OJST  Vol.3 No.9 , December 2013
The transcrestal hydrodynamic ultrasonic cavitational sinuslift: Results of a 2-year prospective multicentre study on 404 patients, 446 sinuslift sites and 637 inserted implants

Introduction: In 2006 an ultrasound-surgery-based method to hydrodynamically detach the sinus-membrane utilizing the ultrasonic cavitation effect—the tHUCSL—was developed and a surgical protocol established. The aim of the study was to determine the indication-range and success-rate of this novelty procedure. Materials & Methods: Between 2007 and 2009, 404 patients were treated by 6 oral surgeons of different experience-levels with the tHUCSL in 446 sinussites. 637 implants were inserted and then prosthodontically treated and observed and documented until December 2011. The subantral space was augmented via the 3 mm transcrestal approach with an augmentation volume of 1.9 ccm (+/? 0.988 ccm) and an augmentation height of 10.7 mm (+/? 2.85 mm). Results: Within the survey-period 15 (2.35%) of the 637 inserted implants were lost, mostly before implant loading due to postsurgical infection and nonosseointegration in the augmentation site. 1 implant was lost after implant loading and prosthetic treatment within 1 year after loading. The overall success rate with functional implants in site is 97.65% evenly distributed among the participating surgeons. 86% of the patients were observed with no postsurgical swelling and 87% no postsurgical pain. Discussion: The results suggest the tHUCSL to be a safe minimal-invasive alternative to traditional lateral approach and transcrestal osteotome sinuslift-procedures applicable to all anatomical situations.

Cite this paper
Troedhan, A. , Kurrek, A. , Wainwright, M. , Schlichting, I. , Fischak-Treitl, B. and Ladentrog, M. (2013) The transcrestal hydrodynamic ultrasonic cavitational sinuslift: Results of a 2-year prospective multicentre study on 404 patients, 446 sinuslift sites and 637 inserted implants. Open Journal of Stomatology, 3, 471-485. doi: 10.4236/ojst.2013.39078.
[1]   Boyne, P. and James, R.A. (1980) Grafting of the maxillary sinus floor with autogenous marrow and bone. Journal of Oral and Maxillofacial Surgery, 17, 113-116.

[2]   Tatum, O.H. (1986) Maxillary and sinus implant reconstruction. Dental Clinics of North America, 30, 207-229.

[3]   Chanavaz, M. (1990) Maxillary sinus: Anatomy, physicology, surgery and bone grafting related to implantology. Eleven years of surgical experience (1979-1990). Journal of Oral Implantology, 16, 199-209.

[4]   Summers, R.B. (1994) A new concept in maxillary implant surgery: The osteotome technique. Compendium of Continuing Education in Dentistry, 15, 152-162.

[5]   Summers, R.B. (1998) Sinus floor elevation with osteotomes. Journal of Esthetic and Restorative Dentistry, 10, 164-171. http://dx.doi.org/10.1111/j.1708-8240.1998.tb00352.x

[6]   Zitzmann, N.U. and Scharer, P. (1998) Sinus elevation procedures in the resorbed posterior maxilla: Comparison of the crestal and lateral approaches. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, 85, 8-17.

[7]   Raghoebar, G.M., Timmenga, N.M., et al. (2001) Maxillary bone grafting for insertion of endosseous implants: results after 12-124 months. Clinical Oral Implants Research, 12, 279-286.

[8]   Kahnberg, K.E., Ekestubbe, A., et al. (2001) Sinus lifting procedure. I. One-stage surgery with bone transplant and implants. Clinical Oral Implants Research, 12, 479-487.

[9]   Marx, R.E. and Garg, A.K. (2002) A novel aid to elevation of the sinus membrane for the sinus lift procedure. Implant Dentistry, 11, 268-271.

[10]   Engelke, E., Schlegel, A., et al. (2002) The endoscopically controlled osteotome sinus floor elevation: A preliminary prospective study. International Journal of Oral & Maxillofacial Implants, 17, 557-566.

[11]   Smiler, D.G. and Holmes, R.E. (1987) Sinus lift procedure using porous hydroxyapatite: A preliminary clinical report. Journal of Oral Implantology, 13, 239-253.

[12]   Block, M.S. and Kent, J.N. (1997) Sinus augmentation for dental implants: The use of autogenous bone. Journal of Oral and Maxillofacial Surgery, 55, 1281-1286.

