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Objectives: To investigate the accuracy and reliability of deep learning in automatic graft material segmentation after maxillary sinus augmentation (SA) from cone‐beam computed tomography (CBCT) images. Materials and Methods: One hundred paired CBCT scans (a preoperative scan and a postoperative scan) were collected and randomly allocated to training (n = 82) and testing (n = 18) subsets. The ground truths of graft materials were labeled by three observers together (two experienced surgeons and a computer engineer). A deep learning model including a 3D V‐Net and a 3D Attention V‐Net was developed. The overall performance of the model was assessed through the testing data set. The comparative accuracy and inference time consumption of the model‐driven and manual segmentation (by two surgeons with 3 years of experience in dental implant surgery) were conducted on 10 CBCT scans from the test samples. Results: The deep learning model had a Dice coefficient (Dice) of 90.36 ± 2.53%, a 95% Hausdorff distance (HD) of 1.59 ± 0.82 mm, and an average surface distance (ASD) of 0.38 ± 0.11 mm. The proposed model only needed 7.2 s, while the surgeon took 19.15 min on average to complete a segmentation task. The overall performances of the model were significantly superior to those of surgeons. Conclusions: The proposed deep learning model yielded a more accurate and efficient performance of automatic segmentation of graft material after SA than that of the two surgeons. The proposed model could facilitate a powerful system for volumetric change evaluation, dental implant planning, and digital dentistry. [ABSTRACT FROM AUTHOR]

Objectives: The objective of the study was to evaluate the radiographic changes in sinus mucosal thickness (SMT) in patients with mucosal thickening of odontogenic origin after maxillary molar extraction and lateral sinus augmentation with simultaneous surgical drainage and implant placement. Materials and Methods: Forty‐six patients were included in this study. The changes in SMT were evaluated using cone‐beam computed tomography images produced at four time points: before extraction (T0), before surgery (T1), immediately after surgery (T2), and after prosthesis delivery (T3), and statistical differences between time points were analyzed. The changes in SMT and augmented bone height (ABH) regarding the reason of extraction, smoking, ostial patency, and the presence of postoperative sinusitis were also evaluated. Results: Over time points, SMT gradually decreased (T0: 19.44 ± 9.22 mm, T1: 15.10 ± 8.89 mm, T2: 8.42 ± 6.01 mm, and T3: 4.16 ± 4.91 mm) (p <.05). Five out of 6 patients with ostial obstruction at T1 presented ostial patency at T3. Two patients developed postoperative sinusitis but recovered with medication. Ostial patency at T1, SMT at T1, and reason of extraction did not statistically significantly influence SMT at T3. SMT at T1 had no statistically significant impact on ABH change between T2 and T3. Conclusion: Sinus mucosal thickness was gradually reduced by extraction of compromised teeth and drainage during lateral sinus augmentation. The drainage contributed more to the reduction in SMT. [ABSTRACT FROM AUTHOR]

Objectives: To retrospectively evaluate whether repositioning the bone window leads to a better outcome of three‐dimensional sinus augmentation in lateral sinus floor elevation (LSFE) with simultaneous implant placement. Methods: 34 patients with a total of 40 implants (14: test group, 26: control group) receiving LSFE with simultaneous implant placement were included in this retrospective research. CBCT images were taken before surgery, immediately and 6 months after surgery. The two‐dimensional augmentation parameters, including apical bone height (ABH), endo‐sinus bone gain (ESBG), and palatal/buccal bone height (PBH/BBH), and three‐dimensional parameters, including augmentation volume (AV) and palatal/buccal augmentation volume (PAV/BAV), were measured. The lateral defect length (LDL) and lateral window length (LWL) were also measured to evaluate the lateral antrostomy recovery. Results: At the 6‐month follow‐up, the reduction rates at ABH, ESBG, and BBH of the test group (ABH: 10.41% ± 30.30%, ESBG: 2.55% ± 8.91%, BBH: 2.50% ± 8.65%) were significantly lower than those of the control group (ABH: 25.10% ± 22.02%, ESBG: 11.47% ± 9.79%, BBH: 7.10% ± 5.37%; p <.05). In addition, the test group showed better three‐dimensional augmentation stability on the buccal side (BAV reduction: 15.51% ± 10.86% vs. 27.15% ± 12.61%; p <.05). Moreover, the LDL/LWL ratio of the test group was significantly lower than that of the control group (p <.05). Conclusion: Within the limitations of this study, repositioning of the bone window in LSFE with simultaneous implant placement could contribute to endo‐sinus augmentation stability on the buccal side at the 6‐month follow‐up. Moreover, it would also facilitate recovery of the lateral antrostomy defect. [ABSTRACT FROM AUTHOR]

