Nathalie Nurdin

Osteotome sinus floor elevation technique without grafting material: 3-year results of a prospective pilot study

OBJECTIVE In a prospective pilot study, short< or =10 mm ITI-SLA implants were placed in the resorbed posterior maxilla by means of an osteotome sinus floor elevation (OSFE) procedure without grafting material. This paper presents 3-year data assessing bone-level changes around implants. MATERIAL AND METHODS Twenty-five implants were placed in 17 patients to rehabilitate 16 molar and nine premolar sites. The mean residual bone height (RBH) was 5.4 +/- 2.3 mm. A healing period of 3-4 months was allowed before abutment tightening. Most implants (21/25) were 10 mm long, and the others were 8 and 6 mm long. At the 3-year control, endo-sinus bone gain, implant length protruding into the sinus and crestal bone loss (CBL) were measured on periapical radiographs. RESULTS All implants fulfilled the survival criteria. Despite the absence of grafting material, implants were embedded into newly formed bone tissue. All implants gained endo-sinus bone; the mean gained bone was 3.1 +/- 1.5 mm. The residual protrusion length decreased from 4.9 +/- 2.1 to 1.8 +/- 2.1 mm. CBL was 0.9 +/- 0.8 mm. CONCLUSIONS This study confirms that the OSFE procedure without grafting material is sufficient to create bone beyond the natural limit of the sinus. On the mid-term of 3 years, the technique was found to be predictable in the posterior maxilla when the RBH is limited. Implants gained endo-sinus bone despite the lack of grafting material. Bone gain was still improving over the first-year control. No shrinkage of the augmented area was observed.

Osteotome sinus floor elevation technique without grafting: a 5-year prospective study

AIM To evaluate the long-term stability of peri-implant bone formation following implant placement without grafting into resorbed posterior maxillae. MATERIALS AND METHODS Twenty-five implants of 10 mm were placed in 17 patients to rehabilitate atrophic maxillae by means of an osteotome sinus floor elevation (OSFE) procedure without grafting. Mean residual bone height was 5.4±2.3mm. Bone levels were evaluated at 1, 3 and 5 years using periapical radiographs. RESULTS All implants fulfilled survival criteria and gained peri-implant bone (mean increase 3.2±1.3mm). Implant protrusion into the sinus decreased from 4.9±1.9mm after surgery to 1.5±0.9mm after 5 years. Mean crestal bone loss amounting to 0.8±0.8mm stabilized over the 5-year observation interval. Twenty implants showed additional peri-implant bone gain following the 1-year control. CONCLUSIONS Implant rehabilitation of atrophic maxillae may be greatly simplified using implants 10mm and the OSFE technique without grafting. Grafting material is not needed to gain at least 3mm of bone in the atrophic maxilla. The procedure appears predictable with favourable long-term results.

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.

Short Implants Placed with or without Grafting in Atrophic Sinuses: The 3‐Year Results of a Prospective Randomized Controlled Study

BACKGROUND The question whether a minimal maxillary residual bone height (RBH) allows the predictable use of osteotome sinus floor elevation (OSFE) remains unresolved. PURPOSE To evaluate the efficacy of short implants placed with OSFE in an RBH of ≤4 mm and to compare bone levels around implants placed with (control) or without (test) grafting after 3 years. MATERIALS AND METHODS Eight-millimeter implants were placed by OSFE in sinuses randomized to receive anorganic bovine bone or no grafting material. Healing time before prosthetic rehabilitation was 10 weeks. Peri-implant bone levels were measured on standardized periapical radiographs. RESULTS Thirty-seven implants (17 test, 20 control) were placed at a mean RBH of 2.4 ± 0.9 mm. Three implants failed during the 3-year follow-up. After 3 years, all implants had gained endosinus bone (test: 4.1 ± 1.0 mm; control: 5.1 ± 1.2 mm; p = .001). Mean bone gain was stable between 1 and 3 years in both groups. CONCLUSIONS Grafting is unnecessary to achieve bone augmentation of 4.1 mm; however, more bone is gained with grafting. Bone gained over 1 year was retained. Atrophic posterior maxillae can be predictably rehabilitated using OSFE and simultaneous placement of 8-mm implants.Background The question whether a minimal maxillary residual bone height (RBH) allows the predictable use of osteotome sinus floor elevation (OSFE) remains unresolved. Purpose To evaluate the efficacy of short implants placed with OSFE in an RBH of ≤4 mm and to compare bone levels around implants placed with (control) or without (test) grafting after 3 years. Materials and Methods Eight-millimeter implants were placed by OSFE in sinuses randomized to receive anorganic bovine bone or no grafting material. Healing time before prosthetic rehabilitation was 10 weeks. Peri-implant bone levels were measured on standardized periapical radiographs. Results Thirty-seven implants (17 test, 20 control) were placed at a mean RBH of 2.4 ± 0.9 mm. Three implants failed during the 3-year follow-up. After 3 years, all implants had gained endosinus bone (test: 4.1 ± 1.0 mm; control: 5.1 ± 1.2 mm; p = .001). Mean bone gain was stable between 1 and 3 years in both groups. Conclusions Grafting is unnecessary to achieve bone augmentation of 4.1 mm; however, more bone is gained with grafting. Bone gained over 1 year was retained. Atrophic posterior maxillae can be predictably rehabilitated using OSFE and simultaneous placement of 8-mm implants.

