The transcrestal hydrodynamic ultrasonic cavitational sinuslift: Results of a 2-year prospective multicentre study on 404 patients, 446 sinuslift sites and 637 inserted implants
Aon1
01 Dec 2013-Open Journal of Stomatology (Scientific Research Publishing)-Vol. 03, Iss: 9, pp 471-485
TL;DR: The results suggest the tHUCSL to be a safe minimal-invasive alternative to traditional lateral approach and transcrestal osteotome sinuslift-procedures applicable to all anatomical situations.
Abstract: Introduction: In 2006 an ultrasound-surgery-based method to hydrodynamically detach the sinus-membrane utilizing the ultrasonic cavitation effect—the tHUCSL—was developed and a surgical protocol established. The aim of the study was to determine the indication-range and success-rate of this novelty procedure. Materials & Methods: Between 2007 and 2009, 404 patients were treated by 6 oral surgeons of different experience-levels with the tHUCSL in 446 sinussites. 637 implants were inserted and then prosthodontically treated and observed and documented until December 2011. The subantral space was augmented via the 3 mm transcrestal approach with an augmentation volume of 1.9 ccm (+/− 0.988 ccm) and an augmentation height of 10.7 mm (+/− 2.85 mm). Results: Within the survey-period 15 (2.35%) of the 637 inserted implants were lost, mostly before implant loading due to postsurgical infection and nonosseointegration in the augmentation site. 1 implant was lost after implant loading and prosthetic treatment within 1 year after loading. The overall success rate with functional implants in site is 97.65% evenly distributed among the participating surgeons. 86% of the patients were observed with no postsurgical swelling and 87% no postsurgical pain. Discussion: The results suggest the tHUCSL to be a safe minimal-invasive alternative to traditional lateral approach and transcrestal osteotome sinuslift-procedures applicable to all anatomical situations.
Citations
More filters
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
Cites background or result from "The transcrestal hydrodynamic ultra..."
...The consistent results of the present study in company with the results of prior similar studies [17, 33, 50, 51] seem to support the suggestion that utilizing Piezotome surgery for preparation of the augmentation site might be the first step to achieve constant high success rates and does not...
[...]
...Contrary, a proven clean periosteal detachment [7] provides higher and constant success-rates in sinus lifting [17] even in the less remodeling-active posterior maxilla [18]....
[...]
...Both from biological and physiological standpoint, sinus lift procedures, regardless if performed with lateral or transcrestal approach, technically have to be considered as “subperiosteal tunnel” or “pocket” techniques, creating a bonebased and enclosed subperiosteal scaffold for guided bone regeneration (GBR) without the need to raise a full thickness mucoperiosteal flap especially in transcrestal procedures [17]....
[...]
TL;DR: Within the limits of this study the results suggest self-hardening solid-block-like bone-graft-materials to achieve significantly better DTV/ITV than loose granulate biomaterials for its suspected improvement of vascularization and mineralization of the subantral scaffold by full immobilized of the augmentation site towards pressure changes in the human sinus at normal breathing.
Abstract: Implant-Insertion-Torque-Value (ITV) proved to be a significant clinical parameter to predict long term implant success-rates and to decide upon immediate loading. The study evaluated ITVs, when four different and commonly used biomaterials were used in sinuslift-procedures compared to natural subantral bone in two-stage-implant-procedures. The tHUCSL-INTRALIFT-method was chosen for sinuslifting in 155 sinuslift-sites for its minimal invasive transcrestal approach and scalable augmentation volume. Four different biomaterials were inserted randomly (easy-graft CRYSTAL n = 38, easy-graft CLASSIC n = 41, NanoBone n = 42, BioOss n = 34), 2 ccm in each case. After a mean healing period of 8,92 months uniform tapered screw Q2-implants were inserted and Drill-Torque-Values (DTV) and ITV were recorded and compared to a group of 36 subantral sites without need of sinuslifting. DTV/ITV were processed for statistics by ANOVA-tests. Mean DTV/ITV obtained in Ncm were: Control Group 10,2/22,2, Bio-Oss 12,7/26,2, NanoBone 17,5/33,3, easy-graft CLASSIC 20,3/45,9, easy-graft CRYSTAL 23,8/56,6 Ncm, significance-level of differences throughout p < 0,05. Within the limits of this study the results suggest self-hardening solid-block-like bone-graft-materials to achieve significantly better DTV/ITV than loose granulate biomaterials for its suspected improvement of vascularization and mineralization of the subantral scaffold by full immobilization of the augmentation site towards pressure changes in the human sinus at normal breathing.
