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PURPOSE: To evaluate and compare the reported sinusitis occurrence after the sinus lift procedure and zygomatic implant placement. METHODS: This meta-analysis has been registered at PROSPERO. Studies were searched on six databases. Two authors screened titles and abstracts and fully analyzed the studies against the inclusion and exclusion criteria. The RoB 2.0 and the ROBINS-I tools were used to assess the quality and risk of bias of the included studies. The random-effects model was used for the meta-analysis. The prevalence of sinusitis was calculated based on the total of patients. Subgroup analysis was performed by sinus lift or zygomatic implant surgery technique. RESULTS: The search identified 2419 references. After applying the inclusion criteria, 18 sinus lift and 9 zygomatic implant placement studies were considered eligible. The pooled prevalence of sinusitis after sinus lift procedure was 1.11% (95% CI 0.30-2.28). The prevalence after zygomatic implant placement was 3.76% (95% CI 0.12-10.29). In the subgroup analysis, the lateral window approach showed a prevalence of sinusitis of 1.35% (95% CI 0.34-2.8), the transcrestal technique of 0.00% (95% CI 0.00-3.18), and the SALSA technique of 1.20% (95% CI 0.00-5.10). Regarding the techniques for zygomatic implant placement, the sinus slot technique showed a prevalence of 21.62% (95% CI 9.62-36.52) and the intrasinus technique of 4.36% (95% CI 0.33-11.08), and the prevalence after the extrasinus technique was 0.00% (95% CI 0.00-1.22). CONCLUSION: The sinusitis occurrence rate was higher after zygomatic implant placement than after sinus lift procedure and this occurrence was different depending on the used technique.

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Introduction: The loss of dental elements can lead to excessive bone loss in the posterior maxillary segments, which can limit the placement of dental implants in that area, the pneumatization of the maxillary sinus and the absence of dental elements to keep the bone active are some of the main causes. Among the wide range of available grafting materials, bovine hydroxyapatite has been extensively studied and has shown excellent clinical and histological results. Materials and methods: A total of 17 maxillary sinus floor elevations were performed (n = 8 Osteodens, n = 9 Bio-Oss). After a healing period of 6 to 8 months, a block of the grafted area was obtained using trephines and analyzed by histomorphometry. Results: The percentage of neoformed bone tissue was higher for Bio-Oss (39.0% ± 11.1) compared to Osteodens (33.4% ± 8.3), while the remaining graft values were slightly lower in Bio-Oss compared to Osteodens (16.3% ± 11.2 and 20.8% ± 12.1, respectively). The proportion of connective tissue was similar in both groups (44.7% Bio-Oss and 45.8% Osteodens). Age, gender, and residual height of the sinus floor did not show statistically significant differences. Conclusions: In this study, both graft materials (Bio-Oss and Osteodens) showed no statistically significant differences in their ability to regenerate suitable bone tissue for implant placement after 6 months of healing. Further studies with a larger sample size are needed to validate these results.

Introducción: La pérdida de elementos dentarios puede provocar una excesiva pérdida ósea en los segmentos maxilares posteriores, lo que puede limitar la colocación de implantes dentarios en esa zona, la neumatización del seno maxilar y la ausencia de elementos dentarios que mantengan el hueso activo son algunas de las principales causas. Entre la amplia gama de materiales de injerto disponibles, la hidroxiapatita bovina ha sido ampliamente estudiada y ha mostrado excelentes resultados clínicos e histológicos. Materiales y métodos: Se realizaron un total de 17 elevaciones del suelo del seno maxilar (n = 8 Osteodens, n = 9 Bio-Oss). Tras un periodo de cicatrización de 6 a 8 meses, se obtuvo un bloque de la zona injertada mediante trépanos y se analizó mediante histomorfometría. Resultados: El porcentaje de tejido óseo neoformado fue mayor en Bio-Oss (39,0% ± 11,1) en comparación con Osteodens (33,4% ± 8,3), mientras que los valores del injerto remanente fueron ligeramente inferiores en Bio-Oss en comparación con Osteodens (16,3% ± 11,2 y 20,8% ± 12,1, respectivamente). La proporción de tejido conjuntivo fue similar en ambos grupos (44,7% Bio-Oss y 45,8% Osteodens). La edad, el sexo y la altura residual del piso sinusal no mostraron diferencias estadísticamente significativas. Conclusiones: En este estudio, ambos materiales de injerto (Bio-Oss y Osteodens) no mostraron diferencias estadísticamente significativas en su capacidad para regenerar tejido óseo adecuado para la colocación de implantes tras 6 meses de cicatrización. Se necesitan más estudios con un tamaño de muestra mayor para validar estos resultados.

