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Alshamrani AM, Mubarki M, Alsager AS, Alsharif HK, AlHumaidan SA, Al-Omar A. Maxillary Sinus Lift Procedures: An Overview of Current Techniques, Presurgical Evaluation, and Complications. Cureus 2023; 15:e49553. [PMID: 38156177 PMCID: PMC10753870 DOI: 10.7759/cureus.49553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
A maxillary sinus lift procedure is indicated if a dental implant needs to be placed in the posterior maxilla with limited bone available to accommodate a dental implant. Both open and closed sinus lifting procedures are reliable approaches for increasing the bone volume needed to support proper implant positioning. However, these methods can lead to several complications. In addition to the general complications commonly linked to oral surgery, such as swelling or hematoma, the primary complication in open sinus lifting is typically the perforation of the Schneiderian membrane during osteotomy. Detailed and extensive presurgical evaluation is crucial to minimize such complications. The objective of this study was to delineate contemporary trends in sinus lift surgery, with a specific emphasis on different techniques of sinus lift procedure, anatomical and surgical factors, presurgical evaluation, bone grafting, and the practical implications of these factors in implant dentistry cases involving a deficient posterior maxilla. In conclusion, while both osteotome and lateral window techniques can assist clinicians in addressing the complexities of implant placement in a deficient posterior maxilla, bone height before implantation remains a critical factor in determining the success and longevity of implants.
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Affiliation(s)
| | - Mazen Mubarki
- Dentistry, College of Dentistry, King Saud University, Riyadh, SAU
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2
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Hsu YT, Rosen PS, Choksi K, Shih MC, Ninneman S, Lee CT. Complications of sinus floor elevation procedure and management strategies: A systematic review. Clin Implant Dent Relat Res 2022; 24:740-765. [PMID: 35737681 DOI: 10.1111/cid.13086] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- Yung-Ting Hsu
- Department of Periodontics, University of Washington School of Dentistry, Seattle, Washington, USA
| | - Paul S Rosen
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Karishma Choksi
- Division of Clinical Dentistry, University of Detroit Mercy School of Dentistry, Detroit, Michigan, USA
| | - Ming-Chieh Shih
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shale Ninneman
- Department of Periodontics, University of Washington School of Dentistry, Seattle, Washington, USA
| | - Chun-Teh Lee
- Department of Periodontics and Dental Hygiene, University of Texas Health Science Center at Houston, Houston, Texas, USA
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Valentini P, Artzi Z. Sinus augmentation procedure via the lateral window technique-Reducing invasiveness and preventing complications: A narrative review. Periodontol 2000 2022; 91:167-181. [PMID: 35924476 DOI: 10.1111/prd.12443] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/30/2022] [Accepted: 05/07/2022] [Indexed: 11/28/2022]
Abstract
Sinus augmentation has become an integrated surgical phase in posterior maxillary implant prosthesis reconstruction. Since the residual alveolar bony height usually requires additional volume particularly at this anatomical region, sinus floor augmentation is advocated routinely. Over the years, Implant success rate is proved to be comparable to the one in the pristine bone, which is well documented in the literature. Anatomical aspects as well as surgeon skills are at most importance to achieve predictable outcome. In this narrative review, the different osteotomy techniques, the indications toward 1 or 2-stage approaches, the control of the Schneiderian membrane integrity as well as the management of intra- and post-operative complications are thoroughly discussed according the current data. In light of the excellent long-term implant success rate concurrent with the application of contemporary advanced techniques of the sinus augmentation via the lateral wall osteotomy approach, reduce invasiveness and less complication occurrences are well documented. A well-codified patient selection involving the rhinologist as an integral medical team would be significantly beneficial toward early diagnosis. In-depth knowledge of the anatomy, execution of a well standardized surgical technique, and understanding the complication etiology and their management are prerequisites for reducing patient morbidity to minimal discomfort and predictable successful outcome.
