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Objective: To assess the effect of topically applied hyaluronic acid (HA) on the stability of immediately loaded implants in the posterior maxilla. Materials and Methods: For the clinical study, a total of 20 implants were placed in 14 patients seeking the replacement of missing single or multiple posterior maxillary teeth. The patients were randomly divided into two groups. In the clinical control group (CC group), 10 implants were placed and immediately loaded, while in the clinical study group (CS group), 10 implants were coated with HA immediately before placement and immediately loaded. All patients had implant stability clinically evaluated at implant placement time (T0) and 1 (T1), 3 (T3), and 6 (T6) months after loading. Peri-implant pocket depth and modified sulcus bleeding index were evaluated clinically at 6 months in all patients. Bone density was evaluated radiographically after 3 months. All the clinical and radiographic data were subjected to statistical analysis. For the animal study, a total of 12 implants were placed in the tibiae of six rabbits. For each rabbit, 1 implant without any applied HA was placed in the left tibia (AC group), and 1 implant coated with HA was placed in the right tibia (AS group). The rabbits were euthanized at 21 and 45 days after implant insertion. Results: There were no significant statistical differences between the two groups regarding implant stability, peri-implant pocket depth, modified sulcus bleeding index, or bone density from the palatal and apical aspects. However, there was a significant statistical difference in the bone density from the buccal aspect in favor of the study group. The animal study showed that the newly formed bone in the right tibiae showed improved quantity and quality of bone, as it had denser bone trabeculae and smaller marrow spaces compared to the left tibiae. Conclusion: In the clinical study, the application of hyaluronic acid had a superior effect on the buccal bone density around immediately loaded implants. In the animal study, hyaluronic acid had a synergistic effect on the quality and quantity of bone formation around dental implants. [ABSTRACT FROM AUTHOR]

Abstract Background The posterior maxilla presents challenges for implant insertion because of the poor bone quality as well as the loss of vertical bone height. Indirect transcrestal sinus lift techniques are advised when a few millimeters of additional height are needed. This study aimed to evaluate the clinical and radiographic outcomes of antral membrane balloon technique versus Densah burs for transcrestal maxillary sinus lifting with simultaneous implant placement. Materials and methods This randomized clinical trial was conducted on 22 patients received 32 dental implants for replacement of missed maxillary posterior teeth after crestal maxillary sinus lifting. The patients were randomly divided into two groups. Group 1, patients underwent crestal sinus floor elevation with simultaneous implant placement using antral membrane balloon technique. Group 2, patients underwent crestal sinus floor elevation with simultaneous implant placement using Densah burs. Patients were evaluated clinically and radiographically using cone beam computed tomography (CBCT) at regular time intervals immediately, 6 months and 12 months after surgery. All clinical and radiographic parameters were statistically analyzed. Results All dental implants were successful for 12 months of follow up. Regarding implant primary stability, there was a statistical significant difference between the study groups in favor of Densah group (P = 0.004), while there was no significant difference after 6 months (P = 0.07). Radiographically, balloon group showed a statistically significant immediate postoperative vertical bone height (P

Background: The posterior maxilla presents challenges for implant insertion because of the poor bone quality as well as the loss of vertical bone height. Indirect transcrestal sinus lift techniques are advised when a few millimeters of additional height are needed. This study aimed to evaluate the clinical and radiographic outcomes of antral membrane balloon technique versus Densah burs for transcrestal maxillary sinus lifting with simultaneous implant placement. Materials and methods: This randomized clinical trial was conducted on 22 patients received 32 dental implants for replacement of missed maxillary posterior teeth after crestal maxillary sinus lifting. The patients were randomly divided into two groups. Group 1, patients underwent crestal sinus floor elevation with simultaneous implant placement using antral membrane balloon technique. Group 2, patients underwent crestal sinus floor elevation with simultaneous implant placement using Densah burs. Patients were evaluated clinically and radiographically using cone beam computed tomography (CBCT) at regular time intervals immediately, 6 months and 12 months after surgery. All clinical and radiographic parameters were statistically analyzed. Results: All dental implants were successful for 12 months of follow up. Regarding implant primary stability, there was a statistical significant difference between the study groups in favor of Densah group (P = 0.004), while there was no significant difference after 6 months (P = 0.07). Radiographically, balloon group showed a statistically significant immediate postoperative vertical bone height (P < 0.0001), and significant reduction in vertical bone height after 6 months (P < 0.0001). Densah group showed significant increase in bone density (P ≤ 0.05). Conclusion: Both techniques demonstrated successful clinical and radiographic outcomes for crestal sinus lift. The antral membrane balloon group demonstrated better immediate postoperative vertical bone gain, while Densah burs had higher implant primary stability and bone density. Trial registration: This study was registered in Clinical-Trials.gov PRS (https://register.clinicaltrials.gov) under identification number NCT05922592 on 28/06/2023. [ABSTRACT FROM AUTHOR]

Background: The aim of this narrative review was to provide insights into the influence of the morphological characteristics of the anatomical structures of the upper jaw based on cone beam computed tomography (CBCT) analysis on the immediate implant placement in this region. Material and Methods:To conduct this research, we used many electronic databases, and the resulting papers were chosen and analyzed. From the clinical point of view, the region of the anterior maxilla is specific and can be difficult for immediate implant placement. Findings: Anatomical structures in the anterior maxilla, such as the nasopalatine canal and accessory canals, may limit and influence the implant therapy outcome. In addition to the aforementioned region, immediate implant placement in the posterior maxilla may be challenging for clinicians, especially in prosthetic-driven immediate implant placement procedures. Data presented within the recently published materials summarize the investigations performed in order to achieve more reliable indicators that may make more accurate decisions for clinicians. Conclusion: The possibility for immediate implant placement may be affected by the NPC shape in the anterior maxilla, while the presence of ACs may increase the incidence of immediate implant placement complications. The variations in IRS characteristics may be considered important criteria for choosing the implant properties required for successful immediate implant placement. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to test the effectiveness and reliability of the alveolar ridge-splitting technique in atrophic posterior arches, investigating the middle-term volumetric and clinical outcomes. Materials and Methods: Atrophic alveolar ridges in the maxillary and mandibular posterior areas were treated with the alveolar ridge-splitting/expansion technique (ARST), immediate implant placement, collagen sponges covering the defect, and healing by secondary intention. Areas were rehabilitated by fixed dental prostheses supported by dental implants. Changes in volume and width of the alveolar ridge were retrospectively calculated by comparing the x-ray tomography scans obtained before and 5 years after surgery. Report of failure in the case sheets was taken into account. Cross-sectional images were also used to assess the thickness of the labial alveolar plates at the implant shoulder. Nonparametric analyses of variance with post hoc and pair-comparison tests were performed with a level of significance of .05. Results: A total of 38 patients were retrospectively selected (23 women and 15 men). Six patients underwent ARST surgeries in both the maxilla and the mandible and were excluded from statistical analysis. Differences between 16 maxillae and 16 mandibles and between 12 single crowns and 20 fixed partial dentures (FPDs) were searched. Episodes of minor swelling occurred within the first 2 days after surgery. Neither mucositis nor flap dehiscence had been registered. The mean values of buccal cortical thickness were 2.46 ± 0.49 mm and 1.15 ± 0.33 mm, respectively, in the maxillary and mandibular areas. After 5 years of survey, maxillary increases in alveolar ridge width and volume were +4.4 ± 0.4 mm and +295 ± 45 mm3, respectively, whereas the same outcome variables (+3.5 ± 0.7 mm and +217 ± 53 mm3) measured in the mandible appeared to be significantly smaller than those in the maxilla (P < .0001). One maxillary single implant failed. Cumulative survival rates at 5 years were 100% for mandibles and 95.5% (95% CI: 86.8% to 100%) for maxillae. Conclusion: Posterior areas of the maxilla displayed a higher increase in alveolar width and volume than mandibular areas, and even if it would be premature to draw survival conclusions at this stage without any statistical support, a lower cumulative survival rate was reported for the maxillary single implants. [ABSTRACT FROM AUTHOR]