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Este trabalho tem por objetivo relatar um caso em que foi realizada a técnica de Summers para elevação do seio maxilar, associada à realização de osseodensificação. Paciente do gênero masculino, 53 anos, apresentando ausência do dente 17, com altura reduzida na área edêntula. Foi realizada a elevação do seio maxilar pela técnica de Summers associada à osseodensificação da região para uma melhora da qualidade óssea. Foi instalado um implante cone morse SIN de 3.8 x 8.5 com torque de 45 newtons. No acompanhamento pós-operatório não houve qualquer sinal ou sintoma de complicação e o paciente foi reabilitada com uma prótese parafusada sobre implante.

This study aims to report a case in which the Summers technique was performed for maxillary sinus elevation, associated with osseodensification. Male patient, 53 years old, with missing tooth 17, with reduced height in the edentulous area. Maxillary sinus elevation was performed using the Summers technique associated with osseodensification of the region for an improvement in bone quality. A 3.8 x 8.5 SIN morse taper implant with a torque of 45 newtons was installed. In the postoperative follow-up, there were no signs or symptoms of complications and the patient was rehabilitated with a screw-retained implant prosthesis.

Este trabajo tiene como objetivo informar de un caso en el que se realizó la técnica de Summers para la elevación del seno maxilar, asociada a la osteodensificación. Paciente varón, de 53 años, que presenta ausencia del diente 17, con altura reducida en la zona edéntula. Se elevó el seno maxilar mediante la técnica de Summers asociada a la osteodensificación de la región para mejorar la calidad ósea. Se instaló un implante morse cónico de 3,8 x 8,5 SIN con un par de 45 newtons. En el seguimiento postoperatorio no hubo signos ni síntomas de complicación y el paciente fue rehabilitado con una prótesis atornillada sobre un implante.

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BACKGROUND AND OBJECTIVE: The resorption of alveolar ridge bone and maxillary sinus pneumatization are challenges to implant-supported prosthetic rehabilitation. Bone regeneration using bone substitutes and growth factors are alternatives for maxillary sinus augmentation (MSA). Therefore, we sought to evaluate the effects of the association between leukocyte and platelet-rich fibrin (L-PRF) and deproteinized bovine bone mineral (DBBM) in MSA procedures. MATERIALS AND METHODS: Thirty-six maxillary sinuses from 24 individuals were included in this randomized clinical trial. The maxillary sinuses were randomly grafted with LPRF and DBBM (test group) or grafted only with DBBM (positive control). Dental implants were installed in the test group following two periods of evaluation: after 4 (DBBM+LPRF4) and 8 (DBBM+LPFR8) months of sinus graft healing, while the control group received implants only after 8 months. Cone beam computed tomography (CBCT) was taken 1 week after surgery (T1) and before implant placement (T2). Bone samples were collected during implant placement for histomorphometric and immunohistochemical (IHC) analysis. The primary implant stability was assessed by resonance frequency analysis. RESULTS: CBCT analysis demonstrated a significant decrease in bone volume from T1 to T2 in all groups without differences among them. Histologically, the test group showed significantly increase in bone neoformation in both periods of evaluation (LPRF+DBBM4: 44.70±14.01%; LPRF+DBBM8: 46.56±12.25%) compared to the control group (32.34±9.49%). The control group showed the highest percentage of residual graft. IHC analysis showed increased staining intensity of osteocalcin (OCN), vascular endothelial growth factor (VEGF), and runt related transcription factor 2 (RUNX-2) in LPRF+DBBM4 group, and osteopontin (OPN) in the L-PRF+DBBM8. Primary implant stability was successfully achieved (above 60 in implant stability quotient) in all the evaluated groups. CONCLUSION: Combination of L-PRF and DBBM increased and accelerated new bone formation allowing early implant placement probably due to the higher protein expression of RUNX2, VEGF, OCN, and OPN. These data suggest that the use of L-PRF might be an interesting alternative to use in combination with DBBM for augment the maxillary sinuses allowing the installation of appropriate length implants in shorter period of time. CLINICAL RELEVANCE: This study showed improvement in bone neoformation and accelerated healing when associating L-PRF and DBBM for maxillary sinus augmentation procedures. TRIAL REGISTRATION: This study was registered before participant recruitment in Brazilian Registry of Clinical Trials (ReBEC - RBR-95m73t).

