The Low Window Sinus Lift: A CAD-CAM-Guided Surgical Technique for Lateral Sinus Augmentation: A Retrospective Case Series

Application of Oral Retractor for Lip Injury Protection in Oral and Maxillofacial Surgeries: A Randomized Controlled Trial

PURPOSE

Iatrogenic lip injury may occur during oral and maxillofacial surgical procedures. This study aimed to evaluate the effect of oral retractors on iatrogenic lip injury prevention during intraoral procedures of oral and maxillofacial surgery.

METHODS

We conducted a randomized controlled trial and included patients who underwent intraoral procedures of oral and maxillofacial surgery. Patients were randomly allocated to receive oral retractor (intervention group) or traditional procedure without lip protection (control group). The incidence of lip injury was the outcome variable. Other study variables included surgical time and satisfaction of patients and surgeons with treatment experience evaluated by visual analog scale (VAS). Student t test and χ 2 test were used to compare both groups' variables and measure the relationship between the predictor variable and the outcome variable. P <0.05 was considered significant for all analyses.

RESULTS

A total of 114 patients were included, with 56 allocated to intervention group and 58 to control group. The results showed that the application of an oral retractor did not significantly increase surgical time ( P =0.318). A total of 12 patients had lip injury, with 1 in the intervention group and 11 in the control group ( P =0.003). For the assessment of satisfaction with treatment experience, the intervention group had significantly higher VAS scores for doctors and patients ( P <0.05).

CONCLUSIONS

We found that the oral retractor was a good tool for iatrogenic lip injury prevention in oral and maxillofacial surgical procedures and could be considered in clinical treatment.

Digital planning and bone regenerative technologies: A narrative review

OBJECTIVES

The aim of this narrative review was to explore the application of digital technologies (DT) for the simplification and improvement of bone augmentation procedures in advanced implant dentistry.

MATERIAL AND METHODS

A search on electronic databases was performed to identify systematic reviews, meta-analyses, randomized and non-randomized controlled trials, prospective/retrospective case series, and case reports related to the application of DT in advanced implant dentistry.

RESULTS

Seventy-nine articles were included. Potential fields of application of DT are the following: 1) the use of intra-oral scanners for the definition of soft tissue profile and the residual dentition; 2) the use of dental lab CAD (computer-aided design) software to create a digital wax-up replicating the ideal ridge and tooth morphology; 3) the matching of STL (Standard Triangulation Language) files with DICOM (DIgital COmmunication in Medicine) files from CBCTs with a dedicated software; 4) the production of stereolithographic 3D models reproducing the jaws and the bone defects; 5) the creation of surgical templates to guide implant placement and augmentation procedures; 6) the production of customized meshes for bone regeneration; and 7) the use of static or dynamic computer-aided implant placement.

CONCLUSIONS

Results from this narrative review seem to demonstrate that the use of a partially or fully digital workflow can be successfully used also in advanced implant dentistry. However, the number of studies (in particular RCTs) focused on the use of a fully digital workflow in advanced implant dentistry is still limited and more studies are needed to properly evaluate the potentials of DT.

Application of titanium 3D-printed double-sleeve guide for zygomatic implants: A technique report

The unique anatomical structure of the atrophic edentulous maxilla limits the placement of endosteal root form dental implants without bone grafting and augmentation. Surgical placement of zygomatic implants in an optimal position remains challenging. This technique report illustrates a novel digital guide technology, including the design workflow, application method, and indications for assisting with the placement of zygomatic implants using a bone-supported titanium double-sleeve guide. In addition, when the implant body reaches the zygomatic bone following an intra-sinus path, including ZAGA type 0 and ZAGA type 1 cases, a matching window osteotomy surgical guide is used to locate the lateral window boundary and protect the sinus membrane. With this technique, the surgical procedure is simplified, and the precision of guided zygomatic implant placement is improved.

Complications of sinus floor elevation procedure and management strategies: A systematic review

AIM

This systematic review aimed to investigates the types and incidences of complications following sinus floor elevations (SFE) along with their prevention and management strategies.

MATERIALS AND METHODS

Electronic database and hand search were conducted to screen the literature published from January 1960 to June 2021. The selected studies had to report well-described SFE techniques, complications during, and post-SFE. Data extraction included types of SFE techniques, complications, and their treatment strategies.

RESULTS

A total of 74 studies with 4411 SFE procedures met the inclusion criteria. Different SFE techniques demonstrated varying patterns for both complications and complication rates. Postoperative pain, swelling, and edema were widely reported. The most common complications that required intervention following Lateral SFE (LSFE) were sinus membrane perforation (SMP), wound dehiscence, graft exposure and failure, and sinusitis. LSFE had more SMPs and sinusitis cases compared with a transcrestal SFE (TSFE). The presence of benign paroxysmal positional vertigo following TSFE was significant in certain selected studies.

CONCLUSION

Given the inherent limitations, this systematic review showed distinct features of complications in SFE using varying techniques. Treatment planning for these procedures should incorporate strategies to avoid complication occurrence.

