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Maxillary sinus lift without grafting


Authors:

Kyung Jin Kim, DDS – Resident, OMFS

Abstract:

Purpose of the Study: The maxillary sinus lift procedure combined with bone graft has been used to allow for proper implant placement in the atrophic maxillary posterior region. However, the risk of complications such as infection may increase due to the complexity and extended length of the procedure. The graft-free maxillary sinus lift technique is less susceptible to such risks as it is a simpler operation. The purpose of this study is to evaluate the tenting effect of implants by analyzing the degree of bone formation around implants placed after maxillary sinus lift without grafting

Methods: A total of 49 implants were placed in 26 patients(11 women and 15 men). Maxillary sinus lift without grafting was done at all sites and implants were placed simultaneously. Panorama and CBCT were taken preoperatively and at 6 months postoperatively. Radiographs were used to evaluate the height of the residual bone, the width of the sinus as well as the presence of lesion within, the amount of bone formation, and the location of adjacent teeth.

Results: A total of 49 implants were placed. No patients developed sinusitis or infection, but 3 implants were removed. The remaining 46 implants is healed well, neither infection nor implant mobility was observed on initiation of loading force from the prosthetic components. Implant survival rate was 93.5%. The gained bone morphology showed three types: tent type, flat type and dehiscence type. Most cases (total 35) showed tent type. The five cases of dehiscence-type were excluded from bone height measurement because it was difficult to determine the bone height. The residual bone height ranged from 2.4 to 9.2 mm, with an average height of 6.5 mm. Implant fixture length measured between 10 to 13mm with an average of 11.1mm. Total bone height ranged from 10 to 13.2 mm, with an average height of 11.2 mm. The range of increased bone height ranged from 2.2 ~ 7.6mm, with and average of 4.7mm. Pearson correlation showed that maxillary sinus width, and increased bone height were not statistically significant and only the amount of residual bone height and increased bone height were significant. In the case of residual bone height of 5mm or less, the increased bone height was about 2mm higher than that of 5mm or more. However, it does not mean that the smaller residual bone has the better osteogenesis capacity. In other words, if the maxillary sinus was lifted without grafting, the increased bone is formed only to the length of the implant fixture.

Conclusion: (1)Sinus lift without graft materials is an effective surgical options for pneumatized Mx. posterior area, but at least 3mm residual bone is needed for implant success. (2)The gained bone morphology is most likely to show tent type and to exist just at the same level to the fixture apex. (3) Mx. sinus width and adjacent teeth do not affect the amount of new bone formation. Only the fixture length is significant.

Articles: Kumar DS. Effect of maxillary sinus floor augmentation without bone grafts. J Pharm Bioallied Sci. 2013; 176–183

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