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BACKGROUND: This study aimed to evaluate peri-implant bone formation in rabbits after sinus grafting mediated by hydroxyapatite and beta-tricalcium phosphate (HA + ß-TCP) in granule or paste configurations, concomitant with immediate implant installation. MATERIAL & METHODS: Thirty-four rabbit maxillary sinuses were grafted with HA + ß-TCP, half of which were applied in a granule and half in a paste composition. Implant placement was performed simultaneously. At 7 and 40 days postoperatively, the animals were euthanized, and samples were prepared for tomographic, microtomographic, histological, histometric (hematoxylin and eosin staining, HE), and immunohistochemical (labeling of transcription factor Runx-2 [RUNX2], vascular endothelial growth factor [VEGF], osteocalcin [OCN], and tartrate-resistant acid phosphatase [TRAP]) analysis. Implant removal torque was also measured. RESULTS: On tomography, maintenance of sinus membrane integrity was observed in both the groups. Higher values of morphometric parameters evaluated by micro-CT were found in the "paste group" after seven days. At 40 days, there were no significant differences between the groups in most of the microtomographic parameters evaluated. In histological sections stained with HE, a higher percentage of newly formed bone was observed in the "granule group" after 40 days. Similar positive immunolabeling was observed for both RUNX2 and OCN in both the experimental groups. TRAP immunolabeling was similar in both groups as well. VEGF labeling increased in the "granule group", indicating a higher osteoconductive potential in this biomaterial. Similar removal torque values were observed in both groups. Thus, the two HA + ß-TCP configurations showed similar healing patterns of simultaneously installed implants adjacent to sinus floor elevation. However, significantly higher bone values were observed for the "granule configuration". CONCLUSIONS: The HA + ß-TCP granules and paste presentations showed favorable long-term healing results, with bone formation in similar quantities and quality adjacent to the implants.

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The aim of the present study is to compare the biphasic calcium phosphate (BCP) using two different forms-(1) granules and (2) paste-in human maxillary sinus bone reconstruction as a split-mouth study using histomorphometric and immunolabeling for osteocalcin. Ten patients with bilateral maxillary posterior partial edentulism were selected in order to reconstruct bone height. They were divided into two groups: BCPG and BCP-P. After six months of bone healing, biopsies were harvested to assess the new bone formation and immunostaining for osteocalcin. The BCP g group had the following results: mean of bone formation in pristine bone 49.4 ± 21.6%, intermediate 49.4 ± 16.2%, and apical 55.3 ± 21.4%. The group BCP-P had a mean of 41.9 ± 17.3% in the pristine bone region, 37.5 ± 7.8% for intermediate, and 39.0 ± 13.5% for apical. The osteocalcin immunolabeling was high for both groups, demonstrating bone calcification. Thus, the two biomaterials present suitable results for the placement of dental implants.

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Abstract The study aimed to evaluate the accuracy of Micro-CT in linear and volumetric measurements in native (NB) and grafted bone (GB) areas. A total of 111 biopsies of maxillary sinuses grafted with deproteinized bovine bone (DBB) in humans were evaluated. The linear measurements were performed to measure the length of the NB and GB. Furthermore, the amount of mineralized tissues at the NB and GB was performed. In the histomorphometry analysis the percentage of mineralized tissues at the NB and GB was obtained in two histological sections while the mineralized tissues were measure in the micro-CT varying the thresholds of the grayscale varying from 90-250 to 90-150 with 10 levels of variation between each one was applied. Then these data were correlated in order to check the higher r level between the histomorphometry and micro-CT thresholds intervals. The linear length of the NB was 2.44±0.91mm and 2.48±1.50mm, respectively, for micro-CT and histomorphometry (r =0.57), while the linear length of the GB was 3.63±1.66mm and 3.13±1.45mm, respectively, for micro-CT and histomorphometry (r =0.74) Histomorphometry showed 45.91±11.69% of bone in NB, and 49.57±5.59% of bone and biomaterial in the GB. The total volume of mineralized tissues that were closest to the histometric analysis were 43.75±15.39% in the NB (Threshold:90-240; r = 0.50) and 51.68±8.42% in the GB (Threshold:90-180; r =-0.028). The micro-CT analysis showed good accuracy in the linear analysis in both portions of the biopsies but for volumetric analysis just in NB.

