scholarly journals Histological, radiological and clinical outcomes of sinus floor elevation using lateral approach pre-/post- extraction of the severe periodontally compromised maxillary molars: a split-mouth randomized clinical trial

2019 ◽  
Author(s):  
Zhaoguo Yue ◽  
Qi Liu ◽  
Haidong Zhang ◽  
Jingwen Yang ◽  
Yalin Zhan ◽  
...  
Keyword(s):  
Tooth Extraction ◽  
Alveolar Bone ◽  
Treatment Time ◽  
Test Group ◽  
Lateral Approach ◽  
Control Group ◽  
Sinus Floor Elevation ◽  
Posterior Maxilla ◽  
Sinus Floor Augmentation ◽  
Sinus Floor

Abstract Background Residual alveolar bone volume is a critical factor for the dental implants’ survival [1]. When the volume of alveolar bone in the posterior maxillary region is less than 4mm, the maxillary sinus floor elevation (MSFE) with lateral approach is an effective way to solve this problem [2]. Traditionally, this standard approach is usually delivered 4 months after the extraction of the tooth. However, the defective dentition due to the extraction would cause impaired masticatory function during the long period of the bone regeneration, especially when molars on both sides are severely periodontal compromised and need to be extracted. So, as periodontists, we start to wonder if we can maintain a compromised tooth so that we perform the sinus floor elevation before the extraction (the modified MSFE) to take fully advantage of residual strength of the teeth. Methods/Design The proposed study is designed as a prospective single-center, split-mouth design, randomized controlled trial. We plan to recruit 10 patients whose molars on both sides are severely periodontal compromised and in need of dental implant treatment in the atrophied posterior maxilla. The two sides of each patients will be divided into two groups randomly using Randomizer for Clinical Trials (Institute for Medical Informatics, Statistics and Documentation, Medical Univ. Graz). Test group: sinus floor augmentation before tooth extraction (the modified MSFE); Control group: sinus floor augmentation after tooth extraction (the standard MSFE). Implant survival rates, mucosal conditions around the implants, complications, treatment time and postoperative discomfort (visual analogue scale for intraoperative pain and postoperative pain/discomfort) will be recorded. The volume of the alveolar bone will be measured 6, 12, 18, and 24 months after the MSFE surgery by means of CBCT. Histological and histomorphometic analysis will be performed on biopsies retrieved from both side of grafting sites. Discussion The current study will explore the effectiveness of the modified MSFE on minimizing the discomfort period caused by defected dentition. To determine whether the modified MSFE will promote the grafting outcomes, the quality and the quantity of the osteogenesis on the sinus floor will also be compared. Depending on the result of the current study, we will determine all the protocols and details about the modified MSFE, including indications, detailed methods, post-operational complications and managements.

scholarly journals Histological, radiological, and clinical outcomes of sinus floor elevation using a lateral approach for pre-/post-extraction of the severely compromised maxillary molars: a study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Zhaoguo Yue ◽  
Qi Liu ◽  
Haidong Zhang ◽  
Jingwen Yang ◽  
Jianxia Hou
Keyword(s):  
Clinical Outcomes ◽  
Alveolar Bone ◽  
Survival Rates ◽  
Lateral Approach ◽  
Control Group ◽  
Study Cohort ◽  
Implant Survival ◽  
Sinus Floor Elevation ◽  
Patient Reported ◽  
Sinus Floor

Abstract Background The volume of residual alveolar bone is critical to the survival of dental implants. When the volume of alveolar bone in the posterior maxillary region is less than 4 mm, maxillary sinus floor elevation (MSFE) with the lateral approach is an effective option. Traditionally, this standard approach is usually conducted at 4–6 months after tooth extraction (standard MSFE). However, defective dentition due to extraction can impair mastication during the period of bone remodeling, especially if the molars on both sides are severely compromised and must be extracted. MSFE before extraction (modified MSFE) can take full advantage of residual tooth strength. However, the effectiveness and practicability of the modified MSFE procedure remain unknown. Therefore, the aim of this study was to compare the clinical outcomes of modified vs. standard MSFE, in order to provide references to periodontists. Methods/design The study cohort included 25 adult patients (50 surgery sites) recruited from Peking University Hospital and School of Stomatology who met the inclusion criteria. The two sides of each patient will be randomly divided into two groups: a test group-modified MSFE or a control group-standard MSFE. The surgical duration and patient-reported outcomes (visual analog scale for discomfort) will be documented. Clinical indicators, including implant survival rates, mucosal conditions, and complications, will be recorded every 6 months during the 5-year follow-up period. The volume of the alveolar bone and marginal bone level will be assessed radiographically (cone-beam CT and periapical films) every 6 months. Histological analysis of biopsy samples retrieved from both sides will be performed to evaluate the biological features of the bone. Discussion The current study will explore the implant survival rates, safety, reliability, effectiveness, and practicability of the modified MSFE procedure. Moreover, the extent of osteogenesis on the sinus floor will also be assessed. The results of this trial will provide strategies for the modified MSFE procedure to achieve ideal clinical outcomes. Trial registration International Clinical Trials Registry Platform ChiCTR1900020648. Registered on 1 January 2019