Background: The aim of this narrative review was to provide insights into the influence of the morphological characteristics of the anatomical structures of the upper jaw based on cone beam computed tomography (CBCT) analysis on the immediate implant placement in this region. Material and Methods:To conduct this research, we used many electronic databases, and the resulting papers were chosen and analyzed. From the clinical point of view, the region of the anterior maxilla is specific and can be difficult for immediate implant placement. Findings: Anatomical structures in the anterior maxilla, such as the nasopalatine canal and accessory canals, may limit and influence the implant therapy outcome. In addition to the aforementioned region, immediate implant placement in the posterior maxilla may be challenging for clinicians, especially in prosthetic-driven immediate implant placement procedures. Data presented within the recently published materials summarize the investigations performed in order to achieve more reliable indicators that may make more accurate decisions for clinicians. Conclusion: The possibility for immediate implant placement may be affected by the NPC shape in the anterior maxilla, while the presence of ACs may increase the incidence of immediate implant placement complications. The variations in IRS characteristics may be considered important criteria for choosing the implant properties required for successful immediate implant placement.

Purpose: The aim of this study was to evaluate the survival and success rates of oral rehabilitations in a shortened maxillary dental arch and expanded maxillary sinus with 4-mm extrashort implants splinted to longer ones. Materials and Methods: One 10-mm and one/two extrashort 4-mm titanium-zirconium SLActive tissue-level dental implants were inserted into 11 patients with limited vertical bone availability due to an expanded maxillary sinus antrum. Immediately and 6 months after insertion, implant stability resonance frequency analysis (RFA) values were assessed with an Osstell device. Splinted crowns combining 4- and 10-mm implants were supplied to all 11 cases. Results: In 10 cases, the bone quality was type III, and in one case, type IV. Among 17 4-mm and 11 10-mm implants, the median RFA values were 61 (interquartile ranges [IQR]: 59 to 64) and 66 (IQR: 64 to 72). One 4-mm implant failed to osseointegrate and was removed. After 6 months of healing, secondary-stability measurements of 16 of the remaining 4-mm implants increased to 68 (IQR: 62 to 72) and of 10-mm implants to 78 (IQR: 77 to 80). After 1 year, all (11/11) oral rehabilitations supported by 10-mm (11/11) and 4-mm (16/16) implants were functional. The medians and IQRs of the probing depths (median: 2.8 mm, IQR: 2.3 to 3.1 mm vs median: 2.9 mm, IQR: 2.4 to 3.1 mm) and the crestal bone loss (median: 0.75 mm, IQR: 0 to 0.9 mm vs median: 0.22 mm, IQR: 0 to 0.4 mm) for the 10-mm and 4-mm implants, respectively, were similar. Conclusion: Rehabilitations with splinted crowns combining 4- and 10-mm implants demonstrated a favorable 1-year performance in a shortened maxillary dental arch. [ABSTRACT FROM AUTHOR]

Purpose: Evidence suggests that maxillary sinus floor augmentation via a lateral approach can be performed without positioning a bone graft inside, when one or more implants can be placed simultaneously. The aim of this study was to test if the placement of a porcine cortical bone layer underneath the sinus membrane can increase bone formation and implant stability. Materials and Methods: One hundred seventy-two patients with posterior maxilla atrophy needing implant rehabilitation were selected. Two hundred six sinus augmentation procedures were performed via a lateral approach, and 295 implants were placed in the same session of the sinus elevation surgery. In all the surgeries, a porcine cortical bone layer was placed underneath the sinus membrane, without using any graft material. After 6 to 7 months of healing, the implants were uncovered, then restored with porcelain-fused-to-metal crowns and monitored with a followup of 1 to 5 years. Results: The implant cumulative success rate was 95.2%, while the residual bone crest height changed from 2.67 ± 1.11 mm to 12.54 ± 1.42 mm, with an increase of 9.87 mm on average. Marginal bone resorption was 0.83 mm on average after 1 year of loading, while the mean implant stability measured at the moment of implant placement and 6 to 7 months later increased from an implant stability quotient (ISQ) of 62.61 ± 5.7 to an ISQ of 70.07 ± 8.2. Conclusion: This study confirms the validity of the graftless sinus elevation surgery when simultaneous implant placement is performed. The use of a porcine cortical bone layer seems to increase, from a radiologic point of view, the amount of bone around the implants, reducing healing time, cost, and biologic complications for the patient. [ABSTRACT FROM AUTHOR]

Implant placement in edentulous posterior maxilla along the maxillary sinuses poses difficulties following tooth extraction due to ridge resorption and pneumatization of sinuses resulting in inadequate vertical bone height. The maxillary sinus lying close to the posterior maxillary edentulous ridge can be augmented by various methods such as lateral window sinus floor elevation, crestal approach, and grafting procedures. Summers introduced the less invasive approach for the sinus floor elevation known as osteotome sinus floor elevation technique in which the vertical bone height was attained by retaining and relocating existing bone using different graded osteotomes. He further modified this technique by addition of bone graft to the osteotomy site before sinus elevation known as bone added osteotome mediated sinus floor elevation (BAOSFE). This case report shows placement of implant in atrophic maxillary region using BAOSFE technique.