Objectives: To compare ear, nose, and throat (ENT) specialists and dentists assessing health or pathology of maxillary sinuses using cone beam computed tomography (CBCT). Material and methods: Two ENT specialists and two oral surgeons assessed 100 CBCT datasets of healthy patients referred for dental implant placement in the posterior maxilla and decided on the possibility of sinus floor elevation or the necessity for further diagnostic examinations based solely on radiographic findings. Inter‐rater agreements within the same specialty were calculated with Cohen's kappa and overall agreements with Fleiss kappa, and factors influencing the decisions taken were evaluated using regression analyses. Results: The correlation between all four raters was generally fair to moderate. The intra‐specialty comparison showed a lower correlation between dentists than between ENT specialists. Absence of membrane thickening and total or subtotal sinus opacification showed the highest predictive value for a consensus in favor of sinus floor elevation and ENT referral, respectively. Flat membrane thickening with an irregular surface morphology was associated with disagreement between the examiners. Dome‐shaped membrane thickenings were often considered as to be referred by dentists but not by ENTs. Conclusion: The assessment of maxillary sinuses using CBCT imaging exhibited unsatisfactory agreement between ENT specialists and oral surgeons. Referral guidelines based on accidental CBCT findings that aim to diagnose relevant sinus pathologies early and avoid unnecessary diagnostics and/or therapies are needed, and an initial proposal for such recommendations is provided. Further research on correct interpretation of sinus findings and a validation of the present recommendations are required. [ABSTRACT FROM AUTHOR]

Objective: Slit‐window technique is a lateral approach sinus floor elevation (SFE) procedure that utilizes a rigid resorbable membrane in conjunction with stabilizing bony slits to tent the Schneiderian membrane without addition of grafting materials. The aim of this randomized clinical trial was to compare clinical and radiographic outcomes of the Slit‐window SFE with those of SFE with bone grafting. Material and Methods: Thirty‐three patients with 38 edentulous sites were included. Edentulous sites were randomly allocated to the Slit‐window SFE or SFE with bone grafting. Simultaneous with SFE, each site received two dental implants. Implant stability quotient (ISQ) values were recorded at baseline and monthly visits for 8 months. The bone coverage and bone height gain at implant sites were recorded on cone beam computed tomography (CBCT) scans 6 and 24 months postoperatively. Results: There were no significant differences in the mean ISQ values between the groups at any time point (p > 0.05). All implants in both groups were found to have complete bone coverage. Significant increases in the bone height were found 6 and 24 months postoperatively in both groups (p < 0.001). Conclusions: Within limitations of the present study, it can be concluded that the Slit‐window SFE technique without the need for bone grafting resulted in sufficient bone height gain around implants placed simultaneous with the SFE procedures. The bone height around these implants was stable during the 2‐year follow‐up period. The treatment outcomes for these implants were comparable to those placed simultaneous with lateral approach SFE in conjunction with bone grafting. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the impact of cone beam computed tomography (CBCT) imaging on treatment planning regarding augmentation procedures for implant placement. Material and methods Panoramic radiographs and CBCT images of 40 patients requesting single-tooth implants in 59 sites were retrospectively analyzed by six specialists in implantology, and treatment planning was performed. Therapeutic recommendations were compared with the surgical protocol performed initially. Results Bone height estimation from panoramic radiographs yielded to higher measures and greater variability compared to CBCT. The suggested treatment plan for lateral and vertical augmentation procedures based on CBCT or panoramic radiographs coincided for 55-72% of the cases. A trend to a more invasive augmentation procedure was seen when planning was based on CBCT. Panoramic radiography revealed 57-63% (lateral) vs. 67% (vertical augmentation) congruent plans in agreement with surgery. Among the dissenting sites, there was a trend toward less invasive planning for lateral augmentation with panoramic radiographs, while vertical augmentation requirements were more frequently more invasive when based on CBCT. Conclusions Vertical augmentation requirements can be adequately determined from panoramic radiographs. In difficult cases with a deficient lateral alveolar bone, the augmentation schedule may better be evaluated from CBCT to avoid underestimation, which occurs more frequently when based on panoramic radiographs only. However, overall, radiographic interpretation and diagnostic thinking accuracy seem to be mainly depending on the opinion of observers. [ABSTRACT FROM AUTHOR]

