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Lin X, Li S, Zheng X, Que G. Comprehensive sinus contour classification and its characteristics from radiographic examination: a cross-sectional study. BMC Oral Health 2024; 24:1021. [PMID: 39215296 PMCID: PMC11365276 DOI: 10.1186/s12903-024-04707-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVE The aim of this study was to propose a comprehensive maxillary sinus (MS) contour classification system based on the evaluation of anatomical characteristics from cone beam computed tomography (CBCT) examination and investigate the relationship between sinus contours and sinus floor elevation (SFE). METHODS A total of 283 CBCT scans from patients who had single tooth loss in the posterior maxilla and underwent SFE were analyzed. The MS was classified at each tooth position. For buccal-palatal evaluation, the classification from Type A to E was narrow-taper, taper, ovoid, square, and irregular, respectively. For mesial-distal evaluation, the classification from Type 1 to 4 was flat, slope, concave, and septa, respectively. The major anatomical parameters evaluated were (1) residual bone height (RBH), (2) sinus width (SW), (3) maxillary sinus angle (MSA), (4) buccal dip angle (BDA), (5) palatonasal recess (PNR), and (6) sinus depth. RESULTS Eleven groups of MS contour were classified after detailed calculation. Differences in the RBH, MSA, BDA, and SW among different groups were statistically significant. The narrow-taper and slope MS (A2) group had the highest RBH (8.66 ± 0.77 mm), largest BDA (79.9° ± 3.18°), smallest MSA (19.8° ± 2.01°), and narrowest SW (6.30 ± 1.23 mm). The lowest RBH was in the square and concave sinus (D3) group (5.11 ± 2.70 mm). The ovoid and concave sinus (C3) group had the smallest BDA (50.64 ± 8.73 mm) and largest MSA (74.11° ± 11.52°). The square and flat MS (D1) group had the widest SW (19.13 ± 3.69 mm). A strongly significant positive correlation was observed between the SW and MSA (r = 0.67) and a strongly negative correlation between the SW and BDA (r = - 0.65). The prevalence of PNR (mean angle: 104.06° ± 16.83°, mean height: 14.72 ± 11.78 mm) was 38% and frequently observed in the ovoid and slope MS (C2) group. CONCLUSION Despite certain characteristics at different tooth sites, the same tooth position was categorized differently using different classification systems, indicating large anatomical variations in the MS. The classification system proposed herein allows for classification based on general characteristics at a single tooth site, aiming to help surgeons in improving presurgical evaluation.
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Affiliation(s)
- Xi Lin
- Affiliated Implantology center, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, People's Republic of China
| | - Shaobing Li
- Affiliated Implantology center, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, People's Republic of China
| | - Xianghuai Zheng
- Affiliated Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, People's Republic of China
| | - Guoying Que
- Affiliated Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, People's Republic of China.
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Qian Y, Zhao Y, Lu Y, Bao S, Zhu W, Chen Q, Si M. Clinical and radiographic outcomes of lateral sinus floor elevation with simultaneous hydrophilic implants placement: A retrospective study of 2-5 years. Clin Oral Implants Res 2024; 35:534-546. [PMID: 38366692 DOI: 10.1111/clr.14249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 01/13/2024] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
AIMS To investigate the clinical and radiographic outcomes of a chemically modified sandblasted large-grit acid-etched implant (hydrophilic) in lateral sinus floor elevation (LSFE), compared with a conventional one (hydrophobic). MATERIALS AND METHODS A retrospective study design was adopted. Patients who received LSFE with simultaneous implant placement were recruited. According to different types of implant surfaces, patients were divided into two groups (the hydrophilic group and the hydrophobic group). Implant survival rate (SR), endo-sinus bone stability on the radiographs, mean probing depths, percentage of bleeding on probing, marginal bone loss, and patient satisfaction were evaluated. RESULTS A total of 106 patients with 180 implants (hydrophilic:101, hydrophobic:79) in 119 maxillary sinuses were included. The follow-up period ranged from 2 to 5 years. Three hydrophobic implants and one hydrophilic implant in four different patients failed. The SR of the hydrophilic group was higher than that of the hydrophobic group but without a significant difference (p > .05). The change and change rate of endo-sinus bone height (ΔESBH and RΔESBH) and bone volume (ΔESBV and RΔESBV) in the hydrophilic group were less than those in the hydrophobic group, with a significant difference at 6 months after implantation. No other significant difference was found between the two groups. CONCLUSION Within the limitations of this study, both hydrophilic and hydrophobic implants were suitable for LSFE with predictable clinical outcomes. Meanwhile, hydrophilic implants could contribute to the grafted endo-sinus bone stability during healing time.
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Affiliation(s)
- Yinjie Qian
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Yuxin Zhao
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Yifan Lu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Siqi Bao
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Weijun Zhu
- The First People's Hospital of Yuhang District, Hangzhou, China
| | - Qianming Chen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Misi Si
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
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Gasparro R, Di Lauro AE, Campana MD, Rosiello N, Mariniello M, Sammartino G, Marenzi G. Effectiveness of Autologous Platelet Concentrates in the Sinus Lift Surgery: Findings from Systematic Reviews and Meta-Analyses. Dent J (Basel) 2024; 12:101. [PMID: 38668013 PMCID: PMC11049363 DOI: 10.3390/dj12040101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/20/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Maxillary sinus augmentation is one of the most predictable procedures for the rehabilitation of the posterior maxilla. The current overview aimed to summarize the findings provided by systematic reviews (SRs) and meta-analyses on the effectiveness of autologous platelet concentrates (APCs) in sinus lift and to assess the methodological quality of the included SRs. Three electronic databases have been explored. SRs and meta-analyses addressing the effectiveness of APCs in sinus lift technique were included. Clinical, radiographic and histomorphometric findings were considered for APCs as solely grafting materials and APCs in combination with biomaterials. Outcomes were implant survival rate (ISR), implant stability (IS), implant failure (IF), postoperative complications, histomorphometric findings, radiographic bone gain, bone volume and bone density. The methodological quality of the included SRs was assessed using the updated version of "A Measurement Tool to Assess Systematic Review" (AMSTAR-2). Thirty SRs were included. The methodological quality of the included reviews ranged from critically low (3 studies) to high (9 studies). The included SRs showed favorable clinical outcomes, short-term new bone formation and no biological complications when APCs were used both as solely graft material or in combination with other biomaterials. However, no significant additional effects in the long-term period were observed. APCs did not add any further positive effects compared to the physiological healing derived by the natural blood clot. The current overview of SRs highlighted the need for high-quality SRs evaluating the role of APCs in sinus lift though network meta-analyses, in order to identify the most powerful material for sinus lift augmentation. The use of APCs improves the healing of soft tissues and the postoperative quality of life in the short-term period. Thus, its application can be recommended.
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Affiliation(s)
| | | | | | | | | | - Gilberto Sammartino
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Section of Oral Surgery, University of Naples Federico II, 80131 Naples, Italy; (R.G.); (A.E.D.L.); (M.D.C.); (N.R.); (M.M.); (G.M.)
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Gao J, Yang Y, Yin W, Zhao X, Qu Y, Yang X, Wu Y, Xiang L, Man Y. A nomogram prediction of implant apical non-coverage on bone-added transcrestal sinus floor elevation: A retrospective cohort study. Clin Oral Implants Res 2024; 35:282-293. [PMID: 38108637 DOI: 10.1111/clr.14225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 11/18/2023] [Accepted: 11/28/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES To identify the risk indicators and develop and validate a nomogram prediction model of implant apical non-coverage by comprehensively analyzing clinical and radiographic factors in bone-added transcrestal sinus floor elevation (TSFE). MATERIAL AND METHODS A total of 260 implants in 195 patients receiving bone-added TSFE were included in the study. The population was divided into a development (180 implants) and a validation (80 implants) cohort. According to 6 months post-surgery radiographic images, implants were categorized as "apical non-coverage" or "apical covered." The association of risk factors including clinical and radiographic parameters with implant apical non-coverage was assessed using regression analyses. A nomogram prediction model was developed, and its validation and discriminatory ability were analyzed. RESULTS The nomogram predicting bone-added TSFE's simultaneously placed implant's apex non-coverage after 6 months. This study revealed that sinus angle, endo-sinus bone gain, implant protrusion length, graft contact walls, and distal angle were predictors of implant apical non-coverage. The generated nomogram showed a strong predictive capability (area under the curve [AUC] = 0.845), confirmed by internal validation using 10-fold cross-validation (Median AUC of 0.870) and temporal validation (AUC = 0.854). The calibration curve and decision curve analysis demonstrated good performance and high net benefit of the nomogram, respectively. CONCLUSIONS The clinical implementation of the present nomogram is suitable for predicting the apex non-coverage of implants placed simultaneously with bone-added TSFE after 6 months.
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Affiliation(s)
- Jiayu Gao
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yufei Yang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Wumeng Yin
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiangqi Zhao
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yili Qu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xingmei Yang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yingying Wu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lin Xiang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yi Man
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Valentini P, Calciolari E, Monlezun S, Akcalı A, Donos N, Quirynen M. APCs in sinus floor augmentation. Periodontol 2000 2024. [PMID: 38363055 DOI: 10.1111/prd.12554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/18/2023] [Accepted: 01/21/2024] [Indexed: 02/17/2024]
Abstract
After tooth loss in the posterior area of the maxilla, sinus floor elevation is often required to compensate the vertical bone loss due to sinus pneumatization. This narrative review reports on the potential benefits of autologous platelet concentrates (APCs) during this procedure. As for transcrestal approach, APCs have been used as "sole" substitute/graft. However, because of the low number of clinical trials available with PRGF, and even none for PRP, no definitive conclusions can be made regarding their efficacy. The number of studies on the use of L-PRF were outnumbered indicating good feasibility for vertical bone gain, with a high implant survival rate and a low degree of complications. PRP and PRGF have not been studied as a "single/sole" substitute for a one-stage lateral window approach, probably because of the weak physical characteristics of the membranes. L-PRF alone appears to be a predictable grafting material for lateral maxillary sinus grafting and a reduced RBH should not be considered as a risk factor. Compared to a "standard" bone substitute L-PRF shows slightly less vertical bone gain (consider enough membrane application and use of bony window as new sinus floor roof over the implant apices), enhanced early resorption (first 6 months after application), but a similar stable bone gain afterward. For a two-stage lateral window approach, APCs "alone" cannot be recommended, due to their weak withstand to the sinus pneumatization forces. APCs combined with bone substitutes seem to accelerate bone formation, without any additional benefits on the long-term new bone gain. The use of L-PRF membranes for the treatment of perforations appears to be an effective treatment option, but further clinical studies are needed to confirm this. Even though the abovementioned statements are based on large numbers of studies, additional RCTs comparing APCs with different types of grafting procedures for sinus elevation are needed.
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Affiliation(s)
- Pascal Valentini
- Department of Implant Surgery Tattone Hospital, University of Corsica Pasquale Paoli, Institute of Health, Corte, France
| | - Elena Calciolari
- Centre for Oral Clinical Research, Institute of Dentistry, Barts & The London School of Medicine and Dentistry, London, UK
- Dental school, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Sebastien Monlezun
- Department of Implant Surgery Tattone Hospital, University of Corsica Pasquale Paoli, Institute of Health, Corte, France
| | - Aliye Akcalı
- Centre for Oral Clinical Research, Institute of Dentistry, Barts & The London School of Medicine and Dentistry, London, UK
- Department of Periodontology, Dental Faculty, University of Dokuz Eylul, Izmir, Turkey
| | - Nikos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Barts & The London School of Medicine and Dentistry, London, UK
| | - Marc Quirynen
- Department of Oral Health Sciences, Katholieke Universiteit Leuven & University Hospitals Leuven, (section Periodontology), Leuven, Belgium
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Wang M, Li B, Feng H, Ye Q, Sun Y, Duan X, He J. Assessment of the osteogenic effect after maxillary sinus floor elevation and simultaneous implantation with or without bone grafts by analyzing trabecular bone parameters: a retrospective study. J Appl Oral Sci 2024; 32:e20230406. [PMID: 38359269 PMCID: PMC10984575 DOI: 10.1590/1678-7757-2023-0406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE The aim of this population-based retrospective study was to compare the osteogenic effect of newly formed bone after maxillary sinus floor elevation (MSFE) and simultaneous implantation with or without bone grafts by quantitatively analyzing trabecular bone parameters. METHODOLOGY A total of 100 patients with missing posterior maxillary teeth who required MSFE and implantation were included in this study. Patients were divided into two groups: the non-graft group (n=50) and the graft group (n=50). Radiographic parameters were measured using cone beam computed tomography (CBCT), and the quality of newly formed bone was analyzed by assessing trabecular bone parameters using CTAn (CTAnalyzer, SkyScan, Antwerp, Belgium) software. RESULTS In the selected regions of interest, the non-graft group showed greater bone volume/total volume (BV/TV), bone surface/total volume (BS/TV), trabecular number (Tb. N), and trabecular thickness (Tb. Th) than the graft group (p<0.001). The non-graft group showed lower trabecular separation (Tb. Sp) than the graft group (p<0.001). The incidence of perforation and bleeding was higher in the graft group than in the non-graft group (p<0.001), but infection did not significantly differ between groups (p>0.05). Compared to the graft group, the non-graft group showed lower postoperative bone height, gained bone height and apical bone height (p<0.001). CONCLUSION MSFE with and without bone grafts can significantly improve bone formation. In MSFE, the use of bone grafts hinders the formation of good quality bone, whereas the absence of bone grafts can generate good bone quality and limited bone mass.
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Affiliation(s)
- Mohan Wang
- Anhui Medical UniversityStomatologic Hospital & CollegeKey Laboratory of Oral Diseases Research of Anhui ProvinceHefeiChinaAnhui Medical University, Stomatologic Hospital & College, Key Laboratory of Oral Diseases Research of Anhui Province, Hefei, China.
- Shanghai Jiao Tong University School of MedicineNinth People's HospitalCollege of StomatologyShanghaiChinaShanghai Jiao Tong University School of Medicine, Ninth People's Hospital, College of Stomatology, Department of Oral and Maxillofacial Surgery, Shanghai, China.
| | - Beibei Li
- Anhui Medical UniversityStomatologic Hospital & CollegeKey Laboratory of Oral Diseases Research of Anhui ProvinceHefeiChinaAnhui Medical University, Stomatologic Hospital & College, Key Laboratory of Oral Diseases Research of Anhui Province, Hefei, China.
| | - Hailiang Feng
- Zhejiang University School of MedicineThe Second Affiliated HospitalDepartment of StomatologyHangzhouChinaZhejiang University School of Medicine, The Second Affiliated Hospital, Linping Campus, Department of Stomatology, Hangzhou, China.
| | - Qingsong Ye
- Anhui Medical UniversityStomatologic Hospital & CollegeKey Laboratory of Oral Diseases Research of Anhui ProvinceHefeiChinaAnhui Medical University, Stomatologic Hospital & College, Key Laboratory of Oral Diseases Research of Anhui Province, Hefei, China.
| | - Yahui Sun
- Anhui Medical UniversityStomatologic Hospital & CollegeKey Laboratory of Oral Diseases Research of Anhui ProvinceHefeiChinaAnhui Medical University, Stomatologic Hospital & College, Key Laboratory of Oral Diseases Research of Anhui Province, Hefei, China.
| | - Xinxiu Duan
- Anhui Medical UniversityStomatologic Hospital & CollegeKey Laboratory of Oral Diseases Research of Anhui ProvinceHefeiChinaAnhui Medical University, Stomatologic Hospital & College, Key Laboratory of Oral Diseases Research of Anhui Province, Hefei, China.
| | - Jiacai He
- Anhui Medical UniversityStomatologic Hospital & CollegeKey Laboratory of Oral Diseases Research of Anhui ProvinceHefeiChinaAnhui Medical University, Stomatologic Hospital & College, Key Laboratory of Oral Diseases Research of Anhui Province, Hefei, China.
