• Maxillofacial Plastic and Reconstructive Surgery
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• v.36 no.4
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• pp.146-153
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• 2014

Purpose: This study compares and evaluates the efficacy of graft materials after maxillary sinus bone grafts with autogenous tooth bone graft material (AutoBT), demineralized freeze-dried bone allograft (DFDBA) and deproteinized bovine bone mineral (DBBM). Methods: The study involved 30 sinuses in 26 patients who visited the Division of Oral and Maxillofacial Surgery, Department of Dentistry in Ajou University Hospital and received either AutoBT, DFDBA or DBBM with sinus elevation using the lateral window technique. Sinus graft height was measured before, immediately after, and six months after bone graft with panoramic radiography and the height changes of the sinus floor was compared according to the graft materials. Results: After six months, the decrease ratio of graft heights were 13.57% for AutoBT group, 14.30% for DFDBA group, and 11.92% for DBBM group. There was no statistically significant difference. Conclusion: The new maxillary sinus floor formed by the upper border of bone graft material, can repneumatize after the maxillary sinus elevation. Thus, long-term stability of sinus graft height represents an important factor for implant success. We found that the three graft materials for sinus elevation do not differ significantly and all three graft materials showed excellent resistance to maxillary sinus repneumatization. However, due to the special circumstances of the maxillary sinus and small sample, the actual difference between the three graft materials may not have been detectable. Therefore further study needs to be conducted for more reliable study results.

• Journal of Korean Dental Science
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• v.12 no.2
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• pp.48-57
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• 2019

Purpose: To investigate whether there are specific surgical or clinical conditions where the use of autogenous bone (AB) is superior to the use of bone substitutes (BSs) for maxillary sinus floor augmentation (MSFA). Materials and Methods: We retrospectively analyzed 386 implants after MSFA in 178 patients. The implants were divided into five groups according to the sinus graft material used. Risk factors for implant failure in MSFA, and correlation between residual bone height (RBH) and graft materials in terms of implant survival were investigated. To investigate risk factors for implant failure in MSFA, implant survival according to graft materials, patients' sex/age, surgical site, RBH, healing period prior to prosthetic loading, staged- or simultaneous implantation with MSFA, the crown-to-implant ratio, prosthetic type, implant diameter, and opposite dentition were evaluated. Result: The cumulative 2- and 5-year survival rates of implants placed in the grafted sinus (independent of the graft material used) were 98.7% and 97.3%, respectively. None of the investigated variables were identified as significant risk factors for implant failure. There was also no statistical significance in implant survival between graft materials. Conclusion: There were no specific surgical conditions in which AB was superior to BSs in terms of implant survival after MSFA.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.33 no.3
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• pp.256-263
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• 2011

Purpose: The purpose of this study was to evaluate the effectiveness of autogenous tooth graft materials after maxillary sinus bone grafts. Methods: The study involved 23 implants in 22 patients who visited the Department of Oral and Maxillofacial Surgery and the Department of Periodontics, Chosun University Dental Hospital, in 2008 and received autogenous tooth graft materials for maxillary sinus bone grafts. Results: For eight patients with maxillary bone graft materials prior to implant placement, the healing period averaged five months. For eleven patients with simultaneous maxillary bone graft and implant placement, eight patients received a second surgery, with an average healing time of six months. Three patients had a longer observation period with only a fixture implanted. Three patients who received only a bone graft required more time to implant placement because of the lack of residual bone and also for personal reasons. Only 5 patients had biopsies performed and complications such as infection and dehiscence healed well. The application of autogenous graft materials to the maxillary bone graft sites did not exert any significant effects on the success rates. When a mixture of graft materials was used, the post-surgical bone resorption rate was reduced. Histological analysis showed that new bone formation and remodeling were initiated during the three-to-six month healing period. Bone formation capacity increased continuously up to six months after the maxillary bone graft. Conclusion: According to this analysis, excellent stability and bone-forming capacity were seen in cases where autogenous materials were used alone or mixed with other materials. Autogenous tooth graft materials may be substituted instead of autogenous bones.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.5
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• pp.442-446
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• 2010

