Evaluation of the effectiveness of a water lift system in the sinus membrane-lifting operation as a sinus surgical instrument

Diagnostic reliability and accuracy of the hydraulic contrast lift protocol in the radiographic detection of sinus lift and perforation: ex vivo randomized split-mouth study in an ovine model

OBJECTIVES

Assessing the diagnostic reliability, validity, and accuracy of the hydraulic contrast lift protocol during transcrestal sinus floor elevation in detecting the lift and perforation of the sinus membrane before graft material application and assessing the effect of its use on the operator's diagnostic confidence.

MATERIAL AND METHODS

A single-blind randomized split-mouth study on fresh refrigerated sheep heads. The first intervention consisted of injecting 0.5 ml iodinated contrast medium on the test side and 0.5 ml saline on the control side. In the second intervention artificial sinus membrane perforations were created followed by injecting 0.5 ml iodinated contrast medium on the test side and 0.5 ml saline on the control side. Intraoperative periapical radiographs were taken for both interventions. The resulting 40 radiographs were assessed by 10 examiners to provide interpretations and confidence ratings. The primary endpoints were diagnostic reliability, validity, accuracy, and perceived diagnostic confidence.

RESULTS

In the hydraulic contrast lift protocol, the detection rate was 99% for sinus elevations and 98% for perforations, the saline protocol yielded a detection rate of 28% and 20% respectively. The hydraulic contrast lift protocol demonstrated a high level of inter-rater agreement for the diagnosis of elevations (p < 0.001) and perforations (p < 0.001), strong diagnostic validity for the diagnosis of elevations (p < 0.001) and perforations (p < 0.001), high sensitivity and specificity (p < 0.001) and higher mean diagnostic confidence ratings for both interventions when compared to the saline protocol (p < 0.001). The difference between the predicted probability for correct diagnosis of the hydraulic contrast lift protocol and the saline protocol was significant (p < 0.001) for the detection of both elevations and perforations.

CONCLUSION

Following the hydraulic contrast lift protocol, the use of a radiographic contrast medium can reliably confirm sinus membrane lift and detect perforation during transcrestal sinus floor elevation prior to bone graft application in addition to improving the diagnostic confidence of the operator while relying on periapical radiographs.

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.

Effectiveness of hydraulic pressure-assisted sinus augmentation in a rabbit sinus model: a preclinical study

OBJECTIVES

To investigate the effectiveness of hydraulic pressure-assisted sinus augmentation (SA) in a rabbit sinus model in terms of radiographical and histological healing.

MATERIALS AND METHODS

Bilateral SA was performed in 12 rabbits. Each sinus was randomly assigned to either a hydraulic pressure-assisted SA (test) or a conventional SA (control) group. Healing periods of 2 and 4 weeks were applied (n = 6 for each week). Healing pattern including newly formed bone (NB) and residual bone substitute material (RM) was analyzed with microcomputed tomographically, histologically, and histomorphometrically.

RESULTS

No sinus membrane perforation was detected in either group. In the microcomputed tomographic analysis, the test group exhibited higher apico-coronal spread of RM compared to the control group (p < 0.05). Particularly, the test group exhibited several masses of NB out of the cluster of RM. Histologically, the test group showed an elongated shape of the augmented space, whereas the control group generally presented a dome shape. Histomorphometrically, the total augmented area and the area of NB (1.32 ± 0.56 vs. 0.84 ± 0.40 mm2 at 2 weeks, 2.24 ± 1.09 vs. 2.22 ± 0.85 mm2 at 4 weeks) were not significantly different between the test and the control groups at both healing periods (p > 0.05).

CONCLUSION

Hydraulic pressure-assisted SA led to new bone formation in the distant areas from the bony access hole, but similar histological healing pattern to conventional SA.

CLINICAL RELEVANCE

Hydraulic pressure-assisted SA is a promising option for treating pneumatized posterior maxilla.

Minimally Invasive Transcrestal Sinus Floor Elevation Procedure in Severely Atrophic Ridge: A Case Report

Typically, the greater the atrophy of the process, the more extensive and invasive the sinus floor elevation procedure is. This case of a 39-year-old man demonstrates a minimally invasive hydrostatic sinus lift from 1.7-mm height process in the site of lost tooth No. 16. Using a small flap, safe drills for a crestal approach diameter of 2.8 mm, 2 mL of saline solution under pressure of a syringe plunger, and 1 g of particulated bovine xenograft, a 14-mm height and 12-mm width sinus floor elevation was obtained. The implant was placed with a torque of 30 Ncm, and a healing cap was attached. Despite the very difficult conditions, the presented method not only resulted in a very good therapeutic effect but also reduced the number of procedures and time necessary for complete rehabilitation of the patient. The total treatment time to the final crown delivery was 6 months.

Different techniques in transalveolar maxillary sinus elevation: A literature review

Dental implant treatment in the posterior maxilla encounters bone quality and quantity problems. Sinus elevation is a predictable technique to overcome height deficiency in this area. Transalveolar sinus elevation is a technique that is less invasive and less time-consuming, first introduced for ridges with at least 5 mm of bone height. Many modifications and innovative equipment have been introduced for this technique. This review aimed to explain the modifications of this technique with their indications and benefits.

An exhaustive search in PubMed Central and Scopus electronic databases was performed until December 2020. Articles were selected that introduced new techniques for the transalveolar maxillary sinus approach that had clinical cases with full texts available in the English language. Finally, twenty-six articles were included. The data were categorized and discussed in five groups, including expansion-based techniques, drill-based techniques, hydraulic pressure techniques, piezoelectric surgery, and balloon techniques.

