• The Journal of the Korean dental association
• /
• v.48 no.3
• /
• pp.205-217
• /
• 2010

Purpose The aim of this study is to evaluate the survival rates and analyze the stability of lateral approach and trans-crestal approach for maxillary sinus floor elevation of simultaneous implant placement. Materials and method 407 patients who have been treated in LivingWell dental hospital between 2003 to 2009 were selected. Lateral window technique, osteotome technique and sinus drill technique were used for sinus floor elevation procedure. A total of 714 implants-MP-1 HA coated implant(Tapered Screw $Vent^{TM}$, $Spline^{TM}$, Zimmer, USA), FBR surfaced implant(Pitt-$Easy^{TM}$, Oraltronics, Germany)-were placed in grafted maxillary sinus simultaneously. The autogenous bone or a combination with the allograft or alloplast was grafted into sinus. Sinus floor elevation was combined with vertical/horizontal onlay bone grafts to reconstruct the defect of alveolar ridge. Results The average preoperative height of the maxillary alveolar bone was 5.78mm(range: 0.4mm~12.5mm). 14 implants failed during the healing period(lateral approach: 4, trans-crestal approach: 10) and 3 implant failed after prosthetic loading(lateral approach: 2, trans-crestal approach: 1). The cumulative survival rate of implants after 6 years was 97.6%. Trans-crestal approach(97.4%) and lateral approach(97.9%) had similar survival rates. Conclusion The results indicate that the trans-crestal approach and lateral approach for maxillary sinus elevation is a acceptable method at atrophic maxillary posterior area.

• Journal of Dental Rehabilitation and Applied Science
• /
• v.33 no.1
• /
• pp.47-54
• /
• 2017

The atrophy of edentulous ridge and pneumatization of the maxillary sinus often limit the volume of bone available for implant placement on maxillary posterior teeth. Most clinicians suffer difficulties from poor bone quality and quantity on maxillary posterior site. Thus, the success of maxillary posterior implant surgery depends on the increase of the available bone and obtaining a good initial stability of the implant after maxillary sinus reconstruction. The maxillary sinus augmentation methods include a crestal approach and a lateral approach. Less morbidity and complications after operation is major advantage to sinus augmentation using crestal approach than lateral approach. However, when the residual ridge height is ${\geq}6mm$, it is known that crestal approach is appropriate. Also delayed implantation after sinus augmentation is recommended in severely atrophic ridge. We present the three cases of implant placement simultaneously sinus augmentation using crestal approach in posterior maxilla site with ${\leq}3mm$ of residual alveolar bone.

• Journal of Periodontal and Implant Science
• /
• v.36 no.2
• /
• pp.345-359
• /
• 2006

Loss of maxillary molar teeth leads to rapid loss of crestal bone and inferior expansion of the maxillary sinus floor (secondary pneumatization). Rehabilitation of the site with osseointegrated dental implants often represents a clinical challenge because of the insufficient bone volume resulted from this phenomenon. Boyne & James proposed the classic procedure for maxillary sinus floor elevation entails preparation of a trap door including the Schneiderian membrane in the lateral sinus wall. Summers proposed another non-invasive method using a set of osteotome and the osteotome sinus floor elevation (OSFE) was proposed for implant sites with at least 5-6mm of bone between the alveolar crest and the maxillary sinus floor. The change of grafted material in maxillary sinus is important for implant survival and the evaluation of graft height after maxillary sinus floor elevation is composed of histologic evaluation and radiomorphometric evaluation. The aim of the present study was radiographically evaluate the graft height change after maxillary sinus floor elevation and the influence of the graft material type in height change and the bone remodeling of grafts in sinus. A total of 59 patients (28 in lateral approach and 31 in crestal approach) who underwent maxillary sinus floor elevation composed of lateral approach and crestal approach were radiographically followed for up to about 48 months. Change in sinusgraft height were calculated with respect to implant length (IL) and grafted sinus height(BL). It was evaluated the change of the graft height according to time, the influence of the approach technique (staged approach and simultaneous approach) in lateral approach to change of the graft height, and the influence of the type of graft materials to change of the graft height. Patients were divided into three class based on the height of the grafted sinus floor relative to the implant apex and evaluated the proportion change of that class (Class I, in which the grafted sinus floor was above the implant apex; Class II, in which the implant apex was level with the grafted sinus floor; and Class III, in which the grafted sinus floor was below the implant apex). And it was evaluated th bone remodeling in sinus during 12 months using SGRl(by $Br\ddot{a}gger$ et al). The result was like that; Sinus graft height decreased significantly in both lateral approach and crestal approach in first 12 months (p$MBCP^{TM}$ had minimum height loss. Class III and Class II was increased by time in both lateral and crestal approach and Class I was decreased by time. SGRI was increased statistically significantly from baseline to 3 months and 3 months(p<0.05) to 12 months(p$ICB^{(R)}$ single use, more reduction of sinusgraft height was appeared. Therefore we speculated that the mixture of graft materials is preferable as a reduction of graft materials. Increasing of the SGRI as time goes by explains the stability of implant, but additional histologic or computed tomographic study will be needed for accurate conclusion. From the radiographic evaluation, we come to know that placement of dental implant with sinus floor elevation is an effective procedure in atrophic maxillary reconstruction.

