Bone Height Gain Following Transcrestal Sinus Floor Elevation Using Piezoelectric Surgery Versus The Conventional Osteotome Technique
Condition: Alveolar Bone Loss
MeSH terms: Alveolar Bone Loss
Study type: Interventional

Summary: 
      Missing teeth usually result in functional and cosmetic deficits. Traditionally, they have
      been restored with dentures or fixed bridges. However, dental implants represent an excellent
      alternative which rely on the maintenance of a direct structural and functional connection
      between living bone and implant surface, which is termed osseointergration. When sufficient
      bone is available in maxilla, implant rehabilitation has shown high success rates of 84-92 %.
      Atrophy of the alveolar crest and pneumatization of the maxillary sinus limits the quality
      and quantity of residual bone, therefore complicating the placement of implants in the
      posterior maxillary area.
    

Detailed description: 
      Many solutions were suggested to overcome the problem of placing implants in the vertically
      compromised bone height in the maxillary posterior region. These solutions include the
      placement of short wide implants, long tilted zygomatic implants, vertical ridge augmentation
      and elevation of the sinus membrane to increase the available length for implant placement.

      The use of short implants (<10 mm in length) is a reasonable solution that reduces the risk
      of interference with anatomic structures and claimed to have success rate as high as
      conventional implants. However, short implants have faced many challenges due to less
      bone-to-implant contact, more crestal bone resorption, and compromised crown-to-implant
      ratio. Another treatment option is the use of zygomatic implants. However, many complications
      may be associated with zygomatic implants such as oro-antral fistula formation, maxillary
      sinusitis, and peri-implant bleeding.

      Vertical augmentation of the resorbed alveolar ridge is another treatment option. It can be
      done by onlay grafting, distraction osteogenesis and guided bone regeneration. Although
      success rates of various bone grafting techniques are high, there are many inherent
      disadvantages which include prolonged treatment times, raised treatment costs and increased
      surgical invasion associated with patient morbidity and potential complications.

      To overcome these problems, elevation of the sinus membrane techniques were proposed, it can
      be performed either through a lateral window, or via a crestal access. The selection between
      these two techniques is mainly based on the remaining residual vertical subsinus bone height.
      Lateral approach of sinus elevation is indicated when the residual bone height is of 4 mm or
      less, while the crestal approach is used in case of residual ridge of 5-6 mm.

      Many long term studies and systematic reviews have showed that osteotome mediated sinus floor
      elevation (OSFE) technique is a highly predictable method for rehabilitation of patients with
      atrophied posterior maxilla with survival rates ranging from 92 % to 100 %. However,
      endoscopic studies have demonstrated the risk of membrane perforation while performing
      transalveolar sinus floor elevation. Moreover, the Summers technique can cause some
      complications as headache and paroxysmal positional vertigo.

      The piezoelectric internal sinus elevation (PISE) technique was first introduced by Sohn in
      2009. Using piezoelectric ultrasonic vibration (25-30 kHz), the piezosurgery device cuts only
      mineralized structures precisely without cutting soft tissues even in case of accidental
      contact. Moreover, the cavitation effect produces a hydropneumatic pressure in the
      physiological saline solution that leads to atraumatic sinus membrane elevation. Another
      advantage of piezosurgery is its precision as the movement of the piezosurgery knife is very
      small, so the cutting precision is great and the patients discomfort is minimal. In addition,
      the air-water cavitation effect of the piezoelectric device sustains a blood-free surgical
      field which improves visualization of the surgical field. This technique overcomes the
      problem of benign paroxysmal positional vertigo caused by malleting during the osteotome
      mediated sinus floor elevation.
    

Intervention name(s): piezoelectric device; Summers technique
Intervention type(s): Procedure; Procedure
Intervention description(s): crestal approach will be used to augment the maxillary sinus with simultaneous implant placement; Summers technique
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment