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This article aims to evaluate and compare the 10-year bone anchorage and protrusion of implants into the sinus using cone beam computerized tomography (CBCT) and periapical radiography. Implants (≤ 10 mm) were placed with osteotome sinus floor elevation (OSFE) without grafting in maxillae with bone height ≤ 8 mm. After 10 years, the CBCT analysis showed bone presence at the buccal and palatal implant sides and corroborated the results obtained using periapical radiographs. In the absence of any symptom or complication, the use of two-dimensional radiography is sufficient for routine long-term follow-up of implants after OSFE without grafting.

Purpose: To evaluate the thickness of the sinus membrane in contact with implants inserted 10 years before using an augmentation procedure without grafting material, and to identify adverse events correlated with implant protrusion in the sinus., Materials and Methods: Osteotome sinus floor elevations were performed without grafting material. The implants (Straumann AG, Basel, Switzerland) were placed simultaneously, all protruded into the sinus. After 10 years, implants were considered viable in the absence of mobility, pain, infection, or continued radiolucency. Sinus health was assessed using cone-beam computed tomography and by the way of a questionnaire in which patients reported symptoms of sinusitis they might have had., Results: Controlled implants (21 implants, 13 patients) were osseointegrated. The membrane thickness was <2 mm in 11 patients and 2 to 3 mm with flat thickening in 2 patients. No patients exhibited any clinical or radiographic signs of sinusitis., Conclusions: No sinus complications were observed after 10 years. The initial protrusion of implants into the sinus did not influence long-term sinus health. The maintenance of successful integration is thus the key to avoiding sinus complication.

Objectives: Over 5 years, (i) to evaluate the clinical efficiency of 8-mm implants placed with osteotome sinus floor elevation (OSFE) in extremely atrophic maxillae and (ii) to compare bone levels around implants placed with and without grafting., Material and Methods: TE ® SLActive ® implants (Institut Straumann AG, Basel, Switzerland) were placed in sites with a residual bone height (RBH) of ≤4 mm. Before surgery, sinuses were randomized to receive anorganic bovine bone (control) or no graft (test). After 10 weeks of healing, implants were functionally loaded with single crowns. Bone levels were measured from standardized peri-apical radiographs., Results: Thirty-seven (17 test, 20 control) implants were placed in 12 patients (RBH: 2.4 ± 0.9 mm). Two early and one late failures occurred. The success rate was 91.9% (94.1% test, 90.0% control). All implants gained endo-sinus bone (3.8 ± 1.0 mm test, 4.8 ± 1.2 mm control; P = 0.004). Mean crestal bone loss (CBL) was 0.6 ± 1.1 mm, without a significant difference between the groups (P = 0.527). Mean bone gain and CBL did not change significantly between 1 and 5 years (P = 0.249 and P = 0.293, respectively)., Conclusions: Atrophic posterior maxillae can be predictably rehabilitated using OSFE with a simultaneous implant placement. The new bone formed around implants after 1 year was stable after 5 years, irrespective of the presence or the absence of graft. Grafting was unnecessary to achieve an average bone augmentation of 3.8 mm, but more bone was gained with grafting., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Oroantral communication (OAC) rarely occurs long after implant placement. The present report describes the rare etiology and the difficulty of the diagnosis of an uncommon OAC occurring 10 years after the implant placement in the posterior maxilla. The difficulty of the diagnosis lies in the absence of clinical symptoms of sinusitis and presence of multiunit prosthesis hiding implant failure. This case report supports the need for sinus check-up during a routine implant examination.

Background: Little is known about the long-term outcome of implants placed in the atrophic maxilla using osteotome sinus floor elevation (OSFE) without grafting., Purpose: The study aims to evaluate the long-term efficiency of the procedure and stability of the peri-implant bone formed following implant placement without grafting into resorbed posterior maxilla., Materials and Methods: Twenty-five implants (≤10 mm in length) were placed in 17 patients using OSFE without grafting. The mean residual bone height was 5.4 ± 2.3 mm. Bone levels were evaluated at 1, 3, 5, and 10 years using periapical radiographs., Results: Fifteen patients (23 implants) participated in the 10-year examination. All implants fulfilled the survival criteria. Following surgery, the implant sites gained endo-sinus bone (mean: 3.0 ± 1.4 mm). The mean crestal bone loss (CBL) was limited to 1.0 ± 0.9 mm. The difference in mean endo-sinus bone gain and CBL was statistically significant between 1 and 10 years, but not between 3 and 5, 3 and 10, and 5 and 10 years., Conclusions: At 10 years, the implant survival rate was 100%. Endo-sinus bone was mainly gained during the first year. This study demonstrates the long-term predictability of OSFE without grafting and simultaneous implant placement., (© 2015 Wiley Periodicals, Inc.)

