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Guo X, Huangphattarakul V, Gao J, Yi Z, Yang X, Man Y. Radiographic Outcomes of Transcrestal Sinus Floor Elevation With RBH ≤ 5 mm: Non-Perforation and Laterally Repaired Cases. Clin Implant Dent Relat Res 2025; 27:e70034. [PMID: 40197860 DOI: 10.1111/cid.70034] [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: 07/30/2024] [Revised: 03/11/2025] [Accepted: 03/26/2025] [Indexed: 04/10/2025]
Abstract
OBJECTIVE This study aimed to compare the clinical effects of implants placed in sites with a transcrestal sinus floor elevation (TSFE) featuring a residual bone height (RBH) of ≤ 5 mm, without Schneiderian membrane perforations, to those in sites where a lateral window approach was utilized to repair perforations that occurred during TSFE. METHODS A total of 104 implants in 80 patients (80 sinuses) with RBH ≤ 5 mm who had undergone TSFE with simultaneous implant placement were included in this retrospective study. The implants were categorized into two groups based on whether the Schneiderian membrane was perforated, and the lateral window technique for sinus floor elevation (LSFE) was utilized to repair perforations that occurred during the TSFE procedure. The early implant loss, endo-sinus bone gain (ESBG), and implant apical bone resorption (ABR) were used to assess new bone formation between the non-perforated and the perforated groups. RESULTS The non-perforation group consisted of 89 implants in 69 patients (69 sinuses), whereas the perforated group included 15 implants in 11 patients (11 sinuses). No early implant loss or postoperative complications were observed in either group during the first 6 months following implant installation. The ESBG was (5.83 ± 2.06) mm for the non-perforation group and (7.76 ± 1.63) mm for the perforation-repaired group (p < 0.001). A linear mixed model indicated that group (β = 2.41, 95% CI = 1.49, 3.33, p < 0.001) and RBH (β = -0.53, 95% CI = -0.80, -0.27, p < 0.001) significantly influenced ESBG. The ABR between the non-perforation and perforated group has no statistically significant difference (β = 0.84, 95% CI = -0.41, 2.08, p = 0.185). CONCLUSION Repairing Schneiderian membrane perforations that occur during TSFE in cases with RBH ≤ 5 mm, using the lateral window technique, leads to ideal internal radiographic bone augmentation volume maintenance in the maxillary sinus compared to cases without perforation; no significant difference in early implant loss was observed. TRIAL REGISTRATION Clinical Trial Registry: (ChiCTR2200062886).
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Affiliation(s)
- Xueqi Guo
- 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
- Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Vicha Huangphattarakul
- 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
| | - 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
| | - Zumu Yi
- 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
| | - 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
| | - 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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Naghavi HH, Amid R, Deporter D, Ketabi M. Impact of short implants numbers and prosthesis design on stress in the posterior mandible: FE analysis. Dent Res J (Isfahan) 2025; 22:12. [PMID: 40191791 PMCID: PMC11970899 DOI: 10.4103/drj.drj_531_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Revised: 12/22/2024] [Accepted: 01/04/2025] [Indexed: 04/09/2025] Open
Abstract
Background This study assessed the effect of the number of short implants on stress and strain distribution in bone in the posterior mandible using finite element analysis (FEA). Materials and Methods The study design utilized FEA, a computational technique. In FEA models, short implants (4 mm diameter and 6 mm length) were placed at the site of the mandibular first premolar to the second molar in four models: (I) two implants at the sites of teeth #4 and #7 with two pontics at the sites of teeth #5 and #6, (II) three implants at #4, #5, and #7 with one pontic at #6, (III) three implants at #4, #6, and #7 with one pontic at #5, and (IV) four implants at #4, #5, #6, and #7 with no pontic. A 100 N load was applied vertically and at a 30° angle to the occlusal surface of the crowns. Stress and strain distribution patterns in bone were evaluated using ANSYS Workbench. Results The highest maximum von Mises and shear stress and strain values under vertical and off-axial loadings were observed in the model with two short implants at the sites of teeth #4 and #7 with two pontics at the sites of teeth #5 and #6. In general, the highest stress and strain values were recorded following the application of off-axial loads compared to vertical loads. In all models, the highest stress was noted in the cervical part of the implants, while the maximum strain occurred in the apical part of the implants. Conclusion Increasing the number of short implants significantly reduces stress and strain values in peri-implant bone.
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Affiliation(s)
| | - Reza Amid
- Department of Periodontics, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Douglas Deporter
- Department of Periodontics, Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Mohammad Ketabi
- Department of Periodontics, Faculty of Dentistry, University of Toronto, Toronto, Canada
- Department of Periodontics, School of Dentistry, Islamic Azad University, Isfahan (khorasgan) Branch, Isfahan, Iran
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Lam L, Ivanovski S, Lee RSB. Alveolar ridge preservation in posterior maxillary teeth for reduction in the potential need for sinus floor elevation procedures: A pilot study. Clin Oral Implants Res 2024; 35:1568-1584. [PMID: 39165113 PMCID: PMC11629457 DOI: 10.1111/clr.14344] [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: 11/27/2023] [Revised: 05/30/2024] [Accepted: 07/29/2024] [Indexed: 08/22/2024]
Abstract
OBJECTIVES To investigate the effects of alveolar ridge preservation (ARP) on ridge height, sinus pneumatization and the potential need for lateral sinus augmentation following extraction in the posterior maxilla. MATERIALS AND METHODS This randomized controlled pilot study included 28 patients requiring extraction in the posterior maxilla with bone height between 6 and 8 mm. The sites were randomly allocated to either unassisted socket healing (Control), ARP with deproteinized bovine bone mineral (DBBM) (Test 1), or collagen-stabilized DBBM (Test 2) groups. Pre- and post-operative CTs at 4 months were taken to determine changes in ridge heights, sinus volume, and the need for sinus floor elevation (SFE) procedures for cases where the residual mid-ridge height was < 5 mm. Site-level analyses for changes in vertical ridge dimensions and sinus volume pre- and post-extraction/ARP were conducted using paired t-tests. Differences in mean changes in vertical ridge dimensions and sinus volume between the groups were determined using one-way ANOVA. RESULTS Significantly greater mean mid-ridge height reduction occurred in the control group (-2.7 ± 0.9 mm) compared to Test 1 (0.9 ± 3.7 mm) and Test 2 (1.0 ± 2.8 mm) groups (p < .05). No significant changes in mean mid-ridge height were found in either test groups. Volumetric analysis showed a significantly greater increase in sinus volume in the control group (0.7 ± 0.7 cm3) compared to Test 1 (n = 3, -0.7 ± 0.8 cm3) group (p = .03). 89% of patients in the control group would require lateral window SFE compared to Test 1 (42.8%) and Test 2 (40%) groups. CONCLUSION ARP was effective in attenuating height changes in the middle of the ridge and may reduce sinus pneumatization following extraction in the posterior maxilla. This could potentially decrease the need for more invasive sinus augmentation procedures.
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Affiliation(s)
- Lisetta Lam
- School of DentistryThe University of QueenslandBrisbaneQueenslandAustralia
| | - Saso Ivanovski
- School of DentistryThe University of QueenslandBrisbaneQueenslandAustralia
- Centre for Orofacial Regeneration, Rehabilitation and Reconstruction (COR3), School of DentistryThe University of QueenslandBrisbaneQueenslandAustralia
| | - Ryan S. B. Lee
- School of DentistryThe University of QueenslandBrisbaneQueenslandAustralia
- Centre for Orofacial Regeneration, Rehabilitation and Reconstruction (COR3), School of DentistryThe University of QueenslandBrisbaneQueenslandAustralia
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Vasiljevic M, Selakovic D, Rosic G, Stevanovic M, Milanovic J, Arnaut A, Milanovic P. Anatomical Factors of the Anterior and Posterior Maxilla Affecting Immediate Implant Placement Based on Cone Beam Computed Tomography Analysis: A Narrative Review. Diagnostics (Basel) 2024; 14:1697. [PMID: 39125573 PMCID: PMC11311595 DOI: 10.3390/diagnostics14151697] [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: 07/14/2024] [Revised: 08/01/2024] [Accepted: 08/03/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND The aim of this narrative review was to provide insights into the influence of the morphological characteristics of the anatomical structures of the upper jaw based on cone beam computed tomography (CBCT) analysis on the immediate implant placement in this region. MATERIAL AND METHODS To conduct this research, we used many electronic databases, and the resulting papers were chosen and analyzed. From the clinical point of view, the region of the anterior maxilla is specific and can be difficult for immediate implant placement. FINDINGS Anatomical structures in the anterior maxilla, such as the nasopalatine canal and accessory canals, may limit and influence the implant therapy outcome. In addition to the aforementioned region, immediate implant placement in the posterior maxilla may be challenging for clinicians, especially in prosthetic-driven immediate implant placement procedures. Data presented within the recently published materials summarize the investigations performed in order to achieve more reliable indicators that may make more accurate decisions for clinicians. CONCLUSION The possibility for immediate implant placement may be affected by the NPC shape in the anterior maxilla, while the presence of ACs may increase the incidence of immediate implant placement complications. The variations in IRS characteristics may be considered important criteria for choosing the implant properties required for successful immediate implant placement.
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Affiliation(s)
- Milica Vasiljevic
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Dragica Selakovic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Gvozden Rosic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Momir Stevanovic
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Jovana Milanovic
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Aleksandra Arnaut
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Pavle Milanovic
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
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Han Z, Wang C, Wei Y, Yang G, Hu W, Chung KH. Associations between the keratinized mucosa width and the underlying alveolar bone dimensions at partial edentulous molar sites: a retrospective cross-sectional study. BMC Oral Health 2024; 24:796. [PMID: 39010031 PMCID: PMC11251357 DOI: 10.1186/s12903-024-04590-2] [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: 02/20/2024] [Accepted: 07/08/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND The assessment of hard and soft tissue at edentulous sites is important for subsequent implant treatment design. The aim of the present study was to explore the associations between the keratinized mucosa width (KMW) and the underlying alveolar bone dimensions at partial edentulous molar sites. METHODS In this retrospective study, a total of 110 patients with at least one missing molar were selected. The buccal KMW of the edentulous molar sites was evaluated. Cone-beam computed tomography scans were collected, and the height discrepancy between the alveolar crest and the buccal bone plate (HC-B) as well as the alveolar bone height (ABH) were measured. The KMW was compared among the HC-B and ABH groups at both maxillary and mandibular sites. Linear regression and generalized estimation equations (GEEs) were used to explore the associations between the KMW and alveolar bone dimensions at α = 0.05. RESULTS Among the 110 patients, 158 edentulous molar sites were analyzed. The average HC-B and ABH were significantly lower at the maxillary sites (1.26 ± 1.62 mm, 11.62 ± 3.94 mm) than at the mandibular sites (3.67 ± 2.85 mm, 14.91 ± 3.01 mm, p < 0.001). The KMW was significantly lower at sites with HC-B > 2 mm than at sites with HC-B ≤ 2 mm both in the maxilla and mandible (p < 0.001). No significant differences were found between the KMW at sites with ABH < 10 mm and sites with ABH ≥ 10 mm (p > 0.05). Linear regression and GEEs analyses revealed that the HC-B was significantly associated with the KMW (B = -0.339, p < 0.001), while the association between the KMW and the ABH was not statistically significant (B = -0.046, p = 0.352). CONCLUSIONS The buccal KMW at edentulous molar sites was significantly associated with the HC-B. Alveolar ridges presenting with a sloped configuration were more prone to possess a narrower band of keratinized mucosa. Both hard and soft tissue augmentation should be considered for implant treatment at these sites. The correlations of dynamic changes between the KMW and alveolar bone dimensions after tooth extraction should be further investigated.
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Affiliation(s)
- Ziyao Han
- Department of Periodontology, National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Cui Wang
- Department of Periodontology, National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yiping Wei
- Department of Periodontology, National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Gang Yang
- Department of Periodontology, National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Wenjie Hu
- Department of Periodontology, National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China.
