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「INTERNATIONAL」 Simultaneous Sinus Lift and Implant Installation 
 drgid (203.♡.26.186) | 13-03-27 22:53
 
Simultaneous Sinus Lift and Implant Installation:
Prospective Study of Consecutive Two Hundred
Seventeen Sinus Lift and Four Hundred
Sixty-Two Implants
Hyun-Suk Cha, DDS, MSD, PhD;* Andrew Kim, DDS, MS;† Hessam Nowzari, DDS, PhD;†
Hoo-Sun Chang, MD, PhD;‡ Kang-Min Ahn, DDS, MSD, PhD§
ABSTRACT
Purpose: If less than 4 mm of residual bone is remained in posterior maxilla, two-stage operation is recommended for
implant installation. However, if primary stability could be obtained using tapered designed implants, one-stage surgery
could be performed with reliable success rate in severely resorbed maxilla. The purpose of this prospective study was to
evaluate survival and success rates of the implants simultaneously placed into grafted sinus using rough-surfaced implant.
Materials and Methods: A total of two hundred seventeen consecutive sinus lifting through lateral approach and four
hundred sixty-two simultaneous implants were installed from November 2003 for 5.5 years. Xenogenic bone was used
solely for bone graft materials. Second surgery was performed around 6 months after operation and porcelain fused metal
or gold crown was used for definitive restorations. Cumulative survival and success rates were evaluated according to
residual alveolar bone height (RABH), smoking status, and Schneiderian membrane perforation.
Results: The mean follow-up was 57.1 1 15.6 (36–98) months. Of the four hundred sixty-two implants, two hundred
sixty-two implants (56.7%: group 1) were installed in posterior maxilla less than 4-mm RABH and two hundred implants
(43.3%: group 2) were placed in over 5-mm RABH. The cumulative survival and success rates were 98.91% and 96.54%.
There was no statistically significant difference in success rate between group 1 and group 2 (p = .3135). Perforation of the
membrane was not related to success (p = .7162), but smoking status is significantly related with implant failure (p = .0003).
Conclusions: Sinus lifting with simultaneous implant placement could be used to treat atrophic maxilla in patients with
minimal RABH when initial stability could be obtained by using taper designed implants with surgical techniques. Smoking
is a possible factor for implant failure. Membrane perforation did not have an adverse effect on implant success if the
membrane was repaired with absorbable membrane and fibrin glue.
KEY WORDS: dental implant, perforation, residual alveolar bone, Schneiderian membrane, sinus lifting, smoking,
xenogenic bone
INTRODUCTION
Sinus lifting and implant placement are predictable
treatment options for pneumatized sinus and severely
resorbed maxillary posterior reconstruction. A
minimum of 4 to 5 mm of residual bone height is
traditionally recommended for the one-stage surgical
procedure of sinus lifting and implant placement to
ensure initial stability from preexisting residual bone.1–4
However, these criteria have been determined arbitrarily
without controlled studies.3–6 In efforts to improve
primary stability and osseointegration, implant designs
and surface treatments have evolved in recent years.
*Associate professor, Department of Prosthodontics, Asan Medical
Center, College of Medicine, University of Ulsan, Seoul, Korea;
†Department of Advanced Periodontics, University of Southern California,
Los Angeles, CA, USA; ‡Department of PreventiveMedicine &
Public Health, College of Medicine, Yonsei University, Seoul, Korea;
§associate professor, Department of Oral and Maxillofacial Surgery,
AsanMedical Center, College of Medicine,University of Ulsan, Seoul,
Korea
Reprint requests: Professor Kang-Min Ahn, Department of Oral
and Maxillofacial Surgery, College of Medicine, University of
Ulsan, Seoul Asan Medical Center, Seoul 138-736, Korea; e-mail:
ahnkangmin@hanmail.net
© 2012 Wiley Periodicals, Inc.