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Krennmair S, Postl L, Schwarze UY, Malek M, Stimmelmayr M, Krennmair G. Clinical, radiographic, and histological/histomorphometric analysis of maxillary sinus grafting with deproteinized porcine or bovine bone mineral: A randomized clinical trial. Clin Oral Implants Res 2023; 34:1230-1247. [PMID: 37610063 DOI: 10.1111/clr.14164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 07/18/2023] [Accepted: 07/25/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVE The present study aimed to compare histomorphometrically evaluated new bone formation, radiographically measured graft stability, and clinical implant outcome between maxillary sinus grafting with either deproteinized porcine bone mineral (DPBM) or deproteinized bovine bone mineral (DBBM). MATERIALS AND METHODS Thirty maxillary sinuses were initially included and randomly assigned to the test group (TG; DPBM, n = 15) or control group (CG; DBBM, n = 15). After a healing period (6 months), axially retrieved bone biopsies of the molar region were used for histological/histomorphometric analysis of new bone formations. Additionally, radiographically measured graft stability and clinical implant outcome were assessed. RESULTS Twenty-three sinus sites with 10 sinuses of the TG and 13 of the CG were ultimately available for data and statistical analysis. In the TG, a slightly, but yet significantly (p = .040) higher proportion of new bone formation (TG: 27.7 ± 5.6% vs. CG: 22.9 ± 5.1%) and a lesser (p = .019) amount of connective (non-mineralized) tissue (TG: 47.5 ± 9.5% vs. CG: 56.1 ± 9.5%) was found than in the CG. However, both xenografts showed comparable (n.s.) residual bone graft (TG: 23.7 ± 7.2% vs. CG: 21.1 ± 9.85.6%), bone-to-graft contacts (TG: 26.2 ± 9.8% vs. CG: 30.8 ± 13.8%), similar graft height reduction over time (TG: 12.9 ± 6.7% CG: 12.4 ± 5.8%) and implant survival/success rate (100%). At the 3-year post-loading evaluation, the peri-implant marginal bone loss (TG: 0.52 ± 0.19 mm; CG: 0.48 ± 0.15 mm) and the peri-implant health conditions (TG: 87.5%/CG: 81.2%) did not differ between implants inserted in both xenografts used. CONCLUSIONS The use of DPBM or DBBM for maxillary sinus augmentation is associated with comparable bone formation providing stable graft dimension combined with healthy peri-implant conditions.
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Affiliation(s)
- Stefan Krennmair
- Department of Oral and Maxillofacial Surgery, Keplerklinikum Linz, Johannes Kepler University (JKU) Linz, Linz, Austria
- NumBiolab Research Associate, Ludwig-Maximilian University (LMU), Munich, Germany
| | - Lukas Postl
- Department of Oral and Maxillofacial Surgery, Keplerklinikum Linz, Johannes Kepler University (JKU) Linz, Linz, Austria
- NumBiolab Research Associate, Ludwig-Maximilian University (LMU), Munich, Germany
| | - Uwe Yacine Schwarze
- Division of Oral Surgery and Orthodontics and Musculo-Skeletal Research Unit for Biomaterials, Medical University Graz, Graz, Austria
| | - Michael Malek
- Department of Oral and Maxillofacial Surgery, Keplerklinikum Linz, Johannes Kepler University (JKU) Linz, Linz, Austria
| | - Michael Stimmelmayr
- Department of Prosthodontics, Ludwig-Maximilian University (LMU), Munich, Germany
| | - Gerald Krennmair
- Department of Prosthodontics, Dental School, Sigmund Freud Medical University of Vienna, Vienna, Austria
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Starch-Jensen T, Bruun NH, Spin-Neto R. Endo-sinus bone gain following osteotome-mediated sinus floor elevation with Bio-Oss Collagen compared with no grafting material: a one-year single-blind randomized controlled trial. Int J Oral Maxillofac Surg 2023; 52:1205-1215. [PMID: 36997448 DOI: 10.1016/j.ijom.2023.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/31/2023]
Abstract
The objective of this study was to assess endo-sinus bone gain (ESBG) following osteotome-mediated sinus floor elevation with Bio-Oss Collagen (test) compared with no grafting material (control) using two- and three-dimensional radiographic methods, as part of a randomized controlled trial (ClinicalTrials.gov, NCT04618900). Forty healthy patients who met the necessary eligibility criteria were allocated by block randomization to either the test group (20 patients) or control group (20 patients). Cone beam computed tomography scans were obtained at enrolment (T0), immediately after surgery (T1), at delivery of the prosthetic rehabilitation (T2), and 1 year after functional implant loading (T3). Mean differences were expressed with the 95% confidence interval; significance was set at P < 0.05. ESBG was significantly increased with Bio-Oss Collagen compared with no grafting material at T1, T2, and T3 (P < 0.001). A gradual decrease in ESBG was observed over time with both treatment modalities (P < 0.001), which diminished the difference between the test and control groups at T2 and T3. ESBG was observed to be positively correlated with implant protrusion length and negatively correlated with the residual bone height. In osteotome-mediated sinus floor elevation, the application of Bio-Oss Collagen underneath the elevated Schneiderian membrane improved ESBG significantly when compared with no grafting material. However, the increased ESBG seems not to have positively improved the treatment outcomes in terms of the implant stability quotient or the survival of the implants or suprastructures.
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Affiliation(s)
- T Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital and Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
| | - N H Bruun
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - R Spin-Neto
- Department of Dentistry and Oral Health, Section of Oral Radiology, Faculty of Health, Aarhus University, Aarhus, Denmark
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Yamaguchi K, Munakata M, Sato D, Kataoka Y, Kawamata R. The Effectiveness and Practicality of a Novel Barrier Membrane for the Open Window in Maxillary Sinus Augmentation with a Lateral Approach, with Risk Indicators for Bone Graft Displacement and Bone Height Decrease: A Prospective Study in Humans. Bioengineering (Basel) 2023; 10:1110. [PMID: 37892840 PMCID: PMC10604179 DOI: 10.3390/bioengineering10101110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/09/2023] [Accepted: 09/19/2023] [Indexed: 10/29/2023] Open
Abstract
Maxillary sinus augmentation with a lateral approach (MSA) is a well-established treatment. In this prospective study, we evaluated risk factors for postoperative bone graft displacement and reported the clinical application of long-term resorbable L-lactic acid/-caprolactone (PLA/PCL) as a barrier membrane to cover the open window in the lateral wall in MSA. Twenty-four patients underwent MSA according to the relevant criteria; CT data obtained before and 1 week (1 w) and 5-6 months (5 m) post-MSA, bone height changes, bone height reduction rates at 1 w and 5 m post-MSA, bone graft displacement measurements, and risk factors were examined. All patients showed bone height increments (p < 0.005). However, no difference was observed between 1 w and 5 m post-MSA. Bone graft displacement was observed in eight patients; the reduction rate from 1 w to 5 m post-MSA was 8.38% ± 4.88%. Sex, septa, maxillary sinus floor-palatal bone distance, and maxillary sinus floor-maxillary ostium distance were associated with bone graft displacement (p < 0.05). The height from the maxillary sinus floor to the palatal bone and the sinus angle influenced the augmentation degree (p < 0.05). The PLA/PCL membrane is compared favorably with other membranes and may be useful as a barrier membrane for the MSA open window.
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Affiliation(s)
- Kikue Yamaguchi
- Department of Implant Dentistry, Showa University School of Dentistry, 2-1-1, Kita-senzoku, Ota-ku, Tokyo 1458515, Japan
| | - Motohiro Munakata
- Department of Implant Dentistry, Showa University School of Dentistry, 2-1-1, Kita-senzoku, Ota-ku, Tokyo 1458515, Japan
| | - Daisuke Sato
- Department of Implant Dentistry, Showa University School of Dentistry, 2-1-1, Kita-senzoku, Ota-ku, Tokyo 1458515, Japan
| | - Yu Kataoka
- Department of Dental Education, Showa University School of Dentistry, 1-8-5, Hatanodai, Shinagawa-ku, Tokyo 1428555, Japan
- Department of Biomaterials and Engineering, Showa University School of Dentistry, 1-8-5, Hatanodai, Shinagawa-ku, Tokyo 14228555, Japan
| | - Ryota Kawamata
- Department of Implant Dentistry, Showa University School of Dentistry, 2-1-1, Kita-senzoku, Ota-ku, Tokyo 1458515, Japan
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10
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Farina R, Riccardi O, Schincaglia GP, Severi M, Trombelli L, Simonelli A. Six-year extension results of a randomized trial comparing transcrestal and lateral sinus floor elevation at sites with 3-6 mm of residual bone. Clin Oral Implants Res 2023; 34:813-821. [PMID: 37303113 DOI: 10.1111/clr.14110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To comparatively evaluate the 6-year outcomes of transcrestal and lateral sinus floor elevation (tSFE and lSFE, respectively). METHODS The 54 patients representing the per-protocol population of a randomized trial comparing implant placement with simultaneous tSFE versus lSFE at sites with a residual bone height of 3-6 mm were invited to participate in the 6-year follow-up visit. Study assessments included: peri-implant marginal bone level at the mesial (mMBL) and distal (dMBL) aspects of the implant, proportion of the entire implant surface in direct contact with the radiopaque area (totCON%), probing depth, bleeding on probing, suppuration on probing, and modified plaque index. Also, the conditions of the peri-implant tissues at 6-year visit were diagnosed according to the case definitions of peri-implant health, mucositis, and peri-implantitis from the 2017 World Workshop. RESULTS Forty-three patients (21 treated with tSFE and 22 treated with lSFE) participated in the 6-year visit. Implant survival was 100%. At 6 years, totCON% was 96% (IR: 88%-100%) in tSFE group and 100% (IR: 98%-100%) in lSFE group (p = .036). No significant intergroup difference in patient distribution according to the diagnosis of peri-implant health/disease was observed. Median dMBL was 0.3 mm in tSFE group and 0 mm in lSFE group (p = .024). CONCLUSIONS At 6 years following placement concomitantly with tSFE and lSFE, implants showed similar conditions of peri-implant health. Peri-implant bone support was high in both groups and was slightly but significantly lower in tSFE group.
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Affiliation(s)
- Roberto Farina
- Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Ferrara, Italy
- Operative Unit of Dentistry, Azienda Unità Sanitaria Locale (A.U.S.L.), Ferrara, Italy
| | | | | | - Mattia Severi
- Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Ferrara, Italy
- Operative Unit of Dentistry, Azienda Unità Sanitaria Locale (A.U.S.L.), Ferrara, Italy
| | - Leonardo Trombelli
- Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Ferrara, Italy
- Operative Unit of Dentistry, Azienda Unità Sanitaria Locale (A.U.S.L.), Ferrara, Italy
| | - Anna Simonelli
- Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Ferrara, Italy
- Operative Unit of Dentistry, Azienda Unità Sanitaria Locale (A.U.S.L.), Ferrara, Italy
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11
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Shiezadeh F, Taher M, Shooshtari Z, Arab H, Shafieian R. Using Platelet-Rich Fibrin in Combination With Allograft Bone Particles Can Induce Bone Formation in Maxillary Sinus Augmentation. J Oral Maxillofac Surg 2023; 81:904-912. [PMID: 37084762 DOI: 10.1016/j.joms.2023.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Sinus pneumatization secondary to posterior maxillary tooth extraction can hinder proper implant installation. Maxillary sinus floor augmentation is a surgical procedure that has been proposed to overcome this issue. PURPOSE The aim of this study was to evaluate and compare the histomorphometric outcomes of sinus floor elevation using allograft bone particles with or without platelet-rich fibrin (PRF). STUDY DESIGN, SETTING, SAMPLE This randomized clinical trial included patients scheduled for maxillary sinus floor elevation in the Implant Department of Mashhad Dental School. Healthy adults with an edentulous maxilla and residual alveolar bone height of 3 mm or less were eligible to participate and were randomly allocated to intervention (A) or control (B) groups. Bone biopsies were obtained 6 months postoperatively. PREDICTOR VARIABLE The predictor variable was using a PRF membrane for maxillary sinus augmentation. In group A, sinus floor elevation was performed using PRF combined with bone allografts, while in group B only allograft particles were used. MAIN OUTCOME VARIABLES The primary outcome variables were the recorded postoperative histologic parameters, as in the area of newly formed bone, new bone marrow, and residual graft particles (μm2). The secondary outcome variables were the radiographically measured postoperative bone height and width at the graft site. COVARIATES Age and sex. ANALYSES Independent sample t-test was employed to compare the postoperative histomorphometric parameters between groups A and B. P value ≤ .05 was considered statistically significant. RESULTS A total of 20 patients (10 per group) completed the study. The mean rate of new bone formation was 43.25 ± 5.22% in group A and 38.25 ± 7.01% in group B. This difference was statistically insignificant (P = .087). The mean amount of newly formed bone marrow was significantly more in group A compared to group B (6.81 ± 2.19% vs 10.23 ± 4.49%; P = .044). The average amount of remaining particles was also significantly less in group A patients (9.35 ± 3.43% vs 13.18 ± 3.67%; P = .027). CONCLUSION AND RELEVANCE Incorporating PRF as an adjunctive grafting material results in fewer residual particles of allograft and in more bone marrow formation and may serve as a treatment option for developing the atrophic posterior maxilla.
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Affiliation(s)
- Farid Shiezadeh
- Associate Professor, Department of Periodontics, Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Milad Taher
- Assistant Professor, Department of Periodontics, Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Shooshtari
- Dentist, Private Practice, Research Assistant, Department of Periodontics, Dental Research Center, Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad, Iran
| | - HamidReza Arab
- Professor, Department of Periodontics, Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reyhaneh Shafieian
- Assistant Professor, Department of Anatomy and Cell Biology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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12
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Galindo-Moreno P, Martín-Morales N, Olaechea A, Hernández-Cortes P, Verdugo-Escamilla C, Martinez-Ruiz F, Carrillo-Galvez AB, O'Valle F, Padial-Molina M. Physico-chemical and biological characterization of a new bovine bone mineral matrix available for human usage. Clin Implant Dent Relat Res 2023; 25:370-380. [PMID: 36709952 DOI: 10.1111/cid.13184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/03/2023] [Accepted: 01/16/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anorganic bovine bone has been deeply studied for bone regeneration in the oral cavity. Different manufacturing processes can modify the final composition of the biomaterial and the responses that induce. AIM To evaluate the physico-chemical characteristics of a bovine bone mineral matrix and the clinical, radiographical, histological, and mRNA results after using it for maxillary sinus floor augmentation in humans. MATERIALS AND METHODS First, the physical-chemical characteristics of the biomaterial were evaluated by X-ray powder diffraction, X-ray fluorescence, and electron microscopy. A frequently used biomaterial with the same animal origin was used as comparator. Then, a clinical study was designed for evaluating clinical, radiographical, histological, and mRNA outcomes. Patients in need of two-stage maxillary sinus floor augmentation were included in the study. Six months after the grafting procedure, a bone biopsy was collected for evaluation. RESULTS In terms of physico-chemical characteristics, no differences were found between both biomaterials. Clinically, 10 patients were included in the study. After 6 months, clinical and radiographical data showed adequate outcomes for allowing implant placement. Histological, immunohistochemical and mRNA analyses showed that the biomaterial in use provides biological support to induce responses similar to those of other commonly used biomaterials. CONCLUSION Bovine bone mineral matrix (Creos™ Xenogain) used as a single material for maxillary sinus floor augmentation shows adequate biological, clinical, and radiological outcomes. In fact, the results from this study are similar to those reported in the literature for another bovine bone-derived biomaterial with whom it shares composition and micro- and nanoscale characteristics.
