Maxillary Sinus Elevation Surgery: An Overview

New York University College of Dentistry, Ashman Department of Implant Dentistry, Division of Reconstructive and Comprehensive Care, New York, NY, USA.
Journal of Esthetic and Restorative Dentistry (Impact Factor: 0.81). 02/2003; 15(5):272-82; discussion 283. DOI: 10.1111/j.1708-8240.2003.tb00298.x
Source: PubMed


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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    • "Conclusions: In completely edentulous patients, inserting implants in sinus septa does not exclude the need for sinus grafting, but in partially edentulous patients, this minimally invasive technique is an alternative to subantral augmentation.The successful placement and restoration of dental implants in the edentulous posterior maxilla could potentially be compromised by a lack of adequate vertical dimension of the alveolar bone present between the alveolar crest and the floor of the maxillary sinus. To address these problems, maxillary sinus elevation surgery was developed to increase the height of the bone available for implant placement in the posterior maxilla[1]. Although the complication rate of maxillary sinus bone augmentation is low[2], there exist intra-operative risks of sinus membrane perforation and bleeding3456789and postoperative risks of wound infection and sinusitis[2,7,8,101112, graft or barrier membrane exposure[13], graft infection (warranting its removal)[14], cyst formation[15], and flap dehiscence. "
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    ABSTRACT: BACKGROUND The aim of this study was to simulate implant placement in the maxillary sinus septum, as a potential alternative site to avoid sinus grafting. MATERIAL AND METHODS One hundred partially or completely edentulous patients, with their maxillary sinus septum present in the edentulous region, were selected from the database of the Department of Maxillofacial Surgery, Cliniques Universitaires Saint Luc, Bruxelles, Belgium. Three-dimensional (3D) reconstructions were created using 3D planning software. 3D reconstructions were performed for each maxillary sinus. Using the software implant library, the implants that presented the best fit with the maxillary sinus septum and that followed the established inclusion criteria were selected. RESULTS All of the implants were inserted in premolar and molar regions. Most implants were inserted in the position of the second molar (21 of 55) or in the position of the first molar (17 of 55). In all sites the most frequently used implant was 4 mm in diameter and 7 mm in height. The mean coronal angle for the implant was 80.19±17.13 degrees and the mean sagittal angle was 94.83±9.94 degrees. The septal height represents 38.13% of the total available bone height (ABH). The mean percentage of the septum used to insert the implants was 47.33±2.47%. The septum increased the available bone height by a mean value of 2.18±1.47 mm. In 45 cases, the septa did not permit implant placement. CONCLUSIONS In completely edentulous patients, inserting implants in sinus septa does not exclude the need for sinus grafting, but in partially edentulous patients, this minimally invasive technique is an alternative to subantral augmentation.
    Full-text · Article · Sep 2015 · Medical science monitor: international medical journal of experimental and clinical research
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    • "Several procedures and materials have been developed to overcome the problem of reduced amount of bone like tilted implants, short implants and vertical bone augmentation. But impredictable success rates have been reported with tilted implants and short implants [4]. "
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    ABSTRACT: Maxillary sinus augmentation surgical techniques have evolved greatly allowing successful placement of dental implants in the atrophic posterior maxillary region. The purpose of the present study is to evaluate the clinical and radiological outcomes and postoperative morbidity of sinus floor elevation procedures performed using the minimally invasive surgical technique the Sinu lift system. Sinus lift procedure was done using the sinu lift system by a transcrestal approach and bone augmentation was done on ten systemically healthy patients using β- tricalcium phosphate and platelet rich plasma mix. The study was evaluated upto six months period with bone related parameters being assessed at base line using CT scan, OPG and after six months the results were analysed using SPSS Version 18.0 software (p < 0.01 (0.005). Wilcoxson signed rank sum test was used to correlate between preoperative and postoperative measurements. Implant placements were done at the desired area of sinus augmentation with a two year follow up. (Nobel Biocare, Nobel Biocare Holding AG, Zürich-Flughafen, Switzerland) Results: The augmented sites had a significant increase in the bone parameters at the desired grafted region. The mean gain in bone height as observed in CT Scan had revealed increased measurements from 5.80mm±0.98 to 10.20mm±1.68 at the sixth month evaluation. This was statistically significant (0.005). Clinically, no complications were observed during or after the surgical procedure. Within the limitations of this study, the Sinu lift system with a controlled working action resulted in high procedural success and this procedure may be an alternative to the currently used surgical methods.
    Full-text · Article · Mar 2015
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    • "Patients without teeth in the posterior region of the maxilla often present atrophy of the alveolar ridge and pneumatization of the maxillary sinus (Hieu et al. 2010). This condition could jeopardize the correct 3D implant placement, which can be solved through a maxillary sinus bone augmentation (Boyne & James 1980; Misch 1987, 2007; Kaufman 2003; Sorn ı et al. 2005; Chambrone et al. 2013). "
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    ABSTRACT: This multislice tomographic study evaluated the dimensional changes after maxillary sinus augmentation using autogenous bone or a mixture of hydroxyapatite and autogenous bone. Ten selected patients, requiring a bilateral maxillary sinus augmentation, were divided, in a split mouth, design as follows: control group (CG n = 10 sinus grafted with autogenous bone) and test group (TG, n = 10 sinus grafted with a mixture of hydroxyapatite and autogenous bone at 80 : 20 w/w). Follow a healing period of 15 and 180 days, computed tomography (CT) measurements were taken by two blinded and calibrated examiners to verify the volumetric dimensional changes of the both groups. The interobserver agreement obtained ranged from good to excellent for both groups. Both groups presented significant dimensional changes after 180 days period healing (P < 0.05). The volumetric reduction in test group was lower (25.87%) when compared with the CG (42.30%) (P < 0.05). The both graft materials improved the bone volumetric ability to anchorage a dental implant. Moreover, the mixture of HA and autogenous bone graft showed lower degree of resorption and higher dimensional stability when compared with autogenous bone graft alone, at least at 180 days of healing. The CT exam protocol should be used as an important tool to measure bone grafts volumetric alterations.
    Full-text · Article · Sep 2013 · Clinical Oral Implants Research
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