Axial Triangle of the Maxillary Sinus, and its Surgical Implication With the Position of Maxillary Sinus Septa During Sinus Floor Elevation: A CBCT Analysis

2020 ◽  
Vol 46 (4) ◽  
pp. 415-422
Author(s):  
Junho Jung ◽  
Jung Soo Park ◽  
Seoung-Jin Hong ◽  
Gyu-Tae Kim ◽  
Yong-Dae Kwon
Keyword(s):  
Maxillary Sinus ◽  
Surgical Techniques ◽  
Lateral Sinus ◽  
Sinus Floor Elevation ◽  
Second Molar ◽  
Sinus Wall ◽  
Posterior Maxilla ◽  
Significant Difference ◽  
Sinus Floor ◽  
Molar Region

The aim of this study was to measure the convexity of the lateral wall of the maxillary (Mx) sinus and identify the locational distribution of antral septa in relation to the zygomaticomaxillary buttress (ZMB), in order to suggest another anatomical consideration and surgical modification of sinus floor elevation procedures. This study was designed as a cross-sectional study, and a total of 134 patients and 161 sinuses containing edentulous alveolar ridges were analyzed. The angle between the anterior and lateral walls of the Mx sinus (lateral sinus angle [LSA]), and the angle between the midpalatal line and the anterior sinus wall (anterior sinus angle [ASA]) were measured. Mean LSAs and ASAs were 105.9° ± 9.86° and 58.4° ± 6.43°, respectively. No significant difference between left and right sides was found (LSA, P = .420; right = 105.5° ± 9.27°; left = 105.5° ± 9.27° and ASA, P = .564; right = 57.9° ± 6.80°; left = 58.8° ± 6.02°). The prevalence of septa was 37.3%, and it was most frequently noted in the second molar region (32.8%), followed by the first molar (20.9%), retromolar (16.4%), and second premolar regions (14.9%). Septa were most frequently located posterior to the ZMB (49.2%), while ZMB was mostly located in the first molar region (66.4%). Narrow LSAs may complicate the surgical approach to the posterior maxilla, especially when sinus elevation should be used in the second molar region. Considering the occasional presence of antral septa, membrane elevation may be complicated when a septum is encountered during the procedure. These results suggest that 3-dimensional examination of the convexity of the Mx sinus should be performed preoperatively to choose proper surgical techniques and minimize surgical complications.

scholarly journals 3D Volumetric Analysis and Anatomical Considerations for Sinus Bone Graft

2021 ◽  
Vol 11 (3) ◽  
pp. 951
Author(s):  
Ji Hyoung Kim ◽  
Hyo Joon Kim ◽  
Ye Joon Jo ◽  
Jun Seok Choi ◽  
Seong Yong Moon
Keyword(s):  
Bone Graft ◽  
Maxillary Sinus ◽  
Alveolar Bone ◽  
Lateral Wall ◽  
Volumetric Analysis ◽  
Ct Scans ◽  
Sinus Floor Elevation ◽  
Sinus Wall ◽  
Sinus Floor ◽  
The Mean

The aim of this study is to evaluate anatomical considerations and assess the volume of the maxillary sinus bone graft. There were sixty-three patients (eighty-three sinuses) who had taken CT scans for implant surgery. Patients included those whose height of the residual alveolar bone was less than 5 mm. The position of posterior superior alveolar artery, the thickness of the maxillary sinus wall, and the volume of the maxillary sinus according to the amount of sinus floor elevation were measured. The mean vertical distance of posterior superior alveolar artery was 11.91 ± 4.79 mm from 3.03 mm to 24.05 mm. The mean thickness of the lateral wall was 1.71 ± 0.55 mm in the range of 0.74 mm to 3.93 mm. The volume of 3 mm, 5 mm, 7 mm, and 10 mm from the sinus floor was 0.173 ± 0.11 cm3, 0.526 ± 0.25 cm3, 1.068 ± 0.43 cm3, and 2.184 ± 0.74 cm3 on average, respectively. The knowledge of the posterior superior alveolar artery position, the lateral wall thickness, and the volume of the maxillary sinus can help the clinician for sinus bone graft.

scholarly journals The Human Amniotic Mesenchymal Stem Cells (hAMSCs) Improve the Implant Osseointegration and Bone Regeneration in Maxillary Sinus Floor Elevation in Rabbits

2019 ◽  
Vol 2019 ◽  
pp. 1-10
Author(s):  
Lu Yin ◽  
Zhi-xuan Zhou ◽  
Ming Shen ◽  
Ning Chen ◽  
Fei Jiang ◽  
...  
Keyword(s):  
Bone Regeneration ◽  
Maxillary Sinus ◽  
Bone Volume ◽  
Control Group ◽  
Sinus Floor Elevation ◽  
Dental Implantation ◽  
Posterior Maxilla ◽  
Maxillary Sinus Floor ◽  
Sinus Floor ◽  
Maxillary Sinus Floor Elevation