Resumo Esse estudo tem como objetivo avaliar a acurácia da análise microtomográfica em mensurações lineares e volumétricas em osso nativo (ON) e enxertado (OE). Para isso, 111 biópsias removidas de seios maxilares de pacientes enxertados com osso bovino desproteinizado foram coletadas e avaliadas. As medidas lineares foram realizadas para medir o comprimento do ON e do OE. Além disso, foi realizada a mensuração da quantidade de tecidos mineralizados em ON e OE. Na análise histomorfométrica a porcentagem de tecidos mineralizados do ON e OE foi obtida em dois cortes histológicos enquanto os tecidos mineralizados foram medidos em microtomografias variando os thresholds da escala de cinza variando de 90-250 a 90-150 com 10 níveis de variação entre cada. Em seguida, esses dados foram correlacionados para verificar o maior nível de R entre os intervalos dos thresholds testados na análise microtomográfica em relação aos dados obtidos na histomorfometria. O comprimento linear do ON foi de 2,44±0,91mm e 2,48±1,50mm, respectivamente, para análises microtomográfica e histomorfométrica (r=0,57), enquanto o comprimento linear do OE foi de 3,63±1,66mm e 3,13±1,45mm, respectivamente, para para análises microtomográfica e histomorfométrica (r =0,74) A histomorfometria detectou 45,91±11,69% de osso na porção de ON e 49,57±5,59% de osso e biomaterial na porção de OE. O volume total de tecidos mineralizados detectados pela análise microtomográfica que apresentou valores mais próximos da análise histomorfométrica foi de 43,75±15,39% no ON (Thresholds:90-240; r = 0,50) e 51,68±8,42% no OE (Thresholds:90-180; r =- 0,028). A análise microtomográfica apresentou boa acurácia na análise linear em ambas as porções das biópsias, porém a mesma apresentou boa acurácia para análise volumétrica apenas em áreas de ON.

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This study aimed to compare two beta-tricalcium phosphates with different particle sizes in human maxillary sinuses lifting. The immunolabeling of cells for RUNX2 and VEGF were performed to evaluate the osteoblast precursor cells and the vascular formation after 6 months of bone repair. Ten maxillary sinuses were grafted with autogenous bone graft (Group 1), 10 were grafted with ChronOs® (Group 2), and 10 were grafted with BETA-TCP® (Group 3). After 6 months of bone healing, biopsies were obtained to assess the new bone formed by histomorphometric and immunohistochemical evaluation for RUNX2 and VEGF. The mean bone formation for Group 1 was 51.4 ± 17.4%. Group 2 presented 45.5 ± 9.9%, and Group 3 conferred 35.4 ± 8.0% of new bone formation. The RUNX2 offered low for Groups 1 and 2 with high cellular activity for osteoblast in Group 3. The VEGF immunolabeling was moderate for Groups 1 and 2 and intense for Group 3. In conclusion, it was possible to show that the bone substitutes evaluated in the present study presented suitable outcomes for bone regeneration, being an alternative for the autogenous bone graft in maxillary sinus bone height reconstruction.

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Down Syndrome or trisomy 21 (T21) is a genetic condition caused by the presence of an extra chromosome in pair 21 and is related to a high prevalence of agenesis of permanent teeth and periodontal alterations that may be associated to the loss of permanent teeth at early ages. With the increase in life expectancy of people with T21 in the last decades, it is necessary to expand the knowledge to offer possibilities of treatment with dental implants, aiming to serve this aging population. AIMS: The aim of this article is to report a surgical procedure of sinus lift to enable the installation of dental implants in the posterior region of the maxilla. METHODS AND RESULTS: A 50 year-old patient with T21 was rehabilitated with implants, simultaneously with sinus lift surgery, by the lateral window technique, using xenogenous bone graft and fibrin-rich plasma. After 1 year, the patient was rehabilitated with prosthetics on implants. CONCLUSION: The feasibility of this technique in patients with Down syndrome could be observed, after 3 years of follow up, with favorable clinical results.

