Aims: To evaluate the clinical and radiographic results of dental implant placed using osteotome sinus floor elevation (OSFE) with and without simultaneous grafting. Materials & Methods: Forty-five patients were randomly assigned into two groups: Group1: OSFE with deproteinized bovine bone mineral (DBBM) mixed with autogenous bone chips, and Group2: OSFE without grafting. The endosinus bone gain (ESBG) was assessed on radiographs at 6, 12, 24, 36 months following surgery as primary outcome measurement. Implant survivals and marginal bone loss (MBL) were assessed as secondary outcome measurements. Results: Twenty-one implants in Group1 and 20 implants in Group2 were analysed. The residual bone height (RBH) was 4.63 AE 1.31 mm in average (4.67 AE 1.18 mm for Group1 and 4.58 AE 1.47 mm for Group2). The 3-year cumulative survival rates of implants were 95.2% for Group1 and 95.0% for Group2. The ESBG in Group1 reduced from 5.66 AE 0.99 mm at 6 months to 3.17 AE 1.95 mm at 36 months, whereas the ESBG in Group2 increased from 2.06 AE 1.01 mm at 6 months to 3.07 AE 1.68 mm at 36 months. The MBL after 3 years was 1.33 AE 0.46 mm in Group1 and 1.38 AE 0.23 mm in Group2. Conclusions: OSFE and simultaneous implant installation with and without grafting both resulted in predictable results. The application of grafting materials has no significant advantage in terms of clinical success. The posterior maxilla is often difficult for implant placement due to the poor bone quality and insufficient bone volume. Maxillary sinus floor elevation is one of the solutions to solve this problem.There are two major approaches to enter sinus cavity and elevate sinus membrane: the lateral approach and transalveolar technique. The transalveolar sinus floor elevation or osteotome sinus floor elevation (OSFE) was first introduced by Tatum (1986) and modified by Summers (1994) later. The literature mainly reported predictable results of implants placed with OSFE (Tan et al. 2008), which is considered much less invasive and traumatic than the lateral approach.However, there is still controversy regarding the necessity of simultaneous grafting materials in OSFE procedure. Autogenous, allogenic or xenogenic grafting materials are often filled into the elevated area to maintain the space for new bone formation

High survival rates for both the implants and the prostheses could be achieved after 5-10 years for short implants supporting single crowns, without severe marginal bone loss and complications. One may conclude that a single crown supported by a short implant is a predictable treatment modality. However, short implants in type IV bone sites should be applied with caution.

The esthetic outcome of soft tissue around the single-tooth implant had improved significantly at follow-up compared with baseline according to PES assessment. The results suggested that the potential for significant changes in soft-tissue levels after restorative therapy needs to be considered for single-implant therapy in the anterior maxilla.

Chemical modification to produce a hydrophilic microrough titanium (Ti) implant surface has been shown to increase osseointegration compared with microrough topography alone. This study aimed to investigate the roles of PI3K/Akt signaling pathway in regulating proliferation and differentiation of osteoblasts in response to surface microroughness and hydrophilicity. Ti disks were manufactured to present different surface morphologies: a smooth pretreatment surface (PT), a rough hydrophobic surface that was sand-blasted, large-grit, acid-etched (SLA), and an SLA surface with the same roughness that was chemically modified to possess high wettability/hydrophilicity (SLActive/modSLA). MC3T3-E1 cells were cultured on these substrates with or without LY294002, a PI3K inhibitor, and their behaviors, including cell viability (MTT colorimetric assay), alkaline phosphatase (ALP) activity, and osteogenic genes expression of osteopontin (OPN) and osteocalcin (OCN) were measured. Western blot was applied to detect the expression of PI3K/Akt signal pathway proteins. The results showed that a decrease in osteoblast proliferation associated with the Ti surfaces (SLActive > SLA > PT) correlated with an increase in activity of the osteogenic differentiation markers ALP. The peak of ALP activity appeared earlier at 7 days for the SLActive surfaces compared with the SLA and PT surfaces. Osteoblast proliferation, as well as the level of p-Akt, was significantly inhibited by LY294002 in all three Ti surfaces. The top value of ALP activity was increased with the inhibition of PI3K/Akt signaling pathway while the time of the peak appeared was not advanced. The expression levels of OPN and OCN were upregulated by the effect of surface roughness and hydrophilicity, which were further enhanced by LY294002. In conclusion, osteogenic responses to SLActive surface were moderately better than the SLA surface and protein expression studies indicated that PI3K/Akt signaling activation may be responsible for this increased osteogenic differentiation. Surface microroughness and hydrophilicity may affect osteoblast functions by targeting osteoblast proliferation and the early stage of osteoblast differentiation through PI3K/Akt signaling pathway.