Purpose: The purpose of this study was to compare the clinical efficacy of popular bone graft materials mineralized allograft and deproteinized bovine bone mineral. Materials and Methods: One hundred seven implants of 78 patients, accompanied by sinus lift using the lateral window technique and simultaneous implantation, were sampled. In addition, some patients with severe systemic conditions were excluded. The initial bone heights of all patients ranged from 3-6 mm. All of the sample cases were treated at our hospital from January 2005 to January 2008. Techniques other than the lateral window technique were excluded, and only one graft material ($Tutoplast^{(R)}$ or Bio-$Oss^{(R)}$) was accepted for inclusion. $Tutoplast^{(R)}$ was used in 63 implants of 41 patients, whereas Bio-$Oss^{(R)}$) was chosen for the remaining 44 implants of 37 patients. The diameters of the particles used ranged from 0.25-1.0 mm, and the volume was 0.5-2 cc (mean, 1.5 cc). Results: The survival rate of the implant fixtures was 99.07% when the lateral window technique was used. Among all of the cases, cases in which $Tutoplast^{(R)}$ was used demonstrated a survival rate of 98.4%, whereas Bio-$Oss^{(R)}$) resulted in 100% survival. With respect to the alveolar bone height, no significant differences were detected between the two graft materials that failed. Conclusion: According to the result reported above, the two common materials for sinus augmentation do not have clinically significant difference. Rather, host factors, such as the height of residual bone, which could be disclosed during questioning patients' systemic conditions, might have greater effects on the prognosis.

• Imaging Science in Dentistry
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• v.53 no.3
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• pp.177-191
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• 2023

Purpose: This systematic review examined the detection of the posterior superior alveolar artery, along with various anatomic characteristics, on cone-beam computed tomography images. Materials and Methods: Studies were identified electronically through the Web of Science, MEDLINE, Scopus, and Embase databases. The quality of the included studies was evaluated using a 5-item binary scale. The detection rate, location, and classified diameter of the posterior superior alveolar artery were estimated as prevalence values. The diameter of this artery, as well as the distances from the artery to the alveolar crest and sinus floor, were estimated as means with associated 95% confidence intervals. Results: Thirty-seven studies were enrolled, with 34 of these included in the meta-analysis. The mean detection rate was 79% (range: 72%-84%), and the mean diameter was 1.06±0.05 mm (range: 0.96-1.16 mm). The posterior superior alveolar artery was located intraosseously in 64% of cases. The mean distance of the artery from the alveolar crest was 16.71±0.49 mm (range: 15.75-17.68 mm), while the mean distance from the artery to the sinus floor was 8.85±0.4 mm (range: 8.05-9.64 mm). Conclusion: According to the findings of this meta-analysis regarding various anatomic characteristics of the posterior superior alveolar artery, severe hemorrhage after damage to this artery during sinus augmentation procedures is not a substantial clinical problem.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.42 no.5
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• pp.278-283
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• 2016

Objectives: The maxillary sinus mucosa is reported to recover to preoperative sterility after sinus floor elevation. However, when drainage of maxillary sinus is impaired, recovery can be delayed and maxillary sinusitis can occur. Therefore, in this study, we investigated the correlations between anatomic variants that can interrupt the ostium of the maxillary sinus and incidence of complication after sinus lifting. Materials and Methods: The subjects are 81 patients who underwent sinus lifting in Wonkwang University Dental Hospital (Iksan, Korea). Computed tomography (CT) images of the subjects were reviewed for presence of nasal septum deviation, anatomic variants of the middle turbinate, and Haller cells. Correlations between anatomic variations and occurrence of maxillary sinusitis were statistically analyzed. Results: Patients with anatomic variants of ostio-meatal units, such as deviated nasal septum, concha bullosa or paradoxical curvature of the middle turbinate, or Haller cells, showed a higher rate of complication. However, only presence of Haller cell showed statistically significant. Conclusion: Before sinus lifting, CT images are recommended to detect anatomic variants of the ostio-meatal complex. If disadvantageous anatomic variants are detected, the use of nasal decongestants should be considered to reduce the risk of postoperative sinusitis.

• Journal of Periodontal and Implant Science
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• v.49 no.4
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• pp.237-247
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• 2019

Purpose: To analyze the maxillary sinus anatomy over edentulous ridges in the bilateral posterior maxillary area in Taiwanese patients using cone-beam computed tomography (CBCT). Methods: In total, 101 anatomical sites from 61 patients, including 32 premolar and 69 molar regions, were analyzed using CBCT. Measurements were made of the width and height of edentulous ridges, the thickness of the lateral wall of the maxillary sinus, and the presence of a sinus septum and the posterior superior alveolar artery (PSAA). A statistical analysis of the measurements was performed, and correlations among the measurements were assessed. Results: The average ridge width was $10.26{\pm}3.16mm$, with a significantly greater ridge width in the second molar region than in the premolar region. The mean residual ridge height was $8.55{\pm}4.09mm$, and ridge height showed an opposite trend from ridge width for the premolar and molar regions. A sinus septum was present at 5.9% of the sites, and the PSAA was observed in 24.5%. The average thickness of the lateral wall of the maxillary sinus was $2.08{\pm}0.94mm$, with no significant difference between the tooth position and lateral wall thickness. Conclusions: This study presents the anatomical features of the maxillary sinus, which should be considered in sinus lift procedures for implant placement, in the Taiwanese population. The use of CBCT is recommended to avoid intraoperative complications.

