Two-Year Follow-up Comparison of Three Surgical Techniques for Implant Placement in Posterior Maxilla with Limited Alveolar Bone Height

Purpose: The aim of this pilot study was to compare three surgical techniques (bicortical fixation, unicortical fixation, and indirect sinus elevation) for implant placement in the posterior maxilla with limited alveolar bone height. This 2-year follow-up assessment on the implants of a previously published prospective clinical trial compared (1) restoration/ implant stability among the three surgical groups, (2) intrasinus bone formation between the bicortical fixation and indirect sinus elevation groups, and (3) implant and prosthetic complications reported among the three groups. Materials and Methods: For the original prospective study, 38 patients were recruited, exhibiting 7 to 11 mm of alveolar bone coronal to the sinus floor as confirmed by preoperative CBCT, and 45 implants were placed using three randomly assigned surgical techniques. No patient received more than two implants, which were placed in opposite sides of the maxilla and using different surgical techniques. At the 2-year follow-up assessment, 32 patients with 37 implants were evaluated. The 2-year follow-up restoration/implant stability was measured with the Periotest stability measuring device. Intrasinus bone formation was measured from the 2-year follow-up CBCT in comparison to the preoperative CBCT. Clinical examination was also performed to identify loose implants and/or implant crowns and signs of peri-implantitis. Patients were interviewed regarding complications experienced with the study implants/restorations, and electronic charts were thoroughly reviewed to identify records of complications. Results: No significant difference in restoration/implant stability (Periotest value [PTV]) was seen between the bicortical fixation, unicortical fixation, and indirect sinus elevation groups (-1.69 [0.80], -1.76 [0.80], -2.22 [0.60], respectively, P = .76) at the 2-year follow-up. The indirect sinus elevation group showed more intrasinus horizontal (1.99 [0.17] vs 1.47 [0.16] mm, P = .03) and vertical (3.15 [0.43] vs 2.35 [0.38] mm, P = .13) bone gain compared with the bicortical fixation group. Conclusion: Within the limitations of this study, placing implants using a bicortical fixation surgical technique in moderately limited alveolar bone height (7 to 11 mm) was not significantly different from the other two techniques and may be a feasible option with limited risks while allowing longer implant placement and negating the need for indirect sinus augmentation, which is accompanied by additional expense and surgical morbidity to the patient. Int J Oral Maxillofac Implants 2022;37:171-180. doi: 10.11607/jomi.8302