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Affiliation(s)
- Pascal Valentini
- Department of Implant Surgery, Tattone Hospital, Institute of Health, University of Corsica Pasquale Paoli, Corte, France
| | - Zvi Artzi
- Department of Periodontology and Oral Implantology, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
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Molnár B, Jung AK, Papp Z, Martin A, Orbán K, Pröhl A, Jung O, Barbeck M, Windisch P. Comparative analysis of lateral maxillary sinus augmentation with a xenogeneic bone substitute material in combination with piezosurgical preparation and bony wall repositioning or rotary instrumentation and membrane coverage: a prospective randomized clinical and histological study. Clin Oral Investig 2022; 26:5261-5272. [PMID: 35593928 PMCID: PMC9381628 DOI: 10.1007/s00784-022-04494-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/13/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The present randomized controlled clinical study aimed to investigate if, in lateral maxillary sinus augmentation, the repositioned bony wall or the application of a collagen membrane results in more preferable new hard tissue formation. MATERIALS AND METHODS Forty patients were divided into two study groups. Both groups received a xenogeneic bone substitute material (BSM) during lateral sinus augmentation. In the bony wall group (BW), following piezosurgery, the retrieved bony wall was repositioned. In the collagen membrane group (CM), following rotary instrument preparation, collagen membrane coverage was applied. After 6 months, biopsies were taken to histologically analyze the percentage of BSM, connective tissue (CT), and newly formed bone (NFB) following both approaches. RESULTS Forty implants were placed and 29 harvested biopsies could be evaluated. Duration of surgery, membrane perforations, and VAS were detected. Histomorphometrical analysis revealed comparable amounts of all analyzed parameters in both groups in descending order: CT (BW: 39.2 ± 9%, CM: 37,9 ± 8.5%) > BSM (BW: 32.9 ± 6.3%, CM: 31.8 ± 8.8%) > NB (BW: 27.8 ± 11.2%, CM: 30.3 ± 4.5%). CONCLUSIONS The results of the present study show that the closure of the access window by means of the retrieved bony wall or a native collagen membrane led to comparable bone augmentation results. CLINICAL TRIAL clinicaltrials.gov NCT04811768. CLINICAL RELEVANCE Lateral maxillary sinus augmentation with the application of a xenogeneic BSM in combination with a native collagen membrane for bony window coverage represents a reliable method for surgical reconstruction of the posterior maxilla. Piezosurgery with bony window repositioning delivers comparable outcomes without membrane coverage.
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Affiliation(s)
- Bálint Molnár
- Department of Periodontology, Semmelweis University Budapest, Szentkiralyi u. 47, 1088, Budapest, Hungary.
| | - Anne-Kathrin Jung
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, Rostock, Germany
| | - Zsuzsanna Papp
- Department of Periodontology, Semmelweis University Budapest, Szentkiralyi u. 47, 1088, Budapest, Hungary
| | - Anna Martin
- Department of Periodontology, Semmelweis University Budapest, Szentkiralyi u. 47, 1088, Budapest, Hungary
| | - Kristóf Orbán
- Department of Periodontology, Semmelweis University Budapest, Szentkiralyi u. 47, 1088, Budapest, Hungary
| | | | - Ole Jung
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, Rostock, Germany
| | | | - Péter Windisch
- Department of Periodontology, Semmelweis University Budapest, Szentkiralyi u. 47, 1088, Budapest, Hungary
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Omori Y, Nakajima Y, Imai H, Yonezawa D, Ferri M, Apaza Alccayhuaman KA, Botticelli D. Influence of Anatomical Parameters on the Dimensions of the Subantral Space and Sinus Mucosa Thickening after Sinus Floor Elevation. A Retrospective Cone Beam Computed Tomography Study. Dent J (Basel) 2021; 9:dj9070076. [PMID: 34202457 PMCID: PMC8304157 DOI: 10.3390/dj9070076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/08/2021] [Accepted: 06/23/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Various anatomical parameters might influence the surgical approach for maxillary sinus floor elevation. The objective of the present study was to retrospectively evaluate the influence of anatomical parameters on the dimensions of the subantral space and of the sinus mucosa thickening after sinus floor elevation. MATERIAL AND METHODS Seventy-eight maxillary sinuses in sixty-five patients were evaluated on cone beam computed tomographies taken before surgery and after one week (t1w) and nine months (t9m). Several parameters such as the distance XF between an axis parallel to the base of the nose (X-axes) and the sinus floor (F) were correlated with the height gain (IF) at t1w and t9m and the post-surgical edema. RESULTS A weak significant positive correlation was observed between height gain vs. sinus height of interest (XF), the balcony, and the sinus floor angle. The post-surgical edema was influenced by the initial mucosa thickness and the xenograft used. CONCLUSIONS Various parameters might affect height gain and sinus mucosa thickening after sinus floor elevation. The height of interest, the balcony, and the sinus floor angle showed significant correlations with height gain. The initial thickness of the mucosa and the biomaterial used influenced the post-surgical edema.