When the posterior maxilla is atrophic, the reference standard of care would be to perform sinus augmentation with an autologous bone graft through the lateral approach and delayed implant placement. However, placement of short implants with the osteotome sinus floor elevation technique and without graft can be proposed for an efficient treatment of clinical cases with a maxillary residual bone height of 4 to 8 mm. The use of grafting material is recommended only when the residual bone height is ≤4 mm. Indications of the lateral sinus floor elevation are limited to cases with a residual bone height ≤ 2 mm and fused corticals, uncompleted healing of the edentulous site, and absence of flat cortical bone crest or when the patient wishes to wear a removable prosthesis during the healing period. The presented case report illustrates osteotome sinus floor elevation with and without grafting and simultaneous implant placement in extreme conditions: atrophic maxilla, short implant placement, reduced healing time, and single crown rehabilitation. After 6 years, all placed implants were functional with an endosinus bone gain.

Objectives: Actually, consensus management of osteonecrosis of the jaws (ONJ) related to nitrogen-containing bisphosphonates (NBPs) is mostly a conservative approach. It does not always control the symptoms and the progression of the disease. The aim of this study was to evaluate the clinical and radiological outcomes of three therapeutic management strategies of established ONJ., Materials and Methods: Three treatment strategies, i.e., conservative approach, minimal invasive surgery, and extensive surgery were evaluated in 39 ONJ patients treated with NBPs for malignant diseases or osteoporosis. The patients were closely monitored, and the outcome (extension, improvement, or healing) of mucosa and bone was clinically and radiographically evaluated on a long-term period (27.05 ± 2.96 months)., Results: Primary pathology (osteoporosis or malignancies) and clinical severity of ONJ (mild, moderate, severe) were decisive factors. Osteoporotic patients showed more frequently complete mucosa or bone healing (p = 0.0128 and p = 0.00021, respectively) than malignant patients. Mucosa closure and bone improvement occurred more in mild ONJ patients than in severe ONJ (p = 0.0053 and p = 0.0319, respectively). Treatment strategy appeared to be a crucial factor for mucosa but not for bone healing. The rate of complete mucosa healing increased after an extensive surgical procedure (p = 0.0096)., Conclusions: A surgical management of patients with ONJ positively influenced the clinical outcome by enhancing mucosa healing., Clinical Relevance: These results deserve further investigations involving a larger cohort. However, they strongly suggest that the guidelines of management of patients with ONJ related to NBPs have to be reconsidered.

Objectives/hypothesis: The aim of this study was to evaluate the nature and incidence of long-term maxillary sinus adverse events related to endosseous implant placement with protrusion into the maxillary sinus., Study Design: Retrospective cohort study., Methods: All patients who underwent placement of endosseous dental implants with clinical evidence of implant penetration into the maxillary sinus with membrane perforation were included in this study. Only patients with a minimum follow-up of 5 years after implant placement were included in this study. Maxillary sinus assessment was both clinical and radiological., Results: Eighty-three implants with sinus membrane perforation in 70 patients met the study's inclusion criteria. Mean age was 65.96 years ± 14.23. Twelve patients had more than one implant penetrating the maxillary sinus, and seven of them had bilateral sinus perforation. Estimated implant penetration was ≤ 3 mm in all cases. The average clinical and radiological follow-up was 9.98 years ± 3.74 (range 60-243 months). At the follow-up appointments, there were no clinical or radiological signs of sinusitis in any patient., Conclusion: This long-term study, spreading over a period of up to 20 years, indicates that no sinus complication was observed following implant penetration into the maxillary sinus. Furthermore, absence of occurrence of such complications is related to the maintenance of successful osseointegration. A contrario, and in the presence of an acute or chronic maxillary sinusitis, the differential diagnosis must always consider other potential odontogenic and nonodontogenic etiologies., (Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives: The aims of this study were (1) to evaluate the vertical shrinkage percentage of nanocrystalline hydroxyapatite embedded in silica gel used for maxillary sinus floor elevation (SFE) and (2) to determine the survival rate of the implants 1 year after placement in the healed grafted sinuses., Materials and Methods: Eleven maxillary sinuses were augmented in eight patients with NanoBone. After a healing period averaging 14.42 months, 19 implants were placed and followed up with clinical and radiographic evaluation. Panoramic radiographs were taken immediately after SFE and at 12 months after grafting. Measurements of changes in height were made by a computerized measuring technique using an image editing software., Results: The mean graft height shrinkage percentage at 12 months after surgery was 8.84% (±5.32). One implant was lost before loading. All the 18 remaining osseointegrated implants received the prosthetic rehabilitation and were controlled after 3 months of functional loading. The implant survival rate at the 1-year interval was 94.74%., Conclusions: A 100% NanoBone alloplastic graft used in lateral SFE procedures presented limited height shrinkage. Implants placed in these grafted sinuses showed survival rates similar to those found in published data. These results should be interpreted cautiously considering the study's reduced sample size.