Introduction and aim: Dental implant treatment in the posterior maxilla is often complicated by the poor healing of the alveolar process and by the pneumatization of the maxillary sinus. The authors are explaining the Cologne Classification of the Alveolar Ridge Defects (CCARD) with special emphasis on the maxillary sinus area and listing the main fators influencing process of selection of dental implant treatment. The aim of this article is to demonstrate, using case reports, four types of treatment. Results and conclusions: There are four types of treatment implant surgeon must choose from while considering treatment in posterior maxilla. Current literature does not give a guidance as to which treatment method to use. Transalveolar sinus lift has a good clinical outcome regardless of presence or absence of grafting material. Short implants with a long clinical crown are good alternative to treatment at times where Schneiderian membrane manipulation is not advised.

Purpose: The aim of this clinical study was to evaluate the long-term outcome of the split bone block (SBB) technique for vertical bone augmentation in the posterior maxilla in combination with sinus floor elevation using a tunneling approach. Materials and Methods: Patients were treated for extensive vertical and horizontal alveolar bone defects without simultaneous implant placement and followed up for at least 10 years postoperatively. Autogenous bone blocks were harvested from the mandibular retromolar area following the MicroSaw protocol. The harvested bone blocks were split longitudinally according to the SBB technique. Implants were inserted and exposed after every 3 months, and prosthetic restoration was performed. Results: One hundred forty-two consecutively treated patients, 154 grafted sites, and 356 inserted implants were documented. Minimal graft exposure (1 to 3 mm) 4 to 8 weeks postoperatively was documented in two sites; infection of the grafted area occurred in one other case. The mean preoperative clinical vertical defect was 7.8 ± 3.9 mm, and the mean horizontal width was 3.1 ± 2.2 mm. Postoperatively, the mean vertical gained dimension was 7.6 ± 3.4 mm (maximum: 13 mm), and the mean width was 8.3 ± 1.8 mm. Implants could be inserted in all sites, with additional local small augmentation in 21 cases. The amount of maximum vertical bone resorption was 0.21 ± 0.18 mm after 1 year, 0.26 ± 0.21 mm after 3 years, 0.32 ± 0.19 mm after 5 years, and 0.63 ± 0.32 mm after 10 years. As part of a total patient dropout of 16.9%, four implants were lost within 10 years. The mean vertically gained bone was stable at 6.82 ± 0.28 mm (maximum: 12 mm). The resorption rate after 10 years was 8.3%. Conclusion: The described tunneling flap approach allows a hermetic soft tissue closure, characterized by a reduction of dehiscence and a secure bone graft healing. The combination of thin autogenous bone blocks and bone particles according to the SBB technique allows an acceleration of transplant revascularization, and thus, of graft regeneration, allowing a shortening of the patient treatment time as well as long-term three-dimensional volumetric bone stability. [ABSTRACT FROM AUTHOR]

The maxillary sinus floor is a key anatomical obstacle for implant procedures carried out in the posterior maxilla. The aim of this study was the quantitative and qualitative evaluation of the available bone for dental implant placement in the maxillary premolar region. Material and Methods: Using cone beam computed tomography (CBCT) scans, we analyzed a group of 31 patients, 10 men and 21 women, aged between 40-70 years, who presented edentulous spans in the premolar region of the maxilla. The study was carried out in accordance with the legislation in force. The radiographic measurements were processed in Stata/MP13 software package using Student’s t-test, ANOVA test and Kruskal-Wallis test. Results: The average width of the available bone in the region of the maxillary first premolar was 6.44 mm, and in the region of the second premolar it was 7.30 mm. The average height of available bone in the area of the first premolar was 11.78 mm, and in the area of the second premolar it was 11.25 mm. The most common bone density was D3, in 74.19% of cases. Conclusions: The bone density of the maxillary premolar region is lower, and the average dimensions of the available bone are favorable for implant placement in subantral class 1 (SAC 1).

The present report describes the rehabilitation of partial edentulism (Kennedy's class II) in an elderly woman presenting with severe atrophy of the posterior maxilla, preventing standard implant placement. The woman had a positive history for osteoporosis and ongoing oral bisphosphonates therapy, thus, bone regeneration procedures, such as sinus lifting, were ruled out from the available options for her. Plus, the woman desired immediate fixed rehabilitation, thus, a 3D-printed custom subperiosteal implant was planned. The entire process, from impression acquisition to implant production was implemented in a digital setting and completed in three weeks. The surgeon was in charge of designing general implant features and the number, size, and position of future abutments. At surgery, the implant showed excellent fit and stability. One year after loading, the implant showed perfect integration and no complication could be recorded. Custom subperiosteal implants might represent a valid alternative for the rehabilitation of severely resorbed maxilla in elderly patients who cannot or do not want to undergo bone regeneration procedures. Further studies with large sample size and longer follow-up are recommended.

Langerhans cell histiocytosis (LCH), earlier recognised as histiocytosis X, is a rare haematological illness involving infants and young children. LCH is caused by unrestrained stimulation and proliferation of usual antigen presenting cells, Langerhans cells (LCs) and the disease demonstrates extensive clinical and radiographic features involving multiple sites. Since the incidence is relatively low limited data is available regarding the epidemiology of LCH, with approximation of 2–5 cases per million populations per year. LCH has male predilection with jaws involved in 10–20% cases and only 1% of the cases affecting maxilla, masquerading as periodontal or periapical pathology. We report a case of 48-year-old female with LCH involving posterior maxilla. This is a unique presentation corresponding to age, gender, location and severity. Dental clinicians should be aware of this and consider it to be a part of their differential diagnosis pertaining to unresolved periodontal pathology as it mimics clinically and radiographically. [ABSTRACT FROM AUTHOR]

Implant placement in edentulous posterior maxilla along the maxillary sinuses poses difficulties following tooth extraction due to ridge resorption and pneumatization of sinuses resulting in inadequate vertical bone height. The maxillary sinus lying close to the posterior maxillary edentulous ridge can be augmented by various methods such as lateral window sinus floor elevation, crestal approach, and grafting procedures. Summers introduced the less invasive approach for the sinus floor elevation known as osteotome sinus floor elevation technique in which the vertical bone height was attained by retaining and relocating existing bone using different graded osteotomes. He further modified this technique by addition of bone graft to the osteotomy site before sinus elevation known as bone added osteotome mediated sinus floor elevation (BAOSFE). This case report shows placement of implant in atrophic maxillary region using BAOSFE technique. [ABSTRACT FROM AUTHOR]

