A Clinical and Histological Case Series Study on Calcium Sulfate for Maxillary Sinus Floor Augmentation and Delayed Placement of Dental Implants

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.

External sinus lifting using calcium sulphate as a bone grafting in an adult male patient: Case report

Introduction

and importance: Nowadays, dental implant is considered as a revolutionary method in teeth replacement. Occasionally, missing bone is seen in the area of missing teeth. Oral surgeons need to rebuild this are before implantology, which could be supported by using bone grafts. The practitioners face a problem in the maxilla because of its anatomy and the presence of maxillary sinus. In some cases, and after losing the bone, maxillary sinus needs to be lift before the implant is placed. Calcium sulphate (CS) is one of the promising methods as one of the biocompatible bone grafts.

Case presentation

A 30-year-old male patient was reported to the oral and maxillofacial surgery in Faculty of Dentistry, Damascus University. The main complaint was to replace missing teeth (teeth no: 26,27). The patient had no contraindication for surgery.Clinical Findings and Investigations: intra-oral examination revealed a good oral hygiene with no other diseases either in bone or in the oral mucosa. Cone-beam computed tomography systems (CBCT) scan was done to determine the thickness of the remaining bone and the treatment plan was discussed with the patient.

Interventions and outcome

the treatment plan was to do external sinus lifting for the posterior left maxilla, using calcium sulphate as a graft and placing the implants after six months. Each procedure during surgical work was documented and monitored using CBCT. The follow-up and results were made by clinical measures as well CBCT to evaluate radiological bone-gain and bone reduction (two-year follow-up).

Relevance and impact

the use of calcium sulphate has tremendous benefit as biocompatible bone grafts in sinus lifting in order to gain bone before dental implantation. It may increase the bone gain which will improve the surgical site of the implant.

Analysis of bone formation and membrane resorption in guided bone regeneration using deproteinized bovine bone mineral versus calcium sulfate

Guided Bone Regeneration (GBR) is a technique based on the use of a physical barrier that isolates the region of bone regeneration from adjacent tissues. The objective of this study was to compare GBR, adopting a critical-size defect model in rat calvaria and using collagen membrane separately combined with two filling materials, each having different resorption rates. A circular defect 8 mm in diameter was made in the calvaria of Wistar rats. The defects were then filled with calcium sulfate (CaS group) or deproteinized bovine bone mineral (DBBM group) and covered by resorbable collagen membrane. The animals were killed 15, 30, 45 and 60 days after the surgical procedure. Samples were collected, fixed in 4% paraformaldehyde and processed for paraffin embedding. The resultant sections were stained with H&E for histological and histomorphometric study. For the histomorphometric study, the area of membrane was quantified along with the amount of bone formed in the region of the membrane. Calcium sulfate was reabsorbed more rapidly compared to DBBM. The CaS group had the highest percentages of remaining membrane at 15, 30, 45 and 60 days, compared to the DBBM group. The DBBM group had the highest amount of new bone at 45 and 60 days compared to the CaS group. Based on these results, it was concluded that the type of filling material may influence both the resorption of collagen membrane and amount of bone formed.

Sinus floor elevation procedures to enable implant placement and integration: techniques, biological aspects and clinical outcomes

Implant treatment in an atrophied edentulous posterior maxilla constitutes a challenge for the therapeutic team. The authors of the present study acknowledge that modern micro-rough surface implants in lengths of about 8-10 mm or longer and of different brands are similarly successful. Consequently, the authors propose that the use of different sinus floor elevation techniques should be considered when < 8 mm of bone is available below the maxillary sinus. The type of sinus floor elevation technique selected is mainly based on residual vertical bone height, marginal bone width, local intrasinus anatomy and the number of teeth to be replaced, although other factors (such as surgical training and surgical experience) may have an impact. It is proposed that a transcrestal sinus floor elevation approach can be considered as a first-choice method for single tooth gaps in situations with sufficient width for implant placement and a residual bone height of 5-8 mm, while lateral sinus floor elevation, with or without grafting materials, is indicated when < 5 mm of bone is available and when several teeth are to be replaced. With regard to time of implant placement, a one-stage procedure is preferred provided that high primary stability can be ensured.

Three-Dimensional Assessment of Volumetric Changes in Sinuses Augmented with Two Different Bone Substitutes

Introduction. The bone volume of the posterior maxilla may not be appropriate for implant placement, due to factors such as pneumatized maxillary sinus. The purpose of this study was to evaluate the percentage of graft volume reduction following sinus floor elevation (SFE), with either slow resorbable bone substitute only or a composite of slow and fast resorbable bone substitutes, using cone beam computed tomography (CBCT). Materials and Methods. In this retrospective study, CBCT scans of SFE procedures were evaluated to determine the volume of grafted sinus with either deproteinized bovine bone (DBB) or a 2 : 1 mixture of biphasic calcium sulfate (CS) and DBB, as a composite. The volumetric changes of sinus augmentations were measured 2 weeks (V-I) and 6 months (V-II) after operation. Results. Thirty-three patients were included in this study. The average percentage volume reduction was 9.39 ± 3.01% and 17.65 ± 4.15% for DBB and composite grafts, respectively. A significant graft volume reduction was observed between V-I and V-II for both groups (p < 0.01). The DBB group exhibited significantly less volume reduction than the composite group (p < 0.01). Conclusions. Augmented sinus volume may change before implant placement. DBB offers greater volume stability during healing than composite grafts.

A comprehensive clinical review of maxillary sinus floor elevation: anatomy, techniques, biomaterials and complications

Several systematic reviews have shown that maxillary sinus augmentation is a predictable and effective procedure for augmentation of an atrophic posterior maxilla. However, we know of no reviews that have covered all the clinical aspects. We searched the PubMed, EMBASE, Cinhal, and Cochrane databases up to January 2015 to select relevant studies that cover the different objectives of this review, including the anatomy of the maxillary sinus, surgical techniques, biomaterials used in the sinus augmentation, and potential complications.

