Closed sinus lifting is a unique technique in being simple and less invasive (Summers, Compendium 15(6):698, 1994). However, it is blind to assess the safety of sinus lining during lifting without perforation. Previously, sinus membrane was assessed endoscopically in an invasive way. We aimed to judge clinically the sinus membrane integrity after crestal elevation by a direct simple less invasive endoscopic visual assessment through the crestal osteotomy site. To confirm undetected perforation, the sinus membrane was monitored dynamically by introducing the endoscope through a trephined opening in the lateral wall of the sinus (Nkenke et al., Int J Oral Maxillofac Implants 17(4):557–66, 2002).PatientsTwelve patients suffering atrophic posterior maxillae ranging 3–5 mm bone height below the sinus membrane were included to perform closed sinus lifting with simultaneous immediate implant placement under direct endoscopic assessment.ResultsThe floor was lifted without perforation in 83.33% of cases. However, it varied according to its thickness. Minor perforations occurred in two cases (16.67%). Both perforations were detected from the crestal endoscopic view while one of them was detected from the lateral endoscopic approach.ConclusionCrestal endoscopic access gives better direct vision to the membrane than the induced opening in the lateral wall of the maxillary sinus. Moreover, it uses the same prepared osteotomy site without doing any extra procedures. Perforation depends on the thickness of sinus lining and its ability to stretch during elevation. Intact crestal sinus floor elevation can never be guaranteed under endoscopic monitoring especially with thin irregular membranes.
Introduction: The achievement of good osseointegration in immediate implant placement can occur in the presence adequate primary stability. The insertion torque varies between cases depending on many factors. Aim: To assess clinically the impact of zero insertion torque on the survival of immediate implant placement in the maxilla for more than 5 years follow-up. Methods: A flapless immediate 2018 implants were in the maxilla in non-restorable single rooted teeth osteotomy site. The insertion torque of the implant was measured clinically by an integrated software. Results: The final insertion torque for 42 implants out of 2018 placed in fresh extraction sockets in the maxilla was zero (no primary stability). Their survival rate was 83.3%. Conclusions: The lack of certain conditions during immediate implant surgical installation and healing had the major effects on success. The loss of torque during immediate implant placement to zero may jeopardize the survival of the implants, but it may not be statistically significant with their failure and loss. The implant primary stability is not an absolute prerequisite to osseointegration; however, it may affect the implant survival rate.
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