The PES reproducibly evaluates peri-implant soft tissue around single-tooth implants. Thus, an objective outcome of different surgical or prosthodontic protocols can be assessed. Orthodontists were clearly more critical than the other observers.

The maxillary blood supply is essential for preserving the vitality of the affected maxillary region, integration of the grafting material, and wound healing such as following sinus floor elevation. Although it is well established that edentulous maxillae demonstrate a decreasing vascularity as bone resorption progresses, the vascular conditions relevant to sinus floor elevation procedures have not been investigated yet. This study deals with maxillary arteries relevant to sinus floor elevation surgery and examines the vascularization of the lateral maxilla after tooth loss. The vessels of the lateral maxilla of 18 maxillary specimens (10 male, 8 female, mean age 67 years) were prepared anatomically and the local main arteries, the number of macroscopically discernible branches and anastomoses, their calibers, and the distance between the caudal main branches and the alveolar ridge recorded. The lateral maxilla is supplied by branches of the posterior superior alveolar artery (PSAA) and the infraorbital artery (IOA) that form an anastomosis in the bony lateral antral wall, which also supplies the Schneiderian membrane. This intraosseous anastomosis was found in all of the specimens. Eight of 18 also showed an extraosseous anastomosis between PSAA and IOA, vestibular to the antral wall, giving off an average of 3 branches cranially and 5 branches caudally. The two anastomoses form a double arterial arcade to supply the lateral antral wall and, partly, the alveolar process. The PSAA had a mean caliber of 1.6 mm and exhibited an average of 2 endosseous and 1 extraosseous branches. The IOA had a mean diameter of 1.6 mm and showed an average of 1 endosseous and 3 extraosseous branches. The mean distance between the intraosseous anastomosis and the alveolar ridge was 19 mm in 2 defined measuring sites. Its mean length was 44.6 mm. The epiperiosteal vestibular anastomosis was situated further cranially at a mean distance of 23 to 26 mm from the alveolar ridge and had a mean length of 46 mm. The rather large caliber of the vessels supplying the lateral antral wall seems to be crucial to the fact that the periosteal blood supply is maintained even in severe maxillary atrophy and after complete disappearance of the centro-medullary vessels.

This experimental study in animals examines the value of bovine hydroxyapatite as grafting material in one-stage sinus lift procedure. The Schneiderian membrane was elevated from extraorally in 54 sinuses of 27 adult female mountain sheep. Two titanium plasma-flame-spray coated cylindrical implants were placed in each sinus in the same session. In 2 groups of 18 sinuses each, the subantral hollow space was filled with bovine hydroxyapatite and autogenous cancellous bone from the iliac crest, respectively. Eighteen sinuses that were left empty served as a control group. Polyfluorochrome sequential labelling (tetracycline, calcein green, alizarin complexon) was carried out 4 weeks postoperatively, 2 weeks before the animals were sacrificed, and halfway through the observation period to assess new bone formation. The selected observation periods were 12 weeks, 16 weeks, and 26 weeks. Six sinuses per observation period and test group were available for histologic evaluation. All implants showed favourable osseointegration into local bone. New bone formation was observed in a triangular area bound by the implant surface, the local buccal antral wall, and submucous connective tissue in all implants. Bovine hydroxyapatite adjacent to local bone was mainly surrounded by bone tissue. There was a great variation in the extent of bony sheathing of the hydroxyapatite particles, irrespective of the animals' survival time. Macrophages were found around HA particles that were not surrounded by bone as well as on free implant surfaces. The mean length of the bone-implant bond was 3.86 mm in the group of empty sinuses, 4.87 mm in the group augmented with hydroxyapatite, and 5.66 mm in the group augmented with autogenous cancellous bone. During the observation period, the relative length of bone in direct contact with the implant surface increased from 20.0% to 25.1% in the control group, from 30.4% to 35.5% in the group treated with autogenous cancellous bone, and from 27.4% to 34.7% in the HA group. Autogenous cancellous bone showed a significantly greater bone-implant contact than did the control group (P = 0.0004) and the HA group (P = 0.0499). When the apical implant portions were examined separately, both HA (P = 0.006) and autogenous cancellous bone (P = 0.005) showed a significantly better bone-implant bond than did the control group.

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