The aim of this randomized clinical trial is to evaluate the effect of changing the sequence of bone grafting during maxillary sinus lifting and simultaneous dental implant placement. The study compares a traditional sequence (sinus elevation, implant placement, then bone grafting) with a modified sequence (sinus elevation, bone grafting, then implant placement). Both procedures utilize a customized surgical guide and are performed on patients with a vertical bone measurement of 5 mm or slightly more. The primary goal is to assess bone density, along with secondary outcomes including vertical bone height gained, bone volume, and implant stability.
Age more than 18 years.
Both sexes.
Patients eligible for maxillary sinus elevation, implant, and bone graft procedures.
Adequate general health for dental interventions.
Systemic conditions affecting implant success.
Patients with vertical bone measurement less than 5 mm.
Previous sinus surgery or dental implant failure.
Medication that can impair or interfere with normal bone metabolism.
Parallel
Traditional sequence
Procedure/SurgerySinus elevation is performed, followed by implant placement, and finally packing the opened lateral window with bone graft, all using a customized surgical guide.
Modified sequence
Procedure/SurgerySinus elevation is performed, followed by packing the sinus with bone graft, and then implant osteotomies are drilled, all using a customized surgical guide.
Bone density
Assessed using Cone-beam computed tomography (CBCT) and measured in Hounsfield Units (HU)
Vertical bone height gained
Evaluated using Cone-beam computed tomography (CBCT) and measured in millimeters (mm)
Bone volume
Computed using Cone-beam computed tomography (CBCT) and measured in cubic centimeters (cm3)
Implant stability
Measured by an implant stability meter (OsstellISQ®) in ISQ VALUE
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