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Objective: The aim of this study was to evaluate the transcrestal sinus lift using Osseodensification technique with simultaneous implant placement. Material and Methods: In this case series 7 patients who needed implant placement in the atrophic posterior maxilla were enrolled. In all the cases the residual bone height between the sinus floor and the alveolar crest was 4-6 mm. Transcrestal sinus lift was performed using Osseodensification with simultaneous implant placement. Cone-beam computed tomography (CBCT) were obtained immediately postoperative and 6 months after operation. Implant stability using Osstell® were assessed at the time of implant placement and implant exposure (6 months). Results: The results showed that the mean bone height gain was 5.33±0.83mm at 6 months postoperatively. Mean bone density value was 818.43±109.63 HU. Mean ISQ value was 80.00±3.11 at 6 months postoperatively. The duration of surgical procedure (minutes) ranged between 25-38 minutes with an average of 30.86±4.10 minutes. Conclusion: The crestal maxillary sinus floor elevation using Osseodensification technique with simultaneous implant placement provide superior results regarding bone density and implant stability and less duration of surgical procedure. (AU)

Objetivo: O objetivo deste estudo foi avaliar a elevação de seio maxilar via crista do rebordo com a técnica de Osseodensificação com instalação simultânea de implante. Material e Métodos: Nesta série de casos, participaram 7 pacientes que necessitavam de implantes em região posterior de maxila atrófica. Em todos os casos a altura de remanescente ósseo entre o soalho do seio e a crista alveolar estava entre 4 a 6 mm. A elevação de seio maxilar via crista do rebordo foi realizada com osseodensificação com instalação simultânea de implante. As Tomografias Computadorizadas Cone Beam (TCCB) foram obtidas imediatamente após a cirurgia e 6 meses depois. A estabilidade dos implantes utilizando Osstell® foi avaliada no momento da instalação do implante e no momento da reabertura (6 meses). Resultados: Os resultados mostraram que a média de ganho de altura óssea foi de 5.33±0.83mm após 6 meses da cirurgia. A média da densidade óssea foi de 818.43±109.63 HU. A média de ISQ foi de 80.00±3.11 após 6 meses da cirurgia. A duração do procedimento cirúrgico (minutos) foi entre 25 a 38 minutos com uma média de 30.86±4.10 minutos. Conclusão: A elevação do soalho de seio maxilar via crista do rebordo com instalação simultânea de implante utilizando osseodensificador promove resultados superiores em relação à densidade óssea, estabilidade do implante e menor duração do tempo cirúrgico (AU)

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ABSTRACT The loss in height of the alveolar bone crest after tooth extraction makes rehabilitation of the posterior maxilla challenging due to low bone density and atrophy, in addition to pneumatization of the maxillary sinus. Maxillary sinus lift surgery prior to implant placement makes implant-supported rehabilitation feasible. This study aimed to describe a case report of maxillary sinus surgery using the side window technique prior to rehabilitation with a prosthesis supported by dental implants, highlighting the importance of planning to minimize intraoperative complications. This is a clinical case report of a 59-year-old male patient who was assisted at a private higher education institution complaining of edentulous spaces and the desire for rehabilitation with implants. He underwent rehabilitation planning, including the surgical treatment of maxillary sinus lifting using the side window technique. Bone gain was confirmed using cone beam computed tomography six months after the surgical approach to the maxillary sinus. The planning of rehabilitation of the posterior maxilla and careful sinus lift surgery using the side window technique is a predictable therapeutic option for clinical cases with bone gain in height of the posterior region of the maxilla prior to the installation of dental implants. The clinical case presented demonstrated success in the gain of bone volume in the posterior region of the maxilla, without postoperative complications, and the patient was still satisfied with the proposed treatment, awaiting complete implant-supported rehabilitation.

RESUMO A perda em altura da crista óssea alveolar pós extração dentária torna a reabilitação da maxila posterior desafiadora devido à baixa densidade e atrofia ósseas, além da pneumatização do seio maxilar. A cirurgia sinusal previamente à instalação de implantes viabiliza a reabilitação implantossuportada. Esse estudo teve como objetivo apresentar um relato de caso clínico submetido à cirurgia de levantamento de seio maxilar pela técnica da janela lateral previamente à reabilitação com prótese suportada por implantes dentários, destacando a importância do planejamento para minimizar complicações transoperatórias. Esse é um relato de caso clínico de um paciente do sexo masculino, 59 anos de idade, assistido em uma Instituição de Ensino Superior Privada, com queixa de espaços edêntulos e desejo de reabilitação com implantes. Foi submetido ao planejamento reabilitador incluindo o tratamento cirúrgico de levantamento de seio maxilar bilateral pela técnica da janela lateral. O ganho ósseo foi confirmado pela tomografia computadorizada de feixe cônico após seis meses da abordagem cirúrgica do seio maxilar bilateralmente. O planejamento reabilitador da região posterior da maxila e a execução da cirurgia de levantamento de seio pela técnica da janela lateral de maneira criteriosa consiste em uma opção terapêutica previsível para os casos clínicos com necessidade de ganho ósseo em altura previamente à instalação de implantes dentários. O caso clínico apresentado demonstrou sucesso no ganho de volume ósseo na região posterior de maxila, sem complicações pós-operatórias e o paciente segue satisfeito com o tratamento proposto, aguardando conclusão da reabilitação implantossuportada.

