Abstract
Closed sinus lifting is a unique technique in being simple and less invasive (Summers, Compendium 15(6):698, 1994). However, it is blind to assess the safety of sinus lining during lifting without perforation. Previously, sinus membrane was assessed endoscopically in an invasive way. We aimed to judge clinically the sinus membrane integrity after crestal elevation by a direct simple less invasive endoscopic visual assessment through the crestal osteotomy site. To confirm undetected perforation, the sinus membrane was monitored dynamically by introducing the endoscope through a trephined opening in the lateral wall of the sinus (Nkenke et al., Int J Oral Maxillofac Implants 17(4):557–66, 2002).PatientsTwelve patients suffering atrophic posterior maxillae ranging 3–5 mm bone height below the sinus membrane were included to perform closed sinus lifting with simultaneous immediate implant placement under direct endoscopic assessment.ResultsThe floor was lifted without perforation in 83.33% of cases. However, it varied according to its thickness. Minor perforations occurred in two cases (16.67%). Both perforations were detected from the crestal endoscopic view while one of them was detected from the lateral endoscopic approach.ConclusionCrestal endoscopic access gives better direct vision to the membrane than the induced opening in the lateral wall of the maxillary sinus. Moreover, it uses the same prepared osteotomy site without doing any extra procedures. Perforation depends on the thickness of sinus lining and its ability to stretch during elevation. Intact crestal sinus floor elevation can never be guaranteed under endoscopic monitoring especially with thin irregular membranes.
Highlights
The evolution of closed sinus lift techniques since 1994 [1] was proposed as a less invasive method for management of atrophic posterior maxillae [2]
The endoscope was used to test the efficiency of the closed sinus lifting to detect the presence or absence of the perforation by doing a large window on the lateral sinus wall
CBCT [9, 10] represented the most commonly used technique to evaluate the thickness of the membrane, but it is not sensitive enough to
Summary
The evolution of closed sinus lift techniques since 1994 [1] was proposed as a less invasive method for management of atrophic posterior maxillae [2]. It is a blind technique that lacks the ability to confirm an intact sinus floor elevation without perforation and represented a real shortcoming [3]. Various forms of osteotome lifters were designed to guarantee safe elevation of maxillary sinus membrane [4,5,6,7,8], but all failed to prove a non-perforated elevation during the actual lifting procedures. The technique is considered an invasive surgery where another sinus surgery is required. CBCT [9, 10] represented the most commonly used technique to evaluate the thickness of the membrane, but it is not sensitive enough to
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