DOI 10.1111/cid.12012
1
Reports in the literatures indicate that frictional resistance
created by rough-surfaced implant combined
with modified surgical techniques can improve initial
implant stability.7,8 In severely resorbed or pneumatized
posterior maxilla, optimal initial stability could be
obtained by underpreparing implant osteotomies and
using tapered designed implants. Various studies have
evaluated sinus lifting and simultaneous implant installation
and showed no relationship between implant
failure and residual alveolar bone height.9,10 Others have
reported that the amount of residual bone height significantly
influences the implant survival rate in sinus
lifting.11 Recently, systemic reviews reported that simultaneous
and delayed implant installation displayed
similar survival rates.12,13 Peleg and colleagues adopted a
one-stage surgical technique that allows implant placement
in as little as 1 to 2 mm of residual bone using
microtextured or coated implants at least 13 mm in
length with predictable success rate.9,10,14 However, these
studies had varying methodologies including implant
design, bone graft materials, and healing periods. The
effect of preoperative residual bone height on success
rate is inconclusive due to the diversity of the study
designs.
To the authors’ best knowledge, a large-scale prospective
study evaluating sinus lifting and simultaneous
implant installation using only xenogenic bone in
severely resorbed maxilla has not been reported. This
prospective study evaluated implants (rough surface
310 mm length) immediately placed into grafted maxillary
sinuses using lateral window approach (xenogenic
bone only) irrespective of residual bone height. The
purpose of this prospective study was to evaluate the
survival and success rates of the implants simultaneously
placed into grafted sinus and evaluate whether
there are any differences in survival and success rates
regarding residual alveolar bone height, smoking status,
and membrane perforation.
MATERIALS AND METHODS
Preoperative Evaluation and Inclusion and
Exclusion Criteria
A total of two hundred seventeen consecutive lateral
window sinus lifts and four hundred sixty-two implant
installations were performed by one experienced oral
and maxillofacial surgeon at the Department of Oral
andMaxillofacial Surgery at Seoul AsanMedical Center.
The Asan Medical Center Institutional Review Board
approved the clinical trial. The inclusion and exclusion
criteria are reported in Table 1. Every patient underwent
a medical and dental history evaluation including the
presence of illness, medications, and smoking habits.
Patients were examined intraorally and extraorally
using panoramic radiograph and cone beam computed
tomography (CT) scan.
Implant Selection
Implants (Implantium®, Dentium Co., Seoul, Korea)
with microthreads in the coronal part with sand blasting,
large grit, and acid etching surface were used in this
study. This tapered implant design has a table that is
0.2 mm wider than lower body area to increase initial
stability in bone. The coronal aspect (2 mm) of the
implant consists of microthreads. The lengths and diameters
of the implants that were used in this study were 10
TABLE 1 Criteria for Patient Selection
Inclusion Criteria Exclusion Criteria
• Posterior maxillary bone
deficiency (residual
alveolar bone 1–8 mm)
without the need for
multiple interventions
(e.g., simultaneous ridge
augmentations)
• Good periodontal health
• More than 2 months of
healing period after
extraction
• Good general health: those
with controlled medical
conditions with physician’s
approval
• Stable mental health
condition
• Ability to complete at least
36 months of clinical
follow-up
• Willingness to provide
signed informed consent
form
• Uncontrolled diabetes
mellitus and hypertension
• History of myocardial
infarction within 6 months
• Use of immunosuppressive
medication
• Use of intravenous
bisphosphonate
• Presence of
immunodeficiency disease
• History of irradiation
associated with head and
neck cancer
• Evidence of acute and
chronic sinusitis
• Presence of cyst or tumor
in maxillary sinus
• History of Caldwell-Luc
operation
• Pregnancy at the time of
operation
• Alcohol or drug abuse
• Unlikely to comply with
study procedures according
to investigators’ judgment
2 Clinical Implant Dentistry and Related Research, Volume *, Number *, 2012
and 12 mm and 3.3, 3.8, 4.3, and 4.8 mm (determined
by the width of the residual ridge), respectively.
