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Flapless sinus lift without graft: A literature Review | Sahar Hefzollesan


Implants have a predictable outcome and are one of the best treatment essence for prosthetic rehabilitation of edentulous patients. Due to loss of bone after tooth extraction and consequently pneumatization of maxillary sinus, the edentulous posterior maxilla is a challenging site for dental implant rehabilitation. Maxillary sinus elevation techniques with and without grafting material( lateral window and transcrestal approach) have been suggested for dental implant placement with regular length (e.g., 10 mm).There is a few evidences to demonstrate the non-grafting indirect sinus floor elevation hence the need for this review. A PubMed and google   search was made freely. 52 articles  with key words; “bone formation”, “dental implants”, “maxillary sinus floor augmentation without graft” , “Schneiderian  membrane”, “osteotome”, “graft less” were selected .The study incidence criteria were (1) indirect sinus lift procedure without any graft material with simultaneous implant placement (2) minimum follow‑up of 5 months till 10 years and radiological analysis of  newly formed bone (3)  English language articles. Exclusion criteria: usage of bone graft or bone substitutes and/or usage of other indirect sinus elevation methods except osteotome mediated elevation during sinus lift operation. The review showed that high survival rate more than (90%), can be attainable even without grafting material in OSFE.  Average mean bone gain was (?). Thinking about all factors reviewed in this regards along with results, the OSFE technique without grafting material can be viable treatment method Just keep in mind that limitations isn’t connivance.



The largest part of paranasal sinuses is pyramidal shaped maxillary sinus that   drains into the middle meatus of nose. Maxillary sinus is lined by pseudostratified ciliated epithelium known as Schneiderian membrane with average thickness of 0.8mm. This membrane consists of the basal cells, columnar cells, and goblet cells fixed to the basal membrane. Approximately 100–150 cilia present on each columnar cell which vibrate at 1000 beats/min. (1).Within 4 paranasal sinuses, the importance of maxillary sinus in dentistry is apparent due to its proximity to teeth (2, 3). By maxillary bone development, sinus cavities are formed and filled by air, the name of this physiologic process is pneumatization. It causes to expansion of maxillary sinus in to adjacent anatomical structures (between adjacent teeth or roots), and creating elevations of the antral surface referred to as hillocks (5, 6). According to the literature, there are some factors that may influence maxillary sinuses pneumotization such as heredity, nasal mucous membrane pneumotization, craniofacial configuration, bone density, sinus surgeries, growth hormones, air pressure within the cavity of sinus and age related process. Posterior teeth loss can also influence it (7, 8). It may vary according to the tooth type and region that can implicate implant surgical process (9). Patients with advanced ridge resorption and sinus pneumatization compounded with a poor quality of bone are often encountered by dental surgeons.

The best choice in these cases is maxillary sinus elevation for increasing vertical height of alveolar bone to replace of dental implants (10). After BOYNE, TATUM was the pioneer of this method, augmented the posterior maxilla with autogenouse rib in 1970 then he developed a modified Caldwell –luc procedure by fracturing the crest of the alveolus in 1974. Then he modified his own procedure by lifting the membrane via a lateral approach. In 1994, Summer introduced another method, named it ‘Summer’s technique, often referred to as ‘osteotome / crestal sinus membrane elevation,’ or OCSME. It   recommended for patients with at least 5.0–6.0 mm of adequate residual alveolar bone below the sinus floor (11).  Maxillary sinus elevation consists of 2 main methods; conventional method with lateral access (direct method) and less invasive modified method with crestal access (indirect). Various crestal approaches such as osteotome mediated sinus floor elevation (OMSFE) 2, piezoelectric internal sinus elevation (PISE) 3, hydraulic sinus condensing (HSC) technique 4, internal sinus manipulation (ISM) procedure ,5,crestal window technique (CWT)  and 6,hydrodynamic piezoelectric internal sinus elevation (HPISE) are as an alternative to lateral window approach for sinus augmentation (12,13,14).

