The retrospective study of survival rate of implants with maxillary sinus floor elevation

Beom Jin Kim; Jae Hoon Lee

doi:10.5125/jkaoms.2010.36.2.108

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Kim and Lee: The retrospective study of survival rate of implants with maxillary sinus floor elevation

Original Article

J Korean Assoc Oral Maxillofac Surg 2010;36(2):108-118.

Published online: 10 January 2010

DOI: https://doi.org/10.5125/jkaoms.2010.36.2.108

The retrospective study of survival rate of implants with maxillary sinus floor elevation

Beom Jin Kim, Jae Hoon Lee

Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University, Cheonan, Korea

Jae-Hoon Lee Department of Oral and Maxillofacial surgery, Dental Hospital, College of Dentistry, Dankook University San 7-1 Sinbu-dong, Cheonan, Chungnam, 330-716, Korea TEL: +82-41-550-1995 FAX: +82-41-551-8988 E-mail: lee201@dankook.ac.kr

Received 4 March 2010 Revised 23 March 2010 Accepted 6 April 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction

Maxillary posterior region, compared to the mandible or maxillary anterior region, has a thin cortical bone layer and is largely composed of cancellous bone, and therefore, it is often difficult to achieve primary stability. In such cases, sinus elevation with bone graft is necessary.

Materials and Methods

In this research, 121 patients who had implant placement after bone graft were subjected to a follow-up study of 5 years from the moment of the initial surgery. The total survival rate, 5-year cumulative survival rate and the influence of the following factors on implant survival were evaluated; the condition of the patient (sex, age, general body condition), the site of implant placement, diameter and length of the implant, sinus elevation technique, closure method for osseous window, type of prosthesis and opposing teeth.

Results

1. The 5-year cumulative survival rate of total implants was 90.5%, there was no significant difference between sex, age, the site of implant placement, diameter and length of the implant, sinus elevation technique, and the type of opposing teeth. 2. Patients with diabetes mellitus & osteoporosis and smooth-surfaced machined group & hydroxyapatite (HA)-treated group and homogenous demineralized freeze dried allogenic bone (DFDB) bone graft only group had significantly lower survival rate. 3. With less than 4 mm of residual alveolar ridge height, lateral approach without closing the osseous window resulted in a significantly lower survival rate. 4. Restoration of a single implant showed a significantly lower survival rate, compared to cases where the superstructure was joined with several implants in the area.

Conclusion

Patients with diabetes or osteoporosis need longer period of time for osseointegration compared to the normal, and the dentists must be prudent when choosing a surface treatment type and the bone graft material. Also, as the vertical dimension of the residual alveolar ridge can influence the result, staged implant placement should be considered when it seems difficult for the implant to gain primary stability from the residual bone with less than 4 mm of vertical dimension. It is recommended to obdurate the bone window and that the superstructure be connected with several impants in the peripheral area.

Keywords: Maxillary sinus, Dental implants, Survival rate

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Fig. 1.

Kaplan-Meier survival analysis.

Table 1.

Patient distribution according to gender

Gender	Number of patient	Number of implant	%
Male	68	172	60.4
Female	53	113	39.6
Total	121	285	100

Table 2.

Patient distribution according to age

Age	Number of implant	%
21–30	5	2
31–40	31	11
41–50	85	30
51–60	96	34
61–70	68	23
Total	285	100

Table 3.

Cumulative survival rate of implants placed in sinus elevated maxilla

Time	Implant at interval start	Failed implant during interval	Survived implant	Survival rate (%) in interval	C.S.R.(%)
Placement to loadin	ng 285	19	266	93.3	93.3
Loading to 1 yr	266	5	261	98.1	91.6
1 to 2 yr	261	2	259	99.2	90.9
2 to 3 yr	259	1	258	99.6	90.5
3 to 5 yr	258	0	258	100.0	90.5

Table 4.

Survival rate of implant according to gender

Gender	State		Survival rate (%)	P value
Gender	Placed	Failed	Survival rate (%)	P value
Male	154	18	89.5	0.663
Female	104	9	92.0	0.663

Table 5.

