Rajiv Gandhi University of Health Science, Bangalore,

Karnataka

MDS ORAL & MAXILLOFACIAL SURGERY

Synopsis for Registration of Dissertation.

M. R. Ambedkar Dental College and Hospital

#1/36, Cline Road, Cooke Town

Bangalore, Karnataka- 560005

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE.

ANNEXURE II

SYNOPSIS FOR REGISTRATION OF DISSERTATION

1 / NAME OF THE CANDIDATE AND ADDRESS / Dr. VINIT ANIL AHER
Dept. Of Oral & maxillofacial surgery
M. R. Ambedkar Dental College & Hospital
#1/36, Cline Road ,Cooke Town
Bangalore-560005.
2 / NAME OF INSTITUTION / M. R. AMBEDKAR DENTAL COLLEGE & HOSPITAL
#1/36, Cline Road ,Cooke Town
Bangalore-560005.
3 / COURSE OF STUDY AND SUBJECT / M.D.S ORAL & MAXILLOFACIAL SURGERY
4 / DATE OF ADMISSION / 02/06/2008
5 / TITLE OF THE TOPIC:
“A PROSPECTIVE STUDY OF BONE REFORMATION AT MAXILLARY SINUS FLOOR FOLLOWING SIMULTANEOUS SINUS MEMBRANE ELEVATION BY DIRECT TECHNIQUE AND IMPLANT PLACEMENT WITHOUT BONE GRAFT ”
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7.2
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7.4
7.5
8 / BRIEF RESUME OF WORK :
NEED FOR STUDY :
Placement of endosseous dental implants for the prosthetic reconstruction of edentulous ridges has been frequently done now a days . This placement of endosseous implants in posterior maxillary region is hampered by the atrophic maxilla which results from bone resorption both palatally & apically after tooth extraction or periodontal diseases.
The restoration of the lost dentition in the atrophic posterior maxilla with implant placement and various techniques of sinus floor augmentation has been challengingly carried out since last two decades in the field of oral & maxillofacial surgery. The bone reformation is achieved using various maxillary sinus floor augmentation techniques with frequent use of bone grafts and bone substitutes for promoting bone formation to enable implant placement.
Previously in many studies it was anticipated that the use of bone grafting for sinus lift procedures is necessary. However recent studies have demonstrated that only the lifting of sinus mucosal lining and simultaneous implant placement without any bone grafting results in the bone formation at the sinus floor.
The need for this study is to evaluate the bone reformation at the maxillary sinus floor following simultaneous elevation of sinus membrane by direct technique & implant placement in maxillary posterior region without graft placement.
REVIEW OF LITERATURE :
Ta-Wei Chen, (2000-2006) studied 33 cases (23 male, 10 females)with a total 47 fixtures with lateral trap door ,open window method for sinus lifting without placement of autogenous or allograft. No patient developed siniusitis or other complications leading to loss of an implant subsequent to performance of the sinus lifting combined immediate impant surgery.the 2 year survival of fixture was 100%.Increase in lifted sinus bone height ranged from 3mm to 9mm with an average of 4.5 mm. The peri-implant health was judged to be good with a peri-implant sulcus depth of 2.7±0.5 mm at 2 year follow up.
Rabah Nedir ,(april 2003-dec2003)studied 17 cases with total 25 implant fixtures protruding into the sinus.at implant placement ,the residual bone height (RBH) umder the maxillary sinus was 5.4±2.3 mm.a healing period of 3-4 months was allowed before abutment tightening at 35 Ncm. The percentage of stable implants at abutment tightening and at the 1 year control was calculated.the endo-sinus bone mean gain was 2.5±1.2 mm.The mean crestal bone loss was 1.2±0.7 mm.
Andreas thor (nov2001-june2004)studied 44 implants placement with a diameter of 4.5 mm or 5mm were installed in 27 sinuses.A sinus lift was performed where a cortical window was removed from the maxillary anterior sinus wall.Firm primary stability was achived for all implants at installation with bone levels in residual bone of 2mm to 9mm.perforation in sinus lining was occurred in 11 of 27 sinuses(41%).The implant survival rate was 97.7%.The average gain of bone at sinus floor was 6.51 mm (SD=2.49,44 Implants)including all measured after a minimum of 1 year follow up.Marked bone formation was observed around the long implants.
