Search Results (129)

Background: Rehabilitation of the severely atrophic maxilla remains a major challenge in implant dentistry, particularly when conventional endosseous implants and regenerative procedures are contraindicated due to extensive bone loss, sinus pathology, or patient-related factors. Advances in digital planning and additive manufacturing have enabled the reintroduction of juxta-osseous subperiosteal implants as a graftless, patient-specific treatment option. This case report aimed to describe the complete digital workflow, surgical placement, and immediate prosthetic rehabilitation of a customized juxta-osseous subperiosteal implant in a patient with severe posterior maxillary atrophy and a history of failed sinus augmentation procedures. Case Presentation: A 75-year-old male patient presenting with left severe posterior maxillary atrophy and previous unsuccessful sinus lift surgeries was rehabilitated using a digitally designed, additively manufactured titanium subperiosteal implant. Cone-beam computed tomography–based planning and CAD–CAM technology were used to design a patient-specific framework, which was rigidly fixed to stable maxillofacial support and immediately loaded with a screw-retained provisional prosthesis. Results: Clinical and radiographic follow-up demonstrated stable implant fixation, soft tissue healing, absence of biological or mechanical complications, and satisfactory functional and aesthetic outcomes. The patient reported high levels of comfort and satisfaction throughout the treatment period. Conclusions: Digitally manufactured juxta-osseous subperiosteal implants may represent a predictable and minimally invasive graftless alternative for selected patients with severe maxillary atrophy, particularly when conventional implant placement or extensive bone augmentation is not feasible. Accurate digital planning, rigid fixation, and appropriate patient selection appear to be key factors for clinical success. Full article

Maxillary sinus augmentation is a key procedure for rehabilitating the atrophic posterior maxilla and enabling predictable implant-supported restorations. Although autogenous bone remains the biological gold standard due to its osteogenic potential, its clinical use has declined because of donor-site morbidity, limited availability, and increased surgical burden. Deproteinized bovine bone mineral (DBBM) is currently the most widely used substitute, providing excellent biocompatibility and long-term volumetric stability. However, its inert nature, limited bioactivity, and slow resorption have driven the development of next-generation graft materials. Recent biomaterial innovations aim to enhance vascularization, accelerate osteogenesis, modulate immune responses, and achieve controlled resorption while maintaining favorable handling properties. These include ion-releasing bioactive ceramics, growth factor-enhanced allografts, polysaccharide–hydroxyapatite composites, smart hydrogels, and synthetic scaffolds with tunable degradation profiles. Given the complexity of bone regeneration, effective clinical translation requires an integrated framework combining in vitro assays, animal models, and human clinical studies. This review synthesizes evidence published since 2018 on emerging biomaterials for sinus floor elevation, critically evaluating their potential to overcome the limitations of DBBM and highlighting the importance of a coordinated preclinical-to-clinical research continuum. Full article

Background: Maxillary sinus floor augmentation is widely used to enable implant placement in the atrophic posterior maxilla, yet comparative data for porcine-derived xenografts remain limited. Objective: To evaluate long-term bone regeneration and implant outcomes following sinus augmentation using a collagenated porcine xenograft. Methods: This paper reports a retrospective case series of three partially edentulous patients (aged 46–56 years) who underwent lateral sinus augmentation with a small-particle collagenated porcine xenograft (THE Graft™, Purgo Biologics, Gyeonggi-do, Republic of Korea) and staged implant placement. In one case, a controlled perforation of the Schneiderian membrane was performed to access and remove a sinus mucocele, followed by repair using a resorbable collagen membrane. Core biopsies were harvested at implant placement for histology (hematoxylin-eosin, Masson–Goldner) and tartrate-resistant acid phosphatase (TRAP) staining. Clinical outcomes included surgical events, vertical bone gain, marginal bone levels, and implant survival at long-term follow-up. Results: Healing was uneventful in all cases. Mean vertical bone gain was 12.0 mm (baseline 1.33 mm to 13.33 mm final). At a mean 46.8-month follow-up (range 38.3–52.2 months), 100% of implants were functional without failure; marginal bone loss remained < 1 mm during the first year and was stable thereafter. Histology at 3.7, 4.7, and 7.5 months showed vascularized new trabecular bone intimately contacting residual xenograft particles (new bone 20–30%, residual biomaterial 30–40%, connective tissue 30–50%). TRAP-positive multinucleated giant cells at 7.5 months indicated ongoing biomaterial degradation without severe inflammatory reactions. Conclusions: Within the limits of a small case series, collagenated porcine xenograft supported predictable bone regeneration and stable long-term implant function after sinus floor elevation, with favorable histologic integration and gradual resorption. Full article