Survival rate of implant according to age

Age	State		Survival rate (%)	P value
Age	Placed	Failed	Survival rate (%)	P value
21–30	5	0	100
31–40	26	2	92.9
41–50	78	7	91.8	0.706
51–60	88	11	88.9
61–70	61	7	89.7

Table 6.

Survival rate of implant according to general disease

General disease	State S		Survival rate (%)	P value
General disease	Placed	Failed	Survival rate (%)	P value
Normal	123	9	93.2
Diabetes mellitus	47	8	85.5	0.002
Osteoporosis	30	6	83.3
Others	58	4	93.5

Table 7.

Survival rate of implant according to implant location

Site	State		Survival rate (%)	P value
Site	Placed	Failed	Survival rate (%)	P value
1 premolar	18	1	94.7
2 premolar	52	4	92.9	0.687
1 molar	102	11	90.3	0.687
2 molar	86	11	88.7

Table 8.

Survival rate of implant according to fixture diameter

Fixture diameter (mm)	State S		Survival rate (%)	P value
Fixture diameter (mm)	Palced	Failed	Survival rate (%)	P value
3.0–3.5	49	5	90.7	0.139
3.75–4.5	159	14	91.9
4.75–5.0	42	5	89.4
5.75-	8	3	72.7

Table 9.

Survival rate of implant according to fixture length

Fixture length (mm)	State		Survival rate (%)	P value
Fixture length (mm)	Placed	Failed	Survival rate (%)	P value
8–10	78	8	90.7
11–13	128	14	90.1	0.562
>14	52	5	91.2

Table 10.

Survival rate of implant according to implant surface texture

Surface texture	State		Survival rate %	P value
Surface texture	Placed	Failed	Survival rate %	P value
Smooth Machined	49	12	80.3
HA	52	10	83.9
Acid etching	46	2	95.8	0.002
Rough TPS	37	1	97.4	0.002
RBM	33	1	97.1
SLA	41	1	97.6

(HA: hydroxyapatite coated, TPS: titanium plasma sprayed, RBM resorable blast media, SLA: sandblasted, large grit, acid etched)

Table 11.

Survival rate of implant according to graft material

Graft material	State		Survival rate %	P value
Graft material	Placed	Failed	Survival rate %	P value
Bio-Oss	61	8	88.4
DFDB	58	11	84.1
Autogenous bone	36	1	97.3	0.043
Bio-Oss+DFDB	30	5	85.7	0.043
Bio-Oss+Autogenous bone	41	0	100.0
DFDB+Autogenous bone	32	2	94.1

Table 12.

Survival rate of implant according to residual bone height

Residual bone height	State		Survival rate (%)	P value
Residual bone height	Placed	Failed	Survival rate (%)	P value
<4 mm	30	13	69.8
4–5 mm	61	7	89.7
5–6 mm	51	5	91.0	0.000
6–7 mm	50	1	98.0
>7 mm	66	1	98.5

Table 13.

Survival rate of implant according to surgery

Surgery method		State		Survival rate (%)	P value
Surgery method		Placed	Failed	Survival rate (%)	P value
Lateral	Simultaneous	84	10	89.4
approach	Staged	93	8	92.1	0.957
Crestal approach		81	9	90.0	0.957

Table 14.

Survival rate of implant according to window management

Window management	State		Survival rate (%)	P value
Window management	Placed	Failed	Survival rate (%)	P value
No closure	87	15	85.3
Cortex repositioning	31	1	96.9	0.022
Resorbable membrane	59	2	96.7

(The group implanted through crestal approach was excluded)

Table 15.

Survival rate of implant according to prosthetic type

Prosthetic type	State		Survival Rate (%)	P value
Prosthetic type	Placed	Failed	Survival Rate (%)	P value
Single	51	6	89.5	0.002
Multiple	207	2	99.0	0.002

(The group failed at the point of preloading was excluded)

Table 16.

Survival rate of implant according to opposing dentition type

Opposing dentition type	State		Survival rate (%)	P value
Opposing dentition type	Placed	Failed	Survival rate (%)	P value
Natural tooth	181	5	97.3
Implant	66	2	97.1	0.540
Removable prosthesis	11	1	91.7

(The group failed at the point of preloading was excluded)

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