Minimal invasiveness in the transcrestal elevation of the maxillary sinus floor: A systematic review

Abstract

In the attempt to reduce the invasiveness of a transcrestal sinus floor elevation procedure, different aspects must be considered; that is, the minimization of intra‑ and postsurgery morbidity, the reduction of treatment time, and the simplification/elimination of the reconstructive technology. Within this context, a systematic literature search was performed for controlled clinical trials evaluating the impact of one or more of these aspects on transcrestal sinus floor elevation invasiveness. Nineteen articles (15 studies) were included. Overall, the results confirmed that transcrestal sinus floor elevation is a minimally invasive and effective option for bone augmentation in the edentulous, atrophic posterior maxilla. By using powered instruments rather than manual osteotomes and hand mallet, the invasiveness of transcrestal sinus floor elevation can be further reduced without affecting its clinical effectiveness. To impact effectively on morbidity, the key elements to consider when selecting instruments for transcrestal sinus floor elevation are (a) their availability as a standardized sequence, to be adapted on predetermined residual bone height, and (b) the possibility to control pressure (eg, with screwable osteotomes) and/or instrument excursion (eg, with stop devices) to fracture the maxillary sinus floor. Among powered instruments, a standardized sequence of drills incorporating a trephine drill seem to be particularly indicated, due to reduced chair time, high tolerability for the patient, and the possibility to isolate a bone core to implement histomorphometric outcomes. At molar extraction sites with an interradicular septum characterized by a height of at least 4 mm, immediate transcrestal sinus floor elevation and implant placement can be considered a valid option to shorten treatment time.

Six‐year extension results of a randomized trial comparing transcrestal and lateral sinus floor elevation at sites with 3–6 mm of residual bone

“…When considered in relation to data recorded at earlier observation intervals (Farina et al, 2019; Farina, Simonelli, Franceschetti, Minenna, et al, 2022), these results suggest that the minor modifications in peri‐implant bone support occurring on average in tSFE group do not compromise implant survival rate and peri‐implant health conditions at 6 years following surgery, thus similarly supporting tSFE and lSFE as equally valid options for the implant‐supported rehabilitation of the atrophic posterior maxilla. This consideration, however, should also be considered in the light of previous companion papers from the same clinical trial (Farina et al, 2018, 2019; Farina, Franzini, Minenna, et al, 2023; Farina, Simonelli, Franceschetti, Minenna, et al, 2022; Farina, Simonelli, Franceschetti, Travaglini, et al, 2022), the results of which favored tSFE for several aspects such as chair time, incidence of postoperative signs and symptoms, discomfort, dose of anesthesia, and amount of xenograft (see Farina, Franzini, Trombelli, & Simonelli, 2023 for review).…”

“…Transcrestal and lateral sinus floor elevation (tSFE and lSFE, respectively) are validated options to restore the ridge dimensions for implant placement at atrophic, edentulous maxillary posterior sites (Al‐Moraissi et al, 2019; Listl & Faggion Jr., 2010; Lundgren et al, 2017). Knowledge of the technical factors that are relevant for reducing the invasiveness has significantly expanded over the years (Farina, Franzini, Trombelli, & Simonelli, 2023, Valentini & Artzi, 2023), thus reinforcing the applicability of both interventions. Several randomized or quasi‐randomized trials have been conducted comparing tSFE and lSFE for chair time (Bacevic et al, 2021; Farina et al, 2018), morbidity (Al‐Almaie et al, 2017; Bacevic et al, 2021; Bensaha, 2011; Cannizzaro et al, 2009; Farina et al, 2018; Temmerman et al, 2017;Yu et al, 2017; Zhou et al, 2021), radiographic outcomes (Al‐Almaie et al, 2017; Bacevic et al, 2021; Bensaha, 2011; Cannizzaro et al, 2009; Farina et al, 2019; Temmerman et al, 2017; Yu et al, 2017; Zhou et al, 2021), surgery‐related costs and specific aspects of oral health‐related quality of life (Farina, Simonelli, Franceschetti, Travaglini, et al, 2022).…”

Effectiveness and complications of transcrestal sinus floor elevation using the cushioned grind‐out technique: A retrospective cohort study with up to 7 years of follow‐up

“…A greenstick fracture is accomplished using a special set of osteotomes to gain access to the Schneiderian membrane through the implant site. Subsequently, the membrane is elevated from the sinus floor with osteotomes, and grafting with biomaterials is performed (Farina, Franzini, et al, 2022). Following this creative technique, many modifications in surgery have been continuously attempted.…”

“…Following this creative technique, many modifications in surgery have been continuously attempted. Farina, Franzini, et al (2022) have summarized the two technical points of the modified TSFE: 'accessing to the maxillary sinus membrane through the implant site' and 'detaching the Schneiderian membrane from the maxillary sinus floor'. In the following text, the modified TSFEs are classified accordingly and listed in chronological order.…”

Sinus floor augmentation using crestal approach in conjunction with hydroxyapatite/cross‐linked collagen sponge: A pilot study

“…In this study, a transcrestal SFA (t‐SFA) was performed. T‐SFA was chosen in order to reduce the invasiveness of the surgery, 8 in particular, in terms of intra‐ and postoperative morbidity 9 . Moreover, this approach involves the simultaneous insertion of the dental implant and avoids second surgery.…”