Maxillary Sinus Floor Augmentation: a Review of Selected Treatment Modalities

Thomas Starch-Jensen, Janek Dalsgaard Jensen, Thomas Starch-Jensen, Janek Dalsgaard Jensen

Abstract

Objectives: The objective of the present study is to present the current best evidence for enhancement of the vertical alveolar bone height and oral rehabilitation of the atrophic posterior maxilla with dental implants and propose some evidence-based treatment guidelines.

Material and methods: A comprehensive review of the English literature including MEDLINE (PubMed), Embase and Cochrane Library search was conducted assessing the final implant treatment outcome after oral rehabilitation of the atrophic posterior maxilla with dental implants. No year of publication restriction was applied. The clinical, radiological and histomorphometric outcome as well as complications are presented after maxillary sinus floor augmentation applying the lateral window technique with a graft material, maxillary sinus membrane elevation without a graft material and osteotome-mediated sinus floor elevation with or without the use of a graft material.

Results: High implant survival rate and new bone formation was reported with the three treatment modalities. Perforation of the Schneiderian membrane was the most common complication, but the final implant treatment outcome was not influenced by a Schneiderian membrane perforation.

Conclusions: The different surgical techniques for enhancement of the vertical alveolar bone height in the posterior part of the maxilla revealed high implant survival with a low incidence of complications. However, the indication for the various surgical techniques is not strictly equivalent and the treatment choice should be based on a careful evaluation of the individual case. Moreover, further high evidence-based and well reported long-term studies are needed before one treatment modality might be considered superior to another.

Keywords: alveolar ridge augmentation; dental implants; oral surgical procedures; review; sinus floor augmentation.

Figures

Figure 1
Figure 1
Maxillary sinus floor augmentation applying the lateral window technique with a grafting material. A = A trapdoor osteotomy is performed on the lateral wall of the maxillary sinus. B = The trapdoor is infractured and the Schneiderian membrane is carefully dissected and elevated from the maxillary sinus floor to create a compartment for placement of the graft material. C = The implant is inserted simultaneously with the augmentation procedure. D = The graft material is densely packed around the exposed implant surface in the created compartment.
Figure 2
Figure 2
Maxillary sinus membrane elevation applying the lateral window technique without a graft material and simultaneous implant installation. A = The lateral cortical bony window is dissected free and removed from the underlying Schneiderian membrane, which is carefully elevated from the maxillary sinus floor to create a compartment for placement of the graft material. B = A blood coagulum is formed around the exposed implant tip in the secluded compartment between the elevated Schneiderian membrane and the original floor of the maxillary sinus. C = The window to the maxillary sinus is covered by the dissected lateral cortical bony window. D = New bone formation around the implant tip in the previous created compartment.
Figure 3
Figure 3
Osteotome-mediated sinus floor elevation and simultaneous installation of implants with or without the use of a graft material. A = The implant bed is prepared with a series of osteotomes with increasing diameter or in combination with burrs to a depth approximately 1-2 mm away from the maxillary sinus floor boundary. B = An up-fracture of the maxillary sinus floor is made with a mallet under light tapping and the Schneiderian membrane with the maxillary sinus floor is carefully elevated with the osteotome or a blunt instrument. C = The implant is inserted in the residual alveolar bone with the implant tip exposed in the lifted area. D = New bone formation around the implant tip in the previous created compartment.
Figure 4
Figure 4
Treatment guidelines for enhancement of the vertical alveolar bone height and oral rehabilitation of the atrophic posterior maxilla with implants.

