Association of Inflammatory Status and Maxillary Sinus Schneiderian Membrane Thickness

Clinical, Radiological, and Histomorphometric Comparison of the Use of Deproteinized Bovine Bone Mineral and Titanium-Prepared Platelet-Rich Fibrin in Maxillary Sinus Augmentation: A Split-Mouth Randomized Controlled Clinical Study

BACKGROUND

Maxillary sinus augmentation (MSA) is a standard and predictable procedure to increase bone height in the atrophic posterior maxilla. Many biomaterials are employed in this technique; however, autologous platelet concentrates have been found to reduce clinical recovery time and improve bone gain in MSA.

PURPOSE

This study aimed to compare the radiographic, histomorphometric, and implant stability outcomes of titanium-prepared platelet-rich fibrin (T-PRF) and deproteinized bovine bone mineral (DBBM) in a two-stage MSA technique.

STUDY DESIGN, SETTING, SAMPLE

This randomized controlled split-mouth study included patients requiring bilateral two-stage MSA at the Periodontology Department of Kutahya Health Sciences University between March 2022 and April 2023. Patients with systemic comorbidities and residual bone height >5 mm in the bilateral posterior maxilla were excluded.

PREDICTOR VARIABLE

The predictor variable was the two-stage MSA technique. Each surgical site was randomly assigned to the T-PRF or DBBM group for two-stage MSA.

MAIN OUTCOME VARIABLES

The primary outcome was the histomorphometric evaluation of the percentage of new bone between the 2 groups. Secondary outcomes included radiographic evaluation of total bone height (ToBH), bone gain, bone density (BD), and graft volume (GV) on cone-beam computed tomography 6 months post-MSA, clinical assessment of primary implant stability at implant placement and secondary stability 3 months postplacement, and histomorphometric evaluation of the percentage of residual particles, percentage of connective tissue, and percentage of blood vessels from bone biopsy samples collected 6 months after MSA.

COVARIATES

Age, sex, periodontitis susceptibility, and smoking status were treated as covariates.

ANALYSES

The Wilcoxon signed-rank test was used for bivariate comparisons between 2 groups, and the Pearson or Spearman test was used to analyze correlations of variables within groups. A P value ≤ .05 was considered statistically significant.

RESULTS

The sample was composed of 10 patients with bilateral maxillary sinuses, 20 MSA regions, 8 (80%) males and 2 (20%) females with a mean age of 51.30 (9.06) year. The percentage of new bone was 19.48 ± 14.60 μm2 in the T-PRF group and 8.31 ± 5.47 μm2 in the DBBM group, and there was no statistically significant difference between the groups (P = .074). Radiographic measurements showed ToBH, GV, and BD values of 10.64 ± 3.96 mm, 989.89 ± 523.07 mm3, and 192.09 ± 127.90 hounsfield unit in the T-PRF group and 14.25 ± 1.65 mm, 1,519.39 ± 432.61 mm3, and 492.77 ± 117.35 hounsfield unit in the DBBM group, respectively. ToBH, GV, and BD values were statistically significant between the groups (P = .01 and P = .00). Primary and secondary implant stability in the T-PRF group were 71.11 ± 12.48 implant stability quotient (ISQ) and 68.03 ± 6.81 ISQ, respectively, compared with 67.94 ± 19.84 ISQ and 72.46 ± 11.21 ISQ in the DBBM group. The difference was not statistically significant between the groups (P = .41 and P = .33).

CONCLUSION AND RELEVANCE

Although T-PRF demonstrated inferior radiographic outcomes compared with DBBM during the initial6-month healing phase, both techniques yielded comparable results regarding new bone formation and implant stability. Further research is warranted to explore the efficacy of different T-PRF applications in MSA. This trial is registered at ClinicalTrials.gov (NCT05596084).

Cone-Beam Computed Tomography Evaluation of Maxillary Sinus Changes in Orthodontic Patients Treated With Extraction of Four First Premolars

The objective of this study was to assess alterations in maxillary sinus mucosa thickness and the distances between the apexes of specific teeth and the maxillary sinus base in adult patients undergoing orthodontic treatment with the extraction of four first premolars. Twenty-one adults, averaging 24.85 years of age, received orthodontic therapy involving the extraction of all four first premolars. Cone-beam computed tomography scans were conducted before and after treatment to evaluate changes. Notably, post-treatment scans revealed a significant increase (P= 0.044) in the distance between the apex of the second premolar and the maxillary sinus floor, with an average augmentation of 1.0141 millimeters. However, no notable alterations were detected in the distances between the apexes of other teeth and the maxillary sinus or in maxillary sinus mucosa thickness. These findings suggest that orthodontic treatment with the extraction of four first premolars may elevate the distance between the maxillary sinus floor and the second premolar apex, which provides a reference for risk assessment and surgical design of first premolar extraction during orthodontic treatment.

