Internal Sinus LiftingNCT07433868
Evaluation of Implant Stability Following Maxillary Sinus Floor Elevation Through Piezoelectric Trans-crestal Approach Versus Crestal Implant Approach
A study testing PISE and Crestal implant approach in people with Internal Sinus Lifting, run by International Dental Contiuing Education.
Trial summary
Rehabilitation of the maxillary posterior region is a challenge in every-day clinical practice. Following extraction of maxillary molars, alveolar ridge atrophy along with maxillary sinus pneumatization decrease the bone volume and increase implant placement complexity (Lyu et al., 2023). Read more about this study
- Who is it for?
- Ages 21 to 55 years
- Conditions the study is for
- Internal Sinus Lifting
- What is being tested?
- PISE and Crestal implant approach
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 26 participants
- Where
- No sites listed yet
- Study dates
- 1 Mar 2026to 1 May 2027
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 21 to 55 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Patients who have at least one missing posterior maxillary tooth with sound adjacent and opposing dentition.
- Adults above the age of 21.
- Bone height from 4mm to 6mm under the maxillary sinus assessed in CBCT.
- Good oral hygiene.
- Patient accepts to provide an informed consent.
Who cannot join
- Smokers.
- Pregnant and lactating females.
- Medically compromised patients.
- Patients with untreated active periodontal diseases.
- Patients with active infection related to the implant site.
- Patients with parafunctional habits.
Show all 9Show fewer
- Patients with Acute or chronic sinusitis.
- Presence of sinus septa
- History of radiotherapy or chemotherapy within the past 2 years
Trial locations and contacts
No sites are listed yet. Contact the study team or a site near you to ask about taking part.
About this study
Official title: Evaluation of Implant Stability Following Maxillary Sinus Floor Elevation Through Piezoelectric Trans-crestal Approach Versus Crestal Implant Approach: A 1-year Randomized Clinical Trial
Rehabilitation of the maxillary posterior region is a challenge in every-day clinical practice. Following extraction of maxillary molars, alveolar ridge atrophy along with maxillary sinus pneumatization decrease the bone volume and increase implant placement complexity (Lyu et al., 2023). Several surgical procedures have been proposed to overcome these complications, including; short implants (Bechara et al., 2017), tilted implants (Meng and Zhang, 2022) as well as different sinus floor elevation techniques (Irinakis, 2011, Bishbish et al., 2023, Dragonas et al., 2023). Crestal maxillary sinus floor elevation has been considered a predictable and less invasive approach, providing sufficient vertical ridge height with high rates of implant survival (Guruprasad et al., 2024). However, there's limited body of evidence comparing the efficacy of different trans-crestal approaches as PISE and crestal implant approach with no bone graft. Thus, further clinical trials are recommended to determine whether the adjunctive use of piezoelectric instrumentation in internal sinus elevation offers significant clinical advantages over the crestal implant approach.
Read the detailed description
Aim of the study: The aim of this study is to evaluate clinical long term implant stability and radiographic vertical bone height gain after implant placement in posterior maxilla using crestal implant approach in comparison to PISE.
Hypothesis:
Research Null hypothesis: There will be no difference between implants placed with crestal implant approach and PISE, regarding long term implant stability and radiographic bone height gain.
The primary objective:
- To compare the implant stability quotient (ISQ) between the two treatment modalities, will be assessed by resonance frequency analysis using "Osstell" (Integration Diagnostics, Save Dalen, Sweden)
The secondary objectives:
- To assess intra-sinus vertical bone gain around dental implants, in mm, will be assessed by CBCT.
- To assess marginal bone level, in mm
- To assess peri-implant soft tissue parameters by modified plaque and bleeding indices.
- To evaluate post-operative pain.
- To assess any surgical or post-surgical complications.
- Conditions
- Internal Sinus Lifting
- Being tested
- PISE, Crestal implant approach
- Keywords
- crestal implant approach, PISE, implant stability
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
PISEProcedure or surgery
Osteotomy site preparation will be initiated using a piezoelectric ultrasonic osteotome under sterile irrigation. Sequential osteotomy preparation will be carried out while maintaining the planned implant angulation 1 mm short of the sinus floor based on preoperative radiographic measurements done using the CBCT. Thinning the sinus floor will be achieved after using subsequent widening drills and the integrity of the Schneiderian membrane and the residual bone thickness will be verified using periapical radiographs to ensure the exact amount of remaining floor bone
Crestal implant approachProcedure or surgery
Osteotomy site preparation and implant drilling sequence were performed according to the manufacturer's instructions. Drilling will be done gently till reaching 0.5-1mm from the sinus floor, checked by periapical radiographs with the drills placed in the osteotomy. During implant placement, the sinus membrane will be gently elevated with the blunt rounded circular apex of the implant
| Study group | Role | What they receive |
|---|---|---|
| Cerstal implant Approach | Active comparator | a mid-crestal incision will be done using a 15c blade (Carl Martin GmbH, Solingen, Germany) and then a full thickness mucoperiosteal flap will be elevated. Osteotomy site preparation and implant drilling sequence were performed according to the manufacturer's instructions. Drilling will be done gently till reaching 0.5-1mm from the sinus floor, checked by periapical radiographs with the drills placed in the osteotomy. During implant placement, the sinus membrane will be gently elevated with the blunt rounded circular apex of the implant (MegaGen AnyRidge®, MegaGen Implant Co., Ltd., Daegu, South Korea) as previously described by Fettouh et al. (2024). Receives: Procedure: Crestal implant approach |
| PISE | Experimental | a mid-crestal incision will be done using a 15c blade (Carl Martin GmbH, Solingen, Germany) and then a full thickness mucoperiosteal flap will be elevated. Osteotomy site preparation will be initiated using a piezoelectric ultrasonic osteotome under sterile irrigation. Sequential osteotomy preparation will be carried out while maintaining the planned implant angulation 1 mm short of the sinus floor based on preoperative radiographic measurements done using the CBCT. Thinning the sinus floor will be achieved after using subsequent widening drills and the integrity of the Schneiderian membrane and the residual bone thickness will be verified using periapical radiographs to ensure the exact amount of remaining floor bone (Baldi et al., 2011). According to the pre-planned prosthetic implant position, the implant will be placed (MegaGen Implant Co., Ltd., Daegu, South Korea). Receives: Procedure: PISE |
What is being measured
The primary outcome is the main question the study is designed to answer.
Intra Sinus bone formation
Four CBCT scans will be done scans; at T0, T1, T2 \& T4, using Cranex® SOREDEX, Finland, Commercially available at ORASCAN oral and maxillofacial imaging centre, Cairo, Egypt, and at the outpatient clinics of faculty of dentistry, Misr International University, Cairo, Egypt. Standardization of the exposure parameters: Field of view 6 x 8 cm, peak kilovoltage of 90 Kv, milliamperage of 10 mA, exposure time of 6.1 seconds and resolution of 0.2 mm (200 μm) voxel size. All data from CBCT examinations will be acquired in a DICOM format which is imported to OnDemand3D ® App software (Cybermed, Seoul, Korea). In order to ensure standardization and reproducibility of the CBCT cross sectional images that will be used in this study, superimposition of DICOM sets of each patient using Fusion module of Ondemand 3D App software will be done. This 3D superimposition technique allows for sub-voxel accuracy and highly strong registration. Both files will be loaded in the Fusion module at the same tim
Measured: 1 year
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted25 Feb 2026
- Study start1 Mar 2026 (estimated)
- Primary completion1 Apr 2027 (estimated)
- Study completion1 May 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Internal Sinus LiftingStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Evaluation Day: Patients Enrollment: For the patients who meet eligibility criteria, the PI will explain the study procedures in details and the informed consent form will be offered in a private area assigned by the IDCE management. The PI will answer all questions the patients have, and after signing the informed consent, patients will be referred to perform CBCT on the same visit. Preoperative procedure: • After patient enrollment, a preoperative CBCT will be performed for each participant prior to the surgery for precise evaluation of residual ridge height, sinus anatomy. o Surgery Day (T0): After administration of local anesthesia, the allocation will be revealed; Group 1 (Test): Implant placement with PISE Group 2 (Control): Implant placement with crestal implant approach
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 26 participants (estimated)
Sponsor and investigators
- Lead sponsor
- International Dental Contiuing Education
- Sponsor type
- Research network
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07433868
- Sponsor's protocol ID
- IDCE-41722026
- Status last verified
- Feb 2026
- First submitted
- 19 Feb 2026
- Last updated
- 2 Mar 2026
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
ALBREKTSSON, T. 1993. On long-term maintenance of the osseointegrated response. Aust Prosthodont J, 7 Suppl, 15-24. ALBREKTSSON, T., ZARB, G., WORTHINGTON, P. & ERIKSSON, A. R. 1986. The long-term efficacy of currently used dental implants: A review and proposed criteria of success. The International journal of oral & maxillofacial implants, 1, 11-25. BALDI, D., MENINI, M., PERA, F., RAVERA, G. & PERA, P. 2011. Sinus floor elevation using osteotomes or piezoelectric surgery. Int J Oral Maxillofac Surg, 40, 497-503. BECHARA, S., KUBILIUS, R., VERONESI, G., PIRES, J. T., SHIBLI, J. A. & MANGANO, F. G. 2017. Short (6-mm) dental implants versus sinus floor elevation and placement of longer (≥10-mm) dental implants: a randomized controlled trial with a 3-year follow-up. Clin Oral Implants Res, 28, 1097-1107. BISHBISH, O., KAN, J. & KIM, Y. J. 2023. Guided Lateral Window Osteotomy Using Dynamic Navigation for Maxillary Sinus Augmentation: A Novel Technique. J Oral Implantol, 49, 316-321. BOYNE, P. J. & JAMES, R. A. 1980. Grafting of the maxillary sinus floor with autogenous marrow and bone. J Oral Surg, 38, 613-6. DRAGONAS, P., PRASAD, H. S., YU, Q., MAYER, E. T. & FIDEL, P. L., JR. 2023. Bone Regeneration in Maxillary Sinus Augmentation Using Advanced Platelet-Rich Fibrin (A-PRF) and Plasma Rich in Growth Factors (PRGF): A Pilot Randomized Controlled Trial. Int J Periodontics Restorative Dent, 43, 319-327. FETTOUH, A. I. A., GHALLAB, N. A., ADEL, N., NASSER, R., GAMAL, N., SAMY, M. & SHEMAIS, N. 2026. Graftless Sinus Floor Elevation Using the Lateral or Transcrestal Approach. A Randomized Clinical Trial With One Year Follow-Up. Clin Oral Implants Res, 37, 87-97. FETTOUH, A. I. A., GHALLAB, N. A., GHAFFAR, K. A., MINA, N. A., ABDELMALAK, M. S., ABDELRAHMAN, A. A. G. & SHEMAIS, N. M. 2023. Bone dimensional changes after flapless immediate implant placement with and without bone grafting: Randomized clinical trial. Clin Implant Dent Relat Res, 25, 271-283. FETTOUH, A. I. A.
Study at a glance
From the registry record, last updated by the sponsor on 2 Mar 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Evaluation of Implant Stability Following Maxillary Sinus Floor Elevation Through Piezoelectric Trans-crestal Approach Versus Crestal Implant Approach: A 1-year Randomized Clinical Trial
- ClinicalTrials.gov ID
- NCT07433868
- Acronym / sponsor ID
- IDCE-41722026
- Conditions
- Internal Sinus Lifting
- Keywords
- crestal implant approach, PISE, implant stability
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 26 participants (estimated)
- Lead sponsor
- International Dental Contiuing EducationResearch network
- Study start
- 1 Mar 2026 (estimated)
- Primary completion
- 1 Apr 2027 (estimated)
- Study completion
- 1 May 2027 (estimated)
- First posted
- 25 Feb 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Rehabilitation of the maxillary posterior region is a challenge in every-day clinical practice. Following extraction of maxillary molars, alveolar ridge atrophy along with maxillary sinus pneumatization decrease the bone volume and increase implant placement complexity (Lyu et al., 2023). Several surgical procedures have been proposed to overcome these complications, including; short implants (Bechara et al., 2017), tilted implants (Meng and Zhang, 2022) as well as different sinus floor elevation techniques (Irinakis, 2011, Bishbish et al., 2023, Dragonas et al., 2023). Crestal maxillary sinus floor elevation has been considered a predictable and less invasive approach, providing sufficient vertical ridge height with high rates of implant survival (Guruprasad et al., 2024). However, there's limited body of evidence comparing the efficacy of different trans-crestal approaches as PISE and crestal implant approach with no bone graft. Thus, further clinical trials are recommended to determine whether the adjunctive use of piezoelectric instrumentation in internal sinus elevation offers significant clinical advantages over the crestal implant approach.