References

    1. Petersen PE, Bourgeois D, Bratthall D, Ogawa H. Oral health information systems--towards measuring progress in oral health promotion and disease prevention. Bull World Health Organ. 2005 Sep;83(9):686-93.
    1. Berglundh T, Persson L, Klinge BA. A systematic review of the incidence of biological and technical complications in implant dentistry reported in prospective longitudinal studies of at least 5 years. J Clin Periodontol. 2002;29(suppl3):197-212, discussion 232-3.
    1. Pjetursson BE, Thoma D, Jung R, Zwahlen M, Zembic A. A systematic review of the survival and complication rates of implant-supported fixed dental prostheses (FDPs) after a mean observation period of at least 5 years. Clin Oral Implants Res. 2012 Oct;23(suppl6):22-38.
    1. Jung RE, Zembic A, Pjetursson BE, Zwahlen M, Thoma DS. Systematic review of the survival rate and the incidence of biological, technical, and aesthetic complications of single crowns on implants reported in longitudinal studies with a mean follow-up of 5 years. Clin Oral Implants Res. 2012 Oct;23(suppl6):2-21.
    1. Buser D, Sennerby L, De Bruyn H. Modern implant dentistry based on osseointegration: 50 years of progress, current trends and open questions. Periodontol 2000. 2017 Feb;73(1):7-21.
    1. Emami E, Heydecke G, Rompré PH, de Grandmont P, Feine JS. Impact of implant support for mandibular dentures on satisfaction, oral and general health-related quality of life: a meta-analysis of randomized-controlled trials. Clin Oral Implants Res. 2009 Jun;20(6):533-44.
    1. Boven GC, Raghoebar GM, Vissink A, Meijer HJ. Improving masticatory performance, bite force, nutritional state and patient's satisfaction with implant overdentures: a systematic review of the literature. J Oral Rehabil. 2015 Mar;42(3):220-33.
    1. Carreño Carreño J, Aguilar-Salvatierra A, Gómez-Moreno G, García Carreño EM, Menéndez López-Mateos ML, Perrotti V, Piattelli A, Calvo-Guirado JL, Menéndez-Núñez M. Update of Surgical Techniques for Maxillary Sinus Augmentation: A Systematic Literature Review. Implant Dent. 2016 Dec;25(6):839-844.
    1. Danesh-Sani SA, Loomer PM, Wallace SS. A comprehensive clinical review of maxillary sinus floor elevation: anatomy, techniques, biomaterials and complications. Br J Oral Maxillofac Surg. 2016 Sep;54(7):724-30.
    1. Lundgren S, Cricchio G, Hallman M, Jungner M, Rasmusson L, Sennerby L. Sinus floor elevation procedures to enable implant placement and integration: techniques, biological aspects and clinical outcomes. Periodontol 2000. 2017 Feb;73(1):103-20.
    1. Burchardt H. The biology of bone graft repair. Clin Orthop Relat Res. 1983 Apr;174:28-42.
    1. Nkenke E, Stelzle F. Clinical outcomes of sinus floor augmentation for implant placement using autogenous bone or bone substitutes: a systematic review. Clin Oral Implants Res. 2009 Sep; 20(Suppl 4):124-33.
    1. Johansson B, Grepe A, Wannfors K, Hirsch JM. A clinical study of changes in the volume of bone grafts in the atrophic maxilla. Dentomaxillofac Radiol. 2001 May;30(3):157-61.
    1. Clavero J, Lundgren S. Ramus or chin grafts for maxillary sinus inlay and local onlay augmentation: comparison of donor site morbidity and complications. Clin Implant Dent Relat Res. 2003;5(3):154-60.
    1. Cricchio G, Lundgren S. Donor site morbidity in two different approaches to anterior iliac crest bone harvesting. Clin Implant Dent Relat Res. 2003;5(3):161-9.
