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Lyu M, Xu D, Zhang X, Yuan Q. Maxillary sinus floor augmentation: a review of current evidence on anatomical factors and a decision tree. Int J Oral Sci 2023; 15:41. [PMID: 37714889 PMCID: PMC10504247 DOI: 10.1038/s41368-023-00248-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/17/2023] Open
Abstract
Maxillary sinus floor augmentation using lateral window and crestal technique is considered as predictable methods to increase the residual bone height; however, this surgery is commonly complicated by Schneiderian membrane perforation, which is closely related to anatomical factors. This article aimed to assess anatomical factors on successful augmentation procedures. After review of the current evidence on sinus augmentation techniques, anatomical factors related to the stretching potential of Schneiderian membrane were assessed and a decision tree for the rational choice of surgical approaches was proposed. Schneiderian membrane perforation might occur when local tension exceeds its stretching potential, which is closely related to anatomical variations of the maxillary sinus. Choice of a surgical approach and clinical outcomes are influenced by the stretching potential of Schneiderian membrane. In addition to the residual bone height, clinicians should also consider the stretching potential affected by the membrane health condition, the contours of the maxillary sinus, and the presence of antral septa when evaluating the choice of surgical approaches and clinical outcomes.
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Affiliation(s)
- Mingyue Lyu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Dingyi Xu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiaohan Zhang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Quan Yuan
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Hsu YT, Rosen PS, Choksi K, Shih MC, Ninneman S, Lee CT. Complications of sinus floor elevation procedure and management strategies: A systematic review. Clin Implant Dent Relat Res 2022; 24:740-765. [PMID: 35737681 DOI: 10.1111/cid.13086] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 12/14/2022]
Abstract
AIM This systematic review aimed to investigates the types and incidences of complications following sinus floor elevations (SFE) along with their prevention and management strategies. MATERIALS AND METHODS Electronic database and hand search were conducted to screen the literature published from January 1960 to June 2021. The selected studies had to report well-described SFE techniques, complications during, and post-SFE. Data extraction included types of SFE techniques, complications, and their treatment strategies. RESULTS A total of 74 studies with 4411 SFE procedures met the inclusion criteria. Different SFE techniques demonstrated varying patterns for both complications and complication rates. Postoperative pain, swelling, and edema were widely reported. The most common complications that required intervention following Lateral SFE (LSFE) were sinus membrane perforation (SMP), wound dehiscence, graft exposure and failure, and sinusitis. LSFE had more SMPs and sinusitis cases compared with a transcrestal SFE (TSFE). The presence of benign paroxysmal positional vertigo following TSFE was significant in certain selected studies. CONCLUSION Given the inherent limitations, this systematic review showed distinct features of complications in SFE using varying techniques. Treatment planning for these procedures should incorporate strategies to avoid complication occurrence.
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Affiliation(s)
- Yung-Ting Hsu
- Department of Periodontics, University of Washington School of Dentistry, Seattle, Washington, USA
| | - Paul S Rosen
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Karishma Choksi
- Division of Clinical Dentistry, University of Detroit Mercy School of Dentistry, Detroit, Michigan, USA
| | - Ming-Chieh Shih
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shale Ninneman
- Department of Periodontics, University of Washington School of Dentistry, Seattle, Washington, USA
| | - Chun-Teh Lee
- Department of Periodontics and Dental Hygiene, University of Texas Health Science Center at Houston, Houston, Texas, USA
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Clarot S, Christensen BJ, Chapple AG, Block MS. Prediction of Residual Alveolar Bone Height in the Posterior Maxilla After Dental Extractions. J Oral Maxillofac Surg 2021; 80:517-524. [PMID: 34871583 DOI: 10.1016/j.joms.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/16/2021] [Accepted: 11/04/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE After tooth extraction in the posterior maxilla, bone resorption often limits implant placement unless additional grafting procedures are performed. However, it is difficult to predict the amount of bone that will remain after extraction based on current evidence. The purpose of this study was to develop a method for predicting the postextraction alveolar bone height in the posterior maxilla. PATIENTS AND METHODS The authors conducted a retrospective cohort study that included all patients who were treated for the extraction and replacement of a maxillary first molar with a dental implant from 2008 to 2019. Potential predictor variables included thirteen pre-extraction radiographic measurements obtained via cone-beam computed tomography. The outcome variable was having more than 6 mm of bone height from the alveolar crest to the sinus floor after extraction. Decision tree analyses were used to search for the best predictors of this outcome using random forest analysis with a maximum of 3 randomly chosen covariates in each candidate tree. RESULTS A total of 63 patients were included in the study; 55.6% were women, and the mean age was 57.6 ± 14.5 years. In this study population, having a bone height from the furcation to the maxillary sinus floor of <6.7 mm had a 7.1% chance of having >6 mm of bone height postoperatively, whereas those patients with ≥6.7 mm at the same position preoperatively had a 61.9% chance of having >6 mm of bone height postoperatively (P < .001). CONCLUSIONS This study suggests that patients with <6.7 mm of bone from the furcation to the sinus are at increased risk of having insufficient bone to support a dental implant without additional grafting at the maxillary first molar position. When treating these patients, the surgeon should consider performing a procedure at the time of extraction to increase bone height or explain additional bone grafting is expected for ideal implant placement.