Background: Maxillary sinus floor augmentation (MSFA) is frequently required for implant placement in the atrophic posterior maxilla. However, limited bone quality and volume can compromise long-term success. Strontium ranelate (SrR), a dual-acting bone agent, stimulates osteoblasts while inhibiting osteoclasts, potentially improving bone density and osseointegration in grafted sites. Objective: This 10-year preliminary split-mouth study evaluated the long-term effects of SrR on bone density, volume, and implant success following MSFA. Methods: Six patients underwent bilateral MSFA using a lateral window approach. One side received systemic SrR (2 g/day for 6 months) after grafting, while the contralateral side served as a control. CBCT and DEXA analyses were performed to assess bone density and volume. Bone biopsies were examined histologically and by microindentation. Data were analyzed using paired t-tests or Wilcoxon signed-rank tests, depending on distribution, with significance at p < 0.05. Results: After 10 years, SrR-treated sites demonstrated a mean 22.9% increase in bone density versus 12.5% in untreated controls. Although both groups experienced minor reductions in bone volume (SrR: −13.3%; control: −12.8%), SrR samples exhibited greater mineralization, hardness, and lamellar bone maturity. Conclusions: SrR improved bone density and mechanical properties but not long-term volume preservation. Given the small sample size (n = 6) and absence of implant stability and patient-reported outcomes, these results should be interpreted with caution. Future large-scale clinical trials incorporating survival, ISQ, and quality-of-life data are warranted. Full article

Cortical laminar bone membranes (CLBMs) combine mechanical strength with controlled resorption to overcome the limitations of conventional guided bone regeneration membranes. This narrative review synthesizes the clinical efficacy and comparative outcomes of CLBMs from human studies. A systematic literature search identified 13 human clinical studies evaluating CLBMs from xenogeneic (porcine, equine, bovine) and autogenous sources. Compared to conventional alternatives, CLBMs demonstrated superior outcomes: horizontal ridge augmentation achieved 3.1–5.8 mm gains with CLBMs versus 2.0–3.0 mm with collagen membranes (50–100% improvement); membrane exposure rates were 3–8% (CLBMs) versus 15–30% (titanium mesh); and socket preservation achieved a 72% resorption reduction versus natural healing controls. Vertical augmentation achieved 7–11 mm gains. Maxillary sinus augmentation achieved a 100% implant success (1–5 year follow-up). The overall implant survival rates ranged 90.9–100% with CLBMs, exceeding the reported success rates (85–95%) of conventional GBR approaches, with complication rates of 0–12.5%. A histomorphometric analysis demonstrated new bone formation of 29.7–40% at 6 months, with a residual biomaterial of 26.2–35%. CLBMs demonstrate favorable exposure rates and excellent biocompatibility. These membranes support lateral, vertical, and combined defect reconstruction, with reduced donor-site morbidity compared to autogenous approaches. High-quality comparative trials and extended follow-up studies are needed to establish definitive clinical guidelines. Full article