- NHC Research Center of Engineering and Technology for Computerized Dentistry, Beijing, China.
| | - Kwok-Hung Chung
- Department of Restorative Dentistry, University of Washington, Seattle, WA, USA
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Lin CH, Wang HL, Yu LW, Chou PY, Chang HC, Chang CH, Chang PC. Deep learning for the identification of ridge deficiency around dental implants. Clin Implant Dent Relat Res 2024; 26:376-384. [PMID: 38151900 DOI: 10.1111/cid.13301] [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: 08/17/2023] [Revised: 11/12/2023] [Accepted: 12/11/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVES This study aimed to use a deep learning (DL) approach for the automatic identification of the ridge deficiency around dental implants based on an image slice from cone-beam computerized tomography (CBCT). MATERIALS AND METHODS Single slices crossing the central long-axis of 630 mandibular and 845 maxillary virtually placed implants (4-5 mm diameter, 10 mm length) in 412 patients were used. The ridges were classified based on the intraoral bone-implant support and sinus floor location. The slices were either preprocessed by alveolar ridge homogenizing prior to DL (preprocessed) or left unpreprocessed. A convolutional neural network with ResNet-50 architecture was employed for DL. RESULTS The model achieved an accuracy of >98.5% on the unpreprocessed image slices and was found to be superior to the accuracy observed on the preprocessed slices. On the mandible, model accuracy was 98.91 ± 1.45%, and F1 score, a measure of a model's accuracy in binary classification tasks, was lowest (97.30%) on the ridge with a combined horizontal-vertical defect. On the maxilla, model accuracy was 98.82 ± 1.11%, and the ridge presenting an implant collar-sinus floor distance of 5-10 mm with a dehiscence defect had the lowest F1 score (95.86%). To achieve >90% model accuracy, ≥441 mandibular slices or ≥592 maxillary slices were required. CONCLUSIONS The ridge deficiency around dental implants can be identified using DL from CBCT image slices without the need for preprocessed homogenization. The model will be further strengthened by implementing more clinical expertise in dental implant treatment planning and incorporating multiple slices to classify 3-dimensional implant-ridge relationships.
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Affiliation(s)
- Cheng-Hung Lin
- Department of Electrical Engineering, College of Technology and Engineering, National Taiwan Normal University, Taipei, Taiwan
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Li-Wen Yu
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
- Division of Periodontics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Yung Chou
- Department of Electrical Engineering, College of Technology and Engineering, National Taiwan Normal University, Taipei, Taiwan
| | - Hao-Chieh Chang
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chin-Hao Chang
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Chun Chang
- Graduate Institute of Clinical Dentistry, School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan
- Division of Periodontics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Padhye NM, Shirsekar VU, Bhatavadekar NB. Cone Beam Computed Tomography Analysis of Posterior-Superior Alveolar Canal from a Fixed Reference Point: Implications for Sinus Floor Elevation Procedure through Lateral Approach. J Maxillofac Oral Surg 2023; 22:1110-1114. [PMID: 38105819 PMCID: PMC10719161 DOI: 10.1007/s12663-023-01894-8] [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: 04/13/2021] [Accepted: 03/02/2023] [Indexed: 12/19/2023] Open
Abstract
Objective Sinus floor elevation is commonly done in the maxillary posterior region prior to dental implant placement. This study primarily aimed at assessing the location of the posterior superior alveolar artery (PSAA) canal on cone beam computed tomography (CBCT) scans and its relation to the alveolar ridge and maxillary sinus from a fixed reference point. Material and Methods A total of 226 edentulous maxillary molar sites were included in this retrospective analysis. The distance from the PSAA to the sinus floor (SF), alveolar crest (AC) and a fixed reference point, that is, the roof of sinus (RS) were measured. The alveolar bone height (ABH), thickness of the crestal keratinized mucosa (CKM) and thickness of Schneiderian membrane (SM) were also evaluated. Results 54 sites (23.89%) were excluded from the study. The SF, AC, RS and ABH values averaged at 11.91 mm ± 3.63 mm, 16.05 mm ± 3.96 mm, 25.32 mm ± 7.13 mm and 4.93 mm ± 4.27 mm respectively. SF and AC was higher in second molar than first molar region (p < 0.001), but RS did not show significant difference (p = 0.85). CKM and SM averaged at 2.02 mm ± 0.68 mm and 1.31 mm ± 0.81 mm respectively. Conclusion The PSAA can be visualized in CBCT scans with a prevalence of 76.11% and may not be detected when adherent to the sinus membrane. This study stresses on the need for a CBCT, prior to sinus surgeries through lateral approach, to assess the PSAA.
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Affiliation(s)
- Ninad Milind Padhye
- Barts and the London School of Medicine & Dentistry, Queen Mary University of London, Turner Street, London, United Kingdom
| | | | - Neel B. Bhatavadekar
- Clarus Dental Specialties, Pune, Maharashtra India
- Adjunct Faculty, University of North Carolina at Chapel Hill, Chapel Hill, USA
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Buser D, Urban I, Monje A, Kunrath MF, Dahlin C. Guided bone regeneration in implant dentistry: Basic principle, progress over 35 years, and recent research activities. Periodontol 2000 2023; 93:9-25. [PMID: 38194351 DOI: 10.1111/prd.12539] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 01/10/2024]
Abstract
Bone augmentation procedures are frequent today in implant patients, since an implant should be circumferentially anchored in bone at completion of bone healing to have a good long-term stability. The best documented surgical technique to achieve this goal is guided bone regeneration (GBR) utilizing barrier membranes in combination with bone fillers. This clinical review paper reflects 35 years of development and progress with GBR. In the 1990s, GBR was developed by defining the indications for GBR, examining various barrier membranes, bone grafts, and bone substitutes. Complications were identified and reduced by modifications of the surgical technique. Today, the selection criteria for various surgical approaches are much better understood, in particular, in post-extraction implant placement. In the majority of patients, biodegradable collagen membranes are used, mainly for horizontal bone augmentation, whereas bioinert PTFE membranes are preferred for vertical ridge augmentation. The leading surgeons are using a composite graft with autogenous bone chips to accelerate bone formation, in combination with a low-substitution bone filer to better maintain the augmented bone volume over time. In addition, major efforts have been made since the millenium change to reduce surgical trauma and patient morbidity as much as possible. At the end, some open questions related to GBR are discussed.
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Affiliation(s)
- Daniel Buser
- School of Dental Medicine, University of Bern, Bern, Switzerland
- Centre for Implantology Buser and Frei, Bern, Switzerland
| | - Istvan Urban
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Alberto Monje
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Periodontology, UIC Barcelona, Barcelona, Spain
- Division of Periodontology, CICOM-Monje, Badajoz, Spain
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Marcel F Kunrath
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Dentistry, School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Christer Dahlin
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Oral, Maxillofacial Surgery and Research and Development, NU-Hospital Organisation, Trollhättan, Sweden
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Lyu M, Xu D, Zhang X, Yuan Q. Maxillary sinus floor augmentation: a review of current evidence on anatomical factors and a decision tree. Int J Oral Sci 2023; 15:41. [PMID: 37714889 PMCID: PMC10504247 DOI: 10.1038/s41368-023-00248-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/17/2023] Open
Abstract
Maxillary sinus floor augmentation using lateral window and crestal technique is considered as predictable methods to increase the residual bone height; however, this surgery is commonly complicated by Schneiderian membrane perforation, which is closely related to anatomical factors. This article aimed to assess anatomical factors on successful augmentation procedures. After review of the current evidence on sinus augmentation techniques, anatomical factors related to the stretching potential of Schneiderian membrane were assessed and a decision tree for the rational choice of surgical approaches was proposed. Schneiderian membrane perforation might occur when local tension exceeds its stretching potential, which is closely related to anatomical variations of the maxillary sinus. Choice of a surgical approach and clinical outcomes are influenced by the stretching potential of Schneiderian membrane. In addition to the residual bone height, clinicians should also consider the stretching potential affected by the membrane health condition, the contours of the maxillary sinus, and the presence of antral septa when evaluating the choice of surgical approaches and clinical outcomes.
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Affiliation(s)
- Mingyue Lyu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Dingyi Xu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiaohan Zhang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Quan Yuan
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Alhossan A, Chang YC, Wang TJ, Wang YB, Fiorellini JP. Reliability of Cone Beam Computed Tomography in Predicting Implant Treatment Outcomes in Edentulous Patients. Diagnostics (Basel) 2023; 13:2843. [PMID: 37685381 PMCID: PMC10486987 DOI: 10.3390/diagnostics13172843] [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: 07/07/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
Since the development of CBCT has been utilized in dentistry, the images of the CBCT can assist the surgeon to evaluate the anatomy carefully. Despite the value of radiology evaluation, implant procedures may require additional consideration rather than only evaluating the anatomical factors. The purpose of this study is to evaluate the predictability of using CBCT alone to plan for implant placement in edentulous patients digitally. CBCT images were analyzed by clinicians, measuring the maxillary and mandibular ridge heights and widths digitally of four predetermined implant sites in the maxillary and two selected implant sites in the mandibular arches of 91 patients planning for implant-supported overdenture. A total of 47 patients out of the 91 had completed implant placement on the edentulous ridge, contributing to 55 upper and/or lower arches (136 dental implants). Both predictabilities are low, implying that CBCT planning for implant placement on the edentulous ridge is not a good index and is insufficient to predict the surgical procedures as a solo method. The findings of this study indicate that digital planning by CBCT is insufficient to serve as an individual tool to predict implant procedures. Further information and evaluation must be considered for implant placement in the edentulous ridge.
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Affiliation(s)
- Abdulaziz Alhossan
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (T.-J.W.); (J.P.F.)
- Department of Periodontics and Community Dentistry, Dental College, King Saud University, P.O. Box 60169, Riyadh 11545, Saudi Arabia
| | - Yu-Cheng Chang
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (T.-J.W.); (J.P.F.)
| | - Tun-Jan Wang
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (T.-J.W.); (J.P.F.)
| | - Yu-Bo Wang
- School of Mathematical and Statistical Sciences, Clemson University, Clemson, SC 29634, USA;
| | - Joseph P. Fiorellini
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (T.-J.W.); (J.P.F.)
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11
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Díaz L, Fan S, Urrutia P, Uriarte X, Fodich I, Torres A, Sáenz-Ravello G. Correlation between periodontal phenotype and sinus membrane thickness: A systematic review. Clin Oral Implants Res 2023; 34:881-891. [PMID: 37427881 DOI: 10.1111/clr.14121] [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: 02/11/2023] [Revised: 06/11/2023] [Accepted: 06/14/2023] [Indexed: 07/11/2023]
Abstract
AIM To assess the correlation between the periodontal phenotype (PP) and sinus membrane thickness (SMT) in humans. METHODS This review was conducted according to the PRISMA guidelines. Two reviewers independently carried out electronic and manual literature searches of studies published in English, German, and Spanish, from 1970 to September 2022 in four electronic databases, PubMed/Medline, Scopus, Cochrane Library, and Web of Science, in addition to gray literature. Studies that assessed the correlation between PP and SMT in adults (aged 18 years) were included. Methodological quality was evaluated using the Appraisal Tool for Cross-Sectional Studies (AXIS) for articles that met the eligibility criteria. RESULTS Six studies, including 510 patients, were considered for qualitative analysis. All included studies were cross-sectional, and the correlation between the PP and SMT was evaluated, finding a positive and high correlation in 83.3% of them, based on a value of ≥0.7. All the included studies were assessed with a high overall risk of bias. CONCLUSIONS Periodontal phenotype and sinus membrane thickness are likely correlated. Nevertheless, further standardized studies are required to draw definitive conclusions.
