Radiographic Analysis of the Cosci Technique: A Multicenter Retrospective Study With a Mean Follow-up of 5 Years.

Department of Periodontology and Implantology, University of Bologna, Bologna, Italy.
Journal of Periodontology (Impact Factor: 2.57). 05/2011; DOI: 10.1902/jop.2011.100684
Source: PubMed

ABSTRACT Background: Various sinus-lift techniques have been described in the literature. The aim of this study was to evaluate the efficacy of the Cosci transalveolar sinus-lift technique in terms of implant survival, marginal bone loss and complications. Methods: A total of 538 patients were examined and following exclusion and inclusion criteria a sample of patients was included with a mean follow-up of 5 years. Implants with smooth or tapered surface were considered. Therefore only sinus lifts with inorganic bovine bone matrix or DBM were included and 1536 periapical radiographs were analyzed. Outcome measures were implant success, implant failure (peri-implantitis and loss of osseointegration), marginal bone resorption, and biological complications (membrane perforations, sinusitis, intra- and/or postoperative hemorrhage). Periapical radiographs were evaluated before and after surgery, then after 6 months, 1, 3, and 5 years. We analyzed the residual crestal bone height under the sinus, the amount (in mm) of height increase after the surgery, and implant marginal bone resorption values for the considered follow-ups. Results: Two hundred and eighty-two patients were excluded from the study. Therefore, 256 patients treated with the Cosci sinus-lift techinique were included. A total of 376 dental implants and 323 sinus lifts were analyzed. The overall implant success and implant failure rates were 94.9% and 5.1%, respectively. The mean bone loss around implants was 1.98 mm (mean follow-up of 5 years). Patients treated with inorganic bovine bone matrix showed a better implant success rate (p = .03) than patients treated with demineralized human matrix. Three Schneiderian membrane perforations occurred in the 323 sinus lifts. In these cases, the surgeon performed another surgical operation after 3 months. Postoperative complications were peri-implantitis (6 cases) and osseointegration losses (13 cases). Conclusions: The Cosci technique is a safe, minimally invasive technique with an implant success rate comparable to traditional implantology. The implant success rate was positively affected by low-resorption graft material, and a low bone resorption rate around implants was found.

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Available from: Vittorio Checchi, Sep 15, 2014
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    ABSTRACT: Purpose: The aim of this work, the first human histologic case report of this technique, was a clinical and histologic evaluation of implant placed in a severely atrophic maxilla using a 2-stage crestal sinus elevation. Case Presentation: A 52-year-old woman required rehabilitation of an atrophic maxilla with a fixed implant-supported prosthesis. At the first surgery, a crestal sinus lift was performed using beta-tricalcium phosphate (beta-TCP), as radiographic tracer, and mineralized human bone allograft (MHBA) as grafting material. After 6 months, a bone core biopsy was taken, and 2 implants were placed in the augmented sites. Four months later, implants were exposed, and 2 splinted gold-porcelain crowns were delivered. Histology highlighted basal bone disappearance, replaced by a wide composite network (similar to 50% vol/vol) of MHBA granules connected by newly formed bone, and osteoblastic activities. Conclusion: This case report demonstrates the possibility of executing a staged transcrestal sinus lift in atrophic situations. MHBA evidenced usefulness in maintaining bone volume. Histologic analyses confirmed the sound outcome of the graft augmentation. Additional studies would be beneficial to confirm or refute the reliability of this technique.
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