Lateral Window Approach Research Articles

New Bone Formation in the Maxillary Sinus Using Peripheral Venous Blood Alone

The purpose of this study was to evaluate the amount of bone formation under a sinus membrane tented with implants and filled with venous blood as a graft material. Fourteen patients (17 sinus augmentations) were consecutively treated with sinus floor elevation via the lateral window approach. The lateral bony window was created using a piezoelectric saw, and the sinus membrane was elevated to make a new compartment. After resorbable blast media-surfaced dental implants were placed simultaneously, the collected peripheral venous blood was applied to support the sinus membrane over the implant apex, and the bony portion of the lateral window was repositioned to seal the lateral window. In 6 cases, samples were taken for biopsy at the time of second stage surgery. An average of 6.8 months after the sinus augmentation, new bone consolidation in the maxillary sinus was observed by radiographic and histologic evaluation. Vital bone formation was 38.70% according to the histomorphometric data. Of the 31 implants placed, 2 failed. The overall implant survival rate was 93.5%. All failures occurred when implants were placed into the extraction socket and were associated with poor initial stability. This study suggests that simultaneous placement of dental implants and injection of peripheral venous blood as a graft material appears to be a safe alternative procedure for maxillary sinus augmentation.

Evaluation of the feasibility of bony window repositioning without using a barrier membrane in sinus lateral approach

Introduction: In the lateral window approach for a maxillary sinus bone graft, there has been considerable controversy regarding the placement of a barrier membrane over the osteotomy site. In particular, when there is no damage to the Schneiderian membrane, clinicians should decide whether to use a barrier membrane or not, considering the benefits and costs. This study presents the clinical cases to demonstrate that only repositioning the detached window can lead to satisfactory bony healing of the grafted material without using a barrier membrane in the lateral approach for a maxillary sinus bone graft. Materials and Methods: Five consecutive patients were treated with the same surgical procedures. After performing the antrostomy on the lateral maxillary wall using a round carbide bur and diamond bur, the bony window was detached by a gentle levering action. After confirming no perforation of the Schneiderian membrane, the grafting procedure was carried out the detached window of the lateral maxillary wall was repositioned over the grafted material without using a barrier membrane. A gross examination was carried out at the postoperative 6 month re-entry, and the the preoperative and postoperative dental computed tomography (CT) at re-entry were compared. Results: All the procedures in the 5 patients went on to uneventful healing with no complications associated with the bone graft. Satisfactory bone regeneration without the interference of fibrous tissue on the gap between the repositioned window and lateral wall of the maxillary sinus was observed in the postoperative 6 month re-entry. The CT findings at re-entry revealed the, reconstruction of the external cortical plate including repositioned bony window. In addition, the loss of the discontinuity of the lateral maxillary wall was confirmed. Conclusion: This preliminary report showed that the detached window, which was just repositioned on the grafted material, could function as a barrier membrane in the lateral approach for a maxillary sinus bone graft. Therefore additional morphometric and histologic studies will be needed.

Crestal Sinus Augmentation: A Simplified Approach to Implant Placement in the Posterior Maxilla

Implant placement in the posterior maxilla can be challenging with relation to the maxillary sinus and may necessitate the need foraugmentation to allow placement of implants. The crestal approach, initially reported by Summers has allowed a more simplified approachto augmenting the maxillary sinus compared to the lateral window approach. A review of the crestal approach using the crestal approachsinus kit (CAS-Kit) (Hiossen, South Korea) is discussed.

Atrophic maxillary floor augmentation by mineralized human bone allograft in sinuses of different size: an histologic and histomorphometric analysis

The aims of this work were to histologically examine the healing of mineralized human bone allograft (MHBA) in sinus augmentation for elevating a severe maxillary atrophy ridge (≤2 mm residual ridge height) and to correlate the results to the sinus cavity size. A two-stage protocol was conducted in 23 patients, all having crestal bone ≤2 mm. A mixture of 80/20 cortical/cancellous of MHBA particles was used to augment sinus using the lateral window approach in narrow (NS; <15 mm bucco-palatal distance) and wide (WS; ≥15 mm bucco-palatal distance) sinuses, based upon computerized tomography (CT) assessment. A bone core biopsy was taken at implant placement, 6 and 9 months after surgery. Microradiography, histology and histochemistry of methacrylate-embedded sections were performed to analyze and to evaluate the bone and graft amount. Newly formed bone around MBHA particles was found in all 28 biopsies. Bone showed a woven structure at 6 months after surgery and a lamellar structure 9 months after surgery. At 6 months after surgery, the 13 NS and 15 WS had 30.5±8.8% and 20.7±4.9% mean±SD bone formation, respectively. At 9 months after surgery, it was 38.8±7% (NS) and 30.7±3% (WS). Residual graft was about 16% (6 months) and 6% (9 months), in both NS and WS. The Mann-Whitney test showed a greater bone formation in NS than in WS (P<0.005). The used 80/20 MHBA mixture appears to promote, in the severe atrophic maxilla, a satisfactory bone formation. Our results prove that the larger the sinus, the longer the maturation time needed to achieve a suitable amount of new bone formation.