Association between maxillary sinus floor perforation by dental implants and mucosal thickening: A cone-beam computed tomography study

OBJECTIVE

To investigate the association of perforation of the maxillary sinus floor by dental implants with mucosal thickening and to describe its characteristics in perforated cases.

STUDY DESIGN

One-hundred and twenty-nine maxillary sinuses of 93 patients presenting 202 dental implants in the maxillary posterior region were retrospectively assessed in cone-beam computed tomography scans and classified according to maxillary sinus perforation, bone graft, mucosal thickening, and mucosal appearance. Logistic regression determined the chance of mucosal thickening in perforated maxillary sinuses. The chi-square test compared categorical variables between maxillary sinus perforated or not by implants and maxillary sinus with or without mucosal thickening. The significance level assumed was 5 % (α = 0.05).

RESULTS

There was perforation of 60 maxillary sinuses floor (46.5 %) by 74 dental implants. The chance of mucosal thickening was higher when the implant tip was trespassing on the maxillary sinus floor (p < 0.001). There was a significant association between maxillary sinus mucosal thickening and perforation by a dental implant with the tip trespassing the maxillary sinus floor (p < 0.05).

CONCLUSION

Maxillary sinus mucosal thickening is associated with sinus floor perforation by dental implants and does not depend on the number of implants perforating it.

CLINICAL RELEVANCE

There is an association between dental implants' perforation of the maxillary sinus floor and the thickening of the maxillary sinus. In those cases, the appearance of the mucosa thickening may be irregular, local, or total opacification of the sinus cavity.

How to avoid intraoperative and postoperative complications in maxillary sinus elevation

Maxillary sinus floor elevation, via the lateral approach, is one of the most predictable bone augmentation procedures performed in implant dentistry. but both intra- and postoperative complications can occur, and some of them are severe. Our aim is as follows: To review the pertinent literature on the topic, especially assessing the risk factors related to complications. To give clinical recommendations to minimize intra- and postoperative complications with the ultimate scope of improving the standard of clinical care and patient safety.

Human maxillary sinus size, shape, and surface area: Implications for structural and functional hypotheses

OBJECTIVES

Although research into human maxillary sinus (MS) morphology has overwhelmingly focused on sinus volume, other aspects of morphology (e.g., overall shape, mucosal surface area) factor prominently in hypotheses regarding MS form and function. Here, we investigate MS volume in conjunction with measures of MS shape and surface area in a large, diverse sample of modern humans. We test whether variation in MS volume is associated with predictable changes in MS shape (i.e., allometry) and investigate the influence of MS size-shape scaling on mucosal surface area dynamics.

MATERIALS AND METHODS

Measures of MS volume and surface area were obtained from computed tomographic (CT) scans of 162 modern human crania from three ancestral backgrounds-Equatorial Africa, Europe, and East Asia. 3D coordinate landmarks and linear measurements were also collected. Multivariate analyses were employed to test for associations between MS volume and other morphological variables.

RESULTS

Significant associations between MS volume and 3D shape were identified both across and within the subsamples. Variation in MS volume was found to predominantly relate to differences in MS height and width dimensions relative to MS length. This pattern of allometric scaling was found to differentially influence total mucosal surface area and the SAV ratio.

CONCLUSION

This study suggests that variation in MS volume is disproportionately mediated by MS width and height dimensions. This finding has implications for hypotheses which structurally link MS morphology to craniofacial ontogeny and those which suggest that MS morphology may perform adaptive physiological functions.

Sinus augmentation procedure via the lateral window technique-Reducing invasiveness and preventing complications: A narrative review

Sinus augmentation has become an integrated surgical phase in posterior maxillary implant prosthesis reconstruction. Since the residual alveolar bony height usually requires additional volume particularly at this anatomical region, sinus floor augmentation is advocated routinely. Over the years, Implant success rate is proved to be comparable to the one in the pristine bone, which is well documented in the literature. Anatomical aspects as well as surgeon skills are at most importance to achieve predictable outcome. In this narrative review, the different osteotomy techniques, the indications toward 1 or 2-stage approaches, the control of the Schneiderian membrane integrity as well as the management of intra- and post-operative complications are thoroughly discussed according the current data. In light of the excellent long-term implant success rate concurrent with the application of contemporary advanced techniques of the sinus augmentation via the lateral wall osteotomy approach, reduce invasiveness and less complication occurrences are well documented. A well-codified patient selection involving the rhinologist as an integral medical team would be significantly beneficial toward early diagnosis. In-depth knowledge of the anatomy, execution of a well standardized surgical technique, and understanding the complication etiology and their management are prerequisites for reducing patient morbidity to minimal discomfort and predictable successful outcome.

