Background:Grafting the floor of the maxillary sinus has become the most common surgical intervention for increasing alveolar bone height prior to the placement of endosseous dental implants in the posterior maxilla. Outcomes of this procedure may be affected by specific surgical techniques, simultaneous versus delayed implant placement, use of barrier membranes over the lateral window, selection of graft material, and the surface characteristics and the length and width of the implants. Rationale:The primary objective of this systematic review was to determine the efficacy of the sinus augmentation procedure and compare the results achieved with various surgical techniques, grafting materials, and implants. Focused Question: In patients requiring dental implant placement, what is the effect on implant survival of maxillary sinus augmentation versus implant placement in the non-grafted posterior maxilla? Search Protocol: MEDLINE, the Cochrane Oral Health Group Specialized Trials Register, and the Database...

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Effect of Maxillary Sinus Augmentation on the Survival of Endosseous Dental Implants. A Systematic Review

Objectives: The objectives of this systematic review were to assess the survival rate of implants placed in sites with transalveolar sinus floor elevation. Material and Methods: An electronic search was conducted to identify prospective and retrospective cohort studies on transalveolar sinus floor elevation, with a mean follow-up time of at least 1 year after functional loading. Failure and complication rates were analyzed using random-effects Poisson regression models to obtain summary estimates/ year proportions. Results: The search provided 849 titles. Full-text analysis was performed for 176 articles, resulting in 19 studies that met the inclusion criteria. Meta-analysis of these studies indicated an estimated annual failure rate of 2.48% (95% confidence interval (95% CI): 1.37‐4.49%) translating to an estimated survival rate of 92.8% (95% CI): 87.4‐96.0%) for implants placed in transalveolarly augmented sinuses, after 3 years in function. Furthermore, subject-based analysis revealed an estimated annual failure of 3.71% (95% CI: 1.21‐11.38%), translating to 10.5% (95% CI: 3.6‐28.9%) of the subjects experiencing implant loss over 3 years. Conclusion: Survival rates of implants placed in transalveolar sinus floor augmentation sites are comparable to those in non-augmented sites. This technique is predictable with a low incidence of complications during and post-operatively.

A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation

Purpose A variety of techniques and materials have been used to establish the structural base of osseous tissue for supporting dental implants. The aim of this systematic review was to identify the most successful technique(s) to provide the necessary alveolar bone to place a dental implant and support long-term survival. Methods A systematic online review of a main database and manual search of relevant articles from refereed journals were performed between 1980 and 2005. Updates and additions were made from September 2004 to May 2005. The hard tissue augmentation techniques were separated into 2 anatomic sites, the maxillary sinus and alveolar ridge. Within the alveolar ridge augmentation technique, different surgical approaches were identified and categorized, including guided bone regeneration (GBR), onlay/veneer grafting (OVG), combinations of onlay, veneer, interpositional inlay grafting (COG), distraction osteogenesis (DO), ridge splitting (RS), free and vascularized autografts for discontinuity defects (DD), mandibular interpositional grafting (MI), and socket preservation (SP). All identified articles were evaluated and screened by 2 independent reviewers to meet strict inclusion criteria. Articles meeting the inclusion criteria were further evaluated for data extraction. The initial search identified a total of 526 articles from the electronic database and manual search. Of these, 335 articles met the inclusion criteria after a review of the titles and abstracts. From the 335 articles, further review of the full text of the articles produced 90 articles that provided sufficient data for extraction and analysis. Results For the maxillary sinus grafting (SG) technique, the results showed a total of 5,128 implants placed, with follow-up times ranging from 12 to 102 months. Implant survival was 92% for implants placed into autogenous and autogenous/composite grafts, 93.3% for implants placed into allogeneic/nonautogenous composite grafts, 81% for implants placed into alloplast and alloplast/xenograft materials, and 95.6% for implants placed into xenograft materials alone. For alveolar ridge augmentation, a total of 2,620 implants were placed, with follow-up ranging from 5 to 74 months. The implant survival rate was 95.5% for GBR, 90.4% for OVG, 94.7% for DO, and 83.8% for COG. Other techniques, such as DD, RS, SP, and MI, were difficult to analyze because of the small sample size and data heterogeneity within and across studies. Conclusions The maxillary sinus augmentation procedure has been well documented, and the long-term clinical success/survival (> 5 years) of implants placed, regardless of graft material(s) used, compares favorably to implants placed conventionally, with no grafting procedure, as reported in other systematic reviews. Alveolar ridge augmentation techniques do not have detailed documentation or long-term follow-up studies, with the exception of GBR. However, studies that met the inclusion criteria seemed to be comparable and yielded favorable results in supporting dental implants. The alveolar ridge augmentation procedures may be more technique- and operator-experience-sensitive, and implant survival may be a function of residual bone supporting the dental implant rather than grafted bone. More in-depth, long-term, multicenter studies are required to provide further insight into augmentation procedures to support dental implant survival.

Which hard tissue augmentation techniques are the most successful in furnishing bony support for implant placement

Background: The advent of osseointegration and advances in biomaterials and techniques have contributed to increased application of dental implants in the restoration of partial and completely edentulous patients. Often, in these patients, soft and hard tissue defects result from a variety of causes, such as infection, trauma, and tooth loss. These create an anatomically less favorable foundation for ideal implant placement. For prosthetic-driven dental implant therapy, reconstruction of the alveolar bone through a variety of regenerative surgical procedures has become predictable; it may be necessary prior to implant placement or simultaneously at the time of implant surgery to provide a restoration with a good long-term prognosis. Regenerative procedures are used for socket preservation, sinus augmentation, and horizontal and vertical ridge augmentation.Methods: A broad overview of the published findings in the English literature related to various bone augmentation techniques is outlined. A comprehensi...

Bone augmentation techniques.

Objective Platelet-rich fibrin (PRF) belongs to a new generation of platelet concentrates, with simplified processing and without biochemical blood handling. The use of platelet gel to improve bone regeneration is a recent technique in implantology. However, the biologic properties and real effects of such products remain controversial. In this article, we therefore attempt to evaluate the potential of PRF in combination with freeze-dried bone allograft (FDBA) (Phœnix; TBF, France) to enhance bone regeneration in sinus floor elevation. Study design Nine sinus floor augmentations were performed. In 6 sites, PRF was added to FDBA particles (test group), and in 3 sites FDBA without PRF was used (control group). Four months later for the test group and 8 months later for the control group, bone specimens were harvested from the augmented region during the implant insertion procedure. These specimens were treated for histologic analysis. Results Histologic evaluations reveal the presence of residual bone surrounded by newly formed bone and connective tissue. After 4 months of healing time, histologic maturation of the test group appears to be identical to that of the control group after a period of 8 months. Moreover, the quantities of newly formed bone were equivalent between the 2 protocols. Conclusions Sinus floor augmentation with FDBA and PRF leads to a reduction of healing time prior to implant placement. From a histologic point of view, this healing time could be reduced to 4 months, but large-scale studies are still necessary to validate these first results.

Platelet-rich fibrin (PRF): A second-generation platelet concentrate. Part V: Histologic evaluations of PRF effects on bone allograft maturation in sinus lift

Boyne Pj

Papers

Grafting of the maxillary sinus floor with autogenous marrow and bone.