Introduction: The placement of implants in atrophic bone has always posed a challenge to the clinicians in terms of good surgical and esthetic results. The placement of implants palatal to the alveolar crest in maxilla allows maximum use of the available bone in patient with severe bone resorption. Objective: To evaluate the quantitative changes in crestal bone levels in palatally positioned two-piece endosseous implants in maxillary posterior region. Materials and methods: Ten Adin (TouaregTM) – root form, threaded collar, two-piece, endosseous, internal hex implant were placed palatally in atrophic posterior maxilla. 25o abutments were used in four patients and 15o abutments were used in remaining six patients out of ten so as to achieve a proper esthetic appearance. Radiographic evaluation of crestal bone was done on on mesial side (Group I) and distal side(Group II) of implant at the time of implant placement, after3 months (time of implant loading) andafter 6 months (3 months post loading). Result: Among Group I (crestal bone level evaluated on mesial side using RVG), three months post implant placement showed the highest Crestal Bone Loss i.e. 0.66±0.070 mm and immediately post implant placement evaluation showed the least value i.e. 0.04±0.07 mm which was statistically significant (p-value < 0.05). Among Group II (crestal bone level evaluated on distal side using RVG), three months post implant placement evaluation showed the highest Crestal Bone Loss i.e. 0.66±0.070 mm and immediately post implant placement evaluation showed the least value i.e. 0.04±0.07 mm which was statistically significant (p-value < 0.05). Conclusion : The mean Crestal Bone loss at the end of 3 months post implant placement observed was 0.29mm and at the end of 6 months post implant placement observed was 0.66mm.The effect of tilting the implants palatally by 15 to 25 degrees did not considerably influence the Crestal Bone Levels around the implant. [ABSTRACT FROM AUTHOR]

Ameloblastoma is a rare odontogenic tumour that develops from the epithelial remains of the dental lamina. It is a benign but locally aggressive neoplasm that typically manifests as slow-growing tumours in the jaw, with posterior maxilla ameloblastoma being the rarer occurrence compared to mandibular ameloblastoma. This case report is about a 46-year-old Malay man who presented with a two-month history of left palatal and cheek swelling, along with symptoms such as left eye blurring, nasal block, and dysphagia. Imaging revealed a massive cystic lesion in the left maxillary sinus, which was diagnosed as a multicystic ameloblastoma after biopsy. The patient underwent surgical resection with a partial maxillectomy and was treated postoperatively with antibiotics, steroids, and regular follow-up appointments. The histopathological examination confirmed the diagnosis, and the patient was given a dental obturator to cover the defect intraorally. He is currently under annual surveillance with no signs or symptoms of recurrence., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Abd Rahim et al.)

Background. Maxillary sinus pathologic conditions increase the risk of complications during sinus augmentation surgeries in the posterior maxilla. The present study aimed to determine the frequencies of maxillary sinus pathologic findings on patients’ cone-beam computed tomography (CBCT) images to receive dental implants. Methods. In this descriptive/cross-sectional study, 140 CBCT images of patients who were candidates to receive dental implants were evaluated for the presence of maxillary sinus pathologic entities during 6 months, were divided into five categories: mucosal thickening of >5 mm, retention cyst, partial or complete opacification of the sinus, polypoidal mucosal thickening, and healthy patients. Age, gender, and dental status were evaluated in terms of relationship with the sinus pathologic findings. Absolute and relative frequencies were used to describe data. The chi-squared test was used to analyze the variables. Statistical significance was set at P

Abstract Background This study analyzed the influence of implant protrusion length (IPL) on the possible factors that affect the long-term outcomes utilizing non-grafting osteotome sinus floor elevation (OSFE) with simultaneous implant placement, and to explore the optimal range of IPL. Materials and methods A retrospective study design was adopted. The clinical and radiographic data of 105 implants in 65 patients were collected after 3–9 (mean 5.04) years follow-up. IPL was divided into three groups (group1, IPL

Aims and Objectives: The aim of this prospective clinical study was to evaluate the success of one-stage direct (lateral) sinus lift procedure in severely atrophic posterior maxilla. Materials and Methods: One-stage direct (lateral) sinus lift procedure was carried out at 15 sites in 13 patients. All patients included in the study presented with partially edentulous posterior maxilla with one or more missing teeth and residual bone height less than 5 mm. Three months after surgery, patients were evaluated to access increase in residual bone height, density of new bone formed and implant stability. Patients were also evaluated after 3 months of prosthetic placement for the success of implant-supported prosthesis. Results: At 3 months post-operatively, increase in residual bone height was 8.31 ± 1.63 mm and the mean density of the newly formed bone around the implants was 417 ± 66.61 HU. All implants were stable and successfully osseointegrated, except one implant that was lost. The success rate of implant stability was 96.3% during the study period. Conclusion: Single-stage direct (lateral) maxillary sinus floor augmentation is a good treatment option with predictable outcome for patients with deficient alveolar bone in posterior maxilla.

Purpose: To determine the potential complications and clinical outcomes using the lateral sinus elevation technique with window repositioning. Materials and Methods: One hundred nine sinus elevations were performed on 102 consecutively treated patients. Following lateral window outward fracturing, sinus mucosa was elevated, and the sinus was grafted with anorganic bovine bone. Two hundred five implants were placed: 160 concomitantly with grafting, and 45 six months after grafting. Seventeen implants replaced single missing molars. One hundred eighty-eight implants replaced multiple missing posterior teeth. The bone window was repositioned over the osteotomy site and the flap sutured. Implants were connected at 6 months and followed up from 12 to 60 months (mean: 29.8 months). In 30 cases, biopsy specimens were harvested from the lateral wall of the sinus for histomorphometric analysis. The Fisher exact test and Kruskal-Wallis test followed by the Mann-Whitney test were used for statistical analysis. Results: No clinically significant complications were encountered in using this technique (mucosa tear, intraoperative bleeding, window sequestration). In three cases, the window was separated in two before outfracturing. In 20 cases, it was stabilized with a collagen fleece. Limited sinus mucosa tears occurred in 14 cases during elevation. They were patched with a collagen membrane, and 18 implants were placed in these cases. All of the latter cases osseointegrated at abutment connection with no statistically significant difference in the outcome compared with implants placed with no tear of the membrane (P < .05). The reconstruction of the lateral wall was confirmed in all cases. No significant differences in outcomes were found between the immediately and delayed placed implants (P < .05). One implant failed in the immediately placed group due to a sinus infection. All other implants were loaded and remained in function during the observation period. Conclusion: Lateral sinus elevation with window repositioning is safe and effective with minimal risks, such as mucosal tear, intraoperative bleeding, or window sequestration. The repositioned window can serve as an alternative for collagen membrane in containing the graft. Graft maturation, percent of vital bone formation, and the potential of the window to serve as a source of osteogenic cells need to be confirmed histomorphometrically. This will be reported in a subsequent article. [ABSTRACT FROM AUTHOR]

