mean difference (MD) - 0.13, 95% confidence interval (CI) - 1.17 to 0.92; P = 0.813) or postoperative pain (directly postoperative: MD -2.32, 95% CI -5.20 to 0.55, P = 0.113; late postoperative: MD -0.01, 95% CI -0.14 to 0.11, P = 0.825) between donor sites. However, the level of evidence is limited, due to the retrospective, non-randomized design of one study. Postoperative gait disturbances were highly prevalent among the anterior iliac crest patients (28-100% after 1 week). The incidence rates of sensory disturbances and other complications were low, and the donor site aesthetic outcomes were favourable for both graft types. To conclude, harvesting bone grafts from the calvarium or anterior iliac crest to augment the severely resorbed edentulous jaw results in similar patient satisfaction. However, the findings for postoperative pain and disturbances in daily living suggest a trend in favour of calvarial bone grafts if harvested using an adjusted technique.
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Affiliation(s)
- D E Wortmann
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - B van Minnen
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - K Delli
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - J Schortinghuis
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - G M Raghoebar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - A Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Pizzini A, Basma HS, Li P, Geurs NC, Abou-Arraj RV. The impact of anatomic, patient and surgical factors on membrane perforation during lateral wall sinus floor elevation. Clin Oral Implants Res 2021; 32:274-284. [PMID: 33314302 DOI: 10.1111/clr.13698] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/24/2020] [Accepted: 11/28/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES This retrospective study aimed to evaluate the influence of anatomical, patient and surgical factors on the occurrence of membrane perforation (MP) during lateral window sinus floor elevation (LWSFE). MATERIAL AND METHODS A review of LWSFE patient records between 2014 and 2019 accounted for MP occurrence, window surface area (WSA), intravenous sedation use, osteotomy instrument type and clinician experience. Preoperative cone beam computed tomography (CBCT) scans were analyzed for lateral wall thickness (LWT), LFM and LAM angles formed between lateral and medial walls at the floor and anterior wall, respectively, sinus width at 5-, 10- and 15-mm (LM-5, LM-10 and LM-15) from the floor, residual bone height (RBH), sinus pathologies, septa and arterial anastomoses. The generalized estimating equation (GEE) approach with a sandwich variance-covariance estimator was used to evaluate the associations with MP. RESULTS MP occurred in 25.74% of 202 LWSFE procedures (166 patients). Mean 1.6 mm-LWT, 3.2 mm-RBH, 95°-LFM, 75.5°-LAM, 12 mm-LM-5, 20.79% septa, 16.83% arterial anastomosis, 37.62% sinus pathology and 29.21% intravenous sedations, 85.24% WSA ≥ 40 mm2 and 57% >10 procedures/clinician were reported. Greater MP rates were encountered as follows: 38.3% (LWT ≥ 1.5 mm), 38% (LFM < 90°), 59.6% (LAM < 70°), 45.4% (LM-5 < 10 mm) and 36.4% (WSA ranged > 80 mm2 ), with statistically significant associations with all these outcomes (p < .05). The presence of pathologies was also associated with MP (p = .013). Associations between MP and the presence of septa and arterial anastomoses, age/gender, right/left sinus, RBH, clinician's experience, instrument type and intravenous sedation use could not be demonstrated. CONCLUSIONS MP is significantly associated with thicker lateral walls, narrower sinuses, larger windows and existing sinus pathology.
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Affiliation(s)
- Andrea Pizzini
- Department of Periodontology, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hussein S Basma
- Department of Periodontology, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Peng Li
- Department of Acute, Chronic and Continuing Care, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nicolaas C Geurs
- Department of Periodontology, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ramzi V Abou-Arraj
- Department of Periodontology, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
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Update of Surgical Techniques for Maxillary Sinus Augmentation: A Systematic Literature Review. IMPLANT DENT 2017; 25:839-844. [PMID: 27540841 DOI: 10.1097/id.0000000000000467] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE A wide range of surgical techniques are available for maxillary sinus augmentation. This review aimed to determine which techniques have achieved the highest success rates and so offer the greatest predictability. MATERIALS AND METHODS A systematic literature review was performed using the PubMed, MEDLINE, and Scopus databases, identifying clinical trials that assessed different surgical techniques for maxillary sinus augmentation, and registered the success rates of subsequent implant placement. RESULTS A total of 40 articles described clinical studies involving different maxillary sinus augmentation procedures with follow-up periods of at least 6 months after dental implant placement. Implant success rates varied between 94% and 100% during the follow-up periods. CONCLUSION A wide variety of clinical techniques are available for maxillary sinus augmentation; the choice of the technique will depend chiefly on the characteristics of the edentulous site, which will permit or prevent the placement of the implant at the moment of sinus augmentation surgery.
