Different Patterns of Bone Formation between Saline and Venous Blood Filling after Hydraulic Lifting of Sinus Membrane.
By: Ki-Hyun Jeong
The purpose of this randomized case-control clinical study was to evaluate implant survival and changes in residual alveolar bone height (RABH) after hydraulic sinus membrane elevation with saline as compared to venous blood. Instead of lateral approach, CAS kit (Osstem, Korea), which is well-known for its hydraulic sinus membrane elevation via crestal approach, is utilized in this study.
Materials & Methods:
The study was approved by the Institutional Review Board of Hanyang University Hospital (HUH IRB 2012-06-014). A total of 40 Korean volunteers consecutively treated at 2 institutions (Division of Oral and Maxillofacial Surgery/Department of Dentistry, Hanyang University Hospital and Apsun Dental Hospital) were included in the study.
The patients were presented with edentulism in the posterior maxilla and a reduced RABH making the placement of implants with standard length longer than 8 mm impossible. None of these patients had systemic or local contraindications, including history of uncontrolled metabolic disorder, smoking habit, bruxism, or uncontrolled periodontal disease.
In a patient with the posterior maxillary edentulism, the placement of dental implants (TS III CA, Osstem), sinus lift surgery via crestal approach by CAS kit. Immediately prior to implant placement, 3 ml of saline or the peripheral venous blood from a patient per an implant site was injected to support the elevated sinus membrane. No bone graft materials were added at any implant site. (Figs 1 & 2, Table 1).
Fig. 1. Crestal approach-sinus (CAS) kit (Osstem, Korea). Fig. 2. Crestal approach for sinus lifting by hydraulic lifter, CAS kit.
Fig. 3. Radiologic responses of the elevated sinus membrane after hydraulic lifting of sinus membrane without bone grafts. Panoramic images at T0 (a), T1 (b), and T4 (c); Coronal CBCT images of the right maxillary second molar implant area at T0 (d), T1 (e), and T4 (f); Coronal CBCT images of the right maxillary first molar implant area at T0 (g), T1 (h), and T4 (i).
- Within limitations of this study, it could be concluded that :
In crestal approach for sinus lift surgery, hydraulic sinus membrane elevation with saline or patient’s own venous blood filling could be an alternative technique to bone grafting in cases where primary stability of implants with standard length was obtained.
- In spite of ‘tent-pole’ effect of implants, drooping of sinus membrane continued up to T4 after sinus membrane elevation with no bone grafts, however, this phenomenon is found to be stabilized at T3.
- Compared to saline, patient’s own venous blood could be better filler to support and maintain the compartment created between the elevated sinus membrane and sinus floor at T4.