Surgical Technique
The modified Caldwell-Luc approach was used to gain
access to the sinus cavity. The lateral wall of the maxilla
was exposed with a full-thickness mucoperiosteal flap
made with crestal incision and two vertical incisions on
the buccal side of the residual alveolar ridge mesially and
distally. The size of the lateral window was determined
by the number of implants to be installed with consideration
to minimize the size of the lateral window as
possible. A #2 carbide round bur was used to create a
window on the lateral maxillary wall using low speed
straight angle handpiece.When the Schneiderian membrane
was visualized under the groove, a #2 diamond
round bur was used to prevent membrane tearing. The
window bone was temporarily removed rather than
infracturing into the sinus (Figure 1). Implant osteotomy
was prepared according to the manufacturer’s
instructions. Countersink drills were not used to optimize
primary stability.
Residual alveolar bone was initially evaluated using
panoramic radiograph and CT scans. After sinus membrane
elevation, the position of the osteotomy was
marked with a sterilized pencil according to surgical
stent. The exact measurement of the clinical residual
alveolar bone was obtained using a depth gauge
(Figure 2).
Xenogenic bone (Bio-Oss®, Geistlich Pharma,Wolhusen,
Switzerland) was soaked with gentamycin (gentamicin
sulfate, Choongwae Pharm, Seoul, Korea) for 5
minutes before application into the maxillary sinus and
grafted until it filled the elevated sinus cavity. The dental
implants were initially placed into the grafted sites using
an automated handpiece and finalized using a hand
wrench with a torque gauge. If the initial stability of
15 Ncm was not obtained by torque gauge, it was
replaced with larger diameter implant.
In case of membrane perforation, porcine membrane
(Bio-Gide, Geistlich Pharma, Wolhusen, Switzerland)
and fibrin glue (Greenplast®, Green Cross Co.
Ltd., Seoul, Korea) were used to repair the perforated
area. The buccal window bone was repositioned to the
original site using fibrin glue. All implants were submerged
and the mucoperiosteal flap was closed using
4-0 Vicryl (Johnson & Johnson, Ethicon, England).
Implants were divided into two groups. Group 1
included implants installed in the posterior maxilla
with residual alveolar bone height of <5 mm. Group 2
included implants installed with alveolar bone height of
35 mm. The survival rate of each group was evaluated.
The smoking status and membrane perforation were
recorded and the same evaluation was performed.
Postoperative Management
Patients were prescribed augmentin (potassium clavulanate
125 mg + amoxicillin sodium 250 mg, two times
daily), airtal (aceclofenac 100 mg, two times daily) for 5
days, prednisolone (10 mg, two times daily) for 2 days,
and hexamedin (0.2% chlorhexidine mouthwash, three
times daily for 5 days). Clindamycin (300 mg, three
times daily) was prescribed to patients with penicillin
allergy. Patients were instructed to avoid blowing their
noses and cough/sneeze with their mouths open when
Figure 1 Diagram of the surgical procedure. Lateral window
was temporarily removed during the sinus membrane elevation.
Xenogenic bone was grafted into the sinus and implant was
placed. Implant has the microthreads and tapered design to
maximize initial stability.
Figure 2 Measurement of the residual alveolar bone using
depth gauge.
Simultaneous Sinus Lift and Implant Installation 3
necessary for at least 2 weeks after surgery to prevent
increased pressure in the operated sinus. Sutures were
removed 10 days after surgery. Patients with removable
prosthesis were instructed not to wear their prosthesis
for 2 weeks after surgery. All patients were instructed to
follow a soft diet for 1 week. Dentures were relined after
sutures removed and monthly thereafter with a soft
tissue conditioner.
