Several techniques have been described for maxillary sinus graft augmentation, including the lateral window technique and crestal approach with osteotomes or osseodensification. Platelet-rich fibrin has been used in maxillary sinus lift procedures due to its ability to accelerate soft and hard tissue healing. The aim of this study was to evaluate the potential of PRF in combination with the synthetic hydroxyapatite NanoBone® to enhance bone regeneration in sinus floor elevation with the lateral window technique. Out of the 50 individuals screened in a preoperative assessment visit from the CESPU-Famalicão clinical unit and intervened upon between January 2023 and December 2023, only 6 patients who met the study\'s inclusion criteria consented to participate. In a split-mouth study, twelve sinus graft surgeries were carried out. Our observations reveal that for the test group (NanoBone®/PRF), there is a 27.5 ± 4.9% increase new vital bone, 23.0 ± 3.7% increase in inert bone particles, and 49.4 ± 2.8% increase in connective tissue. Meanwhile, for the control group (NanoBone®), there is a 19.5 ± 3.0% increase in new vital bone, 23.4 ± 5.7% increase in inert bone particles, and 57.0 ± 3.5% increase in connective tissue. The results strongly indicate that mixing liquid PRF with NanoBone® does not have a negative influence on the amount of viable bone formation, and it seems to slightly increase the amount of new bone formation and revascularization in sinus bone graft procedures with the lateral window technique compared to the single use of NanoBone®.

For a large benign lesion within the maxillary sinus, such as an antral pseudocyst, maxillary sinus floor augmentation is more commonly performed using a two-stage approach. This involves first removing the lesion, and then, re-entry following several months of healing. In this case series, we described the \"one-bony-window\" approach, which is a technical surgical modification of the previous one-stage approach, for simultaneous cyst removal and maxillary sinus floor augmentation. Four patients with large maxillary antral pseudocysts were included. The \"one-bony-window\" approach involves the preparation of a large window opening of approximately 15 mm × 20 mm at the lateral wall. A mesiodistally extended intentional perforation was made in the upper part of the exposed membrane to enhance the access for instrumentation. The antral pseudocyst was removed in its entirety without being deformed to prevent rupture or leakage of the cystic contents. Subsequent detachment and elevation of the Schneiderian membrane at the sinus floor significantly reduced the perforation site, and bone grafting with implant placement was performed simultaneously. This alleviated the need to surgically repair the perforation. The lateral opening was either uncovered or repositioned using bony window lids. Healing abutments were connected after six months, and the final prosthesis was placed after two months. At the 1-year follow-up, the antral pseudocysts had resolved with no specific recurrence, and the stability of the augmented sinus was maintained with excellent implant survival. Within the limitations of our findings, the \"one-bony-window\" technique can be suggested for the simultaneous removal of large antral pseudocysts and maxillary sinus floor augmentation with favorable clinical outcomes.

Perforation of the maxillary sinus membrane is a common complication during maxillary sinus elevation. Intraoperative perforation of the maxillary sinus membrane may complicate the procedure and indirectly lead to implant failure. Timely repair of the perforated maxillary sinus membrane can effectively improve the implant survival rate. This case describes a method of repairing a maxillary sinus membrane perforation with a suture-attached collagen membrane and shows stable repair results at a 31-month follow-up.