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Affiliation(s)
- Leonardo Díaz
- Faculty of Dentistry, Postgraduate School, University of Chile, Santiago, Chile
- Department of Oral and Maxillofacial Surgery, University Medical Center of the Johannes-Gutenberg University, Mainz, Germany
- Perioplastic Institute, Santiago, Chile
| | - Shengchi Fan
- Department of Oral and Maxillofacial Surgery, University Medical Center of the Johannes-Gutenberg University, Mainz, Germany
| | - Pablo Urrutia
- Perioplastic Institute, Santiago, Chile
- Postgraduate Implant Dentistry Department, School of Dentistry, Universidad Andrés Bello, Santiago, Chile
| | | | - Ivo Fodich
- Postgraduate Implant Dentistry Department, School of Dentistry, Universidad Andrés Bello, Santiago, Chile
| | - Alfredo Torres
- Faculty of Dentistry, Postgraduate School, University of Chile, Santiago, Chile
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Gustavo Sáenz-Ravello
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
- Center for Surveillance and Epidemiology of Oral Diseases, Faculty of Dentistry, University of Chile, Santiago, Chile
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12
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Hwang IK, Kang SR, Yang S, Kim JM, Kim JE, Huh KH, Lee SS, Heo MS, Yi WJ, Kim TI. SinusC-Net for automatic classification of surgical plans for maxillary sinus augmentation using a 3D distance-guided network. Sci Rep 2023; 13:11653. [PMID: 37468515 DOI: 10.1038/s41598-023-38273-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/06/2023] [Indexed: 07/21/2023] Open
Abstract
The objective of this study was to automatically classify surgical plans for maxillary sinus floor augmentation in implant placement at the maxillary posterior edentulous region using a 3D distance-guided network on CBCT images. We applied a modified ABC classification method consisting of five surgical approaches for the deep learning model. The proposed deep learning model (SinusC-Net) consisted of two stages of detection and classification according to the modified classification method. In detection, five landmarks on CBCT images were automatically detected using a volumetric regression network; in classification, the CBCT images were automatically classified as to the five surgical approaches using a 3D distance-guided network. The mean MRE for landmark detection was 0.87 mm, and SDR for 2 mm or lower, 95.47%. The mean accuracy, sensitivity, specificity, and AUC for classification by the SinusC-Net were 0.97, 0.92, 0.98, and 0.95, respectively. The deep learning model using 3D distance-guidance demonstrated accurate detection of 3D anatomical landmarks, and automatic and accurate classification of surgical approaches for sinus floor augmentation in implant placement at the maxillary posterior edentulous region.
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Affiliation(s)
- In-Kyung Hwang
- Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, 03080, Republic of Korea
| | - Se-Ryong Kang
- Department of Biomedical Radiation Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, 08826, Republic of Korea
| | - Su Yang
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, 08826, Republic of Korea
| | - Jun-Min Kim
- Department of Electronics and Information Engineering, Hansung University, Seoul, 02876, Republic of Korea
| | - Jo-Eun Kim
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, 03080, Republic of Korea
| | - Kyung-Hoe Huh
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, 03080, Republic of Korea
| | - Sam-Sun Lee
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, 03080, Republic of Korea
| | - Min-Suk Heo
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, 03080, Republic of Korea
| | - Won-Jin Yi
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, 08826, Republic of Korea.
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, 03080, Republic of Korea.
| | - Tae-Il Kim
- Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, 03080, Republic of Korea.
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13
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Aldahlawi S, Nourah DM, Azab RY, Binyaseen JA, Alsehli EA, Zamzami HF, Bukhari OM. Cone-Beam Computed Tomography (CBCT)-Based Assessment of the Alveolar Bone Anatomy of the Maxillary and Mandibular Molars: Implication for Immediate Implant Placement. Cureus 2023; 15:e41608. [PMID: 37565092 PMCID: PMC10409627 DOI: 10.7759/cureus.41608] [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] [Accepted: 07/09/2023] [Indexed: 08/12/2023] Open
Abstract
Purpose This study aims to examine specific aspects of socket morphology, including buccal and palatal/lingual bone width, interradicular bone (IRB) width, and assessments of root apices and furcation proximity to the vital structures of the maxillary and mandibular first and second molars using cone-beam computed tomography (CBCT). Materials and methods The study involved the analysis of 400 maxillary and mandibular first and second molars. Various measurements were taken to assess socket morphology, including mesiodistal (MD) and buccolingual (BL) width, buccal and lingual bone thickness at 2 mm apical to the alveolar crest, IRB width at 2 mm from the furcation, and the distance between the root apices and furcation to vital structures, such as the floor of the maxillary sinus (FMS) and inferior alveolar nerve (IAN). Results The mesiobuccal (MB) root of the second molar commonly intruded into the sinus, followed by the palatal root of the maxillary first molar. The mean FMS-F distance was 7.17 + 3.98 mm, and it was 7.2 + 2.72 mm for maxillary first and second molars, respectively. The mean IRB width was 2.77 + 0.96 and 2.29 + 0.74 mm for the first and second molars. The mandibular second molar had the shortest distance to the IAN in comparison to the first molar. For maxillary teeth, 7% of the first and 4% of the second molars presented alveolar anatomy adequate for immediate implant placement, compared to 84% and 50% of mandibular first and second molars. Conclusion Understanding the local alveolar bone anatomy of molars and its relationship to vital structures is crucial for the effective planning of implant treatments.
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14
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Xue H, Wen J, Liu C, Shuai X, Zhang X, Kang N. Modified transcrestal sinus floor elevation with concomitant implant placement in edentulous posterior maxillae with residual bone height of 5 mm or less: a non-controlled prospective study. Int J Oral Maxillofac Surg 2023; 52:495-502. [PMID: 36058822 DOI: 10.1016/j.ijom.2022.08.014] [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: 10/27/2021] [Revised: 08/15/2022] [Accepted: 08/15/2022] [Indexed: 11/26/2022]
Abstract
The aim of this study was to describe a modified transcrestal sinus floor elevation (mTSFE) technique and to evaluate its clinical effectiveness and reliability when residual bone height is severely reduced. Forty-three maxillary edentulous patients who met the inclusion criteria were enrolled. All patients underwent the mTSFE technique; 66 dental implants were inserted simultaneously. Patient-reported outcomes were assessed 2 weeks after surgery. Prosthetic crowns were placed 6 months after surgery. Radiographic analyses and clinical analyses were conducted to assess the clinical effectiveness and feasibility of mTSFE during a follow-up period of 2-8 years. The mean vertical bone increase after surgery was 8.09 mm, and it decreased to 6.56 mm at 6 months after surgery. Two cases of membrane perforation occurred during surgery and one implant was lost in the third year after surgery; the survival rate at the implant level was 98.48%. No severe postoperative complication was reported and the subjective feeling of patients was acceptable. This mTSFE technique could simplify the operative procedure and might be helpful to reduce intraoperative trauma, as well as to alleviate postoperative discomfort.
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Affiliation(s)
- H Xue
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China; Department of Prosthodontics, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University, School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - J Wen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - C Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - X Shuai
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - X Zhang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
| | - N Kang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China; Department of Oral Implantology (National Key Clinical Department), West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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15
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Criteria for the Classification of the Interradicular Septum Shape in Maxillary Molars with Clinical Importance for Prosthetic-Driven Immediate Implant Placement. Diagnostics (Basel) 2022; 12:diagnostics12061432. [PMID: 35741242 PMCID: PMC9221751 DOI: 10.3390/diagnostics12061432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/04/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to use cone-beam computed tomography (CBCT) to evaluate the morphometric properties of the interradicular septum (IRS) in the maxillary molar region that may be indicative for prosthetic-driven implant placement. Following the repetitive algorithm based on the visual identification of IRS shapes, we described the following IRS shapes: arrow, boat, drop, and palatal and buccal convergence. The incidence of IRS shapes showed significant differences for the first and second maxillary molars (the highest frequency for the arrow shape, and the lowest for the drop shape) with no significant difference between the molars. The most prominent width indicative for implant placement was observed in the palatal convergence shape, whereas the height criteria were the most satisfying in the buccal convergence-shaped IRS for both molars. Apart from the parameters in the coronal view, the image analysis in the axial view revealed that IRS surface area, required for the implant placement, was the most prominent in the palatal convergence shape for the first, and boat shape for the second molars. Our results showed the benefits of CBCT diagnostics in posterior maxilla morphometric analysis. IRS shape classification may be helpful in achieving more rapid and accurate planning for interventions in this region.
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16
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Pavlovic ZR, Milanovic P, Vasiljevic M, Jovicic N, Arnaut A, Colic D, Petrovic M, Stevanovic M, Selakovic D, Rosic G. Assessment of Maxillary Molars Interradicular Septum Morphological Characteristics as Criteria for Ideal Immediate Implant Placement—The Advantages of Cone Beam Computed Tomography Analysis. Diagnostics (Basel) 2022; 12:diagnostics12041010. [PMID: 35454058 PMCID: PMC9032090 DOI: 10.3390/diagnostics12041010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/31/2022] [Accepted: 04/15/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to evaluate the interradicular septum bone morphometric characteristics using cone beam computed tomography (CBCT) images, as well as to establish quantitative shortcuts to allow clinicians to make a faster and more reliable plan for immediate implant placement in the maxillary molars area. This retrospective quantitative study was conducted on CBCT images obtained from 100 patients. The morphometric analysis of the maxillary molars region was based on the parameters obtained on the sagittal and axial slices. The analysis performed on sagittal slices showed that the first maxillary molars had a wider interradicular septum when compared to the second molars, but the septum height in the first molars was significantly below the height in the second maxillary molars. The axial CBCT slices analysis showed that both interradicular septum perimeter and surface area were significantly more pronounced in the first than in the second maxillary molars. The interradicular furcation angle significantly correlated with the surface area (positively) and septum height (negatively) for both molars. The results of this study may recommend CBCT image analysis as a useful tool in predefining the circumstances that can allow for substantially better planning of immediate implant placement procedures in the region of maxillary molars.
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Affiliation(s)
- Zlata Rajkovic Pavlovic
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (Z.R.P.); (M.V.); (A.A.); (D.C.); (M.P.); (M.S.)
| | - Pavle Milanovic
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (Z.R.P.); (M.V.); (A.A.); (D.C.); (M.P.); (M.S.)
- Correspondence: (P.M.); (D.S.)
| | - Milica Vasiljevic
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (Z.R.P.); (M.V.); (A.A.); (D.C.); (M.P.); (M.S.)
| | - Nemanja Jovicic
- Department of Histology and Embryology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Aleksandra Arnaut
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (Z.R.P.); (M.V.); (A.A.); (D.C.); (M.P.); (M.S.)
| | - Djurdjina Colic
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (Z.R.P.); (M.V.); (A.A.); (D.C.); (M.P.); (M.S.)
| | - Marijana Petrovic
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (Z.R.P.); (M.V.); (A.A.); (D.C.); (M.P.); (M.S.)
| | - Momir Stevanovic
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (Z.R.P.); (M.V.); (A.A.); (D.C.); (M.P.); (M.S.)
| | - Dragica Selakovic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
- Correspondence: (P.M.); (D.S.)
| | - Gvozden Rosic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
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17
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Alkhasawnah Q, Elmas S, Sohrabi K, Attia S, Heinemann S, El Khassawna T, Heiss C. Confirmation of Calcium Phosphate Cement Biodegradation after Jawbone Augmentation around Dental Implants Using Three-Dimensional Visualization and Segmentation Software. MATERIALS 2021; 14:ma14227084. [PMID: 34832488 PMCID: PMC8618138 DOI: 10.3390/ma14227084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 01/01/2023]
Abstract
The use of autologous bone graft for oral rehabilitation of bone atrophy is considered the gold standard. However, the available grafts do not allow a fast loading of dental implants, as they require a long healing time before full functionality. Innovative bioactive materials provide an easy-to-use solution to this problem. The current study shows the feasibility of calcium phosphate cement paste (Paste-CPC) in the sinus. Long implants were placed simultaneously with the cement paste, and provisional prosthetics were also mounted in the same sessions. Final prosthetics and the full loading took place within the same week. Furthermore, the study shows for the first time the possibility to monitor not only healing progression using Cone Beam Computer tomography (CBCT) but also material retention, over two years, on a case study example. The segmented images showed a 30% reduction of the cement size and an increased mineralized tissue in the sinus. Mechanical testing was performed qualitatively using reverse torque after insertion and cement solidification to indicate clinical feasibility. Both functional and esthetic satisfaction remain unchanged after one year. This flowable paste encourages the augmentation procedure with less invasive measure through socket of removed implants. However, this limitation can be addressed in future studies.