The Influence of the Bucco‐Palatal Distance on Sinus Augmentation Outcomes

Maxillary sinus augmentation is one of the most reliable implant site development options to increase vertical bone height. However, graft consolidation requires adequate angiogenesis and migration of cells involved in osteogenesis and bone remodeling. It is speculated that these biologic events are greatly determined by the dimensions of the maxillary sinus cavity. Hence, the purpose of this study is to assess the influence of the distance from the lateral to the medial wall of the maxillary sinus on the outcomes of sinus augmentation procedures. A total of 25 patients in need of sinus augmentation were recruited for the study. After initial examination, customized radiographic and surgical guides were fabricated and a cone-beam computerized tomography scan was obtained per patient. The bucco-palatal distance (BPD) was measured at 8, 10, and 12 mm from the alveolar crest. Sinus grafting was performed by a lateral window approach using a particulated allograft material. Patients were followed-up for 6 months. At the time of implant placement, bone core biopsies were harvested using the radiographic-surgical guide. Sections of the bone cores at 8, 10, and 12 mm from the alveolar crest were histomorphometrically analyzed. The proportion of vital bone (%VB) was correlated with the BPD using a statistical model. Twenty-one patients underwent sinus augmentation for a total of 24 sinuses; however, the data analyzed contained only one sinus per patient. One sinus developed an infection after grafting, resulting in a 96% success rate for the sinus grafting procedure. Twenty sinuses were used in the final statistical analysis. Histomorphometric analysis revealed that mean %VB was 22.71 +/- 19.08, mean percent of remaining allograft was 23.39 +/- 20.85, and average percent of non-mineralized connective tissue was 53.90 +/- 13.23. Analysis of the correlation between %VB and BPD by linear regression, using the actual values of BPD showed a strong negative association (R(2) = 0.141; P <0.001). The findings suggest that the %VB formation after maxillary sinus augmentation is inversely proportional to the sinus BPD.

New Bone Formation in the Maxillary Sinus Using Only Absorbable Gelatin Sponge

The purpose of the present study was to evaluate the predictability of new bone formation in the maxillary sinus using only absorbable gelatin as the graft material. Seven patients (9 sinus augmentations) were consecutively treated with sinus floor elevation by the lateral window approach. The lateral bony window was created using a piezoelectric device and the schneiderian membrane was elevated to make a new compartment. After 18 resorbable blast media surfaced dental implants were simultaneously placed, absorbable gelatin sponges were loosely inserted to support the sinus membrane over the implant apex and the bony portion of lateral window was repositioned to seal the lateral window. After uncovering the implants an average of 6 months after placement, new bone consolidation in the maxillary sinus was observed on radiographs without bone graft. Two implants were removed due to failed osseointegration on uncovering. Failures were caused by insufficient initial stability. This study suggests that placement of a dental implant in the maxillary sinus with a gelatin sponge can be a predictable procedure for sinus augmentation.

The effect of piezoelectric use on open sinus lift perforation: a retrospective evaluation of 56 consecutively treated cases from private practices

Piezoelectric surgery, when carrying out a lateral window approach to sinus elevation, may minimise soft tissue damage.

The Effect of Piezoelectric Use on Open Sinus Lift Perforation: A Retrospective Evaluation of 56 Consecutively Treated Cases From Private Practices

The lateral window approach to maxillary sinus augmentation is a well-accepted treatment option in implant dentistry. The most frequent complication reported with traditional techniques has been the perforation of the Schneiderian membrane, with perforation rates ranging from 11% to 56%. The purpose of this retrospective, consecutive case series from two private practices was to report on the rate of Schneiderian membrane perforations and arterial lacerations when a piezoelectric surgical unit was used in conjunction with hand instrumentation to perform lateral window sinus elevations. Clinical data (Schneiderian membrane perforation, Underwood septa, and laceration of the lateral arterial blood supply to the maxillary sinus) were obtained retrospectively from two private practices and pooled for analysis. The information was collated after an exhaustive chart review. Fifty-six consecutively treated lateral window sinus lifts were performed on 50 partially or completely edentate patients. Zero perforations of the Schneiderian membrane occurred during the piezoelectric preparation of the lateral antrostomies, whereas two perforations were noted during subsequent membrane elevations using hand instrumentation. In both instances, membrane perforations were associated with sinus septa. The overall sinus perforation rate was 3.6%. Arterial branches of the posterior superior alveolar artery were encountered in 35 cases, and there were zero instances of arterial laceration. This retrospective case series from clinical private practices confirmed that a lateral window approach to sinus elevation incorporating piezoelectric technology in conjunction with hand instrumentation was an effective means to achieve sinus elevation while minimizing the potential for intraoperative complications. Further prospective and randomized controlled studies are warranted to qualify these observations.

Sinus Augmentation Complications: Etiology and Treatment

Sinus augmentation, either osteotome or lateral window approach, is a predictable procedure to augment vertical height that allows for proper implant placement in areas with previous limited restorative options. Like any surgical procedures, there is always a risk of encountering either intrasurgical or postsurgical complications. A Medline literature search of articles published from 1984 to 2006 related to complications following sinus augmentation were selected and analyzed. To make it easier for understanding, sinus augmentation complications were classified into following categories: systemic disease and mediations related; anatomy and surgical procedure related; sinus pathology related; infection related; and prosthetic related. Depending on the source or cause of complication, treatment may include palliative approach to surgical intervention. This article will review a newly proposed complication classification, discuss treatment modalities for each encountered complication and propose methods to avoid these complications.

Long-term evaluation of implant placed in sites grafed by lateral window approach on maxillary sinus; a 10-year retrospective study

Long-term evaluation of implant placed in sites grafed by lateral window approach on maxillary sinus; a 10-year retrospective study