Membrane Elevation Research Articles

Planning of sinus lift on patients with maxillary mucous retention cysts of various sizes on an outpatient appointment

According to the literature, maxillary mucous retention cysts are a common finding in screening studies. They are incidentally found in 12.4—22% of people with CT examinations of the maxillary and are often asymptomatic. There is still no consensus on the symptomatology of maxillary mucous retention cysts. Objectives — identification of maxillary mucous retention cysts in patients at the initial visit: 1) study the clinical manifestations and radiological features of the maxillary mucous retention cysts depending on the size of the cysts; 2) identify the symptoms of retention cysts depending on the size of the cysts; 3) analyze the size of the cysts, age and gender prevalence, multiplicity and loneliness of retention cysts; 4) study the likelihood of recurrence of retention cysts after their removal; 5) study the effect of cysts on the sinus lift. Materials and methods. Clinical and screening studies were performed in 940 patients who came to the clinic in 2019. Thus, 1880 maxilla sinuses were examined. Patients underwent X-ray examinations and anamnesis. Results and conclusions. The results of the study allow us to conclude that there is no significant symptoms in the presence of maxillary mucous retention cysts. Retention cysts, as a rule, are an accidental finding on CBCT when examining the dento-maxillary system and planning a sinus lift. It is very important to take anamnesis for the prognosis of the postoperative course after the sinus lift. In cases of small cysts (up to 1/3 of the size of the maxilla sinus) detachment and elevation of the Schneiderian membrane together with the retention cyst is possible. There is no need to remove small retention cysts, since the contents of the cyst are sterile. The presence of a retention cyst does not affect the postoperative course and the results of the sinus lift. In cases of large cysts (from 1/2 the volume of the maxilla sinus and more), the operating surgeon must decide to remove the cyst during the operation in order to prevent obstruction of the anastomosis after sinus lift.

Minimally Invasive Sinus Membrane Elevation Techniques: A Literature Review

Sinus augmentation surgery has become a well-accepted pre-prosthetic procedure for placement of endo-osseous implants in compromised posterior edentulous maxilla. Various procedures for bone augmentation have been used to achieve sufficient bone volume for dental implants with the lateral and crystal surgical approaches being the most common. But these bone augmentation methods, including the conventional lateral maxillary approach and sinus elevation by osteotome, have several limitations. Sinus membrane perforation is one of the most common complications of the sinus lift procedure. Thus, to overcome these limitations various minimally invasive techniques have been introduced. These techniques cause minimal postoperative pain, faster recovery and are more economical due to shorter remission period. Hence, the aim of this review article is to discuss the various minimally invasive maxillary sinus floor elevation techniques introduced.

Comparison of Bone Formation After Sinus Membrane Lifting Without Graft or Using Bone Substitute “Histologic and Radiographic Evaluation”

Sinus floor elevation without using autogenous bone graft or bone substitute will eliminate donor site morbidity and reduce the cost and the risk of infection. We evaluated the bone gain after sinus membrane elevation without graft or using bone substitute in the same maxilla. Dental implants were inserted simultaneously as a 1-stage procedure. In a split-mouth design, we conducted a randomized double-blinded clinical trial performing sinus lifts and simultaneous implant insertion in 10 healthy patients (n=20). On the 1 site, we performed graft-less sinus lift (group 1) and on the other site Cerabone was used as bone substitute (group 2), respectively. The quantity and quality of bone gained in each sinus were evaluated and compared radiologically and histomorphometrically. After 6months, the average gain of bone height was 6.21 and 9.58mm in group 1 and 2, respectively, as measured radiologically (P<.001, P<.001). Histomorphometric examination showed significantly higher thickness of trabeculae and bone formation in group 1 (P=.003 and P=.002). However, the neovascularization was higher, but not significantly (P=.288). Radiological bone gain was similar in both groups. However, histomorphometric examination showed superior bone formation in graft-less group as compared to the Cerabone group. The blood clot seems to be an adequate filler and excellent medium for bone formation. More studies in split-mouth design are needed to compare different bone substitutes.

A Minimally Invasive Technique for Short Spiral Implant Insertion with Contextual Crestal Sinus Lifting in the Atrophic Maxilla: A Preliminary Report.

