Immediate nonfunctional loading of implants placed simultaneously using computer-guided flapless maxillary crestal sinus augmentation with bone morphogenetic protein-2/collagen matrix

Clin Implant Dent Relat Res. 2019 Oct;21(5):1054-1061. doi: 10.1111/cid.12831. Epub 2019 Aug 12.


Background: Immediate loading has shown positive results for total, partial, or single edentulism. The effects of BMP-2 addition to graft materials on bone formation and implant stability in the early stages of healing have rarely been studied, especially in patients with severely atrophic maxillae.

Purpose: To evaluate the effects of simultaneously placed immediate non-functional loaded implants and bone morphogenetic protein-2 (BMP-2)-loaded Bio-Oss collagen, on bone formation and implant stability during the early healing stages of patients with a severely atrophic posterior maxilla using crestal approach.

Materials and methods: Thirty-three cases presenting posterior maxillary residual alveolar bone height of 1-3 mm were evaluated. Flapless crestal sinus augmentation surgery was performed using BMP-2-loaded Bio-Oss collagen, with non-functional implants immediately loaded after surgery. The bone height was assessed using preoperative and postoperative cone beam computed tomography (CBCT). Bone density of the sinus graft sites and implant stability (after 3 months) were evaluated using postoperative CBCT scans and Periotest, respectively. The periodontal parameters and marginal bone loss around the implant were checked after 37.3 months of final prosthesis.

Results: The survival rate of the implants was 100% and the gingiva around the implants remained healthy. All implants remained integrated, and all sinus grafts showed radiographic bone formation. The results indicated high level of bone density and good implant stability, showing minimal marginal bone loss after 37.3 months.

Conclusion: This technique could be used in the posterior maxillary region exhibiting poor bone quantity.

Keywords: bone substitutes; dental implant; immediate nonfunctional loading; minimal invasive method.

MeSH terms

  • Alveolar Bone Loss*
  • Collagen
  • Dental Implantation, Endosseous
  • Dental Implants*
  • Dental Prosthesis Design
  • Dental Prosthesis, Implant-Supported
  • Dental Restoration Failure
  • Humans
  • Maxilla
  • Maxillary Sinus
  • Treatment Outcome


  • Dental Implants
  • Collagen