A nomogram prediction of implant apical non-coverage on bone-added transcrestal sinus floor elevation: A retrospective cohort study

Abstract

Objectives: To identify the risk indicators and develop and validate a nomogram prediction model of implant apical non-coverage by comprehensively analyzing clinical and radiographic factors in bone-added transcrestal sinus floor elevation (TSFE). Material and Methods: A total of 260 implants in 195 patients receiving bone-added TSFE were included in the study. The population was divided into a development (180 implants) and a validation (80 implants) cohort. According to 6 months post-surgery radiographic images, implants were categorized as “apical non-coverage” or “apical covered.” The association of risk factors including clinical and radiographic parameters with implant apical non-coverage was assessed using regression analyses. A nomogram prediction model was developed, and its validation and discriminatory ability were analyzed. Results: The nomogram predicting bone-added TSFE's simultaneously placed implant's apex non-coverage after 6 months. This study revealed that sinus angle, endo-sinus bone gain, implant protrusion length, graft contact walls, and distal angle were predictors of implant apical non-coverage. The generated nomogram showed a strong predictive capability (area under the curve [AUC] = 0.845), confirmed by internal validation using 10-fold cross-validation (Median AUC of 0.870) and temporal validation (AUC = 0.854). The calibration curve and decision curve analysis demonstrated good performance and high net benefit of the nomogram, respectively. Conclusions: The clinical implementation of the present nomogram is suitable for predicting the apex non-coverage of implants placed simultaneously with bone-added TSFE after 6 months.