The most recently reported techniques for the rehabilitation of the atrophic posterior maxilla are increasingly less invasive, as they are generally oriented to avoid sinus floor elevation with lateral access. The authors describe a mini-invasive surgical technique for short spiral implant insertion for the prosthetic rehabilitation of the atrophic posterior maxilla, which could be considered a combination of several previously described techniques based on the under-preparation of the implant site to improve fixture primary stability and crestal approach to the sinus floor elevation without heterologous bone graft. Eighty short spiral implants were inserted in the molar area of the maxilla in patients with 4.5–6 mm of alveolar bone, measured on pre-operative computed tomography. The surgical technique involved careful drilling for the preparation of implant sites at differentiated depths, allowing bone dislocation in the apical direction, traumatic crestal sinus membrane elevation, and insertion of an implant (with spiral morphology) longer than pre-operative measurements. Prostheses were all single crowns. In all cases, a spiral implant 2–4 mm longer than the residual bone was placed. Only two implants were lost due to peri-implantitis but subsequently replaced and followed-up. Bone loss values around the implants after three months (at the re-opening) ranged from 0 to 0.6 mm, (median value: 0.1 mm), while after two years, the same values ranged from 0.4 to 1.3 mm (median value: 0.7 mm). Clinical post-operative complications did not occur. After ten years, no implant has been lost. Overall, the described protocol seems to show good results in terms of predictability and patient compliance.

Sinus Lift: Analysis of Schneiderian Membrane Perforations

Complications appeared during or after the sinus membrane elevation are under meticulous investigation of different specialists. Among peroperative ones are: sinus membrane perforation, hemorrhage/bleeding, buccal bone fracture, nonachievement of primary stability, and infraorbital nerve injury. Postoperative complications are usually divided into acute and chronic: bleeding, graft leak, wound opening, infections, endosinus extrusion of the implant, and modification of the mucosa. According to Barone et al a Schneiderian membrane (synonym: mucoperiosteal lining of the maxillary sinus) perforation is the most common complication (noted in the 25 percent of performed sinus lifts). Some studies reported even 56 percent of perforation accidents. Two different classifications of sinus membrane perforations are applied according to a 1) lateral or 2) transcrestal sinus floor elevation. In cases of lateral (synonyms: direct, open)4 lift the perforations are divided into IV Classes proposed by Fugazzotto and Vlassis in 2003 which became a simplified version of the 1999`s V Classes Classification developed by the same authors.

Radiographic bone formation after indirect sinus lift using transcrestal osteotomy with simultaneous implant placement

Dental implants really have transformed the reconstruction and strategic planning of fixed prosthodontics in the edentulous posterior maxilla. Increased bone volume via elevation of sinus membrane enables dental implants to be positioned in dysplastic maxillary ridges. The purpose of the research was to determine retrospectively the volume of hard tissue height acquired through a transcrestal method to sinus lifting utilizing osteotomes, together with the concurrent positioning of implants. Documents from the previous 2-year span of partially edentulous cases checked at Saveetha Dental Hospital were searched for patients undergoing implantation to substitute teeth missing in a posterior edentulous maxillary area with inadequate vertical osseous height. The inclusion criterion, sinus lift operation, was performed without bone grafts. A maximum of 42 people was selected. Among these patients, 35 were classified as cases recommended for indirect sinus lift while 45 were given implants. The implants being used are 3.5 mm or 4.5 mm diameter and 10.5, 11 or 13 mm length. The average survival rate for implants was 97.78 per cent. The mean bone height estimated from alveolar crest to the base of the implant just at the time of implantation was 6.79 mm ± 1.35 mm. Measured mean bone height at the six-month follow-up period was 11.4 mm ±0.88 mm, which was significant (p &lt; 0.05). Transcrestal osteotomy with implants tenting sinus membrane without extra graft material might show a substantial mean osseous height increase of 4.6 mm.

Consensus of the Amapá society of implantodontics on the criteria for choosing a bone graft.

A bone graft may be used in a variety of clinically practiced implant surgeries, namely, guided bone regeneration, extraction socket preservation or reconstruction, ridge augmentation, and sinus membrane elevation. The bone graft is of various types depending on the material, for instance, autogenous bone graft, allograft, xenograft, alloplastic graft, and autogenous bone graft with demineralized dentin matrix, which may be used alone or with other materials. Bioactive agents that promote bone formation, such as recombinant human bone morphogenetic protein-2 (rhBMP-2), have been shown to exhibit a clinically beneficial effect on bone regeneration. Here, we intend to present surgical guidelines for bone grafts and criteria for selection of bone graft materials by referring to evidence-based studies and recent lectures on the subject of ‘bone grafts for implant dentistry’ at the Amapá society of implantodontics, 2020.

Implant placement with sinus floor elevation via the lateral approach using only absorbable collagen sponge: 12-month post-loading radiographical outcomes and implant survival rate.

