Evaluation of bone formation following the osteotome sinus floor elevation technique without grafting using cone beam computed tomography: a preliminary study

Panapohn Suk-Arj, Chanchai Wongchuensoontorn, Patrayu Taebunpakul, Panapohn Suk-Arj, Chanchai Wongchuensoontorn, Patrayu Taebunpakul

Abstract

Background: Osteotome sinus floor elevation (OSFE) is used to increase the bone volume at the site of the maxillary sinus through the transalveolar approach. However, there is uncertainty regarding the necessity of the use of grafting material in order to maintain the space for new bone formation.

Objective: This study aimed to evaluate new bone formation 6 months after osteotome sinus floor elevation without grafting and to evaluate the correlations between residual bone height (RBH), implant protrusion length (IPL), and endo-sinus bone gain (ESBG).

Material and methods: Thirty-one implants (27 patients) from area 14-17 and 24-27 were included in the study. All implants had a history of OSFE without grafting, with cone beam computed tomography (CBCT) taken prior to the surgery. The clinical examination and radiographic examination using CBCT were performed again 6 months after implantation. The RBH, new bone level, ESBG, and IPL were measured. Paired sample t test and Pearson correlation were used to analyze the data.

Results: The average RBH before surgery was 7.14 ± 1.07 mm and 6 months after surgery was 8.95 ± 1.17 mm. There was a significant increase in new bone formation in the 6 months following surgery (p < 0.05). The average ESBG and IPL were 1.8 ± 0.79 mm and 2.02 ± 0.73 mm, respectively. There was a significant positive correlation between the IPL and ESBG (p < 0.05) while there was a negative correlation between RBH and ESBG. This study also demonstrates a decrease in the percentage of bone formation in relation to IPL as the IPL increases. The survival rate of the implant was 100%.

Conclusion: Significant new bone formation can be detected around the implant site 6 months after implantation using OSFE technique without grafting. There is a negative correlation between the RBH and ESBG. While IPL is correlated to ESBG and appears to be the influencing factors of bone formation changes in the maxillary sinus. The preliminary radiographic results suggest that OSFE technique without grafting in combination with optimal IPL can provide sufficient bone height for implant support with a 100% implant survival rate.

Keywords: Endo-sinus bone gain; Implant protrusion; Sinus lift.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Case 1: The CBCT images of implant site 16 before (left column) and 6 months after surgery (right column). The residual bone height (RBH) was measured from the cortex bone to the alveolar bone crest under the sinus floor in a coronal and c sagittal views. The new bone level was measured from the most coronal implant thread to the most apical visible implant at b buccal and palatal sites in coronal view and d mesial and distal sites in sagittal view
Fig. 2
Fig. 2
Case 2: The CBCT images of implant site 16 before (left column) and 6 months after surgery (right column). The residual bone height (RBH) was measured from the cortex bone to the alveolar bone crest under the sinus floor in a coronal and c sagittal views. The new bone level was measured from the most coronal implant thread to the most apical visible implant at b buccal and palatal sites in coronal view and d mesial and distal sites in sagittal view
Fig. 3
Fig. 3
The endo-sinus bone gain in relation to implant protrusion length in a the coronal view and b sagittal view