Time Schedule for Second Surgery and
Prosthodontic Treatment
Uncovery surgery was performed about 6 months after
implant placement.Marginal bone level, implant mobility,
and presence of fistula were examined. Final impression
was taken 2 weeks after second surgery. All patients
were treated with a fixed implant-supported prosthesis
for final restoration. The final tightening torque of abutment
was 32 Ncm. The screw-retained porcelain fused
metal or gold crown was fabricated for definitive restorations
and temporary cement was used for luting. At
the day of final restoration, baseline periapical radiographs
were taken to evaluate marginal bone resorption.
Patients were recalled every 6 months for 3 years after
prosthesis delivery and annually after 3 years. Every
recall visit, the final restorations were removed and
cleaned to examine implant mobility, excessive cement,
and screw loosening in splinted bridges.
Radiographic Analysis
Periapical radiographs (long-cone paralleling technique)
and panoramic radiographs were taken immediately
after surgery, 1 month, 6 months, 1 year postoperation,
and annually thereafter.An independent examiner interpreted
all radiographs. The changes frombaseline (day of
final prosthodontic treatment) were calculated for all
follow-up periods. The implant used in this study has
microthreads in the coronal portion which is 2 mm.
Marginal bone loss was measured on radiographs using
the implant microthreads as internal standard (Figure 3).
Measurement of the marginal bone change was performed
with image analysis software (ImageJ, 1.44p,
National Institutes of Health, Bethesda,MD, USA).
Criteria for Implant Success Rates and
Implant Survival
Those meeting the following parameters were considered
as successful implants, which were suggested by
Albrektsson and colleagues: (1) absence of persistent
pain; (2) absence of peri-implant infection with suppuration;
(3) absence of implant mobility; (4) absence
of continuous peri-implant radiolucency; and (5) periimplant
bone resorption <1.5 mm in the first year
of function and <0.2 mm in the subsequent years.15
Implant survival was defined as functional implants
that followed parameters (1) to (4).
Statistical Methods
Data were collected with regard to success rate and survival
rate according to the residual alveolar bone height
and smoking status. Descriptive statistics and survival
analyses were computed with SPSS statistical software
(version 12.0, SPSS, Inc., Chicago, IL, USA). The
primary analysis of interest was the assessment of the
relationship between residual alveolar bone height and
implant survival rate. The comparison between group
1 and group 2 was performed with the chi-square test.
The success rates of implants in smoking versus nonsmoking
group and membrane perforated versus
nonperforated groups were evaluated with the same
methods. Any patient who smoked more than one
cigarette a day was considered a smoker following the
definition by Wallace.16 Implant survival was defined as
the length of time of implant survival from the date
of implant installation to the date of implant failure.
Implant survival rate was analyzed using the Kaplan-
Meier analysis, and a group comparison was made
using the log-rank test. The statistical significance
(p < .05) of the results was determined.
Figure 3 Periapical radiograph of the implants placed in the
grafted sinus bone. The known length of the microthreads in
implant was used as an internal standard (arrow = 2.0 mm).
4 Clinical Implant Dentistry and Related Research, Volume *, Number *, 2012
RESULTS
Summary of Patient Data
A total of two hundred seventeen sinus lifts and
four hundred sixty-two implants were placed simultaneously
in one hundred sixty-one patients. Among one
hundred sixty-one patients, 56 patients (male : female
[M : F] = 39:17) received bilateral sinus lifts and one
hundred five patients had unilateral sinus lifts and
implant installation (M : F = 57:48). The mean duration
of follow-up of patients after implant placement was
57.1 1 15.6 (36–98) months. Implants were installed
from the first premolar to second molar area (78.2%
molars). A total of two hundred sixty-two of four
hundred sixty-two implants (56.7%) were placed in
ridges that had residual bone height of <5 mm(group 1)
and two hundred implants (43.3%) were installed in
35 mm (group 2). Distribution of the implants placed
in each group and diameters of implants were listed
in Table 2.