Objectives To investigate: (1) sinus membrane thickness in patients receiving lateral window sinus augmentation via cone-beam computed tomography ( CBCT) and (2) the influence of Schneiderian membrane thickness upon membrane perforation during lateral window approach. Material and methods A total of 73 subjects with 81 sinus lift procedures between years 2010 and 2013 were recruited consequently. Each patient selected had CBCT images in initial and immediately after surgery. The values and correlation between variables of membrane thickness, perforation rate, membrane morphology, residual bone height, and elevated bone height were evaluated. Results The mean thickness of the Schneiderian membrane was 1.32 ± 0.87 mm. Perforation rate was lowest (7.14%) when membrane thickness was 1-1.5 mm. As membrane became thicker (≥2 mm) or thinner (<1 mm), the perforation rate increased abruptly. When examined the membrane thickness category, Class B (between ≥1 mm and <2 mm) had the lowest perforation rate. Statistically significant correlation was found between the perforation and the membrane thickness. The amount of the remaining bone height did not significantly correlate to the membrane thickness nor influence the membrane perforation. Conclusions This study demonstrated that membrane thickness was related to the sinus perforation during lateral window sinus augmentation. The perforation rate was lowest when the membrane thickness was 1-1.5 mm. [ABSTRACT FROM AUTHOR]

Purpose Implant therapy has become an excellent treatment modality as its inception into the modern era of dentistry. However, when patients present with advanced atrophy of the maxillary alveolar ridge, the procedure of choice to restore the anatomic bone deficiency is surgical maxillary sinus floor elevation or sinus lift. The purpose of this study was to describe the CT guided sinus lift technique and to illustrate the minimally invasive aspect of this new radiological procedure called radiological sinus lift. Material and methods For this prospective study, 17 cadaver heads which met our inclusion criteria (edentulous posterior maxillary sector and bone height less than 5 mm) were analyzed using cone beam computed tomography (CBCT) and orthopantomography (OPT). CT and sinus endoscopy was used to guide each step in the procedure. The radiological sinus lift technique consists of the following four stages: Approach. A 14.5 G OstyCut needle was inserted mesial to the canine eminence, and manual drilling was performed parallel to the sinus floor. Osteotomy. An inner obturator with a blunt tip was introduced to compress bone, to push it in close proximity to the sinus membrane and finally to create an osseous window opening into the submucosal space. Lifting. The sinus lift was performed using hydrodissection with dilute iodinated contrast medium. Filling. The submucosal space was then filled with an injection of dilute collagen. Success of the radiological sinus lift procedure was defined by the presence of a dome shape visible within the maxillary alveolar recess. All cases were imaged postoperatively using OPT and maxillary CBCT. Results Twelve maxillary sinuses underwent the radiological sinus floor elevation procedure. A dome shape of the Schneiderian membrane was achieved in eight maxillary sinuses (66.7%). All failures ( n = 4) were caused by mucosal perforation at the time of maxillary sinus osteotomy. Mean height of membrane elevation was 12.0 mm, with a mean intervention time of 45 min. Conclusion This experimental study evaluates a new minimally radiological procedure for maxillary sinus floor elevation, which provides an interventional radiological alternative to the classical surgical lateral approach and achieves an equivalent success rate to that cited in the literature for the surgical approach, a low morbidity and a shorter operating time. [ABSTRACT FROM AUTHOR]

Objectives Given that the nature and presence of voids present within grafted sinuses following maxillary sinus elevation procedures were not known, nor was the contribution of these factors to implant success, the purpose of this study was to investigate these parameters and their relationship to implant success. Materials and Methods This study evaluated data from 25 subjects who had a lateral window maxillary sinus augmentation procedure. Cone-beam computed tomography ( CBCT) was performed at baseline and 4 months after surgery. CBCT images were used to evaluate grafted sites prior to implant placement. Using CBCT images, three examiners independently measured bone-grafted areas ( BG), void areas (V), and percentage of void areas (V%) from six different sections within grafted sites. The six sections were defined as a cross-sectional ( CS) midpoint, CS mesial point, CS distal point, horizontal section ( HS) low point, HS midpoint, and HS high point. Implant success was also determined. Results The calculated V% (V/ BG) for the CS midpoint, CS mesial point, CS distal point, HS low point, HS midpoint, and HS high point were 5.30 ± 6.67%, 5.79 ± 8.51%, 6.67 ± 7.12%, 2.07 ± 2.56%, 5.30 ± 6.62%, and 4.92 ± 5.17% respectively. Implant success after 6 months of follow-up approximated 100%. Conclusions Although voids within grafts varied in terms of distribution and size, the V% within the HS low point were significantly smaller compared to those within the CS midpoint and CS distal point, which had the most intra-subject V%. Thus, more attention should be given to the distal aspect of the sinus when compacting graft materials in the lateral wall sinus augmentation procedure. Implant success was not influenced by the existence of voids as implant success remained high. [ABSTRACT FROM AUTHOR]

