Maxillary sinus reconstruction with calvarium bone grafts and endosseous implants

The objectives of this study were 1) to evaluate the survival rate for implants placed in maxillary sinuses augmented with autogenous calvarium bone graft and 2) to evaluate the feasibility, complications, and morbidity of this technique as well as patient satisfaction.

Seventy-nine maxillary sinuses in 58 patients were reconstructed with calvarium grafts between 1992 and 2002 with more than 1 year of prosthetic loading. Two hundred twenty-three implants were placed 3 to 11 months after grafting. Bone levels were measured preoperatively after grafting and 1 year after prosthetic loading.

Successful healing was observed in 77 sinuses (97.4%), and 2 patients (2.6%) showed dehiscence and graft loss. All implants integrated; 211 (94.6%) were used for fixed restorations and 12 implants (5.4%) were used in 2 patients for overdentures (6 implants each). The fixed prosthesis survival rate was 100% after 1 year of loading and remained successful in all cases during the follow-up. At the second stage of surgery, crestal bone loss was measured with a caliper. No crestal bone loss was observed in 210 implants (94%). However, in 13 implants (6%), a crestal bone loss between 1.5 and 2.5 mm was observed, but no further bone loss occurred during the follow-up, as shown on panoramic radiography. Panoramic radiograph measurements showed a total bone height (alveolar bone plus grafted bone) of more than 15 mm in all sinuses and of more than 20 mm in 25 sinuses (32.4%) with a mean of 18 mm. Bone levels were maintained during the follow-up.

1) Calvarium provides graft material of excellent quality and quantity. 2) Satisfactory results can be obtained with implants placed after sinus augmentation with calvarium bone graft as shown in this study with no implant failure. Bone levels, implants, and bridge survival were maintained during the follow-up.