Previous in a randomized way, it will be performance 12 bilateral sinus lift with autologous bone in one side and the in other with xenograft material. After 6 mouths we will place 1 to 3 implants in each side and analyse the survival rate and possibles differences related to; prosthesis failure; biological and prosthetic complications; peri-implant marginal bone level changes.
The study will be performance in 12 patients submitted to a bilateral sinus lift procedure. Six months after the bilateral sinus lifting performed in a randomly way, using as graft materials (100% of autologous bone graft or 100% of xenograft), will be placed 1 to 3 implants in each maxillary sinus. Wait more six months to expose the implant. At the end of 13 months after implant placement it should be in charge. Implant placement (6 months after sinus lift procedure): * Both sides should be treated during the same session. * Patients will receive 2g Amoxicillin one hour before the procedure. Patients allergic to penicillin will be given Clindamycin 600 mg 1 hour before implant placement procedure. * Patients will rinse for 1 minute prior to flap elevation with 0.12% chlorhexidine mouthwash. * After delivery of local anaesthesia, incision and flap elevation, the recommendation of the various implant manufacturers will be followed for placing 1 to 3 implants 9-11 mm long per posterior upper (premolar-molar areas) below the maxillary sinus and a histological sample for each side will be collected. * The neck of the implants will be placed flush to the bone and implants will be submerged under the soft tissues and flaps will be sutured. * Baseline intraoral radiographs of the study implants have to be taken. Post-implant placement instructions: * Chlorhexidine mouthwash 0.12% for 1 minute twice a day for 2 weeks. * Ibuprofen 400 mg will be prescribed to be taken 2-4 times a day during meals, but patients will be instructed not to take them in absence of pain. Patients with gastric problems or allergic to ibuprofen will receive paracetamol 1 g instead. * Sutures will be removed after 10 days. Abutment connection (6 months after implant placement): * Both sides should be treated during the same session. * Patients will rinse for 1 minute prior to flap incision with 0.12% chlorhexidine mouthwash. * Mucosa can be punched or a flap will be elevated according to personal preference of the surgeon, it is important that both sides are treated in the same way. * Individual implants will be tested for stability. * Impressions will be taken. * Healing abutments will be placed. Post-abutment connection instructions: * Chlorhexidine mouthwash 0.12% for 1 minute twice a day for 2 weeks. * Ibuprofen 400 mg will be prescribed to be taken 2-4 times a day during meals, but patients will be instructed not to take them in absence of pain. Patients with gastric problems or allergic to ibuprofen will receive paracetamol 1 g instead. * Sutures will be removed after 10 days. Prosthetic phase: * Within one month after abutment connection, implants will be manually tested for stability. * Provisional reinforced acrylic restorations or definitive screw-retained or provisionally cemented (to allow implant stability assessment) metal-resin or metal-ceramic bridges rigidly joining the 2 or 3 implants will be delivered. * Implants will be splinted under the same prosthesis, each implant supporting one tooth element. * The connection of teeth with implants under the same prosthesis is not allowed. * Similar procedures and materials have to be used in the same patient. * The occlusal surface will be in slight contact with the opposite dentition. * Intraoral radiographs and clinical pictures of the study implants will be taken at initial loading. Maintenance: * All patients will be recalled every 6 months after prosthetic loading for delivery of professional maintenance on individual basis. * Dental occlusion will be evaluated at each maintenance visit.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
12
University of Porto, Faculty of Dental Medicine
Porto, Porto District, Portugal
Histological and histomorphological analysis
Histological and histomorphological analysis of the bone graft
Time frame: 6 mounths
radiological analysis
Comparation of the bone gain in a radiological analysis (initial and at 6 months)
Time frame: 6 mounths
Clinical evaluation - questionary
questionary about patient preference treatment
Time frame: 6 mounths
Implant failure
implant mobility assessed manually with the removed prosthesis and/or any infection dictating implant removal. Assessments will be done at delivery of the provisional and definitive prostheses, 1, 3 and 5 years of loading by tightening the abutment screws with the removed prostheses.
Time frame: up to 5 years of loading
Prosthesis failure
when prosthesis placement will not be possible due to implant failure or secondary to implant failure.
Time frame: up to 5 years of loading
Peri-implant marginal bone level changes
Peri-implant marginal bone level changes assessed on periapical radiographs taken with the paralleling technique at implant placement, at initial prosthetic loading, 1 and 5 years follow-up in function. The distance between marginal bone level and implant/abutment junction, approximated to half mm, will be measured at both mesial and distal sides and averaged. Bone level changes at single implants will be averaged at patients level and then at group level.
Time frame: up to 5 years
Biological complications
Biological complications (number and type). Particular attention will be used to assess possible sinus pathologies.
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Time frame: up to 5 years
Prosthetic complications
Prosthetic complications (number and type).
Time frame: up to 5 years