scholarly journals Assessment of the Simultaneous Use of Biomaterials in Transalveolar Sinus Floor Elevation: Prospective Randomized Clinical Trial in Humans

2020 ◽  
Vol 17 (6) ◽  
pp. 1888 ◽  
Author(s):  
Adrián Maximiano Millán ◽  
Rocío Bravo Álvarez ◽  
Miguel Plana Montori ◽  
María Guerrero González ◽  
David Saura García-Martín ◽  
...  
Keyword(s):  
Test Group ◽  
Control Group ◽  
Simultaneous Application ◽  
Sinus Floor Elevation ◽  
Implant Placement ◽  
Randomized Clinical Study ◽  
Additional Surgery ◽  
Posterior Maxilla ◽  
Sinus Floor ◽  
Bone Gain

Implants inserted in the posterior maxilla frequently need additional surgery for successful bone augmentation. One of the most common procedures for this is transalveolar sinus floor elevation. There are different protocols for this procedure, and there is controversy over the simultaneous application of grafting material upon elevating. In this prospective randomized clinical study in humans, a total of 49 transalveolar sinus floor elevations were performed in 49 different patients, divided into a control group (without graft, 25 patients) and a test group (with graft, 24 patients). The analyzed variables were obtained through digital orthopantomography on day 0 (day of surgery) and 18 months after surgery. These measurements showed a tendency towards greater vertical bone gain in the test group, but this was not statistically significant. Therefore, considering that sinus elevation and implant placement without the application of grafts is a successful treatment with fewer complications, a critical assessment of the need for these biomaterials is necessary.

scholarly journals Two-Year Follow-Up of 4-mm-Long Implants Used as Distal Support of Full-Arch FDPs Compared to 10-mm Implants Installed after Sinus Floor Elevation. A Randomized Clinical Trial

2021 ◽  
Vol 18 (7) ◽  
pp. 3846
Author(s):  
Fabio Rossi ◽  
Lorenzo Tuci ◽  
Lorenzo Ferraioli ◽  
Emanuele Ricci ◽  
Andreea Suerica ◽  
...  
Keyword(s):  
Test Group ◽  
Sinus Floor Elevation ◽  
Relevant Difference ◽  
Short Implants ◽  
Patient Reported ◽  
Bone Level ◽  
Sinus Floor Augmentation ◽  
Sinus Floor ◽  
Distal Support ◽  
Augmentation Procedure

Background: In edentulous patients, bone resorption cannot allow the installation of standard implants and it is demanded to use short implants in the residual alveolar bone or longer implants in grafted bone. Aim: To compare the survival and bone level changes of standard plus short 4-mm implants used as distal support of a maxillary full-arch fixed dental prostheses (FDPs) with standard (10-mm) implants placed in association with a bilateral sinus floor augmentation procedure. Material and Methods: Full-arch FDPs supported by six implants were randomly placed in both groups. In the control group, all implants were 10 mm long and 4.1 mm in diameter. The distal implant in both sides of the maxilla was installed after 4 months from bilaterally sinus floor elevation. In the test group (short group), the distal implant in both sides of the maxilla was 4 mm long and 4.1 mm in diameter. No sinus floor elevations were performed in the test group. Clinical assessments and X-rays were taken at prosthesis delivering and after 6, 12, 18, and 24 months. Patient-reported outcome measures (PROMs) were also evaluated before surgery and after 6, 12, and 24 months. Results: The changes over time of the bone level for the short implants were −0.01 ± 0.11 mm, −0.04 ± 0.13 mm, −0.17 ± 0.29 mm, and −0.28 ± 0.37 mm after 6, 12, 18, and 24 months from prosthesis delivering, respectively. For the standard implants, bone changes were −0.21 ± 0.33 mm (p = 0.103), −0.30 ± 0.32 mm (p = 0.023), −0.40 ± 0.37 mm (p = 0.144), and −0.54 ± 0.49 mm (p = 0.128), respectively. A statistically relevant difference was found only at 12 months after loading between the two groups. Conclusions: Similar results on implant survival rate and marginal bone loss were observed for the short and standard implants, placed in association with a bilateral sinus floor augmentation procedure, used as distal support of a maxillary full-arch FDP. A statistically relevant difference was found only at 12 months after loading between the two groups (p = 0.023).