Background and Clinical Significance: Maxillary sinus augmentation is a well-established surgical procedure for dental implant placement in the posterior maxilla when the residual alveolar bone height is insufficient. Traditionally, the lateral approach has been preferred in cases with less than 4 mm of bone; however, the crestal approach has emerged as a less invasive alternative, particularly with the advent of advanced techniques and tools such as hydraulic pressure systems and dedicated osteotomy kits. Case Presentation: This case report presents the clinical management of a 68-year-old female patient requiring rehabilitation of the right maxillary molars, where the residual bone height measured only 3.6 mm (in position 1.6) and 2.5 mm (in position 1.7). Using the CAS kit system with rounded drills and hydraulic pressure, a controlled crestal sinus elevation was performed, followed by simultaneous implant placement. Despite the extremely limited bone height, a final insertion torque of 30 Ncm was achieved for both implants, likely due to favorable sinus floor anatomy, under-preparation of the implant sites, and the use of tapered, macro-textured implants. Postoperative follow-up over three years showed stable bone levels and successful prosthetic rehabilitation with single crowns. Conclusions: This case report highlights the potential of the crestal approach in anatomically challenging scenarios. Proper planning, technique, and implant selection are mandatory to achieve predictable and long-lasting outcomes, even in cases previously considered contraindicated for this method. Further randomized controlled trials are needed to confirm this preliminary result. Full article

Maxillary sinus floor augmentation is frequently performed to increase bone height for dental implants, with stem cells suggested to boost bone regeneration. Consequently, this study aimed to assess the effects of incorporating stem cells in maxillary sinus floor augmentation. Two reviewers conducted an extensive search using a mix of controlled vocabulary (MeSH) and free-text terms to locate published systematic reviews. Searches were conducted in three major electronic databases (Medline via PubMed, Embase, and Cochrane database) up to July 2025. Initially, 250 articles were found, but only five studies met inclusion criteria for meta-analysis. The meta-analysis revealed a pooled standardized mean difference in new bone formation of 1.06 (95% confidence interval of −0.31 to 2.44). In a subgroup analysis comparing mesenchymal stem cells with autogenous bone, the pooled standardized mean difference was 0.88 (95% confidence interval of 0.34 to 1.42). The study’s results indicated a positive trend towards better outcomes with the use of mesenchymal stem cells, although the effect was not statistically significant at the pooled level. Additionally, combining stem cells with xenograft may yield more favorable results compared to using autogenous bone with xenograft. These findings suggest potential clinical advantages, highlighting the need for further standardized research to verify long-term outcomes. Full article

Background: During maxillary sinus floor augmentation, the elevated sinus mucosa may come into close contact with the pristine mucosa. The presence of xenograft granules can lead to unintended mechanical and biological interactions between the two layers, and the resulting tissue damage remains poorly understood. The aim of this study was to perform a focused histological evaluation of graft-mediated interactions between the elevated and pristine sinus mucosae. Methods: Histological slides from five previously published rabbit sinus augmentation studies using grafts with different resorption rates were retrospectively analyzed. The following main patterns of tissue alteration were identified: (1) Proximity stage, characterized by epithelial thickening, goblet cell hyperactivity, and ciliary shortening; (2) Fusion stage, with epithelial interpenetration and loss of distinct mucosal boundaries; (3) Synechiae stage, featuring connective tissue bridges linking the two mucosae; and (4) Pristine mucosa lesions, caused by direct contact between residual graft particles and the pristine sinus mucosa. Results: A total of 192 sinuses were evaluated. Sinuses augmented with slowly resorbable grafts showed proximity stage in 22.3% of cases, fusion in 7.7%, direct lesions in 9.6%, and only one instance of synechia. In contrast, the faster resorbable xenograft presented only 11.1% of proximity stage, without further alterations. Conclusions: In this rabbit model, xenografts were associated with histological alterations of the sinus mucosa, while synechiae formation was rare. These preclinical findings should not be directly extrapolated to humans but may provide a basis for future investigations. Full article

