Maxillary sinus function after sinus lifts for the insertion of dental implants

Abstract

The authors of this article review some of the anatomic and physiologic factors that lead to maxillary sinusitis and suggest that mechanical obstruction caused by a deviated septum or occlusion of the osteum should be investigated and corrected before sinus bone graft placement. This suggestion is made despite their having two patients who developed postoperative infections respond to medical management alone. Moreover, three other chronic sinusitis sufferers had no flare-up of their condition after sinus grafting. All other patients with a negative history of sinus disease had an uneventful perioperative course. Therefore, it does not necessarily follow from the data presented that endoscopy needs be performed at any higher frequency in the sinus graft patient than in the general population. If the sinusitis is severe enough to warrant endoscopic surgery, this would be the most prudent indication for the procedure and not as attendant care for the sinus grafting procedure. This study clearly shows that when a healthy sinus is present neither the sinus nor the graft are at great risk for perioperative infection. This is valuable information, which is established for the first time using a direct visualization technique. This finding thus lends further credence to the concept that the sinus graft procedure will do no harm to the long-term function of the sinus. The treating oral and maxillofacial surgeon should evaluate the nasal airway and refer the chronic sinusitis patient for endoscopic evaluation when indicated. However, in most instances, it appears that even though chronic sinusitis sufferers may have exacerbation of their condition by surgical manipulation, and even when there is perforation of the sinus membrane, long-term morbidity does not result as long as there is proper medical management associated with the procedure. Although a prospective study should be done using endoscopy before sinus bone grafting, I cannot recommend, based on the current study, that sinus endoscopy be required before sinus grafting as a matter of course. The Sinus Bone Graft Consensus Conference’ in 1996 sponsored by the Academy of Osseointegration reported a high incidence of perforations in implant and bone graft loss cases. However, once again, despite the many apparent obstacles to healing, sinus graft consolidation and implant osseointegration were still maintained at a very high level (approximately 90% of 1,014 sinus grafts with 2,997 implants) at the S-year time frame. The remarkable ability of the sinus floor graft to undergo consolidation via endosteal proliferation is well documented. This study gives further evidence that the biologic basis for the sinus graft procedure is sound.