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Clin Oral Implants Res. 2011 Jun;22(6):669-72. doi: 10.1111/j.1600-0501.2010.01998.x. Epub 2010 Nov 3.

Benign paroxysmal positional vertigo following closed sinus floor elevation procedure: mallet osteotomes vs. screwable osteotomes. A triple blind randomized controlled trial.

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Oral and Implant Surgery Section of the Department of Oral and Maxillo-Facial Sciences, School of Oral Surgery, University Federico II of Naples, Naples, Italy.



To compare mallet osteotomes with screwable osteotomes determining benign paroxysmal positional vertigo (BPPV) following the osteotome closed sinus floor elevation procedure.


This triple-blind randomized controlled trial involved 196 patients affected by edentulous atrophic ridges (107 males and 89 females; mean age 62.05±7.10; age range 49-79 years), requiring an osteotome closed sinus floor elevation procedure. Patients were randomly allocated to either a mallet-osteotomes group (Group 1, n=98) or a screwable osteotomes group (Group 2, n=98). Two different surgeons, blind to the study, performed the closed sinus lift procedure according to the blocks allocation. A complete post-surgical examination, including the Dix-Hallpike maneuver, was performed on 196 patients before and after surgery. The diagnosis of BPPV was supported by the existence of ageotropic nystagmus concurrent with vertigo.


Three patients of Group 1 (3/98-3.06%) showed a BPPV of the posterior semicircular canal omo-lateral to the implanted side 1 or 2 days after the surgical procedure, which was promptly solved using the Epley re-positioning maneuver.


Preparation of implant beds with osteotome and mallet transmits percussive and vibratory forces capable of detaching the otoliths from their normal location; moreover, the patient's surgical head position favors the displacement of otoliths into the posterior semicircular canal. Implant surgeons should be aware of this possible complication following closed sinus lift procedure and patients should always be informed before undergoing surgery.

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