Detailed description
Aim of the study: The aim of this study is to evaluate clinical long term implant stability and radiographic vertical bone height gain after implant placement in posterior maxilla using crestal implant approach in comparison to PISE.
Hypothesis:
Research Null hypothesis: There will be no difference between implants placed with crestal implant approach and PISE, regarding long term implant stability and radiographic bone height gain.
The primary objective:
- To compare the implant stability quotient (ISQ) between the two treatment modalities, will be assessed by resonance frequency analysis using "Osstell" (Integration Diagnostics, Save Dalen, Sweden)
The secondary objectives:
- To assess intra-sinus vertical bone gain around dental implants, in mm, will be assessed by CBCT.
- To assess marginal bone level, in mm
- To assess peri-implant soft tissue parameters by modified plaque and bleeding indices.
- To evaluate post-operative pain.
- To assess any surgical or post-surgical complications.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
- Model description
- Evaluation Day: Patients Enrollment: For the patients who meet eligibility criteria, the PI will explain the study procedures in details and the informed consent form will be offered in a private area assigned by the IDCE management. The PI will answer all questions the patients have, and after signing the informed consent, patients will be referred to perform CBCT on the same visit. Preoperative procedure: • After patient enrollment, a preoperative CBCT will be performed for each participant prior to the surgery for precise evaluation of residual ridge height, sinus anatomy. o Surgery Day (T0): After administration of local anesthesia, the allocation will be revealed; Group 1 (Test): Implant placement with PISE Group 2 (Control): Implant placement with crestal implant approach
| Arm | Type | Receives |
|---|---|---|
| Cerstal implant Approach | Active comparator | Procedure: Crestal implant approacha mid-crestal incision will be done using a 15c blade (Carl Martin GmbH, Solingen, Germany) and then a full thickness mucoperiosteal flap will be elevated. Osteotomy site preparation and implant drilling sequence were performed according to the manufacturer's instructions. Drilling will be done gently till reaching 0.5-1mm from the sinus floor, checked by periapical radiographs with the drills placed in the osteotomy. During implant placement, the sinus membrane will be gently elevated with the blunt rounded circular apex of the implant (MegaGen AnyRidge®, MegaGen Implant Co., Ltd., Daegu, South Korea) as previously described by Fettouh et al. (2024). |
| PISE | Experimental | Procedure: PISEa mid-crestal incision will be done using a 15c blade (Carl Martin GmbH, Solingen, Germany) and then a full thickness mucoperiosteal flap will be elevated. Osteotomy site preparation will be initiated using a piezoelectric ultrasonic osteotome under sterile irrigation. Sequential osteotomy preparation will be carried out while maintaining the planned implant angulation 1 mm short of the sinus floor based on preoperative radiographic measurements done using the CBCT. Thinning the sinus floor will be achieved after using subsequent widening drills and the integrity of the Schneiderian membrane and the residual bone thickness will be verified using periapical radiographs to ensure the exact amount of remaining floor bone (Baldi et al., 2011). According to the pre-planned prosthetic implant position, the implant will be placed (MegaGen Implant Co., Ltd., Daegu, South Korea). |
Who may qualify
- Ages
- 21 to 55 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (5 listed)
- Patients who have at least one missing posterior maxillary tooth with sound adjacent and opposing dentition.
- Adults above the age of 21.
- Bone height from 4mm to 6mm under the maxillary sinus assessed in CBCT.
- Good oral hygiene.
- Patient accepts to provide an informed consent.
Key exclusion criteria (9 listed)
- Smokers.
- Pregnant and lactating females.
- Medically compromised patients.
- Patients with untreated active periodontal diseases.