Schneiderian Membrane Regeneration After Lateral Bony Window Repositioning in Modified Endoscopic-Assisted Maxillary Sinus Surgery: Transmission Electron Microscopy Evaluation

Mandibular reconstruction is one of the most complex procedures concerning the patient’s postoperative facial shape and occlusion condition. In this study, the authors integrated mixed reality, three-dimensional (3D) printing, and robotic-assisted navigation technology to complete the mandibular reconstruction in a novel and more accurate way. Mixed reality can visualize the significant anatomical structures of the operative area, but only be used in simulated operation by now. Three-dimensional printing surgical guide plate makes it easy to separate tissue, while imprecision often occurs due to the potential of displacement and deformation. In recent years, most robotic-assisted navigation surgery technology can only achieve precise position by 2D view on the screen but not realistic 3D navigation. in this study, the integrated 3 technologies were used in mandibular reconstruction. Preoperative imaging examination was performed, and the data were imported into the digital workstation before operation. First, the original data was edited and optimized to reconstruct the digital model and formulate the surgical plan. Then MR was used to output the visualized project and matched the 3D reconstruction model in reality. The 3D plate was printed for surgical guidance. Last, robotic-assisted navigation was used to guide and position the vascularized fibula autograft and the immediate dental implantation. In conclusion, the authors integrated the 3 technologies and constructed a new digital surgical procedure to improve surgical accuracy and simplify the procedure comparing with traditional surgery.

Risk factors for sinus membrane perforation during lateral window maxillary sinus floor elevation surgery: A retrospective study

PURPOSE

To analyze the sinus membrane perforation (SMP) rate and its potential risk factors during lateral window maxillary sinus floor elevation (LSFE).

MATERIALS AND METHODS

For patients with LSFEs at Department of Implantology, Stomatology Hospital, School of Medicine, Zhejiang Universitiy during January 2014 to December 2020, patient-related risk factors (age/sex/smoking habit), surgery-related risk factors (operator experiment/number of tooth units/technique of osteotomy/surgical approach), and maxillary sinus-related risk factors (residual bone height/sinus membrane thickness/lateral wall thickness/maxillary sinus contours/presence of septa/blood vessels at the lateral maxillary sinus wall) were compared between perforated and nonperforated sites and were evaluated for their influence affecting SMP.

RESULTS

The study sample comprised 278 LSFE procedures in 278 patients; a total of 47 LSFE procedures (16.91%) presented SMP. Four significant factors were identified: smoking habit (p < 0.001), thin (≤1.5 mm) sinus membrane (p = 0.027), maxillary sinus contours (p < 0.001), and presence of septa (p = 0.001). The SMP rate of irregular, narrow tapered, and tapering sinus contours was significantly higher than that of ovoid and square one (p < 0.05).

CONCLUSION

In general, smoking habit, thin sinus membrane, irregular, narrow tapered, and tapering sinus contours, and presence of septa may increase the risk of SMP during LSFE.

Periapical Lesions and Their Relationship to Schneider's Membrane in Cone-Beam Computed Tomography

Objective

To determine the relationship between the height of the periapical lesions adjacent to the maxillary sinus and the thickness of the Schneider membrane evaluated with cone-beam tomography. Materials and Methods. The universe was made up of 2432 tomography scans and a sample of 976, by systematic random sampling, and took into account those that presented any of the variables and/or both. For the relationship analysis, the sample was distributed according to sex, maxillary side, and age; it was formed between 18 and 86 years, in age groups of 18–36 years, 37–48 years, 49–59 years, and 60–86 years. The quantitative variables of the statistic descriptive analysis, hypothesis tests, and Spearman correlation were recorded.

Results

A significantly low correlation (p < 0.010) was observed between the periapical lesions and the thickness of the Schneider membrane in women (rho = 0.38) and men (rho = 0.32); in the same way, a significantly low correlation was observed in the age groups of 18–36 years (rho = 0.27) and 37–48 years (rho = 0.28), while a significantly moderate correlation was observed in the age groups of 49–59 years (rho = 0.45) and 60–86 years (rho = 0.44), and with respect to the sides, a significantly low correlation (rho = 0.28) was obtained for the right side and a significantly moderate correlation (rho = 0.45) was obtained on the left side.

Conclusion

We found that the height of the periapical lesions and the thickness of the Schneider membrane are significantly related according to age, sex, and maxillary side, this relationship being accentuated at an older age and on the left side.

Effect of staged crestal maxillary sinus augmentation: A case series

BACKGROUND

In sinus augmentation, when remaining bone height is ≤5 mm, a lateral window approach is often the preferred choice; nonetheless, patients prefer to have a less invasive approach such as crestal sinus augmentation (CSA). Prior case reports have described the use of various staged approaches of a CSA technique in cases of limited bone height. The aim of this report was to describe the results of a case series in which a two-stage CSA technique was used in patients with 4 to 6 mm of bone height.