Aim The aim of this pilot study was to analyze the interfurcal bone height in relation to the possible need for subsequent sinus floor elevation in patients with advanced periodontitis and furcation involvement of first and/or second maxillary molars. Material and methods Seventeen dentate patients, who received cone beam computed tomography ( CBCT) for detailed preoperative diagnosis and planning of surgical interventions at periodontally involved maxillary molars (17 first and 15 second molars), were consecutively recruited for the study. The minimal bone height in the interfurcal region was measured from CBCT and related to furcation involvement, residual bone above the root tips, and the clinical probing pocket depth ( PPD). Results The minimal interfurcal bone height measured 4.1 ± 2.6 mm on average with 75% of maxillary molars having ≤6 mm and almost 60% having only ≤4 mm bone height left below the sinus floor. A higher risk for reduced interfurcal bone height of ≤4 mm was given when residual PPD of ≥6 mm was remaining at two or more tooth sites (OR 0.10; 0.11). Conclusions The majority of periodontally involved maxillary molars had a substantially reduced interfurcal bone height, particularly with at least two sites with residual PPD ≥ 6 mm. This was a predictor for a subsequent need for sinus floor elevation when tooth replacement with a dental implant is desired. [ABSTRACT FROM AUTHOR]

Objectives Graft resorption remains a major disadvantage of the various employed materials in maxillary sinus augmentation. Our aim was to assess the percentage of graft volume reduction in deproteinized bovine bone ( DBB) using cone beam computed tomography ( CBCT). Materials and Methods A retrospective analysis of 29 augmented sinuses in 19 patients was conducted. The graft material was either DBB alone or DBB mixed with autologous bone chips (80% DBB/20% bone chips). CBCT scans of the augmented sinuses were obtained pre- and post-operatively up to 2-year follow-up. Results In total, 55 dental implants were placed in the posterior maxillary region following sinus augmentation. The mean height of the alveolar ridge pre-operative was 2.7 ± 1.2 mm and post-operative was 14.13 ± 4.6 mm. The mean percentages of alveolar ridge height reduction were 18.58% ( SD14.23%) and 27.62% ( SD12.70%), and the mean percentages of graft volume reduction were 19.30% ( SD9.19%) and 19.85% ( SD9.61%) for DBB and DBB + bone chips, respectively. Conclusions The results indicate that DBB graft volume resorption is approximately (20 ± 10%) following 2-year follow-up. CBCT is a useful radiographic tool to follow-up changes in sinus graft volumes. [ABSTRACT FROM AUTHOR]

Purpose The degree of difficulty in performing lateral window sinus augmentation may depend on the morphology of the maxillary sinus. The aim of this was to measure the distances between the medial and lateral sinus wall (sinus width [ SW]) at different levels and apply those SW values to formulate a new sinus classification. Materials and methods Edentulous sites adjacent to maxillary sinuses with inadequate ridge height ( RH; <10 mm) were included from cone-beam computed tomography database in the University of Michigan. SW was measured at the heights of 5, 7, 10, 13, and 15 mm from alveolar crest at the edentulous sites. Mean SW was stratified by residual RH into three different groups (group 1: <4 mm, group 2: ≥4 and <7, and group 3: ≥7 and <10), study sites (first and second premolars and molars), and measurement levels. Results Three hundred and twenty subjects (mean 50.1 years old) with 422 edentulous sites were included. Mean SW was wider at molar sites, higher measurement levels, and sites with shorter residual RH. Mean SW at the lower (average 2.3 mm from sinus floor) and higher boundary (15 mm from the alveolar crest) of lateral window osteotomy was 9.0 (2.8) and 16.0 (4.4) mm, respectively. Narrow, average, or wide sinuses were classified when the SW was <8, 8-10 and >10 mm at the lower boundary or <14, 14-17 and >17 mm at the upper boundary, respectively. Conclusion SW at levels that were relevant to lateral window sinus augmentation was measured. The proposed sinus classification could facilitate communication between health providers and determine the degree of easiness of sinus augmentation. It might be particularly useful for the selection of grafting materials and surgical approaches. Further studies are required to test its clinical implications. [ABSTRACT FROM AUTHOR]

