Mohamed Fekry Khedr

This study evaluated dental implant stability, vertical bone gain, bone density, and crestal bone loss using different crestal sinus lift techniques (osteotomy, Densah burs, and piezosurgery). A total of 21 patients were randomly divided into three groups: Group 1: patients were treated using a Densah drill crestal sinus lift, Group 2: patients were treated using a piezoelectric crestal sinus lift and Group 3: patients were treated using an osteotome crestal sinus lift. The patients in all three groups underwent bone grafting and implant placement. An Osstell device was used to determine the implant stability by recording the values of the implant stability quotient (ISQ). CBCT was performed before and 6 months after implant placement for radiographic evaluation and comparison among the groups. All dental implants were completely successful, and statistically significant differences from baseline to 6 months were noted in all groups (p < 0.05). The Densah burs technique resulted in the best implant stability of all groups, while the osteotome technique demonstrated better vertical bone augmentation. However, the values for bone density and crestal bone loss showed no significant difference among all treated groups (p > 0.05). All three techniques were successful for crestal sinus lifts with good clinical outcomes at a 6-month follow-up. The Densah group demonstrated better implant stability, shorter surgery time, and fewer complications; however, the vertical bone gain was greater with the osteotome technique.

Piezoelectric surgical instruments with various mini-sized tips and cutting technology offer a precise and thin cutting line that could allow the wider use of periodontal osseous wall swaging. This randomized controlled trial was designed to investigate the use of a minimally invasive piezo knife to harvest vascularized interseptal bone pedicles in treating intra-bony defects. Sixteen non-smoking patients (mean age 39.6 ± 3.9) with severe chronic periodontitis were randomly assigned into one of two groups (N = 8). The Group 1 (control) patients were treated by bone substitute grafting of the intra-bony defect, whereas the Group 2 patients were treated by intra-bony defect osseous wall swaging (OWS) combined with xenograft filling of the space created by bone tilting. In both groups, the root surfaces were treated with a neutral 24% EDTA gel followed by saline irrigation. Clinical and radiographic measurements were obtained at baseline and 6 months after surgery. The sites treated with osseous wall swaging showed a statistically significant probing-depth reduction and increase in clinical attachment compared with those of the Group 1 patients. The defect base level was significantly reduced for the OWS group compared to that of the Group 1 control. By contrast, the crestal bone level was significantly higher in the OWS group compared to Group 1. The crestal interseptal bone width was significantly higher in Group 2 at 6 months compared to the baseline value and to that of Group 1 (<0.001). The osseous wall swaging effectively improved the clinical hard- and soft-tissue parameters. The use of mini inserts piezo-cutting, sequential bone expanders for osseous wall redirection, and root surface EDTA etching appears to be a reliable approach that could allow the use of OWS at any interproximal dimension.