Different types of grafting material have been used in sinus augmentation to maintain the space created after Schneiderian membrane elevation (15). These are consisted of Autogenous bone graft and other bone substitutes, such as human allograft, bovine xenograft, and synthetic alloplast.  Autogenous bone is a gold standard bone graft because it possess osteogenicity, osteoinductivity, and osteoconductivity but it is not recommended in maxillary sinus augmentation because of remarkable graft resorption over time and donor site morbidity. Other bone substitutes, such as human allograft, have been suspected with disease transmission, in connection with their sterilization protocols and method of prepration. Bovine xenograft’s drawbacks are low vital bone to biomaterial ratio, low resorption rate and also delay bone regeneration in comparison with autogenous bone or blood clot alone. Synthetic alloplasts are not recommended because they don’t possess the same bone forming potential as other classes(16,17,18).Some, with bone substitutes demonstrated repneumatization and implants placed in grafted sinuses had higher peri-implant marginal bone loss (MBL) compared with native bone. Therefore, some clinicians started for usage of blood clots instead of bone substitutes in sinus floor elevation (SFE). High implant survival rates (ISRs) and high bone gain   in graft-free maxillary SFE (GFSFE) is available which implants acted as a tent against the elevated Schneiderian membrane. The aim of this review is to evaluate effectiveness of GFSFE by determination amount of mean vertical bone gain (VBG), in osteotome sinus surgery at defined follow-up period (19).


Table 1: Bone   height   before and after surgery.

study   RBH    MBG





NEDIR et al(31)
NEDIR et al(32)
NEDIR et al(33)
NEDIR et al(34)
NEDIR et al (34)
NEDIR et al(35)
NEDIR et al(36)
SCHMIDLIN et al(37)
BIJARNI et al(38,39)
ROBERT FERMERGERD &per astrand(,40,44)
LONGLONG HE et al(43)
CABAN J  et al(45)
BRIZUELA et al(46)
MI-si SI et al(48)
ZILL A et al(49)
SUK ARJ P et al(52)
RAWAT A et al(51)
3.8+/-1.2 mm
4.3+/-1.0 mm
6.75+/-1.91 mm
7.4+/-1.07 mm
6.8+/-1.89mm mesial side


2.6+/-1.2 mm


4.5+/-1.4 mm
1.8+/-0,79 mm




Osteotome Technique (OstSFE): This is well-validated surgical option with the use of osteotomes combined with graft material around the dental implants.  A set of osteotomes and a surgical mallet are necessities to break sinus floor and to compact bone graft into the sinus cavity. For osteotome  accommodation,  a pilot drill is usually used to the depth 1-2mm short. Small diameter osteotome is inserted into the prepared bone and compresses sinus followed by wider osteotome and a light pressure on the sinus floor to accommodate implants. The use of osteotomes is more relevant than the use of drill. They can be used for SFE without bone grafting if residual bone height (RBH) is more than 4-5mm and this could lead to a mean endo-sinus bone gain of 1.2-2.5 mm (20,21,22). The osteotomes by laterally condensation of bone can creates a denser interface at the placed implants (22) and improves the initial bone-to-implant contact (BIC) (23, 24). The surgical simplicity, resulting in minimal post-operative symptoms are its benefits. But, possibility of accidental sinus membrane perforation developed from improper drilling due to the magnification of radiograph, improper use of osteotome and excessive compaction of the bone graft, are it’ s drawbacks. Membrane perforation can cause the failure of osseointegration and sinus pathosis. Also, benign positional paroxysmal vertigo (BPPV) can be caused by the damage to the internal ear from striking osteotome and surgical mallet when sinus floor is broken (25). Also The OSFE procedure described by Summer   (26, 27, 28) involves a grafting material that is condensed in the osteotomy site, it can migrate into the sinus if perforation occurs leading to inflammation. Hence, the Non-grafting procedure, has eliminated the risk of undetected perforations that are likely to remain uneventful because the membrane can reform around four mm of protruding implants as a tent screws. The advantages of this procedure were the avoidance of invasive surgery and permitting treatment within a single surgical step (29, 30).

The aim of this study was systemically review the scientific data of patients treated with osteotome mediated sinus floor elevation method without the use of any grafting material and evaluate the mean bone gain in comparison with RBH, implant survival rate in a defined follow up period.

