Marc El Hage

Osteotome sinus floor elevation with and without grafting material in the severely atrophic maxilla. A 1-year prospective randomized controlled study

OBJECTIVES (1) To measure and compare endo-sinus bone levels around implants randomly placed with an osteotome sinus floor elevation (OSFE) procedure in grafted (control) and non-grafted (test) sinuses, (2) to evaluate the OSFE efficacy with short, tapered, and chemically modified hydrophilic surfaced implants in extremely atrophic maxillae, (3) to show that fused corticals may constitute a complication risk. MATERIAL AND METHODS The TE(®) SLActive 8 mm-long implants (Straumann AG) were placed using an OSFE procedure in 4 mm or less of bone height. Healing time before prosthetic rehabilitation was 10 weeks. One year after implant placement, bone levels were measured on standardized periapical radiographs. RESULTS Thirty-seven (17 tests, 20 controls) implants were placed in 12 patients with a mean maxillary residual bone height (RBH) of 2.4 ± 0.9 mm. Before loading, two control implants failed (RBH 1.4 and 1.2 mm); two others rotated at loading (one test, RBH 0.9 mm; one control, RBH 1.5 mm) but were uneventfully loaded after three additional months of healing. These adverse events and complications occurred when implants were placed in merged corticals. Endo-sinus bone gain was 3.9 ± 1.0 and 5.0 ± 1.3 mm for the test and control groups (P = 0.003). The 1-year success rate was 100% and 90%, respectively (P = 0.49). CONCLUSION Although more bone is gained when grafting material is used, this may not be required to promote endo-sinus bone gain. The OSFE procedure with or without grafting material could be efficient when the RBH is ≤ 4 mm. However, when both corticals merged, the risk of complication could increase.

Potential adverse events of endosseous dental implants penetrating the maxillary sinus: long-term clinical evaluation.

The aim of this study was to evaluate the nature and incidence of long‐term maxillary sinus adverse events related to endosseous implant placement with protrusion into the maxillary sinus.

Graft shrinkage and survival rate of implants after sinus floor elevation using a nanocrystalline hydroxyapatite embedded in silica gel matrix: a 1-year prospective study.

Objectives:The aims of this study were (1) to evaluate the vertical shrinkage percentage of nanocrystalline hydroxyapatite embedded in silica gel used for maxillary sinus floor elevation (SFE) and (2) to determine the survival rate of the implants 1 year after placement in the healed grafted sinuses. Materials and Methods:Eleven maxillary sinuses were augmented in eight patients with NanoBone. After a healing period averaging 14.42 months, 19 implants were placed and followed up with clinical and radiographic evaluation. Panoramic radiographs were taken immediately after SFE and at 12 months after grafting. Measurements of changes in height were made by a computerized measuring technique using an image editing software. Results:The mean graft height shrinkage percentage at 12 months after surgery was 8.84% (±5.32). One implant was lost before loading. All the 18 remaining osseointegrated implants received the prosthetic rehabilitation and were controlled after 3 months of functional loading. The implant survival rate at the 1-year interval was 94.74%. Conclusions:A 100% NanoBone alloplastic graft used in lateral SFE procedures presented limited height shrinkage. Implants placed in these grafted sinuses showed survival rates similar to those found in published data. These results should be interpreted cautiously considering the studys reduced sample size.

Paradigm Shift in the Management of the Atrophic Posterior Maxilla

When the posterior maxilla is atrophic, the reference standard of care would be to perform sinus augmentation with an autologous bone graft through the lateral approach and delayed implant placement. However, placement of short implants with the osteotome sinus floor elevation technique and without graft can be proposed for an efficient treatment of clinical cases with a maxillary residual bone height of 4 to 8 mm. The use of grafting material is recommended only when the residual bone height is ≤4 mm. Indications of the lateral sinus floor elevation are limited to cases with a residual bone height ≤ 2 mm and fused corticals, uncompleted healing of the edentulous site, and absence of flat cortical bone crest or when the patient wishes to wear a removable prosthesis during the healing period. The presented case report illustrates osteotome sinus floor elevation with and without grafting and simultaneous implant placement in extreme conditions: atrophic maxilla, short implant placement, reduced healing time, and single crown rehabilitation. After 6 years, all placed implants were functional with an endosinus bone gain.

Osteotome sinus floor elevation procedure for first molar single-gap implant rehabilitation: a case series.

Introduction:This case series describes single implant rehabilitation in the maxillary first molar sites. It aims to show the surgical approaches carried out versus the residual bone height (RBH) and to evaluate implant success rate and bone anchorage height after 1 year. Materials and Methods:Placement of 10-mm-long tapered bone level implants was carried out according to the RBH: when RBH ≥10 mm, standard implant placement; when 6 mm < RBH < 10 mm, osteotome sinus floor elevation procedure (OSFE) without graft; and, when RBH ⩽6 mm, OSFE with graft. Results:Fourteen patients received 15 implants in a mean RBH of 5.0 ± 2.4 mm (range, 2.0–11.0 mm). One implant was placed with a standard placement technique, 4 using OSFE without graft, and 10 using OSFE with graft. The 1-year success rate was 100%, and mean bone anchorage height reached at least 9.5 mm. Conclusions:Almost all cases of maxillary single implant rehabilitation might be performed by using OSFE. In the extremely atrophic maxilla, simultaneous grafting ensures implant embedding in bone.

Unusual Etiology and Diagnosis of Oroantral Communication due to Late Implant Failure

Oroantral communication (OAC) rarely occurs long after implant placement. The present report describes the rare etiology and the difficulty of the diagnosis of an uncommon OAC occurring 10 years after the implant placement in the posterior maxilla. The difficulty of the diagnosis lies in the absence of clinical symptoms of sinusitis and presence of multiunit prosthesis hiding implant failure. This case report supports the need for sinus check-up during a routine implant examination.

Impact of Digital Panoramic Radiograph Magnification on Vertical Measurement Accuracy

Objectives. The purpose of this panoramic radiography study was to assess the impact of image magnification on the accuracy of vertical measurements in the posterior mandible. Methods. Six dental implants, inserted in the posterior segments of a resin model, were used as reference objects. Two observers performed implant length measurements using a proprietary viewer with two preset image magnifications: the low (1.9 : 1) and the medium (3.4 : 1) image magnifications. They also measured the implant lengths in two Digital Imaging Communications in Medicine viewers set at low (1.9 : 1), medium (3.4 : 1), and high (10 : 1) image magnifications. Results. The error between the measured length and the real implant length was close to zero for all three viewers and image magnifications. The percentage of measurements equal to the real implant length was the highest (83.3%) for the high image magnification and below 30% for all viewers with the low image magnification. Conclusions. The high and medium image magnifications used in this study allowed accurate vertical measurements, with all three imaging programs, in the posterior segments of a mandibular model. This study suggests that a low image magnification should not be used for vertical measurements on digital panoramic radiographs when planning an implant in the posterior mandible.