Piezoelectric surgery in maxillary sinus floor elevation with hydraulic pressure for xenograft and simultaneous implant placement

Clinical efficacy of transcrestal sinus floor augmentation, in comparison with lateral approach, in sites with residual bone height ≤6 mm: A systematic review and meta-analysis

OBJECTIVE

This paper addressed two focused questions: Focused question 1 (Q1) "what is the clinical efficacy of transcrestal sinus floor augmentation (TSFA), as compared to lateral sinus floor augmentation (LSFA) in sites with residual bone height (RBH) ≤6 mm, in randomized clinical trials (RCTs) and controlled clinical trials (CCTs)?"; Focused question 2 (Q2) "what is the estimated effectiveness of TSFA for outcomes in Q1, in RCTs, CCTs or cohort studies?"

MATERIALS AND METHODS

An electronic search (PubMed, EMBASE, The Cochrane Central Register of Controlled Trials) and hand search were conducted from January 1986 until December 2022. All eligible clinical studies expressly reporting TSFA in sites with RBH ≤6 mm were included. The data were extracted, and the risk of bias in individual studies was evaluated. Meta-analysis was performed whenever possible.

RESULTS

Seven RCTs were included for Q1 and 25 studies (9 RCTs, 2 CCTs, 14 single arm cohort studies) for Q2. Q1: Meta-analysis did not show significant difference in the implant survival, sinus membrane perforation and marginal bone loss between TSFA and LSFA groups. Q2: Meta-analysis showed TSFA had a high implant survival rate (96.5%, 95% CI: 93.2%-98.9%) at least 1 year after surgery, and limited sinus membrane perforation (5.4%, 95% CI: 2.7%-8.8%). The results also presented higher patient satisfaction for TSFA.

CONCLUSION

With the limitations of the present study (high risk of bias in individual studies), it can be concluded that there was no significant difference in implant survival, Schneiderian membrane perforation and MBL between two approaches in sites with RBH ≤6 mm.

A Comparison of Elevation, Perforation Rate, and Time Spent for the Crestal Sinus Elevation Intervened by Piezosurgery, CAS-Kit, and Osteotome in a Novel Goat Model

Purpose

This study aimed to compare the differences among Piezosurgery, CAS-kit, and Osteotome regarding safe elevation, perforation rate, and time spent and to observe and analyze different sinus lifting efficacy of the three methods.

Materials and Methods

Twenty-one fresh goat heads (42 sinuses) were investigated. CBCT images confirmed the feasibility of the goat model. The maxillary sinus was successively lifted to 5, 7, and 9 mm by Piezosurgery, CAS-kit, and Osteotome until the sinus membrane was perforated or lifted to 9 mm. In the end, final elevation, sinus perforation, and time spent were recorded.

Results

Piezosurgery and CAS-kit lifted sinuses to relatively higher heights than did Osteotome (P = 0.000). Perforation rates (14.29, 21.43%) of the Piezosurgery and CAS-kit were far lower than that of the Osteotome (85.71%). In the Osteotome group, the time of lifting to 9 mm was significantly shorter than that of Piezosurgery and CAS-kit (P = 0.000). There was no statistical difference in time spent between the latter two (P = 0.115).

Conclusions

The lifting height of the Osteotome was limited, but it took the shortest time for sinus lifting. Piezosurgery and CAS-kit had higher lifting heights and lower perforation rates compared with Osteotome.

Complications in sinus lifting procedures: Classification and management

Open and closed sinus lifting procedures are predictable methods to augment the bone needed for appropriate implant placement in the posterior maxilla in cases where available bone is limited. However, these techniques may give rise to complications and associated comorbidities. In the case of open sinus lifting, perforation of the Schneiderian membrane during osteotomy is the most common complication, with an incidence rate of around 20%-25%. Apart from those complications associated with oral surgery in general (such as swelling or hematoma), there are specific complications of open sinus lifting procedures that may arise less frequently (chronic rhinosinusitis, hemorrhage, or ostium blockage by overfilling) but which may nevertheless compromise the viability of the graft and/or the implants and cause substantial discomfort to the patient. Closed sinus lifting is a less invasive approach that allows transcrestal placement of the implants in cases where there is sufficient residual bone height. However, it may also be associated with specific complications, including membrane perforation, benign paroxysmal positional vertigo, and implant displacement to the sinus cavity. New technologies have been proposed to reduce these complications and comorbidities associated with conventional sinus lifting procedures, such as the use of piezoelectric devices and hydraulic sinus lift or reamer burs. The evidence supporting their effectiveness and safety, however, is still lacking. A detailed medical history together with a thorough radiographic and clinical examination are essential prior to any kind of bone regenerative augmentation involving the maxillary sinus. Moreover, it is recommended to employ the most appropriate surgical technique for the specific characteristics of the case and, at the same time, accommodating the experience and skills of the surgeon.

Survival rate of dental implant placed using various maxillary sinus floor elevation techniques: A systematic review and meta-analysis

Aim

The aim of this systematic review is to evaluate the survival rate of dental implant placed using different maxillary sinus floor elevation techniques.

Setting and Design

PRISMA guidelines were used for this systematic review and meta-analysis.