The operator’s choice for transalveolar approach techniques for sinus floor elevation can be based on the clinician’s skill, bone volume, and access to equipment. If possible, a technique with simultaneous implant placement should be preferred.

Sinus Augmentation with Simultaneous, Non-Submerged, Implant Placement Using a Minimally Invasive Hydraulic Technique

Background and objectives: To evaluate whether sinus augmentation, using a minimally invasive implant device, via a non-submerged surgical approach, might negatively influence the outcome. Materials and Methods: A retrospective cohort study was conducted by evaluating patients’ files, classifying them into two groups. Fifty patients (22 men 28 women) were included in the study, 25 in each group. The use of an implant device based on residual alveolar ridge height for sinus augmentation, radiographic evaluation, insertion torque, membrane perforation, post-operative healing, and a minimum of 12 months follow-up were evaluated. Results: The mean residual alveolar ridge height was 5.4 mm for the non-submerged group and 4.2 mm for the submerged group. There were no intraoperative or postoperative complications (including membrane perforations). The mean insertion torque was 45 N/cm for the study group and 20 N/cm for the control group. Complete soft tissue healing was observed within three weeks. Mean bone gain height was 8 mm for the study and 9.3 mm for the control group. All implants osseointegrated after 6–9 months of healing time. Mean follow-up was 17.5 months, range 12–36 months. Marginal bone loss at last follow-up was not statistically significantly different: 1 mm in the non-submerged vs. 1.2 mm in the submerged group. Conclusions: Submerged and non-submerged healing following maxillary sinus augmentation was comparable provided residual alveolar ridge height >5 mm and insertion torque >25 N/cm.

Maxillary Sinus Augmentation Using Hydraulic Pressure by Lateral Approach and Simultaneous Implant Placement: Clinicoradiographic Study

The purpose of this study was to assess clinically and radiographically efficacy of maxillary sinus augmentation using hydraulic pressure in a lateral approach with immediate implant placement. In a total of 10 patients having less than 4 to 6 mm of subantral bone height, lateral approach sinus membrane elevation procedure was performed using hydraulic pressure with the help of a specialized water lift kit followed by grafting and simultaneous implant placement. Cone beam computed tomography analysis was used to assess the change in subantral bone height from baseline to the 6 months postoperatively. Radiographically, subantral bone height increased from 3.86 ± 1.423 mm at baseline to 15.49 ± 2.73 mm at 6 months postoperatively with a gain of 11.63 + 2.63 mm (P < 0.001). Thus, it is concluded that hydraulic pressure may be efficiently used in lateral sinus augmentation procedures along with simultaneous implant placement.

What Affects Postoperative Sinusitis and Implant Failure after Dental Implant: A Meta-analysis

OBJECTIVE

The dental implant is an innovative instrument that enables the edentulous patient to chew. Many factors have a bearing on the success of dental implantation. There are also many complications after dental implantation. In this meta-analysis, we investigated which factors increase the risk of postoperative sinusitis and implant failure after dental implant for the first time.

DATA SOURCES

Included data were searched through the PubMed, EMBASE, and Cochrane library databases. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and 2 authors (J.S.K., S.H.K.) independently extracted data by multiple observers.

REVIEW METHODS

We used a random-effects model considering the variation between and within the included studies.

RESULTS

Twenty-seven studies were included in our final meta-analysis. The proportion of postoperative sinusitis, perforation of the sinus membrane, and implant failure was 0.05 (95% confidence interval [CI], 0.04-0.07), 0.17 (95% CI, 0.13-0.22), and 0.05 (95% CI, 0.04-0.07), respectively, using the single proportion test. The only factors that affected postoperative sinusitis were preoperative sinusitis and intraoperative perforation of the Schneiderian membrane ( P < .01 and P < .01, respectively). The only factors that affected dental implant failure were smoking and residual bone height of the maxilla ( P < .05 and P < .01, respectively).

CONCLUSIONS

Two factors affect postoperative sinusitis after implant surgery: preoperative sinusitis and Schneiderian membrane rupture. It should also be noted that the factors affecting implant failure are residual bone height and smoking. These findings will have a significant impact on the counseling and treatment policy of patients who receive dental implants.

A novel implant system dedicate to hydraulic Schneiderian membrane elevation and simultaneously bone graft augmentation: An up-to 45 months retrospective clinical study

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.

A pilot-study of a minimally invasive technique to elevate the sinus floor membrane and place graft for augmentation using high hydraulic pressure: 18-month follow-up of 20 cases

OBJECTIVE

To evaluate medical efficacy and safety of crestal, minimally invasive sinus floor augmentation (MISFA) using an innovative method based on high hydraulic pressure.

STUDY DESIGN

Twenty MISFA using the novel Jeder-System were performed in 18 patients at 2 study sites in Vienna, Austria. The Jeder-System consists of the Jeder-drill, the Jeder-pump, and a connecting tube-set. The pump generates high hydraulic pressure (1.5 bar) pushing back the sinus membrane from the drill at the first perforation. The pump also monitors the whole procedure by constantly measuring pressure and volume.

RESULTS

Five percent membrane perforation rate (1/20) only detected in the postoperative computed tomography scan and without implication for implant placement. Height gain of 9.2 ± 1.7 mm achieved (from 4.6 ± 1.4 mm to 13.8 ± 2.3 mm). Average patient satisfaction was 9.82 on scale from 1 to 10 (10 = very satisfied). Mean duration of sick leave was 0.19 days. 18-month survival rate was 95% (1/20 implant lost).

CONCLUSIONS

Within the limits of a prospective open cohort study with 20 cases, our data demonstrate the safety and medical efficacy of the novel method.