• Journal of Periodontal and Implant Science
• /
• v.43 no.6
• /
• pp.308-314
• /
• 2013

Purpose: The purposes of this study were to assess the dentists' subjective satisfaction with the crestal approach sinus (CAS) kit, a device for maxillary sinus membrane elevation by the crestal approach using a special drilling system and hydraulic pressure, and to summarize the subjective satisfaction of dental implants placed after a sinus lift procedure with the CAS kit. Methods: Thirty dental clinicians who had experience with dental implant placement after a sinus lift procedure with the CAS kit from June 2010 to May 2012 were included in this study. The questionnaire for the evaluation of the dentists' subjective satisfaction with the CAS kit was sent to the respondents and returned. The questionnaire was composed of two main parts. The first part was related to the sinus membrane perforation rate. The second part was related to the dentists' subjective satisfaction with the CAS kit. Results: A total of 28 dentists answered the questionnaire. Among 924 implant cases, sinus membrane perforation occurred in 38 cases (4.1%). Among the 28 dentists, 26 dentists (92.9%) were satisfied or very satisfied with the CAS kit. In particular, 24 dentists (85.7%) reported that safety, cutting performance, and user-friendliness of the CAS drill were advantages of the CAS kit. However, 7 dentists (25%) did not routinely use the hydraulic lifter for sinus membrane elevation. Conclusions: From the survey, it was shown that the respondents were generally satisfied with the CAS kit and that the cutting performance and safety of the drill component were considered strengths of the CAS kit.

• The Journal of the Korean dental association
• /
• v.56 no.3
• /
• pp.142-150
• /
• 2018

In the posterior maxillary area, due to resorption of the ridge after extraction and pneumatization of the maxillary sinus, the height of the alveolar ridge may not be sufficient for placement of implants. To solve this problem, sinus augmentation using both crestal and lateral approaches have been widely used. Jung et al. (2010) introduced the modified lateral approach technique, which is a simplified technique that combines the advantages of crestal and lateral approaches. The purpose of this case report is to report two cases in the posterior maxilla in which simultaneous implant placement with maxillary sinus augmentation has been performed using the modified lateral approach technique. In two female patients, 67 and 74 years old, respectively, simultaneous implant placement was performed using the modified lateral approach technique on the left maxillary second premolar and the first molar. In both patients, the residual bone height on the distal side of the maxillary second premolar was measured to be approximately 5 mm, and the residual bone height of the first molar was measured to be 2-3 mm. After flap elevation, osteotomy of the lateral window was performed in the form of a mesiodistally extended slot above the sinus floor and the Schneiderian membrane was elevated. Sequenced drilling was performed while protecting the membrane with a periosteal elevator. Bone graft and implant placement was performed after preparation of the implant site. Sufficient primary stability was achieved for each implant and sinus membrane was not perforated. After four and five months respectively, implant second surgery was performed. Clinically, the implants were observed to be stable. Implants and surrounding peri-implant mucosa were well maintained after prosthodontic treatment. In conclusion, the modified lateral approach could be a predictable and efficient technique for implant placement in the atrophied posterior maxilla.

• Journal of Periodontal and Implant Science
• /
• v.44 no.5
• /
• pp.216-221
• /
• 2014

Purpose: This retrospective study compares the amount of bone resorption around implants between an autogenous tooth bone graft (AutoBT) and a synthetic bone graft after a bone-added crestally approached sinus lift with simultaneous implant placements. Methods: In all, 37 patients participated in this study. Seventeen patients were grouped as group I and underwent an AutoBT-added sinus lift using the crestal approach. The remaining 20 patients were grouped as group II and underwent synthetic bone grafting. Both groups received the implant placements simultaneously. Of the 37 participating patients, only 22 patients were included in the final results: Eleven patients of group I and 11 patients of group II. Before the surgery, the distance from the alveolar crest to the sinus floor was measured using panoramic radiography. After the surgery, the distance was measured again from the neck of the implant thread to the most superior border of the added graft materials. Then, the amount of sinus lift was calculated by comparing the two panoramic radiographs. After a year, a panoramic radiograph was taken to calculate the resorption of the bone graft material from the radiograph that was taken after the surgery. The significance of the resorption amount between the two types of graft materials was statistically analyzed. Results: The bone height was increased to an average of 4.89 mm in group I and 6.22 mm in group II. The analysis of panoramic radiographs 1 year after the surgery showed an average bone resorption of 0.76 mm and 0.53 mm, respectively. However, the degree of lifting (P=0.460) and the amount of bone-grafted material resorption (P=0.570) showed no statistically significant difference. Conclusions: Based on this limited study, AutoBT can be considered a good alternative bone graft to a synthetic bone graft in a bone-added sinus lift, when extraction is necessary prior to the surgery.

