Bone Resorption, Maxillary Deficiency
Conditions
Keywords
Bone Ring Technique, Maxillary Sinus Floor Elevation, Dental Implant
Brief summary
This study evaluates the Bone Ring Technique, a single stage procedure that combines external sinus floor elevation and dental implant placement using an autogenous bone ring harvested from the chin. Ten patients with residual alveolar bone height ≤4 mm in the posterior maxilla will be enrolled. Implant stability (ISQ), vertical bone gain, peri implant bone density, and implant survival will be assessed over 6 months. The aim is to reduce treatment time and surgical interventions compared to traditional two stage approaches.
Detailed description
The Bone Ring Technique (BRT) was introduced by Giesenhagen (2004) to address severe posterior maxillary atrophy. In this prospective single arm case series, after obtaining ethics approval (DN 28102025 542, Damascus University), ten patients with residual bone height ≤4 mm will undergo: harvesting of an 8 mm cylindrical autogenous bone ring from the mandibular symphysis using trephine burs; creation of a lateral window in the maxillary sinus using a straight handpiece with a diamond round bur; meticulous elevation of the Schneiderian membrane; placement of the bone ring; simultaneous insertion of a dental implant (ICX) through the ring into the native ridge; filling of the defect with xenograft (bovine) particles; coverage with a collagen membrane; and suturing Primary stability will be measured immediately after implantation using resonance frequency analysis (Mega ISQ II). CBCT scans (PaX i3D, VATECH) will be performed preoperatively, at 1 week, and at 6 months to quantify vertical bone gain (distance from implant shoulder to sinus floor) and peri implant bone density (Hounsfield like units). Clinical follow up includes suture removal at 7 10 days and assessment of implant survival/success at 6 months (absence of mobility, pain, radiolucency, suppuration, crestal bone loss \<1.5 mm). Results will be submitted for publication in a peer reviewed journal.
Interventions
PROCEDUREBone Ring Technique (BRT)
The Bone Ring Technique (BRT) is a one-stage surgical procedure that combines external maxillary sinus floor elevation with simultaneous dental implant placement. An autogenous bone ring is harvested from the mandibular symphysis using trephine burs. The sinus membrane is elevated via a lateral window approach created with a straight handpiece and diamond round bur. The bone ring is then placed into the sinus cavity, and a dental implant is inserted through the ring into the residual alveolar bone. The surgical site is augmented with xenograft particles and covered with a collagen membrane.
Sponsors
Damascus University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Prospective, single-arm case series. All eligible patients with residual alveolar bone height ≤4 mm in the posterior maxilla will receive the same intervention: one-stage external maxillary sinus lifting using the autogenous Bone Ring Technique with simultaneous dental implant placement. Participants will be followed for 6 months post-surgery. No comparator group is included.
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* Need for dental implant in posterior maxilla (premolar/molar). * Residual alveolar bone height ≤4 mm on preoperative CBCT. * Age ≥18 years. * Controlled systemic health. * Able to comply with procedures and follow up. * Good oral hygiene. * Signed written informed consent.
Exclusion criteria
* Uncontrolled systemic disease. * Head/neck radiotherapy. * Bisphosphonate therapy \>3 years. * Autoimmune disease affecting healing. * Pregnancy/lactation. * Active maxillary sinus pathology (sinusitis, cysts, polyps, tumours). * Heavy smoking (\>10 cigarettes/day). * Severe bruxism.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Implant Stability Quotient (ISQ). | Immediately after implant placement (baseline) and 6 months post_surgery (before prosthetic loading). | Measured by resonance frequency analysis with MEGA ISQ II (MegaGen, Korea), Four readings per implant (mesial, distal, buccal, lingual); mean value reported |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Vertical Bone Gain (mm) | at preoperative, 1 week post_surgery , 6 months post_surgery | Distance from implant shoulder to highest point of elevated sinus floor; measured on coronal sections using Ez3D plus software |
| Peri implant Bone Density (gray values) | at preoperative, 1 week post_surgery , 6 months post_surgery | regions of interest: coronal, middle, apical thirds |
| Implant Survival & Success | 6 months post_surgery | Survival = implant in situ. Success = absence of mobility, persistent pain, peri implant radiolucency, suppuration; and crestal bone loss \<1.5 mm on CBCT. |
Countries
Syria
Contacts
CONTACTAdel Alassaf, DDS
STUDY_DIRECTORKhaldoun Darwich, DDS MSc PhD
Damascus University Syria
Outcome results
None listed