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Affiliation(s)
- Qusai Alkhasawnah
- Experimental Trauma Surgery, Faculty of Medicine, Justus-Liebig-University, Aulweg 128, 35392 Giessen, Germany; (Q.A.); (S.E.); (C.H.)
- Center of Dental Implants, Jordan German Dental Institute, Mamdouh Al Saraireh Street 5, Amman 11821, Jordan
| | - Sera Elmas
- Experimental Trauma Surgery, Faculty of Medicine, Justus-Liebig-University, Aulweg 128, 35392 Giessen, Germany; (Q.A.); (S.E.); (C.H.)
| | - Keywan Sohrabi
- Faculty of Health Sciences, University of Applied Sciences, Wiesenstrasse 14, 35390 Giessen, Germany;
| | - Sameh Attia
- Department of Oral and Maxillofacial Surgery, Justus-Liebig University of Giessen, Klinikstr. 33, 35392 Giessen, Germany;
| | | | - Thaqif El Khassawna
- Experimental Trauma Surgery, Faculty of Medicine, Justus-Liebig-University, Aulweg 128, 35392 Giessen, Germany; (Q.A.); (S.E.); (C.H.)
- Faculty of Health Sciences, University of Applied Sciences, Wiesenstrasse 14, 35390 Giessen, Germany;
- Correspondence: ; Tel.: +49-641-993-0581
| | - Christian Heiss
- Experimental Trauma Surgery, Faculty of Medicine, Justus-Liebig-University, Aulweg 128, 35392 Giessen, Germany; (Q.A.); (S.E.); (C.H.)
- Department of Trauma, Hand and Reconstructive Surgery, Justus-Liebig University Giessen, Rudolf-Buchheim-Street 7, 35392 Giessen, Germany
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Henriques I, Caramês J, Francisco H, Caramês G, Hernández-Alfaro F, Marques D. Prevalence of maxillary sinus septa: systematic review and meta-analysis. Int J Oral Maxillofac Surg 2021; 51:823-831. [PMID: 34742634 DOI: 10.1016/j.ijom.2021.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 10/16/2021] [Accepted: 10/19/2021] [Indexed: 10/19/2022]
Abstract
The aim of this systematic review and meta-analysis was to determine the prevalence and characteristics of maxillary sinus septa using cone beam computed tomography and computed tomography data. Publications were searched until October 5, 2020 in three electronic databases. Additionally, article bibliographies were searched, and authors were contacted if required. This review has been registered in PROSPERO (CRD42019124933). Two independent evaluators assessed methodological quality using the Joanna Briggs Institute levels of evidence; inter-rater reliability tests were performed (Cohen's κ). The prevalence of maxillary sinus septa was expressed as a proportion; differences according to sex were reported in terms of the odds ratio (OR) and 95% confidence interval (95% CI). Heterogeneity and sources of heterogeneity were evaluated by meta-regression. Publication bias was assessed by visual analysis of the funnel plot. Statistical significance was set at P < 0.05. The 62 studies identified and included in the review involved 13,701 patients (22,460 sinuses). The meta-analysis of 35 studies (14,664 sinuses) revealed an overall mean sinus septa prevalence per sinus of 33.2% (95% CI 27.8-38.5%; I2 = 98.32%). The meta-analysis of 42 studies (9631 patients) found an overall mean sinus septa prevalence per patient of 41.0% (95% CI 36.0-46.0%, I2 = 96.45%). The OR for the difference in septa prevalence between sexes was 0.785 (95% CI 0.590-1.046; P = 0.098, I2 = 73.24%). Septa were most frequent in the middle area of the sinus and with a transverse orientation (86.0%). Within the limitations, the results suggest a high proportion of septa in the sinus, commonly in the middle area, which can interfere with the success of sinus floor elevation required for implant rehabilitation.
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Affiliation(s)
- I Henriques
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal
| | - J Caramês
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal; Instituto de Implantologia, Lisbon, Portugal; LIBPhys-FCT UID/FIS/04559/2013, Lisbon, Portugal
| | - H Francisco
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal; Instituto de Implantologia, Lisbon, Portugal
| | - G Caramês
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal; Instituto de Implantologia, Lisbon, Portugal
| | | | - D Marques
- Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal; Instituto de Implantologia, Lisbon, Portugal; LIBPhys-FCT UID/FIS/04559/2013, Lisbon, Portugal; Evidence Based Dentistry Research Centre, Cochrane Collaboration Portugal, Lisbon, Portugal.
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19
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Günaçar DN, Köse TE, Arsan B, Aydın EZ. Radioanatomic study of maxillary sinus palatal process pneumatization. Oral Radiol 2021; 38:398-404. [PMID: 34554390 DOI: 10.1007/s11282-021-00569-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To perform a detailed analysis of palatal process pneumatization (PPP) on cone beam computed tomography (CBCT) images. METHODS This study consisted of 376 maxillary sinuses of 188 patients aged 22-88 years who had maxillary CBCT scans. The radioanatomy of the PPP was evaluated at distances 4, 8, 16, and 24 mm posterior to incisive foramen. The types of PPP were classified as follows: type I: maxillary sinus palatal process non-gasified; type II: palatal process gasification into the nasal floor, but not more than half of the width of the nasal floor; and type III: palatal process gasification into the nasal floor more than half of the width of nasal floor. Sinus opening angle (SOA), palatonasal recess angle (PNRA), palatal junction angle (PJA), and palatal depth measurement (PDM) were the evaluated parameters. RESULTS Among the identified 1315 PPPs, type I PPP (880, 66.92%) was the most frequently observed, followed by type II (426, 32.4%), and the least observed was type III PPP (9, 0.68%). There was no significant difference between SOA and PJA according to the types of PPP (p > 0.05). The difference between PNRA and PDM of type I and type II PPP showed a statistically significant difference (p < 0.05). Type I PPP was the most encountered with the highest PDM, and PNRA was narrower in type III than in type II PPP. CONCLUSION Physicians must be aware of these variations to prevent possible complications during surgery because 33.08% of the maxillary sinuses showed extensive pneumatization through the palatal process.
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Affiliation(s)
- Dilara Nil Günaçar
- Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Recep Tayyip Erdoğan University, Rize, Turkey.
| | - Taha Emre Köse
- Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Belde Arsan
- Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Medeniyet University, Istanbul, Turkey
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20
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Hamzani Y, Yassien E, Moskovich L, Becker T, Chaushu G, Haj Yahya B. Potential Circumferential Bone Engagement following Tooth Extraction in the Posterior Mandible: Computed Tomography Assessment. MEDICINA-LITHUANIA 2021; 57:medicina57090874. [PMID: 34577797 PMCID: PMC8467391 DOI: 10.3390/medicina57090874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/19/2021] [Accepted: 08/23/2021] [Indexed: 12/03/2022]
Abstract
Background and Objectives: Immediate implant placement (IIP) is a popular surgical procedure with a 94.9–98.4% survival rate and 97.8–100% success rate. In the posterior mandible, it poses a risk of injury to adjacent anatomical structures if the implant engages apical bone. This study sought to assess the implant dimensions that allow for circumferential bone engagement at each position in the posterior mandible without additional apical drilling. Materials and Methods: An observational, cross-sectional study design was used. The pre-extraction cone beam computed tomography scans of 100 candidates for IIP were analyzed. Measurements of each root of the posterior mandibular second premolar, first molar, and second molar were taken from three aspects: buccolingual, mesiodistal, and vertical. Two-sided p values < 0.05 were considered statistically significant. Results: A total of 478 mandibular teeth and 781 roots were assessed. Based on Straumann® BLX/BLT implant-drilling protocols, predicted rates of radiological circumferential engagement (RCE) were 96% for implants 5 mm in diameter in the second premolar root position; 94% for implants 4.0–4.2 mm in diameter in the first molar root position; and 99% for implants 4.5–4.8 mm in diameter in the second molar root position. Corresponding rates of achieving an available implant length (AIL) of 10 mm were 99%, 90%, and 86%. Patients <40 years old were at higher risk of lower RCE and lower AIL (p < 0.005) than older patients for all roots measured. Conclusions: The high primary stability prediction rates based on the calculation of RCE and AIL support the use of IIPs without further apical drilling in the posterior mandible in most cases.
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Affiliation(s)
- Yafit Hamzani
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (T.B.); (G.C.)
- Correspondence: ; Tel.: +972-3-9377207 or +972-54-7372848; Fax: +972-3-9377204
| | - Emran Yassien
- Department of Oral and Maxillofacial Surgery, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv 6139001, Israel;
| | - Liad Moskovich
- Department of Oral and Maxillofacial Surgery, Galilee Medical Center, Nahariya 2210001, Israel;
| | - Talia Becker
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (T.B.); (G.C.)
| | - Gavriel Chaushu
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (T.B.); (G.C.)
- Department of Oral and Maxillofacial Surgery, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv 6139001, Israel;
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21
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Shemtov-Yona K. Quantitative assessment of the jawbone quality classification: A meta-analysis study. PLoS One 2021; 16:e0253283. [PMID: 34133463 PMCID: PMC8208540 DOI: 10.1371/journal.pone.0253283] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/02/2021] [Indexed: 12/26/2022] Open
Abstract
AIM Bone quality is evaluated using bone density for qualitative classification, a characteristic that may be delicate to evaluate. Contemporary implantology that relies on modern measurement techniques, needs a more quantitative estimate of the bone quality. MATERIALS AND METHODS PubMed and EMBASE databases were searched with no time restriction. Clinical and radiographic studies reporting on alveolar ridge dimensions and its parameters in different areas of the dentate and edentulous jaws were included. A meta-analysis was performed using random effect models to report a combined mean for alveolar ridge and its parameters. Meta regression statistical tests were performed in order to identify differences in those outcome parameters. RESULTS 30 studies were included. The majority of the selected studies (total of 27) used live human subjects and CBCT to analyze alveolar ridge dimensions and its parameters. Using the combined mean obtained from the meta-analysis, a typical portrait of the alveolar ridge was constructed, and a geometrically based quantitative bone classification proposed. The quantitative classification was found to match the existing qualitative classification. CONCLUSION A geometry-based analysis was constructed that yields valuable insights on the bone type based on its components and on the dynamics of the dentate / edentulous states.
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Affiliation(s)
- Keren Shemtov-Yona
- Faculty of Mechanical Engineering, Technion, Haifa, Israel
- The Maurice and Gabriela Goldschleger School of Dental Medicine, Department of Oral Biology, Tel Aviv University, Tel Aviv, Israel
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22
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Munakata M, Yamaguchi K, Sato D, Yajima N, Tachikawa N. Factors influencing the sinus membrane thickness in edentulous regions: a cone-beam computed tomography study. Int J Implant Dent 2021; 7:16. [PMID: 33649993 PMCID: PMC7921232 DOI: 10.1186/s40729-021-00298-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 02/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During implant treatment in the maxillary molar area, maxillary sinus floor augmentation is often performed to ameliorate the reduced alveolar bone height attributable to bone remodeling and pneumatization-induced expansion of the maxillary sinus. However, this augmentation may cause complications such as misplaced implants, artery damage, and maxillary sinus mucosal perforation; infections like maxillary sinusitis; and postsurgical complications such as bone graft leakage and postoperative nasal hemorrhaging. To reduce the complications during maxillary sinus floor augmentation and postoperative infections, we performed retrospective investigations of various systemic and local factors that influence pre-operative sinus mucosal thickness (SMT) by using cone-beam computed tomography (CBCT). Subjects included patients who underwent maxillary sinus floor augmentation in an edentulous maxillary molar area with a lateral approach. Pre-operative SMT, existing bone mass, and nasal septum deviation were measured using CBCT images. Relationships between SMT and the following influencing factors were investigated: (1) age, (2) sex, (3) systemic disease, (4) smoking, (5) period after tooth extraction, (6) reason for tooth extraction, (7) residual alveolar bone height (RBH), (8) sinus septa, and (9) nasal septum deviation. Correlations were also investigated for age and RBH (p < 0.05). RESULTS We assessed 35 patients (40 sinuses; 11 male, 24 female). The average patient age was 58.90 ± 9.0 years (males, 57.9 ± 7.7 years; females, 59.9 ± 9.4 years; age range, 41-79 years). The average SMT was 1.09 ± 1.30 mm, incidence of SMT > 2 mm was 25.0%, incidence of SMT < 0.8 mm was 50.0%, and the average RBH was 2.14 ± 1.02 mm. The factors that influenced SMT included sex (p = 0.0078), period after tooth extraction (p = 0.0075), reason for tooth extraction (p = 0.020), sinus septa (p = 0.0076), and nasal septum deviation (p = 0.038). CONCLUSIONS Factors associated with higher SMT included male sex, interval following tooth extraction < 6 months, periapical lesions, sinus septa, and nasal septum deviation. Factors associated with SMT > 2 mm were sex and reason for tooth extraction, while factors associated with SMT < 0.8 mm were time following tooth extraction and nasal septum deviation. Despite the limitations of this study, these preoperative evaluations may be of utmost importance for safely conducting maxillary sinus floor augmentation.