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The identification and management of interfering maxillary sinus septa is essential to anticipate and prevent membrane perforation and other complications during sinus grafting. A computer-guided sinus approach based on a new magnetic stackable surgical guide was planned, to transfer the exact position of the septum and optimize the positioning of the lateral access windows. This technique reduces the risk of sinus membrane injury, thereby increasing the safety and efficacy of the procedure.

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Objective: the present equivalence two-arm parallel randomized controlled trial aimed to compare survival and marginal bone loss (MBL) of short implants (≤6 mm) and standard implants (≥8.5 mm) associated with sinus floor elevation (SFE). Methods: adult patients with partial edentulism with occlusal stability in the sinus area and intermediate bone height were selected in this double-blind trial (patient and outcome assessment). Patients were randomly allocated into two groups: standard length implants with SFE (control) or short implants (test). Clinical and radiographic assessments were made at the time of implant placement, 6 months, and annually thereafter up to 2 years after loading. The inter-examiner agreement was analyzed using intraclass correlation coefficient (ICC). One-way ANOVA, Kaplan-Meier, and Log-rank tests were used to compare implant survival (primary outcome) and MBL (secondary outcome) (P<0.05). Results: eight short implants and six standard implants were placed (mean age of patients was 47 ±12.5 years). The implant survival rates were 87.5% for short (one 5 mm implant failed at 7 months) and 100% for standard implants with no statistically significant difference between groups (P=0.4). The mean MBL after 1 year was 0.30 ±0.62 mm for short and 0.21 ±0.36 mm for standard implants (P=0.123). The inter-examiner agreement was set in 0.831. Conclusion: survival of short implants and standard implants associated with SFE was similar after two years of clinical service. Trial registration: Registered on 27-03-2018 at ClinicalTrials.gov (NCT03479333). Funding: This study was partially funded by Capes Finance Code 001 and #88881.187933/2018-01. TPC is partially funded by National Council for Scientific and Technological Development (CNPq - Brazil). The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.(AU)

Objetivo: o presente ensaio clínico randomizado de dois braços de equivalência comparou a taxa de sobrevivência e a perda óssea marginal de implantes curtos (≤ 6 mm) e implantes convencionais (≥ 8.5 mm) associados à elevação do seio maxilar. Métodos: edêntulos parciais adultos, com estabilidade oclusal e altura óssea intermediária na região do seio maxilar, foram selecionados neste estudo duplo-cego e alocados randomicamente em dois grupos: implante de comprimento convencional associado à elevação do seio maxilar (controle) ou implante curto (teste). Avaliações clínicas e radiográficas foram realizadas logo após a instalação do implante, seis meses e anualmente por até dois anos. A concordância interexaminador foi avaliada através do coeficiente de correlação intraclasse. Os testes ANOVA de uma via, Kaplan-Meier e Log-rank foram utilizados para comparar a sobrevivência do implante e a perda óssea marginal (P<0.05). Resultados: oito implantes curtos e seis implantes de comprimento convencional foram instalados em onze pacientes (média de idade dos pacientes: 47 ± 12.5 anos). As taxas de sobrevivência dos implantes foram de 87,5% para implantes curtos (um implante de 5 mm falhou aos sete meses), e 100% para implantes convencionais, sem diferença estatisticamente significativa entre os grupos (P=0.4). A perda óssea marginal média após um ano foi de 0.30 ±0.62 mm para implantes curtos e 0.21 ±0.36 mm para implantes convencionais (P=0.123). A concordância interexaminador foi de 0.831. Conclusão: a taxa de sobrevivência de implantes curtos e convencionais associados ao seio maxilar foi semelhante após dois anos de acompanhamento. Registro do estudo: Registrado em 27-03-2018 no ClinicalTrials.gov (NCT03479333).(AU)