Aim: This retrospective observational clinical cohort study evaluated 84-month clinical and radiographic outcomes of a regenerative protocol combining autologous dentin grafts processed with the Tooth Transformer^® device and Concentrated Growth Factors (CGFs) in patients with severe maxillary atrophy undergoing sinus augmentation with simultaneous implant placement. Materials and Methods: Thirty-one patients (30–75 years) with residual crestal bone height ≥ 5 mm and requiring extraction of ≥2 molars were included. Extracted teeth were processed with the Tooth Transformer^® to obtain demineralized dentin granules (500–1000 µm), which were combined with CGFs prepared using the Medifuge MF200^® to form “sticky bone.” All patients underwent sinus lift via a lateral window approach (Hilt Tatum technique) with simultaneous placement of 98 implants (12–14 mm), which were loaded after six months. Results: At the 84-month follow-up, no implant failures or peri-implantitis were recorded. CBCT and clinical evaluations showed stable regenerated bone volume and absence of peri-implant bone resorption. All patients received fixed prostheses within six months without complications. Conclusions: The combined use of processed autologous dentin and CGFs proved to be a safe, predictable, and effective regenerative technique in cases of severe maxillary atrophy, with a 100% implant survival rate at five years. Full article

Background: Maxillary sinus floor augmentation (MSFA) is commonly used to increase posterior maxillary bone volume prior to implant placement. Although generally successful, late complications can impact long-term outcomes. The purpose of the study was to estimate the incidence and timing of atypical late complications following (MSFA) using bovine xenohybrid bone grafts. The study also aimed to evaluate whether preoperative bone volume is associated with the risk of complications. Methods: This retrospective cohort study was conducted at the Center of Oral and Maxillofacial Surgery, Danube Private University, Krems-Stein, Austria, and included patients who underwent MSFA with bovine xenohybrid bone grafts and either simultaneous or staged implant placement between January 2020 and December 2023. Preoperative bone volume of the posterior maxilla measured via cone beam computed tomography (CBCT) in the planned implant insertion position. The primary endpoint was the time (days) from MSFA to the occurrence of a graft-related complication (defined as atypical if occurring more than 6 months after MSFA and not related to peri-implantitis) The covariates included subjects’ age, sex, the quantity of graft used for MSFA, timing of dental implant insertion (simultaneous vs. staged) and implant dimensions. Kaplan–Meier analysis and Cox proportional hazards regression were used to evaluate time-to-event data. Only one graft site per patient was analyzed. Results: Atypical complications occurred in 9 out of 47 patients (19.1%), with an average time to onset of 645 days. In a multivariable analysis, a lower preoperative bone volume was found to be an independent predictor of an increased risk of complications (hazard ratio [HR]: 0.972; 95% confidence interval [CI]: 0.925–1.021; p = 0.252). However, the quantity of graft used for MSFA was not found to be a predictor (p = 0.46). Conclusions: Within the limitations of a retrospective study, reduced native bone volume appears to increase the risk of atypical late complications following MSFA with bovine xenohybrid grafts. This makes closer clinical and radiologic follow-up of patients over a longer period very necessary. Full article

