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Pommer B.,Academy for Oral Implantology | Unger E.,Medical University of Vienna | Busenlechner D.,Academy for Oral Implantology | Haas R.,Academy for Oral Implantology | And 3 more authors.
Materials | Year: 2015

Bone grafting of the maxillary sinus is attempted to compensate for sinus pneumatization and permit reliable insertion of endosseous dental implants for prosthetic rehabilitation. The aim of the present clinical investigation was to study bone regeneration four months after transcrestal sinus floor elevation via the Gel-Pressure Technique (GPT) and application of pasteous nano-crystalline hydroxyapatite bone substitute. A total of 25 patients with deficient alveolar ridges in the posterior maxilla (mean residual bone height: 4.7 ± 1.8 mm) were subjected to 32 flapless transcrestal sinus floor augmentations and simultaneous insertion of 40 implants. Sinus membrane elevation height averaged 11.2 ± 2.7 mm and minimal vertical graft resorption of 0.1 mm was observed after four months. Radiographic bone density averaged 460 Hounsfield units in regions adjacent to the native jawbone (1 to 7 mm distance), while reduction of bone density by -7.2%, -11.3%, -14.8%, -19.6% and -22.7% was recorded in more apical regions of 8, 9, 10, 11, and ≥12 mm distance to the original sinus floor, respectively. The results suggest that graft remodeling is completed up to a distance of 7 mm within a healing period of four months after sinus augmentation using nano-crystalline hydroxyapatite bone substitute material. © 2015 by the authors.

Schwarz L.,Medical University of Vienna | Unger E.,Medical University of Vienna | Watzek G.,Academy for Oral Implantology | Pommer B.,Medical University of Vienna | Pommer B.,Academy for Oral Implantology
Recent Patents on Biomedical Engineering | Year: 2013

Bone volume available for dental implant placement in the posterior maxilla is frequently reduced by maxillary sinus expansion and resorption of the alveolar ridge following tooth loss. Internal bone augmentation of the sinus floor is routinely performed by elevation of the maxillary sinus membrane via a lateral or transcrestal approach. The key issue in minimally invasive transcrestal techniques is the avoidance of membrane perforation in the course of osteotomy and membrane elevation. Novel devices to reduce the risk of membrane perforation have been recently developed and protected by patents. The present review presents recent sinus membrane elevation techniques (balloon-mediated elevation, hydraulic injection, gel-pressure technique) as well as new approaches to prevent sinus membrane perforation during transcrestal osteotomy (lasers, piezoelectric devices, auto-stop drills). The overview of patented designs is supplemented by an outlook on future surgical techniques and technical possibilities in transcrestal sinus floor augmentation surgery. © 2014 Bentham Science Publishers.

Schwarz L.,Medical University of Vienna | Schiebel V.,Medical University of Vienna | Hof M.,Medical University of Vienna | Ulm C.,Medical University of Vienna | And 3 more authors.
Journal of Oral and Maxillofacial Surgery | Year: 2015

Purpose To test patient- and sinus-related risk factors for an association with intraoperative membrane perforation and postoperative complications after sinus floor augmentation surgery. Materials and Methods Sinus floor elevation procedures using a lateral approach were retrospectively analyzed for patients' medical history and sinus anatomy on computed tomographic scans. Complications per sinus after membrane elevation and augmentation using a mixture of autologous bone and deproteinized bovine bone substitute (Bio-Oss) were recorded. Logic regression (adjusted using the generalized estimation equation approach) was performed to analyze the influence of patient age, gender, smoking habits, sinus septa, residual bone height, and mesiodistal elevation width. Results Of 407 sinus grafts in 300 patients (mean age, 56 yr), perforation of the Schneiderian membrane occurred in 35 sinuses (8.6%) and was significantly associated to the presence of sinus septa (odds ratio [OR] = 4.8; P =.002) and decreased residual bone height (OR = 0.01; P <.001). Smoking increased the risk of membrane perforation (OR = 4.8; P =.002), sinusitis (OR = 12.3; P <.001), and wound dehiscence (OR = 16.1; P = .005). Cases of sinus membrane perforation had higher odds for postoperative sinusitis (OR = 10.5; P <.001). The probability of wound dehiscence increased with the size of the elevated area (OR = 3; P <.001). Conclusion The results of the study suggest that the presence of sinus septa and residual bone height less than 3.5 mm are the main risk factors increasing sinus membrane perforation rates. There was a higher prevalence for sinusitis in cases of membrane perforation (31.4%) despite intraoperative closure with resorbable membranes (Bio-Guide). Smokers generally exhibited greater chances for complications. © 2015 American Association of Oral and Maxillofacial Surgeons.

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