Versatility of Direct Implant Valve Approach in Misch class IV posterior maxilla: A clinical study

Q1SM9 ePOSTER CLINICAL INNOVATIONS

Background: In Misch Class IV posterior edentulous maxilla, dental implants are not normally placed at the same time as the sinus lift procedure. For this type of situation, the use of the Direct Implant Valve Approach (DIVA) to immediately bone augmentation and stabilize implants (due to implant external and internal configurations) is proposed.

Aim/Hypothesis: The author hypothesized that implant insertion and injection of bone gel through implant channel in the same step in Misch class IV posterior edentulous maxilla would result in a better outcome and considerable reduction in treatment times.

Materials and Methods: The study was designed and implemented as a prospective clinical study. The sample was composed of 7 patients (5 males and 2 females) and they ranged from 32 to 64 of years with class IV Misch posterior edentulous maxilla. The predictor variables were intraoperative primary stability and level of sinus membrane lifting. The outcome variables were secondary implant stability (Osseointegration) and the level of height of gained bone. Descriptive and bivariate statistics were computed, and the P-value was set at less than .05. The protocol consisted of the following steps: 1) preoperative CBCT evaluation of bone height; 2) crestal approach sinus lifting; 3) osteotomy site preparation and implant installation; 4) irrigation via internal implant port to separate the sinus membrane; 5) slow ratching to elevate the membrane; 6) injection of beta-tricalcium phosphate and hyaluronic acid via the internal port of the implant; 7) sealing and healing screws insertion and wound closure.

Results: The sample was composed of 7 patients (5 males and 2 females) and they ranged from 32 to 64 of years with class IV Misch posterior edentulous maxilla with bone level between 2.5 to 5 mm in height. The number of implants per patient varied from one to four. There was a closed relation between the implant primary stability and bone width so, the highest primary stability values, in all phases, are reached by the implants with the greatest bone widths. Radiographic findings and ISQ measurements in 1, 3, 6, and 12 months respectively testify to the stability of gained bone levels with concur with success criteria. The technique described the ability to ensure success in cases of Misch class IV with the contemporaneous placement of osseointegrated implants.

Conclusions and Clinical Implications: This clinical study describes the success of closed sinus lifting and bone augmentation in Misch class IV posterior edentulous maxilla with the contemporaneous placement of osseointegrated implants. This technique is straight forward and reproducible and does not need further surgical intervention. DIVA allows for stabilization of installed implant in Misch class IV thus a reduction in treatment time.

Keywords: Sinus lifting, DIVA, Misch class IV, osseointegrated implants