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Affiliation(s)
- Pablo Galindo-Moreno
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain
| | - Natividad Martín-Morales
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain.,Department of Pathology, School of Medicine, University of Granada, Granada, Spain.,PhD Program in Biomedicine, University of Granada, Granada, Spain
| | - Allinson Olaechea
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain.,PhD Program in Clinical Medicine and Public Health, University of Granada, Granada, Spain
| | - Pedro Hernández-Cortes
- Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain.,Department of Surgery, School of Medicine, University of Granada, Granada, Spain
| | | | | | - Ana Belen Carrillo-Galvez
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain
| | - Francisco O'Valle
- Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain.,Department of Pathology, School of Medicine, University of Granada, Granada, Spain.,Institute of Biopathology and Regenerative Medicine (IBIMER, CIBM), University of Granada, Granada, Spain
| | - Miguel Padial-Molina
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain
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13
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Wang X, Sun L, Wang L, Shi S, Zhang S, Song Y. Predictors of peri-implant bone remodeling outcomes after the osteotome sinus floor elevation: a retrospective study. BMC Oral Health 2022; 22:622. [PMID: 36539789 PMCID: PMC9764540 DOI: 10.1186/s12903-022-02592-6] [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] [Received: 09/01/2022] [Accepted: 11/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the radiographic outcomes of implants after osteotome sinus floor elevation (OSFE), and further identify the separate predictors for these radiographic outcomes. METHODS In this retrospective cohort study, a total of 187 implants were inserted into 138 patients using the OSFE technique. Seventy-four patients in the grafted group, and 64 patients in the non-grafted group completed this study. The vertical bone gain (VBG) and marginal bone loss (MBL) at 3 years following surgery were assessed as outcome variables. Based on extensive literature results, variables considered potential predictors of outcome variables included sex, age, tooth position, implant length, implant diameter, with or without grafting materials, residual bone height, sinus width, bone density, and sinus membrane thickness. Subsequently, the binary logistic regression analysis was applied with VBG and MBL as dependent variables, respectively. The receiver operating characteristic curve (ROC) with its area under the curve (AUC) was performed to further determine the predictive value of these predictors. RESULTS One hundred and six implants in grafted group and 81 implants in the non-grafted group were analyzed. The average VBG was 2.12 ± 1.94 mm for the grafted group and 0.44 ± 1.01 mm for the non-grafted group at 3 years (P < 0.05). The mean MBL was 1.54 ± 1.42 mm for the grafted group and 1.13 ± 1.69 mm for the non-grafted group at 3 years (P > 0.05). After the adjustment for confounders, logistic regression analysis demonstrated that implant length, grafting, residual bone height, and sinus membrane thickness were predictors of VBG. The odds ratio for VBG was 3.90, 4.04, 4.13 and 2.62, respectively. Furthermore, grafting exhibited the largest AUC at 0.80. While tooth position and implant length were predictors of MBL, the odds ratio for MBL was 3.27 and 7.85, respectively. Meanwhile, implant length exhibited the largest AUC at 0.72. CONCLUSIONS OSFE with or without simultaneous grafting materials both showed predictable clinical outcomes. Additionally, the present study is the first quantitative and significant verification that VBG has a significant association with sinus membrane thickness, as well as residual bone height, implant length and grafting. Whereas tooth position and implant length are markedly associated with MBL.
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Affiliation(s)
- Xingxing Wang
- grid.233520.50000 0004 1761 4404State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Oral Implants, School of Stomatology, The Fourth Military Medical University, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Lijuan Sun
- grid.233520.50000 0004 1761 4404State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Periodontology, School of Stomatology, The Fourth Military Medical University, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Lei Wang
- grid.43169.390000 0001 0599 1243Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi’an Jiaotong University, Xi’an, 710004 Shaanxi People’s Republic of China
| | - Shaojie Shi
- 920th Hospital of Joint Logistics Support Force, Kunming, People’s Republic of China
| | - Sijia Zhang
- grid.233520.50000 0004 1761 4404State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Oral Implants, School of Stomatology, The Fourth Military Medical University, Xi’an, 710032 Shaanxi People’s Republic of China
| | - Yingliang Song
- grid.233520.50000 0004 1761 4404State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Oral Implants, School of Stomatology, The Fourth Military Medical University, Xi’an, 710032 Shaanxi People’s Republic of China
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14
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Lin ZZ, Xu DQ, Wang Y, Gao X, Cai Q, Ding X. Factors impacting new bone formation in transcrestal sinus floor elevation followed by implant placement: a cross-sectional study. BMC Oral Health 2022; 22:319. [PMID: 35909182 PMCID: PMC9341123 DOI: 10.1186/s12903-022-02352-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives This study aimed to evaluate factors related to new bone formation (NBF) following simultaneous implant placement with transcrestal sinus floor elevation (TSFE).
Materials and methods Between 2008 and 2020, 357 implants (276 patients) were placed with TSFE. Clinical and radiographic examinations were performed at the preoperative, postoperative, restoration, and follow-up stages. Marginal bone loss, during healing, and the survival rate were retrospectively analyzed. Results Implant protrusion lengths (IPL: 3–5 mm) significantly influenced NBF during the healing period (P-value = 0.026, Odds Ratio = 1.15, 95% confidence interval = 1.02- 1.30). Bone grafting was correlated with NBF (P-value = 0.001). The distance between the implant and lateral wall of the sinus (mesial: P-value = 0.041, distal: P-value = 0.019, buccal: P-value = 0.032, lingual: P-value = 0.043) and angle between the implant and sinus floor significantly influenced NBF in four directions (mesial: P-value = 0.041, distal: P-value = 0.02, buccal: P-value = 0.047, lingual: P-value = 0.005). Implant shape (cylindrical or conical), perforations, smoking, and diabetes did not significantly affect NBF during the healing period (P > 0.05). Conclusion Increasing the distance and angle between the implant and lateral wall of the sinus floor corresponded with reduced NBF. IPL may be an important factor that should be considered. Clinical relevance Our study analyzed new bone formation following transcrestal sinus floor elevation among patients who underwent this procedure with simultaneous implant placement, several factors (including angle and distance between sinus and lateral wall and implant protrusion length) were included in our study. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02352-6.
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15
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Reich KM, Beck F, Heimel P, Lettner S, Redl H, Ulm C, Tangl S. Bone Graft Packing and Its Association with Bone Regeneration in Maxillary Sinus Floor Augmentations: Histomorphometric Analysis of Human Biopsies. BIOLOGY 2022; 11:biology11101431. [PMID: 36290335 PMCID: PMC9598793 DOI: 10.3390/biology11101431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/26/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022]
Abstract
Research in maxillary sinus floor augmentation (MSFA) focussed on the optimisation of microstructural parameters such as microporosity and particle size of bone substitute particles (BS). However, little is known about the impact of BS packing and the corresponding (void) interparticular space on bone regeneration. The aim of this study was to characterise the spatial distribution of BS and its association with BS integration 6 ± 1 months after MSFA. Histological thin-ground sections of 70 human sinus biopsies were histomorphometrically analysed: In serial zones of 100 µm proceeding from the sinus floor (SF) up to the apical end of the biopsy, we measured the distribution of BS particles within these zones in terms of volume (BSV/TV), number and size of BS particles, interparticle spacing (BS.Sp) and bone-to-BS contact. BS particles were not homogeneously distributed over the length of biopsies: The first 200 µm directly adjacent to the SF represented a zone poor in BS particles but with high osteogenic potential. Graft packing density increased from the SF towards the apical part of the AA. Integration of BS particles was inversely associated with the distance to the SF and the graft packing density. A high packing density through excessive compaction of BS particles should be avoided to optimise the macrostructural environment for bone regeneration.
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Affiliation(s)
- Karoline Maria Reich
- Karl Donath Laboratory for Hard Tissue and Biomaterial Research, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
- Correspondence:
| | - Florian Beck
- Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
| | - Patrick Heimel
- Karl Donath Laboratory for Hard Tissue and Biomaterial Research, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
- Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, 1200 Vienna, Austria
| | - Stefan Lettner
- Karl Donath Laboratory for Hard Tissue and Biomaterial Research, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
| | - Heinz Redl
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
- Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, 1200 Vienna, Austria
| | - Christian Ulm
- Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
| | - Stefan Tangl
- Karl Donath Laboratory for Hard Tissue and Biomaterial Research, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
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16
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Fu M, Jiang Z, Ren L, He J, Zhu D, Yang G. Maxillary sinus floor augmentation comparing removing versus retaining antral pseudocyst: A retrospective cohort study. Clin Oral Implants Res 2022; 33:1098-1113. [PMID: 36062937 DOI: 10.1111/clr.13993] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To retrospectively compare multilevel volumetric changes in both hard and soft tissues between antral pseudocyst (AP) removal and retainment before maxillary sinus floor augmentation (MSFA) and immediate implant placement. MATERIAL AND METHODS Twenty-six patients with thirty-eight implants placed from 2016 to 2021 were included and divided according to a cohort design as follows: 13 removing the cyst (RC group) and 13 "leaving alone" the cyst (LC group). 3D radiographic parameters (primary outcome), 2D parameters and clinical records (secondary outcome) involving both hard and soft tissues were evaluated for 4 periods (T1: immediate postoperative, T2: 6-month, T3: 12-month, and T4: 2- to 5- year follow-up). Possible confounding factors, including sinus anatomical features and implant distribution, were also analyzed to eliminate their disturbance. RESULTS The 3D volumetric change rate of bone grafts in the RC group (-9.32 ± 10.01%) from T2 to T3 was significantly lower than that in the LC group (-19.8 ± 10.59%) (p < .05). The change rate of apical bone height (ABH), endo-sinus bone gain (ESBG) and other 2D parameters were not significantly different between the two groups. 5.3% implants in RC group and 9.1% implants failed during follow-ups. 0% postoperative complications were observed in RC group. The Schneiderian membrane of RC group was significantly thinner than that of LC group at two measuring points in sinus. CONCLUSION The present study demonstrated that compared to AP retainment, AP removal before MSFA and immediate implant placement can obtain higher bone graft volumetric stability and favorable prognosis. The study protocol was approved by the Medical Ethics Committee of the Affiliated Hospital of Stomatology, School of medicine, Zhejiang University, China (Acceptance number: 2021-117(R)).
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Affiliation(s)
- Mengdie Fu
- The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Zhiwei Jiang
- The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Lingfei Ren
- The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Jin He
- The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Danji Zhu
- The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Guoli Yang
- The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, Zhejiang, China
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17
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Stacchi C, Bernardello F, Spinato S, Mura R, Perelli M, Lombardi T, Troiano G, Canullo L. Intraoperative complications and early implant failure after transcrestal sinus floor elevation with residual bone height ≤5 mm: A retrospective multicenter study. Clin Oral Implants Res 2022; 33:783-791. [PMID: 35578774 PMCID: PMC9543216 DOI: 10.1111/clr.13959] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 04/06/2022] [Accepted: 05/02/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Clinical indications for maxillary sinus floor elevation with transcrestal techniques have increased in recent years even in sites with minimal residual bone height (RBH). Nevertheless, limited information is currently available on incidence of intraoperative complications and early implant failure in these cases. MATERIAL AND METHODS This retrospective multicenter study was performed on anonymized clinical and radiographic records of patients who underwent transcrestal sinus floor elevation in seven clinical centers. Influence of different factors related to patient, and sinus anatomy and surgical technique on the incidence of intraoperative complications and early implant failure rate after transcrestal sinus lift were investigated. RESULTS A total of 430 patients treated with transcrestal sinus floor elevation for single-implant insertion in sites with RBH ≤5 mm were included in the final analysis. After 1 year of loading, 418 implants of 430 were satisfactorily in function. Early implant failure was recorded in 12 cases (2.8%); results were significantly associated with the presence of large sinus cavities and with the occurrence of membrane perforation. The following adverse events were recorded: membrane perforation (7.2%), acute sinusitis (0.9%), implant displacement into the sinus cavity (0.7%), oro-antral fistula (0.2%), and benign paroxysmal positional vertigo (0.5% of osteotome cases). A strong direct correlation between sinus membrane perforation and bucco-palatal sinus width (p = .000) was demonstrated. CONCLUSIONS Early implant failure after transcrestal sinus elevation showed significant direct correlation with bucco-palatal maxillary sinus width and the presence of membrane perforation. Sinus membrane perforation was strongly associated with bucco-palatal sinus width (extremely low perforation rate in narrow and much higher incidence in wide sinuses).
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Affiliation(s)
- Claudio Stacchi
- Department of Medical, Surgical and Health SciencesUniversity of TriesteTriesteItaly
| | | | | | | | | | - Teresa Lombardi
- Department of Health SciencesUniversity “Magna Græcia”CatanzaroItaly
| | - Giuseppe Troiano
- Department of Clinical and Experimental MedicineUniversity of FoggiaFoggiaItaly
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18
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Harlos MM, da Silva TB, Montagner PG, Teixeira LN, Gomes AV, Martinez EF. Histomorphometric evaluation of different graft associations for maxillary sinus elevation in wide antral cavities: a randomized controlled clinical trial. Clin Oral Investig 2022; 26:1-9. [PMID: 35511290 DOI: 10.1007/s00784-022-04515-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/23/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Pneumatization of the maxillary sinus can make it difficult, if not impossible, to install osseointegrated implants, and undertake their eventual functional rehabilitation, which may ultimately require regenerative techniques to achieve. This randomized controlled study proposed conducting a histological evaluation of the behavior of different graft materials in wide maxillary sinuses, at a height of 8 to 10 mm from the alveolar ridge, combined with bone remnants less than 3mm. MATERIALS AND METHODS Thirty-six patients underwent a sinus elevation procedure through the lateral window. The sinuses were randomly filled with the following materials (n=12/group): group 1, xenogenic bone + autogenous bone (ratio 70:30, respectively); group 2, xenogenic bone + L-PRF; and group 3, xenogenic bone. At 8 months, bone biopsies of engrafted sites were harvested and analyzed histomorphometrically in order to quantify newly formed bone tissue. RESULTS The results showed a greater area of newly formed bone for G1, averaging 2678.37 (1116.40) μm2, compared with G2 at 984.87 (784.27) μm2, and G3 at 480.66 (384.76) μm2 (p < 0.05). Additionally, fewer xenogenic bone particles and a large amount of connective tissue were observed in G2. CONCLUSIONS In maxillary sinuses with large antral cavities, autogenous bone combined with xenogenic bone seems to demonstrate better graft remodeling and improve bone formation, compared with the addition of L-PRF. CLINICAL RELEVANCE L-PRF produces few advantages regarding new bone formation in the wide maxillary sinuses. TRIAL REGISTRATION Brazilian Clinical Trials Registry (REBEC) number RBR-2pbbrvg.