Purpose: To radiographically monitor sinus membrane swelling after lateral sinus floor elevation surgery at short and long healing periods. Materials and Methods: For 26 patients seeking posterior maxillary implant-supported reconstruction, 32 lateral sinus floor elevations were performed using Piezosurgery. Sinus membranes were grafted using synthetic calcium phosphate bone substitutes, and graft volume was measured in cubic centimeters for each case. Cone beam computed tomography (CBCT) examination was conducted preoperatively in all patients and for each grafted sinus at 1 day (n = 8), 2 days (n = 9), 3 days (n = 8), or 7 days (n = 7) after surgery. Control CBCT was then performed for all patients at 3, 6, and 12 months after surgery. Sinus membrane thickness was measured on cross-sectional CBCT images at nine standardized points per sinus, before lateral sinus floor elevation and at all postoperative examinations. Results: Mean sinus membrane thickness was 0.73 mm before surgery and 5 mm, 4.1 mm, 5.9 mm, and 7 mm, respectively, at 1, 2, 3, and 7 days after surgery. First week combined postoperative CBCT measurements of membrane thickness was 5.4 mm, then 1.3, 0.68, and 0.39 mm at 3, 6, and 12 months, respectively, after surgery. Membrane thickness significantly increased the first week after surgery and gradually decreased significantly at 3, 6, and 12 months in all groups (P < .001). First-week postoperative measurements showed a significant increase in membrane thickness at 3 days compared with the 1- and 2-day results (P < .001) and at 7 days compared with all other time points (P < .001). Membrane thickness at 2 days did not change significantly compared with 1-day measurements. Larger graft volume was positively correlated with an increase in membrane thickness after surgery at all time points (n = 32; r = 0.527; P < .001). Conclusion: After lateral sinus floor elevation surgery, transient swelling of sinus membrane is observed. It reaches a peak value 7 days after surgery and completely resolves over months. This swelling is correlated to the extent of sinus floor elevation. [ABSTRACT FROM AUTHOR]

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Objectives: The aim of the present study was to investigate whether peri-implant clinical parameters (modified plaque index (mPI), bleeding and/or suppuration on probing (B/SOP)) and local factors (type of prostheses, screw emergence, platform diameter, and abutment angulation) might contribute to the development of additional bone loss and peri-implantitis around dental implants. Materials and methods: Two hundred seventy-seven external hex connection implants placed in the posterior maxilla of 124 patients were retrospectively evaluated. They were divided into two groups: physiologic bone loss < 2 mm (PBL) or additional bone loss ≥ 2 mm (ABL). GEE logistic regression was applied to evaluate the influence of type of prostheses (implant-supported single crown (ISSC), fixed partial denture (ISFPD), and full denture (ISFD)) and clinical parameters (mPI and S/BOP) on bone loss. Results: Among the 277 implants, 159 (57.4%) presented PBL and 118 (42.6%) presented ABL. Within the ABL group, 20.6% implants were diagnosed with peri-implantitis. mPI significantly correlated with the type of prosthesis and the highest value of mPI (index = 3) was observed in ISFD (23.8%). Moreover, peri-implantitis was more frequently associated with ISFD (32.79%) than ISSC and ISFDP (13.79% and 13.48, respectively) Conclusions: ISFD in the posterior maxilla presented high rates of ABL and showed a higher prevalence of peri-implantitis. None of the local factors seemed to contribute to the development of these conditions. Further investigations are needed to prospectively support the results of the present study. Clinical relevance: Patients rehabilitated with ISFD should be carefully monitored and have more frequent maintenance visits to prevent or control peri-implant bone loss. [ABSTRACT FROM AUTHOR]

Background and Aims: The aim of this study was to assess the outcome of short implants (

Background: This study analyzed the influence of implant protrusion length (IPL) on the possible factors that affect the long-term outcomes utilizing non-grafting osteotome sinus floor elevation (OSFE) with simultaneous implant placement, and to explore the optimal range of IPL. Materials and methods: A retrospective study design was adopted. The clinical and radiographic data of 105 implants in 65 patients were collected after 3–9 (mean 5.04) years follow-up. IPL was divided into three groups (group1, IPL<2mm; group2, 2mm≤IPL<4mm; group3, IPL≥4mm). Endo-sinus bone gain (ESBG), peri-implant marginal bone loss (MBL), bone to implant contact length (BICL), and percentage of ESBG (%ESBG) were used to evaluate non-grafting OSFE. A Kaplan-Meier analysis was performed to assess the cumulative survival rate. Multiple linear regression model was used to explore the relationship between the possible influence factors and ESBG. Analysis of variance (ANOVA) was applied to explore the correlation of IPL with ESBG, MBL, BICL, and %ESBG. Results: A total of 102 implants in 62 patients fulfilled the survival criteria, giving the cumulative survival rates of 96.4% and 94.1% for implant-based analysis and patient-based analysis, respectively. The mean ESBG, MBL, and BICL at the latest follow-up were 1.95±0.88 mm, 0.58±0.68 mm, and 5.51±1.47 mm. ESBG was found to be positively correlated to IPL. A significant decreased bone formation efficiency was found when IPL was over 4 mm (P=0.02). Conclusions: An optimal range of IPL within 4 mm was recommended for better long-term outcomes when applying non-grafting OSFE with simultaneous implant placement. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this randomised controlled trial was to assess the clinical performance of single crowns in the posterior maxilla supported by either 6-mm or 11-mm implants combined with maxillary sinus floor elevation. Materials and methods: 41 consecutive patients with one missing premolar or molar in the posterior maxilla and with an estimated bone height of 6 to 8 mm in that area were included. Each patient was randomly allocated to one of the two treatment groups, namely to receive an 11-mm implant (OsseoSpeed 4.0S, Dentsply Implants, Mölndal, Sweden) in combination with maxillary sinus floor elevation surgery or to receive a 6-mm implant (OsseoSpeed 4.0S) without any grafting. After a 3-month osseointegration period, all implants were restored with custom-made titanium abutments and cemented zirconia-based porcelain crowns. Outcome measures were: implant survival; radiographic bone changes; plaque accumulation; bleeding tendency; peri-implant inflammation; presence of dental calculus; biological and technical complications; and patients’ satisfaction. Clinical and radiographic examinations were performed at placement of the crown and 12 months thereafter. Patients’ satisfaction was scored before treatment and after 12 months of functioning of the crown. Results: One patient of the 11 mm implant group died during the follow-up. No implant failed and no biological or technical complications occurred. From loading to the 12 months follow-up, no difference was found in mean marginal bone changes between the groups (bone resorption in both groups 0.1 ± 0.3 mm). Clinical items revealed very healthy peri-implant soft tissues in both groups. Patients’ satisfaction scores were high in both groups. Conclusions: 6-mm implants and 11-mm implants combined with sinus floor elevation surgery are equally successful to support a single crown in the resorbed posterior maxilla after 1-year follow-up. [ABSTRACT FROM AUTHOR]