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Affiliation(s)
- Samuel Clarot
- Resident, Department of Oral & Maxillofacial Surgery, Louisiana State University Health Sciences Center, Metairie, LA
| | - Brian J Christensen
- Assistant Professor, Department of Oral & Maxillofacial Surgery, Louisiana State University Health Sciences Center, Metairie, LA.
| | - Andrew G Chapple
- Assistant Professor, Biostatistics Program, School of Public Health, Louisiana State University Health Sciences Center, Metairie, LA
| | - Michael S Block
- Clinical Professor, Department of Oral & Maxillofacial Surgery, Louisiana State University Health Sciences Center; Private Practice, Metairie, LA
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Lafzi A, Atarbashi-Moghadam F, Amid R, Sijanivandi S. Different techniques in transalveolar maxillary sinus elevation: A literature review. JOURNAL OF ADVANCED PERIODONTOLOGY & IMPLANT DENTISTRY 2021; 13:35-42. [PMID: 35919916 PMCID: PMC9327482 DOI: 10.34172/japid.2021.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/05/2021] [Indexed: 01/08/2023]
Abstract
Dental implant treatment in the posterior maxilla encounters bone quality and quantity problems. Sinus elevation is a predictable technique to overcome height deficiency in this area. Transalveolar sinus elevation is a technique that is less invasive and less time-consuming, first introduced for ridges with at least 5 mm of bone height. Many modifications and innovative equipment have been introduced for this technique. This review aimed to explain the modifications of this technique with their indications and benefits. An exhaustive search in PubMed Central and Scopus electronic databases was performed until December 2020. Articles were selected that introduced new techniques for the transalveolar maxillary sinus approach that had clinical cases with full texts available in the English language. Finally, twenty-six articles were included. The data were categorized and discussed in five groups, including expansion-based techniques, drill-based techniques, hydraulic pressure techniques, piezoelectric surgery, and balloon techniques. The operator’s choice for transalveolar approach techniques for sinus floor elevation can be based on the clinician’s skill, bone volume, and access to equipment. If possible, a technique with simultaneous implant placement should be preferred.
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Affiliation(s)
- Ardeshir Lafzi
- Department of Periodontics, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fazele Atarbashi-Moghadam
- Department of Periodontics, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Amid
- Department of Periodontics, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soran Sijanivandi
- Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Block MS. Bone Levels Are Preserved After Simultaneous Sinus Elevation at Time of Implant Placement. J Oral Maxillofac Surg 2019; 77:2019-2026. [PMID: 31348872 DOI: 10.1016/j.joms.2019.06.177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to confirm that after simultaneous implant placement and vertical bone augmentation in the posterior maxilla, the immediate postoperative bone height is maintained after 2 to 3 years of follow-up. PATIENTS AND METHODS Consecutive patients treated with implant placement in the posterior maxilla were evaluated. Cone-beam scans were taken preoperatively; immediately after implant placement; and for the sinus-grafted cases, 2 to 3 years after surgery. Crestal bone heights were measured. Patients were grouped according to the use of sinus augmentation or no sinus augmentation at the time of implant placement. RESULTS The increase in bone height was significant in the graft group when we compared immediate and 3-year follow-up measurements (P < .00001). In the graft group, there were no significant differences in bone height when we compared the immediate and 3-year follow-up periods (P = .31). CONCLUSIONS Simultaneous sinus floor elevation with grafting at implant placement results in stable bone levels after 2 to 3 years' follow-up.
