{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T04:24:55Z","timestamp":1790828695044,"version":"4.1.0"},"reference-count":24,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T00:00:00Z","timestamp":1745798400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dentistry Journal"],"abstract":"<jats:p>Objectives: This retrospective study aimed to evaluate the increase in vertical bone height following sinus lift procedures using the CAS (Crestal Approach Sinus) kit technique in combination with tissue-level implants. Additionally, the quantity of bone between the implant apex and the Schneiderian membrane was assessed to determine the effectiveness and safety of this minimally invasive approach. Methods: The study included 15 patients (20 implants) who underwent sinus lift procedures with the CAS kit technique and tissue-level implants in the posterior maxilla between September 2021 and October 2024. Inclusion criteria required a minimum residual bone height (RBH) of 2 mm. Cone-beam computed tomography (CBCT) scans were used for initial screening, and panoramic radiography evaluated outcomes at implant placement and nine months postoperatively. Primary outcomes included implant and prosthetic survival rates, as well as biological and technical complications. Secondary outcomes were vertical bone height and the amount of bone above the implant tip. Statistical analyses were conducted using the Wilcoxon signed-rank test with a significance level of 0.05. Results: All implants achieved successful osseointegration, with no implant or prosthetic failures and no biological or technical complications reported. The mean RBH at implant placement was 4.2 \u00b1 1.4 mm, which increased to an overall membrane elevation of 13.8 \u00b1 1.8 mm. At the 9-month follow-up, the overall membrane elevation was slightly reduced to 13.0 \u00b1 1.6 mm (p = 0.000), with a mean bone gain of 9.6 \u00b1 2.4 mm. The amount of bone above the implant tip was 3.4 \u00b1 1.7 mm at placement, decreasing to 3.0 \u00b1 1.2 mm at follow-up (p = 0.007). Conclusions: The CAS kit technique combined with tissue-level implants demonstrated significant vertical bone gain and high implant survival rates without complications. This minimally invasive approach proved effective and safe for sinus augmentation in patients with limited residual bone height. The findings support the CAS kit\u2019s potential as a preferred technique for maxillary sinus elevation. Further research with larger cohorts and long-term follow-up is needed to validate these results.<\/jats:p>","DOI":"10.3390\/dj13050193","type":"journal-article","created":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T06:23:32Z","timestamp":1745821412000},"page":"193","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Crestal Hydraulic Sinus Lift with Simultaneous Implant Insertion: A Retrospective Case Series"],"prefix":"10.3390","volume":"13","author":[{"given":"Francesco Mattia","family":"Ceruso","sequence":"first","affiliation":[{"name":"Department of Dentistry \u201cFra G.B. Orsenigo\u2014Ospedale San Pietro F.B.F.\u201d, 00100 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8522-1838","authenticated-orcid":false,"given":"Aurea Immacolata","family":"Lumbau","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery, and Pharmacy, University of Sassari, 07100 Sassari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Pernice","sequence":"additional","affiliation":[{"name":"Department of Dentistry \u201cFra G.B. Orsenigo\u2014Ospedale San Pietro F.B.F.\u201d, 00100 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Mastroianni","sequence":"additional","affiliation":[{"name":"Department of Dentistry \u201cFra G.B. Orsenigo\u2014Ospedale San Pietro F.B.F.\u201d, 00100 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Miranda","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Translational Medicine, University of Rome \u201cTor Vergata\u201d, 00100 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvio Mario","family":"Meloni","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery, and Pharmacy, University of Sassari, 07100 Sassari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Gargari","sequence":"additional","affiliation":[{"name":"Department of Dentistry \u201cFra G.B. Orsenigo\u2014Ospedale San Pietro F.B.F.\u201d, 00100 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9206-0454","authenticated-orcid":false,"given":"Marco","family":"Tallarico","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery, and Pharmacy, University of Sassari, 07100 Sassari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milena","family":"Pisano","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery, and Pharmacy, University of Sassari, 07100 Sassari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/S0011-8532(22)02107-3","article-title":"Maxillary and sinus implant reconstructions","volume":"30","author":"Tatum","year":"1986","journal-title":"Dent. Clin. N. Am."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e13403","DOI":"10.1111\/cid.13403","article-title":"Minimally Invasive Sinus Augmentation: A Systematic Review","volume":"27","author":"Sirinirund","year":"2025","journal-title":"Clin. Implant. Dent. Relat. Res."},{"key":"ref_3","first-page":"e49553","article-title":"Maxillary Sinus Lift Procedures: An Overview of Current Techniques, Presurgical Evaluation, and Complications","volume":"15","author":"Alshamrani","year":"2023","journal-title":"Cureus"},{"key":"ref_4","first-page":"e71424","article-title":"Evolving Techniques and Trends in Maxillary Sinus Lift Procedures in Implant Dentistry: A Review of Contemporary Advances","volume":"16","author":"Alsharekh","year":"2024","journal-title":"Cureus"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1111\/prd.12414","article-title":"Complications in sinus lifting procedures: Classification and management","volume":"88","author":"Molina","year":"2022","journal-title":"Periodontology"},{"key":"ref_6","first-page":"152","article-title":"A new concept in maxillary implant surgery: The osteotome technique","volume":"15","author":"Summers","year":"1994","journal-title":"Compendium"},{"key":"ref_7","first-page":"67","article-title":"Crestal versus lateral sinus lift: One year result from a within-patient randomized controlled trial","volume":"5","author":"Xhanari","year":"2019","journal-title":"Clin. Trials Dent."