Insufficient bone height in the posterior maxilla is a challenging problem in dental implantation. Bio-Oss, though routinely used in maxillary sinus floor elevation (MSFE), is not osteoinductive. Human amniotic mesenchymal cells (hAMSCs) isolated from placental tissues have potential for multidifferentiation and immunomodulatory properties and can be easily obtained without the need for invasive procedures and without ethical concerns. This is the first study to use hAMSCs to improve implant osseointegration and bone regeneration after MSFE. Human AMSCs were loaded into a fibrin gel and injected into rabbit MSFE models. The rabbits were assigned to four groups (n=3 per group), i.e., the control group, the hAMSC group, the Bio-Oss group, and the hAMSC/Bio-Oss group. The animals were sacrificed at postsurgery for four and twelve weeks and evaluated by histology and immunohistochemistry. Bone volume, bone volume/tissue volume, bone-to-implant contact ratio, and vessel-like structures in the hAMSC/Bio-Oss group were significantly better than those in other groups in the peri-implant and augmented areas. Immunofluorescence staining showed that alkaline phosphatase (ALP) activities of two hAMSC groups were higher than those of the other two groups. Sequential fluorescent labeling was performed in all of the 12-week groups. Observations showed that hAMSCs accelerated mineralized deposition rates on implant surfaces and in bone-augmented areas. These data demonstrated that hAMSCs could enhance implant osseointegration and bone regeneration after MSFE and might be used to optimize dental implantation in the future.

scholarly journals Schneider Membrane Elevation in Presence of Sinus Septa: Anatomic Features and Surgical Management

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Mario Beretta ◽  
Marco Cicciù ◽  
Ennio Bramanti ◽  
Carlo Maiorana
Keyword(s):  
Maxillary Sinus ◽  
Lateral Approach ◽  
Sinus Lift ◽  
Sinus Floor Elevation ◽  
Posterior Maxilla ◽  
Maxillary Sinus Floor ◽  
Sinus Floor ◽  
The Right ◽  
Maxillary Sinus Floor Elevation ◽  
Gothic Arch

Maxillary sinus floor elevation via a lateral approach is a predictable technique to increase bone volume of the edentulous posterior maxilla and consequently for dental implants placement. The sinus floor is elevated and it can be augmented with either autologous or xenogeneic bone grafts following an opening bone window created on the facial buccal wall. Maxillary septa are walls of cortical bone within the maxillary sinus. The septa shape has been described as an inverted gothic arch arising from the inferior or lateral walls of the sinus and may even divide the sinus into two or more cavities. Some authors have reported a higher prevalence of septa in atrophic edentulous areas than in nonatrophic ones. Radiographic identification of these structures is important in order to perform the right design of the lateral window during sinus lift. Aim of this investigation is to highlight the correct steps for doing sinus lift surgery in presence of those anatomic variations. Clinicians should always perform clinical and radiographic diagnosis in order to avoid complications related to the sinus lift surgery.

scholarly journals Paradigm Shift in the Management of the Atrophic Posterior Maxilla

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Rabah Nedir ◽  
Nathalie Nurdin ◽  
Paul Khoury ◽  
Marc El Hage ◽  
Semaan Abi Najm ◽  
...  
Keyword(s):  
Lateral Sinus ◽  
Efficient Treatment ◽  
Sinus Floor Elevation ◽  
Implant Placement ◽  
Single Crown ◽  
Posterior Maxilla ◽  
Atrophic Maxilla ◽  
Sinus Floor ◽  
Osteotome Sinus Floor Elevation ◽  
Bone Height

When the posterior maxilla is atrophic, the reference standard of care would be to perform sinus augmentation with an autologous bone graft through the lateral approach and delayed implant placement. However, placement of short implants with the osteotome sinus floor elevation technique and without graft can be proposed for an efficient treatment of clinical cases with a maxillary residual bone height of 4 to 8 mm. The use of grafting material is recommended only when the residual bone height is ≤4 mm. Indications of the lateral sinus floor elevation are limited to cases with a residual bone height ≤ 2 mm and fused corticals, uncompleted healing of the edentulous site, and absence of flat cortical bone crest or when the patient wishes to wear a removable prosthesis during the healing period. The presented case report illustrates osteotome sinus floor elevation with and without grafting and simultaneous implant placement in extreme conditions: atrophic maxilla, short implant placement, reduced healing time, and single crown rehabilitation. After 6 years, all placed implants were functional with an endosinus bone gain.

scholarly journals Influence of Lateral Sinus Floor Elevation Procedures on the Pulpal and Periapical Status of Adjacent Vital Teeth

2020 ◽  
Vol 10 (20) ◽  
pp. 7185
Author(s):  
Ilan Beitlitum ◽  
Gil Slutzkey ◽  
Carlos E. Nemcovsky ◽  
Tamar Blazer ◽  
Eyal Rosen ◽  
...  
Keyword(s):  
Lateral Sinus ◽  
Inclusion Criteria ◽  
Sinus Floor Elevation ◽  
Ridge Height ◽  
Significant Difference ◽  
Sinus Floor ◽  
Pulp Vitality