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Affiliation(s)
- Motohiro Munakata
- Department of Implant Dentistry, Showa University School of Dentistry, 2-1-1, Kita-Senzoku, Ota-ku, 145-8515, Tokyo, Japan.
| | - Kikue Yamaguchi
- Department of Implant Dentistry, Showa University School of Dentistry, 2-1-1, Kita-Senzoku, Ota-ku, 145-8515, Tokyo, Japan
| | - Daisuke Sato
- Department of Implant Dentistry, Showa University School of Dentistry, 2-1-1, Kita-Senzoku, Ota-ku, 145-8515, Tokyo, Japan
| | - Naoko Yajima
- Department of Implant Dentistry, Showa University School of Dentistry, 2-1-1, Kita-Senzoku, Ota-ku, 145-8515, Tokyo, Japan
| | - Noriko Tachikawa
- Tokyo Medical and Dental University Dental Hospital, Tokyo Medical and Dental University, Tokyo, Japan
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23
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Pizzini A, Basma HS, Li P, Geurs NC, Abou-Arraj RV. The impact of anatomic, patient and surgical factors on membrane perforation during lateral wall sinus floor elevation. Clin Oral Implants Res 2021; 32:274-284. [PMID: 33314302 DOI: 10.1111/clr.13698] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/24/2020] [Accepted: 11/28/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES This retrospective study aimed to evaluate the influence of anatomical, patient and surgical factors on the occurrence of membrane perforation (MP) during lateral window sinus floor elevation (LWSFE). MATERIAL AND METHODS A review of LWSFE patient records between 2014 and 2019 accounted for MP occurrence, window surface area (WSA), intravenous sedation use, osteotomy instrument type and clinician experience. Preoperative cone beam computed tomography (CBCT) scans were analyzed for lateral wall thickness (LWT), LFM and LAM angles formed between lateral and medial walls at the floor and anterior wall, respectively, sinus width at 5-, 10- and 15-mm (LM-5, LM-10 and LM-15) from the floor, residual bone height (RBH), sinus pathologies, septa and arterial anastomoses. The generalized estimating equation (GEE) approach with a sandwich variance-covariance estimator was used to evaluate the associations with MP. RESULTS MP occurred in 25.74% of 202 LWSFE procedures (166 patients). Mean 1.6 mm-LWT, 3.2 mm-RBH, 95°-LFM, 75.5°-LAM, 12 mm-LM-5, 20.79% septa, 16.83% arterial anastomosis, 37.62% sinus pathology and 29.21% intravenous sedations, 85.24% WSA ≥ 40 mm2 and 57% >10 procedures/clinician were reported. Greater MP rates were encountered as follows: 38.3% (LWT ≥ 1.5 mm), 38% (LFM < 90°), 59.6% (LAM < 70°), 45.4% (LM-5 < 10 mm) and 36.4% (WSA ranged > 80 mm2 ), with statistically significant associations with all these outcomes (p < .05). The presence of pathologies was also associated with MP (p = .013). Associations between MP and the presence of septa and arterial anastomoses, age/gender, right/left sinus, RBH, clinician's experience, instrument type and intravenous sedation use could not be demonstrated. CONCLUSIONS MP is significantly associated with thicker lateral walls, narrower sinuses, larger windows and existing sinus pathology.
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Affiliation(s)
- Andrea Pizzini
- Department of Periodontology, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hussein S Basma
- Department of Periodontology, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Peng Li
- Department of Acute, Chronic and Continuing Care, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nicolaas C Geurs
- Department of Periodontology, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ramzi V Abou-Arraj
- Department of Periodontology, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
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24
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Fang Y, Bi Y, Mashrah M, Su Y, Ge L, Dong Y, Qin L, Wang L. Does sinus floor elevation in the presence of Schneiderian membrane pathology increase therisk of membrane perforation and implant failure rate? J ORAL IMPLANTOL 2020; 48:147-157. [PMID: 33270880 DOI: 10.1563/aaid-joi-d-20-00145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Schneiderian membrane (SM) thickness >2mm is regarded to be a pathological mucosal change. The aim of the current study is to answer the question" Does presence of pathological changes in the SM increase the risk of sinus perforation during surgical sinus floor elevation (SFE)?" An electronic database (PubMed, Embase, Cochrane Library, and Chinese database) were systemically searched for the studies published until February 2020. Randomized and non-randomized studies that reported the incidence of SM perforation in patients with SM pathology (antral pseudocyst or mucosal thickening) during SFE. The outcome measures were the incidence of SM perforation and implant survival rate. The pooled odds ratio (OR) with 95% confidence intervals and the Fixed-effects model were calculated. P-value ≤ 0.05 was considered to be statistically significant. Eighteen studies with a total of 1542 patients and 1797 SFE were included. Statistically insignificant difference in the incidence of SM perforation was observed between the normal-appearing sinus and thickened sinus mucosa (Fixed; OR, 0.896; 95%CI, 0.504 - 1.59; P =0.707, I 2 =32%). The rate of SM perforation in the normal sinus, mucosal thickening, and antral pseudocysts was 14%, 6%, and 6% respectively. The Implant survival rate was 98% in the normal sinus, and 100% in antral pseudocyst and mucosal thickening. SM thickening or antral pseudocyst did not increase the risk of membrane perforation and implant failure rates. Future RCTs are needed to evaluate the risk of the presence of pathological changes in the SM on the failure of the bone augmentation and dental implant.
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Affiliation(s)
- Ying Fang
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, China
| | - Ye Bi
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, China
| | - Mubarak Mashrah
- Guangzhou Medical University Dental implantology HuangSha street CHINA Guangzhou Guangdong 500332 008613172053275 Guangzhou Medical University
| | - Yucheng Su
- Department of Dental Implantology of Peking Union Medical College Hospital, Beijing, China
| | - Linhu Ge
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, China
| | - Yu Dong
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, China
| | - Lei Qin
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, China
| | - Liping Wang
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, China. Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Affiliated Stomatology Hos
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25
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Tran TB, Estrin NE, Saleh MHA, Yoon TYH, Tattan M, Wang HL. Evaluation of length and location of the maxillary sinus intraosseous artery using computerized tomography. J Periodontol 2020; 92:854-862. [PMID: 33107598 DOI: 10.1002/jper.20-0560] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/08/2020] [Accepted: 09/20/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND The intraosseous artery is a branch of the posterior superior alveolar artery that supplies the lateral wall of the maxillary sinus. The present study seeks to analyze the location of the intraosseous artery and its site of termination. METHODS Cone beam computed tomography was used to evaluate 200 patients making up 400 maxillary sinuses. The following criteria were measured: (1) the distance of the lower border of the intraosseous artery to the floor of the sinus, (2) the average length of the artery, (3) the diameter of the artery, (4) the site at which the artery terminates at, and (5) the distance of the artery from the first premolar, second premolar, first molar, second molar, and third molar. RESULTS The intraosseous artery was identified in 336 (84.0%) quadrants. The most common site of termination was at the mesial of the second molar (22%), regardless of dental status and right or left quadrant. Its overall mean diameter was 0.91 ± 0.56 mm, with no difference within the dental status. Its overall mean length was 7.40 ± 3.39 mm, with a statistically significant difference between dentate and edentulous quadrants (P < 0.001). Its overall mean distance from the floor was 6.95 ± 6.49 mm, with no difference within the dental status. All parameters showed no difference between right or left quadrants. CONCLUSIONS The chances of encountering the intraosseous artery at the premolar area is <21% during a lateral window sinus floor elevation. The most common (22%) site of termination of the intraosseous artery is at the mesial of the second molar. Understanding of the course, location, and termination of the artery enhances the precision of a clinician when it comes to pre-operative treatment planning.
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Affiliation(s)
- Troy B Tran
- Graduate Periodontics, School of Dentistry, University of Louisville, Louisville, Kentucky, USA.,Lake Erie College of Osteopathic Medicine School of Dental Medicine, Bradenton, Florida, USA
| | - Nathan E Estrin
- Lake Erie College of Osteopathic Medicine School of Dental Medicine, Bradenton, Florida, USA.,Department of Periodontology, Stony Brook School of Dental Medicine, Stony Brook, New York, USA
| | - Muhammad H A Saleh
- Graduate Periodontics, School of Dentistry, University of Louisville, Louisville, Kentucky, USA.,Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Thomas Y H Yoon
- Lake Erie College of Osteopathic Medicine School of Dental Medicine, Bradenton, Florida, USA
| | - Mustafa Tattan
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa, USA
| | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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26
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Chen YW, Finkelman M, Papaspirisdakos P, César-Neto JB, Weber HP, de Souza AB. Comparative analysis of dimensional alterations following extraction of maxillary molars using three-dimensional images' superimposition: a CBCT study. Odontology 2020; 109:514-523. [PMID: 33175280 DOI: 10.1007/s10266-020-00568-y] [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: 10/07/2019] [Accepted: 10/26/2020] [Indexed: 01/13/2023]
Abstract
The aims of this study were to (i) evaluate the bone alterations following maxillary molar extraction and (ii) identify the factors associated with bone alterations using a tomographic analysis. Cone Beam Computer Tomographies (CBCTs) of 17 subjects with 25 maxillary molars were analyzed, before and, in average, 12 months following extraction. Fifty CBCTs were segmented as 3D models that were used as reference for analysis. Cross-sectional planes were established to measure the dimensional changes in the vertical, horizontal aspects, and the area of the alveolar bone. Associations between root divergence, initial bone location related to the maxillary sinus, and the thickness of buccal and palatal bone at baseline was assessed using mixed-effect models. Overall, the average reduction in vertical bone height was 35.23% (2.61 ± 1.76 mm). The mean reduction of area of alveolar process and horizontal bone width were 18.89% (56.08 ± 44.23 mm2) and 65.10% (8.33 ± 4.51 mm), respectively. There was a marginal significant association between horizontal bone changes and the thickness of palatal bone (p = 0.05). The results of the present study indicated that following maxillary molar extraction, significant dimensional changes occur in both the vertical and horizontal directions. The vertical changes were mainly attributed to remodeling on the coronal aspect of the alveolar ridge and sinus pneumatization was rare.
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Affiliation(s)
- Yo-Wei Chen
- Department of Prosthodontics, Tufts University School of Dental Medicine, One Kneeland Street, DHS 1242, Boston, MA, 02111, USA
| | - Matthew Finkelman
- Department of Public Health and Community Service, Tufts University School of Dental Medicine, Boston, MA, USA
| | - Panos Papaspirisdakos
- Department of Prosthodontics, Tufts University School of Dental Medicine, One Kneeland Street, DHS 1242, Boston, MA, 02111, USA
| | - João Batista César-Neto
- Discipline of Periodontics, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Hans Peter Weber
- Department of Prosthodontics, Tufts University School of Dental Medicine, One Kneeland Street, DHS 1242, Boston, MA, 02111, USA
| | - André Barbisan de Souza
- Department of Prosthodontics, Tufts University School of Dental Medicine, One Kneeland Street, DHS 1242, Boston, MA, 02111, USA.
