Maxillary sinus floor augmentation (MSFA) with lateral approach has undergone considerable changes since its inception, mainly due to the introduction of a variety of grafting materials and surgical protocols, with the aim of providing predictable and durable support to implants and improving treatment outcomes. The aim of this systematic review was to evaluate the performance of MSFA in terms of graft stability and implant survival, based on randomized clinical trials.
The study protocol was registered on PROSPERO. An electronic search was performed on Medline, Embase, and CENTRAL databases, integrated with hand-searching on the main pertinent Journals and search of gray literature. Randomized studies on MSFA with a lateral approach reporting on radiographic changes in graft height or volume after at least six months of healing, implant survival, and marginal bone level changes after at least 12 months of loading were included. Two independent reviewers selected the studies. Studies included underwent data extraction and risk of bias assessment using the ROB 2.0 Cochrane tool.
Out of 3922 studies retrieved, 49 studies (57 articles) were included for data extraction and qualitative analysis. These studies reported on 1265 patients and 1722 MSFA procedures. Thirteen studies were at low risk, 30 had some concerns, and six were at high risk of bias. No quantitative synthesis was possible due to the characteristics of the studies and their methodology. The overall implant survival rate ranged from 84.6% to 100% without evidence of any relevant difference related to the grafting material.
The results of this review, based on descriptive statistics, may suggest that the success of the lateral MSFA procedure is independent of the graft type, at least in the short term. To verify this interpretation, formal statistical analyses on trustworthy and more detailed clinical data are needed. Also, long-term data on graft dimensional stability from evidence-based studies are needed.
Smoking disrupts macrophage chemokine response and delays healing. This study aims to investigate the effect of smoking on peri-implant crevicular fluid (PICF) levels of macrophage-related chemokines, C-C motif chemokine ligand 2 (CCL-2), C-C motif chemokine ligand 8 (CCL-8), C-X-C motif chemokine ligand 9 (CXCL-9), and C-C motif ligand 3 (CCL-3), before and after non-surgical treatment of initial peri-implantitis.
Fifty-five implants (27 non-smoking [NSPI] and 28 smoking [SPI]) with initial peri-implantitis (bleeding on probing [BOP+], probing pocket depth [PPD] of 6–7 mm) were included in the study. Clinical parameters were recorded, and PICF samples were collected before and 4 months after non-surgical treatment. PICF concentrations of CCL-2, CCL-8, CCL-3, and CXCL-9 were measured with Luminex assay. The Mann–Whitney U-test, Wilcoxon signed-rank test, and repeated measures analysis of variance test were used to analyze differences between and within the groups.
Baseline CCL-2 (p < 0.001) and CXCL-9 (p = 0.026) levels (pg/30 s) were significantly lower in smokers compared to non-smokers, while no difference was observed for CCL-3 between the two groups (p = 0.320). Only CCL-2 levels (pg/30 s) decreased in the NSPI group in response to non-surgical treatment (p = 0.037).
Smoking disturbs the expressions of macrophage-related chemokines in the early phase of peri-implantitis. These findings may indicate the impaired control of infection during initial peri-implantitis and explain the accelerated progression of the disease in smokers. This study was not registered prior to participant recruitment.
https://clinicaltrials.gov/study/NCT06810401
Robot-assisted implant surgery has been shown to achieve high levels of accuracy. However, there is currently a paucity of clinical studies evaluating the accuracy of marker-based intraoral scanner (IOS) registration (IR) methods.
The purpose of this study was to compare the accuracy of the marker-based cone beam computed tomography (CBCT) registration (CR) method and the IR method in the dental implant in the robotic computer-aided implant system (R-CAIS).
This retrospective study included 20 participants, with 10 undergoing implant surgery using the CR method within a robotic system, and the remaining 10 receiving implants using the IR method. Preoperative CBCT images used for implant planning were aligned with the postoperative CBCT images to assess and quantify positional deviations in implant placement. The primary outcome measures were FRE, entry deviation, apical deviation, and angular deviation. A Student's t-test was performed to compare differences between the two groups, with a p-value of < 0.05 considered statistically significant.
The mean ± standard deviation values for FRE were 0.027 ± 0.007 mm for the CR group and 0.031 ± 0.006 mm for the IR group (p = 0.149). The mean ± standard deviation values for entry deviation were 0.58 ± 0.11 mm for the CR group and 0.53 ± 0.15 mm for the IR group (p = 0.072). The mean ± standard deviation values for apical deviation were 0.52 ± 0.12 mm for the CR group and 0.50 ± 0.14 mm for the IR group (p = 0.730). The mean ± standard deviation values for apical deviation were 1.10 ± 0.34 mm for the CR group and 1.17 ± 0.23 mm for the IR group (p = 0.730).
In R-CAIS, the IR method demonstrated accuracy comparable to that of the CR method, with both methods yielding clinically satisfactory outcomes.