    1. Wiltfang J, Schultze-Mosgau S, Nkenke E, Thorwarth M, Neukam FW, Schlegel KA. Onlay augmentation versus sinuslift procedure in the treatment of the severely resorbed maxilla: a 5-year comparative longitudinal study. Int J Oral Maxillofac Surg. 2005;34(8):885-9.
    1. Zizelmann C, Schoen R, Metzger MC, Schmelzeisen R, Schramm A, Dott B, Bormann KH, Gellrich NC. Bone formation after sinus augmentation with engineered bone. Clin Oral Implants Res. 2007 Feb;18(1):69-73.
    1. Jensen T, Schou S, Svendsen PA, Forman JL, Gundersen HJ, Terheyden H, Holmstrup P. Volumetric changes of the graft after maxillary sinus floor augmentation with Bio-Oss and autogenous bone in different ratios. A radiographic study in minipigs. Clin Oral Implants Res. 2012 Aug;23(8):902-10.
    1. Shanbhag S, Shanbhag V, Stavropoulos A. Volume changes of maxillary sinus augmentations over time: a systematic review. Int J Oral Maxillofac Implants. 2014 Jul-Aug;29(4):881-92.
    1. Jensen T, Schou S, Stavropoulos A, Terheyden H, Holmstrup P. Maxillary sinus floor augmentation with Bio-Oss or Bio-Oss mixed with autogenous bone as graft: a systematic review. Clin Oral Implants Res. 2012 Mar;23(3):263-73.
    1. Esposito M, Felice P, Worthington HV. Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus. Cochrane Database Syst Rev. 2014 May 13;(5):CD008397.
    1. Aghaloo TL, Misch C, Lin GH, Iacono VJ, Wang HL. Bone Augmentation of the Edentulous Maxilla for Implant Placement: A Systematic Review. Int J Oral Maxillofac Implants. 2016;31 Suppl:19-30.
    1. Danesh-Sani SA, Engebretson SP, Janal MN. Histomorphometric results of different grafting materials and effect of healing time on bone maturation after sinus floor augmentation: a systematic review and meta-analysis. J Periodontal Res. 2017 Jun;52(3):301-12.
    1. Starch-Jensen T, Aludden H, Hallman M, Dahlin C, Christensen AE, Mordenfeld A. A systematic review and meta-analysis of long-term studies (five or more years) assessing maxillary sinus floor augmentation. Int J Oral Maxillofac Surg. 2017 May 22.
    1. Ting M, Rice JG, Braid SM, Lee CYS, Suzuki JB. Maxillary Sinus Augmentation for Dental Implant Rehabilitation of the Edentulous Ridge: A Comprehensive Overview of Systematic Reviews. Implant Dent. 2017 Jun;26(3):438-64.
    1. Duan DH, Fu JH, Qi W, Du Y, Pan J, Wang HL. Graft-Free Maxillary Sinus Floor Elevation: A Systematic Review and Meta-Analysis. J Periodontol. 2017 Jun;88(6):550-64.
    1. Silva LD, de Lima VN, Faverani LP, de Mendonça MR, Okamoto R, Pellizzer EP. Maxillary sinus lift surgery-with or without graft material? A systematic review. Int J Oral Maxillofac Surg. 2016 Dec;45(12):1570-76.
    1. Nasr S, Slot DE, Bahaa S, Dörfer CE, Fawzy El-Sayed KM. Dental implants combined with sinus augmentation: What is the merit of bone grafting? A systematic review. J Craniomaxillofac Surg. 2016 Oct;44(10):1607-17.
    1. Starch-Jensen T, Schou S. Maxillary Sinus Membrane Elevation With Simultaneous Installation of Implants Without the Use of a Graft Material: A Systematic Review. Implant Dent. 2017 Aug;26(4):621-33.
    1. Moraschini V, Uzeda MG, Sartoretto SC, Calasans-Maia MD. Maxillary sinus floor elevation with simultaneous implant placement without grafting materials: a systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2017 May;46(5):636-47.
    1. Călin C, Petre A, Drafta S. Osteotome-mediated sinus floor elevation: a systematic review and meta-analysis. Int J Oral Maxillofac Implants. 2014 May-Jun;29(3):558-76.