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Affiliation(s)
- Mauricio Marcelo Harlos
- Division of Implantology, Faculdade São Leopoldo Mandic (SLMandic), R. Dr. José Rocha Junqueira, 13, Campinas, São Paulo, Brazil
| | - Thiago Bezerra da Silva
- Division of Implantology, Faculdade São Leopoldo Mandic (SLMandic), R. Dr. José Rocha Junqueira, 13, Campinas, São Paulo, Brazil
| | - Pedro Giorgetti Montagner
- Division of Implantology, Faculdade São Leopoldo Mandic (SLMandic), R. Dr. José Rocha Junqueira, 13, Campinas, São Paulo, Brazil
| | - Lucas Novaes Teixeira
- Division of Cell Biology, Faculdade São Leopoldo Mandic (SLMandic), Campinas, São Paulo, Brazil
| | - Adriana Vanderley Gomes
- Division of Implantology, Faculdade São Leopoldo Mandic (SLMandic), R. Dr. José Rocha Junqueira, 13, Campinas, São Paulo, Brazil
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Galindo-Moreno P, Abril-García D, Carrillo-Galvez AB, Zurita F, Martín-Morales N, O'Valle F, Padial-Molina M. Maxillary sinus floor augmentation comparing bovine versus porcine bone xenografts mixed with autogenous bone graft. A split-mouth randomized controlled trial. Clin Oral Implants Res 2022; 33:524-536. [PMID: 35224778 PMCID: PMC9313845 DOI: 10.1111/clr.13912] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/29/2022] [Accepted: 02/16/2022] [Indexed: 11/30/2022]
Abstract
Aim To compare the effectiveness of two xenografts for maxillary sinus floor augmentation in terms of clinical, radiographical, histologic, and molecular outcomes. Materials and methods A split‐mouth randomized clinical trial was conducted at the University of Granada. Ten consecutive patients in need of bilateral two‐staged maxillary sinus floor augmentation were included. Each patient received both biomaterials (porcine bone mineral and anorganic bovine bone), which were randomly assigned for bilateral sinus augmentation. The maxillary autogenous bone scraped from the sinus access window was mixed with each xenograft at a 20:80 ratio. After a healing period of 6 months, bone biopsies were collected with a trephine during the implant placement in the regenerated area. Histologic, histomorphometrical, immunohistochemical, and molecular outcomes were analyzed. Clinical and radiographical data throughout the treatment phases were also evaluated. Results The resulting anatomic features were similar between both groups. After six months of graft consolidation, the graft resorption rates were similar between both biomaterials. The histologic, histomorphometrical, and immunohistochemical results showed no statistical differences between groups. Conclusion Anorganic bovine bone and porcine bone mineral combined with maxillary autogenous cortical bone show similar biologic and radiologic features in terms of biomaterial resorption, osteoconduction, and osteogenesis when used for maxillary sinus floor augmentation.
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Affiliation(s)
- Pablo Galindo-Moreno
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Dario Abril-García
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Ana Belen Carrillo-Galvez
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Federico Zurita
- Department of Genetics, School of Sciences, University of Granada, Granada, Spain
| | - Natividad Martín-Morales
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain.,Department of Pathology, School of Medicine, University of Granada, Granada, Spain
| | - Francisco O'Valle
- Department of Pathology, School of Medicine, University of Granada, Granada, Spain.,Institute of Biopathology and Regenerative Medicine (IBIMER, CIBM), and Institute of Biosanitary (ibs-Granada), University of Granada, Granada, Spain
| | - Miguel Padial-Molina
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
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20
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Hung KF, Hui LL, Leung YY. Patient-specific estimation of the bone graft volume needed for maxillary sinus floor elevation: a radiographic study using cone-beam computed tomography. Clin Oral Investig 2022; 26:3875-3884. [PMID: 35112191 DOI: 10.1007/s00784-021-04354-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/27/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To develop prediction models for estimating the bone-graft volume needed for sinus floor elevation (SFE) based on the augmentation site, elevation height, and sinus width using cone-beam computed tomography (CBCT). MATERIALS AND METHODS CBCT scans with a medium-to-large field-of-view with bilateral maxillary sinuses partially/entirely visible, acquired from February 2016 to October 2020, were initially screened. Ten defined regions, above the maxillary first (MM1) and second molar (MM2) sites, in the sinuses of the included CBCTs were semi-automatically segmented, and the volumes of the regions were automatically measured using the ITK-SNAP program. The sinus widths at the height ranging between 8 and 16 mm from the sinus floor were measured at the MM1 to MM2 sites, respectively. Multiple linear regression analyses were performed to establish prediction models for estimating the bone graft volume needed for SFE at the MM1 and/or MM2 sites with the sinus width and elevation height as predictors. RESULTS A total of 133 scans (224 sinuses) were included. Three developed prediction models, composed of the sinus width and elevation height, explained 89-91% of the variation in the bone graft volumes estimated for SFE at the MM1, MM2, and MM1-MM2 sites. The mean absolute deviations and absolute percentage deviations between the measured and predicted volumes ranged from 0.12 to 0.28cm3 and from 9.78 to 10.62%, respectively. CONCLUSION The proposed prediction models may enable more patient-specific estimation of the bone graft volume needed for SFE. CLINICAL RELEVANCE The proposed prediction models could facilitate the preparation of an adequate amount of bone graft material and patient-clinician communication about the cost of bone graft material.
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Affiliation(s)
- Kuo Feng Hung
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Liu Ling Hui
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Yiu Yan Leung
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
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21
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Stacchi C, Rapani A, Lombardi T, Bernardello F, Nicolin V, Berton F. Does new bone formation vary in different sites within the same maxillary sinus after lateral augmentation? A prospective histomorphometric study. Clin Oral Implants Res 2022; 33:322-332. [PMID: 34978096 PMCID: PMC9306466 DOI: 10.1111/clr.13891] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate histomorphometric outcomes of lateral maxillary sinus augmentation in different areas of the same cavity and to correlate results to bucco-palatal sinus width (SW) and residual bone height (RBH). MATERIAL AND METHODS Patients needing maxillary sinus floor elevation (RBH <5 mm) to insert two nonadjacent implants were treated with lateral augmentation using a composite graft. Six months later, two bone-core biopsies (mesial/distal) were retrieved in implant insertion sites. SW and RBH were measured on cone beam computed tomography, and correlations between histomorphometric and anatomical parameters were evaluated by multivariate linear regression analysis. RESULTS Twenty patients underwent sinus augmentation, and eighteen were included in the final analysis (two dropouts for membrane perforation). Mean newly formed mineralized tissue percentage (%NFMT) after 6 months in mesial and distal sites was 17.5 ± 4.7 and 11.6 ± 4.7, respectively (p = .0004). Multivariate linear regression showed a strong negative correlation between SW and %NFMT (β coefficient=-.774, p < .0001) and no correlation between RBH and %NFMT (β coefficient =-.038, p = .825). CONCLUSIONS The present study confirms that %NFMT after lateral sinus augmentation occurs at different rates in different anatomical areas of the same maxillary sinus, showing a strong negative correlation with SW, whereas no influence of RBH was observed. Clinicians should regard SW as a guide for graft selection and to decide duration of the healing period. Researchers should consider SW as a predictor variable, when comparing regenerative outcomes of different biomaterials by using maxillary sinus as an experimental model.
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Affiliation(s)
- Claudio Stacchi
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Antonio Rapani
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Teresa Lombardi
- Department of Health Sciences, University 'Magna Graecia', Catanzaro, Italy
| | | | - Vanessa Nicolin
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Federico Berton
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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22
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Zheng X, Huang L, Huang S, Mo A, Zhu J. Influence of anatomical factors related to maxillary sinus on outcomes of transcrestal sinus floor elevation. J Dent Sci 2022; 17:438-443. [PMID: 35028068 PMCID: PMC8740080 DOI: 10.1016/j.jds.2021.07.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/12/2021] [Indexed: 02/08/2023] Open
Abstract
Background/purpose Graft bone maturation and remodeling in the maxillary sinus require adequate angiogenesis and osteoprogenitor cells migration from the surrounding bony walls and Schneiderian membrane. This study aimed to evaluate the influence of anatomical factors related to maxillary sinus on the outcomes of transcrestal sinus floor elevation using cone-beam computed tomography (CBCT). Materials and methods Forty-five patients (63 elevated sites) were included in this study. CBCT were obtained preoperatively, immediately and 6 months after surgery. The anatomical features of residual bone height, maxillary sinus width, maxillary sinus angle and Schneiderian membrane thickness were measured on preoperative CBCT. Descriptive statistics and correlation analysis were conducted to evaluate the influence of anatomical factors on outcome parameters, including sinus lift height, graft bone resorption and marginal bone loss. Results The results showed that there was a positive correlation between sinus width and graft bone resorption. A significantly positive correlation between sinus angle and graft bone resorption was also found. Conclusion Our findings indicate that the anatomical factors of maxillary sinus (sinus width and sinus angle) have influence on the linear change of bone grafts after transcrestal sinus floor elevation.
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Affiliation(s)
- Xiaofei Zheng
- Stomatology Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lirong Huang
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China.,Dental Implant Center, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Si Huang
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China.,Dental Implant Center, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Anchun Mo
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China.,Dental Implant Center, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Juanfang Zhu
- Stomatology Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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23
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Pesce P, Menini M, Canullo L, Khijmatgar S, Modenese L, Gallifante G, Del Fabbro M. Radiographic and Histomorphometric Evaluation of Biomaterials Used for Lateral Sinus Augmentation: A Systematic Review on the Effect of Residual Bone Height and Vertical Graft Size on New Bone Formation and Graft Shrinkage. J Clin Med 2021; 10:jcm10214996. [PMID: 34768518 PMCID: PMC8584826 DOI: 10.3390/jcm10214996] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/19/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of the present systematic review was to investigate the effect of residual bone height (RBH) and vertical bone gain on new bone formation (NBF) and graft shrinkage after lateral sinus lifts using different biomaterials. METHODS An electronic search was conducted on three databases to identify randomized controlled trials (RCTs) published until January 2021 with at least one follow-up at 6 months and at least five patients treated, comparing biomaterials used for maxillary sinus augmentation with a lateral approach. Graft volumetric changes, RBH, vertical bone gain, implant failure, and post-operative complications were evaluated. The risk of bias was assessed using the Cochrane tool. RESULTS We used 4010 identified studies, of which 21 were RCTs. Overall, 412 patients and 533 sinuses were evaluated. Only three publications had an overall low risk of bias. After 6 months, xenograft (XG) showed the least volume reduction (7.30 ± 15.49%), while autogenous graft (AU) was the most reabsorbed (41.71 ± 12.63%). NBF appeared to not be directly correlated with RBH; on the contrary, the overall linear regression analysis showed that NBF significantly decreased by 1.6% for each mm of postoperative vertical graft gain. This finding suggests that the greater the augmentation, the lower the NBF. A similar tendency, with a regression coefficient even higher than the overall one, was also observed with alloplast (AP) and XG. CONCLUSIONS The present results suggested that NBF was essentially independent of preoperative bone height. On the contrary, the smaller the volume was of the graft placed, the higher the amount of new bone formed, and the smaller the graft shrinkage was. Minimizing the augmentation volume might be beneficial to graft healing and stability especially when using AP and XG.
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Affiliation(s)
- Paolo Pesce
- Department of Surgical Sciences (DISC), University of Genoa, Ospedale S. Martino, L. Rosanna Benzi 10, 16132 Genoa, Italy; (M.M.); (L.M.); (G.G.)
- Correspondence:
| | - Maria Menini
- Department of Surgical Sciences (DISC), University of Genoa, Ospedale S. Martino, L. Rosanna Benzi 10, 16132 Genoa, Italy; (M.M.); (L.M.); (G.G.)
| | - Luigi Canullo
- Department of Periodontology, University of Bern, 3012 Bern, Switzerland;
| | - Shahnawaz Khijmatgar
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, 20122 Milan, Italy; (S.K.); (M.D.F.)
| | - Laura Modenese
- Department of Surgical Sciences (DISC), University of Genoa, Ospedale S. Martino, L. Rosanna Benzi 10, 16132 Genoa, Italy; (M.M.); (L.M.); (G.G.)
| | - Gianmarco Gallifante
- Department of Surgical Sciences (DISC), University of Genoa, Ospedale S. Martino, L. Rosanna Benzi 10, 16132 Genoa, Italy; (M.M.); (L.M.); (G.G.)
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, 20122 Milan, Italy; (S.K.); (M.D.F.)
- IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy
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24
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Zhou W, Wang F, Magic M, Zhuang M, Sun J, Wu Y. The effect of anatomy on osteogenesis after maxillary sinus floor augmentation: a radiographic and histological analysis. Clin Oral Investig 2021; 25:5197-5204. [PMID: 33569678 DOI: 10.1007/s00784-021-03827-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/02/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess how anatomy and osteogenesis correlated with results of maxillary sinus floor augmentation (MSFA). MATERIALS AND METHODS Patients with partial edentulism and advanced atrophy of the posterior maxillae (≤ 4 mm residual bone height, RBH) underwent MSFA with sole deproteinized bovine bone matrix (DBBM) through a lateral approach. After a 6 to 9-month healing period, bone core biopsies were obtained from the sites of implant insertion for histological evaluation. The correlations between anatomical and histomorphometric variables were analyzed in a multiple regression model. RESULTS Forty-nine patients were recruited. One biopsy per patient was obtained from the augmented sinus. Thirty-seven bone core biopsies were intact and met the requirement for histomorphometry analysis. The mean (± standard deviation) percentages of vital bone (VB), remaining DBBM, and non-mineralized tissue were 18.25 ± 4.76%, 27.74 ± 6.68%, and 54.08 ± 6.07%, respectively. No statistically significant correlations were found between RBH and VB% (p = 0.44) or between sinus contour and VB% (p = 0.33). However, there was an inverse correlation between the sinus width (SW) and VB % (SW1: R2 = 0.13, p = 0.03; SW2: R2 = 0.15, p = 0.02). CONCLUSIONS After a healing period of 6-9 months, wider sinuses augmented with DBBM alone tended to have a lower proportion of new bone formation, while RBH and sinus contour did not appear to affect osteogenesis after MSFA. CLINICAL RELEVANCE This study emphasized the effect of anatomy on osteogenesis after MSFA. The result of the study may have an indication to the clinician that SW is a consideration when selecting the bone grafting material and deciding the healing period of MSFA.
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Affiliation(s)
- Wenjie Zhou
- Department of Second Dental Center, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai Key Laboratory of Stomatology, National Clinical Research Center of Stomatology, 280 Mohe Road, Shanghai, 201999, China
| | - Feng Wang
- Department of Oral Implantology, Ninth People's Hospital Affiliated with Shanghai Jiao Tong University, School of Medicine, Shanghai Key Laboratory of Stomatology, National Clinical Research Center of Stomatology, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Marko Magic
- Department of Second Dental Center, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai Key Laboratory of Stomatology, National Clinical Research Center of Stomatology, 280 Mohe Road, Shanghai, 201999, China
- School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Minjie Zhuang
- Department of Second Dental Center, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai Key Laboratory of Stomatology, National Clinical Research Center of Stomatology, 280 Mohe Road, Shanghai, 201999, China
| | - Jian Sun
- Department of Oral Maxillofacial-Head Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, National Clinical Research Center of Stomatology, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Yiqun Wu
- Department of Second Dental Center, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai Key Laboratory of Stomatology, National Clinical Research Center of Stomatology, 280 Mohe Road, Shanghai, 201999, China.
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25
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Trimmel B, Gede N, Hegyi P, Szakács Z, Mezey GA, Varga E, Kivovics M, Hanák L, Rumbus Z, Szabó G. Relative performance of various biomaterials used for maxillary sinus augmentation: A Bayesian network meta-analysis. Clin Oral Implants Res 2021; 32:135-153. [PMID: 33230862 PMCID: PMC8247032 DOI: 10.1111/clr.13690] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 10/09/2020] [Accepted: 11/16/2020] [Indexed: 12/29/2022]
Abstract
Objectives To assess the histomorphometric outcomes obtained in randomized clinical trials (RCTs) with different biomaterials used for maxillary sinus augmentation (MSA). Materials and Methods A search of the existing medical literature until October 1, 2019, was performed. Inclusion criteria were (a) RCTs assessing a two‐stage MSA from the lateral approach using autologous bone or biomaterials for grafting and (b) reported histomorphometric outcomes based on crestal bone core biopsy samples. The Bayesian method was used to perform pairwise meta‐analyses and network meta‐analysis (NMA). The primary outcome, the new bone percentage (NB %), was calculated as mean differences with 95% credible intervals. The interventions were ranked by their posterior probability by calculating the surface under the cumulative ranking curve values. Results Thirty‐four RCTs (842 MSAs) were included in the analysis with a normal healing period (5–8 months). All comparisons were presented in a league table. On the basis of the ranking probability, the most effective bone grafting material for NB% was bovine xenograft + bone marrow concentrate (BMC) (81%), followed by bovine xenograft + platelet‐rich plasma (PRP) (77%), bioactive glass ceramic + autologous bone 1:1 (70%), nanocrystalline hydroxyapatite in silica gel (70%), and bioactive glass ceramic (70%). Autologous bone graft alone took the twelfth position with 57%. Conclusion Within the limitations of the present NMA, the analysis did not confirm autologous bone alone as the gold standard for MSA and showed superiority of composite grafts such as bovine xenograft + BMC after 5–8 months of healing.
