AimTo comparatively evaluate the morbidity following maxillary sinus floor elevation according to either transcrestal (tSFE) or lateral (lSFE) approach with concomitant implant placement.Materials & MethodsPatients with ≥1 edentulous maxillary posterior site with residual bone height (RBH) of 3–6 mm were enrolled. tSFE was performed in association with a xenograft and a collagen matrix. For lSFE, the sinus was grafted with the xenograft, and the antrostomy was covered with a membrane. Implants were inserted concomitantly. The postoperative course was assessed through questionnaires. Pain level (VAS pain) was recorded using a 100‐mm visual analogue scale.ResultsTwenty‐nine and 28 patients were included in tSFE and lSFE group, respectively. On the day of surgery, VAS pain was significantly higher for tSFE compared to lSFE, and similar from day 1 to 14. tSFE was characterized by significantly lower incidence of swelling, bruising and nasal discharge/bleeding. Significantly less severe limitation in swallowing, continuing daily activities, eating, speaking, opening the mouth and going to school/work was found for tSFE only at specific postsurgery intervals.Conclusions lSFE was associated with lower pain on the day of surgery, and tSFE revealed lower postoperative morbidity as well as more tolerable postoperative course.

Objectives To comparatively evaluate the radiographic outcomes of transcrestal and lateral sinus floor elevation (tSFE and lSFE, respectively) when applied concomitantly with implant placement. Materials and methods Patients with at least 1 edentulous site with residual bone height (RBH) of 3–6 mm were enrolled in a bi‐center, parallel‐arm, randomized trial. Both tSFE and lSFE were associated with a bovine‐derived xenograft, and implants were inserted concomitantly. In lSFE group, the antrostomy was covered with a resorbable collagen membrane. Marginal bone loss and the maturation of the grafted area were evaluated on periapical radiographs at 6 and 12 months. Twelve‐month CT/CBCT was used to assess the effect of grafting procedures circumferentially around the implant. A per‐protocol analysis was performed. Results The per‐protocol study population consisted of 26 patients in the tSFE group and 28 patients in the lSFE group. At 12 months, the median proportion of the implant surface in contact with the peri‐implant radiopaque area was 100% in both groups, with no significant inter‐group difference. Suboptimal bone‐to‐implant contact was observed in 13% and 3.6% of tSFE and lSFE cases, respectively. In both groups, marginal bone loss was minimal (≤1 mm) and infrequent, and the radiographic aspect was suggestive of an advanced stage of maturation. Conclusions At sites with RBH of 3–6 mm where implants are placed concomitantly with sinus floor elevation, tSFE and lSFE are both highly predictable in obtaining an implant surface completely embedded in a radiopaque area at 12 months post‐surgery. (ClinicalTrials.gov ID: NCT02415946).

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The aim of this study was to evaluate histologically and biomechanically the peri-implant bone healing around implants placed with high torque after a follow-up of 8 and 12 weeks. A total of 12 implants were placed in the lower edge of the mandible of 2 sheep. In each sheep, 3 implants were placed with a low torque (<25 N · cm, LT group) as a control, and 3 implants were placed with a high insertion torque (maximum torque, HT group). The sheep were killed after 8 and 12 weeks of healing, and the implants were examined for removal torque, resonance frequency analysis, and histologic analysis.The mean insertion torque in the LT group was 24 N · cm, whereas it was 105.6 N · cm in HT. All the implants osseointegrated and histologic analysis showed similar aspects of the peri-implant bone tissue for both groups and both healing times. Mean removal torque values for LT implants were 159.5 and 131.5 N · cm after 8 and 12 weeks, respectively, whereas those for the HT were 140 and 120 N · cm at 8 and 12 weeks, respectively. Implant stability quotient values were 26.6 and 76 for the LT group and 74 and 76 for the HT group at 8 and 12 weeks, respectively.It could be concluded that high implant insertion torque does not induce adverse reaction in cortical bone and does not lead to implant failure.

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