BACKGROUND: Maxillary sinus augmentation is one of the most performed procedures to increase the bone quantity of the atrophic maxilla to allow implant placement. The aim of the present case series was to describe a surgical protocol to perform maxillary sinus augmentation with the \"bone lid technique,\" and its outcomes in a cohort of patients eligible for the procedure.
METHODS: After the initial clinical evaluation, a cone-beam computed tomography (CBCT) examination was performed for preoperative assessment. Patients were then scheduled for surgical intervention. At 6-9 months follow-up, patients underwent a second CBCT scan to evaluate bone height following bone graft and to schedule implant placement.
RESULTS: A total of 11 patients were enrolled in the study with a total of 13 sinus lift procedures. Membrane perforation was registered in 4 cases (30.76%). Mean surgical time was 67.69 min (SD 6.51). Postoperative period was uneventful in all patients, in the absence of complications. The mean graft volume increase was 2.46 cm3 (SD 0.85), and the mean height increase was 14.27 mm (SD 3.18). Mean membrane thickness was 1.40 mm (SD 0.75). In all the 4 cases with sinus membrane perforation, the membrane had a thickness lower than 1 mm.
CONCLUSIONS: The present study highlights that the maxillary sinus augmentation with bone lid repositioning could provide repeatable results in terms of bone height increase. The technique appears reliable both in terms of bone gain and absence of complications.
CONCLUSIONS: The bone lid technique for maxillary sinus augmentation provides repeatable results in terms of bone height increase. The favorable clinical outcomes can be related to an enhancement of bone formation due to the unique osteoconductive and osteoinductive properties of autogenous bone, along with a reduction of soft tissue ingrowth. Complications were not observed in any of the patients following the surgical procedures. The risk of Schneiderian membrane perforation is inversely proportional to membrane thickness; the thinner the membrane is, the higher the risk to perforate it.

OBJECTIVE: To evaluate the survival rates of dental implants with a hybrid macrostructure and the surface biomimetically coated with nanohydroxyapatite, placed in horizontally atrophic maxillae previously submitted to the guided bone regeneration (GBR) procedure, associated with the use of a deproteinized bovine bone graft (DBB).
METHODS: Twenty-five patients who received 196 implants were involved in this study. First, these patients were submitted to GBR procedures and maxillary sinus lift, where DBB was used as the grafting material. The dental implants were placed after a minimum period of 6 months of the grafting procedures. The patients were followed up every six months and clinical/radiographic examinations were performed to assess the implants, using the following indicators as a reference: (1) Absence of mobility; (2) Absence of pain. Data about the age, surgery time, smoking status, implant size, and time between the grafting procedure and implant placement were correlated with implant failures.
RESULTS: Twelve implants failed, generating a survival rate of 94.23%. None of the variables analysed correlated with the implant failures.
CONCLUSIONS: Implants with a hybrid macrostructure and surface biomimetically coated with nanohydroxyapatite present good survival rates in horizontally atrophic maxillae grafted with DBB.

This report of cases aims to share our treatment experiences in 4 sinus graft infection cases after sinus floor elevation and simultaneous implant placement. The preoperative and postoperative intraoral and radiographic photographs were collected and used to assess the treatment outcomes. The sinus cavity status, bone augmentation results, and implant stability were used as measurements to determine the treatment effectiveness. Four patients received partial graft removal as their surgical treatment for sinus graft infection combined with antibiotic therapy, with or without immediate secondary grafting. After early intervention, antibiotic therapy, and partial debridement of the infected sinus grafts, radiographic and clinical outcomes indicate successful resolution of the graft infection and stable bone graft levels around the implants. The keys to the successful management of the sinus graft infection were: early detection of the infection; early intervention, including partial debridement of the infected graft particles; and antibiotic therapy.

Many patients require edentulous ridge augmentation for dental implant placement. The main objective of this study was to evaluate the results of maxillary edentulous ridge augmentation exclusively with xenograft materials with and without simultaneous sinus floor elevation. This study reports the data retrieved from the records of 16 patients. The treatment outcome was assessed at least 6 months, postoperatively. Paired samples t-test or Wilcoxon Signed Rank test was used to compare the pre-and postoperative ridge dimensions. Dental implants were placed simultaneously in 7 patients, while 9 patients underwent delayed implant placement. In total, 68 implants were placed, and 12 patients also underwent maxillary sinus floor augmentation. A significant bone gain was achieved in both horizontal and vertical dimensions of edentulous maxillary ridges (P < 0.001). Ridge width increased by an average of 4.35 ± 1.90 mm (95% CI: 3.84 to 4.85 mm) while ridge height in areas of sinus floor augmentation increased by 8.19 ± 2.91 mm (95% CI: 7.33 to 9.05 mm). Within the study limitations, it appears that maxillary ridge augmentation according to the guided bone regeneration (GBR) protocols with exclusive use of xenograft particulate materials can provide optimal bone quantity for dental implant placement.