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Rocha LRS, Aloise AC, Oliveira RDM, Teixeira ML, Pelegrine AA, Macedo LGS. Long-term Retrospective Study of Implants Placed after Sinus Floor Augmentation with Fresh-frozen homologous block. Contemp Clin Dent 2017; 8:248-252. [PMID: 28839411 PMCID: PMC5551330 DOI: 10.4103/ccd.ccd_63_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Aim: The aim of this study was to analyze and follow-up implants placed in the posterior maxillary regions previously grafted with homologous bone. Materials and Methods: Forty-one grafts with homologous bone blocks were performed in maxillary sinuses, and 121 implants were placed in premolar and molar regions approximately 6 months after the grafts. Patients were followed up for periods varying from 12 to 124 months after rehabilitation. Results: The results showed two implant failures, for a 98.3% success rate during the follow-up period. Discussion: The implants placed had an average torque of 40 N-cm, regardless of the, design, diameter, and length of the implants used. Conclusion: After following up on the implants placed in this study, we concluded that those placed in regions of the maxillary sinuses previously grafted with homologous bone blocks had high long-term success rates and met the functional masticatory requirements.
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Affiliation(s)
| | - Antonio Carlos Aloise
- Department of Plastic Surgery of the Federal São Paulo University UNIFESP, Campinas, SP, Brazil
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Block MS. Improvements in the Crestal Osteotome Approach Have Decreased the Need for the Lateral Window Approach to Augment the Maxilla. J Oral Maxillofac Surg 2016; 74:2169-2181. [DOI: 10.1016/j.joms.2016.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/06/2016] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
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Nickenig HJ, Wichmann M, Zöller JE, Grandoch A, Eitner S, Kreppel M. Three-dimensional cone beam computed tomography analysis of maxillary sinus and alveolar bone anatomy in the restorative axis of dental implants using radiopaque drill guides. Int J Oral Maxillofac Surg 2016; 45:1485-1489. [PMID: 27614906 DOI: 10.1016/j.ijom.2016.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 07/07/2016] [Accepted: 08/23/2016] [Indexed: 10/21/2022]
Abstract
The objectives were to assess the sinus anatomy and alveolar ridge dimensions and to identify clinical factors and morphological relationships that may predict the characteristics of the sinus anatomy. A total 336 edentulous molar and 168 edentulous premolar regions were analyzed. The mediolateral maxillary sinus (5mm and 10mm above alveolar bone), lateral maxillary sinus wall, ostium height, and alveolar ridges were measured. Measurement regions were defined by radiopaque simulation of the restoration goal. Mean molar mediolateral dimensions were >10mm: first molar, 11.8mm (range 3.8-21.1mm); second molar, 12.2mm (range 7.9-20.1mm). The extent of the sinus differed significantly between premolars and molars (P<0.001). The first molar region had the highest mean value for the lateral sinus wall (2.4mm, range 0.2-7.9mm) and the greatest distance between the alveolar crest and simulated restorative goal (8.1mm, range 1.1-16.3mm). Septum prevalence was 46% in the molar region and 27% in the premolar region. A lower alveolar ridge height was associated with a wider transverse extent of maxillary sinus and consequently longer distances between the crest and restorative goal. Systematic three-dimensional analysis of the maxillary sinus yields precise preoperative information about sinus configurations. There were significant variations and relationships among characteristics of the maxillary sinus, ridge, and the restorative goal.
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Affiliation(s)
- H-J Nickenig
- Department of Oral and Maxillofacial Plastic Surgery and Interdisciplinary, Department of Oral Surgery and Implantology, University of Cologne, Cologne, Germany
| | - M Wichmann
- Department of Prosthodontics, University Hospital Erlangen, Erlangen, Germany
| | - J E Zöller
- Department of Oral and Maxillofacial Plastic Surgery and Interdisciplinary, Department of Oral Surgery and Implantology, University of Cologne, Cologne, Germany
| | - A Grandoch
- Department of Oral and Maxillofacial Plastic Surgery and Interdisciplinary, Department of Oral Surgery and Implantology, University of Cologne, Cologne, Germany
| | - S Eitner
- Department of Prosthodontics, University Hospital Erlangen, Erlangen, Germany
| | - M Kreppel
- Department of Oral and Maxillofacial Plastic Surgery and Interdisciplinary, Department of Oral Surgery and Implantology, University of Cologne, Cologne, Germany.
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