The aim of the present study was to evaluate the pulpal and periapical status of vital teeth within the area of a lateral sinus floor elevation (LSFE). The files of patients treated by LSFE between 2009 and 2015 were retrospectively evaluated. The radiographic bone measurements and the periapical status of the teeth adjacent to the LSFE area were evaluated preoperatively and 6 months following the surgery by CBCT. The pulpal status of the adjacent teeth was clinically evaluated using thermal pulp vitality testing. Vital teeth within the sinus floor elevation area were the main inclusion criteria for this study. A total of 158 LSFE procedures were evaluated; 18 cases fulfilled the inclusion criteria, and 20 adjacent teeth were vital. There were no cases of periapical pathology or loss of pulp vitality. There was a statistically significant difference in the ridge height between the baseline and 6 months postoperatively and in the distance from the apex to the sinus floor between pre- and 6 months postoperatively (p < 0.01).The pulpal and periapical status of vital teeth was not affected following LSFE.

scholarly journals Peri-implant tissue conditions following transcrestal and lateral sinus floor elevation: 3-year results of a bi-center, randomized trial

2022 ◽  
Author(s):  
Roberto Farina ◽  
Anna Simonelli ◽  
Giovanni Franceschetti ◽  
Luigi Minenna ◽  
Gian Pietro Schincaglia ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Direct Contact ◽  
Lateral Sinus ◽  
Implant Survival ◽  
Implant Surface ◽  
Sinus Floor Elevation ◽  
Post Surgery ◽  
Posterior Maxilla ◽  
Sinus Floor

Abstract Objectives The present study was performed to comparatively evaluate the peri-implant bone stability and conditions of marginal tissues at 3 years following transcrestal and lateral sinus floor elevation (tSFE and lSFE, respectively). Materials and methods Patients included in a parallel-arm randomized trial comparatively evaluating tSFE and lSFE were recalled at 3 years post-surgery. Twenty-one and 24 patients in tSFE and lSFE groups, respectively, participated in the follow-up visit. Peri-implant bone support was evaluated as the proportion of the entire implant surface in direct contact with the radiopaque area (totCON%) on 3-year periapical radiographs. The conditions of the marginal peri-implant tissues at 3-year visit were classified as peri-implant health, peri-implant mucositis, or peri-implantitis. Results At 3 years, both groups showed an implant survival rate of 100%. Median totCON% was stable at 3 years, being 100% in both groups (p = 0.124). Peri-implant health and mucositis were diagnosed in 10 (47.6%) and 11 (52.4%) patients, respectively, in the tSFE group, and in 8 (33.3%) and 16 (66.7%) subjects, respectively, in the lSFE group (p = 0.502). Conclusions At 3 years following surgery, implants placed concomitantly with tSFE and lSFE fully maintain peri-implant bone support. Peri-implant mucositis was the most prevalent condition, with a similar prevalence between groups. Clinical relevance. Based on 3-year data on peri-implant bone support and prevalence of peri-implant diseases, the study suggests that tSFE and lSFE represent two equally valid options for the rehabilitation of the posterior maxilla. ClinicalTrials.gov ID: NCT02415946.

The Incidence of Maxillary Sinus Membrane Perforation During Endoscopically Assessed Crestal Sinus Floor Elevation: A Pilot Study

2012 ◽  
Vol 38 (4) ◽  
pp. 345-359 ◽  
Author(s):  
Antoanela Garbacea ◽  
Jaime L Lozada ◽  
Christopher A. Church ◽  
Aladdin J. Al-Ardah ◽  
Kristin A. Seiberling ◽  
...  
Keyword(s):  
Pilot Study ◽  
Maxillary Sinus ◽  
Surgical Procedure ◽  
Surgical Techniques ◽  
Graft Material ◽  
Sinus Floor Elevation ◽  
Membrane Perforation ◽  
Sinus Floor ◽  
Sinus Membrane Elevation ◽  
Sinus Membrane

Transcrestal sinus membrane elevation is a surgical procedure performed to increase the bone volume in the maxillary sinus cavity. Because of visual limitations, the potential for maxillary sinus membrane perforations may be greater than with the lateral approach technique. The aim of this study was to macroscopically investigate ex vivo the occurrence of sinus membrane perforation during surgery using 3 transcrestal sinus floor elevation methods. Twenty fresh human cadaver heads, with 40 intact sinuses, were used for simultaneous sinus membrane elevation, placement of graft material, and dental implants. Real-time sinus endoscopy, periapical digital radiographs, and cone-beam computerized tomography (CBCT) images were subsequently used to evaluate the outcome of each surgical procedure. Perforation rates for each of the 3 techniques were then compared using a significance level of P &lt; .05. No statistically significant differences in the perforation rate (P = .79) were found among the 3 surgical techniques. Although the sinus endoscope noted a higher frequency of perforations at the time of implant placement as compared with instrumentation or graft insertion, the difference was not statistically significant (P = .04). The CBCT readings were judged to be more accurate for identifying evidence of sinus perforations than the periapical radiographs when compared with the direct visualization with the endoscope. This pilot study demonstrated that a sinus membrane perforation can occur at any time during the sinus lift procedure, independent of the surgical method used.

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