title: Bone formation at the maxillary sinus floor following simultaneous elevation of the mucosal lining and implant installation without graft material: an evaluation of 20 patients treated with 44 Astra Tech implants.
abstract: OBJECTIVE
  Restoration of lost dentition in the severely artrophic posterior maxilla has for the last 2 decades been successfully treated with various sinus augmentation techniques and installation of dental implants. The use of graft material is anticipated to be necessary; however, recent studies have demonstrated that the mere lifting of the sinus mucosal lining and simultaneous placement of implants result in bone formation. This study was conducted in order to evaluate simultaneous sinus mucosal lining elevation and installation of dental implants without any graft material.
  
  
  METHODS
  Twenty patients were consecutively included from November 2001 to June 2004. Forty-four Astra ST dental implants (Astra Tech AB, Mölndal, Sweden) with a diameter of 4.5 mm or 5 mm were installed in 27 sinuses. A sinus lift was performed where a cortical window was removed from the maxillary anterior sinus wall. The sinus mucosal lining was elevated and implants installed in the residual subantral bone. The cortical window was thereafter replaced and the incision closed. The remaining bone height was recorded during surgery as well as perforations of the sinus mucosal lining. After 6 months of healing, abutments were connected (the series included 5 1-stage procedures). Clinical and radiological follow-up after loading was performed up to 4 years after implant installation.
  
  
  RESULTS
  Patients tolerated the procedure well as few complications were observed. Firm primary stability was achieved for all implants at installation with bone levels in residual bone of 2 to 9 mm. Perforations of the maxillary sinus mucosal lining occurred in 11 of the 27 operated sinuses (41%). One implant was lost during a mean follow-up of 27.5 months (range, 14 to 45 months) giving an implant survival rate of 97.7%. The average gain of bone at the sinus floor was 6.51 mm (SD = 2.49, 44 implants) including all measured implants after a minimum of 1 year follow-up. Marked bone formation was observed around long implants and also when the residual bone below the sinus was diminutive.
  
  
  CONCLUSIONS
  The present study including 20 patients showed consistent bone formation at the maxillary sinus floor following simultaneous mucosal lining elevation and installation of implants. It is suggested that the use of this technique can reduce the risk for morbidity related to harvesting of bone grafts and eliminate costs for grafting materials.
authors.affiliation: Department of Surgical Sciences, Oral and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden. andreas.thor@lul.se
authors.forename: Andreas
authors.initials: A
authors.lastname: Thor
authors.forename: Lars
authors.initials: L
authors.lastname: Sennerby
authors.forename: Jan Michael
authors.initials: JM
authors.lastname: Hirsch
authors.forename: Lars
authors.initials: L
authors.lastname: Rasmusson
mesh_terms: D000328:Adult; D000368:Aged; D001862:Bone Resorption; D003758:Dental Implantation, Endosseous; D017267:Dental Prosthesis Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008443:Maxillary Sinus / Q000254:growth & development / Q000601:surgery*; D008875:Middle Aged; D009061:Mouth Mucosa / Q000601:surgery*; D010012:Osteogenesis