Special Issue "Clinical and Histological Healing after Maxillary Sinus Floor Elevation"

A special issue of Dentistry Journal (ISSN 2304-6767).

Deadline for manuscript submissions: closed (31 January 2022) | Viewed by 8778

Special Issue Editors

Dr. Daniele Botticelli
E-Mail Website
Guest Editor
ARDEC Academy, Viale Giovanni Pascoli 67, 47923 Rimini, Italy
Interests: dentistry; implantology; bone volume augmentation
Prof. Dr. Samuel Porfirio Xavier
E-Mail Website
Guest Editor
Department of Oral & Maxillofacial Surgery and Periodontology, University of Sao Paulo, Faculty of Dentistry FORP-USP, Ribeirao Preto, Brazil
Interests: oral and maxillifacial surgery; implantology; bone volume augmentation
Dr. Yasushi Nakajima
E-Mail Website
Guest Editor
Department of Oral Implantology, Osaka Dental University, Osaka, Japan
Interests: dentistry; implantology; bone volume augmentation

Special Issue Information

Dear Colleagues,

It is a pleasure to invite you to submit manuscripts to the forthcoming Special Issue “Clinical and Histological Healing after Maxillary Sinus Floor Elevation” that will be published in Dentistry Journal. A huge number of articles and reviews show the high success rate of implants installed in an elevated sinus floor. However, some aspects still need to be clarified.

Several topics might be suitable for the present Special Issue, including the clinical and histological healing of the various biomaterials used as filler and of the sinus mucosa. The histological healing of implants installed in sinuses elevated with or without biomaterials might also be of great interest. Variables applied in the surgical protocols should be clinically and histologically investigated, such as the influence on the healing of the placement of a collagen membrane to cover the antrostomy or placed subjacent the sinus mucosa. The histological modifications and possible perforations of the sinus mucosa in contact with implants and biomaterials particles should also be explored, as should the influence of the sinus mucosa on bone formation. Clinical studies evaluating cone-beam computed tomography images taken before sinus floor augmentation and after different periods of healing might provide interesting data. Among the possible evaluations, very interesting are those related to the corticalization of the new sinus floor and the closure of the antrostomy. Moreover, the correlations between the radiographic outcomes and the anatomical conditions of the sinus before the surgery might provide useful information for the clinicians.

Dr. Daniele Botticelli
Prof. Dr. Samuel Porfirio Xavier
Dr. Yasushi Nakajima
Guest Editors

Manuscript Submission Information

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Keywords

  • bone healing
  • collagen membrane
  • resorbable material
  • sinus floor elevation
  • sinus augmentation
  • sinus dimension
  • sinus height
  • cone-beam tomography
  • xenograft

Published Papers (9 papers)

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Research

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Article
Sinus Mucosa Thinning and Perforations after Sinus Lifting Performed with Different Xenografts: A Histological Analysis in Rabbits
Dent. J. 2022, 10(1), 2; https://0-doi-org.brum.beds.ac.uk/10.3390/dj10010002 - 28 Dec 2021
Cited by 1 | Viewed by 654
Abstract
Background: Experimental studies have shown a progressive thinning and perforations of the sinus mucosa associated with sharpened edges and the cutting projections of graft particles used simultaneously for maxillary sinus augmentation. Hence, the aim of the present study was to evaluate the damaging [...] Read more.
Background: Experimental studies have shown a progressive thinning and perforations of the sinus mucosa associated with sharpened edges and the cutting projections of graft particles used simultaneously for maxillary sinus augmentation. Hence, the aim of the present study was to evaluate the damaging effects of two different bovine grafts on the sinus mucosa after sinus augmentation. Methods: Twenty New Zealand rabbits received a bilateral sinus lifting using, as fillers, two different types of deproteinized bovine bone in granules, one processed at low temperature (low-T group), and the other at high temperature (high-T group). Thinned mucosa sites (<40 µm) and perforations were evaluated in the sinus mucosa that were in contact with graft granules after 2 and 10 weeks, in ten animals per period. Results: After 2 weeks of healing, the number of thinned mucosa sites was 118 in the low-T group, and 149 in the high-T group (p = 0.191). At the 10-week assessment, the thinned sites increased to 237 and 195 sites, respectively. The numbers of sinus mucosa perforations after 2 weeks were eight and three in the low-T and high-T group, respectively. At the 10-week evaluation, the perforations increased to 19 in the low-T group, and to 14 in the high-T group. Conclusions: The contact with bovine xenografts yielded thinning and perforations of the sinus mucosa. Despite the differences in characteristics and dimensions, no differences were found between the two xenografts in the numbers of thinning mucosa sites and perforations. However, a trend of more events was found in the low-T compared to the high-T group. Full article
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Article
Influence of the Use of a Collagen Membrane Placed on the Bone Window after Sinus Floor Augmentation—An Experimental Study in Rabbits
Dent. J. 2021, 9(11), 131; https://0-doi-org.brum.beds.ac.uk/10.3390/dj9110131 - 12 Nov 2021
Cited by 1 | Viewed by 786
Abstract
Background: We studied the influence on healing of a resorbable membrane covering the osteotomy site after maxillary sinus grafting, evaluated in different regions of the augmented area. Methods: Maxillary sinus augmentation was performed in 24 New Zealand rabbits. Osteotomy, 4 × 6 mm, [...] Read more.
Background: We studied the influence on healing of a resorbable membrane covering the osteotomy site after maxillary sinus grafting, evaluated in different regions of the augmented area. Methods: Maxillary sinus augmentation was performed in 24 New Zealand rabbits. Osteotomy, 4 × 6 mm, were performed bilaterally. A collagenated cortico-cancellous porcine bone was used to fill the elevated region. A collagen membrane was randomly placed over the osteotomy site on one side (MG), and the other side was left uncovered (NMG). The animals were euthanized after 2, 4, and 8 weeks; and histomorphometric analysis was performed in eight different regions. Results: New bone percentages were similar in both groups. There were no statistically significant differences. In MG, the overall percentages were 15.6 ± 7.3%, 22.9 ± 6.1%, and 24.9 ± 12.0% after 2, 4, and 8 weeks, respectively. In NMG, the percentages were 11.2 ± 4.5%, 24.1 ± 5.7%, and 24.5 ± 15.7%, respectively. The proportions of new bone in the various regions after 8 weeks were 31 ± 8.9% and 29.9 ± 9.1% in the bone walls region, 25 ± 10.1% and 32.8 ± 9.1% in the submucosa region, 22.6 ± 21.6% and 10.9 ± 11.5 in the middle region, 17.3 ± 14% and 13.4 ± 9.8% in the close-to-window region, and 21.8 ± 11.6%, 19.1 ± 6.4% in the osteotomy region—for MG and NMG, respectively. Conclusions: In both groups the greatest amounts of bone formation occurred near to the pre-existing bone walls, followed by the sub-mucosa region. The smallest amounts were found in the close-to-window region, followed by the central region. The placement of a collagen membrane to cover the osteotomy site did not influence the amount of new bone formation after sinus grafting. Full article
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Article
A Reliable Surgical Procedure for Sinus Floor Augmentation with Antral Pseudocysts
Dent. J. 2021, 9(10), 122; https://0-doi-org.brum.beds.ac.uk/10.3390/dj9100122 - 18 Oct 2021
Cited by 1 | Viewed by 743
Abstract
An antral pseudocyst (AP) is a common well-defined ‘dome-shaped’ faintly radiopaque lesion of the maxillary sinus, and usually does not require treatment in asymptomatic patients. However, when sinus floor augmentation is required to increase bone volume for implant installation, the elevation of the [...] Read more.
An antral pseudocyst (AP) is a common well-defined ‘dome-shaped’ faintly radiopaque lesion of the maxillary sinus, and usually does not require treatment in asymptomatic patients. However, when sinus floor augmentation is required to increase bone volume for implant installation, the elevation of the sinus mucosa might drive the AP against the ostium. This might cause its obstruction and, as possible consequence, sinusitis. The purpose of this study was to investigate the clinical and tomographic conditions of APs to identify a predictable cyst removal that might allow a safety sinus floor augmentation. A total of 52 maxillary sinuses in 46 patients (mean age 55.1 years) presenting AP were examined by cone beam computed tomographies (CBCTs). A two-stage approach was applied. At the first surgery, the cystic lesions were further inspected by an endoscope through the antrostomy, and histopathological diagnosis of the removed tissues was carried out. After the confirmation of decrease of the swelling of sinus membrane by CBCT, the sinus floor augmentation was performed, at least four months after cyst removal. The color and transparency of the 86 cystic lesions were classified into 4 types. The whitish transparent cysts were 34 (39.5%), the yellowish transparent cysts were 18 (20.9%), the dark purple transparent cysts were 8 (9.3%) and the milky-white opaque cysts were 26 (30.2%). The contents of the 60 (69.8%) transparent cysts were serous fluid, but those of milky-white cysts were composed of viscous or elastic soft tissues, and the aspiration of the contents was unsuccessful. The analysis of the preoperative CBCT did not provide certainty on the contents of the cystic lesions. All cystic lesions were diagnosed as AP, and an infection was identified in one AP, presenting marked infiltration of the inflammatory cells. Considering the difficulties of performing a correct diagnosis of the AP content by a CBCT analysis, the risk of failure of the surgery that creates severe afflictions to the patients, and the necessity of a histological evaluation of the cyst, a two-stage surgery appeared to be the most reliable procedure. Full article
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Article
Argon Bioactivation of Implants Installed Simultaneously to Maxillary Sinus Lifting without Graft. An Experimental Study in Rabbits
Dent. J. 2021, 9(9), 105; https://0-doi-org.brum.beds.ac.uk/10.3390/dj9090105 - 06 Sep 2021
Cited by 2 | Viewed by 813
Abstract
Background: The treatment of the surface of titanium implants with argon plasma improved its hydrophilicity and cell adhesion, resulting in higher bone apposition on implant and graft surfaces. The spontaneous perforation over time of the sinus mucosa after sinus augmentation has been documented [...] Read more.
Background: The treatment of the surface of titanium implants with argon plasma improved its hydrophilicity and cell adhesion, resulting in higher bone apposition on implant and graft surfaces. The spontaneous perforation over time of the sinus mucosa after sinus augmentation has been documented in experimental studies at both implants and graft particles. The aim of the present study was to evaluate the influence of plasma argon treatment of the implant surface on bone apposition and on the rate of sinus mucosa perforations. Methods: A sinus lifting procedure was performed bilaterally in sixteen rabbits, and implants, either treated with argon plasma or left without treatment (control), were placed simultaneously without grafts. After 8 weeks, histological analyses were carried out. Results: A collapse of the sinus mucosa was observed at all implants. Twenty-four out of thirty-two implants presented sinus mucosa perforations at the apex. Several perforations were also found at the threads. Thinned mucosa sites (width < 40 µm) were found around almost all implants. About 2.6–2.9 mm of the apical regions of the implant did not present signs of osseointegration and about 1.3 mm were exposed to the sinus cavity. No statistically significant differences were found between plasma and control sites. Conclusions: In conclusion, the sinus mucosa was damaged and perforated by direct contact with treated and non-treated implant surfaces. The treatment of the implant surface with argon plasma did not affect the outcomes. Full article
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Article
Sinus Mucosa Thickness Changes and Ostium Involvement after Maxillary Sinus Floor Elevation in Sinus with Septa. A Cone Beam Computed Tomography Study
Dent. J. 2021, 9(8), 82; https://0-doi-org.brum.beds.ac.uk/10.3390/dj9080082 - 21 Jul 2021
Cited by 2 | Viewed by 1205
Abstract
Background: A thickening of the sinus mucosa is observed after sinus floor augmentation. The objective of this retrospective study was to evaluate the influence of the presence of septa in the dimensional variation and ostium involvement over time of the Schneiderian mucosa after [...] Read more.
Background: A thickening of the sinus mucosa is observed after sinus floor augmentation. The objective of this retrospective study was to evaluate the influence of the presence of septa in the dimensional variation and ostium involvement over time of the Schneiderian mucosa after sinus floor augmentation. Materials and Methods: Fifteen sinuses with septa (septa group) and 15 without (control group) were selected. CBCTs taken before surgery, and were analyzed after 1 week and after 9 months. Schneiderian membrane thickness changes over time and involvement of the ostium were evaluated. Results: Four perforations occurred in the septa group and none in the control group. After 1 week of healing, the sinus mucosa thickness increased in height by 5.7 mm and 7.1 mm in the septa and control groups, respectively. In this period, the patency of the ostium decreased in both groups, and three infundibula were obstructed in the septa group, and five in the control group. The mucosa was thicker and the edema was closer to the ostium in the control compared to in the septa group. After 9 months of healing, the dimensions regressed to normal pattern and no obstruction of the infundibula were observed. No statistically significant differences were found between septa and control groups. Conclusions: after one week of healing, the sinus mucosa increased in dimensions in both septa and control groups. However, the sinus mucosa presented a tendency of being thicker and closer to the ostium, resulting in a higher number of infundibula obstructions, in the control group compared to in the septa group. After 9 months, the sinus mucosa regressed to normal dimensions and no obstructions of the infundibula were observed in any group. Full article
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Article
Influence of Anatomical Parameters on the Dimensions of the Subantral Space and Sinus Mucosa Thickening after Sinus Floor Elevation. A Retrospective Cone Beam Computed Tomography Study
Dent. J. 2021, 9(7), 76; https://0-doi-org.brum.beds.ac.uk/10.3390/dj9070076 - 24 Jun 2021
Cited by 2 | Viewed by 1079
Abstract
Background: Various anatomical parameters might influence the surgical approach for maxillary sinus floor elevation. The objective of the present study was to retrospectively evaluate the influence of anatomical parameters on the dimensions of the subantral space and of the sinus mucosa thickening after [...] Read more.
Background: Various anatomical parameters might influence the surgical approach for maxillary sinus floor elevation. The objective of the present study was to retrospectively evaluate the influence of anatomical parameters on the dimensions of the subantral space and of the sinus mucosa thickening after sinus floor elevation. Material and Methods: Seventy-eight maxillary sinuses in sixty-five patients were evaluated on cone beam computed tomographies taken before surgery and after one week (t1w) and nine months (t9m). Several parameters such as the distance XF between an axis parallel to the base of the nose (X-axes) and the sinus floor (F) were correlated with the height gain (IF) at t1w and t9m and the post-surgical edema. Results: A weak significant positive correlation was observed between height gain vs. sinus height of interest (XF), the balcony, and the sinus floor angle. The post-surgical edema was influenced by the initial mucosa thickness and the xenograft used. Conclusions: Various parameters might affect height gain and sinus mucosa thickening after sinus floor elevation. The height of interest, the balcony, and the sinus floor angle showed significant correlations with height gain. The initial thickness of the mucosa and the biomaterial used influenced the post-surgical edema. Full article
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Article
Maxillary Sinus Augmentation Using Ceramic Alloplastic Granules or Paste: An Experimental Study in Rabbits
Dent. J. 2021, 9(6), 65; https://0-doi-org.brum.beds.ac.uk/10.3390/dj9060065 - 03 Jun 2021
Cited by 1 | Viewed by 905
Abstract
Background: Due to the lack of data comparing the biological behavior of two formulations, granules and paste, of alloplastic graft from microtomographic and histomorphometric points of view, the aim of the present experiment was to compare the histomorphometric and microtomographic healing of two [...] Read more.
Background: Due to the lack of data comparing the biological behavior of two formulations, granules and paste, of alloplastic graft from microtomographic and histomorphometric points of view, the aim of the present experiment was to compare the histomorphometric and microtomographic healing of two formulations, i.e., granules (MR sites) or paste (MR-inject sites) of an alloplastic graft composed of a combination of beta-tricalcium phosphate and hydroxyapatite used for maxillary sinus lifting. Methods: A sinus lifting procedure was carried out bilaterally in 20 rabbits, and the elevated space was filled with either paste or granules of an alloplastic material. A collagen membrane was placed on the antrostomy and the animals were euthanized after 2 or 10 weeks, 10 animals each group. Microtomographic and histological analyses were performed. Results: Higher proportions of new bone formation were found at the MR, compared to the MR-inject sites both after 2 weeks (2.65 ± 2.89% vs. 0.08 ± 0.12%; p < 0.01) and 10 weeks of healing (34.20 ± 13.86 vs. 23.28 ± 10.35%; p = 0.022). Conclusions: It was concluded that new bone formation was faster in the MR sites, compared to the MR-inject. However, a longer time of healing should be allowed to make final conclusions about the efficiency in bone formation of the paste formulation of the biomaterial used in the present study. Full article
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Article
Osteoconductivity of Bovine Xenograft Granules of Different Sizes in Sinus Lift: A Histomorphometric Study in Rabbits
Dent. J. 2021, 9(6), 61; https://0-doi-org.brum.beds.ac.uk/10.3390/dj9060061 - 31 May 2021
Viewed by 1134
Abstract
Background: Due to the lack of data on bone-to-graft contact (BGC) over time in the various regions within the subantral space of the augmented sinus floor, the present study aimed to evaluate the osteoconductivity of deproteinized bovine bone mineral (DBBM) with granules of [...] Read more.
Background: Due to the lack of data on bone-to-graft contact (BGC) over time in the various regions within the subantral space of the augmented sinus floor, the present study aimed to evaluate the osteoconductivity of deproteinized bovine bone mineral (DBBM) with granules of different sizes applied in maxillary sinus floor elevation. Methods: A maxillary sinus augmentation was performed bilaterally in 18 rabbits using DBBM with particle dimensions of either 0.125–1.0 mm or 1–2 mm. The antrostomy was covered using a collagen barrier. The animals were euthanized in groups of six after 2, 4, and 8 weeks of healing. MicroCT and histological analyses were performed. Results: After 2 weeks of healing, BGC was 10.9% and 11.9% for the small and large granule sites, respectively. After 8 weeks of healing, the BGC increased to 65% and 62% at the small and large granule sites, respectively. The highest values were located close to the bony walls and the bony window. New bone content developed between 2 and 8 weeks from 7.0% to 27.6% and from 6.1% to 27.6% at the small and large granule sites, respectively. Conclusions: Similar outcomes in osteoconductivity and bone formation were found at both small and large DBBM granule sites. Full article
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Systematic Review
Temporal and Permanent Changes Induced by Maxillary Sinus Lifting with Bone Grafts and Maxillary Functional Endoscopic Sinus Surgery in the Voice Characteristics—Systematic Review
Dent. J. 2022, 10(3), 47; https://0-doi-org.brum.beds.ac.uk/10.3390/dj10030047 - 11 Mar 2022
Viewed by 728
Abstract
Sinus surgery procedures such as sinus lifting with bone grafting or maxillary functional endoscopy surgery (FESS) can present different complications. The aims of this systematic review are to compile the post-operatory complications of sinus elevation with bone grafting and FESS including voice changes, [...] Read more.
Sinus surgery procedures such as sinus lifting with bone grafting or maxillary functional endoscopy surgery (FESS) can present different complications. The aims of this systematic review are to compile the post-operatory complications of sinus elevation with bone grafting and FESS including voice changes, and to elucidate if those changes are either permanent or temporary. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used, and the literature was exhaustively searched without time restrictions for randomized and non-randomized clinical studies, cohort studies (prospective and retrospective), and clinical case reports with ≥4 cases focused on sinus lift procedures with bone grafts and functional endoscopic maxillary sinus surgery. A total of 435 manuscripts were identified. After reading the abstracts, 101 articles were selected to be read in full. Twenty articles that fulfilled the inclusion criteria were included for analysis. Within the limitations of this systematic review, complications are frequent after sinus lifting with bone grafts and after FEES. Voice parameters are scarcely evaluated after sinus lifting with bone grafts and no voice changes are reported. The voice changes that occur after FESS include a decreased fundamental frequency, increased nasality, and nasalance, all of which are transitory. Full article
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