  • Primary outcome;
  • Height of new formed bone in vertical dimension
  • Implant survival rate
  • Secondary outcome;
  • Implant stability

Complication; Schneiderian membrane perforation, bone septa, implant failure

Maxillary sinus membrane perforation is a common complication encountered during surgery. If the tear in the sinus membrane is <5 mm, then extended elevation of membrane in all directions is done until it is possible to lift the membrane without tearing and the perforation is allowed to close on itself. In cases where the perforation is more than 5 mm, then, one or two small holes are drilled with a round bur above the window and the lifted membrane is then sutured to the holes close to the perforation.[22,24,29] Another method to close a tear in the sinus membrane was by gently placing a resorbable membrane over the perforation.[27]



STUDY N n Implant survival rate
NEDIR et al(31) 17 25 100%
NEDIR et al(32) 2 8  
NEDIR et al(33) 54 32 100%
NEDIR et al(34) 17 25  
NEDIR et al (34) 17 25 100%
NEDIR et al(35) 12 37 90%
NEDIR et al(36) 12 37 91.9%
SCHMIDLIN et al(37) 24 24 100%
BIJARNI et al(38,39) 181 252 97.4%
ROBERT FERMERGERD &per astrand(,40,44) 36 53 94%
HONGN-CHANG Lai(41) 125 191 95.71%
LONGLONG HE et al(43) 22 27 100%
CABAN J  et al(45) 25 34 100%
BRIZUELA et al(46) 42 36 91.6%
MI-si SI et al(48) 80 96 90.6%
  39 66 98.53%
ZILL A et al(49) 113 233 93.8%
SUK ARJ P et al(52) 27 31 100%
RAWAT A et al(51) 21 26 100%


Articles were searched in NCBI PubMed database, and   Google Scholar which matched the criteria of the review inclusion. The title and abstract of each article were discerned to make this inclusion. If the information present in the abstract was inadequate in making a decision, the entire article was downloaded and reviewed and a decision for inclusion was concluded. The study incidence criteria were (1) indirect sinus lift procedure without any graft material with simultaneous implant placement (2) human studies with a minimum follow‑up of 5 months or more and radiological analysis of   newly formed bone (3) English language articles. Articles were excluded, if usage of bone graft or bone substitutes and/or usage of other indirect sinus elevation methods except osteotome mediated elevation has been made during sinus lift operation.

A total of   52 studies were identified and included in this review.  The Keywords used; bone formation, dental implants, maxillary sinus floor augmentation without graft , Schneiderian membrane, osteotome, graft less.

The included studies based on the inclusion and exclusion criteria are;

Systematic review -. Retrospective study-. Prospective study. Case report. Prospective pilot study, Prospective and Retrospective randomized controls


When using OSFE procedure, reporting the RBH and mean bone gain for influencing the survival rate of implants is essential. Nedir et al reported a survival rate of 100% for144 implants  in 117 patients when mean RBH was 4.48+/-1.8 mm and mean bone gain was 3+/-1.32mm(31,32,33,34); this rate dropped to 91.9%  and 90% when RBH was 2.4+/-0.9 mm(35,36), mean bone gain reported 3.9+/-1.0mm.

In a Retrospective study(37)have been reported a mean 17.6+/-8.4 months implant survival rate of 100% (24 IMPLANT IN 24 PATIENTS), in  another 2 retrospective studies survival rate were 100%(43,45)but it dropped to 94.7% when implants placed in  mean RBH 8.1mm (38,39) and 94% when mean RBH was 6.3+/-0.3 mm,93.8% (49)for a mean RBH 5.9+/_1.7mm and 90.6% (48)when it was 6.75+/-1.91 mm.

In a prospective study, Rawat et al reported a 100% survival rate for 6.8+/-1.89 mm RBH during 6 months(51) and in another analysis have been reported a 91/6 % reduction in survival rate during 2 years(46).

In one preliminary clinical trial, by Hong-chang, 95.71% survival rate had reported. Whereas in other analysis by Suk –Arj, survival rate was 100%.

