Graftless sinus augmentation technique with contextual placement of implants: a case report

Journal of Medical Case Reports

Annalisa Monaco²  Laura Bonanome¹  Alessandro Cielo¹  Gian Luca Sfasciotti³  Roberta Marini³  Nicolae Chipaila² 

[1]‘Private Practice, Via Regina Elena 287/A, 00161 Rome, Italy

[2]University of L’Aquila, Department of Life, Health and Environmental Sciences, Unit of Dentistry, Delta 6 building, Via Vetoio, 1, 67100 L’Aquila, Italy

[3]‘Sapienza’ University of Rome - Department of Oral and Maxillofacial Sciences, Via Caserta, 6, 00161 Rome, Italy

关键词: Implant placement;    Maxillary alveolar ridge atrophy;    Sinus augmentation;   

Others  :  1180907
DOI  :  10.1186/1752-1947-8-437

 received in 2014-07-10, accepted in 2014-10-07,  发布年份 2014

【 摘 要 】

Introduction

The positioning of implants in the jaw bones with contextual graftless lateral approach sinus lifting is finding an increasingly broad consensus in the literature.

Since the 1970s, various clinical research projects have been conducted on applications of biological and synthetic biomaterials in bone regenerative surgery, both in sinus lift procedures and in cystic cavity filling after cystectomy or in bone defects in regenerative periodontal surgery. Currently, we are finding that there is an increasing trend of clinicians aiming to adopt graftless techniques, with satisfactory results in terms of implant survival in the long term.

In our study, through a case report, we describe a variant of graftless sinus augmentation technique with contextual implant placement, emphasizing the role of the blood clot, combined with collagen sponges, as a natural scaffold and the osteogenic potential of the subantral membrane in guided bone regeneration, with reduced morbidity of the patient.

Case presentation

To describe the surgical technique, the clinical case of a 38-year-old Caucasian woman with a lateral posterior edentulism was selected. The rehabilitation was solved by a graftless sinus augmentation technique with a contextual implant placement.

For each implant, a resonance frequency analysis evaluation was reported as implant stability quotient values. The performance of the implant stability quotient values followed a gradual increase from time zero to the sixth month, as the clot was differentiated into osteoid tissue and then into bone tissue, due to the scaffold effect conferred by the equine collagen sponge. The stabilization phase took place between the fourth and the sixth month, according to the implant stability quotient values.

Conclusions

Our graftless sinus augmentation technique seems to be very predictable thanks to the osteoconductive principles on which it is based, and in association with the proper management of peri-implant soft tissue, so as to increase the amount of keratinized tissue, which could represent the new gold standard for this type of rehabilitation in the future.

【 授权许可】

   
2014 Chipaila et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

Figure 6.

Figure 7.

Figure 8.

Figure 9.

Figure 10.

Figure 11.

Figure 12.

Figure 13.

Figure 14.

Figure 15.

Figure 16.

Figure 17.

【 参考文献 】

• [1]Jensen OT, Shulman LB, Block MS, Iacono VJ: Report of Sinus Consensus Conference of 1996. Int J Oral Maxillofac Implants 1998, 13:11-45.
• [2]Stern A, Green J: Sinus lift procedures: an overview of current techniques. Dent Clin North Am 2012, 56:219-233.
• [3]Tasoulis G, Yao SG, Fine JB: The maxillary sinus: challenges and treatments for implant placement. Compend Contin Educ Dent 2011, 32:10-14. 16, 18–19; quiz 20, 34
• [4]He L, Chang X, Liu Y: Sinus floor elevation using osteotome technique without grafting materials: a 2-year retrospective study. Clin Oral Implants Res 2013, Suppl A100:63-67.
• [5]Chen TW, Chang HS, Leung KW, Lai YL, Kao SY: Implant placement immediately after the lateral approach of the trap door window procedure to create a maxillary sinus lift without bone grafting: a 2-year retrospective evaluation of 47 implants in 33 patients. J Oral Maxillofac Surg 2007, 65:2324-2328.
• [6]Lundgren 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.
• [7]Lungren S, Cricchio G, Palma VC, Salata LA, Sennerby L: Sinus membrane elevation and simultaneous insertion of dental implants: a new surgical technique in maxillary sinus floor augmentation. Periodontol 2000, 47:193-205.
• [8]Linkow LI: Maxillary implants. A dynamic approach to oral implantology. North Haven, CT: Glarus; 1997:109-111.
• [9]Tatum H: Maxillary and sinus implant reconstruction. Dent Clin North Am 1986, 30:207-229.
• [10]Boyne PJ, James RA: Grafting of the maxillary sinus floor with the autogenous marrow and bone. J Oral Surg 1980, 38:613-616.
• [11]Branemark PI, Adell R, Albrektsson T, Lekholm U, Lindstrom J, Rockler B: An experimental and clinical study of osseointegrated implants penetrating the nasal cavity and maxillary sinus. J Oral Maxillofac Surg 1984, 42:497-505.
• [12]Smiler DJ, Holmes RE: Sinus lift using porous hydroxyapatite: a preliminary clinical report. J Oral Implant 1987, 13:239-253.
• [13]Moy PK, Lundgren S, Holmes RE: Maxillary sinus augmentation: histomorphometric analysis of graft materials for maxillary sinus floor augmentation. J Oral Maxillofac Surg 1993, 51:857-862.
• [14]Smiler DJ, Johnson PW, Lozada JL, Misch C, Rosenlicht JR, Tatum OH, Wagner JR: Sinus lift grafts and endosseous implants. Dent Clin North Am 1992, 36:151-188.
• [15]Misch CE: Maxillary sinus augmentation for endosteal implants: organized alternative treatment plans. Int J Oral Implant 1987, 4:49-58.
• [16]Favero GA, Branemark PJ: Il rialzo del pavimento del seno mascellare e osseointegrazione. Luglio: Giornale di Stomatologia e Ortognatodonzia; 1994.
• [17]Barone A, Santini S, Marconcini S, Giacomelli L, Gherlone E, Covani U: Osteotomy and membrane elevation during the maxillary sinus augmentation procedure. A comparative study: piezoelectric device vs. conventional rotative instrumentations. Clin Oral Implants Res 2008, 19:511-515.
• [18]Becker ST, Terheyden H, Steinriede A, Behrens E, Springer I, Wiltfang J: Prospective observation of 41 perforations of the Schneiderian membrane during sinus floor elevation. Clin Oral Implants Res 2008, 19:1285-1289.
• [19]Testori T, Wallace SS, Del Fabbro M, Taschieri S, Trisi P, Capelli M, Weinstein RL: Repair of large sinus membrane perforations using stabilized collagen barrier membranes: surgical techniques with histologic and radiographic evidence of success. Int J Perio Rest Dent 2008, 28:9-17.
• [20]Pjetursson 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, Suppl 8:216-240.
• [21]Summers RB: The osteotomy technique: part III- less invasive methods of elevating the sinus floor. Comp Cont Ed Dent 1994, 15:698-708.
• [22]Bruschi GB, Scipioni A, Calesini G, Bruschi E: Localized management of the sinus floor with simultaneous implant placement: a clinical report. Int J Oral Maxillofac Implants 1998, 13:219-226.
• [23]Browaeys H, Bouvry P, De Bruyn H: A literature review on biomaterials in sinus augmentation procedures. Clin Impl Dent Rel Res 2007, 9:166-177.
• [24]Burchardt H: The biology of bone graft repair. Clin Orthop Rel Res 1983, 174:28-40.
• [25]Landi L, Pretel RW Jr, Hakimi NM, Setayesh R: Maxillary sinus floor elevation using combination of DFDBA and bovine-derived porous hydroxyapatite: a preliminary histologic and histomorphometric report. Int J Perio Rest Dent 2000, 20:575-583.
• [26]Froum SJ, Tarnow DP, Wallace SS, Rohrer MD, Cho SC: Sinus floor elevation using an organic bovine bone matrix (Osteograf/N) with and without autogenous bone: a clinical, histologic, radiographic and histomorphometric analysis. Part II of an ongoing prospective study. Int J Perio Rest Dent 1998, 18:528-543.
• [27]Tadjoedin ES, de Lange GL, Lyaruu DM, Kuiper L, Burger EH: High concentrations of bioactive glass material (BioGran) versus autogenous bone for sinus floor elevation. Clin Oral Impl Res 2002, 13:428-436.
• [28]Szabo G, Huys L, Coulthard P, Maiorna C, Gargiola U, Barabas J, Nemeth Z, Hrabak K, Suba Z: 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.
• [29]Dhalin C, Linde A, Gottlow J, Nyman S: Healing of bone defects by guided tissue regeneration. Plast Reconstr Surg 1988, 81:572-576.
