Recent Trends in Sinus Lift Surgery and Their Clinical Implications
Corresponding Author
Mahmoud Al-Dajani DDS, MSc, PhD (OMFS), MSc, FRCD(C) (DPH)
Researcher and instructor
Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
Corresponding Author: Dr. Mahmoud Al-Dajani, Faculty of Dentistry, University of Toronto, 124 Edward Street, Toronto, ON M5G 1G6, Canada; e-mail: [email protected]Search for more papers by this authorCorresponding Author
Mahmoud Al-Dajani DDS, MSc, PhD (OMFS), MSc, FRCD(C) (DPH)
Researcher and instructor
Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
Corresponding Author: Dr. Mahmoud Al-Dajani, Faculty of Dentistry, University of Toronto, 124 Edward Street, Toronto, ON M5G 1G6, Canada; e-mail: [email protected]Search for more papers by this authorAbstract
Background
Sinus lift procedures are used to allow residual bone to accommodate functional implants in atrophic posterior maxilla. Numerous anatomical and surgical advancements in sinus lift surgery are still inspiring clinicians.
Purpose
The purpose of this study was to describe the recent trends in sinus lift surgery focusing on implant survival, bone grafting, anatomical and surgical considerations, and their clinical implications on the practice of implant dentistry in atrophic posterior maxilla.
Materials and Methods
We performed an extensive search in MEDLINE, Embase, Scopus, Web of Science, Trip, Cochrane Oral Health Group's Trials Register, Cochrane Central Register of Controlled Trials, and ProQuest Dissertations & Theses. Articles were critically reviewed to determine the level of evidence as per the Canadian Task Force on Preventive Health Care.
Results
Comprehensive assessment of sinus septa, sinus pathology, and bone quality and quantity using three-dimensional cone beam computed tomography radiographs is important before placing implants in posterior maxilla. With a residual bone height of less than 5 mm, the survival rate of implant decreases substantially. Lateral window approach can increase the vertical bone height to greater than 9 mm, while osteotome approach can increase this height from 3 to 9 mm. The perforation of Schneiderian membrane doubles the risk for the incidence of sinusitis or infection. The use of piezoelectric surgery allows adequate sinus lift while protecting soft tissues and minimizing patient discomfort.
Conclusions
Although both osteotome and lateral window procedures can help clinicians in overcoming the challenges of placing implants in atrophic posterior maxilla, pre-implant residual bone height is crucial in determining the survival of these implants. Future research directions should consider study designs grounded on longitudinal randomized controlled trials of large sample size.
References
- 1Sogo M, Ikebe K, Yang TC, Wada M, Maeda Y. Assessment of bone density in the posterior maxilla based on Hounsfield units to enhance the initial stability of implants. Clin Implant Dent Relat Res 2012; 14(Suppl 1): e183–e187.
- 2Nunes LS, Bornstein MM, Sendi P, Buser D. Anatomical characteristics and dimensions of edentulous sites in the posterior maxillae of patients referred for implant therapy. Int J Periodontics Restorative Dent 2013; 33: 337–345.
- 3Pommer B, Ulm C, Lorenzoni M, et al. Prevalence, location and morphology of maxillary sinus septa: systematic review and meta-analysis. J Clin Periodontol 2012; 39: 769–773.
- 4Hur MS, Kim JK, Hu KS, et al. Clinical implications of the topography and distribution of the posterior superior alveolar artery. J Craniofac Surg 2009; 20: 551–554.
- 5Guncu GN, Yildirim YD, Wang HL, Tozum TF. Location of posterior superior alveolar artery and evaluation of maxillary sinus anatomy with computerized tomography: a clinical study. Clin Oral Implants Res 2011; 22: 1164–1167.
- 6Solar P, Geyerhofer U, Traxler H, et al. Blood supply to the maxillary sinus relevant to sinus floor elevation procedures. Clin Oral Implants Res 1999; 10: 34–44.