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Affiliation(s)
- Yuki Omori
- Department of Oral Implantology, Osaka Dental University, Osaka 573-1144, Japan; (Y.O.); (Y.N.); (H.I.)
| | - Yasushi Nakajima
- Department of Oral Implantology, Osaka Dental University, Osaka 573-1144, Japan; (Y.O.); (Y.N.); (H.I.)
| | - Hideki Imai
- Department of Oral Implantology, Osaka Dental University, Osaka 573-1144, Japan; (Y.O.); (Y.N.); (H.I.)
| | - Daichi Yonezawa
- Department of Applied Prosthodontics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8102, Japan
- Correspondence:
| | - Mauro Ferri
- ARDEC Foundation, 130001 Cartagena de Indias, Colombia;
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Rengo C, Fiorino A, Cucchi A, Nappo A, Randellini E, Calamai P, Ferrari M. Patient-reported outcomes and complication rates after lateral maxillary sinus floor elevation: a prospective study. Clin Oral Investig 2021; 25:4431-4444. [PMID: 33620600 PMCID: PMC8310489 DOI: 10.1007/s00784-020-03755-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/21/2020] [Indexed: 01/29/2023]
Abstract
Objectives Oral surgery morbidity is highly variable based on patients’ characteristics and kind of surgical intervention. However, poor data are available in the literature regarding patient outcomes after oral surgery. The aim of this retrospective study was to evaluate patient-reported outcome and complication rates after maxillary sinus floor elevation. Materials and methods Data from the records of patients undergoing maxillary sinus elevation have been collected from a private dental office. Patient-reported outcome has been assessed using a 100-mm visual analog scale to evaluate the post-operative pain (VASpain) experienced in the first week following surgery and visual rating scales to evaluate discomfort level (VRSdiscomfort: 0 to 4) and willingness to repeat the same surgical procedure (VRSwillingness: 0 to 3). Analgesics intake, swelling onset and duration, and ecchymosis have been also recorded. Results VASpain showed moderate values in the first 2 days (< 50) post-surgery, with a tendency to progressively decrease over the next 2 days. Average assumption of painkillers was 3.93 ± 3.03. Discomfort level (VRSdiscomfort) after surgery was low (median: 1; IR: 1–0), while willingness to undergo the same surgical procedure was very high (77.63% of patients). Swelling and ecchymosis were experienced by 97.36% and 51.32% of patients, respectively, with a mean duration of 4.09 ± 1.43 and 2.21 ± 2.31 days, respectively. Membrane perforation occurred in 4 cases. Other post-operative complications were not observed. Conclusions Maxillary sinus grafting is a safe procedure, with a low complication rate and moderate morbidity that is well tolerated by patients. Particular attention is needed in case selection, surgical planning and operator expertise. Clinical relevance The analysis of patient-reported outcomes can be of great help in surgical planning and in providing correct and adequate treatment.
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Affiliation(s)
- Carlo Rengo
- Department of Prosthodontics and Dental Materials, University of Siena, Viale Bracci, 53100, Siena, Italy.