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The perforation of the Schneiderian membrane (SM) is a common surgical complication during the sinus floor augmentation (SFA) procedure. Different approaches have been proposed to completely closer the SM perforation and to avoid graft contamination or migration and postoperative sinus infection. In this context, the leukocyte and platelet-rich fibrin (L-PRF) membranes have been proposed for SM perforation treatment because of their natural adhesive property and resistance. Thus, this case series aims to evaluate the effectiveness of L-PRF in the treatment of SM large perforations during SFA. A total of 9 SM perforations were treated in this case series. The L-PRF membranes were interposed on the perforated SM until the rupture could not be visualized. The maxillary sinus cavities were filled with deproteinized bovine mineral bone (Bio-oss, Geistlich, Switzerland), and a collagen membrane was positioned to cover the lateral access window. After 8 months, 13 implants were placed, achieving satisfactory primary stability. The osseointegration of all implants and absence of infection signs/mucus in the maxillary sinus were observed in cone beam computed tomography or panoramic radiography qualitative analysis after 3-5 years of follow-up. It can be concluded that the use of L-PRF can be considered a viable alternative for the repair of large SM perforations.

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Abstract Objective The aim of this study is to evaluate the new bone and connective tissue formation and the biomaterial remaining after maxillary sinus bone augmentation using 5 different bone substitutes. The osteocalcin immunolabeling was performed to demonstrate their calcification and the possibility of receiving dental implants. Methodology 40 patients underwent maxillary sinus bone augmentation and were divided in 5 groups: Group 1 with 8 maxillary sinuses were grafted with autogenous bone graft (AB); Group 2 with 8 maxillary sinuses grafted with bioactive glass (BG); Group 3 with 8 maxillary sinuses grafted with bioactive glass added to autogenous bone graft (BG + AB) 1:1; Group 4 with 8 maxillary sinuses grafted with Bio-Oss (BO) and Group 5 with 8 maxillary sinuses grafted with Bio-Oss added to autogenous bone graft (BO + AB) 1:1. Results In group AB, 37.8% of bone was formed in the pristine bone region, 38.1% in the intermediate and 44.5% in the apical region. In group BG, 43.6% was formed in the pristine bone, 37% in the intermediate and 49.3% in the apical region. In group BG + AB 1:1, 39.0% was formed in the pristine bone region, 34.8% in the intermediate and 36.8% in apical region. In group BO, 33.4% was formed in the pristine bone, 32.5% in the intermediate and 34.3% in the apical region. In group BO + AB 1:1, 32.8% was formed in the pristine bone, 36.1% in intermediate and 27.8% in the apical regions. The immunolabeling for osteocalcin showed an intensive staining for all groups, which could demonstrate the calcification of the bone formed. Conclusion This study showed that the groups evaluated formed a suitable lamellar bone in the maxillary sinus reconstruction after six months of bone healing, thus being indicated to receive dental implants.

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Aim: The aim of this study was to report a maxillary sinus lift surgery associated with the installation of an immediate implant associated with late loading in edge with 3.5 mm in height. Methods: The sinus lift surgery was performed using the lateral window technique, followed by the immediate installation of the implant and subsequent manufacture of a screw-retained single prosthesis. Results: Through the technique of breast lift, it was possible to promote local bone formation in a vertical direction, enabling local dental rehabilitation. Conclusions: Following a solid and meticulous planning, even in crests with less than 5 mm in height, a transcrestal technique can be used predictably with an adequate clinical and radiological outcome, giving patients excellent stability of the grafted material and excellent clinical results(AU)

Objetivos: O objetivo deste estudo foi relatar uma cirurgia de levantamento de seio maxilar associada a instalação de implante imediato associado a carga tardia em rebordo com 3,5 mm de altura. Métodos: A cirurgia de levantamento de seio foi realizada através da técnica de janela lateral, seguida da instalação imediata do implante e posterior confecção de prótese unitária aparafusada. Resultados: Através da técnica de levantamento de seio, foi possível promover uma neoformação óssea local no sentido vertical, possibilitando a reabilitação dentária local. Conclusões: Seguindo um planejamento sólido e meticuloso, mesmo em cristas com menos de 5 mm de altura, a técnica de janela lateral pode ser usada de forma previsível com um resultado clínico e radiológico adequado, dando aos pacientes excelente estabilidade do material enxertado e excelentes resultados clínicos(AU)

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RESUMEN La elevación de piso de seno maxilar ha sido sumamente documentada en implantología como una técnica segura y predecible en el procedimiento de ganancia vertical ósea, en el maxilar posterior atrófico. Sin embargo, conjuntamente se han reportado complicaciones en este procedimiento, las cuales podrían poner en peligro los resultados de la regeneración, y por consiguiente la colocación del implante. El propósito de esta revisión de literatura es exponer y analizar diferentes complicaciones que pueden presentarse en la elevación de piso de seno maxilar.