Objectives The superior alveolar canal with its contents is frequently reported as an anatomical point of consideration during lateral sinus floor elevation due to the danger of bleeding and of the subsequent impairment of vision of the surgical field. Malnutrition of the graft may also ensue. This radiographical study uses cone beam computerized tomography to identify the superior alveolar canal, to measure its diameter and its distance from the sinus floor at precise tooth positions to provide the implant surgeon with information about the position and the diameter of the canal. Material and methods One hundred and fifty-six patients (156) scanned with a Newtom VG device were included in this study. A dental and maxillofacial radiologist using the multiplanar capabilities of the device's software identified the canal and assessed its diameter and topography. Results The canal could be identified in 82% of the cases with a mean diameter of 1.1 mm and a range of diameters between 0.2 and 2.6 mm. The distance from the floor of the sinus at various tooth positions ranged between 0 and 28.5 mm. Conclusions In the majority of our cases, the canal could be identified in at least one position, between the most posterior and the most anterior borders of the maxillary sinus. The large variation on the distance of the canal from the sinus floor dictates an individual evaluation of its position and not the use of mean values. Great care must be exercised by the radiologist to reliably identify the canal. [ABSTRACT FROM AUTHOR]

Objective The predictability and simplicity of the Summers' technique for sinus floor elevation encouraged many clinicians to consider this new approach. The impact of such intervention on the sinus mucosa has, however, not been explored extensively. This pilot study followed the response of the Schneiderian membrane, longitudinally, via cone-beam CT images. Material and methods Ten consecutive patients (five women, mean age 58.7 years) referred for implant therapy in the posterior part of the maxilla, in combination with a trans-alveolar sinus floor elevation (13 sinuses involved), were enrolled. CBCT images were taken prior to and at 1 week and 1 month after surgery. The changes in thickness of the Schneiderian membrane were scored at nine standardized points per sinus using reformatted cross-sectional images. Results One week after sinus floor elevation, the Schneiderian membrane showed a significant swelling of 9.2 mm in the middle ( SD 0.3; P < 0.005), 7.2 mm medially ( SD 2.5; P < 0.005) and 3.9 mm laterally ( SD 0,3; P < 0.05), respectively, resulting in an overall mean of 6.7 mm ( SD 2.6), which fully disappeared 3 weeks later. This swelling involved the entire floor of the sinus and not only the augmented area. Conclusions Within the limitations of this pilot study, one can conclude that the Schneiderian membrane responds with a significant 'transient' swelling (5-10× its size) during the first weeks of healing. [ABSTRACT FROM AUTHOR]

Background The transcrestal approach with osteotomes is a commonly applied and predictable technique for maxillary sinus floor elevation. However, Schneiderian membrane perforation is a common and often inevitable intraoperative complication. Recently, the use of balloons has been proposed to reduce the risk of sinus membrane perforation and to facilitate the surgical technique. The aim of this study was to determine membrane elevation height and perforation rate using the transcrestal balloon technique (B) and a conventional osteotome approach, as control (C). Methods Ten fresh, completely edentulous cadaver heads (seven male and three female) were selected. In a split-mouth design, each sinus was randomly assigned to either the experimental or the control technique. Pre-surgical planning was aided by cone-beam computed tomography. During the procedure, an endoscope was used to monitor the elevation procedure and the occurrence of sinus perforation. The elevation continued until either 15 mm (measured from the alveolar crest) was reached or a perforation occurred. The residual ridge and the elevated membrane height were measured and compared with the paired Student's t-test. Presence of sinus perforation was recorded at three cutoff points: 10, 12, and 15 mm. Results The mean age of the specimens was 77.7 ± 14.2 years (range 49-92). The mean initial, final, and elevated sinus membrane height for the B group was 5.3 ± 1.9, 13.7 ± 1.9, and 8.3 ± 3.1 mm, whereas the correspondent values for the C group were 5.1 ± 2.1, 13.2 ± 2.8, and 8.1 ± 3.1 mm. The incidence of sinus perforation, using 10, 12, and 15 mm as end points was 0%, 22.2%, and 44.4% in the B group, whereas in the C group the respective values were 10.0%, 20.0%, and 50.0%. No statistically significant differences were found between the two groups for all the above-mentioned variables. In addition, mean residual ridge height was not significantly different between the non-perforation and perforation sites in the B group (5.2 ± 2.2 and 5.5 ± 1.7 mm) and in the C group (5.2 ± 2.5 and 5.0 ± 2.0 mm). Three cadavers had perforations in both sinuses, accounting for 66.6% of total number of perforations. Conclusions Based on the findings of this study, the balloon and the conventional osteotome approach are comparable in terms of perforation rate as it relates to the elevation height. Also, the amount of residual alveolar bone was not related to the incidence of perforation and the height of sinus elevation. [ABSTRACT FROM AUTHOR]