Survival and Success Rates
A total of five implants from four patients (M : F = 3:1)
were removed during the follow-up periods. The cumulative
survival rate was 98.91% (four hundred fifty-seven
of four hundred sixty-two). The survival rate was
slightly higher in group 2 than in group 1 according to
Kaplan-Meier survival analysis but was not statistically
significant (p = .2866, Figure 4).
After second-stage surgery, no patient presented
with persistent pain, peri-implant infection with
suppuration, and mobility of implant. A total of 11
implants (group 1 = three implants; group 2 = eight
implants) in seven patients (M : F = 3:4) showed more
bone loss than the acceptable parameters according to
Albrektsson and colleagues’ success criteria (>1.5 mmof
marginal bone loss in the first year of function or
>0.2 mm in the subsequent years). Including the five
implants that were removed, a total of 16 implants did
not follow the implant success criteria. The cumulative
success rate was 96.54% (group 1 = 97.33%, group
2 = 95.50%) (Table 3). According to chi-square test
(Table 4), there was no statistically significant difference
in success rate between the two groups (p = .3135).
Clinical photographs and radiographs of one-stage
surgery and implant installation are shown in Figure 5,
A–E.
Sinus Membrane Perforation and
Implant Success
A total of 35 of two hundred seventeen (16.13%) sinus
membranes were perforated during surgery. Membrane
perforations were repaired with collagen membrane,
fibrin glue. Bone grafts and implants were installed as
planned without delay in any case. A total of 68 of four
hundred sixty-two (14.72%) implants were placed in
perforated sinuses and three (4.41%) implants of these
failed. According to chi-square test with Fisher’s exact
test (Table 5), there was no statistically significant difference
in success rate between the implants placed in perforated
and nonperforated sinuses (p = .7162).
Smoking Habits in Implant Success
Among one hundred sixty-one patients, 18 patients
(M : F = 17:1) were smokers. They were heavy smokers
and all of them smoked at least 10 cigarettes a day before
TABLE 2 Distribution of Implant Diameter by
Residual Alveolar Bone Height
RAB
Implants
Diameter (mm) No. Placed
1–4 mm 3.4 3
3.8 46
4.3 96
4.8 117
Total 262
5–8 mm 3.4 6
3.8 31
4.3 86
4.8 77
Total 200
RAB = residual alveolar bone.
Figure 4 Kaplan-Meier survival analysis between group 1 and
group 2.
Simultaneous Sinus Lift and Implant Installation 5
and after operation.A total of 48 implants were placed in
smokers and seven (14.58%) implants failed, whereas a
total of four hundred fourteen implants were placed in
nonsmokers and nine (2.17%) implants failed. According
to chi-square test with Fisher’s exact test (Table 6),
there was a statistically significant difference in success
rate between the smokers and nonsmokers (p = .0003)
and implants placed in smokers and nonsmokers
(p = .0005).
Management of Failed Implant
The causes of the five implant removals were the following:
one implant with acute infection and suppuration 1
month after surgery, three implants with loss of integration
during uncovery surgery, and one implant removal
due to significant peri-implant bone loss after 2 years of
loading. The implant that was removed due to acute
postoperative infection had a membrane perforation.
After 3 months of healing, a short implant (8 mm
length, 4.8 mm–diameter) was placed in the failed
implant site. The implant was considered successful
during a 3-year follow-up (Figure 6, A–C).
The three implants (two patients) that were
removed during uncovery surgery were replaced with
wider diameter implants at the failed sites. All replaced
implants integrated after 6 months of healing and
definitive restorations were delivered successfully. The
implant that was removed after 2 years was the middle
implant of three consecutive implants that were restored
with a fixed partial denture. The patient was a heavy
smoker who smoked more than 40 cigarettes/day. The
implant was removed and the void in the definitive restoration
that was associated with the failed implant was
filled with resin.