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Affiliation(s)
- Bálint Trimmel
- Department of Oral Diagnostics, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
| | - Noémi Gede
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Zsolt Szakács
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Gyöngyi Anna Mezey
- Department of Public Health, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Eszter Varga
- Department of Pediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - Márton Kivovics
- Department of Community Dentistry, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
| | - Lilla Hanák
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Zoltán Rumbus
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - György Szabó
- Department of Oro-Maxillofacial Surgery and Stomatology, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
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26
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Zheng XF, Mo AC, Zhu JF, Wang SP, Du YJ, Yao YZ. [Effect of anatomical parameters of maxillary sinus on the outcomes of transcrestal sinus lift]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2020; 38:652-656. [PMID: 33377342 DOI: 10.7518/hxkq.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the effect of three anatomical parameters (maxillary sinus width, maxillary sinus angle, and residual bone height) on the outcomes of transcrestal sinus lift with simultaneous implant placement. METHODS A total of 60 maxillary sinuses in 42 patients were included in this study. All patients were treated with transcrestal sinus lift procedure associated with simultaneous implant placement using a composite graft material of autogenous bone and Bio-Oss. For each patient, beam computed tomography (CBCT) scans were performed preoperatively, immediately after surgery, and 6 months after surgery. The parameters were measured on the preoperative and postoperative CBCT images. The correlation of three anatomical parameters with graft resorption was analyzed using Pearson's correlation test. RESULTS The average residual bone height was (4.46±1.55) mm. The average width of maxillary sinus was (13.86±2.71) mm. The average sinus angle was 78.09°±10.27°. A significant positive correlation was observed between maxillary sinus width and graft resorption (P<0.01). A positive association was also found between sinus angle and graft resorption (P<0.01). CONCLUSIONS The findings show that graft bone resorption in elevated sinus has a positive correlation with the sinus width and sinus angle.
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Affiliation(s)
- Xiao-Fei Zheng
- Center of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - An-Chun Mo
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Dental Implant, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Juan-Fang Zhu
- Center of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Su-Ping Wang
- Center of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Ya-Jing Du
- Center of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Yong-Zhi Yao
- Center of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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27
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Starch-Jensen T, Deluiz D, Bruun NH, Tinoco EMB. Maxillary Sinus Floor Augmentation with Autogenous Bone Graft Alone Compared with Alternate Grafting Materials: a Systematic Review and Meta-Analysis Focusing on Histomorphometric Outcome. J Oral Maxillofac Res 2020; 11:e2. [PMID: 33262881 PMCID: PMC7644272 DOI: 10.5037/jomr.2020.11302] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/10/2020] [Indexed: 11/16/2022]
Abstract
Objectives The objective of present systematic review was to test the hypothesis of no difference in histomorphometric outcome after maxillary sinus floor augmentation with autogenous bone graft alone compared with alternate grafting materials applying the lateral window technique. Material and Methods MEDLINE (PubMed), Embase and Cochrane library search in combination with hand-search of relevant journals were conducted. Human studies published in English until the 25th of March, 2020 were included. Histomorphometric outcomes were evaluated by descriptive statistics and meta-analysis including 95% confidence interval (CI). Results Electronic search and hand-searching resulted in 1902 entries. Sixteen randomized controlled trials with unclear risk of bias fulfilled the inclusion criteria. Descriptive statistics showed comparable or improved histomorphometric outcomes with autogenous bone graft. Meta-analysis revealed a mean difference of -7.1% (CI = -11.0 to -3.2) indicating a significant higher amount of bone after maxillary sinus floor augmentation with autogenous bone graft compared with alternate grafting materials. Subgroup analysis demonstrated a non-significantly differences of -3.7% (CI = -10.9 to 3.4), -11.5% (CI = -25.9 to 2.8), 2.2% (CI = -16.9 to 21.3), and -4.6% (CI = -14.4 to 5.2), when autogenous bone graft was compared with allogeneic bone graft, xenograft, composite grafting materials involving xenograft or synthetic biomaterial mixed with autogenous bone graft, respectively. Conclusions Maxillary sinus floor augmentation with autogenous bone graft seems to facilitate improved histomorphometric outcomes compared with alternate grafting materials. However, the included studies were characterised by an unclear risk of bias and various methodological confounding factors. Hence, the conclusions drawn from the results of present study should be interpreted with caution.
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Affiliation(s)
- Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, AalborgDenmark
| | - Daniel Deluiz
- Department of Periodontology, Rio de Janeiro State University, Rio de JaneiroBrazil
| | - Niels Henrik Bruun
- Unit of Clinical Biostatistics, Aalborg University Hospital, AalborgDenmark
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Taschieri S, Ofer M, Corbella S, Testori T, Dellavia C, Nemcovsky C, Canciani E, Francetti L, Del Fabbro M, Tartaglia G. The Influence of Residual Alveolar Bone Height on Graft Composition after Maxillary Sinus Augmentation Using Two Different Xenografts: A Histomorphometric Comparative Study. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E5093. [PMID: 33187350 PMCID: PMC7697912 DOI: 10.3390/ma13225093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 02/07/2023]
Abstract
AIM To evaluate the hypothesis of a correlation between the preoperative residual alveolar bone height (RBH) and graft maturation after maxillary sinus floor augmentation procedures using two different bone substitutes. METHODS A total of 20 patients who underwent unilateral maxillary sinus floor augmentation with either mineralized deproteinized bovine bone (DBBM) or a xenograft enriched with polymer and gelatin (NBS) were included in this prospective study. Six months after sinus surgery, bone biopsies were harvested with a 3.2 mm diameter trephine bur, prior to dental implant placement. Histomorphometric analysis was performed, and the results were correlated with the individual RBH. Implants were loaded after 5 months of insertion, and 1-year implant success and marginal bone level change were assessed. RESULTS RBH was 2.17 ± 1.11 mm (range 0.5-3.5 mm) and 2.14 ± 0.72 mm (range 0.5-3.0 mm) in the NBS and DBBM group, respectively. The biopsy analyses for the DBBM group showed woven bone increases by 5.08% per 1-mm increment of RBH; medullary spaces decreased by 9.02%, osteoid decreased by 4.4%, residual biomaterial decreased by 0.34%, and lamellar bone increased by 5.68% per 1-mm increase of RBH. In the NBS group, samples showed woven bone increases by 8.08% per 1-mm increase of RBH; medullary spaces decreased by 0.38%; osteoid increased by 1.34%, residual biomaterial decreased by 0.58%, and lamellar bone decreased by 5.50% per 1-mm increase of RBH. There was no statistically significant difference in the correlation between RBH and lamellar bone, woven bone, and osteoid, independently of the material used. Implant success was 100% in both groups, and marginal bone loss was 1.02 ± 0.42 mm in DBBM and 0.95 ± 0.31 mm in the NBS group after the 1-year follow-up. CONCLUSION In spite of the absence of significance, the observed trend for woven bone to increase and medullary spaces to decrease when RBH increases deserves attention. Residual bone dimension might be a determinant in the bone graft maturation after maxillary sinus augmentation.
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Affiliation(s)
- Silvio Taschieri
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20123 Milan, Italy; (S.T.); (S.C.); (T.T.); (C.D.); (E.C.); (L.F.); (G.T.)
- Dental Clinic, IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy
- Department of Oral Surgery, Institute of Dentistry, I. M. Sechenov First Moscow State Medical University, 119146 Moscow, Russia
| | - Moses Ofer
- Department of Periodontology & Dental Implantology, School of Dental Medicine, University of Tel Aviv, 6997801 Tel Aviv-Yafo, Israel; (M.O.); (C.N.)
| | - Stefano Corbella
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20123 Milan, Italy; (S.T.); (S.C.); (T.T.); (C.D.); (E.C.); (L.F.); (G.T.)
- Dental Clinic, IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy
- Department of Oral Surgery, Institute of Dentistry, I. M. Sechenov First Moscow State Medical University, 119146 Moscow, Russia
| | - Tiziano Testori
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20123 Milan, Italy; (S.T.); (S.C.); (T.T.); (C.D.); (E.C.); (L.F.); (G.T.)
- Dental Clinic, IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy
- Department of Periodontics and Oral Medicine, The University of Michigan, School of Dentistry, Ann Arbor, MI 48109, USA
| | - Claudia Dellavia
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20123 Milan, Italy; (S.T.); (S.C.); (T.T.); (C.D.); (E.C.); (L.F.); (G.T.)
| | - Carlos Nemcovsky
- Department of Periodontology & Dental Implantology, School of Dental Medicine, University of Tel Aviv, 6997801 Tel Aviv-Yafo, Israel; (M.O.); (C.N.)
| | - Elena Canciani
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20123 Milan, Italy; (S.T.); (S.C.); (T.T.); (C.D.); (E.C.); (L.F.); (G.T.)
| | - Luca Francetti
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20123 Milan, Italy; (S.T.); (S.C.); (T.T.); (C.D.); (E.C.); (L.F.); (G.T.)
- Dental Clinic, IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20123 Milan, Italy; (S.T.); (S.C.); (T.T.); (C.D.); (E.C.); (L.F.); (G.T.)
- Dental Clinic, IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy
| | - Gianluca Tartaglia
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20123 Milan, Italy; (S.T.); (S.C.); (T.T.); (C.D.); (E.C.); (L.F.); (G.T.)
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Beck F, Reich KM, Lettner S, Heimel P, Tangl S, Redl H, Ulm C. The vertical course of bone regeneration in maxillary sinus floor augmentations: A histomorphometric analysis of human biopsies. J Periodontol 2020; 92:263-272. [PMID: 32715479 PMCID: PMC7984041 DOI: 10.1002/jper.19-0656] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 04/09/2020] [Accepted: 04/26/2020] [Indexed: 11/07/2022]
Abstract
Background Maxillary sinus floor augmentation (MSFA) is a well‐established and predictable augmentation method in severely resorbed maxillae. However, data on the vertical course of bone graft consolidation within the maxillary sinus are rare. The aim of the present study was to quantify the vertical distribution of new bone formation (nBF) in MSFA and to characterize the vertical gradient of bone graft consolidation. Methods Eighty‐five human sinus biopsies were harvested 6 ± 1 months after MSFA. Histological thin‐ground sections were prepared and histomorphometrically analyzed. The volume of newly formed bone (nBV/TV) was measured in serial zones of 100 μm proceeding from the bottom of the sinus floor (SF) up to the apical top of the biopsy. The gradient of nBV/TV within the augmentation area was determined by the vertical distribution of nBV/TV along these zones. Results In the premolar region, nBV/TV slightly declined from 20.4% in the zone adjacent to the SF to 17.7% at a distance of 8 mm. The gradient was steeper in the molar region: nBV/TV decreased from 18.7% to 12.8%. This decline was even more distinct when the volume fraction and the height of the residual bone of the SF were low. Conclusions nBF follows a gradient from native bone of the SF towards the apical part of the augmentation area. The distance to primordial bone thus plays a critical role for bone regeneration in MSFA, particularly in the molar region.
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Affiliation(s)
- Florian Beck
- Division of Oral SurgeryUniversity Clinic of Dentistry, Medical University of ViennaViennaAustria
| | - Karoline Maria Reich
- Karl Donath Laboratory for Hard Tissue and Biomaterial ResearchDivision of Oral SurgeryUniversity Clinic of Dentistry, Medical University of ViennaViennaAustria
- Austrian Cluster for Tissue RegenerationViennaAustria
| | - Stefan Lettner
- Karl Donath Laboratory for Hard Tissue and Biomaterial ResearchDivision of Oral SurgeryUniversity Clinic of Dentistry, Medical University of ViennaViennaAustria
- Austrian Cluster for Tissue RegenerationViennaAustria
| | - Patrick Heimel
- Karl Donath Laboratory for Hard Tissue and Biomaterial ResearchDivision of Oral SurgeryUniversity Clinic of Dentistry, Medical University of ViennaViennaAustria
- Austrian Cluster for Tissue RegenerationViennaAustria
| | - Stefan Tangl
- Karl Donath Laboratory for Hard Tissue and Biomaterial ResearchDivision of Oral SurgeryUniversity Clinic of Dentistry, Medical University of ViennaViennaAustria
- Austrian Cluster for Tissue RegenerationViennaAustria
| | - Heinz Redl
- Austrian Cluster for Tissue RegenerationViennaAustria
- Ludwig Boltzmann Institute for Experimental and Clinical TraumatologyAUVA Research CentreViennaAustria
| | - Christian Ulm
- Division of Oral SurgeryUniversity Clinic of Dentistry, Medical University of ViennaViennaAustria
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Whitt J, Al-Sabbagh M, Dawson D, Shehata E, Housley-Smith M, Tezanos A, Kutkut A. Efficacy of stem cell allograft in maxillary sinus bone regeneration: a randomized controlled clinical and blinded histomorphometric study. Int J Implant Dent 2020; 6:25. [PMID: 32596764 PMCID: PMC7321846 DOI: 10.1186/s40729-020-00222-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/24/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose This study aimed to evaluate the quality and quantity of newly generated bone in the maxillary sinus grafted with stem cell-based allograft material. Methods This study was a single site, prospective, blinded, randomized, and controlled clinical trial. Eleven subjects with 18 edentulous posterior maxillary sites requiring sinus augmentation for delayed implant placement using a lateral window approach were enrolled. At the time of sinus augmentation, test sinus was grafted with stem cell-based allograft (Osteocel Plus; NuVasive Therapeutics), while the control sinus was grafted with conventional cortico-cancellous allograft (alloOss; ACE Surgical). Cone beam computer tomography (CBCT) scan was taken before and 14 weeks post-sinus augmentation procedure, i.e., 2 weeks before implant placement. Thirty-six trephined core bone biopsies were harvested from the anterior and posterior grafted lateral-window osteotomy sites at the time of implant placement. Results The results showed a statistically significant difference in the vital bone percentage between the test and the control groups at the posterior grafted sites (p = 0.03). There was no significant difference in the percentage of vital bone between the anterior and posterior grafted sites within the test and control groups (p > .05). The CBCT analysis showed that the maxillary sinuses at the posterior grafted sites were statistically wider than those at the anterior grafted sites in both groups (p < .05). Conclusions Different allograft bone materials can be used in the maxillary sinus augmentation procedures. Stem cell allograft has more osteogenic potential with a better outcome in the wide posterior sinus.
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Affiliation(s)
- Josh Whitt
- University of Kentucky College of Dentistry, Lexington, KY, USA
| | - Mohanad Al-Sabbagh
- Division of Periodontology, University of Kentucky College of Dentistry, Lexington, KY, USA
| | - Dolphus Dawson
- University of Kentucky College of Dentistry, Lexington, KY, USA
| | - Ehab Shehata
- Division of Oral and Maxillofacial Surgery, University of Kentucky College of Dentistry, Lexington, KY, USA
| | - Moly Housley-Smith
- Division of Oral and Maxillofacial Surgery, University of Kentucky College of Dentistry, Lexington, KY, USA
| | - Alejandro Tezanos
- Department of Statistics, University of Kentucky College of Dentistry, Lexington, KY, USA
| | - Ahmad Kutkut
- Division of Prosthodontics, University of Kentucky College of Dentistry, 800 Rose St. D646, Lexington, KY, 40536, USA.
