This study evaluates the Bone Ring Technique, a single stage procedure that combines external sinus floor elevation and dental implant placement using an autogenous bone ring harvested from the chin. Ten patients with residual alveolar bone height ≤4 mm in the posterior maxilla will be enrolled. Implant stability (ISQ), vertical bone gain, peri implant bone density, and implant survival will be assessed over 6 months. The aim is to reduce treatment time and surgical interventions compared to traditional two stage approaches.
The Bone Ring Technique (BRT) was introduced by Giesenhagen (2004) to address severe posterior maxillary atrophy. In this prospective single arm case series, after obtaining ethics approval (DN 28102025 542, Damascus University), ten patients with residual bone height ≤4 mm will undergo: harvesting of an 8 mm cylindrical autogenous bone ring from the mandibular symphysis using trephine burs; creation of a lateral window in the maxillary sinus using a straight handpiece with a diamond round bur; meticulous elevation of the Schneiderian membrane; placement of the bone ring; simultaneous insertion of a dental implant (ICX) through the ring into the native ridge; filling of the defect with xenograft (bovine) particles; coverage with a collagen membrane; and suturing Primary stability will be measured immediately after implantation using resonance frequency analysis (Mega ISQ II). CBCT scans (PaX i3D, VATECH) will be performed preoperatively, at 1 week, and at 6 months to quantify vertical bone gain (distance from implant shoulder to sinus floor) and peri implant bone density (Hounsfield like units). Clinical follow up includes suture removal at 7 10 days and assessment of implant survival/success at 6 months (absence of mobility, pain, radiolucency, suppuration, crestal bone loss \<1.5 mm). Results will be submitted for publication in a peer reviewed journal.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
The Bone Ring Technique (BRT) is a one-stage surgical procedure that combines external maxillary sinus floor elevation with simultaneous dental implant placement. An autogenous bone ring is harvested from the mandibular symphysis using trephine burs. The sinus membrane is elevated via a lateral window approach created with a straight handpiece and diamond round bur. The bone ring is then placed into the sinus cavity, and a dental implant is inserted through the ring into the residual alveolar bone. The surgical site is augmented with xenograft particles and covered with a collagen membrane.
Oral and Maxillofacial Surgery Hospital, Faculty of Dentistry, Damascus University, Mezzeh Highway, Damascus, Syria
Damascus, Governorate, Syria
Implant Stability Quotient (ISQ).
Measured by resonance frequency analysis with MEGA ISQ II (MegaGen, Korea), Four readings per implant (mesial, distal, buccal, lingual); mean value reported
Time frame: Immediately after implant placement (baseline) and 6 months post_surgery (before prosthetic loading).
Vertical Bone Gain (mm)
Distance from implant shoulder to highest point of elevated sinus floor; measured on coronal sections using Ez3D plus software
Time frame: at preoperative, 1 week post_surgery , 6 months post_surgery
Peri implant Bone Density (gray values)
regions of interest: coronal, middle, apical thirds
Time frame: at preoperative, 1 week post_surgery , 6 months post_surgery
Implant Survival & Success
Survival = implant in situ. Success = absence of mobility, persistent pain, peri implant radiolucency, suppuration; and crestal bone loss \<1.5 mm on CBCT.
Time frame: 6 months post_surgery
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