[13]   Van den Bergh, J.P.A., Ten Bruggenkate, C.M., et al. (2000) Anatomical aspects of sinus floor elevations. Clinical Oral Implants Research, 11, 256-265.

[14]   Cordioli, G., Mazzocco, C., et al. (2001) Maxillary sinus floor augmentation using bioactive glass granules and autogenous bone with simultaneous implant placement. Clinical and histological findings. Clinical Oral Implants Research, 12, 270-278.

[15]   Cammack, G., Nevins, M., et al. (2005) Histologic evaluation of mineralized and demineralized freeze-dried bone allograft for ridge and sinus augmentations. International Journal of Periodontics and Restorative Dentistry, 25, 231-237.

[16]   Zijderveld, S.A., Zerbo, I.R., et al. (2005) Maxillary sinus floor augmentation using a beta-tricalcium phosphate (Cerasorb) alone compared to autogenous bone grafts. International Journal of Oral & Maxillofacial Implants, 20, 432-440.

[17]   Szabo, G., et al. (2005) A prospective multicenter randomized clinical trial of autogenous bone versus betatricalcium phosphate graft alone for bilateral sinus elevation: Histologic and histomorphometric evaluation. International Journal of Oral & Maxillofacial Implants, 20, 371-381.

[18]   Boyne, P.J., Lilly, L.C., et al. (2005) De novo bone induction by recombinant human bone morphogenetic protein-2 (rhBMP-2) in maxillary sinus floor augmentation. Journal of Oral and Maxillofacial Surgery, 63, 1693-707.

[19]   Kim, Y.-K., Yun, P.-Y., et al. (2009) Analysis of the healing process in sinus bone grafting using various grafting materials. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, 107, 204-211.

[20]   Wallace, S.S. and Froum, S.J. (2003) Effect of maxillary sinus augmentation on the survival of endosseous dental implants. A systematic review. Annals of Periodontology, 8, 328-343. http://dx.doi.org/10.1902/annals.2003.8.1.328

[21]   Wilk, R.M. (1999) Physiology of the maxillary sinus. Oral & Maxillofacial Surgery Clinics of North America, 11, 15-19.

[22]   Solar, P., Geyerhofer, U., et al. (1999) Blood supply to the maxillary sinus relevant to sinus floor elevation procedures. Clinical Oral Implants Research, 10, 34-44.

[23]   Lundgren, S., Anderson, S., et al. (2004) Bone reformation with sinus membrane elevation: A new surgical technique for maxillary sinus floor augmentation. Clinical Implant Dentistry and Related Research, 6, 165-173.

[24]   Celik D, Turan T, Kabukcuoglu F, et al. (2003) Bone induction capacity of the periosteum and neonatal dura in the setting of the zygomatic arch fracture model. Archives of Facial Plastic Surgery, 5, 301-308.

[25]   Ortak, T.O., et al. (2005) Osteogenic Capacities of periost grafts, periost flaps and prefabricated periosteal flaps: Experimental study. Journal of Craniofacial Surgery, 16, 594-600. http://dx.doi.org/10.1097/01.scs.0000168773.71356.62

[26]   Srouji, S., Kizhner, T., et al. (2009) The schneiderian membrane contains osteoprogenitor cells: In vivo and in vitro study. Calcified Tissue International, 84, 138-145.

[27]   Hernández-Alfaro, F., Torradeflot, M.M., et al. (2008) Prevalence and management of Schneiderian membrane perforations during sinus-lift procedures. Clinical Oral Implants Research, 19, 91-98.

[28]   Greenstein, G., Cavallaro, J., et al. (2008) Clinical recommendations for avoiding and managing surgical complications associated with implant dentistry: A review. Journal of Periodontology, 79, 1317-1329.

[29]   Anavi, Y., Allon, D.M., et al. (2008) Complications of maxillary sinus augmentations in a selective series of patients. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, 106, 34-38.

[30]   Li, J. and Wang, H.L. (2008) Common implant-related advanced bone grafting complications: Classification, etiology, and management. Implant Dentistry, 17, 389-401.

[31]   Katranji, A., Fotek, P., et al. (2008) Sinus augmentation complications: Etiology and treatment. Implant Dentistry, 17, 339-349.