DISCUSSION
Sinus lifting is a predictable treatment option for hard
tissue augmentation in the maxillary sinus for facilitation
of implant placement. In a systematic review of
dental implants placed in the posterior maxilla using
sinus lifting and bone graft,Wallace and Froum17 demonstrated
an average survival rate of 92.6% and Del
Fabbro and colleagues12 reported an average survival
rate of 91.5%. A systematic review about simultaneous
sinus lifting and implant placement reported a survival
rate of 90.1% after 3 years of follow-up.18 In the present
study, the cumulative survival and success rates were
TABLE 3 Residual Alveolar Bone Height and Survival, Success Rate
RABH (mm) NOI Removed Failed TF FR
Group 1 1 37 0 1 1 0.22
2 60 2 0 2 0.43
3 92 1 1 2 0.43
4 73 1 1 2 0.43
Group 2 5 69 0 4 4 0.87
6 87 1 1 2 0.43
7 44 0 3 3 0.65
Total 462 5 11 16 3.46
Group 1: residual alveolar bone height of <5 mm; group 2: alveolar bone height of 35 mm.
FR = failure rate; NOI = number of implants placed; RABH = residual alveolar bone height; TF = total failed implants.
TABLE 4 Implant Success according to the Residual Alveolar Bone
Number of Implants
Success Failure Success Rate p Value
Group 1 255 7 97.33% (255/262) .3135
Group 2 191 9 95.50% (191/200)
Total 446 16 96.54% (446/462)
Group 1: residual alveolar bone height of <5 mm; group 2: alveolar bone height of 35 mm.
6 Clinical Implant Dentistry and Related Research, Volume *, Number *, 2012
98.5% and 95.6%, respectively, with an average
follow-up of 57.1 1 15.6 (36–98) months. The results
were favorable compared with other reports despite the
fact that the implants were placed immediately during
sinus lift surgery irrespective of residual bone height
using only Bio-Oss as the bone substitute.19–21 These
differences may be attributed due to implant design,
surface treatment, and surgical skill.
Sinus lifting and implant placement are typically
separated into two stages of surgery when residual
alveolar bone height is less than 4 to 5 mm. However,
these criteria were arbitrarily established when parallel
A B
C
E
D
Figure 5 A, Panoramic radiograph showing loss of right maxillary second premolar and pneumatization of the maxillary sinus. The
residual alveolar bone was 3 mm. B, After elevation of the full-thickness flap, window design was drawn using sterilized pencil. C,
Removal of the lateral sinus wall (wall-off technique). D, After bone graft and implant installation, lateral wall was repositioned to
the original site. E, Panoramic radiograph 4 years after operation.
TABLE 5 Sinus Membrane Perforation and Implant
Success
MP No. of Sinus Success Failure p Value
Yes 35 65 3 .7162
No 182 381 13
Total 217 446 16
Failure = failed implant; MP = membrane perforation; Success =
successful implant.
Simultaneous Sinus Lift and Implant Installation 7
implant designs were the only available options.
Studies demonstrated that marginal bone loss was not
related to the amount of preoperative residual bone
and that success rate was similar when primary stability
was achieved.9,19 In the present study, residual alveolar
bone was divided into two groups according to
Jensen’s criteria of 4 mm and showed that residual
alveolar bone had no effect on the survival and success
rates of implants. The benefits for sinus lifting and
simultaneous implant placement are the following:
reduced number of surgeries, reduced treatment time,
and lateral window access to the maxillary sinus during
implant placement. Fixture designs (e.g., implant
taper) can affect the initial stability of the implant.22
Tapered implant designs increase the compression of
bone and primary stability when placed into a conventional
parallel osteotomy.23 O’Sullivan and colleagues
demonstrated that a 1° taper had more initial stability
than parallel implants and a 2° taper could not be
inserted completely in the same osteotomies. Because
primary stability is important in achieving osseointegration,
2,19 selecting implants that maximize primary
stability is essential when bone is limited in the maxillary
sinus. In this study, tapered implants were used
and had comparable success rates between residual
bone heights of 1 to 4 and 5 to 8 mm.