Osteotome Sinus Floor Elevation Technique Without Grafting Material and Immediate Implant Placement in Atrophic Posterior Maxilla: Report of 2 Cases

PURPOSE This case report discusses 2 patients who required implant placement in the atrophic posterior maxilla to support a fixed prosthesis with the least invasive and shortest procedure. MATERIALS AND METHODS The reference standard of care would be to perform sinus augmentation with an autologous bone graft through the lateral approach with delayed implant placement. However, in these cases, the posterior maxillas were treated with an osteotome sinus floor elevation procedure without grafting material and simultaneous placement of short, 8- and 10-mm-long, tapered implants. RESULTS All implants achieved primary stability and were successfully loaded after 3.6 months of healing. At the 1- and 2-year follow-up visits, they were clinically stable and the final prostheses were functioning. The mean endosinus bone gain was 5.1 +/- 1.3 mm. In 1 of the patients, the implants were completely embedded in the newly formed bone and the sinus floor had been relocated apical to its previous demarcation. CONCLUSIONS The findings from these 2 cases suggest that the osteotome sinus floor elevation procedure without grafting material, and immediate placement of tapered implants, might be applied in situations for which previously only the lateral approach was considered (at the condition that implants achieve firm primary stability). More patients and longer follow-up are warranted to investigate how reliable this technique can be when applied to the atrophic maxilla.

Osteotome Sinus Floor Elevation without Grafting: A 10-Year Prospective Study

BACKGROUND Little is known about the long-term outcome of implants placed in the atrophic maxilla using osteotome sinus floor elevation (OSFE) without grafting. PURPOSE The study aims to evaluate the long-term efficiency of the procedure and stability of the peri-implant bone formed following implant placement without grafting into resorbed posterior maxilla. MATERIALS AND METHODS Twenty-five implants (≤10 mm in length) were placed in 17 patients using OSFE without grafting. The mean residual bone height was 5.4 ± 2.3 mm. Bone levels were evaluated at 1, 3, 5, and 10 years using periapical radiographs. RESULTS Fifteen patients (23 implants) participated in the 10-year examination. All implants fulfilled the survival criteria. Following surgery, the implant sites gained endo-sinus bone (mean: 3.0 ± 1.4 mm). The mean crestal bone loss (CBL) was limited to 1.0 ± 0.9 mm. The difference in mean endo-sinus bone gain and CBL was statistically significant between 1 and 10 years, but not between 3 and 5, 3 and 10, and 5 and 10 years. CONCLUSIONS At 10 years, the implant survival rate was 100%. Endo-sinus bone was mainly gained during the first year. This study demonstrates the long-term predictability of OSFE without grafting and simultaneous implant placement.

A 5‐ to 6‐year radiological evaluation of titanium plasma sprayed/sandblasted and acid‐etched implants: results from private practice

OBJECTIVES This study aimed to determine bone level changes after 5-6 years of follow-up for a large group of one-stage dental implants consecutively placed in private practice. Potential confounding factors influencing crestal bone loss (CBL) were also assessed. MATERIALS AND METHODS A total of 378 transmucosal Straumann implants in 174 patients were examined radiographically. Half of the study population (189 implants) had a titanium plasma sprayed (TPS) surface, and the other half (189 implants) were sandblasted and acid-etched (SLA). Mean CBL was measured from 5 to 6 years post-operative radiographs on the basis of known implant landmarks. Correlations of increased CBL with various independent variables were also investigated. Statistical analyses were performed using generalized estimating equations. RESULTS Radiographic measurements showed a CBL ≤ 1.5 mm for 65% of studied implants. A CBL > 1.5 mm was found for 28% of implants, while 7% of implants had a CBL ≥ 3 mm. Three factors significantly influenced CBL (P < 0.05): implant surface texture (TPS > SLA), smoking status (smokers > non-smokers), and implant location (anterior > posterior). CONCLUSIONS CBL was ≤1.5 mm after 5-6 years for the majority of followed implants. For implants with a CBL > 1.5 mm, statistically significant correlations were found for TPS surface type, anterior jaw locations, and smoking. Implant length did not influence CBL.

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.