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Kuo PY, Lin CY, Chang CC, Wang YM, Pan WL. Grafted bone remodeling following transcrestal sinus floor elevation: A cone-beam computed tomography study. Biomed J 2020; 44:627-635. [PMID: 34740571 PMCID: PMC8640548 DOI: 10.1016/j.bj.2020.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 01/09/2023] Open
Abstract
Background Transcrestal sinus floor elevation is a reliable procedure when additional bone height is needed for maxillary implant placement. However, the grafted bone undergoes remodeling and the dimensional stability of grafted bone height may be affected by several clinical factors, including graft material, sinus anatomy and the morphology of grafted space. Methods This retrospective study examined patients who had undergone transcrestal sinus floor elevation with synthetic biphasic calcium phosphate and single implant placement. The reduction of sinus graft height (GHR) after 6–8 months healing period was measured with cone-beam computed tomography (CBCT) images. Correlating factors, including vertical amount of implant protrusion (IP), sinus width, and the morphology of grafted space were analyzed by Spearman's correlation test. Results A total of 25 implant sites were analyzed. The mean GHR was 0.57 ± 0.49 mm, which was positively correlated with IP, vertical elevation height (VEH), and the ratio of vertical to horizontal elevation of the grafted space. However, GHR was not correlated with sinus width and mesial-distal or buccal-palatal width of the grafted space. Conclusions Synthetic biphasic calcium phosphate used in transcrestal sinus floor elevation underwent shrinkages and graft remodeling. Grafted height reduction was associated with IP, VEH, and the ratio of vertical to horizontal elevation of the grafted space.
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Affiliation(s)
- Pe-Yi Kuo
- Department of Periodontics, Chang Gung Memorial Hospital at Taipei, Taipei, Taiwan
| | - Cho-Ying Lin
- Department of Periodontics, Chang Gung Memorial Hospital at Taipei, Taipei, Taiwan
| | - Chi-Ching Chang
- Department of Periodontics, Chang Gung Memorial Hospital at Taipei, Taipei, Taiwan
| | - Yuan-Min Wang
- Department of Periodontics, Chang Gung Memorial Hospital at Taipei, Taipei, Taiwan
| | - Whei-Lin Pan
- Department of Periodontics, Chang Gung Memorial Hospital at Taipei, Taipei, Taiwan; Graduate Institute of Dental and Craniofacial Science, Chang Gung University, Taoyuan, Taiwan; Department of Nutrition, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.
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Galindo-Moreno P, Padial-Molina M, Lopez-Chaichio L, Gutiérrez-Garrido L, Martín-Morales N, O'Valle F. Algae-derived hydroxyapatite behavior as bone biomaterial in comparison with anorganic bovine bone: A split-mouth clinical, radiological, and histologic randomized study in humans. Clin Oral Implants Res 2020; 31:536-548. [PMID: 32072685 DOI: 10.1111/clr.13590] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 12/13/2019] [Accepted: 02/10/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To analyze a modified biphasic phycogenic biomaterial in comparison with anorganic bovine bone in maxillary sinus floor elevation in humans. MATERIAL AND METHODS Eight male patients in need of bilateral two-stage sinus floor elevation were consecutively recruited for this randomized split-mouth study. A combination of autogenous cortical bone (ACB, 20%) and anorganic bovine bone (ABB, 80%) (ACB + ABB group) or ACB (20%) and modified biphasic phycogenic material (BP, 80%) (ACB + BP group) were randomly assigned to graft each sinus. Patients were followed up for 6 months post-surgery when bone samples were collected for analysis. RESULTS Radiographically, bone height gain was statistically higher in the ACB + ABB versus the ACB + BP group. While the analysis of the biological compartments showed differences in non-mineralized tissue (39.15 ± 20.97% vs. 65.87 ± 28.59%, ACB + ABB vs. ACB + BP respectively; p = .018) and remnant biomaterial particles (22.62 ± 17.01% vs. 7.96 ± 8.57%, respectively; p = .028), the percentage of mineralized tissue (38.23 ± 17.55% vs. 24.14 ± 24.66%, respectively; p = .398) showed no statistically significant difference. In contrast, ACB + ABB biopsies showed higher Musashi-1-positive cells per mm2 compared to ACB + BP biopsies (811.49 ± 875.30 vs. 236.90 ± 280.81; p < .018), where the fusiform cells corresponded mainly with fibroblasts, as demonstrated by ultrastructural analysis. CONCLUSION Both combinations of materials exhibited bone formation after 6 months of healing in the maxillary sinus cavity. However, the combination with biphasic phycogenic biomaterial induced a higher radiographical vertical resorption and graft collapse in comparison with the combination with anorganic bovine bone, possibly due to a higher remodeling of the graft.
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Affiliation(s)
- Pablo Galindo-Moreno
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Miguel Padial-Molina
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Lucia Lopez-Chaichio
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Lourdes Gutiérrez-Garrido
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Natividad Martín-Morales
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain.,Department of Pathology and IBIMER, School of Medicine, University of Granada, Granada, Spain
| | - Francisco O'Valle
- Department of Pathology and IBIMER, School of Medicine, University of Granada, Granada, Spain.,Instituto Biosanitario de Granada (ibs.GRANADA), University of Granada, Granada, Spain
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Yaghobee S, Panjnoush M, Chokami Rafiei S, Amini Shakib P, Mahmoodi S, Rasouli-Ghahroudi AAR, Poursafar F. Effect of Simvastatin on Bone Regeneration: A Histologic and Histomorphometric Analysis. J Oral Maxillofac Surg 2020; 78:927-934. [PMID: 32084353 DOI: 10.1016/j.joms.2020.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE The purpose of the present study was to evaluate the efficacy of simvastatin administration as an osteoinductive agent combined with bovine bone material (BBM) for augmentation of human maxillary sinuses. MATERIALS AND METHODS In the present randomized clinical trial with a split-mouth design, 24 maxillary sinuses in 12 patients were augmented using BBM alone or BBM combined with simvastatin. Biopsy samples were taken 9 months after maxillary sinus floor augmentation for histologic and histomorphometric analyses. A total of 44 implants were placed in the augmented bone. RESULTS The results of the microscopic assessment of most samples revealed no inflammation or only mild chronic inflammation. Lamellation was detectable in old bone trabeculae under polarized light microscopy but was not observed in newly formed bone. Osteocytes were found with a lower frequency in the lacunae of newly formed bone compared with normal bone. No significant differences were found in the amount of newly formed bone and the amount of residual particles between the 2 groups. CONCLUSIONS Despite the greater mean percentage of newly formed bone in the test group, the histomorphometric analysis results did not show a significant positive effect for the use of simvastatin in maxillary sinus augmentation.
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Affiliation(s)
- Siamak Yaghobee
- Associate Professor, Department of Periodontology, Dental Implant Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Panjnoush
- Associate Professor, Department of Oral and Maxillofacial Radiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Chokami Rafiei
- Assistant Professor, Department of Periodontology, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Pouyan Amini Shakib
- Assistant Professor, Department of Oral Pathology, Tehran University of Medical Sciences, Tehran, Iran
| | - Sanaz Mahmoodi
- PhD in Pharmaceutics, Private Practitioner, Tehran, Iran
| | - Amir Ali Reza Rasouli-Ghahroudi
- Associate Professor, Department of Periodontology, Dental Implant Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Poursafar
- Resident, Department of Periodontology, Tehran University of Medical Sciences, Tehran, Iran.
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Starch-Jensen T, Deluiz D, Duch K, Tinoco EMB. Maxillary Sinus Floor Augmentation With or Without Barrier Membrane Coverage of the Lateral Window: a Systematic Review and Meta-Analysis. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2019; 10:e1. [PMID: 32158525 PMCID: PMC7012617 DOI: 10.5037/jomr.2019.10401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/23/2019] [Indexed: 01/17/2023]
Abstract
Objectives Test the hypothesis of no difference in implant treatment outcomes after maxillary sinus floor augmentation with or without barrier membrane coverage of the lateral window. Material and Methods A MEDLINE (PubMed), Embase and Cochrane library search in combination with a hand-search of relevant journals was conducted. Human studies published in English until the 5th of July, 2019 were included. Randomised controlled trials and controlled trials with an observation period of minimum six months were included. Primary outcomes included survival of suprastructures and implants. Secondary outcomes included implant stability quotient, peri-implant marginal bone loss, bone regeneration, patient-reported outcome measures, biologic and mechanical complications. Results The electronic search and hand-searching resulted in 1068 entries. Six randomised controlled trials characterised by low to high risk of bias and one controlled trial with high risk of bias fulfilled the inclusion criteria. High implant survival rate was reported with both treatment modalities. Meta-analyses disclosed a mean difference of newly formed bone of 6.4% (confidence interval = 0 to 12.9) and non-mineralised tissue of -1.1% (confidence interval = -2.7 to 0.5), indicating more newly formed bone and diminished non-mineralised with barrier membrane coverage. Conclusions There seem to be no statistically significant differences in implant treatment outcomes after maxillary sinus floor augmentation with or without barrier membrane coverage of the lateral window. However, barrier membrane coverage increases percentage of newly formed bone and diminishes proliferation of non-mineralised tissue. Thus, barrier membrane coverage seems to be beneficial and also preventing displacement of the grafting material.
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Affiliation(s)
- Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, AalborgDenmark
| | - Daniel Deluiz
- Department of Periodontology, Rio de Janeiro State University, Rio de JaneiroBrazil
| | - Kirsten Duch
- Unit of Clinical Biostatistics, Aalborg University Hospital, AalborgDenmark
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Barbu HM, Iancu SA, Jarjour Mirea I, Mignogna MD, Samet N, Calvo-Guirado JL. Management of Schneiderian Membrane Perforations during Sinus Augmentation Procedures: A Preliminary Comparison of Two Different Approaches. J Clin Med 2019; 8:jcm8091491. [PMID: 31546766 PMCID: PMC6780245 DOI: 10.3390/jcm8091491] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 09/09/2019] [Accepted: 09/12/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The aim of this study was to retrospectively analyze two different sealing techniques for sinus membrane perforations produced during sinus floor augmentation by a lateral approach. METHODS A total of 172 lateral-approach sinus floor augmentation surgeries were performed on 130 patients. Sixty-one membrane perforations (35%) were reported. Most of the perforations were caused by accidental membrane tearing and 16 (26%) were caused by deliberate incision for mucocele removal. In 31 perforation cases (51%), the Schneiderian membrane was sealed by suturing, while the remaining 30 cases (49%) were sealed using a low-resorption collagen membrane coverage. RESULTS Out of the 31 cases treated with a suture-sealing techniques, 26 (84%) were successful, presenting graft integration. Failure occurred in the other five (16%) cases. Out of the 30 perforations sealed with low-resorption collagen membranes, 28 (93%) presented successful graft integration, while two (7%) failed. CONCLUSIONS Both surgical techniques yielded therapeutic success.
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Affiliation(s)
- Horia Mihail Barbu
- Oral Implantology Department, Titu Maiorescu University, 031593 Bucharest, Romania.
| | | | | | - Michele Davide Mignogna
- Head & Neck Clinical Section, Department of Neuroscience, Reproductive and Odontostomatological Sciences, Federico II University of Naples, 80138 Naples, Italy.
| | - Nachum Samet
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, MA 02115, USA.
| | - José Luis Calvo-Guirado
- Department of Oral and Implant Surgery, Universidad Católica of Murcia, 30107 Murcia, Spain.
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Alayan J, Ivanovski S. Biological and technical outcomes of restored implants after maxillary sinus augmentation-Results at 1-year loading. Clin Oral Implants Res 2019; 30:849-860. [PMID: 31148293 DOI: 10.1111/clr.13489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 05/13/2019] [Accepted: 05/22/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report biological and technical outcomes of implant-supported restorations placed into previously maxillary sinus floor augmentation using the lateral wall approach (MSA) using anorganic bovine bone mineral (ABBM) + autogenous bone (AB) (control group) or collagen-stabilized ABBM (test group). MATERIALS AND METHODS Single implant was placed 6 months after MSA in 27 control and 26 test patients. Fixed restorations were delivered 12 weeks later and reviewed 12 months after function. Outcomes measured included implant survival, marginal bone levels (DIB), peri-implant parameters, and incidence of biological and technical complications. RESULTS Seven patients (three control, four test group) did not return for their 1-year review. No significant inter-group differences were noted for all parameters. At baseline (3 months after implant placement), a mean(SD) marginal bone loss of 0.66 mm (0.40) and 0.77 mm (0.48) from the implant shoulder was recorded in the control and test group, respectively. After 12 months of loading, a mean (SD) additional marginal bone loss of 0.32 mm (0.24) and 0.35 mm (0.23) was noted in the control and test group, respectively. Peri-implant mucositis (≥1 site BOP) was diagnosed in 62.9% of control and 69.23% of test patients. No peri-implantitis was diagnosed. Screw retention and single crowns predominated. Technical complications mostly comprised of ceramic veneer chipping and were noted in 7.4% of control and 11.54% of test patients. CONCLUSION Based on a short observation period, implant reconstruction of the partially edentulous posterior maxilla after MSA using ABBM + AB or collagen-stabilized ABBM led stable marginal bone levels, high prevalence of peri-implant mucositis, and low rates of technical complications.
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Affiliation(s)
- Jamil Alayan
- School of Dentistry and Oral Health, Centre for Medicine and Oral Health, Griffith University, Southport, Queensland, Australia
| | - Saso Ivanovski
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
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Evaluation of three-dimensional contraction of the volume of grafts after staged augmentation of the sinus floor, and an analysis of influential factors. Br J Oral Maxillofac Surg 2019; 57:323-329. [PMID: 30940406 DOI: 10.1016/j.bjoms.2019.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 03/07/2019] [Indexed: 11/21/2022]
Abstract
Our aim was to evaluate the volume by which grafts contract after augmentation of the sinuses by three-dimensional analysis on cone-beam computed tomographs (CT), and to investigate the factors that influence the outcomes. The sinus floor was augmented with deproteinised bovine bone mineral in 58 patients with 123 edentulous sites related to 67 sinuses. The outcomes of augmentation were analysed by both linear and volumetric measurements on cone-beam CT images taken immediately after operation and six months later. Mathematical models were established to investigate the influence of anatomical characteristics of the sinuses and patient-related factors on contraction of the volume of the grafts. The mean reduction in the height of the grafts on site-based analysis was 17.8% after six months, and the contraction in volume on sinus-based analysis was 22.7 %. Of the edentulous sites 20/123 (16%) could not have implants 10 mm long inserted at the second stage operation because of insufficient bony height. Linear regression indicated that the type of edentulism (single or multiple teeth lost) was significantly associated with contraction in the volume of the grafts (p=0.006). Mixed model regression showed that the reduction in the height of the grafts was significantly influenced by the width of the sinus floor and the angle between the lateral and the medial wall of sinus (p=0.001, p=0.000). The reduction in height of the grafts and contraction in volume on linear and volumetric measurements six months after augmentation were roughly 18% and 22%, respectively. A wide sinus, large lateromedial angle, and loss of multiple teeth under the same sinus strongly predict that large amount of grafts will resorb. The anatomy of the sinus and patients' characteristics should be taken into consideration before treatment.
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Olaechea A, Mendoza-Azpur G, O Valle F, Padial-Molina M, Martin-Morales N, Galindo-Moreno P. Biphasic hydroxyapatite and ß-tricalcium phosphate biomaterial behavior in a case series of maxillary sinus augmentation in humans. Clin Oral Implants Res 2019; 30:336-343. [PMID: 30809862 DOI: 10.1111/clr.13419] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 01/28/2019] [Accepted: 02/12/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate and compare the morphometric components and the histological properties of pristine bone and bone grafted with a biphasic ß-tricalcium phosphate in humans using the maxillary sinus model. Reparative mesenchymal stem cells in the pristine bone and graft were also evaluated. MATERIALS AND METHODS For this prospective case series, sinus augmentation was performed using a biphasic ß-tricalcium phosphate. After 6 months of healing, a core of remnant native alveolar bone and grafted bone was collected with a trephine. Histological, histomorphometrical, and immunohistochemical techniques were performed. Radiological analysis through cone beam computerized tomography was also conducted. RESULTS A total of 10 patients were enrolled in this study. Radiologically, patients showed an average increase of crestal bone of 8.03 ± 1.72 mm. Morphologically, the grafted area was composed by 34.93 ± 14.68% of new mineralized tissue, 9.82 ± 11.42% of remnant biomaterial particles, and 55.23 ± 11.03% non-mineralized tissue. Histologically, we found no differences in the number of osteocytes per mm2 (p = 0.674), osteoblasts (p = 0.893), and blood vessels (p = 0.894) in the grafted area compared to the pristine bone. Differences were found on the number of osteoclasts (15.57 ± 27.50 vs. 5.37 ± 16.12, p = 0.027). The number of Musashi-1 positive mesenchymal cells (239.61 ± 177.4 vs. 42.11 ± 52.82, p = 0.027) was also significantly higher in the grafted area than in the pristine bone. CONCLUSION Biphasic ß-tricalcium phosphate is a suitable biomaterial to be used in the formation of new bone in sinus floor elevation procedures in humans, not only from the histomorphometrical point of view, but also regarding the cellular and vascular quality of the regenerated bone.