Purpose: Elevated bite forces and reduced bone densities and dimensions associated with posterior regions of the maxilla cause relatively high failure rates when short dental implants are placed to substitute missing teeth. This study uses the finite element method to evaluate four distinctly different short implant designs (Bicon, Neodent, Nobel Biocare, and Straumann) for their influences on the von Mises stress characteristics within the posterior maxilla. Materials and Methods: Finite element models of the supporting bone and tooth crowns are developed based on computed tomography data, and implant geometries are obtained from manufacturers' catalogs. The finite element models are meshed using three-dimensional hexahedral and wedge-shaped brick elements. Assumptions made in the analyses are: linear elastic material properties for bone, 50% osseointegration between bone and implant, and crown height-implant length ratio of 2:1. Results: Bicon's neck indentation produced reduced stress in the cortical bone when compared with the Nobel Biocare and Straumann systems. The increased taper of the Neodent design decreased the stress level in cancellous bone. Nobel Biocare's rounded thread crest and reduced thread pitch produced a smoother stress profile. Straumann's increased thread pitch produced elevated stress in the cancellous bone. Generally, stresses were concentrated in the crestal bone region around the implant neck, attributable to the inclined nature of the masticatory force. Conclusion: Nobel Biocare and Bicon systems are recommended for use in type 4 cancellous and cortical bone, respectively. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate long‐term clinical and radiographic outcomes of dental implants placed after lateral window sinus augmentation utilizing the sagittal sandwich technique. Materials and Methods: Patients treated with sinus augmentation were included in this retrospective case‐series study. The surgical procedure was performed with particulate autogenous bone‐ and anorganic bovine bone‐derived mineral (3:7 ratio). Implants were grouped based on baseline residual alveolar ridge height: group S (residual alveolar ridge height of 0.1–3.5 mm), group M (height of 3.5‐7mm), and group C (native bone). Radiographs were taken at baseline (abutment installation) and annually throughout the 10‐year follow‐up. Results: A total of 86 patients (92 sinus lifts) and 209 implants were included. Ten sinus membrane perforations were recorded (11% incidence), and graft infections occurred in 3 cases (3.2% incidence). During the 10‐year follow‐up, 3 implants (1.4%) failed. No significant differences in the mean implant marginal bone loss (MBL) between the three groups were found after 1‐, 2‐, and 5‐year follow‐up (p >.05). At 10 years, group C exhibited more MBL than group M with a mean difference of −0.53 mm (p =.01). After 10 years, MK III implants displayed significantly more bone loss in native bone than those in augmented bone with a mean difference of 0.48 mm (p =.02). Five patients and 7 implants developed peri‐implantitis with no significant differences between the groups (p =.570). Conclusion: Implant placement after two‐stage sinus grafting utilizing the sagittal sandwich technique is a relatively safe and predictable procedure with minimal complications and MBL after 10‐year follow‐up. [ABSTRACT FROM AUTHOR]

Background. Maxillary sinus pathologic conditions increase the risk of complications during sinus augmentation surgeries in the posterior maxilla. The present study aimed to determine the frequencies of maxillary sinus pathologic findings on patients' cone-beam computed tomography (CBCT) images to receive dental implants. Methods. In this descriptive/cross-sectional study, 140 CBCT images of patients who were candidates to receive dental implants were evaluated for the presence of maxillary sinus pathologic entities during 6 months, were divided into five categories: mucosal thickening of >5 mm, retention cyst, partial or complete opacification of the sinus, polypoidal mucosal thickening, and healthy patients. Age, gender, and dental status were evaluated in terms of relationship with the sinus pathologic findings. Absolute and relative frequencies were used to describe data. The chi-squared test was used to analyze the variables. Statistical significance was set at P<0.05. Results. The frequency of maxillary sinus pathologic entities on CBCT images was 63.5%. The pathologic conditions in descending frequency were as follows: mucosal thickening (31.4%), retention cyst (17.1%), partial or complete opacification of the sinus (9.3%), and polypoidal mucosal thickening (5.7%). The frequency of pathologic findings in the maxillary sinus was higher in the <46-year age group and subjects with partial edentulism; however, the differences were not significant. Conclusion. In the present study, the most frequent maxillary sinus pathologic entity was mucosal thickening. There was no relationship between age, sex, and dentition status and maxillary sinus pathologic findings. [ABSTRACT FROM AUTHOR]

Purpose: Sinus elevation via the lateral approach for implant rehabilitation of atrophic posterior maxillae is considered a safe and predictable therapy. Several xenogeneic biomaterials of different biologic origin have been used as valid and predictable alternatives to autogenous bone. This multicenter randomized controlled double-blind prospective clinical trial aimed to compare histomorphometrically two xenogeneic grafting materials used for sinus elevation with simultaneous implant placement. Materials and Methods: Seven private practices in Italy were involved. Patients presenting at least one site with a residual bone crest height between 2 and 4 mm were treated. Control sites were grafted with 100% deproteinated particulated bovine bone (DPBB), while test sites were grafted with prehydrated corticocancellous porcine bone (PCPB). Root-form implants were placed simultaneously. Insertion torque and clinical stability were assessed and recorded. At 6 months, a biopsy specimen was harvested from each site, and histomorphometric analyses were performed. Results: Thirty-seven patients received 42 sinus elevations (24 test and 18 control). Eighty-two implants with adequate primary stability were placed. Fifty-five implants were placed in residual bone crests greater than 2 mm but less than 4 mm (average 2.7 mm) and achieved an average insertion torque of 22.8 ± 11.3 N/cm. Nineteen implants were placed in ridges greater than 3 mm but less than 5 mm, and eight were placed in ridges with more than 5 mm remaining. After 6 months, three implants had failed to integrate, leading to a survival rate of 96.34%. Forty-two specimens were analyzed histomorphometrically. No significant differences in total bone volume (PCPB 37.43%, DPBB 37.52%) or residual grafting material (PCPB 13.55%, DPBB 16.44%) were detected. Conclusions: In this study, PCPB compared well with DPBB as a grafting material for lateral sinus elevation. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the present study was to evaluate the thickness and anatomic characteristics of the sinus membrane using cone beam computed tomography (CBCT) in patients evaluated for implant surgery in the posterior maxilla. Materials and Methods: The study included 131 consecutive patients referred for dental implant placement in the posterior maxilla. A total of 138 CBCT images was obtained using fields of view of 4 × 4 cm, 6 × 6 cm, or 8 × 8 cm. Reformatted sagittal CBCT slices were analyzed with regard to the thickness and characteristics of the sinus membrane at single-tooth gaps in the posterior maxilla. Factors that might influence the dimensions of the sinus membrane, such as age, sex, endodontic status, and the season, were analyzed. Results: The mean thickness of the maxillary sinus mucosa varied between 2.1 and 2.69 mm in the three locations analyzed. Fewer than half of the evaluated sinuses exhibited a healthy mucosa (49 of 138, or 35.51%). Most of the pathologic findings were flat, shallow thickenings (63 of 138, or 45.65%). Sex did not influence the thickness of the sinus membrane at the root tips of the premolars or at single-tooth gaps, but there was a statistically significant correlation in the region of the maxillary molars. No other evaluated factors had a statistically significant effect on the dimensions of the antral mucosa. Conclusions: In the present study, sex was the only factor influencing the dimension of the sinus membrane, whereas patient age, season, and the endodontic status of neighboring teeth had no significant effect on the thickness of the antral mucosa. Future studies should address which types of mucosal thickening require interdisciplinary therapy. [ABSTRACT FROM AUTHOR]