• [30]Smukler H, Barboza EP, Burliss C: A new approach to regeneration of surgically reduced alveolar ridges in dogs: a clinical and histologic study. Int J Oral Maxillofac Implants 1995, 10:537-551.
• [31]Lundgren S, Andersson S, Sennerby L: Spontaneous bone formation in the maxillary sinus after removal of a cyst: coincidental or expected reaction? Clin Implant Dent Relat Res 2003, 5:78-81.
• [32]Srouji S, Kizhner T, Ben David D, Riminucci M, Bianco P, Livne E: The Schneiderian membrane contains osteoprogenitor cells: in vivo and in vitro study. Calcif Tissue Int 2009, 84:138-145.
• [33]Srouji S, Ben-David D, Lotan R, Riminucci M, Livne E, Bianco P: The innate osteogenic potential of the maxillary sinus (Schneiderian) membrane: an ectopic tissue transplant model simulating sinus lifting. Int J Oral Maxillofac Surg 2010, 39:793-801.
• [34]Palma VC, Magro-Filho O, De Oliveria JA, Lundgren S, Salata LA, Sennerby L: Bone reformation and implant integration following maxillary sinus membrane elevation: an experimental study in primates. Clin Implant Dent Relat Res 2006, 8:11-24.
• [35]Hatano N, Sennerby L, Lundgren S: Maxillary sinus augmentation using membrane elevation and peripheral venous blood for implant supported rehabilitation of the atrophic posterior maxilla: case series. Clin Impl Dent Rel Res 2007, 9:150-155.
• [36]Lambert F, Léonard A, Drion P, Sourice S, Layrolle P, Rompen E: Influence of space-filling materials in subantral bone augmentation: blood clot vs. autogenous bone chips vs. bovine hydroxyapatite. Clin Oral Impl Res 2011, 22:538-545.
• [37]Xu H, Shimizu Y, Ooya K: Histomorphometric study of the stability of new formed bone after elevation of the floor of the maxillary sinus. Br J Oral Maxillofac Surg 2005, 43:493-499.
• [38]Sun XJ, Zhang ZY, Wang SY, Gittens SA, Jiang XQ, Chou LL: Maxillary sinus floor elevation using a tissue-engineered bone complex with OsteoBoneTM and bMSCs in rabbits. Clin Oral Impl Res 2008, 19:804-813.
• [39]Gruber R, Kandler B, Fuerst G, Fischer MB, Watzek G: Porcine sinus mucosa holds cells that respond to bone morphogenetic protein (BMP)-6 and BMP-7 with increased osteogenic differentiation in vitro. Clin Oral Implants Res 2004, 15:575-580.
• [40]Lioubavina-Hack N, Lang NP, Karring T: Significance of primary stability for osteointegration of dental implants. Clin Oral Impl Res 2006, 17:244-250.
• [41]Albrektsson T, Donos N, Working Group 1: Implant survival and complications. The Third EAO Consensus Conference. Clin Oral Implants Res 2012, 23:63-65.
• [42]Meredith N: Assessment of implant stability as a prognostic determinant. Int J Prosthod 1998, 11:491-501.
• [43]Aksoy U, Eratalay K, Tözüm TF: The possible association among bone density values, resonance frequency measurements, tactile sense, and histomorphometric evaluations of dental implant osteotomy sites: a preliminary study. Implant Dent 2009, 18:316-325.
• [44]Riben C, Thor A: The maxillary sinus membrane elevation procedure: augmentation of bone around dental implants without grafts-a review of a surgical technique. Int J Dent 2012, 2012:105483.
• [45]Dikicier S, Dikicier E, Karacayli U: Maxillary sinus augmentation and implant placement using venous blood without graft material: a case report. J Oral Implantol 2012. [Epub ahead of print]
• [46]Ellegaard B, Kølsen-Petersen J, Baelum V: Implant therapy involving maxillary sinus lift in periodontally compromised patients. Clin Oral Implants Res 1997, 8:305-315.
• [47]Haas R, Haidvogl D, Donath K, Watzek G: Freeze-dried homogeneous and heterogeneous bone for sinus augmentation in sheep. Part I: histological findings. Clin Oral Implants Res 2002, 13:396-404.
• [48]Winter AA, Pollack AS, Odrich RB: Sinus⁄alveolar crest tenting (SACT): a new technique for implant placement in atrophic maxillary ridges without bone grafts or membranes. Int J Periodontics Restorative Dent 2003, 23:557-565.
• [49]Dahlin C, Sennerby L, Lekholm U, Linde A, Nyman S: Generation of new bone around titanium implants by a membrane technique: an experimental study in rabbits. Int J Oral Maxillofac Implants 1989, 4:19-25.
• [50]Jensen OT, Greer RO, Johnson L, Kassebaum D: Vertical guided bone-graft augmentation in a new canine mandibular model. Int J Oral Maxillofac Implants 1995, 10:335-344.
• [51]Leghissa GC, Zaffe D, Assenza B, Botticelli AR: Guided bone regeneration using titanium grids: report of 10 cases. Clin Oral Implants Res 1999, 10:62-68.
• [52]Lynch SE, Colvin RB, Antoniades HN: Growth factors in wound healing. Single and synergistic effects on partial thickness porcine skin wounds. J Clin Invest 1989, 84:640-646.
• [53]Smukler H, Capri D, Landi L: Harvesting bone in the recipient sites for ridge augmentation. Int J Periodontics Restorative Dent 2008, 28(4):411-419.
• [54]Tal H, Pitaru S, Moses O, Kozlovsky A: Collagen gel and membrane in guided tissue regeneration in periodontal fenestration defects in dogs. J Clin Periodontol 1996, 23:1-6.
• [55]Sampath TK, Reddi AH: Importance of geometry of the extracellular matrix in endochondral bone differentiation. J Cell Biol 1984, 98:2192-2197.