To analyze the scientific profile of the 100 most cited articles on maxillary sinus lift.
A search was conducted in the Web of Science Core Collection database in February 2024. Two reviewers retrieved the 100 most cited articles. The number of citations for the articles was compared in the Scopus and Google Scholar databases. The VOSviewer software was employed to generate collaborative network maps for authors and keywords. Dimension was consulted to measure altimetry data. Google Trends was used to explore the global popularity of research on maxillary sinus lift.
The number of citations ranged from 120 to 1259. The articles were published between the years 1991 and 2017. The most frequent study design was observational (21%), and the surgical technique was the lateral window (76%). The most used bone graft was autogenous (15%). The journal with the highest number of articles was Clinical Oral Implants Research (29%). The United States was the most prevalent country (27%), and New York University had the highest number of publications (8%). However, the European continent stood out (66%). Froum SJ was the author with the highest number of publications (6%). The most common keywords were “dental implants” (38%). Intense mentions were identified primarily on Mendeley. According to Google Trends, Ukraine was the country that researched maxillary sinus lift the most.
It can be concluded that the 100 most cited articles on sinus elevation were observational studies that evaluated the lateral window technique for sinus elevation.
In vitro studies were conducted to evaluate the effectiveness of combining glycine powder air-polishing (AP) and ultrasonic scaling (US) in surgical bone reconstructive therapy for peri-implantitis.
Twenty clinically failed implants and 60 pristine implants were treated in vitro with AP and/or US by using stainless steel, titanium, or carbon fiber tips. Implant surface topography, contaminant distribution, elemental proportion, and composition were analyzed using scanning electron microscopy and energy-dispersive X-ray spectroscopy.
AP effectively removed bacterial plaques but was unable to eliminate calcified deposits involving calculi and bone fragments. Conversely, US exhibited a high capacity for removing calcified deposits but inevitably altered implant surface topography and the atomic percentages of oxygen (O) and titanium (Ti) regardless of the ultrasonic tip used. AP showed minimal effects on the implant surface and even alleviated the adverse effects of US on the surface topography and the atomic percentages of O, Ti, and even carbon. A sequential protocol involving AP followed by US, with a final AP step, effectively removed contaminants from infected implants while minimally affecting the original surface features.
The combined application of AP and US in surgical peri-implantitis therapy may be a preferred and effective approach for obtaining bone regeneration around infected dental implants.
This study aimed to investigate the accuracy of conventional and digital impression-making and cast-fabrication using coded healing abutments on an edentulous mandibular model under in vitro conditions.
Our study investigated the accuracy of the On1 Concept (Nobel Biocare; Kloten, Switzerland) coded healing abutment system using conventional and digital workflows. The Conical Connection (CC) system (Nobel Biocare; Kloten, Switzerland) was used as the control group in both workflows. 10–10 open-tray impressions and intraoral scans were made from the reference model with each system. Models built from intraoral scans were additively fabricated, and open-tray impressions were poured with type-4 dental stone. The prepared models were digitized using a desktop scanner with an accuracy of 4 μm (E4, 3Shape; Copenhagen, Denmark) and superimposed on the reference scan. Four linear distances and root mean square (RMS) deviations were measured using metrology software.
Five dimensions were measured using signed and absolute deviations, resulting in nine outcomes. RMS and diagonal deviations provided the most insight into overall model deviations. Mean RMS deviations were: 58.30 (14.95) μm for CC_conv, 47.66 (13.04) μm for On1_conv, 204.97 (37.40) μm for CC_dig, and 136.64 (13.49) μm for On1_dig. Significant differences were found between On1_conv vs. CC_dig, On1_conv vs. On1_dig, and CC_conv vs. CC_dig. Mean linear deviations between the molar positions were: 24.49 (58.20) μm for CC_conv, 87.46 (106.70) μm for On1_conv, −104.76 (125.83) μm for CC_dig, and 140.64 (190.56) μm for On1_dig. Significant differences were observed between On1_conv vs. CC_dig and CC_dig vs. On1_dig.
Based on the RMS deviations, the conventional method is significantly more accurate at both implant and platform levels in the case of an in vitro edentulous lower jaw model. The RMS deviations of the implant analogs are smaller on the platform level with both conventional and digital methods.
In many clinical cases, anatomical conditions such as an atrophied alveolar ridge do not allow insertion of normal diameter implants. At this point, narrow dental implants may provide an effective option to avoid complex surgical treatments. The aim of this trial was to evaluate long-term survival, prosthetic and biological complications, and OHRQoL for two-piece narrow dental implants supporting overdentures with Locator-attachments.
Twenty-five patients with edentulous mandibles received four narrow dental implants and retained dentures with Locator attachments. Following successful implantation, immediate loading of anterior implants with Locator attachments was performed, while posterior implants underwent a conventional healing procedure. Follow-up examinations included documentation of implant and denture-related complications, modified gingiva index, modified plaque index, OHIP-G, and radiographic measurements of bone loss.