scholarly journals The Human Amniotic Mesenchymal Stem Cells (hAMSCs) Improve the Implant Osseointegration and Bone Regeneration in Maxillary Sinus Floor Elevation in Rabbits

2019 ◽  
Vol 2019 ◽  
pp. 1-10
Author(s):  
Lu Yin ◽  
Zhi-xuan Zhou ◽  
Ming Shen ◽  
Ning Chen ◽  
Fei Jiang ◽  
...  
Keyword(s):  
Bone Regeneration ◽  
Maxillary Sinus ◽  
Bone Volume ◽  
Control Group ◽  
Sinus Floor Elevation ◽  
Dental Implantation ◽  
Posterior Maxilla ◽  
Maxillary Sinus Floor ◽  
Sinus Floor ◽  
Maxillary Sinus Floor Elevation

Insufficient bone height in the posterior maxilla is a challenging problem in dental implantation. Bio-Oss, though routinely used in maxillary sinus floor elevation (MSFE), is not osteoinductive. Human amniotic mesenchymal cells (hAMSCs) isolated from placental tissues have potential for multidifferentiation and immunomodulatory properties and can be easily obtained without the need for invasive procedures and without ethical concerns. This is the first study to use hAMSCs to improve implant osseointegration and bone regeneration after MSFE. Human AMSCs were loaded into a fibrin gel and injected into rabbit MSFE models. The rabbits were assigned to four groups (n=3 per group), i.e., the control group, the hAMSC group, the Bio-Oss group, and the hAMSC/Bio-Oss group. The animals were sacrificed at postsurgery for four and twelve weeks and evaluated by histology and immunohistochemistry. Bone volume, bone volume/tissue volume, bone-to-implant contact ratio, and vessel-like structures in the hAMSC/Bio-Oss group were significantly better than those in other groups in the peri-implant and augmented areas. Immunofluorescence staining showed that alkaline phosphatase (ALP) activities of two hAMSC groups were higher than those of the other two groups. Sequential fluorescent labeling was performed in all of the 12-week groups. Observations showed that hAMSCs accelerated mineralized deposition rates on implant surfaces and in bone-augmented areas. These data demonstrated that hAMSCs could enhance implant osseointegration and bone regeneration after MSFE and might be used to optimize dental implantation in the future.

scholarly journals Schneider Membrane Elevation in Presence of Sinus Septa: Anatomic Features and Surgical Management

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Mario Beretta ◽  
Marco Cicciù ◽  
Ennio Bramanti ◽  
Carlo Maiorana
Keyword(s):  
Maxillary Sinus ◽  
Lateral Approach ◽  
Sinus Lift ◽  
Sinus Floor Elevation ◽  
Posterior Maxilla ◽  
Maxillary Sinus Floor ◽  
Sinus Floor ◽  
The Right ◽  
Maxillary Sinus Floor Elevation ◽  
Gothic Arch

Maxillary sinus floor elevation via a lateral approach is a predictable technique to increase bone volume of the edentulous posterior maxilla and consequently for dental implants placement. The sinus floor is elevated and it can be augmented with either autologous or xenogeneic bone grafts following an opening bone window created on the facial buccal wall. Maxillary septa are walls of cortical bone within the maxillary sinus. The septa shape has been described as an inverted gothic arch arising from the inferior or lateral walls of the sinus and may even divide the sinus into two or more cavities. Some authors have reported a higher prevalence of septa in atrophic edentulous areas than in nonatrophic ones. Radiographic identification of these structures is important in order to perform the right design of the lateral window during sinus lift. Aim of this investigation is to highlight the correct steps for doing sinus lift surgery in presence of those anatomic variations. Clinicians should always perform clinical and radiographic diagnosis in order to avoid complications related to the sinus lift surgery.