Stefan lundgren (2004)studied a group of 10 patients in whom a total of 12 maxillary sinus floor augmentation were performed without bone graft along with simultaneous total 19 implants in lengths of 10 to 15 mm were placed with an average residual bone height of 7 mm(range of 4 mm-10 mm).all implants remained stable during study period .the study showed that there is great potential for healing and bone formation in the maxillary sinus without the use of additional bone graft or bone substitute.
Alan A Winter (2002)studied 58 implants in 34 consecutive patients with an average bone height of 2.87 mm of residual bone under the sinus. The success rate after the 22 months of loading was 94.1%. The sinus floor was raised on an average of 9.1 mm without benefit of bone grafts and or membranes.
AIMS AND OBJECTIVES OF THE STUDY:
The Aim of this study is to evaluate the amount of bone formation following the simultaneous sinus lining elevation & implant placement without bone graft placement by clinical & radiographic evaluation during follow up visits of patients.
Objectives of the study is to provide:
1.  To achive the increase in alveolar bone height after sinus membrane lift & implant placement without bone graft.
2.  To achive the implant survival in the posterior maxilla with the direct technique of sinus floor lift procedure without bone graft placement and simultaneous implant placement.
MATERIALS AND METHODS:
SOURCE OF DATA:
The preoperative, operative and postoperative, clinical evaluation and radiographs (panoramic view) of minimum 10 implants in patients ( age group 20- 55 years) without any systemic diseases visiting the department of Oral & Maxillofacial surgery , M. R. Ambedkar Dental College and Hospital, Bangalore.
METHOD OF COLLECTION OF DATA:
On clinical evaluation of patient & evaluation of each radiograph following parameters will be recorded:
·  RADIOLOGICAL :
1)Presurgical ridge height in panoramic radiographic view,
2)Post surgical ridge height in panoramic radiographic view at 4 months, 6months & 9 months
·  CLINICALLY :-
1)The average of peri-implant sulcus depth at 6th month follow up.
ANALYSIS OF DATA:
The results will be than statistically analyzed .
DOES THE STUDY REQUIRE ANY INVESTIGATIONS TO BE CONDUCTED ON PATIENTS ON OR OTHER HUMANS OR ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY.
The Study requires panoramic orthopantomogram radiographic view of skull which are routinely done on patients for diagnosis in department of Oral & Maxillofacial surgery, M R Ambedkar Dental College and Hospital, Bangalore and if needed the C-T scan in some patients.
HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.4 ?
YES
LIST OF REFERENCES :
1.  Ta-Wei Chen,Haw-Sheng Chang;Implant placement immediately after the lateral approach of the trap door window procedure to create a maxillary sinus lift without bone grafting :Journal of Oral & maxillofacial surgery, 65:2324-2328, 2007
2.  Nedir R, Bischof M, S-M Serge, Vazquez L, Bernard J-P; Osteotome sinus floor elevation without grafting material : A 1 year prospective study with ITI Implants :Clinic of Oral implants & research.17,2006;679-686.
3.  Andreas Thor ,Lars sennerby , Jan Michale; Bone formation at the Maxillary sinus floor following simultaneous elevation of the mucosal lining and Implant installation without graft material :Evealuation of 20 patients Treated with 44 Astra Tech implants; Journal of Oral & Maxillofacial suregery.65:64-72,2007.
4.  Stefan Lundgren, Sten Andersson, Fredrico Gualini,Lars Sennerby:”Bone reformation with Sinus Membrane Elevation : A New Surgical Technique for Maxillary Sinus Floor Augmentation:Clinical Implant Dentistry and Related Research, volume 6, number 3, 2004.”
5.  Alan A.Winter,Alan S.Pollack,Ronald B.Odrich:”Placement of Implants in the Severely Atrophic Posterior Maxilla Using Localized Management of the Sinus Floor:A Prelimnary Study:”The International Journal of Oral & Maxillofacial Implants 2002;17:687-695”.
6.  Stefan Lundgren, Giovanni Cricchio,Vinicius C.Palma, Luiz A.S.&Lars Sennerby:”Sinus membrane elevation and simultaneous insertion of dental implants :a new technique in maxillary sinus floor augmentation ;Journal of Periodontology , volume 17,193-205”.
9 / SIGNATURE OF THE
CANDIDATE
10 / REMARKS OF GUIDE
11 / NAME AND DESIGNATION OF GUIDE / DR. SHASHIKALA R.
PROFESSOR & HEAD OF DEPARTMENT, DEPARTMENT OF ORAL & MAXILLOFACIAL SURGERY
11.1 / SIGNATURE
11.2 / CO-GUIDE
11.3 / SIGNATURE
11.4 / HEAD OF THE DEPARTMENT / DR. SHASHIKALA R.
PROFESSOR & HEAD OF DEPARTMENT, DEPARTMENT OF ORAL & MAXILLOFACIAL SURGERY.
11.5 / SIGNATURE
11.6 / REMARKS OF PRINCIPAL
11.7 / SIGNATURE