Hydrodynamic Ultrasonic Sinus Floor Elevation—An Experimental Study in Sheep
01 May 2010-Journal of Oral and Maxillofacial Surgery (J Oral Maxillofac Surg)-Vol. 68, Iss: 5, pp 1125-1130
TL;DR: Hydrodynamic ultrasound could be used as an alternative method for sinus floor elevations of any size and volume with a mere 3-mm-diameter transcrestal approach, if findings from clinical investigations confirm the results of the present animal study.
About: This article is published in Journal of Oral and Maxillofacial Surgery.The article was published on 2010-05-01. It has received 32 citations till now.
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TL;DR: This study represented the first confirmation based on histomorphometric data that NFB after tSFE was strongly influenced by sinus width and occurred consistently only in narrow sinus cavities.
Abstract: OBJECTIVE The aim of this multicenter prospective study was to analyze clinically and histologically the influence of sinus cavity dimensions on new bone formation after transcrestal sinus floor elevation (tSFE). MATERIAL AND METHODS Patients needing maxillary sinus augmentation (residual crest height 15 mm), NFB percentages (36%, 13% and 3%, respectively) resulted significantly different. CONCLUSIONS This study represented the first confirmation based on histomorphometric data that NFB after tSFE was strongly influenced by sinus width and occurred consistently only in narrow sinus cavities (SW <12 mm, measured between buccal and palatal walls at 10-mm level, comprising the residual alveolar crest).
53 citations
TL;DR: The use of SHB alone or combined with aPRF seems to be favourable to achieve a superior (bio)mechanical stable restored alveolar bone.
Abstract: Introduction. Bone regenerates mainly by periosteal and endosteal humoral and cellular activity, which is given only little concern in surgical techniques and choice of bone grafts for guided bone regeneration. This study investigates on a clinical level the biomechanical stability of augmented sites in maxillary bone when a new class of moldable, self-hardening calcium-phosphate biomaterials (SHB) is used with and without the addition of Platelet Rich Fibrin (aPRF) in the Piezotome-enhanced subperiosteal tunnel-technique (PeSPTT). Material and Methods. 82 patients with horizontal atrophy of anterior maxillary crest were treated with PeSPTT and randomly assigned biphasic (60% HA/40% bTCP) or monophasic (100% bTCP) SHB without or with addition of aPRF. 109 implants were inserted into the augmented sites after 8.3 months and the insertion-torque-value (ITV) measured as clinical expression of the (bio)mechanical stability of the augmented bone and compared to ITVs of a prior study in sinus lifting. Results. Significant better results of (bio)mechanical stability almost by two-fold, expressed by higher ITVs compared to native bone, were achieved with the used biomaterials and more constant results with the addition of aPRF. Conclusion. The use of SHB alone or combined with aPRF seems to be favourable to achieve a superior (bio)mechanical stable restored alveolar bone.
39 citations
Additional excerpts
...Minimal invasive surgical techniques such as tHUCSLINTRALIFT [56] and the Piezotome-enhanced subperiosteal tunnel or pocket technique (PeSPTT) do not allow the use of autografted, xenogeneic, or synthetic solid bone blocks since they have to be stabilized by osteosynthesis screws....
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TL;DR: The results of this paper prove the key role of the sinus membrane as the main carrier of bone reformation after sinus lift procedures as multiple experimental studies suggested and the importance of minimal invasive and rupture free sinuslift procedures is underlined and does not depend on the type of grafting material used.
Abstract: Introduction. Sinus lift procedures are a commonly accepted method of bone augmentation in the lateral maxilla with clinically good results. Nevertheless the role of the Schneiderian membrane in the bone-reformation process is discussed controversially. Aim of this study was to prove the key role of the sinus membrane in bone reformation in vivo. Material and Methods. 14 patients were treated with the minimal invasive tHUCSL-Intralift, and 2 ccm collagenous sponges were inserted subantrally and the calcification process followed up with CBCT scans 4 and 7 months after surgery. Results. An even and circular centripetal calcification under the sinus membrane and the antral floor was detected 4 months after surgery covering 30% of the entire augmentation width/height/depth at each wall. The calcification process was completed in the entire augmentation volume after 7 months. A loss of approximately 13% of absolute augmentation height was detected between the 4th and 7th month. Discussion. The results of this paper prove the key role of the sinus membrane as the main carrier of bone reformation after sinus lift procedures as multiple experimental studies suggested. Thus the importance of minimal invasive and rupture free sinuslift procedures is underlined and does not depend on the type of grafting material used.
26 citations
TL;DR: The main advantage of this new technique, Intralift, is that it does not require a minimum amount of crestal bone and the possibility of damage to the sinus membrane is minimised by using ultrasound based hydrodynamic pressure to lift it, while applying a very non-aggressive crestal approach.