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27
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Manacorda M, Poletti de Chaurand B, Merlone A, Tetè G, Mottola F, Vinci R. Virtual Implant Rehabilitation of the Severely Atrophic Maxilla: A Radiographic Study. Dent J (Basel) 2020; 8:dj8010014. [PMID: 32024286 PMCID: PMC7148484 DOI: 10.3390/dj8010014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/21/2020] [Accepted: 01/21/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Advanced maxillary atrophy is one of the most common clinical scenarios where implant placement could become difficult. Nevertheless, a volumetric evaluation using a suitable diagnostic software could facilitate the implant planning. The purpose of the present study is to suggest the potential application of the maxillary retro-canine area as the designated location for virtual tilted implants. METHODS A sample of Cone Beam Computed Tomography (CBCT) images from the Department of Dentistry (IRCSS San Raffaele, Milan, Italy) was evaluated. After a 3D anatomical evaluation, tilted implants were virtually positioned in the retro-canine regions. All the implants were inserted using the same procedure at 30° and 45° degrees of tilting. The length, palatal angulation and diameter of the placed implant were identified. RESULTS A total of 220 tilted implants were placed. An average implant measurement of 13.51 mm in length and 3.42 mm in diameter were calculated. Additionally, an average buccal-palatal angulation of 6° was identified. Upon statistical analysis, the implant length was found to be significantly higher at 45° degrees of mesio-distal angulation than at 30° degrees (<0.0001). CONCLUSIONS A considerable number of patients show a significant degree of bone atrophy. The implant-supported treatment plan can rely on three-dimensional imaging of the residual bone as a guiding tool to establish the most effective implant position for each specific case. In this study, it was found that an implant could have a greater length if its mesio-distal angulation was more accentuated. In addition, owing to the volumetric evaluation, it was possible to virtually insert tilted implants in almost all of the cases of atrophy. This could lead clinicians to consider the retro-canine area as a viable place to insert a longer tilted implant.
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Hämmerle CHF, Tarnow D. The etiology of hard- and soft-tissue deficiencies at dental implants: A narrative review. J Periodontol 2019; 89 Suppl 1:S291-S303. [PMID: 29926950 DOI: 10.1002/jper.16-0810] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 11/07/2017] [Accepted: 12/11/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The objective of the present paper was to review factors and conditions that are associated with hard and soft-tissue deficiencies at implant sites. IMPORTANCE Hard- and soft-tissue deficiencies at dental implants are common clinical findings. They can lead to complications and compromise implant survival and, hence, may require therapeutic interventions. It is, therefore, important to understand the etiology of hard and soft-tissue deficiencies. Based on this understanding, strategies should be developed to correct hard and soft-tissue deficiencies with the aim of improving clinical outcomes of implant therapy. FINDINGS A large number of etiological factors have been identified that may lead to hard and soft-tissue deficiencies. These factors include: 1) systemic diseases and conditions of the patients; 2) systemic medications; 3) processes of tissue healing; 4) tissue turnover and tissue response to clinical interventions; 5) trauma to orofacial structures; 6) local diseases affecting the teeth, the periodontium, the bone and the mucosa; 7) biomechanical factors; 8) tissue morphology and tissue phenotype; and 9) iatrogenic factors. These factors may appear as an isolated cause of hard and soft-tissue defects or may appear in conjunction with other factors. CONCLUSIONS Hard- and soft-tissue deficiencies at implant sites may result from a multitude of factors. They encompass natural resorption processes following tooth extraction, trauma, infectious diseases such as periodontitis, peri-implantitis, endodontic infections, growth and development, expansion of the sinus floor, anatomical preconditions, mechanical overload, thin soft tissues, lack of keratinized mucosa, malpositioning of implants, migration of teeth, lifelong growth, and systemic diseases. When more than one factor leading to hard and/or soft-tissue deficiencies appear together, the severity of the resulting condition may increase. Efforts should be made to better identify the relative importance of these etiological factors, and to develop strategies to counteract their negative effects on our patient's wellbeing.
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Affiliation(s)
- Christoph H F Hämmerle
- Chairman of the Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Switzerland
| | - Dennis Tarnow
- Director of Implant Education, Columbia University College of Dental Medicine, New York, NY, USA
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29
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Prevalence of Maxillary Sinus Pathology Based on Cone-Beam Computed Tomography Evaluation of Multiethnicity Dental School Population. IMPLANT DENT 2019; 28:356-366. [PMID: 31135648 DOI: 10.1097/id.0000000000000902] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The goal of the study was to evaluate prevalence of maxillary sinus pathology among populations considered for possible sinus augmentation procedures for dental implants. STUDY DESIGN Eight hundred twenty-one cone-beam computed tomography (CBCT) scans were retrospectively evaluated for prevalence of maxillary sinus pathology. Scans were classified based on the type of sinus pathology detected. Categories of sinus findings were healthy, mucosal thickening larger than 3 mm, polypoidal mucosal thickening, partial opacification, complete opacification, and others. Age, sex, ethnicity, and dentition status were evaluated to determine associated relationships with the incidence of pathology. RESULTS Sixty-two percent (62.79%) of scans presented with bilateral healthy sinuses and 37.21% of scans exhibited pathology. 73.38% of sinuses were classified as clinical healthy, 14.93% presented with mucosal thickening, 8.53% with polypoidal mucosal thickening, 2.13% with partial opacification, 0.66% with complete opacification, and 0.37% with a foreign body. Sex is found to be a significant factor with higher pathology incidence rates in male patients. Age is a significant factor with higher pathology incidence rates in older subjects. Dentition status and ethnicity did not have a significant association with pathology incidence rates. CONCLUSIONS The prevalence of maxillary sinus pathologies and associations with age, sex, ethnicity, and dentition status were obtained. Thirty-seven percent of scans would require further medical consultation before proceeding with maxillary sinus augmentation surgery for dental implants.
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30
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Hämmerle CHF, Tarnow D. The etiology of hard- and soft-tissue deficiencies at dental implants: A narrative review. J Clin Periodontol 2019; 45 Suppl 20:S267-S277. [PMID: 29926502 DOI: 10.1111/jcpe.12955] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 11/07/2017] [Accepted: 12/11/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The objective of the present paper was to review factors and conditions that are associated with hard and soft-tissue deficiencies at implant sites. IMPORTANCE Hard- and soft-tissue deficiencies at dental implants are common clinical findings. They can lead to complications and compromise implant survival and, hence, may require therapeutic interventions. It is, therefore, important to understand the etiology of hard and soft-tissue deficiencies. Based on this understanding, strategies should be developed to correct hard and soft-tissue deficiencies with the aim of improving clinical outcomes of implant therapy. FINDINGS A large number of etiological factors have been identified that may lead to hard and soft-tissue deficiencies. These factors include: 1) systemic diseases and conditions of the patients; 2) systemic medications; 3) processes of tissue healing; 4) tissue turnover and tissue response to clinical interventions; 5) trauma to orofacial structures; 6) local diseases affecting the teeth, the periodontium, the bone and the mucosa; 7) biomechanical factors; 8) tissue morphology and tissue phenotype; and 9) iatrogenic factors. These factors may appear as an isolated cause of hard and soft-tissue defects or may appear in conjunction with other factors. CONCLUSIONS Hard- and soft-tissue deficiencies at implant sites may result from a multitude of factors. They encompass natural resorption processes following tooth extraction, trauma, infectious diseases such as periodontitis, peri-implantitis, endodontic infections, growth and development, expansion of the sinus floor, anatomical preconditions, mechanical overload, thin soft tissues, lack of keratinized mucosa, malpositioning of implants, migration of teeth, lifelong growth, and systemic diseases. When more than one factor leading to hard and/or soft-tissue deficiencies appear together, the severity of the resulting condition may increase. Efforts should be made to better identify the relative importance of these etiological factors, and to develop strategies to counteract their negative effects on our patient's wellbeing.
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Affiliation(s)
- Christoph H F Hämmerle
- Chairman of the Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Switzerland
| | - Dennis Tarnow
- Director of Implant Education, Columbia University College of Dental Medicine, New York, NY, USA
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31
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Ritter A, Rozendorn N, Avishai G, Rosenfeld E, Koren I, Soudry E. Preoperative Maxillary Sinus Imaging and the Outcome of Sinus Floor Augmentation and Dental Implants in Asymptomatic Patients. Ann Otol Rhinol Laryngol 2019; 129:209-215. [PMID: 31631672 DOI: 10.1177/0003489419883292] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Preoperative maxillary sinus imaging findings have been suggested to be associated with complications and outcomes of sinus lift and dental implant procedures; nonetheless the evidence is controversial. The aim of this study was to examine the association between preoperative maxillary sinus imaging findings and outcomes of sinus lift and dental implant procedures in asymptomatic patients. METHODS We included all patients who underwent maxillary sinus lift and dental implant procedures between 2014 and 2017. Maxillary sinus imaging findings were extracted from pre-procedural dental computed tomography scans, and outcomes of the procedures were assessed. RESULTS A total of 145 procedures were included. No sinonasal symptoms were reported preoperatively. In 46% of cases maxillary sinus imaging was abnormal. The most common imaging finding was peripheral mucosal thickening (38%). Sinus floor cyst/polyp was identified in 13% of the cases, of which 47% occupied more than 50% of the sinus volume. Partial or complete opacification of the maxillary sinus was documented in 3% of cases. The sinus ostium and ostiomeatal complex were obstructed in 7% and 1%, respectively. Mucosal perforation was documented in 22% of cases and was inversely related to mucosal thickening (P = 0.011). Other minor post-operative complications did not correlate with radiological findings. Post-surgical sinusitis was not observed in any of the patients regardless of pre-surgical imaging findings. CONCLUSIONS Incidental maxillary sinus imaging findings such as mucosal swelling, cysts or polyps, regardless of their severity or size, and maxillary ostial obstruction may not need to be addressed prior to sinus augmentation and dental implant procedures in asymptomatic patients. Patients with complete sinus opacification should be referred to an otolaryngologist prior to surgery. Further controlled trials, in larger cohorts, are needed to corroborate our findings.
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Affiliation(s)
- Amit Ritter
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Rozendorn
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gal Avishai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Eli Rosenfeld
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Ilan Koren
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ethan Soudry
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Yu SJ, Lee YH, Lin CP, Wu AYJ. Computed tomographic analysis of maxillary sinus anatomy relevant to sinus lift procedures in edentulous ridges in Taiwanese patients. J Periodontal Implant Sci 2019; 49:237-247. [PMID: 31485374 PMCID: PMC6713807 DOI: 10.5051/jpis.2019.49.4.237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 05/26/2019] [Accepted: 06/10/2019] [Indexed: 01/19/2023] Open
Abstract
Purpose To analyze the maxillary sinus anatomy over edentulous ridges in the bilateral posterior maxillary area in Taiwanese patients using cone-beam computed tomography (CBCT). Methods In total, 101 anatomical sites from 61 patients, including 32 premolar and 69 molar regions, were analyzed using CBCT. Measurements were made of the width and height of edentulous ridges, the thickness of the lateral wall of the maxillary sinus, and the presence of a sinus septum and the posterior superior alveolar artery (PSAA). A statistical analysis of the measurements was performed, and correlations among the measurements were assessed. Results The average ridge width was 10.26±3.16 mm, with a significantly greater ridge width in the second molar region than in the premolar region. The mean residual ridge height was 8.55±4.09 mm, and ridge height showed an opposite trend from ridge width for the premolar and molar regions. A sinus septum was present at 5.9% of the sites, and the PSAA was observed in 24.5%. The average thickness of the lateral wall of the maxillary sinus was 2.08±0.94 mm, with no significant difference between the tooth position and lateral wall thickness. Conclusions This study presents the anatomical features of the maxillary sinus, which should be considered in sinus lift procedures for implant placement, in the Taiwanese population. The use of CBCT is recommended to avoid intraoperative complications.