TABLE 6 Smoking and Implant Success
Smoking No of Pt. Success Failure p Value NOI Success Failure p Value
Yes 18 12 6 .0003 48 41 7 .0005
No 143 138 5 414 405 9
NOI = number of implants; Pt = patients.
A
B C
Figure 6 A, Sinus lifting and implant installation. Membrane was perforated during sinus lifting. Implant was removed after 1
month. B, Short implant was placed 3 months after healing. C, Definitive restoration after 3-year follow-up.
8 Clinical Implant Dentistry and Related Research, Volume *, Number *, 2012
A variety of bone graft materials may be used for
sinus augmentation including autogenous bone from
intraoral and extraoral sites, no graft, mineralized or
demineralized freeze-dried allogeneic bone, xenogenic
bone, alloplastic (e.g., hydroxyapatite and tricalcium
phosphate), growth factors, or combination of
materials.24–29 Hurzeler and colleagues30 reported that
there were no differences in implant survival rate with
five different grafting materials. Maiorana and colleagues
demonstrated that alloplasts and xenografts
were reliable for bone regeneration in subantral cavities.
25 In the present study, xenograft alone was used to
augment the maxillary sinus floor. The advantages of
xenografts are the following: no additional surgical site
for bone harvesting, reducing surgical time, and lower
resorption rate.31
The most common intra-operative complication in
sinus lifting is the perforation of the Schneiderian membrane
that has an average occurrence of 19.5% (range
5–56%).32–35 This investigation had a membrane perforation
rate of 16.13%, which was comparable with other
studies. Several authors have reported that membrane
perforation was associated with an increased
failure rate,32 whereas other studies demonstrated that
adequately repaired perforations have no effect on the
survival of implants.9 In the present study, membrane
perforations were repaired with Bio-Gide and fibrin
glue, and its occurrence did not have a significant
adverse effect on implant survival and success. A modified
Caldwell-Luc approach was used in this study. To
prevent membrane exposure, a diamond bur was used
when the window preparation was in close proximity to
the Schneiderian membrane. After isolating the lateral
bony window, it was temporarily removed (rather than
infracturing into the sinus), which increased access and
visibility for membrane dissection and insertion of sinus
elevation instruments. After placement of graft materials,
the sinus opening was covered with the lateral bony
window36 to function as a barrier membrane. Studies
reported that placement of a membrane over the lateral
window had higher implant survival rates than without
a membrane.13,37 Cho and colleagues suggested that the
repositioned bony window is an adequate membrane
after demonstrating healing of the window and regeneration
in the gap with the lateral wall borders.38
Smoking has been associated with increased risk of
implant failure.39,40 In a prospective clinical investigation,
Bain andMoy demonstrated an implant failure rate
of 11.3% for smokers and 4.8% for nonsmokers. Dental
implants placed in grafted maxillary sinuses are also
associated with higher implant failures. Kan and colleagues
demonstrated higher failure rates in smokers
than in nonsmokers in a retrospective study, evaluating
dental implants in grafted sinuses. The present study is
in agreement with these findings and revealed an association
of smoking with a higher failure rate (14.58% for
smokers and 2.17% for nonsmokers) of implants placed
immediately into grafted sinuses.
CONCLUSION
Sinus lifting with simultaneous implant placement can
be used to treat the atrophic maxilla in patients irrespective
of residual bone when careful surgical methods and
taper designed implants are used. Immediate sinus lift
with implant placement can reduce the number of surgeries
and overall treatment time. Smoking is a possible
factor for implant failure. Membrane perforation did
not have an adverse effect on implant success if the
membrane was properly repaired.
ACKNOWLEDGMENTS
This study was self-funded and all authors declare no
interests with any company enlisted in this study.
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Simultaneous Sinus Lift and Implant Installation 11


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