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

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. Part II: transalveolar technique.

Smoking and dental implants: A systematic review and meta-analysis

Background: There are conflicting reports as to the association between smoking, radiotherapy, diabetes and osteoporosis and the risk of dental implant failure. We undertook a meta-analysis to evaluate the association between smoking, radiotherapy, diabetes and osteoporosis and the risk of dental implant failure. Methods: A comprehensive research on MEDLINE and EMBASE, up to January 2013, was conducted to identify potential studies. References of relevant studies were also searched. Screening, data extraction and quality assessment were conducted independently and in duplicate. A random-effects meta-analysis was used to pool estimates of relative risks (RRs) with 95% confidence intervals (CIs). Results: A total of 51 studies were identified in this meta-analysis, with more than 40,000 dental implants placed under riskthreatening conditions. The pooled RRs showed a direct association between smoking (n=33; RR=1.92; 95% CI, 1.67–2.21) and radiotherapy (n=16; RR=2.28; 95% CI, 1.49–3.51) and the risk of dental implant failure, whereas no inverse impact of diabetes (n=5; RR=0.90; 95% CI, 0.62–1.32) on the risk of dental implant failure was found. The influence of osteoporosis on the risk of dental implant failure was direct but not significant (n=4; RR=1.09; 95% CI, 0.79–1.52). The subgroup analysis indicated no influence of study design, geographical location, length of follow-up, sample size, or mean age of recruited patients. Conclusions: Smoking and radiotherapy were associated with an increased risk of dental implant failure. The relationship between diabetes and osteoporosis and the risk of implant failure warrant further study.

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Smoking, Radiotherapy, Diabetes and Osteoporosis as Risk Factors for Dental Implant Failure: A Meta-Analysis

OBJECTIVES: To evaluate the pattern of tissue remodeling after maxillary sinus floor elevation using the transalveolar osteotome technique with or without utilizing grafting materials. METHODS: During the period of 2000-2005, 252 Straumann dental implants were inserted using the transalveolar sinus floor elevation technique in a group of 181 patients. For 88 or 35% of those implants, deproteinized bovine bone mineral with a particle size of 0.25-1 mm was used as the grafting material, but for the remaining 164 implants, no grafting material was utilized. Periapical radiographs were obtained with a paralleling technique and digitized. Two investigators, who were blinded to whether grafting material was used or not, subsequently evaluated the pattern of tissue remodeling. RESULTS: The mean residual bone height was 7.5 mm (SD 2.2 mm), ranging from 2 to 12.7 mm. The mean residual bone height for implants placed with grafting material (6.4 mm) was significantly less compared with the implants installed without grafting material (8.1 mm). The implants penetrated on average 3.1 mm (SD 1.7 mm) into the sinus cavity. The measured mean radiographic bone gain using the transalveolar technique without grafting material was significantly less, 1.7 mm (SD 2 mm) compared with a mean bone gain of 4.1 mm (SD 2.4 mm), when grafting material was used. Furthermore, the probability of gaining 2 mm or more of new bone was 39.1% when no grafting material was used. The probability increased to 77.9% when the implants were installed with grafting material. CONCLUSION: When the transalveolar sinus floor elevation was performed without utilizing grafting material, only a moderate gain of new bone could be detected mesial and distal to the implants. On the other hand, when grafting material was used, a substantial gain of new bone was usually seen on the radiographs.

Transalveolar maxillary sinus floor elevation using osteotomes with or without grafting material. Part II: Radiographic tissue remodeling.

Background: For many clinicians, inadequate alveolar bone height and anatomical features of the maxillary sinus complicate sinus lift procedures and placement of endosseous implants. We present a new internal crestal approach that addresses these issues. Methods: Sinus burs and condensers of increasing width are used in conjunction with pliable atraumatic bone grafting mixture and hydraulic pressure from a surgical handpiece. The risk of a membrane perforation is minimized when the surgeon's tactile skill is administered in a two-stage process to first loosen and then graft bone particulate under the Schneiderian membrane. Threaded implants can then be placed in the same visit and secured via primary closure. Results: A retrospective investigation of 1,100 cases showed that eight implants failed and 14 required longer healing periods in patients with alveolar ridge heights varying between <1 to 5 mm. Conclusions: Our experience suggests that hydraulic sinus condensing is a predictable and minimally invasi...

An 8-year retrospective study: 1,100 patients receiving 1,557 implants using the minimally invasive hydraulic sinus condensing technique.

The purpose of this study was to determine the effect of cigarette smoking and residual native bone height on the survival of dental implants placed immediately in grafted sinuses. In this retrospective study, 334 subject records were screened, and 75 subjects (155 implants) were included. Data collection based on treatment notes and radiographs included age, sex, smoking status, sinus floor bone height, dental implant information, and implant survival. The survival rates of implants for nonsmokers and smokers at stage-two surgery were 93% and 84%, respectively. After 12 months of functional loading, the survival rates of implants for nonsmokers and smokers were 87% (81 of 93) and 79% (49 of 62), respectively (P < .000). Analysis revealed that the effect of smoking on implant survival is significant when the preoperative bone height is less than 4 mm, with an 82.4% implant survival rate in nonsmokers compared to 60% in smokers (P < .05). Smoking should be considered as a high risk factor when implants are placed immediately in grafted sinuses, particularly in areas of limited bone height.

https://www.dentalimplant-elearning.com/docs/documents/20120911094320_International_Journal_of_Periodontics_and_Restorative_Dentistry:_Volume_32,_Issue_3_(June_2012).pdf

The effect of cigarette smoking and native bone height on dental implants placed immediately in sinuses grafted by hydraulic condensation.

Different root coverage procedures have been used to treat cases of gingival recession defects involving single or multiple exposed root surfaces. A therapeutic advantage may be gained if periodontal regeneration is obtained in addition to coverage of the root with gingiva. This article describes the treatment of gingival recession by combining a surgical technique with an enamel matrix derivative.

Root coverage with enamel matrix derivatives.

The use of hydraulic force to condense bone particulate into the maxillary sinus is a predictable and less invasive method of site preparation for many, but not all, dental implant candidates. It is our approach in the primary indication for HSC--patients with advanced periodontitis in whom insufficient cortical bone at the alveolar ridge of the posterior maxilla stands as a detriment to effective implantation. A second indication for HSC accounts for those patients who suffer blood disorders or have sensitivities to certain medications, such as vasoconstrictors, and in whom it is crucial to manage bleeding during surgery. In these cases, changes in the armamentarium used for the procedure can effectively accommodate special needs. These clinical cases were followed for 10 years to show the continued success of the HSC technique.

Leon Chen

Papers

An 8-year retrospective study: 1,100 patients receiving 1,557 implants using the minimally invasive hydraulic sinus condensing technique.

The effect of cigarette smoking and native bone height on dental implants placed immediately in sinuses grafted by hydraulic condensation.

Root coverage with enamel matrix derivatives.

Two different clinical indications using hydraulic sinus condensing (HSC) technique: ten years follow-up.