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Affiliation(s)
- Allinson Olaechea
- Department of Periodontics, School of Dentistry, Universidad Científica del Sur, Lima, Peru
| | - Gerardo Mendoza-Azpur
- Department of Periodontics, School of Dentistry, Universidad Científica del Sur, Lima, Peru
| | - Francisco O Valle
- Department of Pathology and IBIMER, School of Medicine, University of Granada, Granada, Spain.,Instituto Biosanitario de Granada (ibs.GRANADA), Universidad de Granada, Granada, Spain
| | - Miguel Padial-Molina
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Natividad Martin-Morales
- Department of Pathology and IBIMER, School of Medicine, University of Granada, Granada, Spain.,Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Pablo Galindo-Moreno
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
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Flichy-Fernández AJ, Blaya-Tárraga JA, O'Valle F, Padial-Molina M, Peñarrocha-Diago M, Galindo-Moreno P. Sinus floor elevation using particulate PLGA-coated biphasic calcium phosphate bone graft substitutes: A prospective histological and radiological study. Clin Implant Dent Relat Res 2019; 21:895-902. [PMID: 30895713 DOI: 10.1111/cid.12741] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 10/03/2018] [Accepted: 10/23/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Poly (lactic-co-glycolic acid) (PLGA) is widely used for the development of delivery systems for drugs and therapeutic biomolecules in tissue engineering applications. Particles of biphasic calcium phosphate can be covered by PLGA to change their manipulating characteristics. PURPOSE Aim of this study was to investigate the radiological and histomorphometric results of the use of PLGA-coated biphasic calcium phosphate granules in sinus floor elevation and to analyze the underlying molecular processes by immunohistochemical staining. MATERIALS AND METHODS A randomized clinical study was designed to include patients in need of sinus floor elevation. Patients were assigned to receive either PLGA-coated biphasic calcium phosphate particles (group I) or the equivalent but noncoated particles (group II). Cone beam computed tomography (CBCT) scans were performed before and 6 months after the procedure to assess the bone height gain. At the time of implant placement, bone core biopsies were obtained at the site of implant placement. Histological sections were subjected to histomorphometric and immunohistochemical evaluation of differentiation markers (Musashi-1 [MSI1]). RESULTS No statistically significant differences were observed between groups for the radiologic parameters. No differences were observed histologically or histomorphometrically. However, PLGA-coated particles (group I) were more colonized by MSI1-positive osteoblast precursors (P = 0.0001, chi-squared test) and were penetrated by more CD34-positive vascular structures (P = 0.001, chi-squared test) than noncoated particles (group II). CONCLUSIONS PLGA-coated particles are associated with more MSI11-positive cells and more extensive microvascularization than noncoated particles.
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Affiliation(s)
- Antonio J Flichy-Fernández
- Department of Oral Surgery and Implantology, Valencia University Medical and Dental School, Valencia, Spain
| | - Juan A Blaya-Tárraga
- Department of Oral Surgery and Implantology, Valencia University Medical and Dental School, Valencia, Spain
| | - Francisco O'Valle
- Department of Pathology, School of Medicine & Biopathology and Medicine Regenerative Institute (IBIMER, CIBM), University of Granada, Granada, Spain
| | - Miguel Padial-Molina
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Miguel Peñarrocha-Diago
- Department of Oral Surgery and Implantology, Valencia University Medical and Dental School, Valencia, Spain
| | - Pablo Galindo-Moreno
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
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Pignaton TB, Wenzel A, Ferreira CEDA, Borges Martinelli C, Oliveira GJPL, Marcantonio E, Spin-Neto R. Influence of residual bone height and sinus width on the outcome of maxillary sinus bone augmentation using anorganic bovine bone. Clin Oral Implants Res 2019; 30:315-323. [PMID: 30803035 DOI: 10.1111/clr.13417] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 12/20/2018] [Accepted: 02/15/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the influence of the posterior residual bone height and sinus width on the outcome of maxillary sinus bone augmentation using anorganic bovine bone. MATERIAL AND METHODS Bilateral sinus bone augmentation was performed using anorganic bovine bone in 20 patients with residual bone height <2 mm in at least one site on each side. Trephine samples were removed at the implant insertion site 8 months after the grafting procedure, and histological and histomorphometric analyses were performed to examine the relative amount (%) of new bone, anorganic bovine bone, and soft tissue in the grafted area. Based on cone beam computed tomography evaluation, the sites of implant insertion were classified according to sinus width into narrow, average, and wide, and according to residual bone height into ≤2 and >2 mm. RESULTS A total of 146 implants were installed and 103 biopsies were evaluated. New bone formation in sites classified as narrow (69 sites), average (19 sites), and wide (15 sites) was 28.5% ± 9.24, 28.9% ± 8.61, and 30.3% ± 7.80, respectively. The mean posterior maxillary residual bone height was 4.0 ± 2.43 mm, and 26 and 77 sites were classified as ≤2 and >2 mm, respectively. New bone formation was 26.2% ± 9.10 and 29.8% ± 8.67 for residual bone height ≤2 and >2 mm, respectively. The differences were non-significant. CONCLUSIONS Within the limitations of the present study, posterior residual bone height and sinus width were not factors with influence on new bone formation in sinuses grafted exclusively with anorganic bovine bone after 8 months of healing.
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Affiliation(s)
- Túlio Bonna Pignaton
- Department of Periodontology, UNESP - Univ. Estadual Paulista, Araraquara Dental School, Araraquara, Brazil.,Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Ann Wenzel
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | | | | | - Guilherme J P L Oliveira
- Department of Periodontology, UNESP - Univ. Estadual Paulista, Araraquara Dental School, Araraquara, Brazil
| | - Elcio Marcantonio
- Department of Periodontology, UNESP - Univ. Estadual Paulista, Araraquara Dental School, Araraquara, Brazil
| | - Rubens Spin-Neto
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
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Fresh Frozen Allogeneic Bone Block in Maxillary Sinus Floor Elevation: Histomorphometric Analysis of a Bone Specimen Retrieved 15 Years after Grafting Procedure. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9061119] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nowadays implant-prosthetic rehabilitations are one of the best solutions for rehabilitating our patients. These allow obtaining rehabilitations with optimal functional and aesthetic performances. Often patients, who undergo implant-prosthetic therapy, have the conditions of edentulias, single or multiple, that have been going on for some time. This, according to the literature, produces resorption of the alveolar bone, a process that is complicated in the posterior area of the upper arch by a pneumatization of the maxillary sinuses. The loss of vertical height, so that the implant fixtures can be inserted, requires a maneuver called maxillary sinus floor elevation. This procedure, now safely performed with piezoelectric instruments, allows increasing bone height through bone grafting. In this study, the tissue obtained from a patient, after 15 years from the intervention, was evaluated by histological and SEM analyses. The bone healing in the patient has led to a perfect integration between the patient’s bone and the fresh frozen allograft used, however still present and detectable after 15 years.
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Younes F, Cosyn J, De Bruyckere T, Cleymaet R, Eghbali A. A 2-year prospective case series on volumetric changes, PROMs, and clinical outcomes following sinus floor elevation using deproteinized bovine bone mineral as filling material. Clin Implant Dent Relat Res 2019; 21:301-309. [PMID: 30740863 DOI: 10.1111/cid.12730] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/12/2019] [Accepted: 01/16/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND A sinus floor augmentation may be indicated when a lack of hard tissue impedes implant placement. Although clinically successful, evidence supporting the long-term three-dimensional stability of the grafted volume is scarce. Second, evidence on the patient's acceptance of this type of treatment is limited. PURPOSE First is to evaluate the changes in graft volume after lateral wall sinus lifting based on superimposed cone beam computed tomography (CBCT) images and then to assess patient-reported outcome measures (PROMs) and clinical outcomes. MATERIALS AND METHODS Partially edentulous patients in need of a sinus lift and fixed reconstruction on at least two neighboring implants were selected for a prospective case series. Lateral wall sinus augmentation was performed using deproteinized bovine bone mineral (DBBM) as the only filling material. Volumetric changes were quantified on the basis of a preoperative CBCT and three postoperative CBCTs (at 2 weeks, 3 months, and 2 years). PROMs and clinical parameters were registered. RESULTS Twenty-two patients (7 males, 15 females; mean age 59 years) participated of which three patients dropped out during the follow up. Graft volumes amounted to 1418.26 mm3 at 2 weeks, 1201.21 mm3 at 3 months, and 1130.13 mm3 at 2 years postoperative pointing to a relative graft volume stability of 79.7%. Swelling was the leading symptom during the first week. A peak in visual analogue scale scores was observed for pain, swelling, and hematoma the day of surgery and 1 day postoperation with a statistically significant decline between days 3 and 7. Hemorrhage and nose bleeding occurred in 18.2% and 27.3% of the subjects, respectively. About 95.5% of the subjects would undergo the treatment again. All implants integrated successfully and demonstrated healthy clinical conditions. CONCLUSION Lateral wall sinus augmentation using DBBM as the only filling material is a viable treatment concept given limited graft resorption, good patients' tolerance, and clinical outcomes.
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Affiliation(s)
- Faris Younes
- Faculty of Medicine and Pharmacy, Oral Health Research Group (ORHE), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Jan Cosyn
- Faculty of Medicine and Pharmacy, Oral Health Research Group (ORHE), Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Faculty of Medicine and Health Sciences, Department of Periodontology and Oral Implantology, Dental School, Ghent University, Ghent, Belgium
| | - Thomas De Bruyckere
- Faculty of Medicine and Pharmacy, Oral Health Research Group (ORHE), Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Faculty of Medicine and Health Sciences, Department of Periodontology and Oral Implantology, Dental School, Ghent University, Ghent, Belgium
| | - Robbert Cleymaet
- Faculty of Medicine and Pharmacy, Oral Health Research Group (ORHE), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Aryan Eghbali
- Faculty of Medicine and Pharmacy, Oral Health Research Group (ORHE), Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Faculty of Medicine and Health Sciences, Department of Periodontology and Oral Implantology, Dental School, Ghent University, Ghent, Belgium
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Mendoza-Azpur G, Olaechea A, Padial-Molina M, Gutiérrez-Garrido L, O'Valle F, Mesa F, Galindo-Moreno P. Composite Alloplastic Biomaterial vs. Autologous Platelet-Rich Fibrin in Ridge Preservation. J Clin Med 2019; 8:E223. [PMID: 30744095 PMCID: PMC6406621 DOI: 10.3390/jcm8020223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/05/2019] [Accepted: 02/08/2019] [Indexed: 01/17/2023] Open
Abstract
AIM The aim of this study was to examine the clinical and histological differences of using a combination of alloplastic beta triphasic calcium phosphate (β-TCP) and a cross-linked collagen membrane versus autologous platelet-rich fibrin (PRF-L) in ridge preservation after dental extraction. MATERIAL AND METHODS Fifty-one patients were included in this observational case-series study. Dental extractions were performed, after which 25 patients were grafted with β-TCP and 26 with PRF-L. After four months of healing, clinical, radiological, histomorphometric and histological evaluations were performed. RESULTS A significantly higher percentage of mineralized tissue was observed in samples from the PRF-L grafted areas. Cellularity was higher in PRF-L grafted areas (osteocytes in newly formed bone per mm² = 123.25 (5.12) vs. 84.02 (26.53) for PRF-L and β-TCP, respectively, p = 0.01). However, sockets grafted with PRF-L showed a higher reduction in the bucco-lingual dimension after four months of healing (2.19 (0.80) vs. 1.16 (0.55) mm, p < 0.001), as well as a higher alteration in the final position of the mid muco-gingival junction (1.73 (1.34) vs. 0.88 (0.88) mm, p < 0.01). CONCLUSION PRF-L concentrate accelerates wound healing in post-extraction sockets in terms of new mineralized tissue component. However, the use of β-TCP biomaterial appears to be superior to maintain bucco-lingual volume and the final position of the muco-gingival junction.
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Affiliation(s)
- Gerardo Mendoza-Azpur
- Department of Periodontology, School of Dentistry, Cientifica del Sur University, 15067 Lima, Peru.
| | - Allinson Olaechea
- Department of Periodontology, School of Dentistry, Cientifica del Sur University, 15067 Lima, Peru.
| | - Miguel Padial-Molina
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, 18071 Granada, Spain.
| | - Lourdes Gutiérrez-Garrido
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, 18071 Granada, Spain.
| | - Francisco O'Valle
- Department of Pathology & Institute of Biopathology and Regenerative Medicine (IBIMER, CIBM), University of Granada, 18071 Granada, Spain.
| | - Francisco Mesa
- Department of Periodontology, School of Dentistry, University of Granada, 18071 Granada, Spain.
| | - Pablo Galindo-Moreno
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, 18071 Granada, Spain.
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Bertl K, Mick RB, Heimel P, Gahleitner A, Stavropoulos A, Ulm C. Variation in bucco-palatal maxillary sinus width does not permit a meaningful sinus classification. Clin Oral Implants Res 2018; 29:1220-1229. [PMID: 30430654 DOI: 10.1111/clr.13387] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 10/21/2018] [Accepted: 10/30/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The bucco-palatal sinus width (SW) appears as relevant factor for graft consolidation after maxillary sinus (MS) floor augmentation. The present study aimed to assess (a) SW at different height levels of posterior teeth, (b) possible factors influencing SW, and (c) whether a simple/meaningful sinus classification based on SW is possible. METHODS The following parameters were recorded on computed tomographies of 76 edentulous and 86 partially edentulous maxillary quadrants displaying 383 tooth sites in total: (a) alveolar ridge height, (b) -area, (c) -width 2 mm apical to the alveolar crest, (d) -width at the sinus floor, and (e) SW and sinus area at a level 2, 4, 6, 8, and 10 mm above the sinus floor. The possible influence of gender, tooth position [i.e., premolar (PM); molar (M)], tooth-gap extent, and residual alveolar ridge dimensions on SW was assessed. Further, based on percentiles of average values or on the frequency distribution of SW <10, 10-15, or >15 mm, it was attempted to classify the sinus at each given site into narrow, average, or wide. RESULTS Gender and tooth-gap extent presented no relevant impact on MS dimensions; however, significant differences were observed among the various tooth positions regarding all evaluated parameters. The lower the residual alveolar ridge, the wider the MS at 4-10 mm height, while the wider the residual alveolar ridge, the wider the MS. Large variation in SW classes among the different height levels within the same tooth position and among tooth positions within the same person was observed, irrespective of the threshold applied. Further, at a MS height of 10 mm at PM1, PM2, M1, and M2, SW was <10 mm in 68%, 33%, 0%, and 7% of the cases, respectively, while in 3%, 21%, 65%, and 57%, respectively, SW was >15 mm. CONCLUSIONS There is a large variation in SW depending on the height level within the sinus and on tooth position, which does not permit a simple/meaningful classification of each sinus as "narrow," "average," or "wide." Nevertheless, narrow sinuses (<10 mm) are rather prevalent in the premolar region, while wide sinuses (>15 mm) in the molar region; further, a wider and shorter residual alveolar ridge is associated with a wider SW.