Abstract: Objectives: Placing implants in the posterior maxillary area has the drawback of working with scarce, poor quality bone in a significant percentage of cases. Numerous advanced surgical techniques have been developed to overcome the difficulties associated with these limitations. Subsequent to reports on the elevation of the maxillary sinus through the lateral approach, there were reports on the use of the crestal approach, which is less aggressive but requires a minimal amount of bone. Furthermore, it is more sensitive to operator technique, as the integrity of the sinus membrane is checked indirectly. The aim of this paper is to review the technical literature on minimally invasive sinus lift and compare the advantages of different techniques with Intralift™, a new technique. Study Design: The present study is a review of techniques used to perform minimally invasive sinus lift published in Cochrane, Embase and Medline over the past ten years and the description of the crestal sinus lift technique based on minimally invasive piezosurgery, with the example of a case report. Results: Only eight articles were found on minimally invasive techniques for sinus lift. The main advantage of this new technique, Intralift, is that it does not require a minimum amount of crestal bone (indeed, the smaller the width of the crestal bone, the better this technique is performed). The possibility of damage to the sinus membrane is minimised by using ultrasound based hydrodynamic pressure to lift it, while applying a very non-aggressive crestal approach. Conclusions: We believe that this technique is an advance in the search for less traumatic and aggressive techniques, which is the hallmark of current surgery.
Key words: Sinus lift, surgical technique, minimally invasive surgery, ultrasound surgery.
22 citations
TL;DR: The use of ultrasonic surgical devices in reductive rhinoplasty decreases postsurgical morbidity and increases overall patient satisfaction significantly and piezotomes to be the surgical instrument of choice not only for oral surgical procedures, but also for cosmetic surgery on facial bones.
22 citations
Cites background from "Hydrodynamic Ultrasonic Sinus Floor..."
...The rhythmic microscopic oscillating pressurewaves enable the precise and undisruptive separation of tissue layers and periosteum.(25,26)...
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References
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Journal Article•
TL;DR: The author concludes that the osteotome technique is superior to drilling for many applications in soft maxillary bone and allows more implants to be inserted in a greater variety of sites during a routine office procedure.
Abstract: This article reviews the limitations of drilling into soft bone to place endosseous implants. Differences among bone types and the anatomy of the maxilla are described. The osteotome technique, which is a new method of placing implants into maxillary bone without drilling, and the rationale for two other procedures, the osteotome sinus floor elevation and the ridge expansion osteotomy, are detailed. How osteotomes conserve osseous tissue and may improve bone density around the implant is also discussed. A pilot study that shows excellent results with several types of press-fit implants using the osteotome technique is provided. The author concludes that the osteotome technique is superior to drilling for many applications in soft maxillary bone. Furthermore, the osteotome technique allows more implants to be inserted in a greater variety of sites during a routine office procedure.
697 citations
TL;DR: Support is provided for a role of systemic bone loss in the development of tooth loss among postmenopausal women by contributing to the resorption of toothsupporting alveolar bone.
Abstract: Increased systemic bone loss may be a risk factor for tooth loss by contributing to the resorption of toothsupporting alveolar bone. Concurrent longitudinal associations between tooth loss and bone loss at the whole body, femoral neck, and spine were examined in 189 healthy, white, dentate, postmenopausal women who participated in three intervention trials conducted within a 7-year period. None of the subjects was taking estrogen. Bone mineral density (BMD) was measured by dual photon or dual energy X-ray absorptiometry. Teeth were counted at baseline; number and timing of teeth lost over the observation period were assessed by questionnaire. All analyses were controlled for years since menopause, body mass index, number of teeth at baseline, smoking status, and the assigned treatment during each study. These interventions were calcium (Ca) or placebo (P) in Study I, vitamin D+Ca or P+Ca in Study II, and 1 of 2 doses of vitamin D+Ca in Study III. Age at baseline (mean±SD) was 59±6 years and the number of teeth remaining was 23±7. Women who lost teeth during the 7-year follow-up (n=45) experienced less favorable changes in BMD at all sites compared with 144 women who lost no teeth (whole body mean±SE, -0.35±0.08%/year versus -0.11±0.05, P<0.01; femoral neck -0.48±0.38%/year versus -0.14±0.35, P<0.05; and spine, +0.05±0.21%/year versus +0.45±0.16, P<0.05). For each 1%/year decrement in BMD, relative risks (and 95% CI) of losing a tooth were significantly elevated at the whole body (RR=relative risks, CI=confidence interval) (RR=4.83, CI=1.72–13.52, n=180), femoral neck (1.50, 1.02 to 2.22, n=189), and spine (1.45, 1.00 to 2.11, n=167). These results provide support for a role of systemic bone loss in the development of tooth loss among postmenopausal women.
193 citations
"Hydrodynamic Ultrasonic Sinus Floor..." refers background in this paper
...( one loss occurs in the maxilla for varying reasons, ncluding failures in periodontal therapy,(1,2) orthodonic treatment,(3) and general bone diseases in adult atients.(4-6) Furthermore, the long-term success rate of sinus oor elevations is superior to that of onlay grafts in he maxilla....
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TL;DR: A marked increase in the prevalence of root resorption and alveolar bone loss occurred over the course of treatment and may be higher for incisors than in previously reported adolescent studies.
182 citations
TL;DR: A review of maxillary sinus floor elevation as an integral part of restoring the posterior maxilla is discussed and the related anatomy of the area and the current techniques available are reviewed.
Abstract: A review of maxillary sinus floor elevation as an integral part of restoring the posterior maxilla is discussed. The related anatomy of the area and the current techniques available are reviewed. The classic lateral antrostomy pioneered by Tatum appears to be the most common sinus lift procedure. The more conservative crestal approach, advocated by Summers, provides another effective way of allowing implant fixture placement in the atrophic maxilla.
144 citations
TL;DR: The experience suggests that hydraulic sinus condensing is a predictable and minimally invasive alternative for prosthetic rehabilitation of maxillary anterior and posterior regions in the presence of anatomical restrictions to implant placement.
Abstract: 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...
139 citations