Endoscope-controlled maxillary sinus floor elevation: a review of the literature

Diagnostic reliability and accuracy of the hydraulic contrast lift protocol in the radiographic detection of sinus lift and perforation: ex vivo randomized split-mouth study in an ovine model

OBJECTIVES

Assessing the diagnostic reliability, validity, and accuracy of the hydraulic contrast lift protocol during transcrestal sinus floor elevation in detecting the lift and perforation of the sinus membrane before graft material application and assessing the effect of its use on the operator's diagnostic confidence.

MATERIAL AND METHODS

A single-blind randomized split-mouth study on fresh refrigerated sheep heads. The first intervention consisted of injecting 0.5 ml iodinated contrast medium on the test side and 0.5 ml saline on the control side. In the second intervention artificial sinus membrane perforations were created followed by injecting 0.5 ml iodinated contrast medium on the test side and 0.5 ml saline on the control side. Intraoperative periapical radiographs were taken for both interventions. The resulting 40 radiographs were assessed by 10 examiners to provide interpretations and confidence ratings. The primary endpoints were diagnostic reliability, validity, accuracy, and perceived diagnostic confidence.

RESULTS

In the hydraulic contrast lift protocol, the detection rate was 99% for sinus elevations and 98% for perforations, the saline protocol yielded a detection rate of 28% and 20% respectively. The hydraulic contrast lift protocol demonstrated a high level of inter-rater agreement for the diagnosis of elevations (p < 0.001) and perforations (p < 0.001), strong diagnostic validity for the diagnosis of elevations (p < 0.001) and perforations (p < 0.001), high sensitivity and specificity (p < 0.001) and higher mean diagnostic confidence ratings for both interventions when compared to the saline protocol (p < 0.001). The difference between the predicted probability for correct diagnosis of the hydraulic contrast lift protocol and the saline protocol was significant (p < 0.001) for the detection of both elevations and perforations.

CONCLUSION

Following the hydraulic contrast lift protocol, the use of a radiographic contrast medium can reliably confirm sinus membrane lift and detect perforation during transcrestal sinus floor elevation prior to bone graft application in addition to improving the diagnostic confidence of the operator while relying on periapical radiographs.

Endoscope-assisted maxillary sinus floor augmentation with a mini-lateral window: A retrospective study

OBJECTIVES

The aim of this study was to evaluate the efficacy of endoscope-controlled sinus floor augmentation through a mini-lateral window, compared with traditional lateral window approach.

MATERIALS AND METHODS

This retrospective research included 19 patients and 20 augmented sinuses using lateral window approach with simultaneous implant placement (test group: a 3-4 mm round osteotomy; control group: a 10 × 8 mm rectangular osteotomy). Preoperatively (T0), immediately after surgery (T1), and 6 months postoperatively (T2), cone-beam computed tomography (CBCT) scans were obtained. Residual bone height (RBH), lateral window dimension (LWD), endo-sinus bone gain (ESBG), apical bone height (ABH), and bone density were measured. Intraoperative and postoperative complications were recorded. Patients' evaluation of pain first day after surgery and a week later was assessed by visual analog scale (VAS).

RESULTS

No significant difference was found in ESBG, ABH between the two groups at T1, T2 or their changes from T1 to T2. However, the increase of bone density value in the test group was significantly higher than control group (356.28 ± 149.59 vs. 242.99 ± 129.54; p < 0.05). The sinus perforation rate of test and control group was 10% and 20%, respectively. The VAS score of the test group at the first day after surgery was significantly lower than control group (4.20 ± 1.03 vs. 5.60 ± 1.71; p < 0.05).

CONCLUSIONS

Endoscope-controlled maxillary sinus floor augmentation through a mini-lateral window yield similar result with traditional approach in terms of bone height gain. The modified approach could facilitate new bone formation, reducing sinus perforation rate and postoperative pain.