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Affiliation(s)
- Kristina Bertl
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden.,Division of Oral Surgery, School of Dentistry, Medical University of Vienna, Vienna, Austria
| | - René-Bernard Mick
- Division of Oral Surgery, School of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Patrick Heimel
- Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Division of Oral Surgery, Medical University of Vienna, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Ludwig Boltzmann Institute for Clinical and Experimental Traumatology, Vienna, Austria
| | - André Gahleitner
- Department of Diagnostic Radiology, Division of Osteoradiology, General Hospital, Medical University of Vienna, Vienna, Austria
| | - Andreas Stavropoulos
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden
| | - Christian Ulm
- Division of Oral Surgery, School of Dentistry, Medical University of Vienna, Vienna, Austria
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Turco G, Porrelli D, Marsich E, Vecchies F, Lombardi T, Stacchi C, Di Lenarda R. Three-Dimensional Bone Substitutes for Oral and Maxillofacial Surgery: Biological and Structural Characterization. J Funct Biomater 2018; 9:jfb9040062. [PMID: 30413004 PMCID: PMC6306815 DOI: 10.3390/jfb9040062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/29/2018] [Accepted: 11/02/2018] [Indexed: 12/15/2022] Open
Abstract
Background: Bone substitutes, either from human (autografts and allografts) or animal (xenografts) sources, suffer from inherent drawbacks including limited availability or potential infectivity to name a few. In the last decade, synthetic biomaterials have emerged as a valid alternative for biomedical applications in the field of orthopedic and maxillofacial surgery. In particular, phosphate-based bone substitution materials have exhibited a high biocompatibility due to their chemical similitude with natural hydroxyapatite. Besides the nature of the biomaterial, its porous and interconnected architecture is essential for a correct osseointegration. This performance could be predicted with an extensive characterization of the biomaterial in vitro. Methods: In this study, we compared the biological, chemical, and structural features of four different commercially available bone substitutes derived from an animal or a synthetic source. To this end, µ-CT and SEM were used to describe the biomaterials structure. Both FTIR and EDS analyses were carried out to provide a chemical characterization. The results obtained by these techniques were correlated with cell adhesion and proliferation of the osteosarcoma MG-63 human cell line cultured in vitro. Results: The findings reported in this paper indicate a significant influence of both the nature and the structure of the biomaterials in cell adhesion and proliferation, which ultimately could affect the clinical performance of the biomaterials. Conclusions: The four commercially available bone substitutes investigated in this work significantly differed in terms of structural features, which ultimately influenced in vitro cell proliferation and may so affect the clinical performance of the biomaterials.
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Affiliation(s)
- Gianluca Turco
- Department of Medical Sciences, University of Trieste, Piazza dell'Ospitale 1, I-34125 Trieste, Italy.
| | - Davide Porrelli
- Department of Medical Sciences, University of Trieste, Piazza dell'Ospitale 1, I-34125 Trieste, Italy.
| | - Eleonora Marsich
- Department of Medical Sciences, University of Trieste, Piazza dell'Ospitale 1, I-34125 Trieste, Italy.
| | - Federica Vecchies
- Department of Medical Sciences, University of Trieste, Piazza dell'Ospitale 1, I-34125 Trieste, Italy.
| | - Teresa Lombardi
- Private Practice, Studio Odontoiatrico Hesire, I-87011 Cassano allo Ionio, Italy.
| | - Claudio Stacchi
- Department of Medical Sciences, University of Trieste, Piazza dell'Ospitale 1, I-34125 Trieste, Italy.
| | - Roberto Di Lenarda
- Department of Medical Sciences, University of Trieste, Piazza dell'Ospitale 1, I-34125 Trieste, Italy.
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Efficacy of Alveolar Ridge Preservation after Maxillary Molar Extraction in Reducing Crestal Bone Resorption and Sinus Pneumatization: A Multicenter Prospective Case-Control Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9352130. [PMID: 30519592 PMCID: PMC6241373 DOI: 10.1155/2018/9352130] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/23/2018] [Indexed: 12/28/2022]
Abstract
Aim To evaluate, with three-dimensional analysis, the effectiveness of alveolar ridge preservation (ARP) after maxillary molar extraction in reducing alveolar bone resorption and maxillary sinus pneumatization when compared to unassisted socket healing. Methods Patients were included in the study following inclusion criteria and underwent minimally traumatic maxillary molar extraction followed by ARP using synthetic nanohydroxyapatite (Fisiograft Bone, Ghimas, Italy) (test group) or unassisted socket healing (control group). Cone-beam computerized tomographies (CBCT) were performed immediately after tooth extraction (T0) and 6 months postoperatively (T1). CBCTs were superimposed by using a specific software (Amira, Thermo Fisher Scientific, USA) and the following items were analyzed in both groups: (i) postextractive maxillary sinus floor expansion in coronal direction and (ii) postextractive alveolar bone dimensional changes (both vertical and horizontal). All data were tested for normality and equality of variance and subsequently analyzed by independent samples T-test and Mann–Whitney test. Results Thirty patients were treated by three centers and twenty-six (test n=13; control n=13) were included in the final analysis. Mean sinus pneumatization at T1 was 0.69±0.48 mm in the test group and 1.04±0.67 mm in the control group (p=0.15). Mean vertical reduction of the alveolar bone at T1 was 1.62±0.49 mm in the test group and 2.01±0.84 mm in the control group (p=0.08). Mean horizontal resorption of crestal bone at T1 was 2.73±1.68 mm in test group and 3.63±2.24 mm in control group (p=0.24). Conclusions It could be suggested that ARP performed after maxillary molar extraction may reduce the entity of sinus pneumatization and alveolar bone resorption, compared to unassisted socket healing. This technique could decrease the necessity of advanced regenerative procedures prior to dental implant placement in posterior maxilla.
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Scarano A, de Oliveira PS, Traini T, Lorusso F. Sinus Membrane Elevation with Heterologous Cortical Lamina: A Randomized Study of a New Surgical Technique for Maxillary Sinus Floor Augmentation without Bone Graft. MATERIALS 2018; 11:ma11081457. [PMID: 30126102 PMCID: PMC6119994 DOI: 10.3390/ma11081457] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 08/08/2018] [Accepted: 08/14/2018] [Indexed: 12/13/2022]
Abstract
Background: The aim of this randomized controlled clinical trial was to compare the efficacy of two different techniques for maxillary sinus augmentation using a lateral window approach: Heterologous cortical lamina without any grafting material versus 100% collagenated granular collagen porcine bone. Methods: Twenty-three healthy patients with not relevant past medical history (14 women and 9 men, non-smokers, mean age 52 years, range 48–65 years) were included. In Group I, the sinus was filled with collagen porcine bone (Geno-os, OsteoBiol, Turin, Italy) and a collagen membrane (Evolution, OsteoBiol, Turin, Italy) was used to close the lateral window of the sinus. In Group II, the sinus was treated with heterologous cortical lamina only (Lamina, OsteoBiol, Turin, Italy). Results: There was a statistically significant difference in the surgical time required to complete the augmentation procedures: 18.3 ± 2.1 min for lamina treated sites versus 12.5 ± 3.1 min for porcine bone treated sites. In Group I, the mean volume of the graft was 3101 ± 321 mm3 in the immediate postoperative examination (5–7 days), while after a six-month healing period it was 2716.7 ± 432 mm3. Conclusion: This study demonstrates that the use of heterologous cortical lamina is a valid technique for the mechanical support of sinus membranes resulting in only bone tissue formation and not mixed with the graft. The graft material was biocompatible and not completely resorbed after six months, although the remains were integrated into the bone.
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Affiliation(s)
- Antonio Scarano
- Department of Medical, Oral and Biotechnological Sciences and CeSi-Met, 'G. D'Annunzio' University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy.
| | - Pablo Santos de Oliveira
- Department of Oral Implantology, Dental Research Division, College Ingà, UNINGÁ, Cachoeiro de Itapemirim, 29312 Espirito Santo, Brazil.
| | - Tonino Traini
- Department of Medical, Oral and Biotechnological Sciences and CeSi-Met, 'G. D'Annunzio' University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy.
| | - Felice Lorusso
- Department of Medical, Oral and Biotechnological Sciences University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy.
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Bertl K, Domic D, Hirtler L, Heimel P, Esfandeyari A, Stavropoulos A, Ulm C. Micro-CT evaluation of the cortical bone micro-architecture in the anterior and posterior maxilla and the maxillary sinus floor. Clin Oral Investig 2018; 23:1453-1459. [PMID: 30112634 DOI: 10.1007/s00784-018-2573-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 08/09/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To perform a within-subject comparison of the cortical bone micro-architecture of the maxillary sinus floor (MSF) to that of the buccal aspect of the anterior and posterior maxilla. METHODS Micro-CT scans of the buccal aspect of the anterior and posterior maxilla and of the MSF in 14 human anatomical specimens were recorded. Within-subject comparisons were performed for cortical thickness (Ct.Th) and porosity (Ct.Po), average pore volume (AvgPo.V), and pore density (Po.Dn). RESULTS The MSF presented the lowest and the anterior maxilla the highest Ct.Th, while Ct.Po was significantly higher at the MSF compared to the posterior maxilla (p = 0.021). No relevant differences were recorded for AvgPo.V and Po.Dn among regions (p > 0.067). Further, an increased Ct.Th at the MSF was significantly associated with a lower Po.Dn, while a higher Ct.Th and an increased AvgPo.V in the anterior maxilla were associated with a higher Ct.Th and an increased AvgPo.V, respectively, in the posterior maxilla and MSF. Finally, within each region, the AvgPo.V was associated positively with Ct.Po and negatively with Po.Dn. CONCLUSIONS The cortical bone of the MSF is slightly less thick and slightly more porous compared to the cortical bone at the buccal aspect of the anterior and posterior maxilla. CLINICAL RELEVANCE During lateral and vertical bone augmentation procedures, the cortical recipient bone is perforated several times to open the bone marrow compartment to facilitate provision of osteoinductive cells and molecules in the augmented space. Whether it is meaningful to approach the MSF in a similar way during MSF augmentation procedures or whether the slightly more porous structure of the MSF observed herein reduces the cortical barrier function already sufficiently has to be assessed in future clinical trials.
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Affiliation(s)
- Kristina Bertl
- Department of Periodontology, Faculty of Odontology, University of Malmö, Carl Gustafs väg 34, 20506, Malmö, Sweden
- Division of Oral Surgery, School of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Danijel Domic
- Division of Oral Surgery, School of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Lena Hirtler
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Patrick Heimel
- Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Division of Oral Surgery, Medical University of Vienna, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
- Ludwig Boltzmann Institute for Clinical and Experimental Traumatology, Vienna, Austria
| | - Azadeh Esfandeyari
- Division of Oral Surgery, School of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Andreas Stavropoulos
- Department of Periodontology, Faculty of Odontology, University of Malmö, Carl Gustafs väg 34, 20506, Malmö, Sweden.
| | - Christian Ulm
- Division of Oral Surgery, School of Dentistry, Medical University of Vienna, Vienna, Austria
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Dragonas P, Katsaros T, Avila-Ortiz G, Chambrone L, Schiavo JH, Palaiologou A. Effects of leukocyte-platelet-rich fibrin (L-PRF) in different intraoral bone grafting procedures: a systematic review. Int J Oral Maxillofac Surg 2018; 48:250-262. [PMID: 30058532 DOI: 10.1016/j.ijom.2018.06.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 04/26/2018] [Accepted: 06/07/2018] [Indexed: 12/11/2022]
Abstract
This systematic review aimed to assess the effects of leukocyte-platelet-rich fibrin (L-PRF) on bone regeneration, soft tissue healing, and postoperative complications in patients undergoing ridge preservation, ridge augmentation, and maxillary sinus augmentation procedures. A comprehensive literature search was conducted by two independent reviewers. Only randomized and non-randomized controlled clinical trials were selected. Outcome data were extracted and critically analyzed. A total of 17 articles were included in the qualitative synthesis. The use of L-PRF in extraction sockets was associated with a modest beneficial effect by decreasing alveolar ridge remodeling and postoperative pain when compared to natural healing. In contrast, the use of L-PRF in maxillary sinus augmentation procedures was not associated with more favorable outcomes, and its use in ridge augmentation procedures could not be assessed adequately as it was reported in only one study. No meta-analysis could be conducted due to the heterogeneity of the selected studies. The limited evidence on the effects of L-PRF in intraoral bone grafting procedures highlights the need for further research to fully assess its clinical indications, with an emphasis on the application of standardized protocols for the preparation of this autologous product.
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Affiliation(s)
- P Dragonas
- Department of Periodontics, School of Dentistry, Louisiana State University Health Sciences Center, New Orleans, USA.
| | - T Katsaros
- Department of Periodontics, College of Dentistry, University of Iowa, Iowa City, USA
| | - G Avila-Ortiz
- Department of Periodontics, College of Dentistry, University of Iowa, Iowa City, USA
| | - L Chambrone
- Department of Periodontics, College of Dentistry, University of Iowa, Iowa City, USA; Unit of Basic Oral Investigation (UIBO), School of Dentistry, El Bosque University, Bogota, Colombia; MSc Dentistry Program, Ibirapuera University, Sao Paulo, Brazil
| | - J H Schiavo
- Department of Libraries, Louisiana State University Health Sciences Center, New Orleans, USA
| | - A Palaiologou
- Department of Periodontics, School of Dentistry, Louisiana State University Health Sciences Center, New Orleans, USA
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50
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Niu L, Wang J, Yu H, Qiu L. New classification of maxillary sinus contours and its relation to sinus floor elevation surgery. Clin Implant Dent Relat Res 2018; 20:493-500. [PMID: 29691967 DOI: 10.1111/cid.12606] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/25/2018] [Accepted: 02/25/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND It is complicated to select an appropriate sinus floor elevation and the procedure for sinus floor elevation lacks of consensus. Sinus contour plays an important role in choosing a surgery approach. But there are still no published articles revealing the influence of sinus contours to sinus floor elevation surgery. PURPOSE We propose a new classification depending on sinus contours from cone-beam computed tomography (CBCT), analyze clinical characters of different types, and investigate the relationship between sinus contours and sinus floor elevation. MATERIALS AND METHODS We divide sinus into five categories: narrow tapered, tapering, ovoid, square, and irregular. For the first four types, subtypes are classified into three categories: without recess, with buccal-sinus-recess (BSR), and with palate-nasal-recess (PNR). For irregular type, subtypes are classified into three categories: tooth protruding into sinus floor, irregular floor, and septa/exostosis on sinus floor. Then the distribution features of sinuses of 698 patients are described. Sinus widths are measured at second premolar, first and second molar on both sides, and are compared among different types and subtypes. RESULTS Narrow tapered sinus occupies 88% at second premolar sites, while tapered sinus occupies almost 50% at first and second molar sites. At second premolar and first molar sites, 62% are without recess types. While 92% are without recess types at second molar. Sinuses with BSR present in only three of 3765 sites. There is an increasing trend of sinus width from narrow tapered to irregular type. Sinus width of the group with recesses is significantly higher than the one without recess. At the end, we provide corresponding treatment recommendations for each sinus types and subtypes. CONCLUSION This is the first classification system that gives treatment recommendations for sinus floor elevation surgery based on sinus contours. The classification system is consistent, easy to visualize, and practicable.
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Affiliation(s)
- Lixuan Niu
- The 4th Dental Division of School and Hospital of Stomatology, Peking University, Beijing, China
| | - Juan Wang
- The 4th Dental Division of School and Hospital of Stomatology, Peking University, Beijing, China
| | - Huajie Yu
- The 4th Dental Division of School and Hospital of Stomatology, Peking University, Beijing, China
| | - Lixin Qiu
- The 4th Dental Division of School and Hospital of Stomatology, Peking University, Beijing, China
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