The purpose of the present study was to evaluate the radiographical outcomes and survival rate of implants placed during graftless lateral sinus lift approach (GLSLA) using an absorbable collagen sponge. Fourteen patients (14 sinus augmentations) were consecutively treated with GLSLA. After Schneiderian membrane elevation and implant insertion, only collagen sponges were used to fill the new sinus compartment. After 4months of healing, implants were functionally loaded. The radiographical marginal bone variation and apical bone gain were assessed on periapical radiographs taken 4months after the surgery (at crown insertion) and at 12months post-loading. A total of 41 implants were placed in a mean initial residual bone height of 3.5mm (range 1.6-6.7mm). No failure was recorded and all the implants were successfully loaded with fixed prosthesis. Twelve months post-loading the mean radiographic bone remodeling was 2.22mm. The mean ridge height was 8.4mm and the mean apical bone gain amounted for 4.4mm. Within the limitations of this study, the placement of dental implants in conjunction with GLSLA using only a collagen sponge to fill the sinus compartment seems to be feasible and accompanied by a high implant survival rate. Further studies on a large population and with a longer follow-up are warranted to drawn definitive conclusions.

Sinus membrane elevation and implant placement.

Sinus Schneiderian membrane elevation surgery is widely performed for dental implant placement in the maxillary posterior region. With regard to sinus elevation surgery, various complications can occur and lead to implant failure. For successful implants in the maxillary posterior region, the clinician must be well acquainted with sinus anatomy and pathology, a variety of bone graft materials, the principles of sinus elevation surgery, and prevention and management of complications.

Wire loop sinus membrane elevator: a novel instrument for lateral window sinus lift

This technical note introduces a novel instrument to facilitate lateral window sinus membrane elevation. The fabrication and use of the instrument are reported. The features of this instrument include easy control, good tactile sensation, flexibility in adjusting the instrument, and simple to replicate. Since its introduction, it has been the preferred instrument of our implant surgical trainees. Most importantly, it has proved to be an invaluable teaching tool, as it has helped not only to boost trainee confidence in the procedure, but also in their use of other sinus elevation instruments.

Axial Triangle of the Maxillary Sinus, and its Surgical Implication With the Position of Maxillary Sinus Septa During Sinus Floor Elevation: A CBCT Analysis.

The aim of this study was to measure the convexity of the lateral wall of the maxillary (Mx) sinus and identify the locational distribution of antral septa in relation to the zygomaticomaxillary buttress (ZMB), in order to suggest another anatomical consideration and surgical modification of sinus floor elevation procedures. This study was designed as a cross-sectional study, and a total of 134 patients and 161 sinuses containing edentulous alveolar ridges were analyzed. The angle between the anterior and lateral walls of the Mx sinus (lateral sinus angle [LSA]), and the angle between the midpalatal line and the anterior sinus wall (anterior sinus angle [ASA]) were measured. Mean LSAs and ASAs were 105.9° ± 9.86° and 58.4° ± 6.43°, respectively. No significant difference between left and right sides was found (LSA, P = .420; right = 105.5° ± 9.27°; left = 105.5° ± 9.27° and ASA, P = .564; right = 57.9° ± 6.80°; left = 58.8° ± 6.02°). The prevalence of septa was 37.3%, and it was most frequently noted in the second molar region (32.8%), followed by the first molar (20.9%), retromolar (16.4%), and second premolar regions (14.9%). Septa were most frequently located posterior to the ZMB (49.2%), while ZMB was mostly located in the first molar region (66.4%). Narrow LSAs may complicate the surgical approach to the posterior maxilla, especially when sinus elevation should be used in the second molar region. Considering the occasional presence of antral septa, membrane elevation may be complicated when a septum is encountered during the procedure. These results suggest that 3-dimensional examination of the convexity of the Mx sinus should be performed preoperatively to choose proper surgical techniques and minimize surgical complications.

Minimally Invasive Transalveolar Sinus Augmentation: An Answer to Sinus Conundrum

Dental implants have become the routine option for replacement of missing teeth, but it is challenging to place implants in the posterior maxilla due to inadequate bone dimensions and pneumatization of the maxillary sinus. Several techniques have been introduced over the years for sinus augmentation and bone grafting; both lateral and crestal approaches to sinus lift have been used with good results. In recent times, a minimally invasive technique has been used as a modification of crestal approach to sinus augmentation called minimally invasive technique sinus augmentation (MITSA). This method utilizes the calcium phosphosilicate putty for hydraulic sinus membrane elevation along with osseodensification drills. MITSA has simplified the sinus lift technique with predictable good results.

