Sinus Grafting Procedure Research Articles

Brisk, Prolonged Pulsatile Hemorrhage During the Sinus Graft Procedure: A Case Report With Discussion on Intra-Operative Hemostatic Management

The maxillary sinus graft procedure is the treatment of choice to increase the vertical bone height in the atrophic posterior maxilla to place dental implants. It is considered as a routine surgical procedure with predictable results. However, complications have been reported with this grafting procedure. With any surgical procedure, complications may arise, and the surgeon must be prepared to effectively manage the complication. In addition to detailed knowledge of the maxillofacial anatomy, recognition of surgical emergencies and its management is critical for the implant surgeon. A case of brisk, prolonged pulsatile hemorrhage during the sinus graft procedure is described, and its intra-operative management with topical Thrombin is presented.

Methods to Treat the Edentulous Posterior Maxilla: Implants With Sinus Grafting

Prosthetic rehabilitation of the edentulous posterior maxilla with implant-supported prostheses frequently presents a challenge for the oral surgeon because of the lack of bone due to alveolar ridge resorption or maxillary sinus pneumatization. To overcome these problems, different solutions were proposed over the years, such as the use of short implants or tilted implants (including zygoma implants), with the aim of avoiding maxillary sinus floor elevation. Both of these techniques have advantages and disadvantages that should be evaluated carefully to choose the most appropriate treatment. Zygoma implants or short/tilted implants are not a panacea for the treatment of patients with inadequate posterior maxillary bone stock. Instead, treatment should be based on the characterization of resorption patterns of the posterior maxilla, and may include the need for sinus grafting or other grafting procedures to reestablish not only adequate bone volume for implant placement, but also a favorable intermaxillary relationship, to optimize the functional and esthetic outcome of the final prosthetic rehabilitation. The authors discuss the indications, advantages, and disadvantages of sinus-grafting procedures in association with or without other reconstructive procedures.

Bone Reformation: Contemporary Bone Augmentation Procedures in Oral and Maxillofacial Implant Surgery

Bone Reformation: Contemporary Bone Augmentation Procedures in Oral and Maxillofacial Implant Surgery

Endoscopic removal of alloplastic sinus graft material via a wide middle antrotomy

The purpose of this paper is to discuss the treatment required for a patient affected by chronic maxillary sinusitis following a sinus grafting procedure with an alloplastic material. Sinusitis was not the consequence of migration of alloplastic material into the maxillary sinus, but rather the consequence of overfilling the subantral space followed by obstruction of the ostium. The treatment involved removal of the alloplastic material and correction of the ostium obstruction via a nasal endoscopic approach.

Prevalence and management of Schneiderian membrane perforations during sinus‐lift procedures

This clinical study was undertaken to evaluate the prevalence of surgical complications of the sinus graft procedure and to set a protocol to repair sinus membrane perforations intraoperatively using a variety of techniques and materials. From January 2000 to May 2005, 338 patients were studied, on whom 474 sinus floor augmentation procedures were performed, and a total of 1166 dental implants were simultaneously placed. A total of 104 perforations of the sinus membrane were observed (19 were bilateral). In group number 1, sinus membrane perforations of <5 mm were observed in 56 sinus augmentation procedures (53.85%), 44 were treated using a resorbable collagen membrane and 12 were sutured with a resorbable material. In group number 2, 28 sinus membranes had a perforation size between 5 and 10 mm (26.92%) and were treated using lamellar bone combined with a resorbable membrane. Group number 3 consisted of 20 sinus membrane perforations>10 mm (19.23%), 10 were covered with lamellar bone combined with a buccal fat pad flap, six were treated with a mandibular block graft and four perforations were treated with only a lamellar bone sheet. Two-hundred and seventy-eight implants were placed under repaired membrane perforations and 247 implants survived. Interestingly enough, all the 25 implants that failed to integrate were placed under perforated and reconstructed membranes during the sinus lift procedure. Based on the results of this study, the survival rates of implants placed under reconstructed membranes correlate inversely with the size of the perforations.

Prevalence of Maxillary Sinus Septa in 1024 Subjects With Edentulous Upper Jaws: A Retrospective Study

Maxillary sinus floor augmentation has been routinely performed to optimize dental implant placement in the posterior maxilla. However, complications during a sinus grafting procedure, such as perforation of the Schneiderian membrane, have been reported. This complication is generally associated with the presence of maxillary septa. Therefore, the aim of this retrospective study was to evaluate the prevalence of maxillary sinus septae in completely edentulous subjects by means of panoramic radiography. A total of 1024 panoramic radiographs were evaluated by 3 calibrated examiners. From these radiographs, 307 maxillary septa were detected in 221 subjects (21.58%); 86 (8.40%) of the subjects showed maxillary septa in both maxillary sinuses. Logistic regression failed to detect any correlation between the presence of maxillary septa, age, and gender (P > .05). Within the limits of the study, the prevalence of maxillary septa in this Brazilian population was shown to be moderate, indicating that dentists must be aware of the presence of this anatomic structure during maxillary sinus elevation grafting.

