J Periodontal Implant Sci.  2013 Apr;43(2):58-63.

Peri-implant bone length changes and survival rates of implants penetrating the sinus membrane at the posterior maxilla in patients with limited vertical bone height

• Kim HY
• Yang JY
• Chung BY
• Kim JC
• Yeo IS

Abstract

PURPOSE
The aim of this study was to measure the peri-implant bone length surrounding implants that penetrate the sinus membrane at the posterior maxilla and to evaluate the survival rate of these implants.
METHODS
Treatment records and orthopantomographs of 39 patients were reviewed and analyzed. The patients had partial edentulism at the posterior maxilla and limited vertical bone height below the maxillary sinus. Implants were inserted into the posterior maxilla, penetrating the sinus membrane. Four months after implant insertion, provisional resin restorations were temporarily cemented to the abutments and used for one month. Then, a final impression was taken at the abutment level, and final cement-retained restorations were delivered with mutually protected occlusion. The complications from the implant surgery were examined, the number of failed implants was counted, and the survival rate was calculated. The peri-implant bone lengths were measured using radiographs. The changes in initial and final peri-implant bone lengths were statistically analyzed.
RESULTS
Nasal bleeding occurred after implant surgery in three patients. No other complications were found. There were no failures of the investigated implants, resulting in a survival rate of 100%. Significantly more bone gain around the implants (estimated difference=-0.6 mm, P=0.025) occurred when the initial residual bone height was less than 5 mm compared to the >5 mm groups. No significant change in peri-implant bone length was detected when the initial residual bone height was 5 mm or larger.
CONCLUSIONS
This study suggests that implants penetrating the sinus membrane at the posterior maxilla in patients with limited vertical bone height may be safe and functional.

Keyword

Biomechanics; Biostatistics; Maxilla; Maxillary sinus; Sinus floor augmentation

MeSH Terms

Biomechanics
Biostatistics
Epistaxis
Humans
Maxilla
Maxillary Sinus
Membranes
Sinus Floor Augmentation
Survival Rate

Figure

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  Figure 1 A schematic diagram of implant surgery. The black arrow-heads indicate the Schneiderian membrane, and the white arrowheads represent the periosteum. Note that the inserted implants have penetrated the sinus membrane, leaving the apical portion in the maxillary sinus. The top of the implant was positioned about 0.5 mm supracrestally. The cross-sectioned diagram of the implant at the second molar area shows the screw- and friction-retained connection at the interface between the fixture and abutment.

• 

  Figure 2 A radiograph and schematic diagram of the method for measuring peri-implant bone length. The bottom portions of the inserted implants (black arrowheads) are observed in the maxillary sinus on this radiograph (A). The white arrowheads indicate the inferior border of the maxillary sinus. Magnified ratios had to be considered for measurements on the radiographs because they were orthopantomographic images. The real bone length was calculated as follows (B). m, d, and f on the schematic figure indicate the measured lengths on the orthopantomograph. M and D are the real lengths that we want to know, and F is the real length of the inserted implant that is already known. The bone lengths of the mesial and distal sides are calculated through the following proportional expressions: f:F=m:M and f:F=d:D. The peri-implant bone length was a mean value of the mesial and distal bone lengths around the implant; that is, L (peri-implant bone length)=(M+D)/2.

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