The aim of this systematic review and meta-analysis was to critically evaluate the currently existing clinical evidence on the efficacy of graftless maxillary sinus membrane elevation for implantation in the atrophic posterior maxilla. A search protocol without limitations to November 2020 was followed by two independent researchers. Randomized controlled trials using the lateral window approach for graftless sinus membrane elevation were included. Uncontrolled, retrospective, non-comparative studies, case reports, and experimental studies in animals or cadavers were excluded. The search identified 2777 studies. Critical selection by two independent researchers then led to the inclusion of a total of nine studies. A risk of bias assessment was applied using the revised Cochrane risk-of-bias tool for randomized trials. A meta-analysis was conducted for seven studies. Results showed a high overall implant survival rate in both the graftless and bone-grafted sinus lift groups (97.92% and 98.73%, respectively). The graftless sinus lift group showed a significantly lower vertical bone height gain, with a mean difference of -1.73mm (P=0.01), and a significantly lower bone density, with a mean difference of -94.7 HU (P<0.001). The implant stability quotient values did not differ significantly between the test and control groups (P=0.07).

The study aimed to evaluate and discuss the use of an innovative PSI made of porous hydroxyapatite, with interconnected porosity promoting osteointegration, called MyBone Custom® implant (MBCI), for maxillofacial bone reconstruction. A multicentric cohort of 13 patients underwent maxillofacial bone reconstruction surgery using MBCIs for various applications, from genioplasty to orbital floor reconstruction, including zygomatic and mandibular bone reconstruction, both for segmental defects and bone augmentation. The mean follow-up period was 9 months (1-22 months). No infections, displacements, or postoperative fractures were reported. Perioperative modifications of the MBCIs were possible when necessary. Additionally, surgeons reported significant time saved during surgery. For patients with postoperative CT scans, osteointegration signs were visible at the 6-month postoperative follow-up control, and continuous osteointegration was observed after 1 year. The advantages and disadvantages compared with current techniques used are discussed. MBCIs offer new bone reconstruction possibilities with long-term perspectives, while precluding the drawbacks of titanium and PEEK. The low level of postoperative complications associated with the high osteointegration potential of MBCIs paves the way to more extensive use of this new hydroxyapatite PSI in maxillofacial bone reconstruction.

This study compared cone-beam computed tomography (CBCT) and photon-counting detector computed tomography (PCD-CT) for detecting simulated mandibular osseous lesions, emphasizing lesion detectability, quantitative accuracy, and inter-reader reliability at equivalent radiation doses. Three types of simulated osseous lesions (sequestrum/fracture, cystic lesion, and extended periodontal gap) were evaluated by two readers, across three radiation dose levels: high (360 μSv), standard (122 μSv), and low (20 μSv). Image quality, artifact presence, and lesion detectability were qualitatively evaluated using a 5-point Likert scale (5 = highest to 1 = lowest rating). Lesion dimensions were quantitatively measured. Statistical analysis included descriptive statistics and weighted kappa for interobserver reliability. High-dose PCD-CT consistently provided the highest image quality, lesion detectability, and minimal artifacts across all lesion types (5 ± 0), achieving perfect inter-reader agreement (100 %). PCD-CT outperformed CBCT in lesion detectability, with the greatest difference at lower doses (3.87 ± 0.35 to 4.83 ± 0.39 vs. 3.13 ± 0.53 to 4.5 ± 0.52). PCD-CT demonstrated superior inter-reader reliability, with perfect agreement for high-dose (κ = 1.0; p < 0.001) and good agreement for standard- and low-dose protocols (κ = 0.909 and κ = 0.744; p < 0.001). Quantitative measurements showed minimal intermodal differences ranging from 0.15 to 0.34 mm, confirming PCD-CT's clinical precision even at low-dose protocols. These findings highlight PCD-CT's potential in dentomaxillofacial imaging, enhancing diagnostic capabilities and reducing radiation exposure.

Purpose: The success rate of dental implants after graftless sinus augmentation versus conventional sinus augmentation surgery in atrophic maxillae in edentulous patients was investigated.Methods: This randomized study was performed in ten edentulous patients with marked maxillary atrophy. On the graftless side, the sinus membrane was lifted by a resorbable membrane. The control side was augmented with a mixture of autografts and xenografts. Implant placement followed 6 months postoperatively. Outcomes were implant survival, success of prosthetic rehabilitation and stability of vertical bone gain.Results: Ten patients were included. Postoperative radiology showed sufficient bone gain on both maxillary sides. Follow-up varied from 57 to 88 months. The conventional side showed significant (p = 0.041) more bone gain than the experimental side (respectively, 9.69 mm and 6.20 mm). A total of 59 implants were placed: 30 after conventional, 29 after graftless augmentation. One implant was lost on the conventional side and four on the experimental side. The implant survival was significantly higher on the conventional side (96.7% vs. 86.2%,p < 0.001, RR = 4.14). Prosthetic restoration was functionally successful in all cases.Conclusion: Bone gain and implant survival were significantly lower in the non-grafted side versus the grafted side. Prosthetic rehabilitation was possible in all ten patients. The non-grafted technique may have some potential for clinical use, although it showed poorer results.Trial registrationThe Netherlands Trialregister. NTR NL3541 (NTR3696). Registered 20 January 2013,https://www.trialregister.nl/trial/3541.