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Affiliation(s)
- Shun-Jen Yu
- Department of Periodontics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Hao Lee
- Department of Orthodontics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Ping Lin
- Department of Periodontics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Aaron Yu-Jen Wu
- Department of Dentistry, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Quantitative Assessment of the Edentulous Posterior Maxilla for Implant Therapy: A Retrospective Cone Beam Computed Tomographic Study. J Maxillofac Oral Surg 2019; 19:125-130. [PMID: 31988575 DOI: 10.1007/s12663-019-01236-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/03/2019] [Indexed: 10/26/2022] Open
Abstract
Aim Dimensional changes of the alveolar bone are often noted in horizontal and vertical planes as a sequel to tooth extraction, particularly in the maxillary posterior region due to alveolar bone resorption combined with pneumatization of the sinus. The aim of this retrospective study was to quantitatively assess the maxillary residual alveolar ridge using cone beam computed tomography (CBCT) scans. Materials and methods A total of 349 edentulous sites from 250 CBCTs were evaluated. The apico-coronal bone height and bucco-palatal crest width were measured in sagittal and coronal slices, respectively. Additionally, the obliqueness of the sinus floor at the edentulous sites was also evaluated. Results One hundred and twelve (55.45%) of the molar and 74 (54.42%) of the premolar sites had a horizontal ridge dimension < 6 mm, whereas 137 (67.83%) of the molar and 61 (44.86%) of the premolar sites showed an apico-coronal height < 8 mm. Furthermore, 183 (54.14%) of the evaluated sites had an oblique sinus floor morphology. Conclusion Additional augmentative procedures are thus required in a high percentage of the population at the edentulous maxillary posterior site for rehabilitation using a standard dimension implant. This study stresses on the need for a three-dimensional CBCT prior to implant surgery for proper treatment planning.
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Gong T, Hu C, Chen Y, Zhou N, Wu H, Man Y. Raising the transcrestal sinus floor in the presence of antral pseudocysts, and in sinus floors with a normal Schneiderian membrane: a retrospective cohort study. Br J Oral Maxillofac Surg 2019; 57:466-472. [PMID: 31047720 DOI: 10.1016/j.bjoms.2019.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 04/09/2019] [Indexed: 02/05/2023]
Abstract
In this study we sought to investigate the influence of antral pseudocysts on the raising of the transcrestal sinus floor. We retrospectively studied two groups (test group: those with antral pseudocysts, and controls: those with normal Schneiderian membranes). The crestal approach with simultaneous placement of implants was used for all patients. Cone-beam computed tomography was done before, immediately afterwards, and 4-6 months postoperatively. Nineteen participants (16 male, three female, mean (SD) age 48 (10) years) were enrolled in the test group, and 73 (38 male, 35 female, 44 (11) years) in the control group. Immediately postoperatively the mean (SD) residual bone height was 5.15 (1.34) mm in the test group and 5.36 (1.28) mm in the control group (p = 0.15), and the raised heights of the sinus floor were 4.98 (2.01) mm and 5.47 (2.13) mm (p = 0.35) in the test and control groups, respectively. Four to six months postoperatively the endo-sinus bone gain values were 3.55 (2.46) mm and 4.03 (2.33) mm in the test and control groups, respectively (p = 0.26). All pseudocysts swelled immediately after operation. Four to six months postoperatively, two had remained unchanged, three had increased in volume, six had disappeared, and eight had decreased in volume. The survival rate of implants was 100% for both groups. Within the limitations of this study, transcrestal raising of the sinus floor in the presence of antral pseudocysts may be a viable technique, as they may not influence the clinical effects of raising the sinus floor during healing.
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Affiliation(s)
- Ting Gong
- Department of Geriatric Dentistry, West China Hospital of Stomatology, Sichuan University
| | - Chen Hu
- Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University
| | - Yaqian Chen
- Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University
| | - Nan Zhou
- Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University
| | - Hongkun Wu
- Department of Geriatric Dentistry, West China Hospital of Stomatology, Sichuan University.
| | - Yi Man
- Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University.
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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: 10] [Impact Index Per Article: 1.4] [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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Cavalcanti MC, Guirado TE, Sapata VM, Costa C, Pannuti CM, Jung RE, César Neto JB. Maxillary sinus floor pneumatization and alveolar ridge resorption after tooth loss: a cross-sectional study. Braz Oral Res 2018; 32:e64. [PMID: 30088551 DOI: 10.1590/1807-3107bor-2018.vol32.0064] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/04/2018] [Indexed: 11/21/2022] Open
Abstract
This is a cross-sectional study that aimed to estimate maxillary sinus floor (MSF) pneumatization in single missing tooth of posterior maxilla, by using cone-beam computed tomography (CBCT). CBCT images were analyzed bilaterally and divided into 2 groups: edentulous site (EdS) - edentulous single region of upper second premolar, first or second molars; Tooth site (TS) - contralateral region homologous to the EdS region, with tooth present. Variables evaluated were: sinus height (SH), estimated sinus pneumatization (eSP: ∆ EdS - TS), healed ridge height (HR) and presence of localized sinus pneumatization (LSP) in molars teeth at TS. HR were categorized according to therapeutic option for posterior maxilla. 183 CBCT scans were included and it was observed that EdS presented a higher SH than the TS (p < 0.001) showing an eSP of 0.9 ± 2.93 mm. First molars presented the highest SH for both sides, although significant differences were detected when compared to second molars. First molars were mostly affected by LSP at TS (36 out of 43). Individuals with LSP at TS presented lower HR than the ones without LSP (p < 0.05). 54% of the cases presenting LSP obtained HR < 5 mm, which indicates sinus lift surgery. The present study showed that tooth loss in posterior maxilla favors sinus pneumatization and the identification of LSP at molar roots seems to indicate a greater necessity for sinus lift surgeries.
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Affiliation(s)
- Marília Cabral Cavalcanti
- Universidade de São Paulo - USP, School of Dentistry, Division of Periodontology, São Paulo, SP, Brazil
| | - Thais Eiler Guirado
- Universidade de São Paulo - USP, School of Dentistry, Division of Periodontology, São Paulo, SP, Brazil
| | - Vitor Marques Sapata
- Universidade de São Paulo - USP, School of Dentistry, Division of Periodontology, São Paulo, SP, Brazil
| | - Claudio Costa
- Universidade de São Paulo - USP, School of Dentistry, Division of Radiology, São Paulo, SP, Brazil
| | - Cláudio Mendes Pannuti
- Universidade de São Paulo - USP, School of Dentistry, Division of Periodontology, São Paulo, SP, Brazil
| | - Ronald Ernst Jung
- University of Zurich, Clinic for Fixed and Removable Prosthodontics and Dental Material Science, Zurich, Switzerland
| | - João Batista César Neto
- Universidade de São Paulo - USP, School of Dentistry, Division of Periodontology, São Paulo, SP, Brazil
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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: 30] [Impact Index Per Article: 4.3] [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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Lundgren S, Cricchio G, Hallman M, Jungner M, Rasmusson L, Sennerby L. Sinus floor elevation procedures to enable implant placement and integration: techniques, biological aspects and clinical outcomes. Periodontol 2000 2018; 73:103-120. [PMID: 28000271 DOI: 10.1111/prd.12165] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Implant treatment in an atrophied edentulous posterior maxilla constitutes a challenge for the therapeutic team. The authors of the present study acknowledge that modern micro-rough surface implants in lengths of about 8-10 mm or longer and of different brands are similarly successful. Consequently, the authors propose that the use of different sinus floor elevation techniques should be considered when < 8 mm of bone is available below the maxillary sinus. The type of sinus floor elevation technique selected is mainly based on residual vertical bone height, marginal bone width, local intrasinus anatomy and the number of teeth to be replaced, although other factors (such as surgical training and surgical experience) may have an impact. It is proposed that a transcrestal sinus floor elevation approach can be considered as a first-choice method for single tooth gaps in situations with sufficient width for implant placement and a residual bone height of 5-8 mm, while lateral sinus floor elevation, with or without grafting materials, is indicated when < 5 mm of bone is available and when several teeth are to be replaced. With regard to time of implant placement, a one-stage procedure is preferred provided that high primary stability can be ensured.
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Costa F, Emanuelli E, Robiony M. Incidence of Maxillary Sinus Disease Before Sinus Floor Elevation Surgery as Identified by Cone-Beam Computed Tomography: A Literature Review. J ORAL IMPLANTOL 2017; 44:161-166. [PMID: 29116888 DOI: 10.1563/aaid-joi-d-17-00209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of this study is to review the literature to assess the incidence of maxillary sinus disease before sinus floor elevation surgery (SFE) as identified by cone-beam computerized tomography (CBCT). Only studies in which CBCT was performed in patients for dental implant placement in the past 10 years were considered. Eleven studies were identified. A total of 1792 patients were collected. All the studies reviewed reported on thickening of the sinus mucosa as a criterion for sinus disease with different threshold values. All studies reported mucosal thickening (MT) ranging between 25.5% and 93.1%. The mean incidence of MT was 54.99%. Two studies examined the correlation of MT with clinical symptoms. Three studies reported evaluation of the ostiomeatal complex (OMC). There is a high probability of detecting a certain degree of MT in patients referred for SFE. There is no consensus regarding the threshold values beyond which MT is considered pathological. Independently from the threshold values or the type of MT, the studies lack correlation with clinical data regarding patients' sinusitis-related history or symptoms. CBCT with a large field of view to evaluate the OMC is appropriate in patients scheduled for SFE. Future studies should include a systematic correlation with clinical symptoms and the possible presence of OMC obstruction. A clinical assessment that includes nasal endoscopy is indicated when MT and obstruction of the OMC are identified. Surgical correction of OMC obstruction seems to be appropriate to increase the success rate and to avoid possible complication after SFE.
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Affiliation(s)
- Fabio Costa
- 1 Maxillofacial Surgery Unit, Azienda Ospedaliero Universitaria of Udine, Udine, Italy
| | - Enzo Emanuelli
- 2 Department of Otorhinolaryngology and Otologic Surgery, Azienda Ospedaliera-Policlinico of Padova, Padova, Italy
| | - Massimo Robiony
- 3 Department of Medical and Biological Science, Azienda Ospedaliero Universitaria of Udine, University of Udine, Udine, Italy
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Monje A, Diaz KT, Aranda L, Insua A, Garcia-Nogales A, Wang HL. Schneiderian Membrane Thickness and Clinical Implications for Sinus Augmentation: A Systematic Review and Meta-Regression Analyses. J Periodontol 2016; 87:888-99. [PMID: 27086614 DOI: 10.1902/jop.2016.160041] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Schneiderian membrane thickness (SMT) has been regarded as a key factor for influencing membrane perforation, which may jeopardize the final clinical outcome of sinus augmentation. Hence, this systematic review aims at studying the mean SMT and further investigating patient-related factors that may affect SMT. As a secondary goal, the association between SMT and membrane perforation rate was studied. METHODS Three independent reviewers in several databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register databases, conducted electronic and manual literature searches. This review was written and conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and MECIR (Methodological Expectations of Cochrane Intervention Reviews) guidelines. Quantitative assessment was performed for articles that met the inclusion criteria to investigate the mean SMT, its contributing factors, and the influence on membrane damage and surgical complications. RESULTS Thirty-one studies that reported maxillary SMT were considered for qualitative analysis. Nineteen were further meta-analyzed. Overall mean ± SE SMT was 1.17 ± 0.1 mm (95% confidence interval [CI] = 0.89 to 1.44). Although mean SMT for the three-dimensional radiography (3DR) group was 1.33 mm (95% CI = 1.06 to 1.60), for the histology group, it was 0.48 mm (95% CI = 0.12 to 1.1). Random-effects model showed that, although there is a trend for thicker SMT as determined using 3DR compared with histologic analysis, such difference did not reach statistical significance (P = 0.15). Also, regression analyses demonstrated that the variables periodontitis (P = 0.13) and smoking (P = 0.11) showed thicker SMT. Inconclusive data were obtained when correlating SMT and perforation rate, although it seems that thicker SMT might be more prone to perforation (P = 0.14). CONCLUSIONS SMT is, on average, 1 mm in patients seeking sinus augmentation. Three-dimensional technologies overestimate approximately 2.5 times SMT when compared with histologic analysis. Periodontitis and smoking may result in thickening of the sinus membrane. However, current data were inconclusive to link SMT to the rate of membrane damage.