Clinical, Histomorphometric and Radiographic Evaluation of Dental Extraction Sockets Treated with Autologous Stem Cells

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2398-2398
Author(s):  
André Pelegrini ◽  
Maria Elvira P Corrêa ◽  
Thiago Oliveira ◽  
Carmino De Souza ◽  
José Francisco Marques
Keyword(s):  
Stem Cells ◽  
Bone Marrow ◽  
Bone Loss ◽  
Dental Implants ◽  
Tooth Extraction ◽  
Alveolar Bone ◽  
Test Group ◽  
Autologous Bone Marrow ◽  
Control Group ◽  
Autologous Bone

Abstract Abstract 2398 Introduction: Autologous bone marrow has mesenchymals stem cells that can differentiate into osteoblasts. Therefore, the use of these cells in bone reconstruction therapy is becaming promising. Purpose: The first aim of this study was to evaluate the potential of autologous bone marrow graft aspirate containing mesenchymal stem cells in preserving the alveolar ridges following tooth extraction. A second aim was to clinically and radiographically evaluate the outcomes of dental implants installed in the healed sockets after one year in function. Methods: 13 healthy patients requiring upper anterior teeth extractions were enrolled in this study. They were randomized into two groups: Test group: 7 patients (n = 15 teeth); Control group: 6 patients (n = 15 teeth). 5 ml of autologous bone marrow from the iliac posterior crest were collected by haematologists immediately before the extractions and it was placed in alveolar sockets right after the teeth extractions in the test group. Nothing was grafted in the control sites. Following tooth extraction and evaluation of a buccal full-thickness flap, titanium screws were positioned throughout the buccal to the palatal plate and were used as reference points for measuring purposes. After 6 months, the sites were re-opened and bone loss measurements for thickness and height were taken. Additionally, prior to implant placement, bone cores were harvested and prepared for histologic and histomorphometric evaluation. Data of clinical probing and radiographic analysis were done in all sites after 1 year of follow up. Results: The test group had better results in preserving alveolar ridges for thickness showing 1.14+0.87mm of bone loss compared with the control group that showed 2.46+0.4mm (P<0.05). The test group showed also a less height of bone loss on the buccal plate, 0.62+0.51 and 1.17+0.26mm, respectively (P<0.05). Complimentary procedures were required before install the implants in five sites in the control group, but not, in the test group. The histomorphometric analysis showed similar amounts of mineralized bone in both control and test groups, 42.87+11.33% and 45.47+7.21% respectively (P>0,05). The results of 1 year clinical probing follow-up showed deeper probing depths around the control group dental implants when compared to the test group, 4.45+1.58mm and 3.78+1.58mm, respectively (P< 0,05). Radiographic analysis showed more marginal bone level loss in the control group when compared to test group, 3.44+3.39mm and 1.05+0.9mm, respectively (P<0,05). Conclusion: These findings suggest that the autologous bone marrow graft can contribute to alveolar bone repair after tooth extraction and can also minimize the dental implants attachment loss. This study indicate that the participation of mesenchymal stem cell in the alveolar bone healing should be better understanding to explain this process of repairement. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Staged Osteotome Sinus Floor Elevation for Progressive Site Development and Immediate Implant Placement in Severely Resorbed Alveolar Bone: A Case Report

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Saad Al-Almaie
Keyword(s):  
Case Report ◽  
Bone Grafting ◽  
Alveolar Bone ◽  
Lateral Approach ◽  
Sinus Floor Elevation ◽  
Site Development ◽  
Implant Placement ◽  
Initial Stability ◽  
Sinus Floor ◽  
Osteotome Sinus Floor Elevation

This case report discusses osteotome sinus floor elevation (OSFE) and immediate placement in 2 stages in severely resorbed alveolar bone height in which multiple implant placement is not otherwise feasible due to a lack of initial stability. The first implant placed using OSFE without bone grafting prepares the adjacent resorbed sites for further implant placement in the sinus areas, which allows for better initial stability and early functional loading. This process avoids the conventional extensive lateral approach for sinus lifting and bone grafting procedures even in extremely resorbed alveolar bone.

scholarly journals Histological and Histomorphometric Analyses after Sinus Floor Augmentation with Different Grafting Materials

2021 ◽  
Vol 1 (4) ◽  
Author(s):  
Luís Otávio Palhari
Keyword(s):  
Maxillary Sinus ◽  
Alveolar Bone ◽  
Bone Matrix ◽  
Microscopic Analysis ◽  
Invasive Technique ◽  
Osseointegrated Implants ◽  
Posterior Maxilla ◽  
Sinus Floor Augmentation ◽  
Sinus Floor ◽  
Grafting Materials

