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S i n u s l i f t a n d M g-e H A/c o l l a g e n-b a s e d s c a f f o l d Figs. 2A–C Figs. 2D–F A D B E C F Figs. 2A–F (A) Following the limits of the sinus, a bone window was outlined along the sinus edge with a round diamond bur (2,000 rpm) under copious irrigation. (B) The sinus mucosa was elevated, taking care to avoid laceration, and RegenOss was inserted to protect the membrane during insertion of the graft material. (C) An Mg-e HA collagen- based scaffold was elevated to allow particulate graft material to fill the sinus cavity. (D) SINTlife graft material was compacted in the sinus cavity. (E) Implants were inserted. Final step of the surgery: No membrane was used. Implant insertion. (F) Final filling of the sinus cavity. increased pressure in the operated sinus. They underwent a new digital panoramic radiograph for postoperative evaluation. Clinical and surgical postoperative complications were measured. S e c o n d - s t a g e p r o c e d u r e a n d f o l l o w - u p e v a l u a t i o n Second-stage surgery to expose the implants was performed 6 months after implant place- ment. After performing a minimal crestal inci- sion just over the area corresponding to the implant, the cover screws were exposed and removed. Attached keratinized mucosa was left on both the palatal and buccal aspects around all of the implants, and healing abutments were screwed in at a torque of 10 Ncm. Clinical evaluation criteria at the time of implant exposure included stability in all direc- tions, eventual crestal bone resorption, and any reported pain or discomfort. One week later, after impression taking using pickup coping transfers, titanium abutments were screwed in at a torque of 32 Ncm. In the same procedure, an additional impression of the screwed-in abut- ment was taken using the metallic structure. The provisional restoration was seated. In order to allow better distribution of the occlusal forces, splinted crowns were used. Implants inserted in residual neighboring bone without augmentation were not splinted to the ones inserted in augmented bone. One week later, definitive crowns were cemented using a provi- sional cement (Temp-Bond, Kerr, Orange, Calif., U.S.) Twelve months after prosthetic loading, a digital panoramic radiograph was obtained to assess the newly formed bone and its interface with the implant (Fig. 3). I m p l a n t s t a b i l i t y m e a s u r e m e n t s Immediately after implant insertion (baseline, T0), resonance frequency analysis (RFA; Osstell Mentor, Osstell, Gothenburg, Sweden) for each implant was carried out and the values were used as baseline. The transducer was hand- screwed into the implant body as recommended by manufacturer. The RFA value is represented by a quantitative parameter called ISQ (Implant Stability Quotient). The ISQ ranges between 1 and 100. The measurements were repeated for each implant after 6 (T1) and 12 months after prosthetic loading (T2). Each measurement was taken twice buccolingually and the mean value was used. Because each transducer had a unique fundamental RF, the measurements were cali- brated using a calibration block. All stable implants were considered successful. C o m p l i c a t i o n s Any technical (implant fracture, screw loosen- ing, etc.) and/or biological (pain, swelling, sup- puration, etc.) complications were considered. R a d i o g r a p h i c e v a l u a t i o n The grafted area was evaluated with a comput- erized measuring technique applied to the digital panoramic radiographs (preoperative and 12-month follow-up). In each case, the surface of grafted sinus was marked with a virtual mark- ing instrument. An image analysis software pro- gram (AutoCAD 2006, Version Z 54.10, Autodesk) calculated the total (native + grafted) bone height changes at the level of the implant site, comparing preoperative and follow-up Journal of Oral Science & Rehabilitation Volume 4 | Issue 1/2018 11