| | - Antonino Fiorino
- Dentistry Unit, Catholic University of Sacred Heart, Rome, Italy
| | | | - Antonio Nappo
- Department of Prosthodontics and Dental Materials, University of Siena, Viale Bracci, 53100, Siena, Italy
| | | | | | - Marco Ferrari
- Department of Prosthodontics and Dental Materials, University of Siena, Viale Bracci, 53100, Siena, Italy
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Kadkhodazadeh M, Moscowchi A, Zamani Z, Amid R. Clinical and Radiographic Outcomes of a Novel Transalveolar Sinus Floor Elevation Technique. J Maxillofac Oral Surg 2020; 21:548-556. [DOI: 10.1007/s12663-020-01439-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/18/2020] [Indexed: 01/19/2023] Open
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Hirota A, Lang NP, Ferri M, Fortich Mesa N, Apaza Alccayhuaman KA, Botticelli D. Tomographic evaluation of the influence of the placement of a collagen membrane subjacent to the sinus mucosa during maxillary sinus floor augmentation: a randomized clinical trial. Int J Implant Dent 2019; 5:31. [PMID: 31423548 PMCID: PMC6702501 DOI: 10.1186/s40729-019-0183-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 08/05/2019] [Indexed: 12/17/2022] Open
Abstract
Aim To study the influence of a collagen membrane placed subjacent to the sinus mucosa on the dimensional changes of augmented maxillary sinus floor. Methods Twenty patients were recruited in the study and randomly assigned to two groups. After the elevation of the maxillary sinus mucosa, a collagen membrane with standardized dimensions was placed at the test sites subjacent to the sinus mucosa and the elevated space was filled with a xenograft, both at test and control sites. A collagen membrane was then used to cover the antrostomy at both sites, and sutures were applied to close the wounds. Cone beam computed tomographies (CBCTs) were taken for all patients before surgery (T0), after 1 week from sinus floor augmentation (T1), and after 9 months of healing (T2). Dimensional changes over time of soft and hard tissues were evaluated on the CBCTs. Results After 1 week of healing, the sinus floor was elevated by 10.0 ± 2.8 mm and 10.6 ± 2.5 mm at the no-membrane and membrane groups, respectively. After 9 months of healing, a similar reduction of the height was observed in both groups, providing a total vertical augmentation of 8.6 ± 2.8 mm at the no-membrane sites and 9.1 ± 3.1 mm at the membrane sites. After 9 months of healing, the hard tissues subjacent to the sinus mucosa appeared to be partially corticalized in three patients in the no-membrane group and in six patients in the membrane group. Conclusions The use of collagen membranes subjacent to the sinus mucosa did not influence the dimensional variations of the augmented regions and the clinical outcomes after 9 months of healing also in absence of perforations.
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Affiliation(s)
- Atsuya Hirota
- Department of Oral Implantology, Osaka Dental University, Osaka, Japan.,ARDEC Academy, Ariminum Odontologica, 47923, Rimini, Italy
| | - Niklaus P Lang
- School of Dental Medicine, University of Berne, Berne, Switzerland
| | - Mauro Ferri
- Corporación Universitaria Rafael Núñez, Cartagena de Indias, Colombia
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Marin S, Kirnbauer B, Rugani P, Payer M, Jakse N. Potential risk factors for maxillary sinus membrane perforation and treatment outcome analysis. Clin Implant Dent Relat Res 2018; 21:66-72. [PMID: 30475442 DOI: 10.1111/cid.12699] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/23/2018] [Accepted: 10/28/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Most common complication of sinus floor elevation (SFE) is sinus membrane perforation (SMP). PURPOSE To investigate the correlation between SMP and potential risk factors and to evaluate SMP treatment outcomes. MATERIALS AND METHODS This study included patients who had undergone a SFE at Division of Oral Surgery and Orthodontics, Medical University of Graz from 2013 to 2017. Analysis of patients' records and CBCT focused on patient-related risk factors (sinus contours, thickness of membrane and lateral sinus wall, interfering septa, crossing vessels, former oroantral communication) and intervention-related risk factors (surgical approach, sides, number of tooth units, and sites). The outcome of SMP treatment was analyzed in the recalls. RESULTS In all, 121 patients underwent 137 SFE. There were 19 cases of SMP (13.9%). Two significant factors were identified: maxillary sinus contours (P = .001) and thickness of the sinus membrane (P = .005). The sinus membrane perforation rate was highest in narrow tapered sinus contours and when the sinus membrane was thinner than 1 mm. Among 19 cases with SMP, no complications were seen upon recall. CONCLUSIONS Maxillary sinus contours and sinus membrane thickness seem to be relevant factors for SMP. Sinus membrane perforations were successfully treated by coverage with collagen membrane.
