Clinical Outcomes of an Osteotome Technique and Simultaneous Placement of Neoss Implants in the Posterior Maxilla

Assessment of the Quality of Sinus Elevation with Lateral Window Approach Procedure Videos on YouTube: A Content-quality Analysis

Although the lateral window approach allows for greater graft material delivery and bone formation, it is more challenging and invasive, prompting keen interest among dentists to master this method. YouTube is increasingly used for medical training; however, concerns regarding the quality of instructional videos exist. This study proposes new criteria for evaluating YouTube videos on maxillary sinus elevation with the aim of establishing standards for assessing instructional content in the field. We sourced 100 maxillary sinus elevation videos from YouTube and, following exclusion criteria, analyzed 65 remaining videos. The video characteristics, content quality, and newly developed criteria were evaluated. Statistical analyses, employing ordinal logistic regression, identified the factors influencing the quality of instructional videos and evaluated the significance of our new criteria. Although video interaction and view rate exhibited positive relations to content quality, they were not significant ( P =0.818 and 0.826, respectively). Notably, videos of fair and poor quality showed a significant negative relation ( P <0.001). Audio commentary, written commentary, and descriptions of preoperative data displayed positive but statistically insignificant relationships ( P =0.088, 0.228, and 0.612, respectively). The comparison of video evaluation results based on the developed criteria with content quality scores revealed significant negative relationships for good, fair, and poor videos ( P <0.001, Exp(B)=-4.306, -7.853, -10.722, respectively). Among the various video characteristics, only image quality showed a significant relationship with content quality. Importantly, our newly developed criteria demonstrated a significant relationship with video content quality, providing valuable insights for assessing instructional videos on maxillary sinus elevation and laying the foundation for robust standards.

Osteotome-Induced Blood Clot and Subsequent Bone Formation with the Use of Collagen Sponge for Integration of Single Dental Implants into the Atrophied Posterior Maxilla: A Retrospective Follow-Up of 36 Implants after 5 to 13 years

Background

Atrophy of the posterior maxilla as a consequence of tooth loss and sinus pneumatization is a frequent condition encountered in the clinical practice. Prosthetic rehabilitation with implants in these patients often requires some kind of bone regeneration procedure to increase the bone volume.

Aim

The aim of the present retrospective study is to analyze the survival and success rates of a series of implants placed in the atrophic posterior maxilla with a transcrestal osteotome procedure, without placing a bone grafting material.

Materials and Methods

From 2006 to 2014, 36 dental implants (Neoss Ltd., Harrogate, UK) were inserted in 36 patients with at least 4 mm of bone below the maxillary sinus using transcrestal osteotome sinus floor elevation and placement of collagen sponge below the sinus membrane. ISQ measurements were made after implant placement and at abutment surgery after 4 to 6 months. The vertical bone height (VBH) was evaluated in intraoral radiographs taken prior to surgery and in radiographs from annual check-up appointments 5 to 13 years after implant placement. In addition, marginal bone loss (MBL) was evaluated.

Results

One implant was lost after four years of prosthetic loading. The remaining 35 implants showed no complications and were loaded with single crowns after 4–6 months of healing. All 35 implants showed clinical success after 8.5 ± 2.8 years of prosthetic loading (from 5 to 13 years). The vertical bone height was 5.9 ± 1.4 mm at surgery, 9.7 ± 1.1 mm at second surgery after 4–6 months, and 8.3 ± 1.8 at the follow-up at 8.5 ± 2.8 years (from 5 to 13 years). The implant stability registered was 73.2 ± 6.2 ISQ at the surgery and 75.8 ± 3.9 at the second surgery after 4–6 months.

Conclusions

The present long-term follow-up study showed that the crestal approach for sinus floor bone augmentation without additional bone grafting results in predicable bone formation and high implant survival. The osteotome technique is a valid alternative to the more invasive lateral window technique in single cases with a minimum of 4 mm of VBH below the maxillary sinus.

Outcomes of implants placed after osteotome sinus floor elevation without bone grafts: a systematic review and meta-analysis of single-arm studies

Background

The aim of this study is to evaluate the implant survival/success rate, gain in alveolar bone height, crestal bone loss, and complications associated with implants placed in the posterior maxilla after osteotome sinus floor elevation without bone substitutes.

Methods

The electronic databases, such as MEDLINE, EMBASE, CENTRAL, and SCOPUS were systematically and manually searched for publications in peer-reviewed journals. The included articles were subjected to qualitative and quantitative analyses, and the meta-analysis was carried out for single-arm studies. Methodological quality assessment was made for all the included studies.