    1. Del Fabbro M, Corbella S, Weinstein T, Ceresoli V, Taschieri S. Implant survival rates after osteotome-mediated maxillary sinus augmentation: a systematic review. Clin Implant Dent Relat Res. 2012 May;14 Suppl 1:e159-68.
    1. Corbella S, Taschieri S, Del Fabbro M. Long-term outcomes for the treatment of atrophic posterior maxilla: a systematic review of literature. Clin Implant Dent Relat Res. 2015 Feb;17(1):120-32.
    1. Pinchasov G, Juodzbalys G. Graft-free sinus augmentation procedure: a literature review. J Oral Maxillofac Res. 2014 Apr 1;5(1):e1.
    1. Tatum H Jr. Maxillary and sinus implant reconstruction. Dent Clin North Am. 1986 Apr;30(2):207-29.
    1. Boyne PJ, James RA. Grafting of the maxillary sinus floor with autogenous marrow and bone. J Oral Surg. 1980 Aug;38(8):613-6.
    1. Corbella S, Taschieri S, Weinstein R, Del Fabbro M. Histomorphometric outcomes after lateral sinus floor elevation procedure: a systematic review of the literature and meta-analysis. Clin Oral Implants Res. 2016 Sep;27(9):1106-22.
    1. Handschel J, Simonowska M, Naujoks C, Depprich RA, Ommerborn MA, Meyer U, Kübler NR. A histomorphometric meta-analysis of sinus elevation with various grafting materials. Head Face Med. 2009 Jun 11;5:12.
    1. Suárez-López Del Amo F, Ortega-Oller I, Catena A, Monje A, Khoshkam V, Torrecillas-Martínez L, Wang HL, Galindo-Moreno P. Effect of barrier membranes on the outcomes of maxillary sinus floor augmentation: a meta-analysis of histomorphometric outcomes. Int J Oral Maxillofac Implants. 2015 May-Jun;30(3):607-18.
    1. Del Fabbro M, Bortolin M, Taschieri S, Weinstein RL. Effect of autologous growth factors in maxillary sinus augmentation: a systematic review. Clin Implant Dent Relat Res. 2013 Apr;15(2):205-16.
    1. Jensen T, Schou S, Gundersen HJ, Forman JL, Terheyden H, Holmstrup P. Bone-to-implant contact after maxillary sinus floor augmentation with Bio-Oss and autogenous bone in different ratios in mini pigs. Clin Oral Implants Res. 2013 Jun;24(6):635-44.
    1. Schwartz-Arad D, Herzberg R, Dolev E. The prevalence of surgical complications of the sinus graft procedure and their impact on implant survival. J Periodontol. 2004 Apr;75(4):511-6.
    1. Ardekian L, Oved-Peleg E, Mactei EE, Peled M. The clinical significance of sinus membrane perforation during augmentation of the maxillary sinus. J Oral Maxillofac Surg. 2006 Feb;64(2):277-82.
    1. Lee HW, Lin WS, Morton D. A retrospective study of complications associated with 100 consecutive maxillary sinus augmentations via the lateral window approach. Int J Oral Maxillofac Implants. 2013 May-Jun;28(3):860-88.
    1. Geminiani A, Tsigarida A, Chochlidakis K, Papaspyridakos PV, Feng C, Ercoli C. A meta-analysis of complications during sinus augmentation procedure. Quintessence Int. 2017;48:231-40.
    1. Schwarz L, Schiebel V, Hof M, Ulm C, Watzek G, Pommer B. Risk Factors of Membrane Perforation and Postoperative Complications in Sinus Floor Elevation Surgery: Review of 407 Augmentation Procedures. J Oral Maxillofac Surg. 2015 Jul;73(7):1275-82.
    1. Ghasemi S, Fotouhi A, Moslemi N, Chinipardaz Z, Kolahi J, Paknejad M. Intra- and Postoperative Complications of Lateral Maxillary Sinus Augmentation in Smokers vs Nonsmokers: A Systematic Review and Meta-Analysis. Int J Oral Maxillofac Implants. 2017 July/August;32(4):759–67.
    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):165-73.
