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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (1): 95-101. doi: 10.19723/j.issn.1671-167X.2021.01.015

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Radiography study on osteotome sinus floor elevation with placed implant simultaneously with no graft augmentation

LI Peng1,Δ(),PIAO Mu-zi1,HU Hong-cheng1,WANG Yong2,ZHAO Yi-jiao2,SHEN Xiao-jing2   

  1. 1. Second Clinical Division, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100101, China
    2. Center of Digital Dentistry, Peking University School and Hospital of Stomatology, Beijing 100081, China
  • Received:2020-09-23 Online:2021-02-18 Published:2021-02-07
  • Contact: Peng LI E-mail:kqlipeng05420533@sina.com

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Abstract:

Objective: To investigate the change of endo-sinus bone height and bone volume in osteotome sinus floor elevation (OSFE) without bone graft but placing implants simultaneously by using cone beam computed tomography (CBCT) and three dimensional analysis, and to find the impacting factors on endo-sinus bone augmentation.Methods: OSFE was performed in 38 edentulous patients with missing teeth at posterior maxillary region, and 44 implants were placed and referred for OSFE using no graft materials. CBCT was performed pre-surgery and 9-68 months post-surgery when the patients encountered another implant surgery. The gained bone height at mesial, distal, buccal and palatal sites around the implant in sinus were measured, volumetric measurements of the endo-sinus gained bone volume (ESGBV) in the elevated region were calculated by Mimics software. Univariate analysis and multiple linear regression were performed to investigate the impacting factors on the gained bone height and ESGBV. Marginal bone loss was recorded according to the periapical radiography after implant restoration.Results: The mean residual bone height (RBH) pre-surgery was (3.41±1.23) mm, the mean protruded length (PL) into sinus of implant post-surgery was (3.41±1.28) mm, the mean endo-sinus gained bone height was (2.44±1.23) mm at distal sites, (2.88±1.20) mm at mesial sites, (2.83±1.22) mm at buccal sites and (2.96±1.16) mm at palatal sites, the mean endo-sinus gained bone height at distal sites was significantly lower than the other three sites (P<0.05). The average endo-sinus gained bone height was (2.78±1.13) mm. The mean ESGBV was (122.15± 73.27) mm3. Univariate analysis showed the more RBH, the less bone height gained in sinus, which existed at buccal, lingual, mesial and distal sites (P<0.001), and the more RBH, the smaller ESGBV gained (P=0.012). The ESGBV was significantly higher in the subjects whose bone generation period was more than 24 months than those whose bone generation period less than 24 months (P=0.034). The more PL, the more bone height and ESGBV gained (P=0.008). Multivariate analysis showed after adjusting factors of gender, age, smoking, width of sinus floor, thickness of sinus membrane pre-surgery, diameter and length of the implant, PL and bone generation period was positively correlated with mean endo-sinus gained bone height and ESGBV, while RBH negatively correlated with mean endo-sinus gained bone height. During the follow-up, the mean marginal bone loss was 0 (0-1.41) mm and all the implants loaded successfully.Conclusion: OSFE without bone graft but with placed implant simultaneously can increase endo-sinus gained bone height and ESGBV. RBH, PL and bone generation period are the significant factors impacting endo-sinus bone augmentation.

Key words: Sinus floor augmentation, Dental implants, X-ray computed tomography

CLC Number: 

  • R783

Figure 1

Periapical radiograph immediately after implant surgery (A) and after second stage surgery (B)"

Figure 2

Measurement the residual bone height (RBH) and width (W) of sinus floor before surgery"

Figure 3

Measurement of the distance from crest of bone to the apex of implant A A was the distance from the crest of bone to the apex of implant along the axis of implant."

Figure 4

Measurement of bone height at buccal (HB) and palatal (HP) site on coronal plane of CBCT(A) and measurement of bone height at mesial (HM) and distal (HD) site on sagittal plane of CBCT post-surgery (B)"

Figure 5

Volumetric measurement of new bone generation in sinus by Mimics software A, registration of sinus models pre-surgery and post-surgery on coronal plane; B, registration on axial plane; C, registration on sagittal plane, red line represent inner border of sinus presurgery, green line represent inner border of sinus post-surgery; D, the difference between two models was V1-V2 calculated by Boolean calculation; E, three dimensional model of new bone generation after reducing the implant volume by Boolean calculation."

Table 1

The effect of RBH, bone generation period and PL on BH, ABH and ESGBV"

Items BHM/mm BHD/mm BHB/mm BHP/mm ABH/mm ESGBV/mm3
RBH
≤3 mm (n=13) 4.06±0.85 3.62±0.74 4.09±1.06 4.04±1.03 3.95±0.78 162.55±62.28
3-5 mm (n=27) 2.66±0.59 2.17±0.74 2.56±0.51 2.77±0.55 2.54±0.50 88.10(10.47-234.06)*
≥5 mm (n=4) 0.25(-0.2-1.73)* 0.70(-1.75-2.24)* 0.35(0.2-1.54)* 0.52(0.17-1.83)* 0.45(-0.38-1.83)* 51.34(6.34-78.48)
P <0.001 <0.001 <0.001 <0.001 <0.001 0.012
T
≤24 months (n=29) 2.75(-0.2-4.35) 2.25±1.28 2.69±1.28 2.75(0.17-5.37) 2.61±1.13 103.82±63.41
>24 months (n=15) 3.23±1.25 2.81±1.07 3.11±1.06 3.25±1.15 3.10±1.09 157.61±80.01
P 0.316 0.185 0.316 0.298 0.23 0.034
PL
≤3 mm (n=15) 2.00(-0.2-2.72)* 1.45(-1.75-2.55)* 2.10(0.2-2.92)* 1.90±0.87 2.08(-0.38-2.54)* 77.37(6.34-214.14)*
3-6 mm (n=29) 3.37(2.32-6.31)* 3.02±0.89 3.35±1.03 3.38(2.42-5.89)* 3.15(2.28-5.68)* 142.87±72.32
P <0.001 <0.001 <0.001 <0.001 <0.001 0.008

Table 2

Multiple analysis of average bone height gained in sinus"

Variables B 95%CI P
PL 0.37 0.05-0.69 0.025
T 0.012 0.003-0.022 0.012
RBH -0.48 -0.81 to -0.15 0.005
Constant 2.91 0.76-5.06 0.009

Table 3

Multiple analysis of endo sinus gained bone volume"

Variables B 95%CI P
PL 30.20 16.30-44.10 0.001
T 1.86 0.36-3.37 0.016
Constant -21.83 -78.92-35.26 0.444
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