20 citations
TL;DR: The results of the present study suggest tHUCSL-INTRALIFT should be used to perform predictable and safe detachment of the periosteum from the bony sinus floor as a prerequisite for undisturbed and successful physiologic subantral bone regeneration.
17 citations
TL;DR: Two different sealing techniques for sinus membrane perforations produced during sinus floor augmentation by a lateral approach yielded therapeutic success, according to retrospectively analyze two different surgical techniques.
Abstract: Background: The aim of this study was to retrospectively analyze two different sealing techniques for sinus membrane perforations produced during sinus floor augmentation by a lateral approach. Methods: A total of 172 lateral-approach sinus floor augmentation surgeries were performed on 130 patients. Sixty-one membrane perforations (35%) were reported. Most of the perforations were caused by accidental membrane tearing and 16 (26%) were caused by deliberate incision for mucocele removal. In 31 perforation cases (51%), the Schneiderian membrane was sealed by suturing, while the remaining 30 cases (49%) were sealed using a low-resorption collagen membrane coverage. Results: Out of the 31 cases treated with a suture-sealing techniques, 26 (84%) were successful, presenting graft integration. Failure occurred in the other five (16%) cases. Out of the 30 perforations sealed with low-resorption collagen membranes, 28 (93%) presented successful graft integration, while two (7%) failed. Conclusions: Both surgical techniques yielded therapeutic success.
12 citations
17 Oct 2015
TL;DR: The combination of postextraction ridge resorption and pneumatization of the maxillary sinus often limits the bone available for implant placement in the posterior maxilla, and the lateral and transcrestal approaches to sinus floor elevation (SFE) and augmentation can reproduce adequate subantral bone volumes for implant-supported rehabilitation in this region.
Abstract: The combination of postextraction ridge resorption [1] and pneumatization of the maxillary sinus [2, 3] often limits the bone available for implant placement in the posterior maxilla. Fortunately, the lateral and transcrestal approaches to sinus floor elevation (SFE) and augmentation can reproduce adequate subantral bone volumes for implant-supported rehabilitation in this region. The lateral window osteotomy (LWO) is the most frequently invoked method, providing ready access to the sinus, significant elevation of the floor, and creation of sufficient bone volume to provide long-term support for implants in the posterior maxilla [4–11]. However, this technique can be quite aggressive and often patients would prefer an option that stresses a less invasive (LI) approach. The LI transcrestal approach for SFE was first suggested by Tatum [12] and later developed as an osteotome technique by Summers [13, 14]. Summers’ boneadded osteotome sinus floor elevation (BAOSFE) procedure uses tapered concave-tipped osteotomes to reposition existing crestal bone under the sinus along with graft materials, elevating the sinus floor and increasing osseous support for the simultaneously placed implant [14] (Figs. 20.1 and 20.2). BAOSFE was recommended for patients with at least 5.0–6.0 mm of residual subantral bone height (RSBH). A number of case series reports [15–21] attest to the success of this procedure, furthering its popularity amongst clinicians. It was originally suggested that grafting material be used in combination with osteotome-mediated sinus floor elevation (OMSFE) to facilitate the postulated
8 citations
References
More filters
Journal Article•
1,378 citations
"The transcrestal hydrodynamic ultra..." refers background in this paper
...Various surgical techniques have been developed, described and scientifically evaluated over the centuries with clinically good results [1-10]....
[...]
...Therefore, sinuslift procedures also follow the trend from massive invasive surgical protocols with a lateral approach and lateral window preparation [1-3] towards minimal invasive ultrasound surgical techniques [34] based on the idea of the minimal invasive transcrestal approach [4,5]....