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Chrcanovic BR, Abreu MHNG. Survival and complications of zygomatic implants: a systematic review. Oral Maxillofac Surg 2013; 17:81-93. [PMID: 22562293 DOI: 10.1007/s10006-012-0331-z] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 04/21/2012] [Indexed: 05/31/2023]
Abstract
PURPOSE This systematic review attempted to answer the focused questions: "What is the survival rate of zygomatic implants (ZIs)?" and "What are the most common complications related to surgery of zygomatic implants?" METHODS An electronic search without date or language restrictions was undertaken in PubMed in March 2012. Titles and abstracts from these results (n = 123) were read for identifying studies that meet the eligibility criteria. Eligibility criteria included studies reporting clinical series of zygomatic implants (ZIs). Because of the scarcity of articles with high-level grades of evidence, all articles, including studies with few case reports, were considered for inclusion. All reference lists of the selected and review studies were hand-searched for additional papers that might meet the eligibility criteria. Simple case report articles were not included. Review articles without original data were excluded. Quantitative data extracted from the included studies that provided data for the period of failure of ZIs were used for the calculation of interval survival rate during each follow-up period and cumulative survival rate (CSR) over a 12-year period. RESULTS Thirty-seven studies were identified without repetition and five more studies were included by hand-searching, giving a total of 42; 12 evaluated the use of ZI applied with immediate function protocols and 3 for rehabilitating patients after maxillary resections for tumor ablations. These latter three studies showed smaller ZI success. Postoperative complications reported were as follows: 70 cases of sinusitis, 48 of soft tissue infection, 15 of paresthesia, and 17 cases of oroantral fistulas. However, this number may be underestimated, since most of the studies did not mention the presence or absence of these complications. Most ZI failures were detected at the abutment connection phase (6 months after the surgery of implant placement) or before. The CSR over a 12-year period was 96.7 %. CONCLUSIONS Despite the high survival rate observed, there is an impending need for conducting randomized controlled clinical trials to test the efficacy of these implants in comparison with the other techniques to treat the atrophic maxilla. Thus, the findings reported in the review must be interpreted with considerable caution. Moreover, more studies with longer follow-up periods involving adequate number of ZIs are needed. This will help to obtain a better understanding of the survival of ZIs in a long term. It is suggested that multicenter, randomized controlled clinical trials and longer clinical studies should be implemented in this area, before recommending routine use of ZIs for patients could be given. The placement of zygomatic implants requires very experienced surgeons because it is not risk free since delicate anatomic structures such as the orbita and brain may be involved.
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Affiliation(s)
- Bruno Ramos Chrcanovic
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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Schmitt CM, Doering H, Schmidt T, Lutz R, Neukam FW, Schlegel KA. Histological results after maxillary sinus augmentation with Straumann® BoneCeramic, Bio-Oss®, Puros®, and autologous bone. A randomized controlled clinical trial. Clin Oral Implants Res 2012; 24:576-85. [PMID: 22324456 DOI: 10.1111/j.1600-0501.2012.02431.x] [Citation(s) in RCA: 128] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE This investigation focused on a comparison of clinical and histological characteristics after sinus floor augmentation with biphasic calcium phosphate (BCP, Straumann BoneCeramic(®) ), anorganic bovine bone (ABB, Geistlich Bio-Oss(®) ), mineralized cancellous bone allograft (MCBA, Zimmer Puros(®) ), or autologous bone (AB). MATERIALS AND METHODS Thirty consecutive patients with a posterior edentulous maxillary situation and a vertical bone height less than or equal to 4 mm were included in this study. A two-stage procedure was carried out. After augmentation of the maxillary sinus with ABB, BCP, MCBA, or AB followed by a healing period of 5 months, biopsies were taken with simultaneous implant placement. The samples were analyzed using microradiography and histology. RESULTS Ninety-four implants were placed in the augmented positions and 53 bone biopsies were taken and evaluated. The bone volume fraction of newly formed bone was measured as 30.28 ± 2.16% for BCP, 24.9 ± 5.67% for ABB, 41.74 ± 2.1% for AB, and 35.41 ± 2.78% for MCBA with significant increases in bone volume of AB vs. BCP and ABB, and MCBA vs. ABB samples. Significantly different residual bone substitute material was measured as 15.8 ± 2.1% in the BCP group and 21.36 ± 4.83% in the ABB group. CONCLUSION As it provides the highest rate of de novo bone formation, AB can be considered to remain the gold standard in sinus floor augmentation. All tested control materials showed comparable results and are suitable for maxillary sinus augmentation.