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1111\/cid.12021","article-title":"Minimally invasive sinus lift implant device: A multicenter safety and efficacy trial preliminary results","volume":"16","author":"Better","year":"2014","journal-title":"Clin. Implant. Dent. Relat. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1111\/cid.13389","article-title":"Clinical and radiographic changes following transcrestal sinus augmentation: A scoping review of the last 25 years","volume":"26","author":"Decker","year":"2024","journal-title":"Clin. Implant. Dent. Relat. Res."},{"key":"ref_10","first-page":"325","article-title":"Crestal sinus lift using an implant with an internal L-shaped channel: 1-year after loading results from a prospective cohort study","volume":"10","author":"Tallarico","year":"2017","journal-title":"Eur. J. Oral Implantol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s40729-017-0103-5","article-title":"Comparison of three different methods of internal sinus lifting for elevation heights of 7 mm: An ex vivo study","volume":"3","author":"Alsabbagh","year":"2017","journal-title":"Int. J. Implant. Dent."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1007\/s12663-022-01793-4","article-title":"A Comparison of Elevation, Perforation Rate, and Time Spent for the Crestal Sinus Elevation Intervened by Piezosurgery, CAS-Kit, and Osteotome in a Novel Goat Model","volume":"21","author":"Wu","year":"2022","journal-title":"J. Maxillofac. Oral Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"308","DOI":"10.5051\/jpis.2013.43.6.308","article-title":"Assessment of dentists\u2019 subjective satisfaction with a newly developed device for maxillary sinus membrane elevation by the crestal approach","volume":"43","author":"Kim","year":"2013","journal-title":"J. Periodontal Implant. Sci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"593","DOI":"10.11607\/prd.3403","article-title":"Maxillary Sinus Membrane Elevation Using a Special Drilling System and Hydraulic Pressure: A 2-Year Prospective Cohort Study","volume":"38","author":"Gatti","year":"2018","journal-title":"Int. J. Periodontics Restor. Dent."},{"key":"ref_15","first-page":"11","article-title":"Report of the Sinus Consensus Conference of 1996","volume":"13","author":"Jensen","year":"1998","journal-title":"Int. J. Oral Maxillofac. Implant."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1111\/j.1600-051X.2008.01272.x","article-title":"A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation","volume":"35","author":"Pjetursson","year":"2008","journal-title":"J. Clin. Periodontol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1902\/annals.2003.8.1.328","article-title":"Effect of maxillary sinus augmentation on the survival of endosseous dental implants. A systematic review","volume":"8","author":"Wallace","year":"2003","journal-title":"Ann. Periodontol."},{"key":"ref_18","unstructured":"European Commission\u2014European Medicines Agency (2025, April 21). Report on the conference on the Operation of the Clinical Trials Directive (Directive 2001\/20\/EC) and Perspectives for the Future, Conference held on 3 October 2007 at the EMEA, London (Report Issued on November 30, 2007; Doc. ref.: EMEA\/565466\/2007). Available online: https:\/\/health.ec.europa.eu\/system\/files\/2017-02\/ec_emea_conference_on_clinical%252520_trials_en_0.pdf."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Ceruso, F.M., Ieria, I., Tallarico, M., Meloni, S.M., Lumbau, A.I., Mastroianni, A., Zotti, A., and Gargari, M. (2022). Comparison between Early Loaded Single Implants with Internal Conical Connection or Implants with Transmucosal Neck Design: A Non-Randomized Controlled Trial with 1-Year Clinical, Aesthetics, and Radiographic Evaluation. Materials, 15.","DOI":"10.3390\/ma15020511"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1570","DOI":"10.1016\/j.ijom.2016.09.023","article-title":"Maxillary sinus lift surgery-with or without graft material? A systematic review","volume":"45","author":"Silva","year":"2016","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"206","DOI":"10.3390\/prosthesis6010016","article-title":"The Use of a Surgical Template for the Insertion of Dental Implants and Sinus Lift with the Summers Technique Based on Digital Planning: A Case Report","volume":"6","author":"Speroni","year":"2024","journal-title":"Prosthesis"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.3390\/prosthesis6050084","article-title":"Evaluation of Bone Turnover around Short Finned Implants in Atrophic Posterior Maxilla: A Finite Element Study","volume":"6","author":"Kondratiev","year":"2024","journal-title":"Prosthesis"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"923","DOI":"10.3390\/prosthesis6040067","article-title":"Comparative Evaluation of Primary Stability in Truncated Cone Implants with Different Macro-Geometries in Low-Density Polyurethane Blocks Simulating Maxillary Sinus Rehabilitations","volume":"6","author":"Comuzzi","year":"2024","journal-title":"Prosthesis"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1111\/j.1600-0501.2012.02506.x","article-title":"Sinus augmentation via transcrestal approach: A comparison between the balloon and osteotome technique in a cadaver study","volume":"24","author":"Chan","year":"2013","journal-title":"Clin. Oral Implant. Res."}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/13\/5\/193\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:23:07Z","timestamp":1760030587000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/13\/5\/193"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,28]]},"references-count":24,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["dj13050193"],"URL":"https:\/\/doi.org\/10.3390\/dj13050193","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,28]]}}}