Implant Tribune Italian Edition

26 Implant Tribune Italian Edition - Novembre 2012 1. Eufinger, H., König, S. & Eufinger, A. (1997) The role of alveolar ridge width in dental implantology. Clinical Oral Investigations 1: 169-177. 2. Eufinger, H., König, S., Eufinger, A. & Machtens, E.(1999) Significance of the height and width of the alveolar ridge in implantology in the edentulous maxilla. Analysis of 95 cadaver jaws and 24 consecutive patients. Mund-, Kiefer- und Gesichtschirurgie 3(Suppl 1): S14-S18. (article in german). 3. Farina, R., Pramstraller, M., Franceschetti, G., Pramstraller, C. & Trombelli, L. (2011) Alveolar ridge dimensions in maxillary posterior sextants. A retrospective comparative study of dentate and edentulous sites using computerized tomography data. Clinical Oral Implants Research 22: 1138-1144. 4. Pramstraller, M., Farina, R., Franceschetti, G., Pramstraller, C. & Trombelli, L. (2011) Ridge dimensions of the eden- tulous posterior maxilla. A retrospective analysis of a cohort of 127 using computerized tomography data. Clinical Oral Implants Research 1: 54-61. Erratum in: Clinical Oral Implants Research 2:54-61. 5. Coatoam, G.W. (1997) Indirect sinus augmentation procedures using one-stage anatomically shaped root-form im- plants. Journal of Oral Implantology 23: 25-42. 6. Bruschi, G.B., Scipioni, A., Calesini, G. & Bruschi, E. (1998) Localized management of sinus floor with simultaneous implant placement: a clinical report. The International Journal of Oral & Maxillofacial Implants 13: 219-226. 7. Deporter, D., Todescan, R. & Caudry, S. (2000) Simplifying management of the posterior maxilla using short, porous- surfaced dental implants and simultaneous indirect sinus elevation. International Journal of Periodontics and Resto- rative Dentistry 20: 476-485. 8. Tatum, H. Jr (1986) Maxillary and sinus implant reconstructions. Dental Clinics of North America 30: 207-229 9. Cosci, F. & Luccioli, M. (2000) A new sinus lift technique in conjunction with placement of 265 implants: a 6-year retrospective study. Implant Dentistry 9: 363-368. 10. Fugazzotto, P.A. (2002) Immediate implant placement following a modified trephine/osteotome approach: success rates of 116 implants to 4 years in function. International Journal of Oral and Maxillofacial Implants 17: 113-120. 11. Le Gall, M.G. (2004) Localized sinus elevation and osteocompression with single-stage tapered dental implants: technical note. The International Journal of Oral & Maxillofacial Implants 19: 431-437. 12. Soltan, M. & Smiler, D.G. (2004) Trephine bone core sinus elevation graft. Implant Dentistry 13: 148-152. 13. Chen, L. & Cha, J. (2005) An 8-year retrospective study: 1100 patients receiving 1557 implants using the minimally invasive hydraulic sinus condensing technique. Journal of Periodontology 76: 482-491. 14. Vitkov, L., Gellrich, N.C. & Hannig, M. (2005) Sinus floor elevation via hydraulic detachment and elevation of the Schneiderian membrane. Clinical Oral Implants Research 16: 615-621. 15. Pjetursson, B.E., Ignjatovic, D., Matuliene, G., Brägger, U., Schmidlin, K. & Lang, N.P. (2009) Maxillary sinus floor elevation using the osteotome technique with or without grafting material. Part II – Radiographic tissue remode- ling. Clinical Oral Implants Research 20: 677-683. 16. Trombelli, L., Minenna, P., Franceschetti, G., Farina, R. & Minenna, L. (2008) SMART-LIFT: a new minimally invasive procedure for the elevation of the maxillary sinus floor. Dental Cadmos 76: 71-83. 17. Trombelli, L., Minenna, P., Franceschetti, G., Minenna, L. & Farina, R. (2010) Transcrestal Sinus Floor Elevation with a Minimally Invasive Technique. A Case Series. Journal of Periodontology 81: 158-166. 18. Trombelli, L., Minenna, P., Franceschetti, G., Minenna, L., Itro, A. & Farina, R. (2010) A Minimally Invasive Appro- ach for Transcrestal Sinus Floor Elevation: a Case Report. Quintessence International 41: 363-369. 19. Pjetursson, B.E., Rast, C., Brägger, U., Schmidlin, K., Zwahlen, M. & Lang, N.P. (2009) Maxillary sinus floor eleva- tion using the (transalveolar) osteotome technique with or without grafting material. Part I: Implant survival and patients’ perception. Clinical Oral Implants Research 20: 667-676. 20. Trombelli L, Franceschetti G, Rizzi A, Minenna P, Minenna L, Farina R. Minimally invasive transcrestal sinus floor elevation with graft biomaterials. A randomized clinical trial. Clin Oral Implants Res. 2012 Apr;23(4):424-32. 21. Cochran D. Implant therapy I. Ann Periodontol 1996;1:707-790. 22. Frizt ME. Implant therapy II. Ann Periodontol 1996;1:796-815. 23. Tan WC, Lang NP, Zwahlen M, Pjetursson BE. A systematic review of the success of sinus floor elevation and survi- val of implants inserted in combination with sinus floor elevation. Part II: Transalveolar technique. J Clin Periodon- tol 2008;35 (Suppl. 8):241-254. 24. Reiser GM, Rabinovitz Z, Bruno J, Damoulis PD, Griffin TJ. Evaluation of maxillary sinus membrane respon- se following elevation with the crestal osteotome technique in human cadavers. Int J Oral Maxillofac Implants 2001;16:833-840. 25. Engelke W, Deckwer I. Endoscopically controlled sinus floor augmentation. A preliminary report. Clini Oral Impl Res 1997;8:527-531. 26. Nkenke E, Schlegel A, Schultze-Mosgau S, Neukam FW, Wiltfang J. The endoscopically controlled osteotome sinus floor elevation: a preliminary prospective study. Int J Oral Maxillofac Implants 2002;17:557-566. 27. Berengo M, Sivolella S, Majzoub Z, Cordioli G. Endoscopic evaluation of the bone-added osteotome sinus floor eleva- tion procedure. Int J Oral Maxillofac Surg 2004;33:189-194. 28. Jung JH, Choi BH, Zhu SJ, et al. The effects of exposing dental implants to the maxillary sinus cavity on sinus com- plications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102:602-605. 29. Galli M, Petracca T, Minozzi F, Gallottini L. Complications in implant surgery by Summers’ technique: benign paroxysmal positional vertigo (BPPV). Minerva Stomatol 2004;53:535-541. 30. Rodríguez-Gutiérrez C, Rodríguez-Gómez E. Positional vertigo after wards maxillary dental implant surgery with bone regeneration. Med Oral Patol Oral Cir Bucal 2007;12:E151-153. 31. Peñarrocha-Diago M, Rambla-Ferrer J, Perez V, Pérez-Garrigues H. Benign paroxysmal vertigo secondary to place- ment of maxillary implants using the alveolar expansion technique with osteotomes: a study of 4 cases. Int J Oral Maxillofac Implants 2008;23:129-132. References Figg. 2.h, i - An implant***, Ø 4.0 X 11.0 mm was positioned.Figg. 2.f, g - Additional biomaterial (biphasic calcium phosphate composed of hydroxyapatite (60%) and beta form of tricalcium phosphate (40%)**) was inserted into the implant site, to be grafted into the sinus. << pagina 25 In relation to the extent of vertical bone augmentation to be achieved, a cortical bone particulate or a bone substitute can be further grafted and condensed into the sinus by the osteotome. Again, the Smart Lift Ele- vator is used with the adjustable stop device at the surgical working length, thus preventing any unwanted pene- tration of the instruments into the sinus cavity. Provided that the resi- dual bone may ensure an adequate primary stability, an implant can be inserted during the same surgical session (Fig. 1.m). Otherwise, a staged approach is recommended. Clinical case report A53year-oldmale,formersmokerpa- tient presented with an edentulous lacuna in the maxillary left quadrant (Fig. 2.a). Neither systemic or local conditions contraindicating implant surgery or sinus lift procedures were identified at the screening visit. The prosthetic rehabilitation included the placement of a prosthetic crown supported by one implant, placed in the region of the left second pre- molar. The pre-operatory periapical radiograph showed a radiographic working length of 6.5 mm at location of the edentulous lacuna (Fig. 2.b). Therefore, a transcrestal sinus floor elevation was planned to allow for the placement of an implant of ade- quate length. A full-thickness flap was elevated to access the alveolar crest and the implant site in the position 2.5 was prepared using the Smart Lift techni- que. First, the Locator Drill was used to perforate the cortical bone crest at implant sites. Then, the Probe Drill was used with the 6-mm adjustable stop device. The surgical working length was assessed at 6.5 mm throu- gh tactile perception of the sinus floor using the Probe Osteotome (Fig. 2.c). A countersink was prepared by the Guide Drill, then a trephined bone core was created by the Smart Lift Drill Ø 3.2, with the stop device set at 7 mm (Fig. 2.c). The bone core created by the Smart Lift Drill (Fig. 2.e) was gently malleted upwards using the Ø 3.2 Smart Lift Elevator until the sinus floor was fractured. Additional bio- material (biphasic calcium phospha- te composed of hydroxyapatite (60%) and beta form of tricalcium phospha- te (40%)**) was grafted into the sinus (Fig. 2.f, g). Visual inspection and Val- salva manoeuvre did not reveal signs of perforation of the sinus membra- ne. One implant***, Ø 4.0 x 11.0 mm was positioned (Fig. 2.h, i, l). At 2 years following surgery, the implant was clinically stable (Fig. 2.m). On peria- pical radiographs, a radiopaque area corresponding to the augmented sinus floor was present around and above the apical portion of the distal implant (Fig. 2.n). Discussion and Conclusions The present case report illustrates a minimally-invasive procedure ai- med at sinus floor elevation with transcrestal approach for implant insertion. The rationale for this tech- nique is essentially derived from a previously described procedure whe- re the combined use of a trephine bur and osteotomes was suggested10 . Briefly, this technique implied the use of a trephine drill penetrating up to 1 mm from the sinus floor. Then, an osteotome was used to implode (by the use of a mallet) the trephined bonecoretoadepthof1mmlessthan the initial trephine cut. The hydraulic pressure exerted by the autogenous bone core determined the fracture of the sinus floor with vertical augmen- tationoftheimplantsite.Previousre- ports with such technique showed a cumulative success rate of 98.0% fol- lowing 13-48 months of follow-up10 . Although proven effective, the tech- nique proposed by Fugazzotto10 se- ems highly technique-sensitive, par- ticularly with respect to the control of the working action of both trephi- ne bur and osteotome. It may be conceivable that, during the drilling action of the trephine bur and the mallet pressure onto the osteotomes, a direct damage of the sinus mem- brane due to instrument penetration over the sinus floor can occur. Recently, a systematic review23 repor- ted an incidence of membrane per- foration ranging from 0% to 21.4%, and postoperative infection from 0% to 2.5% following transcrestal si- nus elevation procedures. In an ex- perimental evaluation of maxillary sinus membrane response following elevation with osteotome techni- que in human cadavers, membrane perforation was observed in 6 out of 25 implants (24%), the risk being increased with an increasing extent of sinus floor elevation to be obtai- ned24 . An endoscopic study revealed that the sinus floor may be elevated up to 5mm without perforating the sinus membrane25 . However, other endoscopic studies have demonstra- ted the risk of membrane perforation while performing transalveolar sinus floor elevation26 . An endoscopic eva- luation of the bone-added osteoto- me sinus floor elevation procedure revealed that the surgical approach may lead to large detachment of the membrane over a broad area exten- ding both apically and laterally to the implant tip contour. However, in 2 out of 8 analyzed patients mem- brane perforation with partial loss of the graft particles was observed27 . Whether and to what extent mem- brane perforation may compromise the implant survival is still unclear. In this respect, a preclinical study demonstrated that implants inten- tionally exposed for 4-8 mm into the sinus cavity following transcrestal sinus elevation procedures were only partially recovered by sinus muco- sa, the exposed part of the implant being recovered by debris potentially resulting in sinus infection28 . In our procedure, the working action of the rotating and manual instru- ments is restricted to the residual (native) bone. The working length is first established radiographically, but then confirmed by the combined use of the Probe Drill and Probe Oste- otome. Probe Drill is provided with a top cutting edge which can easily proceed into the cancellous bone rea- ching the proximity of the sinus flo- or. Then, the surgical working length is defined by tactile perception of the cortical bone of the sinus floor deri- ved from the gentle use of the Probe Osteotome. <> pagina 27 Letteratura internazionale original article