[...]
Journal Article•
TL;DR: The root and sinus series of the Omnii system have been used extensively and their design attempts to maximize the use of the available bone, and placement techniques allow the manipulation of bone to form sockets in otherwise deficient areas of bone.
1,350 citations
"The transcrestal hydrodynamic ultra..." refers background in this paper
...Various surgical techniques have been developed, described and scientifically evaluated over the centuries with clinically good results [1-10]....
[...]
...Therefore, sinuslift procedures also follow the trend from massive invasive surgical protocols with a lateral approach and lateral window preparation [1-3] towards minimal invasive ultrasound surgical techniques [34] based on the idea of the minimal invasive transcrestal approach [4,5]....
[...]
TL;DR: The implant survival rates reported in this systematic review compare favorably to reported survival rates for implants placed in the non-grafted posterior maxilla, and rough-surfaced implants have a higher survival rate than machine-surfacing implants when placed in grafted sinuses.
Abstract: 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...
858 citations
"The transcrestal hydrodynamic ultra..." refers background in this paper
...Nevertheless a survey over the current literature and systematic reviews [20] suggests the success of sinus floor augmentation procedures to be related more to the medical history of the augmented sinus and the skills of the surgeon than the used bone graft material [21]....
[...]
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
"The transcrestal hydrodynamic ultra..." refers background in this paper
...Various surgical techniques have been developed, described and scientifically evaluated over the centuries with clinically good results [1-10]....
[...]
...Therefore, sinuslift procedures also follow the trend from massive invasive surgical protocols with a lateral approach and lateral window preparation [1-3] towards minimal invasive ultrasound surgical techniques [34] based on the idea of the minimal invasive transcrestal approach [4,5]....
[...]
TL;DR: Obstruction of the antro-nasal foramen is, due to its high location, not a likely complication, nor is the occurrence of severe haemorrhages since the trap door is in the periphery of the supplying vessels.
Abstract: Inadequate bone height in the lateral part of the maxilla forms a contra-indication for implant surgery. This condition can be treated with an internal augmentation of the maxillary sinus floor. This sinus floor elevation, formerly called sinus lifting, consists of a surgical procedure in which a top hinge door in the lateral maxillary sinus wall is prepared and internally rotated to a horizontal position. The new elevated sinus floor, together with the inner maxillary mucosa, will create a space that can be filled with graft material. Sinus lift procedures depend greatly on fragile structures and anatomical variations. The variety of anatomical modalities in shape of the inner aspect of the maxillary sinus defines the surgical approach. Conditions such as sinus floor convolutions, sinus septum, transient mucosa swelling and narrow sinus may form a (usually relative) contra-indication for sinus floor elevation. Absolute contra-indications are maxillary sinus diseases (tumors) and destructive former sinus surgery (like the Caldwell-Luc operation). The lateral sinus wall is usually a thin bone plate, which is easily penetrated with rotating or sharp instruments. The fragile Schneiderian membrane plays an important role for the containment of the bonegraft. The surgical procedure of preparing the trap door and luxating it, together with the preparation of the sinus mucosa, may cause a mucosa tear. Usually, when these perforations are not too large, they will fold together when turning the trap door inward and upward, or they can be glued with a fibrin sealant, or they can be covered with a resorbable membrane. If the perforation is too large, a cortico-spongious block graft can be considered. However, in most cases the sinus floor elevation will be deleted. Perforations may also occur due to irregularities in the sinus floor or even due to immediate contact of sinus mucosa with oral mucosa. Obstruction of the antro-nasal foramen is, due to its high location, not a likely complication, nor is the occurrence of severe haemorrhages since the trap door is in the periphery of the supplying vessels. Apart from these two aspects, a number of anatomical considerations are described in connection with sinus floor elevation.
470 citations
"The transcrestal hydrodynamic ultra..." refers background in this paper
...Various authors published different results and preferences on the grafting material subantrally inserted (autologous, heterologous, xenogenic, allogenic bone, synthetic bone grafts) [11-19]....
[...]