The amount of newly formed bone in sinus grafting procedures depends on tissue depth as well as the type and residual amount of the grafted material

Bone replacement substitutes are almost unavoidable in augmentation procedures such as sinus grafting. The objective of the present study was to evaluate the osteoconductive capability of two different scaffold fillers in inducing newly formed bone in this procedure. Sinus floor augmentation and implant placement were carried out bilaterally in 12 patients. Bovine bone mineral (BBM) was grafted on one side and beta-tricalcium phosphate (beta-TCP) on the contralateral side. Both were mixed (1:1 ratio) with autogenous cortical bone chips harvested from the mandible by a scraper. Hard tissue specimen cores were retrieved from the augmented sites (at the previous window area) at 12 months. Decalcified sections were stained with haematoxylin-eosin and the fraction area of new bone and filler particles was measured. In addition to the effect of the filler on new bone formation, the latter was tested to determine whether it correlated with the tissue depth and residual amount of the grafted material. Bone area fraction increased significantly from peripheral to deeper areas at both grafted sites in all cores: from 26.0% to 37.7% at the beta-TCP sites and from 33.5% to 53.7% at the BBM-grafted sites. At each depth the amount of new bone in BBM sites was significantly greater than that in TCP sites. However, the average area fraction of grafted material particles was similar in both fillers and all depth levels (beta-TCP=27.9-23.2% and BBM=29.2-22.6%, NS). A significant negative correlation was found between bone area fraction and particle area fraction at the middle (p=0.009) and deep (p=0.014) depths in the beta-TCP sites, but not at the BBM sites. At 12 months post-augmentation, the two examined bone fillers, beta-TCP and BBM, promoted new bone formation in sinus grafting but the amount of newly formed bone was significantly greater in BBM-grafted sites. However, both exhibited similar residual grafted material area fraction at this healing period. This could imply that BBM possesses better osteoconductive properties.

Endoscopic surgical treatment of the maxillary sinus disease before sinus graft procedure

Endoscopic surgical treatment of the maxillary sinus disease before sinus graft procedure

The prevalence of surgical complications of the sinus graft procedure and their impact on implant survival.

Grafting of the maxillary sinus floor has been performed successfully over the last decade. The ultimate goal of this procedure is to allow surviving implants to support a functional prosthesis. Surgical complications of the procedure are rarely reported and their impact on implant survival has been investigated even to a lesser extent. The purpose of this study was to evaluate the prevalence of surgical complications of the sinus graft procedure and their impact on implant survival. The study consisted of 70 patients who underwent 81 sinus graft procedures using the lateral wall approach from 1995 to 2000. A total of 212 screw-shaped implants were placed in the grafted sinuses and were restored by fixed prosthesis. Mean follow-up period for the implants was 43.6 months. Intra- and postoperative complications were thoroughly documented regarding clinical signs, times of occurrence, and treatment regimens. Perforation of the Schneiderian membrane was the major intraoperative complication, observed in 36 of the 81 sinuses (44%). Of the 70 patients, seven (10%) suffered from postoperative complications, specifically related to the sinus graft procedure, which included an uncommon cyst formation and an infection. Membrane perforations were strongly associated with the appearance of postoperative complications (specific and non-specific to the procedure) (P < 0.001). However, no association was found between membrane perforations or postoperative complications and implant survival. Intraoperative complications may lead to postoperative complications. Surgical complications did not significantly influence implant survival.

Discussion

Since the development of the sinus graft procedure in the mid-1970s, clinicians have been evaluating alternatives to autologous bone. Tatum 1 Tatum H Maxillary and sinus implant reconstructions. Dent Clin North Am. 1986; 30: 207 PubMed Google Scholar was the first to consider a bone substitute in sinus grafts and used tricalcium phosphate. Over the years, numerous bone substitutes, including allografts, alloplasts, and xenografts, have been used or combined with autologous bone for sinus grafting. The 1996 Sinus Consensus Conference evaluated retrospective data on various graft materials and concluded that they all seemed to perform well. 2 Jensen OT Shulman LB Block MS et al. Report of the Sinus Consensus Conference of 1996. Int J Oral Maxillofac Implants. 1998; 13: 11 PubMed Google Scholar However, the data analysis did not consider the amount of residual bone below the sinus. Bone substitutes were recommended for the posterior maxilla with less resorption or sinus pneumatization. Prospective clinical trials were recommended to evaluate bone substitutes in cases with minimal residual bone height.

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

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.