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P15
Comparing Osteotome Technique to Osseodensification for Implant Stability in Sinus Lift
Thursday, March 1 / 12:50-1:00pm / Monitor 3

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Compare Osteotome Technique to Osseodensification for Implant stability in Sinus Lift

P. Famili, N. Anzur

 

Implants to replace teeth is becoming the standard of care. Although implants have a greater than 95% success rate, the maxillary posterior region often poses a challenge to replace with implants due to bone resorption and the presence of the maxillary sinuses. Several techniques have been used to overcome this problem; sinus augmentation with lateral window approach, indirect technique using osteotomes, or a newer technique using osseodensification technique for sinus lifting.

Purpose:

The purpose of this study was to review the literature to compare two different indirect techniques in sinus lifting and look at implant stability at the time of implant placement.

Method:

A systemic search was conducted using Ovoid, Pub Med, and Cochrane library to look for sinus augmentation from 2010 to 2017. The key notes used were indirect sinus lift, osteotome, osseodensification, and implant stability. All human and animal studies were included, case reports were excluded. A total of twenty-two articles were selected and analyzed.

Result:

The results showed implant survival was 92% for implants placed with autogenous bone graft compared to 93% for implants placed into composite grafts. One animal study using osseodensification technique resulted in no implant failures. A significant increase in ridge bone volume was observed p=0.05. Osteotome sinus floor augmentation had a longer history of use and several studies showed a 12-year cumulative survival of 94.8%. The literature shows osseodensification technique creates a compact auto graft of bone along the osteotomy and increases implant primary stability.

Conclusion:

Based on the available literature and systemic reviews it was difficult to show which surgical procedures provide better outcomes. The limitation of this review was although osseodensification method showed promising results, there was no long-term study found. There is a need to conduct a review with larger sample sizes and longer observation times to confirm this finding.

Introduction:

Replacing maxillary posterior teeth with implants is a challenge due to sinus pneumatizing and ridge resorption. Many different techniques have been recommended so implants can replace maxillary posterior teeth, these include short implants and ridge augmentation. (2, 3) The non-dense bone present in the maxillary posterior is another problem making it difficult to stabilize the implant and risking implant migration into the sinus. For these reasons, sinus augmentation is recommended. Several techniques have been introduced with different bone grafting materials. The two main techniques used for sinus lifting and augmentation are the crestal approach and the lateral window approach. Crestal approach uses mainly osteotomes. Although both techniques give predictable results, the lateral window technique is safer if there is not adequate bone height. Complications can occur due to sinus anatomy and skill level of the surgeon. To prevent these complications, CBCT radiographs of the sinus is recommended before the procedures.

Sinus lifting and bone grafting in the maxillary posterior is a commonly used procedure. When sinus grafting is performed by the lateral window approach, it takes longer to heal and placing implants can be delayed up to 4 to 12 months.

The osteotome procedure is a simple, fast, and reliable technique to augment an atrophic maxillary posterior ridge. The augmentation and implant placement can be done at the same time and does not need extensive elevation of the sinus membrane and large volumes of bone grafting material. (5)

Bone grafting may not be required for bone formation with the osteotome technique because of potential bone healing and formation under the sinus membrane. Several studies support this finding.

Bone is a special tissue that consist of protein molecules and minerals that combine together and is stiff but flexible. Bone strength not only depends on its mineral content but also its collagen composition (Lang, 2002)

Osseodensification is a unique technique which uses a multi-fluted densifying bur technique (Versah, LLc) that condenses bone when the densifying bur is rotted at 800-1500 RPM in a counterclockwise direction. It generates a densified layer of bone through compaction and auto grafting the implant. If the bur rotates in a clockwise direction then it is on cutting mode. This makes it possible to auto graft and place the implant in the sinus area at the same time. (6, 7)

Method:

A systemic search was conducted using Ovoid, Pub Med, and Cochrane library to look for sinus augmentation from 2010 to 2017. The key notes used were indirect sinus lift, osteotome, osseodensfication, and implant stability. All human and animal studies were included, case reports were excluded. Twenty-two articles were selected and analyzed.

Result: 

The results showed implant survival was 92% for implants placed with autogenous bone graft compared to 93% for implants placed into composite grafts. One animal study using osseodensification technique resulted in no implant failures. A significant increase in ridge bone volume was observed p=0.05. Osteotome sinus floor augmentation had a longer history of use and several studies showed a 12-year cumulative survival of 94.8%. The literature shows osseodensification technique creates a compact auto graft of bone along the osteotomy and increases implant primary stability.

 

Conclusion:

Based on the available literature and systemic reviews it was difficult to show which surgical procedures provide better outcomes. The limitation of this review was although osseodensification method showed promising results, there was no long-term study found. There is a need to conduct a review with larger sample sizes and longer observation times to confirm this finding.

 

References:

  1. Van den Bergh JP, Ten Bruggenkate CM, Disch FJ, Tuinzing DB. Anatomical aspects of sinus floor elevations. Clin Oral Implants Res 2000; 11:256-265
  2. Monje A, Chan HL, Suarez F, Galindo- Moreno P, Wang HL. Marginal bone loss around tilted implants in compression to straight implants: A meta-analysis. Int. J. Oral Maxillofac Implants 2012 ; 27: 1576-1583
  3. Del Fabbro M, Bellini CM, Romeo D, Francetti L. Tilted implants for the rehabilitation of edentulous Jaw: A sys thematic review. Clin Implant Dent Relat Res 2010; 14: 612-621
  4. Rabah N., Nathalie, N., Vazquez, L. Abi Najm, S.Biischof, M. Clinical Implant Dentistry and Related Research, 2016; 18: 609-617
  5. Albreksson T., Branemark PL. Hansson HA, Lindstrom, J. Osseointegrated titanium Implants. Requirements for ensuring a long lasting direct bone to Implant anchorage in man. Acta Ortho Scand. 1981; 52(2) : 155-170
  6. Meyer E, Huwais, S. Osseodensification is a novel implant preparation technique that increases implant primary stability by compaction and auto grafting bone. American Academy of Periodontology (abstract) . San Francisco, CA. 2014

Trisi P., Pertetti G. Balodoni E., Berardi D., Colagiovanni M., Scogna G., Implant micromotion is related to peak insertion torque and bone density. Clin Oral Implant Research, 2009; 20 (5) : 467-471

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