[32]   Jerjes, W., Upile, T., et al. (2010) Experience in third molar surgery: An update. British Dental Journal, 209, E1. http://dx.doi.org/10.1038/sj.bdj.2010.581

[33]   Waseem, J., Mohammed, E., et al. (2006) Experience versus complication rate in third molar surgery. Head & Face Medicine, 2, 14.

[34]   Vercellotti, T., De Paoli, S., et al. (2001) The piezoelectric bony window osteotomy and sinus membrane elevation: Introduction of a new technique for simplification of the sinus augmentation procedure. International Journal of Periodontics and Restorative Dentistry, 21, 561-567.

[35]   Kfir, E., Kfir, V., et al. (2006) Minimally invasive antral membrane balloon elevation followed by maxillary bone augmentation and implant fixation. Journal of Oral Implantology, 32, 26-33. http://dx.doi.org/10.1563/782.1

[36]   Vitkov, L., Gellrich, N.C., et al. (2005) Sinus floor elevation via hydraulic detachment and elevation of the Schneiderian membrane. Clinical Oral Implants Research, 16, 615-621.

[37]   Sotirakis, E.G. and Gonshor, A. (2005) Elevation of the maxillary sinus floor with hydraulic pressure. Journal of Oral Implantology, 31, 197-204.

[38]   Troedhan, A.C., Kurrek, A., et al. (2010) Hydrodynamic ultrasonic sinus floor elevation—An experimental study in sheep. Journal of Oral and Maxillofacial Surgery, 68, 1125-1130. http://dx.doi.org/10.1016/j.joms.2009.12.014

[39]   Velázquez-Cayón, R., Romero-Ruiz, M.M., et al. (2012) Hydrodynamic ultrasonic maxillary sinus lift: Review of a new technique and presentation of a clinical case. Medicina Oral Patologia Oral y Cirugia Bucal, 17, e271-e275. http://dx.doi.org/10.4317/medoral.17430

[40]   Wainwright, M., Troedhan, A., et al. (2007) The IntraLift: A new minimal invasive ultrasonic technique for sinus grafting procedures. Implants, 3, 30-34.

[41]   Jank, S., Kurrek, A., et al. (2011) Rupture length of the sinus membrane after 1.2 mm puncture and surgical sinus elevation: An experimental animal cadaver study. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, 112, 568-572.

[42]   Wallace, S.S., Mazor, Z., et al. (2007) Schneiderian membrane perforation rate during sinus elevation using piezosurgery: Clinical results of 100 consecutive cases. International Journal of Periodontics and Restorative Dentistry, 27, 413-419.

[43]   Schaeren, S., Jaquiery, C., et al. (2008) Assessment of nerve damage using a novel ultrasonic device for bone cutting. Journal of Oral and Maxillofacial Surgery, 66, 593. http://dx.doi.org/10.1016/j.joms.2007.03.025

[44]   Pavlíková, G., Foltán, R., et al. (2011) Piezosurgery in oral and maxillofacial surgery. International Journal of Oral and Maxillofacial Surgery, 40, 451-457.

[45]   Schlee, M., Steigmann, M., et al. (2006) Piezosurgery: basics and possibilities. Implant Dentistry, 15, 334-340.

[46]   Seshan, H., Konuganti, K. and Zope, S. (2009) Piezosurgery in periodontology and oral implantology. Journal of Indian Society of Periodontology, 13, 155-156.

[47]   Del Fabbro, M., Corbella, S., et al. (2012) Implant survival rates after osteotome-mediated maxillary sinus augmentation: A systematic review. Clinical Implant Dentistry and Related Research, 14, e159-e168.

[48]   Yeong-Wook, K., Yoon-Seon, K., et al. (2010) A retrospective study of trans-crestal approach to maxillary sinus floor-elevation and simultaneous implant placement. Journal of the Korean Academy of Implant Dentistry, 29, 1-9.

[49]   Tan, W.C., Lang, N.P., et al. (2008) A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation Part II: Transalveolar technique. Journal of Clinical Periodontology, 35, 241-254.

[50]   Troedhan, A., Kurrek, A., et al. (2012) Biological principles and physiology of bone regeneration under the Schneiderian membrane after sinus lift surgery: A radiological study in 14 patients treated with the transcrestal hydrodynamic ultrasonic cavitational sinus lift (intralift). International Journal of Dentistry, 2012, Article ID: 576238.