Luigi Minenna

Transcrestal Sinus Floor Elevation With a Minimally Invasive Technique

BACKGROUND Recently, we proposed a minimally invasive technique to limit the postoperative morbidity of transcrestal sinus floor elevation procedures. The technique is based on the use of specially designed drills and osteotomes. The purpose of the present study is to present data on the clinical outcomes and postoperative morbidity of sinus floor elevation procedures performed using the proposed technique. METHODS Fourteen implants were placed in the posterior portions of the maxilla areas of 11 patients using the proposed technique. Postoperative pain and discomfort were assessed using a 100-mm visual analog scale (VAS). The incidences of intra- and postoperative complications were recorded. The position of the grafted sinus floor with respect to the implant apex was assessed on periapical radiographs 6 months post-surgery. RESULTS The augmented sites had a presurgery residual bone height of 6.1 mm, whereas the mean length of the implants inserted in augmented sites was 10.3 +/- 0.9 mm. Immediately after surgery, VAS scores for pain and discomfort were 9.4 +/- 13.4 and 17.0 +/- 22.2, respectively. The 7-day VAS score for pain was 2.1 +/- 4.9. No complications were observed during or after the surgical procedure. Six months after surgery, a newly formed mineralized tissue was found at or beyond the level of the implant apex in all cases. CONCLUSION The proposed technique represents a suitable option to elevate the sinus floor due to a predictable displacement of the sinus floor and a limited post-operative morbidity.

Minimally invasive transcrestal sinus floor elevation with deproteinized bovine bone or β‐tricalcium phosphate: a multicenter, double‐blind, randomized, controlled clinical trial

AIMS To evaluate the outcomes of transcrestal sinus floor elevation (tSFE) performed with a minimally invasive procedure (Smart Lift technique) combined with the additional use of deproteinized bovine bone mineral (DBBM) or β-tricalcium phosphate (β-TCP). METHODS In a multicenter randomized controlled trial, 38 sites in 38 patients were treated with the Smart Lift technique in association with DBBM (n = 19) or β-TCP (n = 19). The extent of the sinus lift (SL) and the height of the graft apical to the implant apex (aGH) were assessed on periapical radiographs taken immediately after surgery and at 6 months following surgery. RESULTS (i) Substantial aGH and SL were observed immediately after surgery and at 6 months, with no significant differences between DBBM and β-TCP groups; (ii) a significant graft remodelling was observed from post-surgery to 6-months in the β-TCP group and (iii) limited incidence of complications as well as limited post-operative pain and discomfort were associated with the use of both graft materials. CONCLUSIONS The Smart Lift technique in conjunction with the additional use of either DBBM or β-TCP may provide a substantial elevation of the maxillary sinus floor along with limited post-surgical complications and post-operative pain/discomfort.

Single-Flap Approach in Combination with Enamel Matrix Derivative in the Treatment of Periodontal Intraosseous Defects

Twenty-four periodontal intraosseous defects were accessed with a buccal single-flap approach (SFA) and treated with enamel matrix derivative (EMD) or EMD + deproteinized bovine bone mineral (DBBM) according to the surgeon,s discretion. EMD with or without DBBM was clinically effective in the treatment of periodontal intraosseous defects accessed with a buccal SFA. The adjunctive use of DBBM in predominantly one-wall defects seemed to compensate for, at least in part, the unfavorable osseous characteristics in terms of the outcomes of the procedure.

Change in the Gingival Margin Profile After the Single Flap Approach in Periodontal Intraosseous Defects

BACKGROUND The aim of the present study is to evaluate the association of patient-related and site-specific factors, as well as the adopted treatment modality, with the change in buccal (bREC) and interdental (iREC) gingival recession observed at 6 months after treatment of periodontal intraosseous defects with the single flap approach (SFA). METHODS Sixty-six patients contributing 74 intraosseous defects accessed with a buccal SFA and treated with different modalities were selected retrospectively. A two-level (patient and site) model was constructed, with the 6-month changes in bREC and iREC as the dependent variables. RESULTS (1) Significant 6-month increases in bREC (-0.6 ± 0.7 mm) and iREC (-0.9 ± 1.1 mm) were observed. (2) bREC change was significantly predicted by presurgery interproximal probing depth (PD) and depth of osseous dehiscence at the buccal aspect. (3) iREC change was significantly predicted by presurgery interproximal PD and the treatment modality, with defects treated with SFA in combination with a graft material and a bioactive agent being less prone to iREC increase compared to defects treated with SFA alone. CONCLUSIONS After buccal SFA, greater post-surgery increase in bREC must be expected for deep intraosseous defects associated with a buccal dehiscence. The combination of a graft material and a bioactive agent in adjunct to the SFA may limit the postoperative increase in iREC.

Learning Curve of a Minimally Invasive Technique for Transcrestal Sinus Floor Elevation: A Split-Group Analysis in a Prospective Case Series With Multiple Clinicians.

