Poster 144: Maxillary Sinus Augmentation With Large Quantity of Autogenous Tibial Bone Graft

Abstract

Autologous bone is the gold standard material used for augmentations in oral and maxillofacial surgery. The sinus floor has been augmented with bone grafts derived from the iliac crest, the mandibular symphysis, the maxillary tuberosity, the mandibular ramus, or tibial bone. Chen showed that proximal tibia offers a reliable site for harvest of large quantities of good-quality cancellous bone. We present our private practice experience of tibial bone grafting for sinus lift as well as implant placement, demonstrating both its ease as an office procedure, low morbidity, and large quantity of high quality cancellous bone. This is a retrospective study that evaluated autologous tibial bone for maxillary sinus lift and placement of maxillary implants. We followed 27 patients who had 28 sinus lift augmentations with tibial bone grafting. Our patients’ ages ranged from 35 to 76 years old. Patients were excluded based on: uncontrolled diabetes, smoking, and ongoing maxillary sinus infection. The same surgeon performed all surgeries. The patients were followed up to 11 years post sinus lift procedure at the following interval: 1 week, 6 weeks, 3 months, 4 months and 1 year after sinus procedure. All patients received ampicillin or clindamycin pre-operatively and augmentin for 7 days post-operatively. All patients were placed on standard maxillary sinus precautions. This is a case study. All of our patients were examined and followed by the same surgeon. All sinus lifts had implants placed. 89 implants were placed in the sinus lift site: 36 implants were placed at the same time as the sinus lift procedure and 53 implants were placed 10 weeks after sinus lift procedure. No implants were lost. Our patients had minimal morbidity. Two complained of hypertrophic scars at the site of bone harvesting. Another patient complained of leg pain for 10 weeks after sinus lift, which resolved. Our patients were followed radiographically with a panorex the day of surgery, then pa’s at 3 months and a panorex after 1 year. There was no significant reduction in bone height. The surgical harvesting for proximal tibial bone has a low incidence of overall complication, mild postoperative pain, and relative ease of harvest, decreased operative time, immediate ambulation, and rapid recovery. We believe that augmentation of the maxillary sinus with tibial bone graft is a reliable and successful way of achieving the placement of dental implants when a large amount of graft is required.