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ePaper created 2015-11-17, 15:11:47 | version 1.38.0
Volume 1 | Issue 1/2015 71Journal of Oral Science & Rehabilitation S uc c es s o f i mplants place d af te r di re ct si nu s li f t Materials&methods The studywas approved bythe University ofVa- lencia ethics committee (#H1410262226693). All patients gave written informed consent be- foresurgery,inaccordancewiththeprinciplesof theDeclarationofHelsinki. St ud y s a m ple A retrospective clinical study was performed between September 2009 and June 2012 of patients treated with dental implants placed in one-stage (simultaneous) and two-stage (de- layed) direct sinus lift procedures. A minimum follow-up period of 12 months after implant loading was requested. Patients who failed to attend scheduled follow-up visits were ex- cluded. Surgi c a l proc ed ures All of the procedures were performed by two expertsurgeons,professorsattheOralSurgery Unit, Department of Stomatology, University ofValencia, under local anesthesia with 4% ar- ticaine and 1:100,000 epinephrine (Laborato- rios Inibsa, Lliçà de Vall, Spain). Full-thickness flaps were raised. Awindow in the sinus lateral wall was made with round tungsten carbide burs and finalized with ultrasonic tips. The sinus membrane was detached with curettes and elevated using a bone graft material. A xenograft (Geistlich Bio-Oss, Geistlich Pharma, Wolhusen, Switzerland) was used as the only bone graft material (1.5–2 g). The sinus window was covered with a resorbable membrane (Geistlich Bio-Gide, Geistlich Pharma, Wolhusen, Switzerland). The im- plants used in this study were TSA implants with anAvantblast surface (Phibo Dental Solu- tions,Sentmenat,Spain).Implantswereplaced in the same surgery if the residual bone height was 4–6 mm, or delayed by six months if the height was < 4 mm. Allofthepatientswereprescribedthesame postoperative medication: amoxicillin and clavulanic acid (Augmentin, GlaxoSmithKline, Madrid, Spain) 500 mg/8 h for seven days, ibuprofen (Bexistar, Laboratorio Barcino, Barcelona, Spain) 600 mg/8 h for three days, and a 0.12% chlorhexidine mouthrinse (GUM, Sunstar Americas, Chicago, Ill., U.S.) t.i.d. for seven days. Data co lle cti o n Patient oral hygiene was evaluated using the SimplifiedOralHygieneIndex(OHI-S).24 Thiswas obtainedbymeasuringthepresenceofdebrisand calculus on the buccal surfaces of the maxillary right central incisor, mandibular left central inci- sorandmaxillaryfirstmolars,aswellasonthelin- gual surfaces ofthe mandibularfirst molars. The criteria for classifying debris were as follows: no debris,nostains(0);softdebriscoveringlessthan one-thirdofthetoothsurface(1);softdebriscov- ering more than one-third, but less than two- thirds of the exposed tooth surface (2); and soft debris covering more than two-thirds of the ex- posed tooth surface (3). The criteria for classify- ing calculus were as follows: no calculus (0); supragingival calculus covering less than one- thirdoftheexposedtoothsurface(1);supragingi- val calculus covering more than one-third, but lessthantwo-thirdsoftheexposedtoothsurface (2); and supragingival calculus covering more thantwo-thirds ofthe exposedtooth surface (3). TheOHI-Swasobtainedfromthecombinationof the two subindices. The grading scale was 0–1.2 (good oral hygiene), 1.3–3 (regular oral hygiene), or 3.1–6 (poor oral hygiene). Each patient was classified as having good oral hygiene, regular oralhygieneorpoororalhygiene. The implant success rate was recorded ac- cording to the clinical and radiographic criteria of Buseretal.25 Implantswereclassifiedassuccess- fuliftheyfulfilledallofthecriteria(absenceofclin- icallydetectableimplantmobility,absenceofpain or any subjective sensation, absence of recurrent periimplant infection, and absence of continuous radiolucency around the implant after 12 months of loading) and as failed if any criterion was not met. Radiographic examination was performed with an X-Mind intra-oral system (ACTEON MÉDICO-DENTAL IBÉRICA, Sentmenat, Spain) and an RVG intra-oraldigitalreceptor(RVG 5100, Carestream Dental, Atlanta, Ga., U.S.). In order to reproduce the patient alignments, the Rinn XCP system (DENTSPLY, Des Plaines, Ill., U.S.) was usedwithabiteregistrationmaterialintheareain whichthe parallelometerwasfixed. Marginalim- plantbonelosswasmeasuredinmillimetersusing the RVG software. For measurement purposes, two visible and easily locatable reference points were selected at the junction point between the implant and prosthetic restoration.Astraight line was traced between these two reference points