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Affiliation(s)
- Saša Marin
- Department of Oral Surgery, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Barbara Kirnbauer
- Division of Oral Surgery and Orthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, Graz, Austria
| | - Petra Rugani
- Division of Oral Surgery and Orthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, Graz, Austria
| | - Michael Payer
- Division of Oral Surgery and Orthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, Graz, Austria
| | - Norbert Jakse
- Division of Oral Surgery and Orthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, Graz, Austria
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Schneiderian Membrane Perforation Rate and Increase in Bone Temperature During Maxillary Sinus Floor Elevation by Means of Er: YAG Laser-An Animal Study in Pigs. IMPLANT DENT 2018; 26:238-244. [PMID: 27893513 DOI: 10.1097/id.0000000000000520] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess the time of preparation, bone temperature increase, and the Schneiderian membrane perforation rate during maxillary sinus floor elevation. MATERIALS AND METHODS The research included 30 maxillary sinuses (n = 30) of a pig, divided into 2 groups (n = 15). The lateral bony windows were created using Er:YAG laser (200 mJ, 15 Hz, energy density: 25.48 J/cm) and a diamond bur (control). The membrane was elevated using laser (50 mJ, 50 Hz) and hand instruments. The bone temperature was measured by K-type thermocouple. RESULTS Significantly lower rates of the Schneiderian membrane perforation were found in the laser group (6.67%) compared with the bur (33%) (P < 0.05). The significant higher increase in temperature (mean 7.6°C) was found in the experimental group as compared with the control group (mean 2°C) (P = 0.0000033). The average time necessary for the laser bony window osteotomy was 10 minutes and 37 seconds, whereas using the bur required middling 5 minutes and 50 seconds (P = 0.000283). CONCLUSION The application of Er:YAG laser may significantly reduce the risk of iatrogenic perforation of the Schneiderian membrane and does not cause an irreversible thermal damage in a pig model.
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Membrane perforation rate in lateral maxillary sinus floor augmentation using conventional rotating instruments and piezoelectric device-a meta-analysis. Int J Implant Dent 2018; 4:3. [PMID: 29376211 PMCID: PMC5787532 DOI: 10.1186/s40729-017-0114-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 12/20/2017] [Indexed: 12/18/2022] Open
Abstract
Objectives Maxillary sinus augmentation (MSA) is a successful and predictable intervention with low complication rates. Perforations of the Schneiderian membrane may occur impairing the general success. The aim of this study was to compare the incidence of membrane perforations between conventional rotating instruments and piezoelectric devices in a meta-analysis. Material and methods An electronic research on MEDLINE and PubMed database was performed evaluating the literature from 1980 till 2016. Meta-analysis was performed with the studies matching the inclusion criteria. The incidence of perforations between conventional and piezo during the lateral maxillary sinus floor elevation was determined, and forest plots and a t test for significance analysis were performed. Results The search provided 377 articles of which 69 could be included. Selected non-randomised and non-controlled prospective and retrospective studies were incorporated. Conventional rotary instruments were associated with a perforation rate of 24%, the piezoelectric devices with 8% with statistically significant difference between both modalities (p < 0.05). Conclusion Membrane perforations in MSA may be significantly reduced applying piezoelectrical devices for MSA.
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12
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Physics and Histologic Evaluation of Rotary, Ultrasonic, and Sonic Instruments. J Craniofac Surg 2017; 28:e609-e614. [PMID: 28806375 DOI: 10.1097/scs.0000000000003738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Rotary instruments (RIs) are the most commonly used to perform osteotomies in many fields of medicine. Owing to a new interest in performing a minimally invasive surgery, over last fifteen years new devices have been used in oral surgery such as ultrasonic instruments (UIs) and, lately, sonic instruments (SIs). Nowadays, bone preservation and regeneration are paramount in many clinical situations and, consequently, it is crucial to rely upon instruments, which cause the least tissue damage during the surgery. Concerning SIs, there is still few information about workload to be applied and related temperature increases; furthermore, there are no comparative in-vivo studies, which analyze the thermal and mechanical effects on bone. Thus, SIs have been compared with UIs and RIs in terms of heat generation, operating time, accuracy, and tissue damage. Decalcification and sectioning procedure resulted in no significant differences between the applied instruments in terms of bone damage. RIs resulted more efficient than UIs (P < 0.001), but demonstrated low accuracy (NRS 4.9), whereas SIs (P = 0.005) required more time to perform the osteotomy. The maximum temperature increase occurred in the ultrasonic group. Even though SI were the slowest, they have proved to be the most accurate (NRS 8.4) in comparison with UI (NRS 7.6) and RI (NRS 4.9). Within the limit of this study, sonic instruments could be considered a safe alternative to ultrasonic instruments.