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Affiliation(s)
- Christian Martin Schmitt
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
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Choi SY, Jang YJ, Choi JY, Jeong JH, Kwon TG. Histomorphometric analysis of sinus augmentation using bovine bone mineral with two different resorbable membranes. Clin Oral Implants Res 2011; 24 Suppl A100:68-74. [DOI: 10.1111/j.1600-0501.2011.02377.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2011] [Indexed: 11/30/2022]
Affiliation(s)
- So-Young Choi
- Department of Oral & Maxillofacial Surgery; School of Dentistry; Kyungpook National University; Daegu; Korea
| | | | - Je-Yong Choi
- Department of Biochemistry; School of Medicine; Kyungpook National University; Daegu; Korea
| | - Jae-Hwan Jeong
- Department of Biochemistry; School of Medicine; Kyungpook National University; Daegu; Korea
| | - Tae-Geon Kwon
- Department of Oral & Maxillofacial Surgery; School of Dentistry; Kyungpook National University; Daegu; Korea
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Inlay–onlay grafting for three-dimensional reconstruction of the posterior atrophic maxilla with mandibular bone. Int J Oral Maxillofac Surg 2010; 39:350-7. [DOI: 10.1016/j.ijom.2010.02.016] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 12/13/2009] [Accepted: 02/12/2010] [Indexed: 01/09/2023]
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Virnik A, Gaggl A, Likar R, Stettner H, Chiari F. Vergleich der peripheren und zentralen Opiatwirkung bei Beckenkammtransplantaten. Schmerz 2009; 23:259-62, 264-6. [DOI: 10.1007/s00482-009-0784-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stübinger S, Saldamli B, Seitz O, Sader R, Landes CA. Palatal versus vestibular piezoelectric window osteotomy for maxillary sinus elevation: a comparative clinical study of two surgical techniques. ACTA ACUST UNITED AC 2009; 107:648-55. [PMID: 19201630 DOI: 10.1016/j.tripleo.2008.12.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Revised: 10/14/2008] [Accepted: 12/14/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The goal of this study was to compare the surgical advantages and disadvantages of a new palatal access osteotomy for sinus elevation with a conventional lateral approach. STUDY DESIGN In 32 patients, either a palatal (n = 16) or a lateral (n = 16) osteotomy to the maxillary sinus was performed under local anesthesia. The palatal access included a circular paramarginal incision and elevation of a palatal mucosal flap based on a median pedicle. The lateral access was performed by vestibular standard incision and development of a mucoperiosteal flap with a vestibular and superior basis. For all osteotomies a piezoelectric device was used. The sinus cavity was augmented with synthetic nanostructured hydroxyapatite graft material. RESULTS Intraoperative complications during both procedures were minimal and wound healing was uneventful. Membrane perforation occurred in 19% of the palatal group and in 19% of the lateral group. Soft tissue management of the palatal technique was superior to that of the lateral approach, because the vestibular anatomy was not altered and consequently no disharmonious soft tissue scarring and no postoperative swelling occurred. CONCLUSION The palatal approach permitted higher postoperative comfort, especially for edentulous patients, because full dentures could be incorporated directly after surgery with almost perfect fit.
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Affiliation(s)
- Stefan Stübinger
- Hightech Research Center of Craniomaxillofacial Surgery, University of Basel, Basel, Switzerland.
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Pjetursson BE, Tan WC, Zwahlen M, Lang NP. A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation. J Clin Periodontol 2009; 35:216-40. [PMID: 18724852 DOI: 10.1111/j.1600-051x.2008.01272.x] [Citation(s) in RCA: 477] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
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.
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Tan WC, Lang NP, Zwahlen M, Pjetursson BE. A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation Part II: Transalveolar technique. J Clin Periodontol 2008; 35:241-54. [DOI: 10.1111/j.1600-051x.2008.01273.x] [Citation(s) in RCA: 255] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Nemec S, Formanek M, Czerny C. [Postoperative imaging of paranasal sinuses]. Radiologe 2008; 47:621-7. [PMID: 17549448 DOI: 10.1007/s00117-007-1506-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The radiological interpretation of postoperative changes of the paranasal sinuses requires knowledge of why and how the surgical intervention was performed and what the basic clinical findings were. It is important to know whether there was an inflammation, a reconstructive procedure, or a tumorous process. Multidetector computed tomography (MDCT) evaluated in a high-resolution bone window level setting represents the method of choice for imaging after nonfunctional and functional procedures after inflammatory changes as well as for imaging after reconstructive surgery because of facial trauma or before dental implantation. In the postoperative follow-up of tumor patients contrast-enhanced MDCT evaluated in a soft tissue window and bone window and especially magnetic resonance imaging (MRI) represent the standard. In many cases it is possible to differentiate tumor recurrence from inflammation with the help of contrast-enhanced multiplanar MRI and to detect bone marrow changes prior to CT.
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Affiliation(s)
- S Nemec
- Abt. für Osteologie, Klinik für Radiodiagnostik, AKH/Medizinische Universität Wien.
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