- Patients with active infection related to the implant site.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| PISEOsteotomy site preparation will be initiated using a piezoelectric ultrasonic osteotome under sterile irrigation. Sequential osteotomy preparation will be carried out while maintaining the planned implant angulation 1 mm short of the sinus floor based on preoperative radiographic measurements done using the CBCT. Thinning the sinus floor will be achieved after using subsequent widening drills and the integrity of the Schneiderian membrane and the residual bone thickness will be verified using periapical radiographs to ensure the exact amount of remaining floor bone | Procedure or surgery | PISE |
| Crestal implant approachOsteotomy site preparation and implant drilling sequence were performed according to the manufacturer's instructions. Drilling will be done gently till reaching 0.5-1mm from the sinus floor, checked by periapical radiographs with the drills placed in the osteotomy. During implant placement, the sinus membrane will be gently elevated with the blunt rounded circular apex of the implant | Procedure or surgery | Cerstal implant Approach |
Primary outcome
Intra Sinus bone formation
Time frame: 1 year
Four CBCT scans will be done scans; at T0, T1, T2 \& T4, using Cranex® SOREDEX, Finland, Commercially available at ORASCAN oral and maxillofacial imaging centre, Cairo, Egypt, and at the outpatient clinics of faculty of dentistry, Misr International University, Cairo, Egypt. Standardization of the exposure parameters: Field of view 6 x 8 cm, peak kilovoltage of 90 Kv, milliamperage of 10 mA, exposure time of 6.1 seconds and resolution of 0.2 mm (200 μm) voxel size. All data from CBCT examinations will be acquired in a DICOM format which is imported to OnDemand3D ® App software (Cybermed, Seoul, Korea). In order to ensure standardization and reproducibility of the CBCT cross sectional images that will be used in this study, superimposition of DICOM sets of each patient using Fusion module of Ondemand 3D App software will be done. This 3D superimposition technique allows for sub-voxel accuracy and highly strong registration. Both files will be loaded in the Fusion module at the same tim
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 2 Mar 2026.
- BackgroundALBREKTSSON, T. 1993. On long-term maintenance of the osseointegrated response. Aust Prosthodont J, 7 Suppl, 15-24. ALBREKTSSON, T., ZARB, G., WORTHINGTON, P. & ERIKSSON, A. R. 1986. The long-term efficacy of currently used dental implants: A review and proposed criteria of success. The International journal of oral & maxillofacial implants, 1, 11-25. BALDI, D., MENINI, M., PERA, F., RAVERA, G. & PERA, P. 2011. Sinus floor elevation using osteotomes or piezoelectric surgery. Int J Oral Maxillofac Surg, 40, 497-503. BECHARA, S., KUBILIUS, R., VERONESI, G., PIRES, J. T., SHIBLI, J. A. & MANGANO, F. G. 2017. Short (6-mm) dental implants versus sinus floor elevation and placement of longer (≥10-mm) dental implants: a randomized controlled trial with a 3-year follow-up. Clin Oral Implants Res, 28, 1097-1107. BISHBISH, O., KAN, J. & KIM, Y. J. 2023. Guided Lateral Window Osteotomy Using Dynamic Navigation for Maxillary Sinus Augmentation: A Novel Technique. J Oral Implantol, 49, 316-321. BOYNE, P. J. & JAMES, R. A. 1980. Grafting of the maxillary sinus floor with autogenous marrow and bone. J Oral Surg, 38, 613-6. DRAGONAS, P., PRASAD, H. S., YU, Q., MAYER, E. T. & FIDEL, P. L., JR. 2023. Bone Regeneration in Maxillary Sinus Augmentation Using Advanced Platelet-Rich Fibrin (A-PRF) and Plasma Rich in Growth Factors (PRGF): A Pilot Randomized Controlled Trial. Int J Periodontics Restorative Dent, 43, 319-327. FETTOUH, A. I. A., GHALLAB, N. A., ADEL, N., NASSER, R., GAMAL, N., SAMY, M. & SHEMAIS, N. 2026. Graftless Sinus Floor Elevation Using the Lateral or Transcrestal Approach. A Randomized Clinical Trial With One Year Follow-Up. Clin Oral Implants Res, 37, 87-97. FETTOUH, A. I. A., GHALLAB, N. A., GHAFFAR, K. A., MINA, N. A., ABDELMALAK, M. S., ABDELRAHMAN, A. A. G. & SHEMAIS, N. M. 2023. Bone dimensional changes after flapless immediate implant placement with and without bone grafting: Randomized clinical trial. Clin Implant Dent Relat Res, 25, 271-283. FETTOUH, A. I. A.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Questions about this trial
What is this clinical trial studying?
A study testing PISE and Crestal implant approach in people with Internal Sinus Lifting, run by International Dental Contiuing Education.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 2 Mar 2026. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Nourhan G Dr. Nourhan Gamal (01064249441, Nourhannegamal259@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Intra Sinus bone formation (time frame: 1 year). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07433868, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 Mar 2026.