Nanostructured platforms for the sustained and local delivery of antibiotics in the treatment of osteomyelitis

This article provides a critical view of the current state of the development of nanoparticulate and other solid-state carriers for the local delivery of antibiotics in the treatment of osteomyelitis. Mentioned are the downsides of traditional means for treating bone infection, which involve systemic administration of antibiotics and surgical debridement, along with the rather imperfect local delivery options currently available in the clinic. Envisaged are more sophisticated carriers for the local and sustained delivery of antimicrobials, including bioresorbable polymeric, collagenous, liquid crystalline, and bioglass- and nanotube-based carriers, as well as those composed of calcium phosphate, the mineral component of bone and teeth. A special emphasis is placed on composite multifunctional antibiotic carriers of a nanoparticulate nature and on their ability to induce osteogenesis of hard tissues demineralized due to disease. An ideal carrier of this type would prevent the long-term, repetitive, and systemic administration of antibiotics and either minimize or completely eliminate the need for surgical debridement of necrotic tissue. Potential problems faced by even hypothetically "perfect" antibiotic delivery vehicles are mentioned too, including (i) intracellular bacterial colonies involved in recurrent, chronic osteomyelitis; (ii) the need for mechanical and release properties to be adjusted to the area of surgical placement; (iii) different environments in which in vitro and in vivo testings are carried out; (iv) unpredictable synergies between drug delivery system components; and (v) experimental sensitivity issues entailing the increasing subtlety of the design of nanoplatforms for the controlled delivery of therapeutics.

Fresh-frozen allografts combined with bovine bone mineral enhance bone formation in sinus augmentation

We evaluated histologically, histomorphometrically, and tomographically the effects of the association of fresh-frozen bone allograft (FFB) with bovine bone mineral (BBM) in maxillary sinus floor augmentation. In total, 34 maxillary sinuses from 29 patients, with a mean age of 51.32 (±6.44) years, underwent sinus augmentation. Patients were divided into control and test groups (17 sinuses each). The controls were grafted with allograft bone, and the test group received a combination of FFB and BBM at a 2:1 ratio. After 6 months, bone samples were collected for histological and histomorphometric examinations. The implant survival rates were 93.02% (control group) and 100% (test group) at 6 months after functional loading. Median volumetric reductions of 28.32% (17.05-44.05) and 12.62% (5.65-16.87) were observed for the control and test groups, respectively. Statistically significant histomorphometric differences were found between the control and test groups regarding newly formed bone 12.54% (10.50-13.33) vs. 24.42% (17.62-35.92), p < 0.001, total bone 48.34% (39.03-54.42) vs. 61.32% (50.61-64.96), p = 0.007, and connective tissue 51.66% (45.57-60.97) vs. 39.30% (35.03-49.37), p = 0.007. The addition of BBM to allograft bone in maxillary sinus augmentation resulted in higher percentages of new bone formation and total bone, and permitted implant placement with a low rate of osseointegration failure at the 6-month follow-up.

Comparative maxillary bone-defect healing by calcium-sulphate or deproteinized bovine bone particles and extra cellular matrix membranes in a guided bone regeneration setting: an experimental study in rabbits

OBJECTIVES

The aim of this study was to histologically compare the dynamics of bone healing response between calcium sulphate (CaS) and deproteinized bovine bone mineral (DBBM) particles in guided bone regeneration utilizing an extracellular matrix membrane (ECM) as barrier.

MATERIALS AND METHODS

Eighteen rabbits were used in thisstudy. 5 × 5 mm defects were created in the edentulous space between the incisors and molars in the maxilla. The CaS and DBBM particles were placed in the defects, with or without the placement of a membrane by means of random selection. Healing was evaluated at 2, 4 and 8 weeks by histology.

RESULTS

A total resorption of the CaS material was seen already at 2 weeks. Only minor resorption could be seen of the DBBM particles. The CaS group showed significantly more bone regeneration at all three healing periods compared to the DBBM group. The addition of an ECM membrane demonstrated significant additional effect on bone regeneration. The CaS group showed significant increased amounts of blood vessels compared to the DBBM group.

CONCLUSIONS

Thisstudy showed that CaS in combination with an ECM membrane provided synergistic effects on bone regeneration, seemingly due to stimulating angiogenesis in the early healing process.

Socket Preservation and Sinus Augmentation Using a Medical Grade Calcium Sulfate Hemihydrate and Mineralized Irradiated Cancellous Bone Allograft Composite

Regeneration and preservation of bone after the extraction of a tooth are necessary for the placement of a dental implant. The goal is to regenerate alveolar bone with minimal postoperative pain. Medical grade calcium sulfate hemihydrate (MGCSH) can be used alone or in combination with other bone grafts; it improves graft handling characteristics and particle containment of particle-based bone grafts. In this case series, a 1:1 ratio mix of MGCSH and mineralized irradiated cancellous bone allograft (MICBA) was mixed with saline and grafted into an extraction socket in an effort to maintain alveolar height and width for future implant placement. MGCSH can be used in combination with other bone grafts and can improve handling characteristics and graft particle containment of particle-based bone grafts. In the cases described, we found that an MGCSH:MICBA graft can potentially be an effective bone graft composite. It has the ability to act as a space maintainer and as an osteoconductive trellis for bone cells, thereby promoting bone regeneration in the extraction socket. MGCSH, a cost-effective option, successfully improved MICBA handling characteristics, prevented soft tissue ingrowth, and assisted in the regeneration of bone.