- 7Manor Y, Mardinger O, Bietlitum I, et al. Late signs and symptoms of maxillary sinusitis after sinus augmentation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 110: e1–e4.
- 8Doud Galli SK, Lebowitz RA, Giacchi RJ, Glickman R, Jacobs JB. Chronic sinusitis complicating sinus lift surgery. Am J Rhinol 2001; 15: 181–186.
- 9Misch CE, Perel ML, Wang HL, et al. Implant success, survival, and failure: the International Congress of Oral Implantologists (ICOI) Pisa Consensus Conference. Implant Dent 2008; 17: 5–15.
- 10Rosen PS, Summers R, Mellado JR, et al. The bone-added osteotome sinus floor elevation technique: multicenter retrospective report of consecutively treated patients. Int J Oral Maxillofac Implants 1999; 14: 853–858.
- 11Yoon WJ, Jeong KI, You JS, Oh JS, Kim SG. Survival rate of Astra Tech implants with maxillary sinus lift. J Korean Assoc Oral Maxillofac Surg 2014; 40: 17–20.
- 12Fermergard R, Astrand P. Osteotome sinus floor elevation without bone grafts – a 3-year retrospective study with Astra Tech implants. Clin Implant Dent Relat Res 2012; 14: 198–205.
- 13Tatum H Jr. Maxillary and sinus implant reconstructions. Dent Clin North Am 1986; 30: 207–229.
- 14Geminiani A, Weitz DS, Ercoli C, et al. A comparative study of the incidence of schneiderian membrane perforations during maxillary sinus augmentation with a sonic oscillating handpiece versus a conventional turbine handpiece. Clin Implant Dent Relat Res 2013; DOI: 10.1111/cid.12110.
- 15Blus C, Szmukler-Moncler S, Salama M, Salama H, Garber D. Sinus bone grafting procedures using ultrasonic bone surgery: 5-year experience. Int J Periodontics Restorative Dent 2008; 28: 221–229.
- 16Summers RB. A new concept in maxillary implant surgery: the osteotome technique. Compendium 1994; 15: 152–160.
- 17Bruschi GB, Crespi R, Cappare P, et al. Localized management of sinus floor technique for implant placement in fresh molar sockets. Clin Implant Dent Relat Res 2013; 15: 243–250.
- 18Winter AA, Pollack AS, Odrich RB. Placement of implants in the severely atrophic posterior maxilla using localized management of the sinus floor: a preliminary study. Int J Oral Maxillofac Implants 2002; 17: 687–695.
- 19Leblebicioglu B, Ersanli S, Karabuda C, Tosun T, Gokdeniz H. Radiographic evaluation of dental implants placed using an osteotome technique. J Periodontol 2005; 76: 385–390.
- 20Del Fabbro M, Corbella S, Weinstein T, Ceresoli V, Taschieri S. Implant survival rates after osteotome-mediated maxillary sinus augmentation: a systematic review. Clin Implant Dent Relat Res 2012; 14(Suppl 1): e159–e168.
- 21Hu X, Lin Y, Metzmacher AR, Zhang Y. Sinus membrane lift using a water balloon followed by bone grafting and implant placement: a 28-case report. Int J Prosthodont 2009; 22: 243–247.
- 22Rao GS, Reddy SK. Antral balloon sinus elevation and grafting prior to dental implant placement: review of 34 cases. Int J Oral Maxillofac Implants 2014; 29: 414–418.
- 23Velazquez-Cayon R, Romero-Ruiz MM, Torres-Lagares D, et al. Hydrodynamic ultrasonic maxillary sinus lift: review of a new technique and presentation of a clinical case. Med Oral Patol Oral Cir Bucal 2012; 17: e271–e275.
- 24Emmerich D, Att W, Stappert C. Sinus floor elevation using osteotomes: a systematic review and meta-analysis. J Periodontol 2005; 76: 1237–1251.
- 25Tan WC, Lang NP, Zwahlen M, Pjetursson BE. A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation. Part II: transalveolar technique. J Clin Periodontol 2008; 35(8 Suppl): 241–254.