METHODS

Nineteen subjects with 28 sinuses of initial vertical bone height of 4 to 6 mm were included in which a two-stage CSA technique was used in place of a lateral window approach. In the first surgery, 0.3 mL graft material was inserted into all sites. In the second surgery, 13 sites were filled with 0.2 mL graft material and remaining 15 sites were filled with 0.4 mL.

RESULTS

No damage was observed in the maxillary sinus floor membrane after first 0.2 mL filling; however, one case had Schneiderian membrane perforation after filling 0.4 mL. The average elevation height (EH) after first surgery was 5.81 ± 0.7 mm, 5.15 ± 0.91 mm before second surgery, 6.69 ± 0.89 mm with 0.2 mL filling (total 0.5 mL) and 8.11 ± 1.24 mm with 0.4 mL filling (total 0.7 mL). The thickness of maxillary sinus membrane before first surgery was 2.6 ± 2.59 mm; however, it has become 0.97 ± 1.59 mm before second surgery, with a decrease of 1.6 mm estimate.

CONCLUSION

This case series that assessed outcomes of staged crestal maxillary sinus augmentation was an effective approach to elevating 6 or 8 mm alveolar bone height without causing major membrane perforation. However, the two-stage approach was used in the limited residual bone height (4 to 6 mm) and required two separate surgical procedures.

Does intraoperative perforation of Schneiderian membrane during sinus lift surgery causes an increased the risk of implants failure?: A systematic review and meta regression analysis

PURPOSE

There is still debate whether intraoperative Schneiderian membrane (SM) perforation in the maxillary sinus lift causes an increase the risk of implants failure. The aim of this study was to assess an association between SM perforation and implants loss following the maxillary sinus lift.

MATERIALS AND METHODS

A systematic review and meta-analysis of clinical studies assessing association between SM perforation and implants failure based on PRISMA was conducted. Three major databases were used to gather research dating from their respective inception up until March 2018. All clinical studies expressly reported the number of the SM perforation and implants loss that installed in the perforated and nonperforated sinuses were included. The statistical analyses used were Pearson's correlation, simple linear regression, and meta regression. The risk ratio (RR) of implant loss between perforated and nonperforated sites was estimated.

RESULTS

A total of 2947 patients with 3884 maxillary sinuses augmentations who received 7358 implants, enrolled in 58 studies were included in this study. There was a significant relationship between the implants' failure and SM perforation according to simple linear regression (P < .001) and meta regression analysis (P = .06). There was a significant decrease (moderate quality evidence) in implant loss in the nonperforated sinuses compared to perforated sunrises (RR = 2.17, CI: 1.52-3.10, P = .001). There was also no significant association between implant loss in the perforated sinuses and the surgical devices used (piezosurgical or rotary), surgical approach applied (lateral or crestal sinus lift), barrier membrane used and type of bone grafting materials.

CONCLUSION

The results of this study showed that an intraoperative SM perforation could increase the risk of implant failure after the sinus lift surgery.

Mechanical characteristics of the maxillary sinus Schneiderian membrane ex vivo

OBJECTIVES

It has been speculated that certain Schneiderian membrane thickness (SMT) might be more prone to perforation. This investigation was aimed at studying the mechanical characteristics of the Schneiderian membrane under one- and two-dimensional tests and their correlation to the histological SMT in human samples.

MATERIAL AND METHODS

Sixteen Schneiderian membranes were collected from 11 cadaver heads treated with Thiel's embalming method. The samples were processed and analyzed clinically and histologically. One-dimensional maximum elongation until perforation and two-dimensional resistance to ball penetration were performed after the biopsy. Data was analyzed by using the Wilcoxon rank test and the Spearman's rank correlation.

RESULTS

The histological SMT was 1.36 ± 0.42 mm, whereas the clinical thickness was 0.27 ± 0.21 mm, yielding statistical significance (p = 0.000). The resistance under ball penetration was 0.59 ± 0.43 N and the mean maximum elongation in the one-dimension test 11.19 ± 7.14 mm. Expressed in percentage, the mean stretch was 241.36 ± 227.97% (range 31.5 up to 947%). A weak positive correlation was found between the ball penetration test and the SMT (r = 0.10, p = 0.711), while a weak negative correlation was found between stretching test and the SMT (r = -0.021, p = 0.94).

CONCLUSIONS

Mechanical tests seem to indicate that SMT might not significantly predispose to Schneiderian membrane perforation. Hence, other anatomical and operator's factors should be considered of surpassing importance.

CLINICAL RELEVANCE

Thinner SM might be more prone to perforation when detaching it from the maxillary sinus antrum; however, a thick membrane is not prevented to tear, as their resistance under elastic forces is not higher than thinner ones.