Bone Reformation with Sinus Membrane Elevation: A New Surgical Technique for Maxillary Sinus Floor Augmentation

Abstract

Various maxillary sinus floor augmentation techniques using bone grafts and bone substitutes are frequently used to enable placement of dental implants in the posterior maxilla. A previous case report demonstrated the possibility of promoting bone formation in the sinus by lifting the membrane without using a grafting material. However, the predictability of the technique is not known. The aim of this study was to investigate whether sinus membrane elevation and the simultaneous insertion of titanium implants without additional grafting material constitute a valid technique for bone augmentation of the maxillary sinus floor. The study group comprised 10 patients in whom a total of 12 maxillary sinus floor augmentations were performed. A replaceable bone window was prepared in the lateral sinus wall with a reciprocating saw. The sinus membrane was dissected, elevated superiorly, and sutured to the sinus wall to create and maintain a compartment for blood clot formation. One to three dental implants were inserted through the residual bone and protruded at least 5 mm into the maxillary sinus. The bone window was replaced and secured with the overlying mucosa. Bone height was measured directly at each implant site at the time of insertion. Resonance frequency analysis (RFA) was performed on each implant at the time of initial placement, at abutment surgery, and after 12 months of functional loading. Computed tomography (CT) was performed in the immediate postoperative period and 6 months later, prior to exposure of the implants. A total of 19 implants (Brånemark System, TiUnite, Nobel Biocare AB, Gothenburg, Sweden) in lengths of 10 to 15 mm were placed, with an average residual bone height of 7 mm (range, 4-10 mm). All implants remained clinically stable during the study period. Comparisons of pre- and postoperative CT radiography clearly demonstrated new bone formation within the compartment created by the sinus membrane elevation procedure. RFA measurements showed mean implant stability quotient values of 65, 66, and 64 at placement, at abutment connection, and after 12 months of loading, respectively. The study showed that there is great potential for healing and bone formation in the maxillary sinus without the use of additional bone grafts or bone substitutes. The secluded compartment created by the elevated sinus membrane, implants, and replaceable bone window allowed bone formation according to the principle of guided tissue regeneration. The precise mechanisms are not known, and further histologic studies are needed. Sinus membrane elevation without the use of additional graft material was found to be a predictable technique for bone augmentation of the maxillary sinus floor.