References

    1. Pjetursson BE, Tan WC, Zwahlen M, Lang NP. A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation. J Clin Periodontol. 2008;35(8 Suppl):216–240. doi: 10.1111/j.1600-051X.2008.01272.x.
    1. Krekmanov L, Kahn M, Rangert B, Lindstrom H. Tilting of posterior mandibular and maxillary implants for improved prosthesis support. Int J Oral Maxillofac Implants. 2000;15(3):405–414.
    1. Anitua E, Orive G, Aguirre JJ, Andia I. Five-year clinical evaluation of short dental implants placed in posterior areas: a retrospective study. J Periodontol. 2008;79(1):42–48. doi: 10.1902/jop.2008.070142.
    1. Jensen OT, Shulman LB, Block MS, Iacono VJ. Report of the sinus consensus conference of 1996. Int J Oral Maxillofac Implants. 1998;13(Suppl):11–45.
    1. Zitzmann NU, Scharer P. Sinus elevation procedures in the resorbed posterior maxilla. Comparison of the crestal and lateral approaches. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85(1):8–17. doi: 10.1016/S1079-2104(98)90391-2.
    1. Jensen SS, Terheyden H. Bone augmentation procedures in localized defects in the alveolar ridge: clinical results with different bone grafts and bone-substitute materials. Int J Oral Maxillofac Implants. 2009;24(Suppl):218–236.
    1. Chiapasco M, Casentini P, Zaniboni M. Bone augmentation procedures in implant dentistry. Int J Oral Maxillofac Implants. 2009;24(Suppl):237–259.
    1. Summers RB. A new concept in maxillary implant surgery: the osteotome technique. Compendium. 1994;15(2):152.
    1. Summers RB. The osteotome technique: part 3--less invasive methods of elevating the sinus floor. Compendium. 1994;15(6):698.
    1. Summers RB. The osteotome technique: part 4--future site development. Compend Contin Educ Dent. 1995;16(11):1090.
    1. Bragger U, Gerber C, Joss A, Haenni S, Meier A, Hashorva E, et al. Patterns of tissue remodeling after placement of ITI dental implants using an osteotome technique: a longitudinal radiographic case cohort study. Clin Oral Implants Res. 2004;15(2):158–166. doi: 10.1111/j.1600-0501.2004.00988.x.
    1. Trombelli L, Minenna P, Franceschetti G, Minenna L, Farina R. Transcrestal sinus floor elevation with a minimally invasive technique. J Periodontol. 2010;81(1):158–166. doi: 10.1902/jop.2009.090275.
    1. Lai HC, Zhuang LF, Lv XF, Zhang ZY, Zhang YX, Zhang ZY. Osteotome sinus floor elevation with or without grafting: a preliminary clinical trial. Clin Oral Implan Res. 2010;21(5):520–526. doi: 10.1111/j.1600-0501.2009.01889.x.
    1. Nedir R, Bischof M, Vazquez L, Szmukler-Moncler S, Bernard JP. Osteotome sinus floor elevation without grafting material: a 1-year prospective pilot study with ITI implants. Clin Oral Implan Res. 2006;17(6):679–686. doi: 10.1111/j.1600-0501.2006.01264.x.
    1. Pjetursson BE, Ignjatovic D, Matuliene G, Bragger U, Schmidlin K, Lang NP. Transalveolar maxillary sinus floor elevation using osteotomes with or without grafting material. Part II: radiographic tissue remodeling. Clin Oral Implan Res. 2009;20(7):677–683. doi: 10.1111/j.1600-0501.2009.01721.x.
    1. Lundgren S, Andersson S, Gualini F, Sennerby L. Bone reformation with sinus membrane elevation: a new surgical technique for maxillary sinus floor augmentation. Clin Implant Dent Relat Res. 2004;6(3):165–173. doi: 10.1111/j.1708-8208.2004.tb00224.x.
    1. Nedir R, Bischof M, Vazquez L, Nurdin N, Szmukler-Moncler S, Bernard JP. Osteotome sinus floor elevation technique without grafting material: 3-year results of a prospective pilot study. Clin Oral Implan Res. 2009;20(7):701–707. doi: 10.1111/j.1600-0501.2008.01696.x.
    1. Cricchio G, Sennerby L, Lundgren S. Sinus bone formation and implant survival after sinus membrane elevation and implant placement: a 1- to 6-year follow-up study. Clin Oral Implants Res. 2011;22(10):1200–1212. doi: 10.1111/j.1600-0501.2010.02096.x.
    1. Farahamnd A, Sarlati F, Eslami S, Ghassemian M, Youssefi N, Jafarzadeh EB. Evaluation of impacting factors on facial bone thickness in the anterior maxillary region. J Craniofac Surg. 2017;28(3):700–705. doi: 10.1097/SCS.0000000000003643.
    1. Rahpeyma A, Khajehahmadi S. Open sinus lift surgery and the importance of preoperative cone-beam computed tomography scan: a review. J Int Oral Health. 2015;7(9):127–133.
    1. Buser D, Weber HP, Lang NP. Tissue integration of non-submerged implants. 1-year results of a prospective study with 100 ITI hollow-cylinder and hollow-screw implants. Clin Oral Implants Res. 1990;1(1):33–40. doi: 10.1034/j.1600-0501.1990.010105.x.
    1. Santagata M, Tozzi U, Tartaro G, Santillo V, Giovanni C, Lamart E, et al. Maxillary sinus augmentation with autologous and heterologous bone graft: a clinical and radiographic report of immediate and delayed implant placement. J Maxillofac Oral Surg. 2014;13(4):401–408. doi: 10.1007/s12663-013-0569-5.
    1. Nedir R, Nurdin N, Khoury P, Bischof M. Short implants placed with or without grafting in atrophic sinuses: the 3-year results of a prospective randomized controlled study. Clin Implant Dent Relat Res. 2016;18(1):10–18. doi: 10.1111/cid.12279.
    1. Si MS, Zhuang LF, Gu YX, Mo JJ, Qiao SC, Lai HC. Osteotome sinus floor elevation with or without grafting: a 3-year randomized controlled clinical trial. J Clin Periodontol. 2013;40(4):396–403. doi: 10.1111/jcpe.12066.
    1. Gabbert O, Koob A, Schmitter M, Rammelsberg P. Implants placed in combination with an internal sinus lift without graft material: an analysis of short-term failure. J Clin Periodontol. 2009;36(2):177–183. doi: 10.1111/j.1600-051X.2008.01357.x.
    1. Dahlin C, Linde A, Gottlow J, Nyman S. Healing of bone defects by guided tissue regeneration. Plast Reconstr Surg. 1988;81(5):672–676. doi: 10.1097/00006534-198805000-00004.
    1. Boyne PJ. Analysis of performance of root-form endosseous implants placed in the maxillary sinus. J Long Term Eff Med Implants. 1993;3(2):143–159.
    1. Kaneko T, Masuda I, Horie N, Shimoyama T. New bone formation in nongrafted sinus lifting with space-maintaining management: a novel technique using a titanium bone fixation device. J Oral Maxillofac Surg. 2012;70(3):e217–e224. doi: 10.1016/j.joms.2011.10.025.
    1. Yang J, Xia T, Fang J, Shi B. Radiological changes associated with new bone formation following osteotome sinus floor elevation (OSFE): a retrospective study of 40 patients with 18-month follow-up. Med Sci Monit. 2018;24:4641–4648. doi: 10.12659/MSM.910739.
    1. Riben C, Thor A. The maxillary sinus membrane elevation procedure: augmentation of bone around dental implants without grafts-a review of a surgical technique. Int J Dent. 2012;2012:105483. doi: 10.1155/2012/105483.
    1. Xu H, Shimizu Y, Ooya K. Histomorphometric study of the stability of newly formed bone after elevation of the floor of the maxillary sinus. Br J Oral Maxillofac Surg. 2005;43(6):493–499. doi: 10.1016/j.bjoms.2005.02.001.
    1. Balleri P, Veltri M, Nuti N, Ferrari M. Implant placement in combination with sinus membrane elevation without biomaterials: a 1-year study on 15 patients. Clin Implant Dent Relat Res. 2012;14(5):682–689. doi: 10.1111/j.1708-8208.2010.00318.x.
    1. Li Y, Yamada S, Aizawa H, Qi FF, Shimane T, Morioka M, et al. Effects of a micro-thread at the implant neck on securing the quantity and quality of bone formation around implants. J Oral Max Surg Med. 2019;31(1):13–19.
    1. Chowdhary R, Halldin A, Jimbo R, Wennerberg A. Influence of micro threads alteration on osseointegration and primary stability of implants: an FEA and in vivo analysis in rabbits. Clin Implant Dent Relat Res. 2015;17(3):562–569. doi: 10.1111/cid.12143.
    1. Waechter J, Madruga MD, do Carmo LC, FRM L, Schinestsck AR, Faot F. Comparison between tapered and cylindrical implants in the posterior regions of the mandible: a prospective, randomized, split-mouth clinical trial focusing on implant stability changes during early healing. Clin Implant Dent R. 2017;19(4):733–741. doi: 10.1111/cid.12501.
    1. Heitz-Mayfield LJ, Darby I, Heitz F, Chen S. Preservation of crestal bone by implant design. A comparative study in minipigs. Clin Oral Implants Res. 2013;24(3):243–249. doi: 10.1111/j.1600-0501.2012.02513.x.
    1. Bahaa-Eldin K, Mostafa B, Nasry S, Reda A, Shoeib M. Maxillary sinus augmentation using a titanium mesh: a randomized clinical trial. Open Access Maced J Med Sci. 2017;5(3):359–369.
    1. Diserens V, Mericske E, Mericske-Stern R. Radiographic analysis of the transcrestal sinus floor elevation: short-term observations. Clin Implant Dent Relat Res. 2005;7(2):70–78. doi: 10.1111/j.1708-8208.2005.tb00049.x.
    1. Kim YK, Yun PY, Kim SG, Kim BS, Ong JL. Evaluation of sinus bone resorption and marginal bone loss after sinus bone grafting and implant placement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107(2):e21–e28. doi: 10.1016/j.tripleo.2008.09.033.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe