Radiographic Analysis of a Transalveolar Sinus-Lift Technique: A Multipractice 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: 2.71). 05/2011; 84(8). DOI: 10.1902/jop.2011.100684
Source: PubMed


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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    • "This technique documented a 5-year survival rate superior to 92.7% for implants placed in less than 5 mm ridge height and 94.9% for implants inserted in more than 5 mm ridge height [11] [12]. These results are strictly linked to the absence of intraoperative and postoperative complication such as membrane perforation, postoperative sinusitis, disturbed wound healing, hematoma, sequestration of bone, and partial or complete graft failure [13] [14]. "
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    ABSTRACT: Aim. The aim of this study was to assess the success and the survival rate of dental implants placed in augmented bone after sinus lifting procedures. Material and Methods. 31 patients were mainly enrolled for a residual upper jaw crest thickness of 3 mm. CBCT scans were performed before and after the augmentation technique and at the follow-up appointments, at 3, 6, 12, 24, and up to 60 months. The follow-up examination included cumulative survival rate of implants, peri-implant marginal bone loss, and the height of sinus floor augmentation. Results. This retrospective study on 31 patients and 45 implants later inserted in a less than 3 mm crest showed excellent survival rates (99.5%), one implant was lost before loading due to an acute infection after 24 days, and two implants did not osteointegrate and were removed after 3 months. The radiological evaluation showed an average bone loss of 0.25 mm (±0.78 mm) at the first follow-up appointment (3 months) up to 0.30 mm (±1.28 mm) after 60-month follow-up. Conclusion. In this study it was reported how even in less than 3 mm thick crest a transcrestal technique can predictably be used with a long-term clinical and radiological outcome, giving patients excellent stability of the grafted material and healthy clinical results.
    Full-text · Article · Sep 2015 · International Journal of Dentistry
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    ABSTRACT: This chapter reviews the implant survival and success rate of the most commonly used sinus lift techniques and grafting materials. It focuses on the dental implant success and survival rates of the lateral and transalveolar approaches. The ultimate goal of the lateral window and the transalveolar approaches is the elevation of the Schneiderian membrane from the underlying sinus wall, creating room for the insertion of either bone grafts or the implant(s) or both. Implant(s) can be placed either together with the procedure (simultaneous placement) or during a second appointment after a period of healing (delayed placement). The chapter discusses the factors, implant design/length, residual bone height/quality, medical/dental conditions, and selection of grafting materials, that could affect the success and survival rates of the dental implants placed in augmented sinuses.
    No preview · Chapter · Mar 2014
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    ABSTRACT: Purpose: To compare the effectiveness of two different techniques to lift the maxillary sinus via a crestal approach: the Summers versus the Cosci technique. Materials and methods: Fifteen partially edentulous patients missing bilaterally maxillary molars and/ or premolars, having 4 to 7 mm of residual crestal height and at least 5 mm thickness below the maxillary sinuses measured on CT scans, were randomised to have implants placed in sinuses crestally lifted according to the Cosci or the Summers techniques, with bone substitutes according to a split-mouth design. Implants were left to heal submerged for 6 months. Implants were loaded with acrylic provisional crowns/prostheses. Screw-retained definitive metal-ceramic prostheses were delivered 4 months after provisional loading. Outcome measures were: prosthesis and implant failures; any complications; operation time; operator preference; patient preference and peri-implant marginal bone level changes assessed by a blinded outcome assessor. All patients were followed to 3 years after implant loading. Results: Nineteen study implants were placed according to each technique. Three years after loading, 3 patients dropped out and no implant failed. No discomfort/complications occurred at sites treated with the Cosci technique, whereas 12 patients reported discomfort during the augmentation procedure at the side treated with the Summers technique; this was statistically significant (P = 0.0005). In one of these patients, a perforation of the sinus membrane occurred. Postoperatively, headache was reported by 9 patients and swelling occurred in 3 of these patients at the Summers treated sides. Statistically significant less time (9.7 mins, SD = 4.0, P < 0.001, 95% CI -11.9 to -7.5) was required to place implants according to the Cosci technique (33 versus 24 mins on average). The 2 operators and 14 out of 15 patients preferred the Cosci technique 1 month after surgery (P = 0.001), and 1 year after surgery (13 out of 15 patients, P = 0.007). The ceramic layer of one prosthesis of the Summers' group and one abutment screw of the Cosci's group loosened between 1 to 3 years post-loading. After 3 years, implants inserted according to the Cosci technique lost 1.39 mm of peri-implant bone versus 1.54 mm for the implants placed with the Summers technique. There were no statistically significant differences for marginal bone level changes between the two groups (difference 0.15 mm, 95% CI -0.11 to 0.41, P = 0.24). Conclusions: Both crestal sinus lift techniques produced successful results over a 3-year follow-up period, but the Cosci technique required less surgical time, determined less intra- and postoperative morbidity and was preferred by patients. Conflict of interest statement: This was an investigator-initiated trial, however the trial was partially supported by Zimmer Dental Italy, Vittorio Veneto (TV), Italy. One of the authors (Dr Cosci), who treated 8 patients in this study, is the inventor of the Cosci technique and his partipation was a prerequisite of the sponsor to support the trial.
    No preview · Article · Jun 2014 · European Journal of Oral Implantology
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