The aim of this study was to evaluate the radiographic and clinical outcomes of patients undergoing sinus membrane elevation via a minimally invasive crestal approach utilizing the dental implant. Twenty patients having 1 or more missing posterior teeth were included. The maxillary sinus membrane was elevated using dental implant via a crestal approach in areas with insufficient residual bone. CBCT scans were used to measure the amount of newly formed bone, implant length inside the sinus, bucco-palatal sinus width, and bone thickness. Surgical and postsurgical complications along with implant survival were also measured. The mean (±SD) values for the newly formed bone after 1 year were 2.4 (±1.87) mm, while values for implant length inside the sinus were 4 (±1.49) mm. The results showed that percentage of implant length inside the sinus and the palatal bone thickness were statistically significant positive predictors of the newly formed bone. Higher percentage of implant length inside the sinus and increased palatal bone thickness were associated with larger amounts of newly formed bone. A high patient satisfaction was reported along with a 100% implant survival. The utilization of the novel dental implant approach for crestal sinus elevation demonstrated predictable clinical and radiographic outcomes. This novel technique is simple to both patients and clinicians, rendering it a promising and cost-efficient procedure.

OBJECTIVE: Endodontic microsurgery (EMS) of maxillary molars may represent a complex challenge to the clinician due to the location of the roots and the proximity of the maxillary sinus floor. This report aimed to describe the simultaneous use of a computer-assisted dynamic navigation (C-ADN) system and piezoelectric bony-window osteotomy for the transantral microsurgical approach of a maxillary left first molar with adequate root canal filling and symptomatic apical periodontitis.
CONCLUSIONS: This case report highlights the importance of C-ADN to carry out a minimally invasive buccal surgical access to palatal roots affected by apical periodontitis and provides a practical example to help clinicians make treatment decisions based on the available evidence. Clinical and tomographic evaluations were performed before the surgical procedure and at 24-month follow-up. This case was treated using a C-ADN system fitted to a piezotome for the buccal approach of the buccal roots, maxillary sinus membrane lifting, and for transantral location, root-end resection, cavity preparation, and filling of the palatal root. The navigation system allowed to achieve an accurate apical canal terminus location and root-end filling of the three roots with a minimally invasive piezoelectric crypt approach. At the 24-month follow-up examination, the patient remains asymptomatic, with normal periapical structures, and regeneration of maxillary sinus walls. It was concluded that the combination of dynamic navigation with piezoelectric bony-window osteotomy offers enhanced accuracy, tissue preservation, diminished risk of iatrogenic complications, and could maximize success and survival rates in transantral EMS.

A sinus floor elevation via lateral window (LSFE) is one of the most widely used bone augmentation procedures for implant therapy in the posterior area of the maxilla. Locating and preparing a correct opening window on the lateral sinus wall is a key step of this procedure. Conventionally, the surgeon designs and locates the window after the flap is reflected based on the information obtained from cone-beam computed tomography (CBCT) images or other diagnostic aids. Nevertheless, in spite of the advancements in CBCT imaging, clinicians may still experience hardships in situating and procuring meticulous access to the maxillary sinus by using CBCT alone. Therefore, in cases requiring an LSFE simultaneous to implant placement, a maxillary sinus surgical guide has been tested and reported to be the amiable method to be utilized as a conjunct to prevent unpredictable consequences according to its application in implying both the direction for the implant and the location of the lateral window. This article presents 3 clinical cases with a fully digital approach to guide the opening of the lateral wall of the maxillary sinus as well as the simultaneous placement of a single implant in an ideal 3D position. Based on the CBCT images and intraoral scan, a surgical guide was fabricated based on 3D software. During surgery, this teeth-supported template can be placed intraorally, guiding sinus window opening preparation. This technique makes the sinus window opening procedure simple and predictable, reduces surgical time and the risk of complications, and allows the placement of the implant in the ideal 3D position.