Maturation of Maxillary-Sinus-Bone-Craft with Simultaneous Implantation in 2-5mm Bone Height

Alveolar Ridge Bone Height (ARBH) of 3-5mm has been considered feasible to immobilize implants during bone graft maturation. However, the optimal time for implant loading depend on craft size/material, implant surface area/type and is still unclear. Objectives: To assess the Maturation of Maxillary Sinus Bone Craft with Simultaneous Implantation (MSBC-SI) in 2-5mm ARBH and the effect of pre-load. Methods: six MSBC-SI of 12mm long and 4.8mm wide ITI-SLA implants performed in 5 patients (2w; 3m) were assessed by 31 scintigraphies, measured up to 32 weeks after surgery. The regions of interest (ROI) marked over the maxillary sinus in the coronal and sagital scintigraphies were expressed as percentage of increased activity of control ROIs marked over the calvarium and vertebra in the coronal and sagital planes, respectively. 31 sagital and 31 coronal scintigraphy measurements, averaged in time-domain, were pulled. Results: Implant success rate was 100%. Averaged (coronal,sagital) craft activity was greater than control activity by 86%(105%,68%), 80%(83%,77%), 60%(60%,60%), 32%(20%,44%), 41%(38%,44%), 39%(33%,46%), 23%(39%,8%) and 0%(0%,0%) at weeks 2[1-3; n=6], 6[5-7; n=4], 10[9-10; n=5], 13[12-14; n=3], 18[16-18; n=4], 21[20-22; n=4], 28[27-29; n=2] and 32[31-33; n=3]. A considerable maturation was seen at the 13th week, representing a decrease of 63% of the initial activity(p<0,05); therefore, abutment with an initial pre-load of 20N and protection 4 mm height cap were placed. As a result, there was 30% increase in the craft metabolic activity at week 18th(p<0,05), that dropped to base line levels at week 32th. Conclusions: MSBC-SI in 2-5 mm ARBH is quite feasible. About 2/3 of the craft maturation accurs up to the 13th week. Pre-load around the 13th week induces an increase in bone metabolic activity and may optimize maturation and bone density. The fast craft maturation may have been a result of simultaneous small surgical window/graft and SLA surface implant placement.