Response of bone tissue and mucosa of the maxillary sinus to bone substitutes for subantral augmentation in dental implantation: results of a prospective cohort study

Objective. Increasing the effectiveness of dental implantation after subantral augmentation through postoperative assessment of bone tissue and mucous membrane parameters of the maxillary sinus, taking into account the response to various bone substitutes. Materials and methods. The study included 62 patients (25—65 years old) with alveolar process atrophy of the maxilla, divided into two groups depending on the stage and method of treatment: control (n=48) — two-stage sinus lifting with mineralized allogeneic spongy powder and bioresorbable membrane “Lioplast”, implantation after 6 months; main (n=76) — one-stage augmentation with allogeneic bone rings “Maxgraft Bonering”, filling with platelet-rich plasma (OPP gel, PRP gel — platelet-rich plasma-gel) and a bioresorbable membrane. The assessment was carried out using cone beam computed tomography (CBCT): thickness of the mucous membrane of the maxillary sinus (SM MMP), height of the bone tissue of the maxillary sinus (CT MMP); Implant stability was determined using the dental implant stability coefficient (DISC) using resonance frequency analysis (Osstell ISQ). Measurements were taken immediately after surgery and after 12, 24, and 36 months. Results. In the study group, by 36 months, a more stable maxillary sinus thickness was observed (2.83±0.14 mm in the study group and 4.84±0.72 mm in the control group, p<0.01), along with a higher maxillary sinus height (10.83±0.43 mm in the study group and 9.23±0.46 mm in the control group, p<0.05) and DIC (80.44±0.27 units in the study group and 78.51±0.62 units in the control group, p<0.05). Statistically significant time and between-group differences (p<0.001) confirm progressive osseointegration and reduced postoperative swelling without complications. Conclusion. One-stage subantral augmentation with allogeneic bone rings and PRP is superior to the two-stage method in terms of peri-implant tissue stability, minimizing the risk of Schneiderian membrane perforation and mucosal hypertrophy. Preoperative CBCT analysis and the use of bioresorbable materials are recommended to optimize dental implant placement.