Osseodensification versus piezoelectric internal sinus elevation (PISE) technique in delayed implant placement (a randomized controlled clinical trial)

Abstract

Transalveolar sinus elevation is a minimally invasive technique aimed at augmenting the vertical bone height in the posterior maxilla, facilitating successful implant placement in areas with insufficient bone volume. This study compares the efficacy of osseodensification and piezoelectric internal sinus elevation (PISE) techniques in delayed implant placement. The primary objective was to radiographically assess vertical bone gain and bone density, while secondary objectives included clinical assessment of primary implant stability and post-operative satisfaction of both patients and operators. The study population of a total of 16 patients was randomly divided into two groups. Group 1 underwent osseodensification sinus lift using sticky bone as a graft material, whereas Group 2 received PISE with the same graft material. Results indicated that the osseodensification technique led to greater bone gain, improved bone density, and shorter surgical duration. Additionally, osseodensification was associated with enhanced rapid healing and higher patient satisfaction. Conversely, the PISE technique demonstrated superior primary stability of implants on the day of surgery. These findings suggest that while both techniques are effective, osseodensification may offer advantages in terms of bone gain, density, and patient satisfaction, making it a reliable method for enhancing rapid healing in delayed implant placement. the study was registered on clinicaltrials.gov at 26^th September 2023 and clinical trials ID is NCT06055127.

Keywords: Implant Dentistry; Osseodensification; Piezoelectric surgery; Postierior Maxilla; Sinus elevation; Sticky Bone; i-PRF.

Fig. 1

10 ml whole blood was drawn into glass-coated plastic tubes without anticoagulant and centrifuged immediately at 700 rpm for 3 minutes

Fig. 2

Red colored sticky bone

Fig. 3

Pre-operative clinical occlusal view (missing Upper 1^st molar)

Fig. 4

Per-operative CBCT cross-section cut

Fig. 5

Paralleling pin 2mm from the sinus floor

Fig. 6

Final osteotomy drill was advanced with gentle pressure at 100 rpm counterclockwise without irrigation until a bouncing sensation occurs “haptic feedback” at this point infracture of the sinus had taken place

Fig. 7

Post-operative periapical Radiograph of implant in place after sinus floor elevation

Fig. 8

Torque wrench (measuring 30-35N/cm²)

Fig. 9

ISQ value

Fig. 10

Final screw retained crown after implant osseointegration

Fig. 11

Intralift™ Kit

Fig. 12

Pre-operative clinical occlusal view (missing Upper 1^st molar)

Fig. 13

TKW 3 advanced to 1-2 mm from the sinus floor

Fig. 14

Post-operative periapical Radiograph of implant in place after sinus floor elevation

Fig. 15

a Torque wrench (measuring 45-50 N/cm²). b ISQ value

Fig. 16

Final screw retained crown after implant osseointegration

Fig. 17

Superimposition of Pre&post-operative CBCT to compare vertical bone gain. Per & post-operative Sinus floor level is marked by the arrows

Fig. 18

The ROI tool of the software was implemented to measure the bone density buccal and palatal to the implant site in the exact same place and with the exact area on the superimposed per-operative and post-operative CBCTs

Fig. 19

Comparison between Group 1 and Group 2 according to % of Bone gain

Fig. 20

Comparison between Group 1 and Group 2 according to Insertion torque (IT)

Fig. 21

Comparison between Group 1 and Group 2 according to Implant stability quotation (ISQ)

Fig. 22

Box plot between Time and VAS score

Fig. 23

Box plot between Group and Operator satisfaction survey