Materials and Methods

Relevant articles were searched from Medline, PubMed, Google Scholar, ScienceDirect, and Cochrane trials. Articles published in English language were selected. Hand search was further conducted. For risk of bias, two tools were used, i.e., Cochrane tool for randomized controlled trials (RCTs) and new castle Ottawa quality assessment tool for non-RCTs.

Statistical Analysis

For statistical meta-analysis RevMan 5.4 software was used.

Results

Seventeen studies were finalized. All studies were included in the meta-analysis to check the implant survival rate. There is no statistical difference between direct and indirect techniques, and forest plot was derived for direct approach (P = 0.688, 95% confidence interval [CI] 0.9691) and for indirect approach (P = 0.686 and 95% CI 0.970).

Conclusion

There is no statistically significant difference in the survival rate of implant placed using direct or indirect sinus lift approach procedures. Hence, the technique is selected as per the indications given for each direct and indirect procedure.

An alternative approach to transalveolar sinus elevation for the placement of multiple implants

Traditional approaches to sinus floor elevation for dental implant placement have limitations. This technical report describes a modified transalveolar method of elevating the sinus membrane when 2 or more implants are placed simultaneously in a maxillary posterior area where the residual bone height is insufficient. With a narrow osteotomy connecting drilled holes, the Schneiderian membrane can be directly elevated with curettes as with the lateral approach, resulting in a reduced risk of perforation.

Radiographical and histological evaluation of bioactive synthetic bone graft putty in sinus floor augmentation: A pre- and post-intervention study

Objective:

The main objective is to evaluate the quantity and quality of bone formed after use of bioactive synthetic bone graft putty in sinus augmentation and to radiographically and histologically evaluate increase in alveolar bone height in augmented sinus.

Materials and Methods:

It is a pre- and post-intervention study of 15 patients (present at both baseline and at 6 months) with 80% power and 95% confidence level.

Results:

The mean increase in alveolar bone height is 7.08 ± 1.42 mm ranging from 5.6 mm to 10.7 mm. It is evident from the data that there has been increase in alveolar bone height postbone graft augmentation. P < 0.001 shows that increase in alveolar bone height is highly significant as compared to preoperative bone height. The mean postoperative density is 525.43 ± 104.18 hounsfield unit ranging from 649 HU to 350 HU. This is also a D3 quality bone as per Misch classification. The mean difference in alveolar bone density is 104 ± 125.16 HU. P = 0.0053 shows that increase in alveolar bone density is significant as compared to preoperative bone density.

Conclusion:

Bioactive synthetic bone graft putty yields sufficient quantity of mineralized tissue for implant placement in patients with 2–6 mm of alveolar bone height before grafting. Histologically, it has shown that it has good osteoconductive properties and good quality of bone is formed within 6 months of its augmentation.

Treatment of dental implant displacement into the maxillary sinus

Background

Displacement of dental implants into the maxillary sinus is rare, but it primarily occurs in patients with severe pneumatization of the maxillary sinus and/or deficiency of the alveolar process. Some complications such as the infection of the paranasal sinuses and formation of the oroantral fistula can be followed by the displacement of a dental implant. Therefore, the displaced implant has to be removed immediately with surgical intervention show and another plan for rehabilitation should be considered.

Main body

The conventional procedure for the removal of a displaced implant from the maxillary sinus involves sinus bone grafting and new implant placement performed in two or more steps with a significant time gap in between. Simplification of these surgical procedures can decrease the treatment duration and patient discomfort.

Conclusions

In this review, we discuss the anatomical characteristics of the maxillary sinus and the complications associated with implant displacement into the sinus.

Update of Surgical Techniques for Maxillary Sinus Augmentation: A Systematic Literature Review

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.

Autotransplantation donor tooth site harvesting using piezosurgery

BACKGROUND

The harvesting of a tooth as a candidate for tooth autotransplantation requires that the delicate dental tissues around the tooth be minimally traumatized. This is especially so for the periradicular tissues of the tooth root and the follicular tissues surrounding the crown. The aim of this report is to describe the use of piezosurgery as an attempt at morbidity reduction in the harvesting of teeth for autotransplantation.

METHODS

A piezosurgical handpiece and its selection of tips were easily adapted to allow the harvesting and delivery of teeth for autotransplantation purposes.

RESULTS

Twenty premolar teeth were harvested using a piezosurgical device. The harvested teeth were subsequently successfully autotransplanted. All twenty teeth healed in a satisfactory manner without excessive mobility or ankyloses.

CONCLUSIONS

Piezosurgery avoids some of the traumatic aspects of harvesting teeth and removing bone which are associated with thermal damage from the use of conventional rotary instruments or saws. Piezosurgery can be adapted to facilitate the predictable harvesting of teeth for autotransplantation purposes.

Implant over implant: an alternative method for solving malpositioned osseointegrated implants at the sinus floor

An implant was malpositioned and osseointegrated at the maxillary sinus floor with no complications. However, unexpected bone formation over the implant made the implant nonfunctional. Because the patient rejected the removal of the implant, it was left in place while another short implant was placed into the newly formed bone in approximately the same position as the old implant to restore the posterior maxillary tooth. Within 6 months, the new implant over the old asymptomatic implant was functional. Radiographs revealed osseointegration and stable periimplant marginal bone level with no signs of infection or inflammation.