Sinus Lift and Implant Insertion on 3D-Printed Polymeric Maxillary Models: Ex Vivo Training for In Vivo Surgical Procedures

Background and Objectives: The aim of this study is to demonstrate the increased efficiency achieved by dental practitioners when carrying out an ex vivo training process on 3D-printed maxillaries before performing in vivo surgery. Materials and Methods: This developed ex vivo procedure comprises the following phases: (i) scanning the area of interest for surgery; (ii) obtaining a 3D virtual model of this area using Cone Beam Computed Tomography (CBCT); (iii) obtaining a 3D-printed model (based on the virtual one), on which (iv) the dental practitioner simulates/rehearses ex vivo (most of) the surgery protocol; (v) assess with a new CBCT the 3D model after simulation. The technical steps of sinus augmentation and implant insertion could be performed on the corresponding 3D-printed hemi-maxillaries prior to the real in vivo surgery. Two study groups were considered, with forty patients divided as follows: Group 1 comprises twenty patients on which the developed simulation and rehearsal procedure was applied; Group 2 is a control one which comprises twenty patients on which similar surgery was performed without this procedure (considered in order to compare operative times without and with rehearsals). Results: Following the ex vivo training/rehearsal, an optimal surgery protocol was developed for each considered case. The results of the surgery on patients were compared with the results obtained after rehearsals on 3D-printed models. The performed quantitative assessment proved that, using the proposed training procedure, the results of the in vivo surgery are not significantly different (p = 0.089) with regard to the ex vivo simulation for both the mezio-distal position of the implant and the distance from the ridge margin to sinus window. On the contrary, the operative time of Group 1 was reduced significantly (p = 0.001), with an average of 20% with regard to in vivo procedures performed without rehearsals (on the control Group 2). Conclusions: The study demonstrated that the use of 3D-printed models can be beneficial to dental surgeon practitioners, as well as to students who must be trained before performing clinical treatments.

Vertical Bone Gain after Sinus Lift Procedures with Beta-Tricalcium Phosphate and Simultaneous Implant Placement-A Cross-Sectional Study

OBJECTIVES

The objective of this cross-sectional study was to evaluate the vertical bone gain achieved after the sinus lift procedure with beta-tricalcium phosphate (β-TCP) used as a bone substitute and simultaneous implant placement.

METHODS

One hundred and twenty-eight sinus lift procedures (utilizing a synthetic ceramic containing 99.9% tricalcium phosphate as a bone substitute) and simultaneous implant placements were performed on 119 patients. The lateral window approach surgical protocol for maxillary sinus lift was performed on the patients. The implants were evaluated using cone-beam computed tomography (CBCT) at 6 months following placement. The vertical bone gain was considered a primary variable, while implant length, diameter, and location were considered secondary variables.

RESULTS

The ANOVA results showed no statistical difference in vertical bone gain with implant parameters like implant length, width, and position. Pearsons correlation revealed a statistically significant positive correlation with vertical bone gain and implant length and diameter. A further multivariate linear regression analysis was performed and it observed statistically significant associations between the variables in the study after adjusting for confounding factors.

CONCLUSIONS

This study concluded that there was vertical bone gain with the usage of β-TCP in maxillary sinus lift surgical procedure with immediate implant placement and that implant variables like length and diameter had a significant influence on the average bone gain values. The implant position did not have a statistically significant influence but there was considerable variation in the bone gain between first, second premolar, and molar regions.

A Simple and Safe Approach for Maxillary Sinus Augmentation with the Advanced Surgical Guide

Objective: The development of digital dentistry has contributed to the astonishing advancement of implant dentistry. Furthermore, digital technology is expected to be applied extensively to sinus augmentation, which is an advanced technique for implant surgery. This study introduces a simple method for a safer and more precise lateral window opening for sinus augmentation using a navigation program. Methods: Five eligible patients with residual alveolar bone of 4 mm or less are presented, requiring lateral approach for sinus augmentation. Navigation system was opted for the sinus lift with simultaneous implant placement. Virtual planning started with establishing the adequate position of the lateral window based on the radiographic images and the scanned file of the dentition. The position of the window was indicated on the guide within the program. Afterwards, the virtually designed surgical guide was fabricated either with 3D printer or milling machine for the actual surgery. Results: All the patients who underwent surgery with the surgical guide showed no sign of clinical complications including pain, swelling, nausea, epistaxis, or early loss of the implants. Results of radiographic evaluation also showed adequate placement of the implants in a pre-planned position, and the sinus window was also formed in the desired location. Conclusion: Lateral window opening combined with digital navigation system is believed to be a promising technique for a more precise as well as safer sinus augmentation.

Guided Lateral Sinus Lift Procedure Using 3-Dimensionally Printed Templates for a Safe Surgical Approach: A Proof-of-Concept Case Report

The purpose of this article was to present a guided lateral window sinus lift procedure with the aid of a fully digital workflow using surgical templates for window osteotomy preparation and implant placement. A 22-year-old patient with insufficient residual bone height in the posterior maxilla was treated with a maxillary sinus augmentation procedure with a lateral window technique and simultaneous implant installation using 3-dimensionally printed surgical guides. The surgical guides, used for the preparation of both the lateral window and the implant site according to the optimal prosthodontic and anatomic position, were based on a fully digital workflow and virtual pre-planning with modified implant-planning software. Successful functional and esthetic rehabilitation of the patient was accomplished using standard surgical techniques and instruments but an innovative method for the production and application of surgical templates ensured a precise and safe approach for the lateral window osteotomy preparation. This guided lateral window sinus lift technique may reduce the incidence of surgical complications and failures and enhance patient-related outcomes.