Effect of Buccal Fat Pad and Platelet Rich Fibrin After Ultrasonic Hydrodynamic Maxillary Sinus Membrane Elevation

Effect of Buccal Fat Pad and Platelet Rich Fibrin After Ultrasonic Hydrodynamic Maxillary Sinus Membrane Elevation

Maxillary Sinus Augmentation Using Hydraulic Pressure by Lateral Approach and Simultaneous Implant Placement: Clinicoradiographic Study.

The purpose of this study was to assess clinically and radiographically efficacy of maxillary sinus augmentation using hydraulic pressure in a lateral approach with immediate implant placement. In a total of 10 patients having less than 4 to 6 mm of subantral bone height, lateral approach sinus membrane elevation procedure was performed using hydraulic pressure with the help of a specialized water lift kit followed by grafting and simultaneous implant placement. Cone beam computed tomography analysis was used to assess the change in subantral bone height from baseline to the 6 months postoperatively. Radiographically, subantral bone height increased from 3.86 ± 1.423 mm at baseline to 15.49 ± 2.73 mm at 6 months postoperatively with a gain of 11.63 + 2.63 mm (P < 0.001). Thus, it is concluded that hydraulic pressure may be efficiently used in lateral sinus augmentation procedures along with simultaneous implant placement.

Blood clot stability and bone formation following maxillary sinus membrane elevation and space maintenance by means of immediate implant placement in humans: A computed tomography study

Abstract Objective The present controlled clinical pilot study proposed to assess blood clot contraction and bone neo-formation following maxillary sinus lift (MSL) with immediate implant placement without using grafts using cone beam tomography exams. Materials and methods Ten implants were placed in ten patients with a residual bone crest height ≥4 and ≤ 7 mm, in maxillary premolars or 1st or 2nd molars regions, using MSL and immediate implant placement without grafts, by means of the lateral window approach. A resorbable membrane (Bio-Gide®, Geistlich, USA) was used to close the window. Computed tomography images were taken after 15 (T1) and 180 (T2) days to assess the rate of blood clot contraction and bone neo-formation. The images were analysed by OsirixMD software. The Shapiro Wilk test was used to verify the normality hypothesis and the data were submitted to Student's paired t-test. Results The mean of bone clot height in mesial, apical and distal area referred to implant, presented 4.77 mm, 0.77 mm and 5.30 mm respectively. The mean measurements of new bone formation presented 2.95 mm, 0.44 mm and 3.45 mm. The height contraction (coagulum/new bone formation), between T1 and T2, presented 38%, 43% and 35% respectively, with a significant statistical value p The volume measurements at T1 presented a mean volume of 0.90 cm3 sd ± 0.60 cm3 and at T2 a mean volume of 0.75 cm3 sd ± 0.62 cm3, with a significant volume contraction between T1 and T2, p Conclusion The present study demonstrates consistent bone formation around all assessed implants, although with significant contraction of the blood clot. The need for longitudinal studies to establish a long-term prognosis in different modalities of prosthetic rehabilitation of those implants is strongly suggested.

Suction dissector device for sinus membrane elevation

The maxillary sinus floor augmentation technique requires lifting of the sinus membrane with a series of curved elevators. Lifting of the sinus membrane can be difficult due to the presence of bleeding, requiring the alternate use of curved elevators and the aspirator. This technical note presents a new surgical device, a suction dissector specifically designed for sinus membrane elevation. The suction dissector has a curvature similar to that of the curved dissector commonly used for lifting of the sinus membrane and contains an internal channel that allows the aspiration of liquid.

Microscope and micro-camera assessment of Schneiderian membrane perforation via transcrestal sinus floor elevation: A randomized ex vivo study.

We sought to assess the effectiveness of using a microscope and non-invasive camera for assessing sinus membrane perforations during transcrestal sinus floor elevation (TSFE). Five fresh human cadaver heads corresponding to eight maxillary sinuses (six bilateral and two unilateral) underwent 4 TSFEs per sinus (a total of 32 single site elevations). Each elevation was randomly assigned to receive a three or sixmm membrane elevation height (MEH). A microscope and micro-camera were used to assess the sinus membrane perforation. Afterwards, radiological and clinical membrane perforation assessments were performed. The statistical analysis results are expressed using the means, standard deviations, range values of the residual ridge height (RRH), residual ridge width (RRW), sinus membrane thickness (SMT) and incidence of perforation (IoP). Generalized linear methods were used to test for the correlation of RRH and MEH to the microscope and micro-camera perforation assessments and the correlation of microscope and micro-camera assessments with the post-operative CBCT and crestal liquid evaluation. The cumulative percentage of IoP was 40.62%, (23.07% with 3mm MEH, and 76.92% with 6mm MEH, p<0.05). The perforation assessed using either the microscope or micro-camera coincided with the post-operative CBCT and crestal liquid assessment in 87.55% sites. No significant correlation was found between the microscope or micro-camera assessments with RRH or MEH. Application of a microscope and micro-camera during transcrestal sinus floor elevation may allow the detection of the integrity of the Schneiderian membrane with greater than 85% accuracy in this ex vivo model.