Results

The included studies were of moderate quality, with the overall implant success and survival rates of 98.3% and 97.9% respectively. The most frequent intra-surgical complication was sinus membrane perforation, accounting for 3.08% of the total implants with reported perforations. The overall crestal bone loss in patients with immediate implants placed with OSFE after a 5-year follow-up was 0.957 mm 95%CI (0.538, 1.377).

Conclusion

Within the limitations of this review, it can be concluded that the survival and success rates of implants placed immediately along with OSFE without any bone substitutes are acceptable and show adequate implant stability with less crestal bone loss over 5 years.

Influence of implant protrusion length on non-grafting osteotome sinus floor elevation with simultaneous implant: a 3- to 9-year retrospective study

BACKGROUND

This study analyzed the influence of implant protrusion length (IPL) on the possible factors that affect the long-term outcomes utilizing non-grafting osteotome sinus floor elevation (OSFE) with simultaneous implant placement, and to explore the optimal range of IPL.

MATERIALS AND METHODS

A retrospective study design was adopted. The clinical and radiographic data of 105 implants in 65 patients were collected after 3-9 (mean 5.04) years follow-up. IPL was divided into three groups (group1, IPL<2mm; group2, 2mm≤IPL<4mm; group3, IPL≥4mm). Endo-sinus bone gain (ESBG), peri-implant marginal bone loss (MBL), bone to implant contact length (BICL), and percentage of ESBG (%ESBG) were used to evaluate non-grafting OSFE. A Kaplan-Meier analysis was performed to assess the cumulative survival rate. Multiple linear regression model was used to explore the relationship between the possible influence factors and ESBG. Analysis of variance (ANOVA) was applied to explore the correlation of IPL with ESBG, MBL, BICL, and %ESBG.

RESULTS

A total of 102 implants in 62 patients fulfilled the survival criteria, giving the cumulative survival rates of 96.4% and 94.1% for implant-based analysis and patient-based analysis, respectively. The mean ESBG, MBL, and BICL at the latest follow-up were 1.95±0.88 mm, 0.58±0.68 mm, and 5.51±1.47 mm. ESBG was found to be positively correlated to IPL. A significant decreased bone formation efficiency was found when IPL was over 4 mm (P=0.02).

CONCLUSIONS

An optimal range of IPL within 4 mm was recommended for better long-term outcomes when applying non-grafting OSFE with simultaneous implant placement.

Therapeutic outcomes of non-grafted and platelet concentrations-grafted transcrestal maxillary sinus elevation (TSFE): a systematic review and meta-analysis

To evaluate and compare the stability, quantity and quality of bone augmentation at maxillary sinus elevation sites by non-grafted transcrestal sinus floor elevation (TSFE) and platelet concentration grafted transcrestal sinus floor elevation (PC-TSFE). A complete literature search was performed up to April 2019. Clinical controlled trials, retrospective cohort studies, and prospective cohort studies were selected based on inclusion criteria. The clinical outcomes were implant survival rate (ISR), marginal/crestal bone loss (MBL/CBL) and endo-sinus bone gain (ESBG). Meta‐analysis was conducted on these 1-year based values. Furthermore, another meta-analysis on 1-year ISR value was conducted among studies with different residual bone heights (RBH) within the non-grafted TSFE group. A total of 18 studies were included: 13 in TSFE group and 5 in PC-TSFE group. No significant differences were displayed between the 1-year ISR of TSFE (97%, 95%CI = 0.96–0.99) and PC-TSFE group (99%, 95%CI = 0.97–1.00). Among the various studies with different RBH within TSFE group, no significant differences in 1-year ISR were displayed. The 1-year MBL/CBL value of PC-TSFE group (0.73 mm, 95%CI = 0.43–1.13 mm) did not show significant difference as compared to TSFE group (0.60 mm, 95%CI = 0.10–1.10 mm). Furthermore, no significant enhancement was observed on 1-year ESBG value on PC-TSFE group (3.51 mm, 95%CI = 2.31–4.71 mm) in comparison with the TSFE group (2.87 mm, 95%CI = 2.18m–3.55 mm). Grafting platelet concentrations around dental implants at TSFE sites did not significantly enhance the adjacent bone regeneration. Moreover, TSFE was shown to be a reliable therapeutic option for implant sites that need simultaneous maxillary sinus augmentation, even under limited RBH.

Radiological Changes Associated with New Bone Formation Following Osteotome Sinus Floor Elevation (OSFE): A Retrospective Study of 40 Patients with 18-Month Follow-Up

Background

Osteotome sinus floor elevation (OSFE) is used to increase the bone volume at the site of the maxillary sinus through the transalveolar approach, and may require support with bone grafting. The aim of this retrospective study was to evaluate the radiological changes associated with new bone formation following OSFE during an 18-month follow-up period.

