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KMID : 0363020060360020345
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Journal of Korean Academy of Periodontology
2006 Volume.36 No. 2 p.345 ~ p.359
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Radiographic change of grafted sinus floor after maxillary sinus floor elevation and placement of dental implant
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조상호
김옥수
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Abstract
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Loss of maxillary molar teeth leads to rapid loss of crestal bone and inferior expansion of the
maxillary sinus floor (secondary pneumatization). Rehabilitation of the site with osseointegrated
dental implants often represents a clinical challenge because of the insufficient bone volume resulted
from this phenomenon. Boyne & James proposed the classic procedure for maxillary sinus floor elevation entails preparation of a trap door including the Schneiderian membrane in the lateral sinus
wall. Summers proposed another non-invasive method using a set of osteotome and the osteotome
sinus floor elevation (OSFE) was proposed for implant sites with at least 5-6mm of bone between the
alveolar crest and the maxillary sinus floor. The change of grafted material in maxillary sinus is
important for implant survival and the evaluation of graft height after maxillary sinus floor elevation is composed of histologic evaluation and radiomorphometric evaluation. The aim of the present
study was radiographically evaluate the graft height change after maxillary sinus floor elevation and
the influence of the graft material type in height change and the bone remodeling of grafts in sinus.
A total of 59 patients (28 in lateral approach and 31 in crestal approach) who underwent maxillary
sinus floor elevation composed of lateral approach and crestal approach were radiographically followed for up to about 48 months. Change in sinusgraft height were calculated with respect to implant length (IL) and grafted sinus height(BL). It was evaluated the change of the graft height according to time, the influence of the approach technique (staged approach and simultaneous approach) in lateral approach to change of the graft height, and the influence of the type of graft materials to change of the graft height. Patients were divided into three class based on the height of
the grafted sinus floor relative to the implant apex and evaluated the proportion change of that class
(Class I, in which the grafted sinus floor was above the implant apex; Class II, in which the implant
apex was level with the grafted sinus floor; and Class III, in which the grafted sinus floor was below
the implant apex). And it was evaluated th bone remodeling in sinus during 12 months using SGRI
(by Br gger et al).
The result was like that;
Sinus graft height decreased significantly in both lateral approach and crestal approach in first 12
months (p<0.01). Significant difference was not observed between staged approach and simultaneous
approach in graft height change according to time in lateral approach. However, staged approach had
more height loss to simultaneous approach in all observed time. In lateral approach, there was significant difference in BL/IL change according to the type of graft material (p<0.05). Autogenous bone
had maximum height loss and MBCPTM had minimum height loss. Class III and Class II was increased
by time in both lateral and crestal approach and Class I was decreased by time. SGRI was increased
statistically significantly from baseline to 3 months and 3 months(p<0.05) to 12 months(p<0.01) in
both approach.
From above mentioned results, we concluded that progressive sinus graft height reduction occurs
in both maxillary sinus floor elevation approaches and then stability of sinus graft height is
achieved. In case of autogenous bone or ICB single use, more reduction of sinusgraft height was
appeared. Therefore we speculated that the mixture of graft materials is preferable as a reduction of
graft materials. Increasing of the SGRI as time goes by explains the stability of implant, but additional histologic or computed tomographic study will be needed for accurate conclusion. From the radiographic evaluation, we come to know that placement of dental implant with sinus floor elevation
is an effective procedure in atrophic maxillary reconstruction. 2)
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KEYWORD
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Maxillary sinus, graft material, sinus floor elevation technique
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