Maxillary sinus elevation surgery: an overview.
ABSTRACT Maxillary sinus elevation surgery was developed to increase the height of bone available for implant placement in the posterior maxilla. The efficacy and predictability of this procedure have been determined in numerous studies. The basic approach to the sinus (Caldwell-Luc operation) involves an osteotomy performed on the lateral maxillary wall, elevation of the sinus membrane, and placement of bone graft material. The graft materials can be categorized into four groups: autogenous bone, allografts (harvested from human cadavers), alloplasts (synthetic materials), and xenografts (grafts from a nonhuman species). These graft materials can be used alone or in combination with each other. Implant placement can occur at the same surgical procedure (immediate placement) or following a healing period of 6 to 9 months (delayed placement). A more conservative approach to the sinus, the osteotome technique, has been described as well. CLINICAL SIGNIFICANCE: This article provides an overview of the surgical technique, with emphasis on anatomic considerations, preoperative patient evaluation (clinical and radiographic), indications and contraindications to the procedure, and possible risks and complications.
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ABSTRACT: Sinus augmentation is a procedure used for augmenting insufficient bone height that is often observed in the maxillary posterior areas. Many different techniques as well as bone graft regimens have been suggested for performing this procedure. It was the goal of this study to compare, clinically and histologically, two different composite grafting regimens used for sinus augmentation. Five patients, needing a bilateral sinus augmentation to allow implant placement, were recruited for this study. Right sinuses were grafted with cortical bone (collected from overlying the sinus membrane) and bovine hydroxyapatite (HA), while the left side sinuses were grafted with overlying autologous bone plus a bioglass (BG) material. Bone core biopsies were taken at 6 months after sinus graft or at the time of implant insertion. A waiting period of 6 additional months was granted to allow healing, before prosthetic restoration and functional loading. The level of peri-implant bone was evaluated 12 months after loading. A comparative histomorphometric analysis was conducted and a statistical analysis was performed. All implants in both groups were functional after a 12-month loading period. No bone loss was observed radiographically or clinically in both groups. Histologic analysis revealed that both composite grafts had a high biocompatibility. In the bovine HA-containing group, minimal xenogenic graft absorption was noted. In contrast, BG group samples presented a high absorption rate with some remaining particles imbedded in new normal bone. Sinus augmentation using a combination of autogenous bone plus either bovine HA or BG is a predictable technique.Clinical Oral Implants Research 07/2008; 19(8):755-9. DOI:10.1111/j.1600-0501.2008.01536.x · 3.12 Impact Factor
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ABSTRACT: This retrospective study sought to demonstrate the outcome of maxillary sinus elevation surgery in a series of 177 procedures performed over 12 years and to determine the existence of variables that could independently predict implant survival. A retrospective descriptive and analytic study of a series of maxillary sinus elevation procedures performed between 1996 and 2007 was undertaken. The sample was composed of patients with severe atrophy of the posterior maxilla who had been rehabilitated with osseointegrated implants placed in grafted maxillary sinuses. Several features of the patients (smoking habit, presence of comorbidities, and previous oral carcinoma) and of the surgical procedure (grafting material, associated procedures, associated materials, simultaneous/delayed implant placement, and complications) related to implant survival or failure were monitored during the follow-up period. Implant survival and the existence of variables that could predict implant survival independently were analyzed statistically. One hundred seventy-seven sinus augmentation procedures were performed in 119 consecutive patients (mean age 50.02 years; SD 11.5). Of the 272 implants placed in sinus-augmented regions, 19 were lost. The mean follow-up period was 60.7 months (SD 36.5). The overall cumulative implant survival rate was 93% after 5 years. The multivariate analysis showed that the presence of complications related to the sinus augmentation procedure (membrane perforation and sinusitis) and peri-implantitis were factors in predicting implant failure. On the basis of this retrospective analysis, it might be concluded that sinus augmentation is a very versatile procedure. Its efficacy and predictability in terms of implant survival rate is extremely high and independent of the graft material, surgical technique, associated comorbidities, smoking habits, and timing of implant placement. Complications such as membrane perforation, sinusitis, and peri-implantitis appeared to influence implant failure.The International journal of oral & maxillofacial implants 01/2010; 25(5):1019-27. · 1.49 Impact Factor
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ABSTRACT: OBJECTIVE: This study compared three marker-free registration methods that are applicable to a navigation system that can be used for maxillary sinus surgery, and evaluated the associated errors, with the aim of determining which registration method is the most applicable for operations that require accurate navigation. METHODS: The CT digital imaging and communications in medicine (DICOM) data of ten maxillary models in DICOM files were converted into stereolithography file format. All of the ten maxillofacial models were scanned three dimensionally using a light-based three-dimensional scanner. The methods applied for registration of the maxillofacial models utilized the tooth cusp, bony landmarks and maxillary sinus anterior wall area. The errors during registration were compared between the groups. RESULTS: There were differences between the three registration methods in the zygoma, sinus posterior wall, molar alveolar, premolar alveolar, lateral nasal aperture and the infraorbital areas. The error was smallest using the overlay method for the anterior wall of the maxillary sinus, and the difference was statistically significant. CONCLUSION: The navigation error can be minimized by conducting registration using the anterior wall of the maxillary sinus during image-guided surgery of the maxillary sinus.Dentomaxillofacial Radiology 04/2012; 41(8). DOI:10.1259/dmfr/21358271 · 1.27 Impact Factor