Background: Survival rates of implants placed in transalveolar sinus floor augmentation sites are comparable with those placed in non-augmented sites. Flapless implant surgery can minimize postoperative morbidity, alveolar bone resorption and crestal bone loss. The use of cone beam computerized tomography (CBCT) provides 3D presentations with reduced dose exposure. Objectives: To evaluate a flapless, CBCT-guided transalveolar sinus floor elevation technique with simultaneous implant installation. Material and methods: Fourteen consecutive patients in need of maxillary sinus floor augmentation were enrolled in this study. Preoperative CBCT with a titanium screwpost as an indicator at the intended implant position was used to visually guide the flapless surgical procedure. Twenty one implants all with a length of 10 mm and a diameter of 4.1 and 4.8 mm were inserted and followed clinically and with CBCT for 3, 6 and 12 months postoperatively. Intraoral radiographs were taken for comparison. All patients were provided with permanent prosthetic constructions 8-12 weeks after implant surgery. Results: Ten (47.6%) implants were inserted in residual bone of 2.6-4.9 mm and 11 (52.3%) implants were inserted in residual bone of 5-8.9 mm. No implants were lost after surgery and follow-up. There was no marginal bone loss during the follow-up verified by CBCT. The implants penetrated on average 4.4 mm (SD 2.1 mm) into the sinus cavity and the mean bone gain was 3 mm (SD 2.1 mm). Conclusion: Flapless transalveolar sinus lift procedures visually guided by preoperative CBCT can successfully be used to enable placement, successful healing and loading of one to three implants in residual bone height of 2.6-8.9 mm. There was no marginal bone loss during the 3-12 months follow-up. To cite this article: Fornell J, Johansson L-Å, Bolin A, Isaksson S, Sennerby L. Flapless, CBCT-guided osteotome sinus floor elevation with simultaneous implant installation. I: radiographic examination and surgical technique. A prospective 1-year follow-up. Clin. Oral Impl. Res. 23, 2012; 28-34. doi: 10.1111/j.1600-0501.2010.02151.x [ABSTRACT FROM AUTHOR]

Background: Numerous studies have been published on the healing of sinus grafts. Most of these reports provide histological information, implant survival or success rates and/or quantitative evaluation of dimensional changes of the graft during healing. To this date, however, there is a lack of information regarding qualitative radiologic changes (i.e. presence of voids or areas of reduced mineralization) during post-augmentation healing. Aim/Hypothesis: The purpose of the present study was to describe qualitative radiologic changes (i.e. presence of voids or areas of reduced mineralization) of anorganic bovine bone grafts used in maxillary sinus floor augmentations after a 6-month healing period. Material and Methods: Grafts were performed on consecutively treated patients. One hundred and sixty-one sinus augmentations were available for the study. Anorganic bovine bone alone (Bio-Oss, Geistlich, Wolhusen, Switzerland) was used as graft material. Observations were based on CBCT made before surgery (T0), immediately after the sinus graft (T1) and 6 months thereafter, before implant placement (T2). Sagittal sections obtained from T1 and T2 CBCT were compared. Cases were classified in four groups depending on graft aspect at 6 months: good homogeneous aspect of graft (group A), presence of areas of reduced mineralization (group B), voids and/or areas of reduced mineralization (group C), disturbed and non-homogeneous aspect of the graft (group D). Results: 42% of grafts were classified in group A, 36% in group B, 18% in group C and 4% in group D. Differences between groups were evaluated using Pearson’s chi-square test (P < 0.05). There were more patients in groups A and B than in groups C and D (78%, P < 0.001). Cochran-Armitage trend test revealed that age and sex did not affect distribution among the groups and that there were statistically more smokers in group D. Conclusions and Clinical Implications: Most grafts (78%) displayed a homogenous aspect with or without a small area of reduced mineralization usually located in the center or the upper portion of the graft. Sometimes, the defect was more pronounced, voids were present (18%) but implant placement was not compromised. In 4% of the grafted sinuses, healing was significantly disturbed and implant placement was compromised. [ABSTRACT FROM AUTHOR]