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Tallarico M, Better H, De Riu G, Meloni SM. A novel implant system dedicate to hydraulic Schneiderian membrane elevation and simultaneously bone graft augmentation: An up-to 45 months retrospective clinical study. J Craniomaxillofac Surg 2016; 44:1089-94. [PMID: 27316855 DOI: 10.1016/j.jcms.2016.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 04/13/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To evaluate clinical and radiographic performance of a novel implant system that allows for hydraulic Schneiderian membrane elevation and simultaneously bone graft augmentation. MATERIALS AND METHODS Sixty-two consecutive patients with a mean age of 53.1 years and a severe atrophy of the posterior maxilla (3.0 to 7.0 mm) underwent 64 transcrestal sinus floor elevations and submerged implant placement. The following clinical and radiographic parameters were assessed: implant failure, any complications and bone gain measured using cone beam computed tomography. RESULTS No patient dropped out. No implants failed and all the prostheses were uneventful at the last follow-up examination (mean 23.0 months; range 12-45). All the procedures were completed successfully, with elevation of the sinus membrane and insertion of bone graft and the dental implant at the planned site. No intraoperative or postoperative adverse events were observed, such as membrane tears or facial hematoma. The mean residual alveolar ridge height was 5.2 ± 1 mm (range 3.3-7.0 mm). Mean bone gain was 10.9 ± 2.43 mm (range 5.3-16.5) after an average healing period of 8 months. CONCLUSIONS Hydraulic elevation of the Schneiderian membrane using the iRaise sinus-lift system (Maxillent Ltd) can be considered a valuable treatment option for the rehabilitation of atrophic edentulous posterior maxillae.
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Affiliation(s)
- Marco Tallarico
- Surgical, Micro-surgical and Medical Science Department, University of Sassari, Italy
| | - Haddar Better
- Private Clinic, Tel Aviv, Israel; Maxillent Ltd, Herzliya, Israel
| | - Giacomo De Riu
- Maxillofacial Surgery Unit, University of Sassari, Italy
| | - Silvio Mario Meloni
- Surgical, Micro-surgical and Medical Science Department, University of Sassari, Italy.
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Fugazzotto P, Melnick PR, Al-Sabbagh M. Complications when augmenting the posterior maxilla. Dent Clin North Am 2016; 59:97-130. [PMID: 25434561 DOI: 10.1016/j.cden.2014.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The maxillary posterior edentulous region presents a challenge when planning for restoring missing teeth with a dental implant. The available bone in such cases is often not dense and not adequate for the placement of a properly sized implant because of maxillary sinus pneumatization and alveolar bone loss. Maxillary sinus lift is a predictable procedure to provide adequate bone height for the purpose of implant placement. However, complications are encountered during or after the execution of the sinus lift procedure. In this article, the prevention and management of maxillary sinus complications are discussed.
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Affiliation(s)
| | - Philip R Melnick
- Private Practice, 4281 Katella Avenue, Suite 112, Los Alamitos, CA 90720, USA
| | - Mohanad Al-Sabbagh
- Division of Periodontology, Department of Oral Health Practice, College of Dentistry, University of Kentucky, 800 Rose Street, Lexington, KY 40536, USA
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15
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Lin YH, Yang YC, Wen SC, Wang HL. The influence of sinus membrane thickness upon membrane perforation during lateral window sinus augmentation. Clin Oral Implants Res 2015; 27:612-7. [PMID: 26076580 DOI: 10.1111/clr.12646] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate: (1) sinus membrane thickness in patients receiving lateral window sinus augmentation via cone-beam computed tomography (CBCT) and (2) the influence of Schneiderian membrane thickness upon membrane perforation during lateral window approach. MATERIAL AND METHODS A total of 73 subjects with 81 sinus lift procedures between years 2010 and 2013 were recruited consequently. Each patient selected had CBCT images in initial and immediately after surgery. The values and correlation between variables of membrane thickness, perforation rate, membrane morphology, residual bone height, and elevated bone height were evaluated. RESULTS The mean thickness of the Schneiderian membrane was 1.32 ± 0.87 mm. Perforation rate was lowest (7.14%) when membrane thickness was 1-1.5 mm. As membrane became thicker (≥2 mm) or thinner (<1 mm), the perforation rate increased abruptly. When examined the membrane thickness category, Class B (between ≥1 mm and <2 mm) had the lowest perforation rate. Statistically significant correlation was found between the perforation and the membrane thickness. The amount of the remaining bone height did not significantly correlate to the membrane thickness nor influence the membrane perforation. CONCLUSIONS This study demonstrated that membrane thickness was related to the sinus perforation during lateral window sinus augmentation. The perforation rate was lowest when the membrane thickness was 1-1.5 mm.
