Maxillary Sinus Elevation for Implant Placement Using Calcium Sulfate With and Without DFDBA: Six Cases

Maxillary Sinus Elevation for Implant Placement Using Calcium Sulfate With and Without DFDBA: Six Cases
September 2004
Andreana, Sebastiano DDS, MS*; Cornelini, Roberto MD, DDSÇƒÜ; Edsberg, Laura E. PhDÇƒ?; Natiella, Joseph R. DDS¨?
Implant Dentistry: Volume 13(3) September 2004 pp 270-277
Lippincott Williams & Wilkins
*Clinical Assistant Professor, Department of Periodontology, School of Dental Medicine, SUNY at Buffalo, Buffalo, New York.
ÇƒÜVisiting Professor, Department of Restorative Dentistry, School of Dentistry, University of Chieti, Italy, and Private Practice, Rimini, Italy.
Çƒ?Assistant Professor, Department of Natural Sciences and Director Natural & Health Sciences Research Center, Daemen College, Amherst, New York.
¨?Professor, Department of Oral Diagnostic Sciences, School of Dental Medicine, SUNY at Buffalo, Buffalo, New York.
Reprint requests and correspondence to: Sebastiano Andreana, DDS, MS, SUNY at Buffalo, School of Dental Medicine, Department of Periodontology, 250 Squire Hall, 3435 Main St., Buffalo, NY 14214, Phone: (716) 829-3845, Fax: (716) 837-7623, E-mail: andrean@buffalo.edu
Abstract
Maxillary sinus lift is a surgical procedure performed to increase the volume of bone mass so that dental implants can be placed in the maxillary arch. Several materials have been suggested to be used for this procedure. The purpose of this study was to present the clinical and histologic results of using calcium sulfate with and without demineralized freeze-dried bone allograft (DFDBA) in sinus lift. Medical-grade sterile calcium sulfate was used alone or in combination with DFDBA in 6 patients undergoing sinus lift surgery for implant placement. Bone biopsies were taken at different times ranging from 6 to 24 months. All samples examined showed bone growth with some possible remnants of the grafted DFDBA. Implants were inserted either at the time of the lift or 6 months later. All of them were secure with primary stability. The cases reported indicate that calcium sulfate can be successfully used alone or in combination with DFDBA for sinus lift procedures and that possible residues of DFDBA can be found within newly generated bone. (Implant Dent 2004;13:270-277)
Lack of bone could represent a clinical problem when placement of dental implants is the treatment chosen to replace missing teeth. Unfavorable anatomy such as the presence of the maxillary sinus in close proximity to the alveolar crest could be one of the factors responsible for the lack of adequate bone mass. In these instances, some authors suggest that by elevating the lower portion of the maxillary sinus mucosa and filling the space between the lifted mucosa and the alveolar crest, it is possible to gain viable bone mass suitable for implant placement. 1-4 According to Wallace et al., 5 this method has become one of the most common methods for increasing vertical bone height for implant placement in the posterior atrophic maxilla.
The surgical technique has been described by several authors. 2,4,6,7 It consists, essentially, of opening a window in the buccal maxillary alveolar bone, elevating the Schneiderian membrane from the bone and filling the obtained space with grafting material. Implants can be placed either at the time of the surgery, just before inserting the grafting material or when reparative bone is visible radiographically, usually 6 to 9 months after grafting procedures. 8
Several materials have been used as grafting material: autogenous bone harvested from different skeletal areas, demineralized freeze-dried bone allograft (DFDBA), beta tricalcium phosphate, and hydroxyapatite among the most common. 9,10
Among grafting materials for bone regeneration, calcium sulfate has been successfully used for guided bone regeneration in implantology as reported by Sottosanti 11,12 and by Rocci. 13 Calcium sulfate has been shown to induce bone formation in several in vivo experimental use studies. 14-16
An initial report by Pecora et al. 17 described the results of bone biopsies taken from 2 patients 9 months after the sinus elevation using a graft of medical-grade calcium sulfate hemi-hydrate. The results indicated that there was new bone formation. Similar histologic findings were confirmed by De Leonardis and Pecora 18 on a series of 60 cases. Guarnieri and Bovi 19 used a calcium sulfate, which was prehard-ened at 140¨?C for 1 hour and then implanted with some freshly prepared calcium sulfate and found newly generated bone in a trabecular structure.
The aim of this retrospective study was to evaluate histologically and clinically the use of calcium sulfate alone or in combination with DFDBA for sinus lift procedures.
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