The reason of any failure may be inadequate amount of bone gain and the special care allocated on these cases. Long-term preservation of crestal bone height around implants is one of the major success criteria. Crestal bone level remodeling was reported to occur predominantly during the unloaded healing phase and then to slightly decrease at a rate of about 0.1–0.2 mm/year (Albrektsson et al. 1986). Nedir et al’ s analysis recounted 3+/-1.32   mm cumulative MBG around implants(31 till36) whereas this number is 2.35+/-1.6mm in analysis by SCHMIDLIN et al(37). It has been reported 1.7 mm in another ones (38-39).other two analysis  had been reported these number 1.8+/-0.54mm cumulatively (46, 52). Average amount of MBG were 2.58+/-0.89 mm in these studies (41, 43, 45, 46, 48). RAWAT A et al(51)  gained  1.97+/-1.99  mm MBG.  High amount of it, has reported by ZILL A et al(49) about 4.5+/-1.4 mm and min of it has been reported 0.6+/-0.09mm(40-44).

These findings were not in agreement with previously reported data (Bra¨gger et al. 2004, Hatano et al. 2004). The more implants protruded simultaneously and   postoperatively into the sinus, the more peri-implant bone was gained at year 5. This finding, in combination with the previously mentioned bone graft shrinkage addresses the question of the optimal bone height. The present data suggests that extended grafting is unnecessary for implant function. The height of the graft should match the expected implant apex and not be above it.


  1. Rabah Nedir et al, in 2006, placed 25 implants in 17 patients protruding in sinus (31). Most of them were 10 mm long. Residual bone height (5.4+/-2.3) and MBG (2.5+/-2.1) are measured. Implant survival rate at one year control was calculated.
  2. Furthermore Nedir R   et al, conducted a case reports of 2 patients (32) in which short, 8-10 mm long, tapered implants were placed.1-2 year follow up visits, showed   clinically stable and functionally  perfect prosthesis on implants, the mean bone gain was 5.1+/- 1.3mm.
  1. In another study Nedir and et al. (33) were performed OSFE without grafting material and simultaneous placement of 54 tapered implants in 32 patients. At the 1- year radiographic control, the mean bone gain was 2.3+/-1.8 mm with a 100% success rate and 94.4%respectively for all loaded implants.
  2. To evaluate long term stability of peri-implant bone formation in the resorbed posterior maxilla without any graft material, Nedir R and his team (34) choose 17 patients with atrophic maxilla. They inserted 25 implants with 10 mm length by OSFE procedure without graft.20 implants with additional peri-implant bone gain during 1 year follow up by peri-apical radiograph, showed a good and acceptable result. Mean bone gain for all implants were 3.2+/-1.3mm and survival rates showed a predictable long term results.
  3. In a prospective randomized controlled study at 2012, Nedir R, Khoury P et al. (35) compared OSFE with and without grafting material in severely resorbed maxilla. The result was interesting. They indicated although bone gain is high with grafting material but it is not necessary. Beside of it, the risk of complication could be increased.
  4. 6.In another prospective randomized controlled study during 5 years(36), Rabah N and his collageuses 2016, presented a challenge to evaluate the efficiency of OSFE in severely resorbed maxilla with simultaneously insertion of 37, short implants (8 mm lengths) in 12 patients. All implants were stable with success rate of 91.9%. RBH was2.4+/-0.9. Mean bone gain was 3.8+/-1.0mm for test and 4.8+/-1.2 mm for control group. It was significantly without change during 5 years.
  1. In another similar retrospective study, Schmidlin, P R et al. (37) performed modified OSFE with simultaneously insertion of implants in patients. Observation period was 17.6+/-8.4 months. 24 patients were available for follow up. New bone formation was 86.3%+/-22.1% mesially and 89.7%+/-13.3% distally. Furthermore, implant survival rate was 100%. Good clinical success was achieved even in absence of graft material.
  2. Bjaini E. Pjetursson et al. (38) in 2 continues years (2008-2009) started a comparison between 2 groups. Their aim was presence and absence of grafting material in OSFE. Their study consisted of 2parts. In part 1, they studied implant survival rates and in part 2, radiographic tissue remodeling. Part one’s materials were 252 dental implants which inserted in 181 patients during 2000-2005. 3 implants  were lost before loading, and another 3 were lost in first and second years after loading. As for residual bone height, survival rate was 91.3% for implant sites less than 4mm, and 90% for sites with 4mm and 5mm and 100% in sites with bone height above 5mm. According to implant length, the survival rates were 100% for 12mm, 98% for 10 mm, 98,7% for 8mm,and only 47.6% for 6mm implants.
  3. In part 2, 252 dental implants (39) were inserted in 181 patients during same years with part one. For 88 patients were utilized deproteinized bovine bone mineral with a 0.25-1 mm particle size and for remaining 164 implants, no grafting material were used. Parallel peri-apical radiographs were obtained for evaluation the pattern of tissue remodeling. The significant results indicated that moderate new bone gain could be detected in mesial and distal of implants without utilization of bone graft (1.7mm) but when bone graft was used, the mean one gain was seen strong and solid in radiographs (4.1mm).
  4. Robert Fermergard in 2008(40), placed 53 implant in 36 patients. OSFE was carried out in patients with 10 mm or less than 10 mm maxillary bone height below sinus. Two implants has been lost. Clinical and radiographic outcomes of implants in a one year retrospective study showed a predictable results in posterior part of maxilla.
  5. 11.Olaf, Gabbert et al. in 2009(41), in an analysis of short – term failure of implants placed in combination with an internal sinus lift without graft material, inserted 92 screw shaped implants on 36 patients. 44 patients with 77 implants served as controls. 4 failures in experimental and 2 in control group were observed. For both groups, survival rates was above 94%. 6-9 months after surgery. Bone gain was observed in 29out of 92 implants.
  6. In 2010, Hong Chang Lai et al (42) carried out a clinical trial on 202 patients. They inserted 280 implants by OSFE technique. 191 implants were placed in patients without grafting. Healing time for non-grafting cases were 3-4 months and for grafted cases were 6-8 months. For 268 0f 280 implants, survival rate percentile was95.71%. There were not significant differences in RBH for both groups. Radiographically, a mean bone height gain of 2.26 +/- 0.92 mm and 2.66+/-0.87mm at 3and 9 months follow-up was observed. It seems that endo _ sinus bone gain was significantly related with implant protrusion length.
  7. A pilot study was demonstrated by Senyilmaz DP and Kasaboglu O (43) in 2011. The base of study was OSFE without graft material. 27 (4.1mm) dental implant inserted on 17 sinuses simultaneously with sinus elevation. At 2 year follow-up, they reported 100% success rate. They also indicated that lack  of graft material never interfere with endo-sinus bone gain.
  8. Longlong He, Xiaofeng Chang and Yanpu Liu (44) were inquisitive for the result of OSFE without graft material hence  they started to assess the result of this method on their patients with residual bone height less than 8mm. 27implant with 4.7 diameter and 10 mm length were inserted simultaneously with OSFE in patients. During their 2 year retrospective study, they reported that mean bone gain was 2.5 mm.
  1. In 2012, Fermergard R, Astrand P (45) presented a 3 year retrospective study. They inserted 53 implants in36 patients, with 10 mm or less maxillary bone height.2 implants were lost in 1-year of follow up and one more at 3-year examination. Cumulative Survival rate of remaining 50 implants at the end of 3 years was 94%. Mean bone gain in the intended implant sites was 6.3+/-0.3mm.
  2. Furthermore Caban J, Fermergard R and Abtahi J (46), in a retrospective study   informed about the success rate of OSFE just in association with RBH. At 10 year follow up, 36 implants in 25 patients were inserted. 100% survival rate for implants and 2.6+/-1.2 mm mean bone gain were a strong reason for this result during 10 years follow up.
  3. Brizuela et al. (47) conducted a prospective clinical trial to view the new bone formation in maxillary sinus without bone grafting. By OSFE, they inserted 36 implants with 2.1+/-0.3mean implant protrusion length into sinus, in 37 patients. RBH at implant placement averaged 7.4+/-0,4mm and mean bone gain was 1, 8+/-0,3mm.
  4. In a private practice by D.SPINELLI et al in Rome, (Italy), were studied placement of 66 implants in 39 patients through the transcrestal guided sinus floor elevation. During 3 years follow-up period, cumulative implant survival rate was 98.53%. The average  residual bone height of alveolar bone ridge before treatment was 6.7to 1.6 mm and average bone gain was 6.4-1.6 mm (48).
  5. Long-term outcomes of a clinical retrospective study in 2015 by Mi-si Si et al, (49) demonstrated a predictable treatment modality for OSFE without bone grafting. just they were cautioned it completely depend on initial bone height and implant protrusion length in sinus cavity.96 implants in 80 patients gave cumulative survival rates more than 90% and 2.16+/-1.13mm ESBG during 4-9 follow up.
  6. Zill A, Precht C, et al, in 2016(50) presented a retrospective study on 113 patients with 1-11 mm 0f residual bone height. They inserted 233 implants on patients and followed up during 5 years after loading of implants. 7implants failed.36 patients dropped out of follow up. Implant survival rate was 93.8%, implant success rate was 92.7%. Average mean bone gain was 4.5+/-1.4 mm after 5 years of loading.
  7. In another retrospective study by David French (51) et al, in 2016, up to 10 years follow up’s results were highly successful although RBH was less than 5 mm and implants were short. They reported 93.8% survival rate, and 95.4% success rate for implants.
  8. In 2019, Aditi Rawat and her collegeous (52) placed 26 implants on 21 patients using OSFE without bone use. They followed up them by intra-oral periapical radiographs for determination mean bone gain. Stable implant at the end of 6 months follow-up presented 100% survival rate. Mean bone gain for all implants were 1.97mm.This result demonstrated high success rate of this method without association to bone graft.
  9. In a preliminary study in 2019, Suk-Arj P et al (53), tried to evaluate new bone formation after OSFE without bone graft. Follow up period was 6 months. ESBG was 1.8+/-0.73 mm and 100% survival rate for implants.


