J Periodontal Implant Sci.  2010 Apr;40(2):76-85. 10.5051/jpis.2010.40.2.76.

A hybrid technique for sinus floor elevation in the severely resorbed posterior maxilla

• Jung UW
• Hong JY
• Lee JS
• Kim CS
• Cho KS
• Choi SH

• KMID: 1783538
• DOI: http://doi.org/10.5051/jpis.2010.40.2.76

Abstract

PURPOSE
This study aimed to evaluate the effectiveness of the modified sinus floor elevation technique described hereafter as a "hybrid technique," in 11 patients with severely resorbed posterior maxillae.
METHODS
Eleven patients who received 22 implants in the maxillary premolar and molar areas by the hybrid technique were enrolled in this study. A slot-shaped osteotomy for access was prepared on the lateral wall along the lower border of the sinus floor. The Schneiderian membrane was fully reflected through the lateral slot. Following drilling with the membrane protected by a periosteal elevator, the bone was grafted. All implants were placed simultaneously with sinus augmentation. The cumulative success rate was calculated and clinical parameters were recorded. Radiographic measurements were performed.
RESULTS
All implants were well maintained at last follow up (cumulative success rate=100%). The mean residual bone height, augmented bone height, crown-to-implant ratio, and marginal bone loss were 4.1+/-1.64 mm, 8.76+/-1.77 mm, 1.21+/-0.33 mm, and 0.34+/-0.72 mm, respectively.
CONCLUSIONS
Simultaneous implant placement with sinus augmentation by hybrid technique showed successful clinical results over a 2-year observation period and may be a reliable modality for reconstruction of a severely resorbed posterior maxilla.

Keyword

Bone substitutes; Dental implants; Maxillary sinus

MeSH Terms

Bicuspid
Bone Substitutes
Chimera
Dental Implants
Elevators and Escalators
Floors and Floorcoverings
Follow-Up Studies
Humans
Mandrillus
Maxilla
Maxillary Sinus
Membranes
Molar
Nasal Mucosa
Osteotomy
Transplants
Bone Substitutes
Dental Implants

Figure

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  Figure 1 Pre-operative computed tomography. (A) Panoramic view. (B) Three-dimensional reconstructed image. Note that there was a septum at the second molar area in the left maxillary sinus.

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  Figure 2 Preparation of the access slot and drilling of the implant site.

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  Figure 3 After reflection of the flap, the access slot was prepared along the lower borderline of the sinus with the piezoelectric device. Drilling was performed while the Schneiderian membrane was protected by the periosteal elevator.

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  Figure 4 Bone grafting through lateral slot and drilled sites.

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  Figure 5 Simultaneously placed implants at the second molar area.

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  Figure 6 Radiographs on the day of surgery (A) and 27 months after surgery (B). Arrowheads: augmented bone area.

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  Figure 7 (A) Following extraction of the maxillary premolars and molars due to generalized aggressive periodontitis, a thin alveolar ridge remained. (B) Simultaneous implant placement with sinus floor elevation using a hybrid technique. (C) Radiograph 25 months after surgery.

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  Figure 8 (A) Bilateral edentulous alveolar ridge in the posterior maxilla. (B) Simultaneous implant placement with sinus floor elevation using a hybrid technique. (C) Radiograph 27 months after surgery.

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  Figure 9 (A) Extremely resorbed and pneumatized posterior maxilla. Note that 1-2 mm of alveolar bone height remained. (B) Simultaneous implant placement with sinus floor elevation using a hybrid technique. (C) Dome-shaped augmented bone can be observed on cross-sectional view.

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  Figure 10 Inter-examiner agreement (correlation coefficient=0.99, P<0.0001).

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