Osteonecrosis of the jaw (ONJ) can be associated with nitrogen-containing bisphosphonates (NBPs) therapy. Various mechanisms of NBP-associated ONJ have been proposed and there is currently no consensus of the underlying pathogenesis. The detailed medical and dental histories of 30 ONJ patients treated with NBPs for malignant diseases (24) or osteoporosis (6) were analyzed. The necrotic bone was resected and analyzed histologically after demineralization. In 10 patients the perinecrotic bone was also resected and processed without demineralization. Alveolar bone samples from 5 healthy patients were used as controls. In 14 ONJ patients, serial technetium-99m-methylene diphosphonate scintigraphic scans were also available and confronted to the other data. Strong radionuclide uptake was detected in some patients several months before clinical diagnosis of ONJ. The medullary spaces of the necrotic bone were filled with bacterial aggregates. In the perinecrotic bone, the bacteria-free bone marrow characteristically showed an inflammatory reaction. The number of medullary inflammatory cells taken as an index of inflammation allowed us to discriminate two inflammation grades in the ONJ samples. Low-grade inflammation, characterized by marrow fibrosis and low inflammatory cells infiltration, increased numbers of TRAP(+) mono- and multineacleated cells was seen in patients with bone exposure<2 cm(2). High-grade inflammation, associated with larger lesions, showed amounts of tartrate-resistant acid phosphatase(+)/calcitonin receptor(-) mono- and multinucleated cells, osteocyte apoptosis, hypervascularization and high inflammatory cell infiltration. The clinical extent of ONJ was statistically linked to the numbers of inflammatory cell. Taken together these data suggest that bone necrosis precedes clinical onset and is an inflammation-associated process. We hypothesize that from an initial focus, bone damage spreads centrifugally, both deeper into the jaw and towards the mucosa before the oral bone exposure and the clinical diagnosis of ONJ.

This paper reports a 5-year life-table analysis on wide neck (WN) ITI implants placed in a private practice. In 212 patients, 263 implants were placed in the posterior region; 97% rehabilitated the molar area. Implants in the mandible and in the maxilla were 61.2% and 38.8%, respectively; the mean implant length was 9.7 and 8.9 mm, respectively. Eighty-nine percent sites had both vestibular and buccal bone lamellae > or =1 mm, 9.1% had one of them <1 mm and 1.9% had both lamellae <1 mm. Sinus perforation during surgery occurred in 52% of the maxillary implants. Prosthetic information was available for 249 implants; implants were involved in 157 single crowns (SC) and 80 fixed partial dentures (FPD). Radiographic analysis was performed on 102 implants that reached the 2-year control, and crestal bone loss (CBL) was measured. Results showed that five implants failed; the 5-year cumulative survival rate was 97.89%. The 1-year survival rate based on 259 implants was 98.8% and the 2-year survival rate based on 174 implants was 97.7%. In this 5-year timeframe, 94.3% of the SCs and 96.2% of the FPDs were free of complication. The mean CBL at the mesial and distal sides was 0.71 and 0.60 mm, respectively; bone losses >1 and >2 mm were recorded for 29.7% and 2.5% of the sides, respectively. This mid-term study showed that the WN ITI implants were highly predictable in private practice and that prosthetic complication in the molar area was an infrequent event.

Introduction: The latest generations of bisphosphonates constitute a major advance in the management of disorders including Paget's disease, osteoporosis, and osteolytic bone tumors. Recent reports describe numerous cases of osteonecrosis of the jaw in patients treated with bisphosphonates. Some of these reports mention predisposing factors, including surgical procedures, chemotherapy, and radiotherapy., Cases: In the past 12 months, we have observed and treated 9 cases of maxillary osteonecrosis, which we present summarily., Discussion: Some of our cases (3 of 9), like many of those described in literature, do not present predisposing factors. The osteonecrosis may thus be due mainly to the effect of bisphosphonates that, by blocking bone remodeling, may cause excessive bone mineralization. If this hypothesis is confirmed, these cases of osteonecrosis may be due to excess doses. Better dose adjustment should thus help prevent this complication.