Sinus augmentation provides a well-established model for investigating the three-dimensional morphometry and macromolecular dynamics of bone regeneration, particularly when using biphasic calcium phosphate (BCP) graft substitutes. This case series included six biopsies from patients who underwent maxillary sinus augmentation using BCP granules composed of 30% hydroxyapatite (HA) and 70% β-tricalcium phosphate (β-TCP). Bone core biopsies were obtained at healing times of 6 months, 9 months, and 12 months. Histological evaluation yielded qualitative and quantitative insights into new bone distribution, while micro-computed tomography (micro-CT) and Raman microspectroscopy (RMS) were employed to assess the three-dimensional architecture and macromolecular composition of the regenerated bone. Micro-CT analysis revealed progressive maturation of the regenerated bone microstructure over time. At 6 months, the apical regenerated area exhibited a significantly higher mineralized volume fraction (58 ± 5%) compared to the basal native bone (44 ± 11%; p = 0.0170), as well as significantly reduced trabecular spacing (Tb.Sp: 187 ± 70 µm vs. 325 ± 96 µm; p = 0.0155) and degree of anisotropy (DA: 0.37 ± 0.05 vs. 0.73 ± 0.03; p < 0.0001). By 12 months, the mineralized volume fraction in the regenerated area (53 ± 5%) was statistically comparable to basal bone (44 ± 3%; p > 0.05), while Tb.Sp (211 ± 20 µm) and DA (0.23 ± 0.09) remained significantly lower (Tb.Sp: 395 ± 41 µm, p = 0.0041; DA: 0.46 ± 0.04, p = 0.0001), indicating continued structural remodelling and organization. Raman microspectroscopy further revealed dynamic macromolecular changes during healing. Characteristic β-TCP peaks (e.g., 1315, 1380, 1483 cm⁻¹) progressively diminished over time and were completely absent in the regenerated tissue at 12 months, contrasting with their partial presence at 6 months. Simultaneously, increased intensity of collagen-specific bands (e.g., Amide I at 1661 cm⁻¹, Amide III at 1250 cm⁻¹) and carbonate peaks (1065 cm⁻¹) reflected active matrix formation and mineralization. Overall, this case series provides qualitative and quantitative evidence that bone regeneration and integration of BCP granules in sinus augmentation continues beyond 6 months, with ongoing maturation observed up to 12 months post-grafting. Full article

Background: Dynamic computer-aided navigation systems are a real-time motion tracking technology widely applied in oral implantology and endodontics to enhance precision and reduce complications. However, their reliability, accuracy, and usability in dentoalveolar surgery and maxillary bone augmentation remain underinvestigated. Methods: A systematic review following PRISMA guidelines was conducted and registered on PROSPERO (CRD42024610153). PubMed, Scopus, Web of Science, and Cochrane Library databases were searched until October 2024 to retrieve English eligible studies, without restrictions on the publication year, on dynamic computer-assisted navigation systems in dentoalveolar and bone augmentation surgeries. Exclusion criteria were surgery performed without dynamic computer-assisted navigation systems; dental implant placement; endodontic surgery; and maxillo-facial surgery. The outcomes were reliability, accuracy, post-operative course, surgical duration, complications, patient- and clinician-reported usability, acceptability, and satisfaction. Included studies were qualitatively synthetized and judged using dedicated tools for the different study designs. Results: Twenty-nine studies with 214 patients were included, showing high reliability in dentoalveolar and bone augmentation surgeries comparable to or superior to freehand surgeries, higher accuracy in dentoalveolar surgery compared to maxillary bone augmentation, and reduced complication rates across all surgeries. While overall surgical duration slightly increased due to technology installation, operative time was reduced in third molar extractions. Patient-reported outcomes were poorly investigated. Clinician-reported outcomes were mixed, but difficulties in the differentiation of soft tissue from hard tissue were recorded, especially in sinus floor elevation. Conclusions: Dynamic computer-assisted navigation systems enhance accuracy and safety in dentoalveolar and bone augmentation surgery. Further studies are needed to assess the underinvestigated patient-reported outcomes and standardize protocols. Full article