Material/Methods

Forty patients (including 51 implants) underwent OSFE with final dental reconstruction with a single crown, six months after surgery. Of the 51 dental implants, 24 were implanted with bone grafts, and 27 were implanted without bone grafts. All patients were reviewed using preoperative cone beam computed tomography (CBCT) and panoramic radiographs in postoperative follow-up immediately after OSFE, at six-month follow-up, at 12-month follow-up, and at 18-month follow-up. The degree of new bone formation following OSFE was measured by endo-sinus bone gain (ESBG) in the digital radiographs, and the related factors were analyzed.

Results

At 18-month follow-up, the mean ESBG was 2.55±2.24 mm (range, 0.1–8.6 mm). Partial correlation analysis showed that there was no significant correlation between residual bone height (RBH) and ESBG (partial correlation coefficient −0.143) (P=0.328). There were significant positive correlations between the implant protrusion length (IPL) and ESBG (partial correlation coefficient 0.560) (P=0.000), and whether to perform bone grafts and ESBG (partial correlation coefficient 0.596) (P=0.000).

Conclusions

Following OSFE combined with a short implant, the IPL and the performance of bone grafts were significantly associated with new bone formation.

Graft-Free Maxillary Sinus Floor Elevation: A Systematic Review and Meta-Analysis

BACKGROUND

This systematic review and meta-analysis aims to investigate survival rates of dental implants placed simultaneously with graft-free maxillary sinus floor elevation (GFSFE). Factors influencing amount of vertical bone gain (VBG), protruded implant length (PIL) in sinus at follow-up (PILf), and peri-implant marginal bone loss (MBL) are also evaluated.

METHODS

Electronic and manual searches for human clinical studies on simultaneous implant placement and GFSFE using the lateral window or transcrestal approach, published in the English language from January 1976 to March 2016, were conducted. The random-effects model and mixed-effect meta-regression were used to analyze weighted mean values of clinical parameters and evaluate factors that influenced amount of VBG.

RESULTS

Of 740 studies, 22 clinical studies were included in this systematic review. A total of 864 implants were placed simultaneously with GFSFE at edentulous sites having mean residual bone height of 5.7 ± 1.7 mm. Mean implant survival rate (ISR) was 97.9% ± 0.02% (range: 93.5% to 100%). Weighted mean MBL was 0.91 ± 0.11 mm, and it was significantly associated with the postoperative follow-up period (r = 0.02; R2 = 43.75%). Weighted mean VBG was 3.8 ± 0.34 mm, and this parameter was affected significantly by surgical approach, implant length, and PIL immediately after surgery (PILi) (r = 2.82, 0.57, 0.80; R2 = 19.10%, 39.27%, 83.92%, respectively). Weighted mean PILf was 1.26 ± 0.33 mm (range: 0.3 to 2.1 mm).

CONCLUSION

Within limitations of the present systematic review, GFSFE with simultaneous implant placement can achieve satisfactory mean ISR of 97.9% ± 0.02%.

Maxillary sinus floor elevation with simultaneous implant placement without grafting materials: a systematic review and meta-analysis

The present study aimed to conduct a systematic review and meta-analysis on the effectiveness of maxillary sinus floor elevation and immediate implant installation without the use of grafting material. An electronic search without date or language restriction ​​was performed in PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, Embase, and the grey literature, to May 2016. Eligibility criteria encompassed prospective and retrospective cohort studies, controlled clinical trials, and randomized clinical trials. The search and selection process yielded 18 studies, published between 2005 and 2016. A meta-analysis was conducted only for experimental studies comparing sinus floor elevation with and without grafting material; results were expressed as the standardized mean difference (SMD) or risk ratio (RR) with the 95% confidence interval (CI). An average gain in bone height of 4.7mm over an average 39.4 month period was observed in the sinus elevated without grafting material. Regarding implants, there was a cumulative average survival rate of 97%. On meta-analysis, bone gain (P=0.98) and implant survival (P=0.13) did not differ significantly between sinuses lifted with or without grafting material, with a SMD of 0.01 (95% CI -0.42 to 0.44) and with a RR of 0.55 (95% CI 0.26 to 1.19), respectively.

Clinical and radiological evaluation of implants placed with osteotome sinus lift technique: 19-month follow-up

Aims:

Implant placement in the posterior region of the maxilla might be problematic due to poor regional bone quality. The aim of this study was to clinically and radiologically evaluate implants which were placed in the posterior region of the maxilla (with insufficient bone height) with osteotome sinus lift technique after 19-month follow-up.

Materials and Methods:

Twenty-four patients with posterior maxillary alveolar height ranging from 5 to 8 mm were chosen for this prospective study. After breaking of the cortical bony sinus floor, sufficient bone substitute was placed, and sinus floor was elevated. In this way, a new sinus floor was created, which was designated for further implants placement. Fifty implants were placed immediately after osteotomy sinus lift technique. The mean clinical and radiological follow-up period was 19 months (with a range of 14–24 months). Success factors such as the absence of mobility, pain, infection, and the amount of crestal bone loss were determined in this study. For data analyzing, Kruskal–Wallis and Mann–Whitney tests were used.

Results:

After 19 months, results showed 96% success rate. Two out of fifty implants failed due to mobility. The mean depth of implants in sinus, mean height of residual crestal bone before surgery, and the mean rate of crestal bone loss were 3.8, 7.9, and 0.71 mm, respectively.

Conclusion:

Osteotome sinus lift technique is a noninvasive surgical method for enhancing a desired length. Furthermore, implants insertion was successful after osteotome sinus lift technique in cases with insufficient bone height.

Osstell Resonance Frequency Measurement Values as a Prognostic Factor in Implant Dentistry

Resonance frequency analysis (RFA) using the Osstell device (Osstell AB, Gothenburg, Sweden) has been advocated for quantifying implant stability on a relative scale of implant stability quotients (ISQ). It was the goal of this prospective clinical study to evaluate whether a certain ISQ level, at the time an implant is placed, correlates with successful osseointegration as some have claimed. Four hundred ninety-five implants (Straumann AG, Basel, Switzerland), varying in length and diameter, were placed in a private practice, strictly adhering to the implant manufacturer's surgical protocol. After placement and after healing periods of 42 days in the mandible and 56 days (implant manufacturer's protocol) in the maxilla, implant stability was measured using RFA. After healing, implants were torqued forward at 35 Ncm and allowed to heal further if the patients felt discomfort. Statistical analysis of the data obtained was based on Welch tests and Kolmogorov-Smirnow tests (level of significance α = 0.05). Results showed that 432 implants were osseointegrated after the predefined healing periods while 8 implants were lost and, in 55 cases, healing was prolonged. Both at insertion (P = .025) and after healing (P &lt; .001), successful implants showed significantly different ISQ values as compared to implant failures or implants with prolonged healing. However, overlapping ISQ distributions at implant insertion demonstrated that there was no correlation among the data that could be used to predict successful osseointegration. Within the limits of this study, the prognostic value of ISQ values appears to be ambiguous.

Does the Implant Surgical Technique Affect the Primary and/or Secondary Stability of Dental Implants? A Systematic Review

Background. A number of surgical techniques for implant site preparation have been advocated to enhance the implant of primary and secondary stability. However, there is insufficient scientific evidence to support the association between the surgical technique and implant stability. Purpose. This review aimed to investigate the influence of different surgical techniques including the undersized drilling, the osteotome, the piezosurgery, the flapless procedure, and the bone stimulation by low-level laser therapy on the primary and/or secondary stability of dental implants. Materials and methods. A search of PubMed, Cochrane Library, and grey literature was performed. The inclusion criteria comprised observational clinical studies and randomized controlled trials (RCTs) conducted in patients who received dental implants for rehabilitation, studies that evaluated the association between the surgical technique and the implant primary and/or secondary stability. The articles selected were carefully read and classified as low, moderate, and high methodological quality and data of interest were tabulated. Results. Eight clinical studies were included then they were classified as moderate or high methodological quality and control of bias. Conclusions. There is a weak evidence suggesting that any of previously mentioned surgical techniques could influence the primary and/or secondary implant stability.

Osteotome-Mediated Sinus Lift without Grafting Material: A Review of Literature and a Technique Proposal

Implant rehabilitation of the edentulous posterior maxilla may be a challenging procedure in the presence of insufficient bone volume for implant placement. Maxillary sinus augmentation with or without using grafting materials aims to provide adequate bone volume. The aim of the present study was to systematically review the existing literature on transalveolar maxillary sinus augmentation without grafting materials and to propose and describe an osteotome-mediated approach in postextraction sites in combination with platelet derivative. The systematic review showed that high implant survival rate (more than 96% after 5 years) can be achieved even without grafting the site, with a low rate of complications. Available alveolar bone height before surgery was not correlated to survival rate. In the described case report, three implants were placed in posterior maxilla after extraction of two teeth. An osteotome-mediated sinus lifting technique was performed with the use of platelet derivative (PRGF); a synthetic bone substitute was used to fill the gaps between implant and socket walls. No complications occurred, and implants were successfully in site after 1 year from prosthetic loading. The presented technique might represent a viable alternative for the treatment of edentulous posterior maxilla with atrophy of the alveolar bone though it needs to be validated by studies with a large sample size.