Up to 9 years after restoration, 18 patients with 72 implants were available for the follow-up. During the observation period, one implant was lost in the immediate loading group. Implant survival was 98% and 100%. The outcomes of mPI and mGI for the 18 patients hardly differed between the groups. During the observation period, 136 prosthetic complications occurred. Scores for the different OHIP-G domains at the last follow-ups were stable over the years.
Throughout an extended period of observation, we found stable implant survival rates, good maintenance of oral hygiene, and manageable prosthetic complications. The OHRQoL was satisfying over the years, suggesting that this treatment option could be favorable for older individuals.
https://drks.de/search/en/trial/DRKS00005497
Maxillary sinus elevation is a critical procedure in dental implantology, often necessary to address bone deficiencies in the posterior maxilla. However, various medical conditions, local factors, and surgical complexities can significantly influence the outcomes. This article delves into the implications of systemic conditions such as smoking, diabetes, osteoporosis, antiresorptive and antiangiogenic medications, radiotherapy, immunocompromised states, cardiovascular diseases, chronic alcoholism, and oxidative stress on sinus floor elevation and associated dental implant placements. Each condition presents unique challenges and necessitates tailored clinical considerations to mitigate risks and enhance surgical success. A comprehensive pre-operative assessment is essential, including detailed patient history and radiographic evaluation. Local conditions affecting the maxillary sinus, such as sinusitis, require careful examination and possible otolaryngologist consultation. The article discusses a standardized Digital Surgical Planning (DSP) protocol involving CBCT imaging, intraoral scans, virtual diagnostic wax-ups, and guided implant placement to optimize surgical planning and outcomes. Surgical techniques for lateral window antrostomy are examined, including flap design, window size and location, and piezoelectric and rotary instrumentation. Subsequent regenerative procedures involve meticulous membrane elevation and particulate graft placement, with considerations for graft material and technique to ensure stability and volume retention. Post-operative care, encompassing antibiotic prophylaxis, corticosteroid use, and decongestants, is outlined to prevent infections and manage edema. Conclusively, the article stresses the necessity for implantologists to be proficient in various techniques and make evidence-based decisions tailored to individual patient needs, ensuring optimal implant therapy outcomes. The lateral window approach remains a cornerstone of regenerative dental procedures, maintaining its significance through evolving methodologies and clinical advances. The lateral window sinus elevation procedure has demonstrated consistent success as a pre-prosthetic surgical intervention for over four decades, supported by multiple reviews. Initially a hospital-based procedure requiring autogenous bone harvesting, it has evolved into a minimally invasive, office-based procedure without the need for donor bone. Smaller access windows and flaps have further reduced morbidity. Despite the emergence of less invasive techniques such as the transcrestal approach and the use of tilted or short implants, the lateral window procedure remains relevant due to its unique advantages: Provides greater access to overcome obstacles like septa. Facilitates single-surgery management of multiple implant sites. Remains applicable regardless of residual crestal bone height. Allows intraoperative management of complications such as membrane perforations.
This study aims to develop an innovative dry preservation surface modification for strontium-modified pure titanium implants to prevent surface degradation by hydrocarbon pollutants in the air and to enhance osseointegration.
An optimal parameter dry preservation surface modification was established by immersing samples in a 0.1 M KCl + 0.1 M SrCl2 mixed solution for 12 h, followed by air-drying and storing in sealed glass vials, as the strontium-doped dry preservation (SrP) group. Surface characteristics were analyzed using appropriate instrumentation. Cell adhesion, proliferation, and osteogenic differentiation were assessed in in vitro studies. Forty-eight male Sprague–Dawley rats were included in in vivo studies, with a total of 96 implants placed bilaterally in the tibiae. Micro-CT, removal torque tests, and histological analyses after 4 or 8 weeks were conducted in order to evaluate the osseointegration in each group.
Four distinct groups were involved in this study: the SrP group, the freshly prepared strontium-doped (SrF) group, the strontium-doped group with no dry preservation (SrN), and the modified sand-blasted large grit acid-etched (modSLA) group. After 6 months of storage, the SrP surface maintained favorable hydrophilicity, micro-nano morphology, and consistent strontium ion release similar to SrF. Moreover, it maintained similar levels of cell proliferation and osteogenic differentiation as SrF while exhibiting significantly better performance than SrN in in vitro studies (p < 0.05). Additionally, after 12 months of storage, it demonstrated excellent osseointegration comparable to the SrF group while significantly outperforming SrN in in vivo studies 4 weeks post-surgery (p < 0.05).
The dry preservation surface modification successfully maintained the nanotopography and hydrophilicity of strontium-doped pure titanium implants during 6–12 months of storage, and effectively mitigated the premature release of strontium ions associated with wet preservation methods, thereby significantly preserving the osseointegration performance of strontium-doped titanium implants.
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