Background: Radiographic evaluation of bone regeneration following maxillary sinus floor elevation commonly emphasizes volumetric gains. However, the qualitative microarchitecture of the regenerated bone, particularly when assessed via two-dimensional imaging modalities, such as panoramic radiographs, remains insufficiently explored. This study aimed to evaluate early trabecular changes in grafted maxillary sinus regions using fractal dimension, first-order statistics, and gray-level co-occurrence matrix analysis. Methods: This retrospective study included 150 patients who underwent maxillary sinus floor augmentation with bovine-derived xenohybrid grafts. Postoperative panoramic radiographs were analyzed at 6 months to assess early healing. Four standardized regions of interest representing grafted sinus floors and adjacent tuberosity regions were analyzed. Image processing and quantitative analyses were performed to extract fractal dimension (FD), first-order statistics (FOS), and gray-level co-occurrence matrix (GLCM) features (contrast, homogeneity, energy, correlation). Results: A total of 150 grafted sites and 150 control tuberosity sites were analyzed. Fractal dimension (FD) and contrast values were significantly lower in grafted areas than in native tuberosity bone (p < 0.001 for both), suggesting reduced trabecular complexity and less distinct transitions. In contrast, higher homogeneity (p < 0.001) and mean gray-level intensity values (p < 0.001) were observed in the grafted regions, reflecting a more uniform but immature trabecular pattern during the early healing phase. Energy and correlation values also differed significantly between groups (p < 0.001). No postoperative complications were reported, and resorbable collagen membranes appeared to support graft stability. Conclusions: Although the grafted sites demonstrated radiographic volume stability, their trabecular architecture remained immature at 6 months, implying that volumetric measurements alone may be insufficient to assess biological bone maturation. These results support the utility of advanced textural and fractal analysis in routine imaging to optimize clinical decision-making regarding implant placement timing in grafted sinuses. Full article

Effective bone tissue regeneration remains pivotal in implant dentistry, particularly for edentulous patients with compromised alveolar bone due to atrophy and sinus pneumatization. Biomaterials are essential for promoting regenerative processes by supporting cellular recruitment, vascularization, and osteogenesis. This study presents the development and characterization of a novel lithography-printed ceramic β-TCP scaffold, with a macro/micro-porous lattice, engineered to optimize osteoconduction and mechanical stability. Morphological, structural, and biomechanical assessments confirmed a reproducible microarchitecture with suitable porosity and load-bearing capacity. The scaffold was also employed for maxillary sinus augmentation, with postoperative evaluation using micro computed tomography, synchrotron imaging, histology, and Fourier Transform Infrared Imaging analysis, demonstrating active bone regeneration, scaffold resorption, and formation of mineralized tissue. Advanced imaging supported by deep learning tools revealed a well-organized osteocyte network and high-quality bone, underscoring the scaffold’s biocompatibility and osteoconductive efficacy. These findings support the application of these 3D-printed β-TCP scaffolds in regenerative dental medicine, facilitating tissue regeneration in complex jawbone deficiencies. Full article

Background: The combination of polynucleotides and hyaluronic acid with bovine bone grafts in maxillary sinus lift procedures appears to be a promising strategy to enhance bone regeneration. This study aimed to analyze implant osseointegration, bone repair and sinus mucosa integrity using Bio-Oss^® and Hyaluronic Acid-Polynucleotide Gel (Regenfast^®) in maxillary sinus augmentation in rabbits. Methods: Sinus floor elevation was performed in 12 rabbits, with one implant placed per sinus simultaneously. In the control group, sinuses were grafted with deproteinized bovine bone mineral (Bio-Oss^®) alone; in the test group, Bio-Oss^® was combined with Regenfast^®. Two histological slides were obtained per sinus after 2 weeks (six animals) and 10 weeks (six animals): one from the grafted area alone (non-implant sites), and one from the implant site. Primary outcome variables included the percentage of newly formed bone, the extent of implant osseointegration, and the number of sinus mucosa perforations caused by contact with graft granules. Results: After 10 weeks of healing, the test group showed a significantly higher percentage of new bone formation (37.2 ± 6.7%) compared to the control group (26.8 ± 10.0%; p = 0.031); osseointegration extended to the implant apex in both groups; fewer sinus mucosa perforations were observed in the test group (n = 5) than in the control group (n = 14). Conclusions: The addition of Regenfast^® to Bio-Oss^® granules promoted enhanced bone regeneration within the elevated sinus area and was associated with a lower incidence of sinus membrane perforations compared to the use of Bio-Oss^® alone. Full article