The present data suggests that Peri-implant bone formation was observed; this confirms that a grafting material is not required to promote osteogenesis and maintain the newly formed bone volume. Peri-implant bone was mainly gained during the first year, it did not shrink with time, but rather increased. Thus although OSFE has own limitation depend on vertical height of atrophied posterior site of maxilla and bone septa inside of maxilla but this treatment modality without any graft  can be a viable option for sinus floor elevation simultaneous implant placement. Hence as a result, high survival rate and bone gain around  implants are main outcomes of this techniques.



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  1. Osteotome Sinus Floor Elevation Technique Without Grafting Material and Immediate Implant Placement in Atrophic Posterior Maxilla: Report of 2 Cases Rabah Nedir, DMD , , Correspondence information about the author DMD Rabah Nedir Email the author DMD Rabah Nedir,Nathalie Nurdin, PhD †Serge Szmukler-Moncler, DDS, IEP, PhD,Mark Bischof, DMD § DOIhttps://doi.org/10.1016/j.joms.2008.12.013
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  3. Osteotome sinus floor elevation technique without grafting: a 5year prospective study

Rabah Nedir ,Nathalie NurdinLydia Vazquez Serge Szmukler‐Moncler Mark Bischof Jean‐Pierre Bernard


  1. Osteotome sinus floor elevation with and without grafting material in the severely atrophic maxilla. A 1-year prospective randomized controlled study,Nedir R1Nurdin NKhoury PPerneger THage MEBernard JPBischof M. . Clin Oral Implants Res.2013 Nov;24(11):1257-64. doi: 10.1111/j.1600-0501.2012.02569.x. Epub 2012 Aug 27Clin Oral Implants Res.2013 Nov;24(11):1257-64. doi: 10.1111/j.1600-0501.2012.02569.x. Epub 2012 Aug 27.


36.Short implants placed with or without grafting into atrophic sinuses: the 5year results of a prospective randomized controlled study Rabah NedirNathalie Nurdin ,Semaan Abi Najm ,Marc El Hage ,Mark Bischofhttps://doi.org/10.1111/clr.12893

  1. Sinus floor elevation using an osteotome technique without grafting materials or membranes.

Schmidlin PR1Müller JBindl AImfeld H. PMID:18717379




  1. Maxillary sinus floor elevation using the (transalveolar) osteotome technique with or without grafting material. Part I: Implant survival and patients’ perceptionArticleinClinical Oral Implants Research20(7):667-76 · July 2009 with 713 Reads DOI: 10.1111/j.1600-0501.2009.01704.x· Source: PubMed

39.Transalveolar maxillary sinus floor elevation using osteotomes with or without grafting material. Part II: Radiographic tissue remodeling.Pjetursson BE1Ignjatovic DMatuliene GBrägger USchmidlin KLang NP. 2009 Jul;20(7):677-83. doi: 10.1111/j.1600-0501.2009.01721.x.


