In direct sinus elevation using different bone grafts in Indian population

Abstract

Background: The posterior edentulous maxilla presents special challenges to the implant surgeon due to the presence of the maxillary sinus. After tooth loss, the maxillary bone resorbs in both horizontal dimension and also in the vertical dimension. This is often associated with the remodeling of the buccal bone plate and also loss in crestal height due to pneumatization of the maxillary sinus. Maxillary Sinus elevation procedure with a lateral approach has been used for many years but there is a definite indication for indirect sinus elevation where the residual crestal bone is between 4 and 6 mm. Various bone grafts and substitutes have been used to augment the sinus in order to improve the quantity of bone for implantation. Aim/Hypothesis: To assess Osteotome Mediated Sinus Floor Elevation (OMSFE) with simultaneous implant placement using an in situ hardening biphasic calcium phosphate (BCP) compared to xenograft as a control. Material and Methods: Patients needing sinus floor augmentation in one or both sinuses were selected for this randomized controlled clinical trial. Only sites presenting a residual sinus floor height of 3–6 mm and eligible for Osteotome Mediated Sinus Floor Elevation‐OMSFE were included in the study. Eligible sites were randomly assigned to receive either BCP (test) or Xenograft particles (control). CBCT scans were performed before and at the time point of implant loading (180 days). Difference in Sinus Floor height gain between the two groups was set as the primary endpoint parameter for equivalence testing. Implant insertion torque (ITV) was recorded and implant stability (ISQ) was assessed using Ostell RFA at implant placement, abutment connection (160 days) and implant loading (180 days). Results: A total of 52 sinus lifts were performed in 42 patients including 12 bilateral cases. Four implants failed (2 in both groups) and a total of 6 patients were lost to follow‐up corresponding to 5 sites in the test group and 6 sites in the control group. Statistical analysis of sinus floor height revealed no significant differences (_I_P_i_ < 0.05) between groups at baseline (test = 5.01 ± 0.89 mm+ control = 4.76 ± 0.82 mm) nor 180 days after augmentation (test = 12.26 ± 1.87 mm+ control = 12.05 ± 1.43 mm). There was no statistical difference in sinus floor height gain between the two groups (test = 7.25 ± 1.78 mm+ control = 7.26 ± 1.47 mm) as supported by the 90% confidence intervals of the between group difference (lower CI90 = −0.99 mm, higher CI90 = +0.72 mm). Good primary implant stability was confirmed for both treatment groups by ITV and ISQ measurements. Conclusions and Clinical Implications: Within the limits of this study it can be concluded that OMSFE using a in situ hardening biphasic calcium phosphate (BCP) particles results in equivalent sinus floor height gain than using Xenograft particles but offers an easier handling. [ABSTRACT FROM AUTHOR] Copyright of Clinical Oral Implants Research is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)