• Journal of Periodontal and Implant Science
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• v.47 no.1
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• pp.2-12
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• 2017

The aim of this narrative review is to describe treatment options for the posterior regions of the mandible and the maxilla, comparing short implants vs. longer implants in an augmented bone. The dental literature was screened for treatment options enabling the placement of dental implants in posterior sites with a reduced vertical bone height in the maxilla and the mandible. Short dental implants have been increasingly used recently, providing a number of advantages including reduced patient morbidity, shorter treatment time, and lower costs. In the posterior maxilla, sinus elevation procedures were for long considered to be the gold standard using various bone substitute materials and rendering high implant survival rates. More recently, implants were even placed without any further use of bone substitute materials, but the long-term outcomes have yet to be documented. Vertical bone augmentation procedures in the mandible require a relatively high level of surgical skill and allow the placement of standard-length dental implants by the use of autogenous bone blocks. Both treatment options, short dental implants, and standard-length implants in combination with vertical bone augmentation procedures, appear to result in predictable outcomes in terms of implant survival rates. According to recent clinical studies comparing the therapeutic options of short implants vs. long implants in augmented bone, the use of short dental implants leads to a number of advantages for the patients and the clinician.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.38
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• pp.35.1-35.5
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• 2016

Background: Mucous retention cyst refers to a cyst made by expansion due to the blockage of the salivary gland near the maxillary sinus, and it is surrounded by epithelial cells. Most of them are small; therefore, they cannot be found well and are frequently with antral polyp. The aim of this study was to evaluate the clinical prognosis of sinus bone graft in patients with mucous retention cyst. Methods: This study was performed retrospectively on 23 patients who had sinus bone graft. Group 1 was 8 patients (10 sinuses) who had a mucous retention cyst, and group 2 was 15 patients (17 sinuses) who had no pathologic history about the maxillary sinus. For these patients, sinus bone graft was performed using the lateral approach technique. The total 51 implants were placed 6.22 weeks on the average after sinus bone graft. Sinus membrane perforation during operation, postoperative complications, marginal bone loss after restorative function, implant success rate, and survival rate were analyzed. Results: There was no complication in group 1, and there were three complications in group 2. In group 2, two cases of implants failed. The types of postoperative complications consisted of two minor infections and one wound dehiscence. Two implants of total 51 implants were removed, and the survival rate of implants was 96.08 % (group 1 100 %, group 2 93.5 %). The total success rate of implants was 92.2 % (group 1 95 %, group 2 90.3 %). Conclusions: The clinical prognosis was not affected by the presence of mucous retention cyst.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.26 no.6
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• pp.644-651
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• 2000

In cases of severe alveolar bony resorption in the edentulous posterior maxillae, implant placement is limited anatomically due to maxillary sinus. If the ridge is atrophic, the various bone grafting methods are required for the ridge augmentation. But the result of the onlay grafting procedure is not always promising. On the posterior maxilla, maxillary sinus mucosa lifting and bone grafting into the sinus floor, subantral augmentation(SA) technique are recommended. Various SA procedures have been developed for implant installation. We perfer to simultaneous block bone graft and implant installation through the residual alveolar ridge into the grafted block bone to fix the grafted bone and to gain the primary stability of the installed fixture. When a sagittal skeletal discrepancy in present due to the severe alveolar bony resorption of the maxilla, the advancement of the maxilla by Le Fort I osteotomy simultaneously with installation of implant fixtures combined with sinus lifting and interpositional bone graft procedure can be indicated. We applied various SA techniques for implant installtion to the 46 edentulous posterior maxillae, and total 154 implants were installed at our department from 1992 to 1999. Various SA techniques were classified in detail and the indications of each techniques were discussed. The changes of residual bony height following SA procedure were studied. The results were as follows. 1. The SA procedure combined with bone graft and simultaneous fixture installation were performed in 41 cases, 126 fixtures were installed and 5 fixtures were removed out of them. Le Fort I osteotomy procedure combined with sinus lifting and interpositional bone graft simultaneous with fixture installation were performed in 5 cases. Total 28 fixtures were installed and 2 fixtures were removed so far. 2. Autogenous block bone graft into sinus floor were performed in 35 cases, autogenous particulated marrow cancellous bone(PMCB) graft in 9 cases, and demineralized human bone powder in 2 cases. The donor site for bone graft were anterior iliac bone in 39 cases, posterior iliac bone in 3 cases and mandibular symphysis in 1 case and mandibular ramus in 1 case. 3. In 9 cases with which SA procedure had been performed with the block bone graft, the change of pre- and postoperative residual bony height were measured using MPR(multiplanar reformatted)-CT. The mean residual bony height was 8.0mm preoperatively, 20.2mm at 6 months following up operation and we gained average 12.2mm alveolar bony height. So, we can recommend this one-stage subantral augmentation and fixture installation technique as a time conserving, safe and useful method for compromised posterior edentulous maxilla.