Homogeneous grafts from a bone bank, heterogeneous grafts and allow plastic grafts have already been studied and used for maxillary sinus elevation in order to reconstruct the bone for placement of dental implants. The present work aims to histologically assess bone neoformation from autogenous and heterogeneous (or xenogenous) bone grafts, in maxillary sinus lift surgery, an invasive technique. Six patients (total of 10 elevated maxillary sinuses) participated in the study with an alveolar bone remnant in the posterior region of the maxilla, less than 5mm, classification by Misch SA-4, evidenced through panoramic radiography. After a waiting period of tissue repair of 8 months, samples were collected and microscopic analysis was performed in 3 groups: autogenous group, Bio-Oss® group and Endobon® group. It was observed that the autogenous group has a statistically higher amount of bone matrix when compared to the other 2 groups. These did not differ from each other. The three types of grafts used promoted the expected new bone formation. Thus, one can choose any of the grafts evaluated to enable the installation of Osseointegrated implants and prosthetic rehabilitation in patients with the atrophic posterior maxilla.

scholarly journals A Minimally Invasive Technique for Short Spiral Implant Insertion with Contextual Crestal Sinus Lifting in the Atrophic Maxilla: A Preliminary Report

Healthcare ◽  
2020 ◽  
Vol 9 (1) ◽  
pp. 11
Author(s):  
Massimo Corsalini ◽  
Silvia D’Agostino ◽  
Gianfranco Favia ◽  
Marco Dolci ◽  
Angela Tempesta ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Alveolar Bone ◽  
Primary Stability ◽  
Invasive Technique ◽  
Sinus Floor Elevation ◽  
Posterior Maxilla ◽  
Atrophic Maxilla ◽  
Sinus Floor ◽  
Short Spiral ◽  
Heterologous Bone Graft

The most recently reported techniques for the rehabilitation of the atrophic posterior maxilla are increasingly less invasive, as they are generally oriented to avoid sinus floor elevation with lateral access. The authors describe a mini-invasive surgical technique for short spiral implant insertion for the prosthetic rehabilitation of the atrophic posterior maxilla, which could be considered a combination of several previously described techniques based on the under-preparation of the implant site to improve fixture primary stability and crestal approach to the sinus floor elevation without heterologous bone graft. Eighty short spiral implants were inserted in the molar area of the maxilla in patients with 4.5–6 mm of alveolar bone, measured on pre-operative computed tomography. The surgical technique involved careful drilling for the preparation of implant sites at differentiated depths, allowing bone dislocation in the apical direction, traumatic crestal sinus membrane elevation, and insertion of an implant (with spiral morphology) longer than pre-operative measurements. Prostheses were all single crowns. In all cases, a spiral implant 2–4 mm longer than the residual bone was placed. Only two implants were lost due to peri-implantitis but subsequently replaced and followed-up. Bone loss values around the implants after three months (at the re-opening) ranged from 0 to 0.6 mm, (median value: 0.1 mm), while after two years, the same values ranged from 0.4 to 1.3 mm (median value: 0.7 mm). Clinical post-operative complications did not occur. After ten years, no implant has been lost. Overall, the described protocol seems to show good results in terms of predictability and patient compliance.

3D Cone Beam Radiodensitometry in Evaluation of Hydroxyapatite (HAP)/Tissue Hybrid after Maxillary Sinus Floor Elevation

2011 ◽  
Vol 222 ◽  
pp. 251-254 ◽  
Author(s):  
Girts Salms ◽  
Ilze Salma ◽  
Andrejs Skagers ◽  
Janis Locs
Keyword(s):  
Maxillary Sinus ◽  
Dental Implant ◽  
Alveolar Bone ◽  
Cone Beam ◽  
Study Patient ◽  
Sinus Floor Elevation ◽  
Sinus Floor Augmentation ◽  
Maxillary Sinus Floor ◽  
Sinus Floor ◽  
Maxillary Sinus Floor Augmentation

Clinical and radiological outcomes of one and two stage maxillary sinus floor augmentation with HAP granules and dental implant insertion, degree of mineralization of residual bone and augmented sinus part were evaluated. 180 dental implant insertions in 84 patients in the age from 32-68 years were included in this study. Patient clinical and CBCT (Cone Beam Computer Tomography) were analyzed by quantitative radiodensitometry using HU (Hounsfield units) after 1 to 5 years after functional loading. Four implants were lost during osseointegration phase the 176 implants survived. We found 2.5 times denser synthetic HAP/bone area comparing with residual bone. With time there was a decrease in radiodensity in HAP augmented maxillary sinus area and an increase of radiodensity in the area of residual alveolar bone.

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