Aim: This systematic article reviews the literature on the confounding parameters that affect short implant survival in order to establish specific surgical and prosthetic protocols that create an optimal biomechanical scenario and ensure implant longevity. Materials and methods: The available literature was screened for randomized clinical trials and prospective cohort and retrospective studies, published up to February 20, 2020, on the prognosis of short-length implants placed in posterior jaws. Studies evaluating the 5-year clinical performance of short dental implants (5 mm or 6 mm) in fixed rehabilitations of partially edentulous posterior jaws were included. Results: Eleven studies were selected after assessment of inclusion and exclusion criteria, of which 8 were RCTs, 2 were prospective studies, and 1 was a retrospective study. After 5 years in function, 22 short (12 in maxilla and 10 in mandible) and 10 standard (2 in maxilla and 8 in mandible) implants were lost, resulting in high survival rates independent of implant length or location. More biological complications were found in standard implants especially those placed in augmented posterior mandibles (135 complications compared to 48 in short mandibular implants). Splinted prostheses were associated with less technical complications (15 out of 53 complications affecting short implants). Conclusion: The findings of this review showed that, when used correctly, short implants achieve predictable and promising long-term outcomes, provided they are placed following a comprehensive surgical and prosthetic protocol, based on the different biomechanical parameters essential to optimize long-term prognosis. Clinical significance: The use of short implants in clinical practice has considerably increased in a wide variety of cases, given that they offer several advantages for both patient and practitioner. Recent literature shows that, when specific criteria are respected, new generations of short implants present high, long-term survival rates. This review is designed to provide a thorough understanding of the surgical and prosthetic protocols that create an optimal biomechanical scenario for short implants and improve their prognosis. [ABSTRACT FROM AUTHOR]

The aim of this case report was to report the course of treatment for advanced paranasal sinus infection triggered by peri-implantitis, managed using functional endoscopic sinus surgery (FESS), with outcomes. A nonsmoking male patient received sinus augmentation with implant placement on his left posterior maxilla 15 years ago. Possibly due to noncompliance to maintenance, peri-implantitis developed and progressed into the augmented bone area in the maxilla. Eventually, maxillary sinusitis occurred concomitantly with a spread of the infection to the other paranasal sinuses. Implant removal and intraoral debridement of inflammatory tissue were performed, but there was no resolution. Subsequently, FESS was performed, with removal of nasal polyp and sequestrum. After FESS, the patient's sinusitis resolved. Histologically, the sequestrum was composed of bone substitute particles, necrotic bone, stromal fibrosis, and a very limited cellular component. Two implants were placed on the present site, and no adverse event occurred for up to 1 year after the insertion of the final prosthesis. Peri-implantitis in the posterior maxilla can trigger maxillary sinusitis with concomitant infection to the neighboring paranasal sinuses. FESS should be considered to treat this condition. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The aim of this prospective clinical study was to evaluate the success of one-stage direct (lateral) sinus lift procedure in severely atrophic posterior maxilla.Materials and Methods: One-stage direct (lateral) sinus lift procedure was carried out at 15 sites in 13 patients. All patients included in the study presented with partially edentulous posterior maxilla with one or more missing teeth and residual bone height less than 5 mm. Three months after surgery, patients were evaluated to access increase in residual bone height, density of new bone formed and implant stability. Patients were also evaluated after 3 months of prosthetic placement for the success of implant-supported prosthesis.Results: At 3 months post-operatively, increase in residual bone height was 8.31 ± 1.63 mm and the mean density of the newly formed bone around the implants was 417 ± 66.61 HU. All implants were stable and successfully osseointegrated, except one implant that was lost. The success rate of implant stability was 96.3% during the study period.Conclusion: Single-stage direct (lateral) maxillary sinus floor augmentation is a good treatment option with predictable outcome for patients with deficient alveolar bone in posterior maxilla. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this ongoing prospective study was to determine the 5-year survival rate of short porous dental implants in the posterior atrophic maxilla combined, when necessary, with crestal sinus floor elevation and often adding an organic bovine bone.Materials and methods: In 87 partially edentulous patients, 110 short porous implants were placed and followed up for 5 years. The implants used were of two lengths (5 and 7 mm) and two diameters(4.1 and 5 mm) and were chosen according to the available crestal height and width. In 47 sites,osteotome sinus floor elevation was performed (in 8 cases compacting basal bone, in 39 adding a xenograft). The unloaded healing period was 6 months. A total of 63 implants were restored with single crowns and 47 were splinted to the adjacent implants. Outcome measures were prosthesis and implant failures, any complications, and peri-implant marginal bone resorption.Results: Five years after loading, no patients dropped out. Eleven implants failed: 2 implants at uncovering and 9 after prosthetic loading. Eleven patients (12.6%) lost 1 implant. In 6 patients(6.9%) a prosthesis failure occurred (implants loaded with single crowns). One surgical complication(membrane perforation) occurred but the implant was normally inserted. No complicationsoccurred during the healing period. In 3 patients, severe peri-implantitis occurred post loading and the implants had to be removed. Two abutments became loose and one crown chipped. At the end of the follow-up period the implant survival rate was 90%, and 93.1% with regard to prostheticreconstruction. The mean peri-implant marginal bone loss was 1.4 mm.Conclusions: The use of short porous implants showed an acceptable clinical outcome in the treatment of the posterior maxilla in this interim 5-year report. Longer follow-ups are needed to confirm these results.Conflict-of-interest statement: The authors declare no conflict of interest. All of the materials and implants were purchased and paid for by the dental clinic. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this retrospective study was to evaluate the outcomes, after 5 years of functional loading, of four different types of implants supporting prostheses in the posterior maxilla and mandible. Materials and Methods: Patients missing posterior teeth were treated with implants between 1998 and 2004. The implants were evaluated by clinical and radiographic parameters and Plaque Index, Sulcus Bleeding Index (BI), peri-implant probing depths (PD), and marginal bone loss (MBL) were recorded. Repeated-measures analysis of variance, Kruskal-Wallis, and Wilcoxon signed rank tests were used for statistical analysis. Results: In all, 244 implants were placed in 83 patients: 86 Straumann implants, 35 Swiss Plus implants, 90 Camlog implants, and 33 Frialit implants. Patients received 93 single crowns and 71 fixed partial dentures (FPDs). Nine FPDs were cemented to both implants and natural teeth, and 62 FPDs were supported by implants only. At the 5-year recall, plaque accumulation was significantly higher than at baseline for all groups (P = .01). Mean PD was 1.8 mm in the maxilla and 1.6 mm in the mandible. The mean PD values were 1.77 ± 0.52 mm for Straumann, 1.87 ± 0.64 mm for Swiss Plus, 2.33 ± 0.58 mm for Camlog, and 2.29 ± 0.46 mm for Frialit. MBL was 0.19 ± 0.07 mm for Straumann, 0.27 ± 0.06 mm for Camlog, 0.26 ± 0.07 mm for Swiss Plus, and 0.24 ± 0.07 mm for Frialit. The mean MBL of Straumann implants was significantly lower than that seen in the other groups (P = .001). Conclusion: The four types of implants resulted in similar clinical success after 5 years. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to retrospectively analyze a cohort of patients who had implants placed in the posterior maxilla and assess and identify the predictors of implant failure. Materials and Methods: With institutional review board approval, dental records from a population of patients who had maxillary posterior implants placed were used to create a database. Independent variables were divided into continuous (age of the patient at stage-one implant surgery [S1], time between extraction and S1, time between extraction and sinus augmentation, time between sinus augmentation and S1, time between S1 and stage-two implant surgery [S2], and the time between S2 and restoration of the implant) and categorical (gender, American Society of Anesthesiologists [ASA] status, current smoking status, implant position, implant proximity, residual crestal bone height, implant length and diameter, and sinus augmentation technique and materials). The dependent variable was implant failure, which was defined as complete removal of the implant. Simple logistic regression was used to assess the influence of each of the predictors on implant failure (P < .05). Results: The final database included 504 maxillary posterior implants with an overall survival rate of 93.2% over a mean follow-up period of 35.7 months. For the continuous variables, the age of the patient at S1 was statistically associated with implant failure (P = .028), as was the time between extraction and S1 (P = .014). For the categorical variables, ASA status (P < .001), implant proximity (P = .043), residual crestal bone height (P < .001), implant diameter (P = .050), sinus augmentation technique (P = .002), and sinus graft materials (P < .001) were statistically associated with implant failure. Conclusion: Within the limitations of this retrospective study, the results suggest that there are risk factors associated with maxillary posterior implant failure. Implants placed in areas with inadequate residual crestal bone height that required sinus augmentation were statistically associated with implant failure. [ABSTRACT FROM AUTHOR]