40.Osteotome sinus floor elevation and simultaneous placement of implants–a 1-year retrospective study with Astra Tech implants.Fermergård R1Astrand P. Clin Implant Dent Relat Res. 2008 Mar;10(1):62-9. doi: 10.1111/j.1708-8208.2007.00062.x.

41.Osteotome sinus floor elevation with or without grafting: a preliminary clinical trial.

Lai HC1Zhuang LFLv XFZhang ZYZhang YXZhang ZY. 2010 May;21(5):520-6. doi: 10.1111/j.1600-0501.2009.01889.x. Epub 2010

  1. Osteotome sinus floor elevation without bone grafting and simultaneous implant placement in the atrophic maxilla: a pilot study.Senyilmaz DP1Kasaboglu O. Indian J Dent Res.2011 Nov-Dec;22(6):786-9. doi: 10.4103/0970-9290.94669.


  1. Sinus floor elevation using osteotome technique without grafting materials: a 2-year retrospective study.

He L1Chang XLiu Y.

  1. Osteotome sinus floor elevation without bone grafts–a 3-year retrospective study with Astra Tech implants.Fermergård R1Åstrand P. . Clin Implant Dent Relat Res.2012 Apr;14(2):198-205. doi: 10.1111/j.1708-8208.2009.00254.x. Epub 2009 Nov 10.


45.Long-term evaluation of osteotome sinus floor elevation and simultaneous placement of implants without bone grafts: 10-Year radiographic and clinical follow-up.

Caban J1Fermergård R1Abtahi J2. Clin Implant Dent Relat Res. 2017 Dec;19(6):1023-1033. doi: 10.1111/cid.12530. Epub 2017 Aug 29.


  1. osteotome sinus floor elevation without grafting material: Results of a 2-year prospective study Aritza Brizuela, Nerea Martin, Felipe José ,Fernández-González, Carolina Larrazábal DOI: 10.4317/jced.51576
  2. transcrestal guided sinus lift without grafting materials: a 36 months clinical prospective study D. SPINELLI1 , G. DE VICO1 , R. CONDÒ2 , L. OTTRIA2 , C. ARCURI2 1 Private practice in Rome, Italy 2 Department of Clinical Science and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy

48...Long-term outcomes of osteotome sinus floor elevation without bone grafts: a clinical retrospective study of 4-9 years. Si MS1Shou YW1Shi YT2Yang GL1Wang HM1He FM3. Clin Oral Implants Res. 2016 Nov;27(11):1392-1400. doi: 10.1111/clr.12752. Epub 2016 Jan 11

  1. Implants inserted with graftless osteotome sinus floor elevation – A 5-year post-loading retrospective study.Zill APrecht CBeck-Broichsitter BSehner SSmeets RHeiland MRendenbach CHenningsen A. PMID:27722225, Eur J Oral Implantol.2016;9(3):277-289.
  2. Survival and Success Rates of Dental Implants Placed Using Osteotome Sinus Floor Elevation Without Added Bone Grafting: A Retrospective Study with a Follow-up of up to 10 Years.

French DNadji NShariati BHatzimanolakis PLarjava H. Int J Periodontics Restorative Dent. 2016;36 Suppl:s89-97. doi: 10.11607/prd.2191.


51.Indirect sinus floor elevation technique with simultaneous implant placement without using bone grafts
Aditi Rawat,HimanshuThukral,AnsonJose DOI: 10.4103/ams.ams_11_19 PMID: 3129393 . doi: 10.1186/s40729-019-0181-7.

  1. Evaluation of bone formation following the osteotome sinus floor elevation technique without grafting using cone beam computed tomography: a preliminary study.Suk-Arj P1Wongchuensoontorn C1Taebunpakul P2.


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