The Edentulous Posterior Maxilla Health And Social Care Essay

The most widely used approach for sinus floor elevation is the classical lateral window technique introduced by Tatum in 1976.This technique had potential complications include tearing of the membrane, bleeding, infection, and sinus obstruction149.This technique requires considerable surgical skill and time and also often giving rise to unpleasant sequelae such as edema and discomfort.

A less invasive alternative was introduced by Summer in 1994 to obtain a smaller,localized elevation of the sinus floor.They involve a crestal approach,common to standard implant surgery,with little or no contact between the surgical instruments and the schneiderian membrane,which reduces the risk of surgical complications.

136These techniques (osteotome sinus floor elevation [OSFE] and bone-added OSFE [BAOSFE] allow one-stage implant placement through a very small,noninvasive sinus management during a standard office procedure when there is an adequate quantity of bone for primary stabilization of the implants.A similar crestal approach has also been proposed for a two-stage procedure when the available bone is inadequate for immediate implant stabilization. (Summers RB, Saadoun AP)

The inclusion criteria used in this study was patient with crestal bone height greater than 5mm below sinus floor. 121 According to the standard protocol,the osteotome technique can be used when the ridge height is more than 6mm where implants are placed simultaneously with elevation of sinus floor (Wallace 2003 Ann periodontal).82Brushi et al 1992 reported a success rate of 97% in function for 2 to 5 years using osteotome technique with a residual bone height of 5 to 7mm.Rosen et al has shown that cumulative survival rate was reduced to 85.7% when residual bone was less than 5mm.

128Among the exclusion criteria considered smoking and uncontrolled diabetes are two known risk factors that impact implant survival.The literature suggested the smoking markedly increase the risk of implant failure.Hence this study excluded the above risk factors among other exclusion criteria.

The present study asseses the survival of implant which is placed simultaneously using indirect osteotome technique without bone grafts and followed for a period of 6 months.

Sinus elevation technique has shown a reasonable degree of predictability in implant survival.141Survival was defined as the implant remaining in situ during the entire observation period.The studies all reported high survival of implants placed utilizing the transalveolar approach(Rosen et al ). Rosen et al. IJOMI 1999 In a multicentric retrospective study that evaluated the application of the Summers technique for placement of 174 implants in 101 patients,the survival rate was 96% when residual bone height was 5 mm or more but declined to 85.7% when residual bone height was 4mm or lessIn a recent study Ferrigno et al 2006, Clin Oral Imp Res,survival and success rates of 588 implants placed in 323 consecutive patients with a residual bone height ranging from 6 to 9mm were evaluated.After a mean observation period of 5 years,the survival and success rates were 94.8% and 90.8% respectively

In this study Implant survival is assessed over a period of 6 months using The survival criteria proposed by Buser et al. and Cochran et al. were assessed clinically and radiographically: [14],[15] (i) absence of clinically detectable implant mobility, (ii) absence of pain or any subjective sensation, (iii) absence of recurrent periimplant infection, (iv) absence of continuous radiolucency around the implant Radiographic evaluation using

Panaromic radiographs and digital periapical radiographs were taken at the time of implant placement, 3 months and 6 months. They were analyzed by the same investigator

In the present study 10 Zimmer implants are placed simultaneously using indirect osteotme technique in 8 patients without bone graft in posterior edentulous maxilla.Results showed that 7 implant survived out of 9 implants when followed over a period of six months among which one patient has no 6 month postoperative.Early implant failure was recorded in two patients due to loss of osseointegration

Similar study was done by Lablebicioglu et al 2005 assessed radiographically bone formation around dental implant surfaces without any bone graft using drills and osteotome.Mean Gain in bone height was 3.9±1.9mm in location <9mm initial bone height and 2.9±1.2mm mean gain in height in location of >9mm of initial bone height.the survival rate was 97.3%.Likewise,Diss et al 2008 placed 35 implants using drills and osteotome without bone graft with the residual bone height of 6.5±1.7 mm achieved a 97.1% survival rate.Fermegard et al 2008 placed 53 Astra implant using indirect osteotome technique without bone graft with a residual bone height of 6.3±0.3mm showed 96% survival rate

26 One of the most important criteria for evaluating implant success is determining crestal bone levels surrounding an implant,Initial breakdown of implant-tissue interface begins at the crestal region in a successfully osseointegrated endoosseoud dental implant.Stress concentration is found to be concentrates more on crestal region when compare to implant apex.Crestal bone loss can lead to increased bacterial accumulation resulting to secondary periimplantitis which can further result in loss of bone support leading to occlusal overload and gain crestal bone loss loss (Steflik J Dent Res 1982).This will end up in a vicious cycle,ultimately causing implant failure.

In this study the length of implant protruded into sinus was assessed radiographically using RVG and OPG in 3 months and 6 months period.OPG showed mean length of 2.13±1.13 mm protruded into sinus.Whereas RVG showed mean length of 1.74±1.04mm.P value was significant P<0.05 when compared to baseline.According to Patrick Schmidlin 2008 showed radiographically osteotome sinus elevation of 3.6±1.6 mm measured as the distance between the implant apex and initial sinus floor,were 2.6±1.8mm mesially and 2.8±1.7 mm distally.Leblebioglu et al reported mean gain of alveolar bone height in scanned panoramic radiographs was 3.9±1.9mm when residual bone height was <9mm

Hence in this study crestal bone loss was evaluated at mesial and distal surface of implant using RVG and OPG.In RVG crestal bone loss was measured from from implant collar to first crestal bone contact was assessed.At the baseline Crestal bone height was 2.10±1.1mm was increased to 3.38±0.74 at 3 months and 4±0.63 at 6 months

Mesial crestal bone height showed significant difference P<0.05 at 3 months and 6 months when compared to baseline.Distal crestal bone height did not show any significant difference at 3 months and 6 months.

Assessment of crestal bone height using OPG revealed 7.20±2.78 at baseline,7.13±2.10mm at 3 months,8.14±2.27mm at 6 months.Mesial and distal crestal bonr height did not show any significant difference in P val .

129H Miguel Penarrocha 2004 assessed periimplant bone loss using conventioval periapical,Digital periapical and extraoral Panaromic radiographs at the time of prosthetic loading and after 1 year.Average periimplant bone loss was 1.36 mm as measured on OPG,0.76 on conventional radiographs and 0.95 mm as measured on digital periapical radiographs

135H Young-Kyu Shin et al in 2006 assesed radiographically marginal bone level around implant with different neck surface.The group with rough surfaced microthreaded implant neck showed least amount of bone loss(mean 0.18±0.16

mm) and the group with machined neck showed greatest amount of bone loss (mean 1.32±0.27 mm) after 1 year of functional loading

Postoperative complication were recorded in this study.There was a subjective sign of postoperative pain and swelling reported in 2 patients.There was no Benign paroxysmal positional vertigo,sinus perforation,sinusitis,discharge from nose or oraantral fistula reported inthis study . None of the patients exhibited sinus pathology during the 6 month follow-up period. This was probably the result of meticulous surgical protocol, patient selection and the minimal invasiveness of indirect osteotome technique.

Indirect osteotome technique with simultaneous implant placement technique showed a mean increase in residual bone height of 2.13±1.13mm with overall implant survival rate of ___% without use of bonegrafts.Hence this technique proves to be a less invasive surgical technique and economical without use of autogenous graft where there is presence morbidity,allograft and alloplast where there is risk of antigenicity and has only osteoconductive property.

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