Purpose: The aims of this prospective study were to: (1) determine clinical and radiographic success and survival rates of implants placed in a staged procedure after sinus augmentation; and (2) compare the success and survival rate of implants in two patient groups with different ridge height prior to treatment (those with minimal residual crestal bone [< 3.5 mm] below the sinus and those with moderate residual crestal bone [> 3.5 mm]). Materials and Methods: The study used anorganic bovine bone-derived mineral and autogenous bone for the sagittal sandwich bone augmentation technique, a collagen membrane to protect the sinus window, and a staged approach for implant placement; all implants featured an anodized surface. Results: Two hundred forty-five implants were placed in 100 sinus sites (79 patients), and 244 have survived to date. The cumulative success and survival rates of all implants overall at 5 years were 96.5% (SE 2.0%) and 99.6% (SE 0.4%), respectively. The overall success and survival rates at 5 years for implants placed into minimal residual crestal bone were 94.1% (SE 3.4%) and 99.4% (SE 0.6%), respectively. For implants placed into moderate crestal bone, overall success and survival rates were both 100.0% (SE 0.0%). Conclusions: Success of implants placed after sinus augmentation appears similar to implants placed in native bone when a classical submerged implant healing time of 6 months is used. The success and survival rates and crestal bone remodeling of implants placed in minimal residual crestal bone were comparable to those of implants placed in moderate residual crestal bone. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate early and immediate loading of implants in the posterior maxilla and to investigate whether there is a difference in success rates, survival rates, and peri-implant parameters, including marginal bone level changes. Materials and Methods: A comprehensive systematic review of the literature was conducted. The selection of publications reporting on human clinical studies was based on predetermined inclusion criteria and was agreed upon by two reviewers. Results: Twelve papers were identified on early loading (two randomized controlled clinical trials [RCTs] and 10 prospective case series studies). Six papers were found on immediate loading (one RCT, four prospective case series, and one retrospective study). Conclusions: Under certain circumstances it is possible to successfully load dental implants in the posterior maxilla early or immediately after their placement in selected patients. The success rate appears to be technique sensitive, although no study has directly assessed this. A high degree of primary implant stability (high value of insertion torque) and implant surface characteristics play an important role. It is not possible to draw evidence-based conclusions concerning contraindications, threshold values for implant stability, bone quality and quantity needed, or impact of occlusal loading forces. As for the impact of the surgical technique on implant outcome in different bone densities, no studies prove significant superior results with one technique over another. Well-designed RCTs with a large number of patients are necessary to make early/immediate loading protocols in posterior maxilla evidence based, but ethical and practical considerations may limit the real possibility of such studies in the near future. [ABSTRACT FROM AUTHOR]

Purpose: Recent research has demonstrated that modification of implant surface chemistry can influence osseointegration events, leading to increased bone-to-implant contact at earlier times. Clinical studies have been initiated to investigate the potential of modified surfaces to reduce the needed healing period between surgery and prosthesis insertion. The purpose of this prospective clinical study was to evaluate the clinical outcome after 3 weeks of loading single implants with hydrophilic surfaces in the maxillary molar areas. Materials and Methods: This prospective two-center clinical trial consecutively included healthy patients who needed an implant in the maxillary molar areas. Drilling was limited to the minimum, most of the site preparation was produced with osteotomes, and screw tapping was never performed. Abutment connection was carried out at 15 Ncm, at 21 (± 2) days after surgery, and provisional restorations were fabricated in occlusion. Further abutment tightening at 35 Ncm was performed after 4 to 6 additional weeks, for the definitive restoration. Results: Thirty-five patients were treated. No major adverse events were registered during and/or after surgery. Primary stability was always achieved. At abutment connection, six of the 35 patients reported minor pain, and placement of provisional restorations was postponed for 4 additional weeks. Clinical and radiographic measures were taken at baseline (abutment connection) and at the 1-year follow-up appointment. No patients dropped out, and no implant losses were registered during the first 12 months of observation. No significant differences between baseline and the 1-year examination were recorded for any outcome measure. Conclusions: These results suggest that, by means of the surgical and restorative technique presented, surface-modified hydrophilic implants are suitable for loading at 3 weeks in maxillary molar areas. [ABSTRACT FROM AUTHOR]