- 26Esposito M, Grusovin MG, Rees J, et al. Effectiveness of sinus lift procedures for dental implant rehabilitation: a Cochrane systematic review. Eur J Oral Implantol 2010; 3: 7–26.
- 27Turkyilmaz I, Aksoy U, McGlumphy EA. Two alternative surgical techniques for enhancing primary implant stability in the posterior maxilla: a clinical study including bone density, insertion torque, and resonance frequency analysis data. Clin Implant Dent Relat Res 2008; 10: 231–237.
- 28Pjetursson BE, Tan WC, Zwahlen M, Lang NP. A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation. J Clin Periodontol 2008; 35(8 Suppl): 216–240.
- 29Misch CE, Dietsh F. Bone-grafting materials in implant dentistry. Implant Dent 1993; 2: 158–167.
- 30Zijderveld SA, Zerbo IR, van den Bergh JP, Schulten EA, ten Bruggenkate CM. Maxillary sinus floor augmentation using a beta-tricalcium phosphate (Cerasorb) alone compared to autogenous bone grafts. Int J Oral Maxillofac Implants 2005; 20: 432–440.
- 31Browaeys H, Bouvry P, De Bruyn H. A literature review on biomaterials in sinus augmentation procedures. Clin Implant Dent Relat Res 2007; 9: 166–177.
- 32Szabo G, Huys L, Coulthard P, et al. A prospective multicenter randomized clinical trial of autogenous bone versus beta-tricalcium phosphate graft alone for bilateral sinus elevation: histologic and histomorphometric evaluation. Int J Oral Maxillofac Implants 2005; 20: 371–381.
- 33Esposito M, Grusovin MG, Rees J, et al. Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus. Cochrane Database Syst Rev 2010; 3:CD008397.
- 34Lindgren C, Mordenfeld A, Hallman M. A prospective 1-year clinical and radiographic study of implants placed after maxillary sinus floor augmentation with synthetic biphasic calcium phosphate or deproteinized bovine bone. Clin Implant Dent Relat Res 2012; 14: 41–50.
- 35Nkenke E, Stelzle F. Clinical outcomes of sinus floor augmentation for implant placement using autogenous bone or bone substitutes: a systematic review. Clin Oral Implants Res 2009; 20(Suppl 4): 124–133.
- 36Schliephake H. Clinical efficacy of growth factors to enhance tissue repair in oral and maxillofacial reconstruction: a systematic review. Clin Implant Dent Relat Res 2013; DOI: 10.1111/cid.12114.
- 37Devine JG, Dettori JR, France JC, Brodt E, McGuire RA. The use of rhBMP in spine surgery: is there a cancer risk? Evid Based Spine Care J 2012; 3: 35–41.
- 38Thor A, Wannfors K, Sennerby L, Rasmusson L. Reconstruction of the severely resorbed maxilla with autogenous bone, platelet-rich plasma, and implants: 1-year results of a controlled prospective 5-year study. Clin Implant Dent Relat Res 2005; 7: 209–220.
- 39Raghoebar GM, Schortinghuis J, Liem RS, et al. Does platelet-rich plasma promote remodeling of autologous bone grafts used for augmentation of the maxillary sinus floor? Clin Oral Implants Res 2005; 16: 349–356.
- 40Sauerbier S, Rickert D, Gutwald R, et al. Bone marrow concentrate and bovine bone mineral for sinus floor augmentation: a controlled, randomized, single-blinded clinical and histological trial–per-protocol analysis. Tissue Eng Part A 2011; 17: 2187–2197.
- 41Rickert D, Sauerbier S, Nagursky H, et al. Maxillary sinus floor elevation with bovine bone mineral combined with either autogenous bone or autogenous stem cells: a prospective randomized clinical trial. Clin Oral Implants Res 2011; 22: 251–258.
- 42Lundgren S, Andersson S, Gualini F, Sennerby L. Bone reformation with sinus membrane elevation: a new surgical technique for maxillary sinus floor augmentation. Clin Implant Dent Relat Res 2004; 6: 165–173.
