Sergio Spinato Fabio Bernardello Pablo Galindo-Moreno Davide Zaffe Maxillary sinus augmentation by crestal access: a retrospective study on cavity size and outcome correlation Authors’ affiliations: Sergio Spinato, Unit of Periodontology and Implantology, Department of Biomedical and Neuromotor Sciences, School of Dentistry, University of Bologna, Bologna, Italy Fabio Bernardello, Private Practice, Terranegra di Legnago, VR, Italy Pablo Galindo-Moreno, Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain Davide Zaffe, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy Corresponding author: Prof. Davide Zaffe Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Sezione di Morfologia umana, Universit a di Modena e Reggio Emilia, Via del pozzo 71, Policlinico, 41124 Modena MO, Italy Tel.: +39 0594224804 Fax: +39 0594224861 e-mail: davide.zaffe@unimore.it Key words: crestal sinus augmentation, intra-sinus bone loss, marginal bone loss, maxillary sinus size, radiographic and CBCT evaluation Abstract Objective: Cone-beam computed tomography (CBCT) and radiographic outcomes of crestal sinus elevation, performed using mineralized human bone allograft, were analyzed to correlate results with maxillary sinus size. Material and methods: A total of 60 sinus augmentations in 60 patients, with initial bone ≤5 mm, were performed. Digital radiographs were taken at surgical implant placement time up to post- prosthetic loading follow-up (12–72 months), when CBCT evaluation was carried out. Marginal bone loss (MBL) was radiographically analyzed at 6 months and follow-up time post-loading. Sinus size (BPD), implant distance from palatal (PID) and buccal wall (BID), and absence of bone coverage of implant (intra-sinus bone loss – IBL) were evaluated and statistically evaluated by ANOVA and linear regression analyses. Results: MBL increased as a function of time. MBL at final follow-up was statistically associated with MBL at 6 months. A statistically significant correlation of IBL with wall distance and of IBL/ mm with time was identified with greater values in wide sinuses (WS ≥ 13.27 mm) than in narrow sinuses (NS < 13.27 mm). Conclusions: This study is the first quantitative and statistically significant confirmation that crestal technique with residual ridge height <5 mm is more appropriate and predictable, in terms of intra- sinus bone coverage, in narrow than in WS. Sinus augmentation with lateral access has been widely studied and is considered a safe and highly predictable treatment (Smiler et al. 1992; Zinner & Small 1996; Block et al. 1998; Wallace & Froum 2003; Del Fabbro et al. 2004; Aghaloo & Moy 2007; Pjetursson et al. 2008). Most studies on maxillary sinus augmenta- tion concerned the procedure (Boyne & James 1980; Vercellotti et al. 2001; Sohn et al. 2010; Stelzle & Benner 2011; Garc  ıa-Denche et al. 2013) or the type of graft used (Schlegel et al. 2003; Raghoebar et al. 2005; Galindo- Moreno et al. 2008, 2010; Chackartchi et al. 2011), but few studies correlated the initial condition with the radiographic (Hatano et al. 2004; Zijderveld et al. 2009) or CT out- come (Peleg et al. 1999; Sbordone et al. 2009, 2013; Umanjec-Korac et al. 2013). Even today, few articles correlate the size of the maxillary sinus with its augmentation out- come (Avila et al. 2010; Jang et al. 2010; So- ardi et al. 2011). The sinus grafting procedure with lateral access is often recommended to provide suffi- cient support for implants in extremely atro- phic maxillary posterior ridge. To regenerate bone for implant placement in a more conser- vative, less invasive, and simpler manner than the lateral approach, Summers (1994) proposed the osteotome technique. After- ward, to perform the maxillary sinus floor augmentation, some authors proposed modi- fications to the Summer’s technique essen- tially based on the use of different biomaterials or instruments and on the expansion and compression of the alveolar crest (Bruschi et al. 1998; Cosci & Luccioli 2000; Fugazzotto 2001; Kim et al. 2012). Crestal procedures were also demonstrated to be safe and highly predictable treatments when residual bone height was 5 mm or more (Rosen et al. 1999). A sinus lift one- stage crestal approach using sequential drills was presented in 2000 (Cosci & Luccioli 2000). The shape of the drill tip was designed to prevent perforation of the sinus membrane and permit gentle abrasive removal of the cortical bone of the sinus floor without frac- ture. This procedure has proved to be a safe Date: Accepted 29 July 2014 To cite this article: Spinato S, Bernardello F, Galindo-Moreno P, Zaffe D. Maxillary sinus augmentation by crestal access: a retrospective study on cavity size and outcome correlation. Clin. Oral Impl. Res. 00, 2014, 1–8 doi: 10.1111/clr.12477 © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd 1