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Affiliation(s)
- Alberto Monje
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, MI
| | - Karla Tatiana Diaz
- Department of Oral Implantology, Cayetano Heredia Peruvian University, Lima, Perú
| | - Luisiana Aranda
- Department of Periodontology and Implant Dentistry, Cayetano Heredia Peruvian University
| | - Angel Insua
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, MI
| | | | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, MI
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Kuchler U, Chappuis V, Bornstein MM, Siewczyk M, Gruber R, Maestre L, Buser D. Development of Implant Stability Quotient values of implants placed with simultaneous sinus floor elevation - results of a prospective study with 109 implants. Clin Oral Implants Res 2016; 28:109-115. [DOI: 10.1111/clr.12768] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Ulrike Kuchler
- Department of Oral Surgery and Stomatology; University of Bern; Bern Switzerland
- Department of Oral Surgery; Medical University of Vienna; Vienna Austria
| | - Vivianne Chappuis
- Department of Oral Surgery and Stomatology; University of Bern; Bern Switzerland
| | - Michael M. Bornstein
- Department of Oral Surgery and Stomatology; University of Bern; Bern Switzerland
| | - Marta Siewczyk
- Department of Oral Surgery and Stomatology; University of Bern; Bern Switzerland
- Department of Reconstructive Dental Medicine and Gerodontology; School of Dental Medicine; University of Bern; Bern Switzerland
| | - Reinhard Gruber
- Laboratory of Oral Cell Biology; School of Dental Medicine; University of Bern; Bern Switzerland
- Department of Oral Biology; Medical University of Vienna; Vienna Austria
| | - Laura Maestre
- Department of Oral Surgery and Stomatology; University of Bern; Bern Switzerland
| | - Daniel Buser
- Department of Oral Surgery and Stomatology; University of Bern; Bern Switzerland
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Ananda GK, Nambiar P, Mutalik S, Shanmuhasuntharam P. Anatomical considerations for implant placements in first maxillary molar extracted sites in East Asian patients. Surg Radiol Anat 2015; 37:1099-108. [PMID: 25850735 DOI: 10.1007/s00276-015-1473-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/27/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE With the advent of cone-beam computed tomography (CBCT) for maxillofacial imaging, there has been a paradigm shift from two dimensional panoramic radiography to three dimensional imaging. This study investigated the microanatomy of the maxillary permanent first molar socket and its relationship to the floor of the maxillary sinus, especially for immediate or early implant placement. MATERIALS AND RESULTS Sixty CBCT scans of 30 Malay and 30 Chinese subjects were selected from over 300 archived images. Ninety-five percent of the subjects had sinus floor extending anterior to the first molar, while 72% had the floor dipping between the roots. Seventy-five percent of the patients had inter-radicular bone and almost 50% had intrusion of root apices into the floor of the maxillary sinus. The dimensions of the socket were as follows: the mean width was 11.42 ± 0.86 mm; the mean length was 7.70 ± 0.56 mm; the mean height on the coronal plane was 6.48 ± 3.77 mm while on the sagittal plane it was 6.85 ± 3.67 mm. CONCLUSIONS Any implant length greater than the mean height of the socket (approximately 7 mm) has a fair chance of perforation into the maxillary sinus if placed without any additional adjunct procedures. In addition, 50% of the apices opened into the maxillary sinus, thereby risking the creation of perforations or root displacements into the maxillary sinus during exodontia-mandating CBCT scanning prior to any surgical implant procedures.
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Affiliation(s)
- G K Ananda
- Department of Oral and Maxillofacial Surgery, Enche' Besar Hajjah Khalsom Hospital, Kluang, Johore, Malaysia
| | - Phrabhakaran Nambiar
- Department of Diagnostic and Integrated Dental Practice, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Sunil Mutalik
- School of Dentistry, International Medical University, Bukit Jalil, Malaysia
| | - Palasuntharam Shanmuhasuntharam
- Department of Oro-Maxillofacial Surgical and Medical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
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Monteiro DR, Silva EVF, Pellizzer EP, Filho OM, Goiato MC. Posterior partially edentulous jaws, planning a rehabilitation with dental implants. World J Clin Cases 2015; 3:65-76. [PMID: 25610852 PMCID: PMC4295221 DOI: 10.12998/wjcc.v3.i1.65] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 07/22/2014] [Accepted: 12/10/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To discuss important characteristics of the use of dental implants in posterior quadrants and the rehabilitation planning.
METHODS: An electronic search of English articles was conducted on MEDLINE (PubMed) from 1990 up to the period of March 2014. The key terms were dental implants and posterior jaws, dental implants/treatment planning and posterior maxilla, and dental implants/treatment planning and posterior mandible. No exclusion criteria were used for the initial search. Clinical trials, randomized and non randomized studies, classical and comparative studies, multicenter studies, in vitro and in vivo studies, case reports, longitudinal studies and reviews of the literature were included in this review.
RESULTS: One hundred and fifty-two articles met the inclusion criteria of treatment planning of dental implants in posterior jaw and were read in their entirety. The selected articles were categorized with respect to their context on space for restoration, anatomic considerations (bone quantity and density), radiographic techniques, implant selection (number, position, diameter and surface), tilted and pterygoid implants, short implants, occlusal considerations, and success rates of implants placed in the posterior region. The results derived from the review process were described under several different topic headings to give readers a clear overview of the literature. In general, it was observed that the use of dental implants in posterior region requires a careful treatment plan. It is important that the practitioner has knowledge about the theme to evaluate the treatment parameters.
CONCLUSION: The use of implants to restore the posterior arch presents many challenges and requires a detailed treatment planning.
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Al-Dajani M. Recent Trends in Sinus Lift Surgery and Their Clinical Implications. Clin Implant Dent Relat Res 2014; 18:204-12. [PMID: 25274014 DOI: 10.1111/cid.12275] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Sinus lift procedures are used to allow residual bone to accommodate functional implants in atrophic posterior maxilla. Numerous anatomical and surgical advancements in sinus lift surgery are still inspiring clinicians. PURPOSE The purpose of this study was to describe the recent trends in sinus lift surgery focusing on implant survival, bone grafting, anatomical and surgical considerations, and their clinical implications on the practice of implant dentistry in atrophic posterior maxilla. MATERIALS AND METHODS We performed an extensive search in MEDLINE, Embase, Scopus, Web of Science, Trip, Cochrane Oral Health Group's Trials Register, Cochrane Central Register of Controlled Trials, and ProQuest Dissertations & Theses. Articles were critically reviewed to determine the level of evidence as per the Canadian Task Force on Preventive Health Care. RESULTS Comprehensive assessment of sinus septa, sinus pathology, and bone quality and quantity using three-dimensional cone beam computed tomography radiographs is important before placing implants in posterior maxilla. With a residual bone height of less than 5 mm, the survival rate of implant decreases substantially. Lateral window approach can increase the vertical bone height to greater than 9 mm, while osteotome approach can increase this height from 3 to 9 mm. The perforation of Schneiderian membrane doubles the risk for the incidence of sinusitis or infection. The use of piezoelectric surgery allows adequate sinus lift while protecting soft tissues and minimizing patient discomfort. CONCLUSIONS Although both osteotome and lateral window procedures can help clinicians in overcoming the challenges of placing implants in atrophic posterior maxilla, pre-implant residual bone height is crucial in determining the survival of these implants. Future research directions should consider study designs grounded on longitudinal randomized controlled trials of large sample size.
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Tsai CY, Garaicoa-Pazmino C, Mori K, Benavides E, Kaigler D, Kapila Y. Implant success remains high despite grafting voids in the maxillary sinus. Clin Oral Implants Res 2014; 26:447-453. [PMID: 24720484 DOI: 10.1111/clr.12386] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Given that the nature and presence of voids present within grafted sinuses following maxillary sinus elevation procedures were not known, nor was the contribution of these factors to implant success, the purpose of this study was to investigate these parameters and their relationship to implant success. MATERIALS AND METHODS This study evaluated data from 25 subjects who had a lateral window maxillary sinus augmentation procedure. Cone-beam computed tomography (CBCT) was performed at baseline and 4 months after surgery. CBCT images were used to evaluate grafted sites prior to implant placement. Using CBCT images, three examiners independently measured bone-grafted areas (BG), void areas (V), and percentage of void areas (V%) from six different sections within grafted sites. The six sections were defined as a cross-sectional (CS) midpoint, CS mesial point, CS distal point, horizontal section (HS) low point, HS midpoint, and HS high point. Implant success was also determined. RESULTS The calculated V% (V/BG) for the CS midpoint, CS mesial point, CS distal point, HS low point, HS midpoint, and HS high point were 5.30 ± 6.67%, 5.79 ± 8.51%, 6.67 ± 7.12%, 2.07 ± 2.56%, 5.30 ± 6.62%, and 4.92 ± 5.17% respectively. Implant success after 6 months of follow-up approximated 100%. CONCLUSIONS Although voids within grafts varied in terms of distribution and size, the V% within the HS low point were significantly smaller compared to those within the CS midpoint and CS distal point, which had the most intra-subject V%. Thus, more attention should be given to the distal aspect of the sinus when compacting graft materials in the lateral wall sinus augmentation procedure. Implant success was not influenced by the existence of voids as implant success remained high.
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Affiliation(s)
- Ching-Yu Tsai
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Carlos Garaicoa-Pazmino
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Kuniyasu Mori
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Erika Benavides
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Darnell Kaigler
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Yvonne Kapila
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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Walter C, Dagassan-Berndt DC, Kühl S, Weiger R, Lang NP, Zitzmann NU. Is furcation involvement in maxillary molars a predictor for subsequent bone augmentation prior to implant placement? A pilot study. Clin Oral Implants Res 2013; 25:1352-8. [PMID: 24147971 DOI: 10.1111/clr.12275] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2013] [Indexed: 11/26/2022]
Abstract
AIM The aim of this pilot study was to analyze the interfurcal bone height in relation to the possible need for subsequent sinus floor elevation in patients with advanced periodontitis and furcation involvement of first and/or second maxillary molars. MATERIAL AND METHODS Seventeen dentate patients, who received cone beam computed tomography (CBCT) for detailed preoperative diagnosis and planning of surgical interventions at periodontally involved maxillary molars (17 first and 15 second molars), were consecutively recruited for the study. The minimal bone height in the interfurcal region was measured from CBCT and related to furcation involvement, residual bone above the root tips, and the clinical probing pocket depth (PPD). RESULTS The minimal interfurcal bone height measured 4.1 ± 2.6 mm on average with 75% of maxillary molars having ≤ 6 mm and almost 60% having only ≤ 4 mm bone height left below the sinus floor. A higher risk for reduced interfurcal bone height of ≤ 4 mm was given when residual PPD of ≥ 6 mm was remaining at two or more tooth sites (OR 0.10; 0.11). CONCLUSIONS The majority of periodontally involved maxillary molars had a substantially reduced interfurcal bone height, particularly with at least two sites with residual PPD ≥ 6 mm. This was a predictor for a subsequent need for sinus floor elevation when tooth replacement with a dental implant is desired.
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Affiliation(s)
- Clemens Walter
- Department of Periodontology, Endodontology and Cariology, University of Basel, Basel, Switzerland; Department of Oral Surgery, School of Dentistry, University of Birmingham, Birmingham, UK
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