Aims:To assess the learning curve of a minimally invasive procedure for maxillary sinus floor elevation with a transcrestal approach (tSFE) and evaluate the influence of clinicians experience in implant surgery on its outcomes. Materials and Methods:Patients were treated by clinicians with different levels of experience in implant surgery and inexperienced with respect to the investigated tSFE technique. The initial (n = 13) and final (n = 13) groups treated by the expert clinician were compared for tSFE outcomes. Additionally, the high, moderate, and low groups (n = 20 each) treated by the expert, moderately experienced, and low experienced clinician, respectively, were compared. Results:(1) No significant differences in clinical and radiographic outcomes were observed between initial and final groups; (2) high, moderate, and low groups showed substantial vertical augmentation in limited operation time with treatment outcomes being influenced by the level of experience in implant surgery. Conclusions:The investigated technique allows for a substantial vertical augmentation at limited operation times when used by different clinicians. The extent of sinus lift (as radiographically assessed) seems to be influenced by the clinicians level of experience in implant dentistry.

Effect of a Connective Tissue Graft in Combination With a Single Flap Approach in the Regenerative Treatment of Intraosseous Defects

BACKGROUND In the attempt to limit the post-surgery increase in buccal gingival recession (bREC), effect of a connective tissue graft (CTG) when combined with a buccal single flap approach (SFA) in the regenerative treatment of intraosseous defects is evaluated. METHODS Data related to 30 patients with an intraosseous defect treated with a buccal SFA with (SFA+CTG group; n = 15) or without (SFA group; n = 15) placement of a CTG and regenerative treatment were retrospectively derived at three clinical centers. bREC and probing parameters were assessed at presurgery and 6 months post-surgery. RESULTS In addition to a significant attachment gain and probing depth reduction, adjunctive use of a CTG to a buccal SFA in the regenerative treatment of periodontal intraosseous defects associated with a buccal bone dehiscence resulted in a limited post-surgery bREC, a lower prevalence of defects with a clinically detectable apical displacement of the gingival margin, and an increase in gingival width and thickness. CONCLUSION Adjunctive use of a CTG in the regenerative treatment of intraosseous defects associated with buccal bone dehiscence accessed by buccal SFA may support the stability of the gingival profile.BACKGROUND In the attempt to limit the post-surgery increase in buccal gingival recession (bREC), effect of a connective tissue graft (CTG) when combined with a buccal single flap approach (SFA) in the regenerative treatment of intraosseous defects is evaluated. METHODS Data related to 30 patients with an intraosseous defect treated with a buccal SFA with (SFA+CTG group; n = 15) or without (SFA group; n = 15) placement of a CTG and regenerative treatment were retrospectively derived at three clinical centers. bREC and probing parameters were assessed at presurgery and 6 months post-surgery. RESULTS In addition to a significant attachment gain and probing depth reduction, adjunctive use of a CTG to a buccal SFA in the regenerative treatment of periodontal intraosseous defects associated with a buccal bone dehiscence resulted in a limited post-surgery bREC, a lower prevalence of defects with a clinically detectable apical displacement of the gingival margin, and an increase in gingival width and thickness. CONCLUSION Adjunctive use of a CTG in the regenerative treatment of intraosseous defects associated with buccal bone dehiscence accessed by buccal SFA may support the stability of the gingival profile.

Morbidity following transcrestal and lateral sinus floor elevation: A randomized trial

Abstract Aim To comparatively evaluate the morbidity following maxillary sinus floor elevation according to either transcrestal (tSFE) or lateral (lSFE) approach with concomitant implant placement. Materials & Methods Patients with ≥1 edentulous maxillary posterior site with residual bone height (RBH) of 3–6 mm were enrolled. tSFE was performed in association with a xenograft and a collagen matrix. For lSFE, the sinus was grafted with the xenograft, and the antrostomy was covered with a membrane. Implants were inserted concomitantly. The postoperative course was assessed through questionnaires. Pain level (VAS pain) was recorded using a 100‐mm visual analogue scale. Results Twenty‐nine and 28 patients were included in tSFE and lSFE group, respectively. On the day of surgery, VAS pain was significantly higher for tSFE compared to lSFE, and similar from day 1 to 14. tSFE was characterized by significantly lower incidence of swelling, bruising and nasal discharge/bleeding. Significantly less severe limitation in swallowing, continuing daily activities, eating, speaking, opening the mouth and going to school/work was found for tSFE only at specific postsurgery intervals. Conclusions lSFE was associated with lower pain on the day of surgery, and tSFE revealed lower postoperative morbidity as well as more tolerable postoperative course.

Regenerative Periodontal Treatment with the Single Flap Approach in Smokers and Nonsmokers

The present study was performed to evaluate the impact of smoking status on 6-month clinical outcomes of a regenerative procedure based on enamel matrix derivative and deproteinized bovine bone mineral in the treatment of intraosseous defects accessed with buccal single flap approach. A total of 22 defects were selected in smoking (n = 11) and nonsmoking (n = 11) patients. Regenerative treatment resulted in similar clinical attachment level (CAL) gain in both smokers and nonsmokers. A trend toward lower 6-month CAL gain and probing depth reduction was observed in patients smoking 11 to 20 cigarettes per day compared to those smoking 1 to 10 cigarettes per day.