ABSTRACT Maxillary sinus floor elevation has been extensively documented as a safe and predictable procedure for gaining vertical bone height in the atrophic posterior maxilla. Even though, complications have been reported, which can potentially jeopardize the outcome of the regeneration and implant therapy. Therefore, the purpose of this literature review is to present, debate and analyze the different complications that can occur during a sinus floor elevation.

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AIM: To develop a new surgical model for sinus floor augmentation (SFA) in rabbit for experimental purposes. MATERIALS AND METHODS: Eight adult rabbits were used, two for a surgical design using the anatomical dissection study, and the other six for an endoscopically assisted intraoral approach of SFA unilaterally, creating a subantral space where an allograft biomaterial was deposited. SFA was verified through cone-beam computerized tomography. Healing, weight, food, feces, and behavior were evaluated for 4 weeks post-operatively. RESULTS: All animals survived. There was no bleeding or infection; inflammation was mild. No changes were observed in terms of feeding, weight, feces, or behavior. Tissue healing was normal. CONCLUSION: This model is a refinement of the experimental technique and is a real option for SFA, without compromising animal morbidity because of its conservative design. The minimally invasive approach with endoscopic assistance reduces bias and improves surgical predictability.

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OBJECTIVE: To evaluate the influence of the posterior residual bone height and sinus width on the outcome of maxillary sinus bone augmentation using anorganic bovine bone. MATERIAL AND METHODS: Bilateral sinus bone augmentation was performed using anorganic bovine bone in 20 patients with residual bone height <2 mm in at least one site on each side. Trephine samples were removed at the implant insertion site 8 months after the grafting procedure, and histological and histomorphometric analyses were performed to examine the relative amount (%) of new bone, anorganic bovine bone, and soft tissue in the grafted area. Based on cone beam computed tomography evaluation, the sites of implant insertion were classified according to sinus width into narrow, average, and wide, and according to residual bone height into ≤2 and >2 mm. RESULTS: A total of 146 implants were installed and 103 biopsies were evaluated. New bone formation in sites classified as narrow (69 sites), average (19 sites), and wide (15 sites) was 28.5% ± 9.24, 28.9% ± 8.61, and 30.3% ± 7.80, respectively. The mean posterior maxillary residual bone height was 4.0 ± 2.43 mm, and 26 and 77 sites were classified as ≤2 and >2 mm, respectively. New bone formation was 26.2% ± 9.10 and 29.8% ± 8.67 for residual bone height ≤2 and >2 mm, respectively. The differences were non-significant. CONCLUSIONS: Within the limitations of the present study, posterior residual bone height and sinus width were not factors with influence on new bone formation in sinuses grafted exclusively with anorganic bovine bone after 8 months of healing.

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PURPOSE: To investigate the effectiveness of adding leukocyte and platelet-rich fibrin (L-PRF) to deproteinized bovine bone mineral (DBBM) for early implant placement after maxillary sinus augmentation. MATERIALS AND METHODS: Twelve patients requiring two-stage bilateral maxillary sinus augmentation were enrolled to the study. The elevated sinus cavities were randomly grafted with DBBM + L-PRF (test) or DBBM alone (control) in a split-mouth design. Implants were placed in the augmented sites after 4 months in the test group and 8 months in the control group. Bone biopsies were collected during implant placement for histomorphometric evaluation. Resonance frequency analysis was performed immediately after implant placement and at implant loading in both groups. Cone-beam computed tomography was obtained preoperatively and postoperatively for evaluation of graft volume changes. RESULTS: Both procedures were effective for maxillary sinus augmentation. Cone-beam computed tomography analysis did not reveal differences in graft volume between test and control group at any of the evaluated time points (P > .05). Histological evaluation demonstrated increased percentage of newly formed bone for the test group (44.58% ± 13.9%) compared to the control group (30.02% ± 8.42%; P = .0087). The amount of residual graft in the control group was significantly higher (13.75% ± 9.99%) than in the test group (3.59 ± 4.22; P = .0111). Implant stability quotient (ISQ) immediately after implant placement was significantly higher in the control group (75.13 ± 5.69) compared to the test group (60.9 ± 9.35; P = .0003). The ISQ values at loading did not differ between the groups (P = .8587). Implant survival rate was 100% for both groups. CONCLUSION: The addition of L-PRF to the DBBM into the maxillary sinus allowed early implant placement (4 months) with increased new bone formation than DBBM alone after 8 months of healing.

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