- 43Thor A, Sennerby L, Hirsch JM, Rasmusson L. Bone formation at the maxillary sinus floor following simultaneous elevation of the mucosal lining and implant installation without graft material: an evaluation of 20 patients treated with 44 Astra Tech implants. J Oral Maxillofac Surg 2007; 65(7 Suppl 1): 64–72.
- 44Hatano N, Sennerby L, Lundgren S. Maxillary sinus augmentation using sinus membrane elevation and peripheral venous blood for implant-supported rehabilitation of the atrophic posterior maxilla: case series. Clin Implant Dent Relat Res 2007; 9: 150–155.
- 45Fermergard R, Astrand P. Osteotome sinus floor elevation and simultaneous placement of implants–a 1-year retrospective study with Astra Tech implants. Clin Implant Dent Relat Res 2008; 10: 62–69.
- 46Pjetursson BE, Ignjatovic D, Matuliene G, et al. Transalveolar maxillary sinus floor elevation using osteotomes with or without grafting material. Part II: radiographic tissue remodeling. Clin Oral Implants Res 2009; 20: 677–683.
- 47Nedir R, Bischof M, Vazquez L, et al. Osteotome sinus floor elevation technique without grafting material: 3-year results of a prospective pilot study. Clin Oral Implants Res 2009; 20: 701–707.
- 48Nolan PJ, Freeman K, Kraut RA. Correlation between Schneiderian membrane perforation and sinus lift graft outcome: a retrospective evaluation of 359 augmented sinus. J Oral Maxillofac Surg 2014; 72: 47–52.
- 49Bae JH, Kim YK, Kim SG, Yun PY, Kim JS. Sinus bone graft using new alloplastic bone graft material (Osteon)-II: clinical evaluation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109: e14–e20.
- 50Fugazzotto PA, Vlassis J. A simplified classification and repair system for sinus membrane perforations. J Periodontol 2003; 74: 1534–1541.
- 51Malo P, Nobre M, Lopes A. Immediate loading of “All-on-4” maxillary prostheses using trans-sinus tilted implants without sinus bone grafting: a retrospective study reporting the 3-year outcome. Eur J Oral Implantol 2013; 6: 273–283.
- 52Malo P, Nobre M, Lopes A, Francischone C, Rigolizzo M. Three-year outcome of a retrospective cohort study on the rehabilitation of completely edentulous atrophic maxillae with immediately loaded extra-maxillary zygomatic implants. Eur J Oral Implantol 2012; 5: 37–46.
- 53Davo R, Malevez C, Rojas J, Rodriguez J, Regolf J. Clinical outcome of 42 patients treated with 81 immediately loaded zygomatic implants: a 12- to 42-month retrospective study. Eur J Oral Implantol 2008; 1: 141–150.
- 54Aparicio C, Ouazzani W, Aparicio A, et al. Extrasinus zygomatic implants: three year experience from a new surgical approach for patients with pronounced buccal concavities in the edentulous maxilla. Clin Implant Dent Relat Res 2010; 12: 55–61.
- 55Zitzmann NU, Schärer P. Sinus elevation procedures in the resorbed posterior maxilla. Comparison of the crestal and lateral approaches. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 85: 8–17.
- 56Diss A, Dohan DM, Mouhyi J, Mahler P. Osteotome sinus floor elevation using Choukroun's platelet-rich fibrin as grafting material: a 1-year prospective pilot study with microthreaded implants. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 105: 572–579.
- 57Schmidlin PR, Muller J, Bindl A, Imfeld H. Sinus floor elevation using an osteotome technique without grafting materials or membranes. Int J Periodontics Restorative Dent 2008; 28: 401–409.
- 58Nedir R, Nurdin N, Szmukler-Moncler S, Bischof M. Placement of tapered implants using an osteotome sinus floor elevation technique without bone grafting: 1-year results. Int J Oral Maxillofac Implants 2009; 24: 727–733.