The Use of the Facial Sinus Wall as Bone Shell Onlay Graft for Maxillary Posterior Ridge Reconstruction: A Retrospective Case Series

Stefan Krennmair; Michael Weinländer; Michael Malek; Thomas Forstner; Michael Stimmelmayr; Gerald Krennmair

doi:10.1111/clr.14387

The Use of the Facial Sinus Wall as Bone Shell Onlay Graft for Maxillary Posterior Ridge Reconstruction: A Retrospective Case Series

Clin Oral Implants Res. 2024 Dec 8. doi: 10.1111/clr.14387. Online ahead of print.

Authors

Stefan Krennmair^{1

2}, Michael Weinländer³, Michael Malek⁴, Thomas Forstner⁵, Michael Stimmelmayr⁶, Gerald Krennmair⁷

Affiliations

¹ Department of Oral and Maxillofacial Surgery, Keplerklinikum Linz, Johannes Kepler University (JKU) Linz, Linz, Austria.
² NumBiolab Research Associate, Ludwig-Maximilian University (LMU), Munich, Germany.
³ Dental School, Karl Franzens Medical University Graz, Graz, Austria.
⁴ Head of Department of Oral and Maxillofacial Surgery, Keplerklinikum Linz, Johannes Kepler University (JKU) Linz, Linz, Austria.
⁵ Department of Applied Systems and Statistics, Johannes Kepler University Linz (JKU), Linz, Austria.
⁶ Department of Prosthodontics, Ludwig-Maximilian University (LMU), Munich, Germany.
⁷ Head of Department of Prosthodontics, Dental School, Sigmund Freud Medical University of Vienna, Vienna, Austria.

PMID: 39648281
DOI: 10.1111/clr.14387

Abstract

Purpose: To evaluate the performance and clinical outcome of vertical and horizontal bone augmentation (VHBA) in posterior maxillary regions combining lateral window sinus floor elevation (LWSFE) with a horizontal bone shell technique applying the maxillary facial sinus wall as a bone plate.

Materials and methods: In 18 patients, LWSFE was combined with a horizontal bone shield augmentation procedure utilizing the maxillary facial sinus bone wall as a lateral bone plate. Both the sinus cavity and the lateral bone box created were grafted with a mixture of autogenous bone/venous blood and bovine bone mineral. The primary aim was to assess the performance of combined techniques enabling subsequent implant placement. Using radiographic measurements (preoperative, after VHBA, at implant placement, and at follow-up), bone gain/reduction of augmented horizontal ridge width (HRW) and vertical bone height (VBH) were evaluated. Additionally, clinical outcome assessing implant survival/success rate, marginal bone loss (MBL), and implant health (mucositis/peri-implantitis) was evaluated.

Results: For the combined VHBA techniques, HRW and VBH increased significantly (p < 0.001) from preoperative 3.5 ± 1.4 mm/3.6 ± 2.1 mm to 9.7 ± 1.9 mm/18.0 ± 1.6 mm post-augmentation. However, HRW and VBH dimensions decreased up to 8.9 ± 1.8 mm/17.1 ± 1.4 mm at implant placement and 8.6 ± 1.7 mm/16.7 ± 1.3 mm at follow-up evaluation (3.8 ± 1.8 years; p < 0.001, respectively). Augmented bone reduction was significantly higher (-7.7%) between the augmentation procedure and implant placement than in the post-implant-placement period (-2.5%). All implants survived (100%) representing peri-implant MBL of -0.9 ± 0.7 mm, pocket depth of 3.4 + 1.8 mm, and prevalences of 5%/0% for peri-implant mucositis/peri-implantitis.

Conclusion: The combination of horizontal bone augmentation using local bone shield transfer from the maxillary facial sinus wall with LWSFE enables sufficient reconstruction of maxillary posterior ridge.

Keywords: bone shield; horizontal augmentation; sinus augmentation.