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Affiliation(s)
- Yen-Hua Lin
- Department of dentistry, Cathay General Hospital, Taipei City, Taiwan
| | - Yueh-Chao Yang
- Department of dentistry, Cathay General Hospital, Taipei City, Taiwan
| | | | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
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Ferri M, Lang NP, Angarita Alfonso EE, Bedoya Quintero ID, Burgos EM, Botticelli D. Use of sonic instruments for implant biopsy retrieval. Clin Oral Implants Res 2014; 26:1237-43. [PMID: 25109369 DOI: 10.1111/clr.12466] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate in vitro the quality of dental implant biopsies collected using trephines or a sonic instrument. METHOD Sixty implants, 4 mm long and 2.4 mm in diameter, were installed in twelve fresh bovine ribs. Biopsies were collected after using three different methods for retrieval, 20 biopsies representing each group: (A) A trephine used concentrically; (B) a trephine used eccentrically; and (C) a sonic device (Sonosurgery(®) ). The time used for biopsy collection was recorded, and an evaluation of the quality of the biopsies obtained was performed. The specimens were subsequently prepared for ground sections, and tissue-to-implant contact percentages (TIC%) were evaluated in a stereomicroscope. RESULTS Time needed for biopsy collection in Groups A and B was between 2 and 3 min, while in C, it amounted to 10-11 min. The differences between Group C and the other two groups were statistically significant (P < 0.00006). Group C showed significantly greater volumes of tissue around the apex of the implants compared with the other two groups (P < 0.027). Groups A and C showed biopsies with higher quality compared with Group B (P < 0.05). Group C presented a higher TIC% compared with the other two groups (P < 0.008). CONCLUSION Compared with the use of trephines, the use of a sonic device for harvesting biopsies resulted in higher-quality biopsies and generated smaller residual defects. However, the harvesting was more time-consuming and was limited to one aspect of the implants.
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Affiliation(s)
- Mauro Ferri
- Universidad Militar Nueva Granada, Fundación CIEO, Bogotá, Colombia
| | | | | | | | | | - Daniele Botticelli
- ARDEC, Ariminum Odontologica, Rimini (Italy) and Faculty of Dentistry, University of Medical Science, La Habana, Cuba
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Viganò P, Botticelli D, Salata LA, Schweikert MT, Urbizo Velez J, Lang NP. Healing at implant sites prepared conventionally or by means of Sonosurgery ®. An experimental study in dogs. Clin Oral Implants Res 2014; 26:377-382. [PMID: 24524198 DOI: 10.1111/clr.12348] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare peri-implant tissue healing at implants installed in sites prepared with conventional drills or a sonic device. MATERIAL AND METHODS In six Beagle dogs, the mandibular premolars and first molars were extracted bilaterally. After 3 months, full-thickness muco-periosteal flaps were elevated and recipient sites were prepared in both sides of the mandible. In the right side (control), the osteotomies were prepared using conventional drills, while, at the left side (test), a sonic device (Sonosurgery(®)) was used. Two implants were installed in each side of the mandible. After 8 weeks of non-submerged healing, biopsies were harvested and ground sections prepared for histological evaluation. RESULTS The time consumed for the osteotomies at the test was more than double compared to the conventional control sites. No statistically significant differences were found for any of the histological variables evaluated for hard and soft tissue dimensions. Although not statistically significant, slightly higher mineralized bone-to-implant contact was found at the test (65.4%) compared to the control (58.1) sites. CONCLUSIONS Similar healing characteristics in osseointegration and marginal hard tissue remodeling resulted at implants installed into osteotomies prepared with conventional drills or with the sonic instrument (Sonosurgery(®)).
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Affiliation(s)
- Paolo Viganò
- Faculty of Dentistry, University of Medical Science, La Habana, Cuba
| | - Daniele Botticelli
- Faculty of Dentistry, University of Medical Science, La Habana, Cuba.,ARDEC, Ariminum Odontologica, Rimini, Italy.,Faculdade de Odontologia de Araçatuba, UNESP - Univ Estadual Paulista, São Paulo, Brasil.,The University of Hong Kong, Prince Philip Dental Hospital, Hong Kong, China
| | - Luiz A Salata
- Faculty of Dentistry, São Paulo University USP, Ribeirão Preto São Paulo, Brazil
| | | | | | - Niklaus P Lang
- The University of Hong Kong, Prince Philip Dental Hospital, Hong Kong, China.,University of Zurich, Zurich, Switzerland
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