Efficacy of injectable demineralized bone matrix as graft material during sinus elevation surgery with simultaneous implant placement in the posterior maxilla: clinical evaluation of 49 sinuses.
OBJECTIVE
The purpose of the present retrospective investigation was to evaluate the survivability and success of single implants placed simultaneously during direct sinus lifts with allograft forms of bone and to investigate the effect demineralized bone matrix paste has on time management and membrane integrity during these procedures.


METHODS
The charts of 49 consecutively treated nonsmoking patients who had met the inclusion criteria were examined. All the patients had undergone unilateral direct sinus augmentation using the lateral window technique, during which only 1 implant (minimum 10 mm in length) was placed in the premolar or molar maxillary region. All implants were submerged using a 2-stage technique and with at least 3 mm of residual sinus floor bone height. The control group of 27 patients had received particulate allograft bone as the graft material, and the 22 test patients had received allograft bone in a paste form (DynaBlast). No implants were loaded before a minimum of 6 months from the date of fixture placement. All implant-supported single crowns in the present study had been functioning for at least 12 months. All patients were seen immediately after placement of the final crown and were requested to return to the surgeon's practice for 1 annual radiographic follow-up examination. The range of follow-up for these patients was 12 to 24 months based entirely on patient compliance. This interval constituted the loading time. The patients were not seen by the specialist in between the "final crown" appointment (original radiograph) and the "annual" follow-up evaluation (final radiograph). No patients experienced complications that required surgical re-entry. The average loading time for the control group was 13.62 months and was 18.77 months for the test group. The survivability and success of the implants were studied, along with the operative time, between the 2 groups. Statistical analysis was performed for various comparisons in the present study.


RESULTS
None of the fixtures placed in these patients failed. The success and survivability criteria as stated were met for all 49 implants, regardless of the allograft formulation used. The average operative time in the control group was 70.11 minutes and was 62.36 minutes in the test group. This difference was statistically significant (P < .05).


CONCLUSIONS
Using an injectable formulation of allograft material during simultaneous direct sinus lift and implant placement seems to be an acceptable alternative to particulate forms of allograft bone. In addition, when using the injectable graft evaluated in our study, a statistically significant 11% decrease in the operative time resulted.
Graduate Periodontics Program, Division of Periodontics and Implant Surgery, University of British Columbia, Faculty of Dentistry, Vancouver, BC, Canada. irinakis@interchange.ubc.ca
Tassos
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Irinakis
D020341:Absorbable Implants; D000328:Adult; D000368:Aged; D000540:Alveolar Ridge Augmentation / Q000379:methods*; D001857:Bone Matrix / Q000637:transplantation*; D015331:Cohort Studies; D003442:Crowns; D003724:Dental Arch / Q000601:surgery; D003758:Dental Implantation, Endosseous / Q000379:methods*; D019250:Dental Implants, Single-Tooth; D017267:Dental Prosthesis Design; D019094:Dental Prosthesis, Implant-Supported; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008437:Maxilla / Q000601:surgery*; D008443:Maxillary Sinus / Q000473:pathology / Q000601:surgery*; D008567:Membranes, Artificial; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D016348:Osseointegration / Q000502:physiology; D012189:Retrospective Studies; D013524:Surgical Flaps; D016019:Survival Analysis; D013997:Time Factors; D014021:Tissue Preservation / Q000379:methods; D016896:Treatment Outcome
D008567:Membranes, Artificial