The International journal of oral & maxillofacial implants · 2026
Implant Outcomes in Crestal Versus Open Sinus Elevation: A Randomized Clinical Trial.
СтатьяРандомизированное исследованиеСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Mattar Hebatallah, Nasr Tamer A, Keraa Khaled M, ElSholkamy Mohammed
Аннотация
PURPOSE: To evaluate the clinical, radiographic, patient-centered, and patient-reported outcomes of dental implants placed with maxillary sinus bone augmentation using two different sinus floor elevation techniques in sites with a reduced residual bone height of 4 to 7 mm.
MATERIALS AND METHODS: A total of 30 implants were placed in conjunction with 30 maxillary sinus elevations in 17 patients with residual bone heights of 4 to 7 mm; these treatments were primarily performed due to sinus pneumatization rather than postextraction resorption, as evidenced by the preoperative CBCT analysis and comparison to neighboring alveolar bone level heights, with either crestal (indirect/osteotome) or open (direct/lateral window) sinus augmentation using allograft material. Patients were randomly assigned to the crestal technique (test group) or the open technique (control group). A 12-month follow-up assessed implant stability through resonance frequency analysis (RFA) and monitored plaque, bleeding index (BI), and peri-implant probing depths. Changes in vertical, crestal, and buccal bone around the implants were examined directly after surgery and at 6 and 12 months using low-dose CBCT scans with a fusion module. Additionally, relative radiographic bone density was evaluated using specialized software at 6, 9, and 12 months postoperative. Finally, the patient-centered outcome of edema was objectively measured and subjectively reported by the patient.
RESULTS: After the 12-month follow-up, no significant differences were observed between the groups regarding radiographic parameters. There were no statistically significant differences in implant stability quotient (ISQ) scores or implant success/failure rates (P > .05). Clinically, the test group exhibited a lower BI score (P = .027) and more favorable edema outcome scores (measured by both patient-centered and patient-reported methods) than the control group (P = .016 and P = .003, respectively).
CONCLUSIONS: The test group (crestal sinus elevation) using osteotomes-performed simultaneously with implant placement and allogeneic bone grafting-showed only superior clinical BI scores, radiographic buccal bone changes, and patient-centered and patient-reported edema outcomes compared to the control group (open sinus elevation). Therefore, the present findings suggest that, while the crestal approach demonstrates certain advantages, both techniques can be considered for managing crestal bone heights ranging from 4 to 7 mm, thus providing surgeons with two viable options for dealing with such reduced bone heights. When treating severely atrophic maxillary ridges (4-7 mm of residual bone height), the optimal surgical technique remains debated. This study proposes crestal sinus augmentation as a minimally invasive alternative to the open approach, with the potential to achieve comparable clinical outcomes.
MATERIALS AND METHODS: A total of 30 implants were placed in conjunction with 30 maxillary sinus elevations in 17 patients with residual bone heights of 4 to 7 mm; these treatments were primarily performed due to sinus pneumatization rather than postextraction resorption, as evidenced by the preoperative CBCT analysis and comparison to neighboring alveolar bone level heights, with either crestal (indirect/osteotome) or open (direct/lateral window) sinus augmentation using allograft material. Patients were randomly assigned to the crestal technique (test group) or the open technique (control group). A 12-month follow-up assessed implant stability through resonance frequency analysis (RFA) and monitored plaque, bleeding index (BI), and peri-implant probing depths. Changes in vertical, crestal, and buccal bone around the implants were examined directly after surgery and at 6 and 12 months using low-dose CBCT scans with a fusion module. Additionally, relative radiographic bone density was evaluated using specialized software at 6, 9, and 12 months postoperative. Finally, the patient-centered outcome of edema was objectively measured and subjectively reported by the patient.
RESULTS: After the 12-month follow-up, no significant differences were observed between the groups regarding radiographic parameters. There were no statistically significant differences in implant stability quotient (ISQ) scores or implant success/failure rates (P > .05). Clinically, the test group exhibited a lower BI score (P = .027) and more favorable edema outcome scores (measured by both patient-centered and patient-reported methods) than the control group (P = .016 and P = .003, respectively).
CONCLUSIONS: The test group (crestal sinus elevation) using osteotomes-performed simultaneously with implant placement and allogeneic bone grafting-showed only superior clinical BI scores, radiographic buccal bone changes, and patient-centered and patient-reported edema outcomes compared to the control group (open sinus elevation). Therefore, the present findings suggest that, while the crestal approach demonstrates certain advantages, both techniques can be considered for managing crestal bone heights ranging from 4 to 7 mm, thus providing surgeons with two viable options for dealing with such reduced bone heights. When treating severely atrophic maxillary ridges (4-7 mm of residual bone height), the optimal surgical technique remains debated. This study proposes crestal sinus augmentation as a minimally invasive alternative to the open approach, with the potential to achieve comparable clinical outcomes.