    1. Lin IC, Gonzalez AM, Chang HJ, Kao SY, Chen TW. A 5-year follow-up of 80 implants in 44 patients placed immediately after the lateral trap-door window procedure to accomplish maxillary sinus elevation without bone grafting. Int J Oral Maxillofac Implants. 2011 Sep-Oct;26(5):1079-86.
    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 Oct;22(10):1200-12.
    1. Borges FL, Dias RO, Piattelli A, Onuma T, Gouveia Cardoso LA, Salomão M, Scarano A, Ayub E, Shibli JA. Simultaneous sinus membrane elevation and dental implant placement without bone graft: a 6-month follow-up study. J Periodontol. 2011 Mar;82(3):403-12.
    1. Altintas NY, Senel FC, Kayıpmaz S, Taskesen F, Pampu AA. Comparative radiologic analyses of newly formed bone after maxillary sinus augmentation with and without bone grafting. J Oral Maxillofac Surg. 2013 Sep;71(9):1520-30.
    1. Thor A, Sennerby L, Hirsch JM, Rasmusson L. Bone formation at the maxillary sinus floor following simultaneous elevation of the mucosal lining and implant installation without graft material: an evaluation of 20 patients treated with 44 Astra Tech implants. J Oral Maxillofac Surg. 2007 Jul;65(7 Suppl 1):64-72. Erratum in: J Oral Maxillofac Surg. 2008 Oct;66(10):2195-6.
    1. Sohn DS, Lee JS, Ahn MR, Shin HI. New bone formation in the maxillary sinus without bone grafts. Implant Dent. 2008 Sep;17(3):321-31.
    1. Moon JW, Sohn DS, Heo JU, Shin HI, Jung JK. New bone formation in the maxillary sinus using peripheral venous blood alone. J Oral Maxillofac Surg. 2011 Sep;69(9):2357-67.
    1. Falah M, Sohn DS, Srouji S. Graftless sinus augmentation with simultaneous dental implant placement: clinical results and biological perspectives. Int J Oral Maxillofac Surg. 2016 Sep;45(9):1147-53.
    1. Summers RB. The osteotome technique: Part 3–Less invasive methods of elevating the sinus floor. Compendium. 1994 Jun;15(6):698, 700, 702-694 passim; quiz 710.
    1. Pjetursson BE, Lang NP. Sinus floor elevation utilizing the transalveolar approach. Periodontol 2000. 2014 Oct;66(1): 59-71.
    1. Pjetursson BE, Rast C, Brägger U, Schmidlin K, Zwahlen M, Lang NP. Maxillary sinus floor elevation using the (transalveolar) osteotome technique with or without grafting material. Part I: Implant survival and patients' perception. Clin Oral Implants Res. 2009 Jul;20(7):667-76.
    1. Shi JY, Gu YX, Zhuang LF, Lai HC. Survival of Implants Using the Osteotome Technique With or Without Grafting in the Posterior Maxilla: A Systematic Review. Int J Oral Maxillofac Implants. 2016 Sep-Oct;31(5):1077-88.
    1. Chen MH BE, Shi JY. Clinical and Radiological Outcomes of Implants in Osteotome Sinus Floor Elevation with and without Grafting: A Systematic Review and a Meta-Analysis. J Prosthodont. 2017 Jan 12.
    1. Pjetursson BE, Ignjatovic D, Matuliene G, Brägger U, Schmidlin K, Lang NP. Maxillary sinus floor elevation using the osteome technique with or without grafting material. Part II – Radiographic tissue remodeling. Clin Oral Implants Res. 2009 Jul:20(7):677-83.
    1. Nedir R, Nurdin N, Vazquez L, Abi Najm S, Bischof M. Osteotome Sinus Floor Elevation without Grafting: A 10-Year Prospective Study. Clin Implant Dent Relat Res. 2016 Jun;18(3):609-17.
    1. Tan WC, Lang NP, Zwahlen M, Pjetursson BE. 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. J Clin Periodontol. 2008 Sep:35(8 Suppl): 241-54.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever