This study evaluated the success of a crestal approach sinus lift procedure combined with immediate implant placement in patients with varying amounts of residual alveolar bone (RAB). 102 patients received 109 implants across three clinical sites. Patients were divided into two groups based on RAB height: group 1 had 24 mm RAB and group 2 had >4 mm RAB. The success rate was 100% for group 1 and 98.5% for group 2 after 6-100 months. Both groups experienced minimal crestal bone loss on average (0.55 mm for group 1 and 0.07 mm for group 2) with no significant difference between groups. The study concludes the crestal approach is a viable technique for patients with as little as
Sinus Lift and Immediate Implant PlacementDental Evo
Sinus Lift and Immediate Implant Placement, using LAS kit and TS3 implants.
Presentation by Dr Nicola Baldini DDS
http://www.dentalevo.it/dentistry-materials/sinus-lift-big-buccal-window/
http://www.dentalevo.it/dentistry-materials/sinus-lift-small-buccal-window/
Modified osteotome sinus floor elevation by using combination PRF membrane, b...Dr. Anuj S Parihar
The osteotome technique is more predictable with simultaneous implant placement when there is less than 5 to 7 mm of pre-existing alveolar bone height beneath sinus. Proper combination of PRF membrane, MFDBA and autogenous bone has been recommended for this situation. The purpose of this article is to describe the proper method and materials which can grow more than 10 mm bone with osteotome technique and grafting materials where the edentulous posterior maxilla radiographically showed less bone between the alveolar crest and sinus floor.
“Perio-Implant surgery: Expanding the Horizons”- Three lectures on “Sinus lifts- Alternative techniques and Strategies”, “Preparing PRF- What to do, what not to do” and “When not to use regenerative materials” organized by the Society of Periodontists and Implantologists of Kerala” at Kochi, India on 24/07/2016.
“Sinus lifts- Alternative techniques and Strategies” and “When not to use regenerative materials”- Guest lecture as a part of Dr NTRUHS Zonal CDE programme in G Pulla Reddy Dental College and Hospital, Kurnool, India on 07/10/2016.
Sinus lift with dental implants Placement.(with Clinical Photographs) Dr. ...All Good Things
Hi. This is Dr. Amit T. Suryawanshi. Oral & Maxillofacial surgeon from Pune, India. I am here on slideshare.com to share some of my own presentations presented at various levels in the field of OMFS. Hope this would somehow be helpful to you making your presentations. All the best & your replies are welcomed!
Sinus Lift and Immediate Implant PlacementDental Evo
Sinus Lift and Immediate Implant Placement, using LAS kit and TS3 implants.
Presentation by Dr Nicola Baldini DDS
http://www.dentalevo.it/dentistry-materials/sinus-lift-big-buccal-window/
http://www.dentalevo.it/dentistry-materials/sinus-lift-small-buccal-window/
Modified osteotome sinus floor elevation by using combination PRF membrane, b...Dr. Anuj S Parihar
The osteotome technique is more predictable with simultaneous implant placement when there is less than 5 to 7 mm of pre-existing alveolar bone height beneath sinus. Proper combination of PRF membrane, MFDBA and autogenous bone has been recommended for this situation. The purpose of this article is to describe the proper method and materials which can grow more than 10 mm bone with osteotome technique and grafting materials where the edentulous posterior maxilla radiographically showed less bone between the alveolar crest and sinus floor.
“Perio-Implant surgery: Expanding the Horizons”- Three lectures on “Sinus lifts- Alternative techniques and Strategies”, “Preparing PRF- What to do, what not to do” and “When not to use regenerative materials” organized by the Society of Periodontists and Implantologists of Kerala” at Kochi, India on 24/07/2016.
“Sinus lifts- Alternative techniques and Strategies” and “When not to use regenerative materials”- Guest lecture as a part of Dr NTRUHS Zonal CDE programme in G Pulla Reddy Dental College and Hospital, Kurnool, India on 07/10/2016.
Sinus lift with dental implants Placement.(with Clinical Photographs) Dr. ...All Good Things
Hi. This is Dr. Amit T. Suryawanshi. Oral & Maxillofacial surgeon from Pune, India. I am here on slideshare.com to share some of my own presentations presented at various levels in the field of OMFS. Hope this would somehow be helpful to you making your presentations. All the best & your replies are welcomed!
Maxillary ridge augmentation is a common procedure nowadays, This presentation is about the direct and indirect procedures for maxillary sinus lift for implant placement. with recent advancement in the procedures.
Indirect Sinus Lift
A sinus lift procedure is essentially done to increase bone height and density in the posterior maxilla.
Extremely effective in increasing bone height. for more details visit our website https://www.implantdentistindia.com/i...
Direct Sinus Lift
The direct sinus lift or the lateral window sinus elevation is a widely used technique when resorption of the alveolar bone which leads to insufficient bone height (No bone to place implant). for more details please visit https://www.implantdentistindia.com/d...
We will assure you of the best treatment in this area.
Experienced Implantologist -Dr. Sudhakar Reddy, a Maxillofacial surgeon by specialization has vast experience with such a surgical procedures and can make this surgery very simple.
Book an appointment now
Implant surgeries to overcome anatomic difficulties ii / dental implant cour...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Sinus lift procedure: the maxillary sinus elevation and the bone augmentation procedure is technique sensitive, requiring meticulous surgical skills and expertise.
Connect with me @ https://in.linkedin.com/in/drmaggitom
Maxillary ridge augmentation is a common procedure nowadays, This presentation is about the direct and indirect procedures for maxillary sinus lift for implant placement. with recent advancement in the procedures.
Indirect Sinus Lift
A sinus lift procedure is essentially done to increase bone height and density in the posterior maxilla.
Extremely effective in increasing bone height. for more details visit our website https://www.implantdentistindia.com/i...
Direct Sinus Lift
The direct sinus lift or the lateral window sinus elevation is a widely used technique when resorption of the alveolar bone which leads to insufficient bone height (No bone to place implant). for more details please visit https://www.implantdentistindia.com/d...
We will assure you of the best treatment in this area.
Experienced Implantologist -Dr. Sudhakar Reddy, a Maxillofacial surgeon by specialization has vast experience with such a surgical procedures and can make this surgery very simple.
Book an appointment now
Implant surgeries to overcome anatomic difficulties ii / dental implant cour...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Sinus lift procedure: the maxillary sinus elevation and the bone augmentation procedure is technique sensitive, requiring meticulous surgical skills and expertise.
Connect with me @ https://in.linkedin.com/in/drmaggitom
omfs journal club ppt on bone ridge augmentationAkhil Sankar
This is a journal club to start with for new omfs pgs . This is correctly criticized and cross-checked ppt. Also, it is a relevant topic in day to day preactise
An Evaluation of Short Term Success and Survival Rate of Implants Placed in F...DrHeena tiwari
An Evaluation of Short Term Success and Survival Rate of Implants Placed in Fresh Extraction Socket Post Prosthetic Rehabilitation- A Prospective Study
Ghar pe hi alg se baat kr rha hu or not want a new one is a good time with my new favorite song is the best friend is a good day for you to everyone who was a great day of I was a great day of I don't know how to get a chance to get a free to go to go to go to the world to me hasnt as I don't think so I can see it on might be in the middle of the day
A simplified technique of esophageal self-expandable metallic stent placement...Peachy Essay
The advantages of the simplified technique are as follows: technical ease, cost-effectiveness, no exposure to radiation,
requirement of minimal manpower, and less time-consuming; these advantages make it the technique day-care procedure.
Effects of rapid palatal expansion on the sagittal and vertical dimensions of...EdwardHAngle
The purpose of this study was to use cone-beam computed tomography imaging to examine the skeletal and dental changes in the sagittal and vertical dimensions after rapid palatal expansion.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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2. formed internally, maintaining a layer of cortical bone at
the crest of the alveolar ridge.2
The lateral antrostomy and the crestal approach are
commonly used techniques for augmentation of the max-
illary sinus. The lateral antrostomy involves the elevation
of the schneiderian membrane through preparation of
a window in the lateral wall of the maxillary sinus.3
The
crestal approach involves utilizing tapered osteotomes
with increasing diameters for creating an osteotomy for
the selected implant. By gently tapping the osteotome in a
vertical direction, the floor of the maxillary sinus is frac-
tured and the membrane is simultaneously lifted.4
Both
techniques allow the space beneath the membrane to be
grafted using several different materials.
The more conservative crestal approach has several
advantages over the lateral antrostomy, which include
reduction of operation time, trauma, and postopera-
tive morbidity.5
Historically, the use of this technique
was limited to patients with at least 5 mm of residual
alveolar bone (RAB).6,7
In light of the numerous benefits
bestowed to the patient with the use of the crestal
approach, there is a great interest in expanding its appli-
cability. This study was performed to provide evidence
in support of the use of crestal approach with simulta-
neous implant placement in patients with residual bone
height of 2 to 4 mm.
MATERIALS AND METHODS
Patients
The study was approved by the University of Southern
California Institutional Review Board (UP-09–00081).
A total of one hundred two patients, 53 males and 49
females, ranging from 23 to 89 years of age (mean = 56.2
years old) were assessed in the study. The patients were
divided into two groups based on RAB height (group 1:
RAB of 24 mm; n = 35 and group 2: RAB > 4 mm;
n = 67). Patients diagnosed with acute sinus infection or
significant systemic chronic conditions were excluded.
Surgical Procedures
In this three-site multicenter study, three experienced
surgeons (>15 years) had performed the crestal
approach sinus lift microsurgeries with simultaneous
implant placement. A total of one hundred nine
implants were placed at the time of the sinus lift
procedure. The elevation forces facilitated membrane
detachment without exceeding its deformation capacity,
so that no perforations occurred.8
For the patients who
received alloplast, two tubes of 0.25 cc beta-tricalcium
phosphate-coated hydroxyapatite (Osteon, Dentium
USA, Cypress, CA, USA) with 0.5 to 1.0-mm particle size
were placed underneath the elevated membrane using a
3.0-mm diameter osteotome (Genoss, Gyeonggi R&DB
Center, Yeongtong-gu, Suwon-si, Gyeonggi-do, Korea).
For the patients who received autogenous particu-
lated graft, the bone was harvested form the adjacent
surgical site or the mandibular retromolar area and was
inserted into the osteotomy site. Prosthetic surgical
guides were used to locate implants insertion sites.
Straumann, Nobel Biocare, and Dentium systems were
used for implant placement, and a primary stability of
25 to 45 Ncm was achieved for all implants (Straumann,
Andover, MA, USA; Nobel Biocare USA, LLC, Yorba
Linda, CA, USA; Dentium USA, Cypress, CA, USA;
Dentium Korea, Samsung-dong, Gangnam-gu, Seoul,
Korea). Prostheses were delivered after 6 months of
healing.
Postsurgical Procedures
Oral and written postoperative instructions were given
to all of the patients. Patients were instructed to take
two 500 mg capsules (1 g) of amoxicillin starting 1 hour
prior to the surgery and to take one 500 mg capsule
every 8 hours for 7 days thereafter. Additionally, patients
were instructed to take pseudoephedrine for 1 week after
the surgery, and 600 mg of ibuprofen every 6 hours for
pain. Sutures were removed 1 week after the surgery.
Radiographic Analysis
At baseline and the follow-up appointments, indepen-
dent, calibrated examiners measured radiographic inter-
proximal bone level using standardized digital periapical
and three-dimensional intraoral radiographs. Three-
dimensional radiographs provided quantitative infor-
mation on maxillary sinus anatomy. Preoperatively,
the bone height that could be achieved was estimated.
Periapical radiographs were obtained with a dental
X-ray machine operating at 60 kVp, perpendicular to
the long axis of the implants with a long-cone parallel
technique on a template. Mesial and distal marginal
radiographic bone level changes were recorded using
ImageJ for Windows (National Institutes of Health
[NIH], Bethesda, Maryland, USA), which calculates area
and pixel value statistics for user-defined selections.
Spatial calibration was set to express dimensional units
2 Clinical Implant Dentistry and Related Research, Volume *, Number *, 2013
3. in millimeters. The platform of the implant served as
a reference to the radiographic bone level. The fixture
threads served as an internal reference. Bone level
was measured as the distance from the platform of
the implant to the crest of the bone. Presurgical and
postsurgical radiographic evaluations of the implant
was performed. For each follow-up appointment, the
radiographic change in the interproximal bone level was
numerically calculated by comparing the previous level
with the current level (see Figures 1–3).
A B
C D
E F
Figure 1 A and B, Clinical photograph and periapical radiograph taken prior to crestal approach sinus lift and simultaneous implant
placement. Note the severity of maxillary sinus pneumatization prior to sinus lift procedure. C and D, Clinical photograph and
periapical radiograph taken immediately after crestal approach sinus lift using beta tricalcium phosphate and simultaneous implant
placement. E and F. Clinical photograph and periapical radiograph taken at the time of crown installation at 9 months after sinus
grafting.
Crestal Approach Sinus Augmentation 3
4. Statistical Analyses
Data are compiled from three treatment centers: Seoul,
Taipei, and Los Angeles. Of those patients with more
than one implant (n = 6), all but one of the implants
were randomly deleted from analysis. Subjects were
grouped by RAB level using 24 mm and >4 mm as
the grouping criteria. Age was categorized by 10-year
age group (20–30, 31–40, 41–50, 51–60, 61–70, 71–80,
81–90). Because crestal bone loss of 2 mm or less
is a common finding, 2 mm was used as the cutoff
A
B C
Figure 2 A, Computerized tomography scan measuring <2 mm of residual alveolar ridge height at the site of future implant
placement. B, Periapical radiograph taken at the time of crestal approach sinus lift using intraoral bone as the graft matieral and
simultaneous implant placement. C, Periapical radiograph taken at the time of crown installation, 8 months postsinus grafting and
simultaneous implant placement.
4 Clinical Implant Dentistry and Related Research, Volume *, Number *, 2013
5. for evaluating bone loss. No subject had >2 mm of
radiographic bone loss. Consequently, only descriptive
analyses were performed. Quartiles of bone loss were
obtained by age, gender, and center, and all analyses were
performed using STATA version 12 (StataCorp LP,
College Station, TX, USA).
RESULTS
There were no adverse events observed clinically in the
oral tissues or the maxillary sinus. No sinus membrane
perforation was detected. A total of one hundred nine
implants were placed in one hundred two patients. Forty
implants were placed into the patients in group 1, and
69 implants were placed into the patients in group 2.
With the exception of one implant failure from group 2,
all implants were clinically successful. The cumulative
success rate was 100% for group 1 and 98.51% for group
2, after a period of 6 to 100 months (mean = 29.7) of
loading. The mean sinus membrane elevation achieved
in the patients in group 1 was 8.76 mm and 3.96 mm for
the patients in group 2.
The patients in group 1 lost a mean of 0.55 mm
(interquartile range [IQR] = 0.5 [0–1]) of crestal bone,
and the patients in group 2 lost a mean of 0.07 mm
(IQR = 0 [0–0]) of crestal bone over 6 months to 8 years
of loading. There was no statistically significant differ-
ence in crestal bone loss between the two groups of
patients. Clinical outcomes were independent of age,
gender, and ethnicity (Tables 1–4).
DISCUSSION
The present study compared sinus augmentation via
crestal approach with simultaneous implant placement
in patients with 24 mm of RAB versus those with
>4 mm of RAB. A total of one hundred two implants
were placed in 96 consecutive patients with an equal
gender distribution and a wide age range. No complica-
tions were encountered throughout the study, and
D E
F G
Figure 2 (continued) D and E, Periapical radiographs taken at 3 and 4 years postloading. Note crestal bone stability and apical
shifting of maxillary sinus floor as a result of sinus grafting. F and G, Buccal and occlusal view of the final restoration in place at
4 years.
Crestal Approach Sinus Augmentation 5
6. the technique was performed with relative ease in all
patients.
The results obtained compare favorably with the
findings from a similar study by Winter and colleagues,
in which 58 implants were placed into a severely
resorbed ridge, with less than 4 mm of residual bone
height. The sinus lifts were accomplished via the LMSF
technique (localized management of the sinus floor
technique), and the implants were placed immediately.
The authors found an implant success rate of 91.4%
after 22 months of loading.9
However, Rosen and colleagues reported that the
survival rate of implants dropped significantly from
96% to 85.7% when RAB height was 4 mm or less.
According to their findings, the most influential factor
affecting implant survival was the height of bone from
the crest of the alveolar ridge to the sinus floor.7
More
recent studies have found increased success rates with
A B
C D
Figure 3 A, Periapical radiograph taken at the time of sinus grafting using autogenous bone from intraoral source and simultaneous
implant placement. Note the height of the crestal alveolar bone. B, Periapical radiograph taken at the time of abutment connection.
Note the height of the crestal alveolar bone. C, Periapical radiograph taken at the time of crown insertion. D, Periapical radiograph
taken at 3 years after implant placement. Note new bone formation within the maxillary sinus surrounding the implant body.
TABLE 1 Bone Loss for Groups 1 and 2
RAB n Mean SD Min 0.25 Median 0.75 Max Interquartile Range (IQR)
24 35 0.55 0.63 0 0 0.5 1 2 0.5 (0–1)
>4 66 0.07 0.2 0 0 0 0 1 0 (0–0)
6 Clinical Implant Dentistry and Related Research, Volume *, Number *, 2013
7. simultaneous implant placement and sinus lift via the
crestal approach in patients with residual bone height
of 4 mm or less. In 2006, Peleg and colleagues found a
survival rate of 97.9% for implants placed immediately
in the grafted maxillary sinus, where less than 5 mm of
bone remained.10
There are several advantages to a one-stage
approach to maxillary sinus floor elevation and implant
placement, including reduced treatment time and elimi-
nation of the need for a second surgical procedure.11
However, the ability to ensure a high primary stability
in a severely atrophied ridge is of chief concern. Several
TABLE 2 Bone Loss for Groups 1 and 2 Separated into 10-Year Age Cohorts
Age Group n Mean SD Min 0.25 Median 0.75 Max Interquartile Range (IQR)
RAB 2 4
20–30 0 – – – – – – –
30–40 4 0.25 0.5 0 0 0 0.5 1 0 (0–0.5)
40–50 7 0.19 0.34 0 0 0 0.5 0.84 0 (0–0.5)
50–60 6 0.25 0.61 0 0 0 0 1.5 0 (0–0)
60–70 11 0.73 0.61 0 0 0.5 1.5 1.5 0.5 (0–1.5)
70–80 4 1 0.71 0 0.5 1.25 1.5 1.5 1.25 (0.5–1.5)
80+ 3 1.13 0.78 0.5 0.5 0.9 2 2 0.9 (0.5–2)
RAB > 4
20–30 5 0 0 0 0 0 0 0 0 (0–0)
30–40 4 0 0 0 0 0 0 0 0 (0–0)
40–50 12 0.03 0.09 0 0 0 0 0.3 0 (0–0)
50–60 18 0.1 0.26 0 0 0 0 1 0 (0–0)
60–70 13 0.02 0.08 0 0 0 0 0.3 0 (0–0)
70–80 13 0.08 0.19 0 0 0 0 0.5 0 (0–0)
80+ 1 1 – 1 1 1 1 1 1 (1–1)
TABLE 3 Bone Loss for Groups 1 and 2 Separated into Gender Cohorts
Gender n Mean SD Min 0.25 Median 0.75 Max Interquartile Range (IQR)
RAB 2 4
Male 19 0.65 0.68 0 0 0.5 1.5 2 0.5 (0–1.5)
Female 16 0.43 0.57 0 0 0 0.95 1.5 0 (0–0.95)
RAB > 4
Male 33 0.08 0.26 0 0 0 0 1 0 (0–0)
Female 33 0.05 0.14 0 0 0 0 0.5 0 (0–0)
TABLE 4 Bone Loss for Groups 1 and 2 Separated into Treatment Center Cohorts
Treatment Center n Mean SD Min 0.25 Median 0.75 Max Interquartile Range (IQR)
RAB 2 4
Seoul 5 0.6 0.65 0 0 0.5 1 1.5 0.5 (0–1)
Taipei 15 0.12 0.31 0 0 0 0 0.9 0 (0–0)
Los Angeles 15 0.97 0.61 0 0.5 1 1.5 2 1 (0.5–1.5)
RAB > 4
Seoul 53 0.07 0.22 0 0 0 0 1 0 (0–0)
Taipei 13 0.07 0.13 0 0 0 0 0.3 0 (0–0)
Los Angeles 0 – – – – – – –
Crestal Approach Sinus Augmentation 7
8. studies have described that the initial stability of the
implants is provided by the ubiquitous presence of cor-
tical bone at the crestal aspect of the ridge. Cardaropoli
and colleagues described the presence of the cortical
bone layer consistently covering the marginal portion
of a healing extraction socket at 60, 90, and 180 days.12
Ohnishi and colleagues also described the corticaliza-
tion of the alveolar bone, which provided a consistent
layer of cortical bone at the crestal aspect of the ridge.13
The ability to elevate the schneiderian membrane,
without perforation, utilizing the crestal approach was
consistently observed throughout the study. In addition
to thorough sinus anatomy evaluation, membrane
detachment force, angle of instrumentation, and elastic-
ity and deformation capacity assessment are all im-
portant factors to consider. Additionally, the number
of insertion sites can increase the elastic properties of
schneiderian membrane for more elevation height.
Berengo and colleagues evidenced that sinus anatomy,
as well as elastic properties of the schneiderian mem-
brane, correlate with the maximum elevation height
that is achievable.14
In the present study, detachment was
gradually reduced at the center and targeted membrane
circumference. Several authors have reported elevation
of the sinus membrane to heights of 2.5 mm to 8.6 mm,
employing the crestal approach.11,15–19
However, crestal
approach cannot be performed in all cases. Perforation
may lead to postoperative maxillary sinusitis or graft
migration into the sinus. Crestal approach requires
a thorough assessment of the anatomy, elasticity, and
deformation capacity of the membrane and precise
surgical approach.
The necessity for use of graft materials for maxillary
sinus floor elevation is controversial. Several authors
have described successful maxillary sinus floor eleva-
tions without the use of graft materials. In 2007, Thor
and colleagues performed sinus floor elevations without
grafting material and found an implant survival rate
of 97.7% and a mean bone gain of 6.51 mm after a
minimum follow-up of 1 year.20
Bone formation around
implants within the sinus has been reported without
the use of bone grafting or biomaterials in animal and
human studies alike.11,21,22
When a graft material is to be used, autogenous
bone remains the gold standard for augmentation of the
maxillary sinus. However, autologous bone undergoes
extensive resorption,23
which may be associated with
contamination from intraoral pathogens.24
The graft
materials used in this study were autogenous bone and
beta-tricalcium phosphate-coated hydroxyapatite. Beta-
tricalcium phosphate resorbs at a relatively slow rate
and effectively maintains the sinus membrane elevated
throughout the healing process. Its resorption is less
than that of autogenous bone25
and does not require
a second surgical site.26
In the present study, both
techniques provided the same success rate.
The findings of the present study suggest that the
crestal approach for maxillary sinus floor elevation is
a viable technique for use in patients with minimal
residual bone height, of 2 4 mm, in the edentulous pos-
terior maxilla. Further clinical and in vitro investiga-
tions are needed to measure the mechanical properties
of the schneiderian membrane, minimum force needed
for its detachment from the underlying bone and its
elasticity and load limits.8
In spite of the known limita-
tions encountered in a retrospective study, the favorable
results obtained merit further studies that examine
the long-term outcome of implants placed under these
conditions.
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Crestal Approach Sinus Augmentation 9