Available online 20 March 2024

Author links open overlay panel, , , ABSTRACTStatement of problem

Rehabilitation of elderly or medically compromised patients with an atrophied unilateral posterior maxillary ridge by an implant-supported prosthesis may be complicated by maxillary sinus pneumatization with insufficient bone for implant placement.

Purpose

This short-term clinical trial assessed clinical results of closed sinus lift and fixed prosthesis versus implant-assisted overdentures in the management of participants with atrophied distal extension maxillary ridges.

Material and methods

Forty participants with unilateral atrophying distal extension maxillary ridges were randomly assigned into 2 groups. The CSL group (n=20) participants received fixed prostheses supported by 3 implants following a closed sinus lift. The IOD group (n=20) participants received removable partial overdentures assisted by a single implant that was positioned mesially to the maxillary sinus. The modified plaque index (MPI), modified gingival index (MGI), pocket depth (PD), implant stability (IS), and vertical bone loss (VBL) were measured at prosthesis delivery (T0), and 6 (T6) and 12 months (T12) after delivery. The oral health impact profile (OHIP-14) questionnaire was used to assess oral health-related quality of life (OHRQoL) at T12. Significant differences between observation times were performed using Friedman and Wilcoxon signed-rank tests for MPI and MGI and using repeated measures ANOVA with Bonferroni correction of P values for PD, IS, VBL, and OHIP. Between-group comparison of MPI and MGI the Mann-Whitney test was used, while for PD, IS, VBL, and OHIP comparison was made using independent samples t test (α=.05 for all tests).

Results

The implant survival rates were 100% for both groups. MPI and PD significantly increased with time for both groups. MGI significantly increased with time for the CSL group only (P=.049). The IS significantly decreased with time for the IOD group. VBL increased significantly from T6 to T12 for the CSL (P=.042) and the IOD (P=.002) groups. The CSL group recorded higher MPI, MGI, PD, and IS values than the IOD group (P<.05). The IOD group recorded higher VBL than the CSL group (P<.001). The CSL group scored significantly lower OHIP-14 values (better OHRQoL) than the IOD group for all values (P<.05).

Conclusions

In comparison with implant-assisted partial overdentures, closed sinus lift with fixed prostheses had higher implant stability, reduced bone loss, and higher participant OHRQoL. However, peri-implant soft tissue health was found to be better with implant overdentures.

Section snippetsMATERIAL AND METHODS

A 2-arm parallel randomized controlled clinical trial including 40 partially edentulous participants with unilaterally atrophying distal extension maxillary ridges was conducted. Participants were enrolled from the Prosthodontic Department outpatient clinic between March and June 2021. A computer software program (G*power version 3.1.5; Heinrich Heine University Düsseldorf) was used to conduct power analysis to determine the sample size. The calculations were made using data from earlier

RESULTS

The baseline criteria for participants in both groups are presented in Table 1. The baseline criteria of the 2 groups were statistically similar. The implant survival rates were 100% for both groups. However, as time progressed, both groups showed a significant increase in MPI (P<.001). At T0, no difference in MPI and MGI was found between the 2 groups. However, at T6 and T12, the CSL group had significantly higher MPI than the IOD group (P=.044 and P=.021, respectively). Additionally, only the

DISCUSSION

The closed sinus lift, together with the flapless computer-guided surgical approach, was used as a minimally invasive procedure that has been associated with reduced postoperative edema and discomfort, making it appropriate for elderly or medically compromised patients.16 Additionally, this technique improves implant placement accuracy and reduces surgery time with less bone graft material.

The null hypothesis that no significant differences in clinical outcomes would be found between the 2

CONCLUSIONS

Based on the findings of this clinical study, the following conclusion was drawn:

1.

Except for peri-implant soft tissue health, the closed sinus lift with fixed prostheses achieved good clinical outcomes compared with implant-assisted overdentures for managing atrophied distal extension maxillary ridges.

PATIENT CONSENT

Informed patient consent has been obtained.

REFERENCES (39)J.J. da Rocha Ferreira et al.Effect of crown-to-implant ratio and crown height space on marginal bone stress: A finite element analysis

Int J Implant Dent

(2021)

G.G. Zafiropoulos et al.Rehabilitation of an extremely edentulous atrophic maxilla with a pseudoskeletal class III relationship

Case Rep Den

(2019)

C.H. Hämmerle et al.A systematic review of the survival of implants in bone sites augmented with barrier membranes (guided bone regeneration) in partially edentulous patients

J Clin Periodontol

(2002)

B.S. McAllister et al.Bone augmentation techniques

J Periodonto

(2007)

M. Chiapasco et al.Le Fort I osteotomy with interpositional bone grafts and delayed oral implants for the rehabilitation of extremely atrophied maxillae: A 1-9-year clinical follow-up study on humans

Clin Oral Implants Res

(2007)

R.B.J.C. SummersThe osteotome technique: Part 3--Less invasive methods of elevating the sinus floor

Compendium

(1994)

M. Del Fabbro et al.Systematic review of survival rates for implants placed in the grafted maxillary sinus

Int J Periodontics Restorative Dent

(2004)

M. Esposito et al.A 3-year post-loading report of a randomised controlled trial on the rehabilitation of posterior atrophic mandibles: Short implants or longer implants in vertically augmented bone?

Eur J Oral Implantol

(2011)

M. Leung et al.Patient-related risk factors for maxillary sinus augmentation procedures: A systematic literature review

Int J Periodontics Restorative Dent

(2021)

View full text

Copyright © 2024 by the Editorial Council of The Journal of Prosthetic Dentistry. All rights reserved.