• Journal of Periodontal and Implant Science
• /
• v.37 no.2
• /
• pp.151-164
• /
• 2007

Objective: The sinus floor elevation procedures have been used to facilitate implant placement in the severely atrophic posterior maxilla. Many variables may have an influence on the outcomes of the sinus floor elevation in combination with implant treatment. The aim of this study was to analyze survival rate of implants placed in the edentulous maxillae of patients in whom sinus floor elevation was undertaken according to variables. Materials and Methods: It consisted of 96 patients(50 male and 46 female), ranging in age from 31 to 70 years(mean 49 years), who underwent sinus floor elevation procedure(94 implants in left side and 106 implants in right side) from 2001 to 2002. A total of 200 implants were placed in the grafted sinus(73 implants in lateral approach and 127 implants in crestal approach). All implants were restored by fixed prosthesis. All patients were healthy. Follow-up periods for implants were between 48 to 60 months. Results: The cumulative survival rate of implants was 91.5%. Gender, age and operation site did not have an influence on the survival rate. There was statistically significant differences for the implants which placed in less than 4 or 5 rom residual bone height, the survival rate was 60%, 81.4% respectively (p<0.05). There was no statistically significant difference of implants survival rate ac- cording to approach technique. The survival rate for 100% autogenous bone grafts was lower with respect to composite grafts containing autogenous bone and 100% substitutes. The survival rate for hydroxyapatite-coated implants was statistically significant lower than other textured group (p<0.05). Conclusion: Residual bone height, surface texture and graft materials have an influence on the survival rate. To use autogenous bone as a part of a composite bone replacement, implant texture which leads to more favorable implant-bone interface were necessary. To determine residual bone height for initial implant stability was important.

• Journal of Periodontal and Implant Science
• /
• v.37 no.3
• /
• pp.647-653
• /
• 2007

Rapid crestal bone resorption following maxillary tooth loss is further accentuated in the posterior regions because of pneumatization and enlargement of the maxillary sinuses. A treatment rationale that allows preservation and augmentation of vertical available bone at the time of posterior maxil-lary tooth extraction may offer numerous therapeutic benefits which are more short courses of ther-apy and no needs of additional surgical augmentation. The present study comprised 3 patients who had 4 posterior maxillary teeth with no evident bone between the tooth apex and sinus floor, as estimated through preoperative radiographic analysis. Sinus floor augmentation at the time of tooth extraction was chosen for the ltreatment of these patients. After the tooth was carefully extracted, the empty alveolus was thoroughly debrided and a trephine approach was performed. Particulated autogenous bone was gently pushed beyond the empty alveolus to elevate the sinus membrane using an osteotome. The distance between bone crest and si-nus floor was radiographically estimated 4 months after the first procedure. Another procedure was then carried out to place the implants of 11 mm length without another augmentation procedure. All implant were clinically stable, with no sign of infection. The presented surgical procedure performed at the time of extraction of posterior maxillary teeth in close proximity to the sinus floor allowed placement of implants of proper length.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.39
• /
• pp.18.1-18.4
• /
• 2017

Background: Postoperative infection occurs when bone graft material is dislodged into the maxillary sinus cavity and most of the patients are often uncomfortable with the drainage and irrigation procedures to eradicate the infection. In this case report, we share a technique in treating patients with such condition. Material and methods: A 47-year-old patient was referred after sinus elevation using the crestal socket osteotome, bone graft, and implant insertion at a local clinic. Clinical and radiographic findings confirmed the diagnosis of right maxillary sinusitis. A surgical and medical treatment regimen was applied. Results: By using this technique for irrigation, we were able to achieve successful results, and the patient was satisfied due to less discomfort during the irrigation process. Conclusion: This method is a patient-friendly technique for sinus irrigation. It is not only limited to sinus grafted patients, but also maxillary sinusitis patients in any other type of odontogenic infection.

• The Journal of Korean Academy of Prosthodontics
• /
• v.58 no.1
• /
• pp.23-29
• /
• 2020

Purpose: The purpose of this retrospective study was to evaluate the method using the S-reamer and gel-type graft material by the success rate and survival rate. Materials and methods: Implantation period was from 2008 to 2014, Follow check up year is 2019. There were 59 patients and 117 implants. All implants were placed in the posterior maxilla with the sinus lift. The patients population consisted of 34 men and 25 women, ranging from 19 to 75 years. The residual bone heights were from 1 mm to 6 mm. Sinus was perforated with S-reamer without membrane tearing and gel type bone graft material was used for membrane lifting and filling the space. all implants were placed simultaneously. Panoramic X-ray was taken. After 5 - 6 months healing period, final prostheses were restored. After more 5-years implant surgery, Panoramic X-ray was obtained and X-ray analysis and clinical examination were performed. Success criteria was referred to a Buser's success critera. All implants were classified to success implant, survival implant, failed implant. A success implant was satisfying success criteria, a survival implant was a implant that was acute infection with suppuration and bone loss, a failed implant was a implant that was mobile, removed. Results: Five implants were removed, and 4 implants had infected with bone loss. Survival rate was 95.7% and success rate was 92.3%. Conclusion: This retrospective study presented that this method with S-reamer and gel-type graft material was a successful treatment without membrane tear in the condition of 1-6 mm residual bone height.