Clinical outcome and factors determining new bone formation in lateral sinus membrane elevation with simultaneous implant placement without grafting material: A cross-sectional, 3-17 year follow-up study.

Lateral sinus membrane elevation with simultaneous implant placement without grafting material (graft-less LSFE) is a widely investigated method for bone augmentation of the maxillary sinus floor. Long-term follow-up studies are rare. This study aimed to investigate the long-term effects of implants placed with graft-less LSFE. The study group was comprised of 111 patients previously treated with graft-less LSFE. The first follow-up visit, which occurred after a mean of 5 years after surgery, included a clinical examination, cone beam computerized tomography, and panorama or intraoral radiography. The second follow-up included panorama or intraoral radiography, and it was conducted after a mean of 8 years. Overall, 218 implants were placed in 127 sinuses. Nine of the 218 implants failed resulting in an overall implant survival of 95.9%. The average bone gain at the follow-up was 4.0 ±2.0 mm. The implant-supported rehabilitation achieved using graft-less LSFE was stable over time, and there was no or little impact on sinus health. Furthermore, it was concluded that the new bone formation and the amount of bone gain is proportional to the length of the implant protruding into the sinus cavity.

Using Absorbable Gelatin Sponge to Facilitate Sinus Membrane Elevation during Open Sinus Lift: Technical Notes and Case Series

Ridge atrophy accompanied by the pneumatization of maxillary sinus in the maxillary posterior region may lead to inadequate bone height, thereby precluding implant placement. Therefore, it may be mandatory to perform a sinus membrane elevation procedure and augmentation in the bone. The present study aimed to introduce a novel modification method for sinus floor elevation using a gelatin sponge (Gelatamp, COLTENE ROEKO, India) in order for better visualization, hemostasis, and conservative maxillary sinus membrane dissection with the low risk of complications. Implant placement was performed in a case series of 28 patients with hyperpneumatized sinus or a moderately resorbed posterior maxillary alveolus. According to the findings, implant placement caused no complications in the patients. Furthermore, none of the patients experienced infections, sinusitis or graft and implant failure clinically and radiographically at the three- and six-month follow-up. Therefore, it could be concluded that gelatamp-assisted sinus lift is a simple, safe, noninvasive, and innovative technique for sinus membrane elevation. In addition, it is predictable and efficient, especially in the cases where piezoelectric surgery armamentarium is not available.

Comparative Study of Bone Formation around the Implant Surface Following Simultaneous Sinus Membrane Elevation and Implant Placement With and Without Platelet Rich Fibrin.

Brief Background Rehabilitation of edentulous posterior atrophic maxilla has always been an exigent task in the field Implantology. Studies have shown, the use of Choukron’s platelet rich fibrin as a sole grafting material in sinus floor and immediate implant placement leading to bone formation in the peri-implant region. Purpose of the Study This study was conducted as novel research where, Direct Sinus Membrane elevation and simultaneous Implant placement without any bone graft resulted in bone formation in sub-antral space. This study compares and evaluates the bone formation with the help of Cone Beam CT Scan (CBCT) in sub-antral space following direct sinus membrane elevation and simultaneous implant placement and platelet rich fibrin as the sole graft. Materials and Methods 48 patients who fulfill the inclusion criteria were divided as Group I- direct sinus membrane elevation and implant placement without any graft and Group II- direct sinus membrane elevation and implant placement along with PRF as sole graft Results and Analysis Unpaired‘t test’ was used where, we ‘p’ value was compared with the level of significance. On comparing the peri-implant bone density in Hounsefield units, in CBCT scans; the bone density was more in group II which was statistically significant (p&lt;0.05). Summary and Conclusions PRF has proved to be a valuable autologous augmenting material in direct sinus membrane elevation and simultaneous implant placement in edentulous posterior maxilla. Key Words Hounsefield Units, Sub-antral space, Peri-implant, Cone Beam CT Scan.