• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제29권3호
• /
• pp.241-249
• /
• 2007

An augmentation of the maxillary sinus floor facilitates placement of dental implants in the posterior atrophic maxilla. However, a maxillary sinus augmentation has potential complications that can lead to early failure and loss of the bone graft. One specific complication is sinus membrane perforation. Especially, large perforations may cause loss of the graft materials into the sinus and infection, so, early failure of the sinus lift. Attempts at managing sinus membrane perforations are difficult because of the limited access to them and friability of the thin Schneiderian membrane. Repair of sinus membrane perforations intraoperatively may be performed using a variety of techniques and materials, including sutures, collagen membranes, fibrin glue. Inspite of various repair technique, as has been reported extensively in the literature, large perforations represent an absolute contraindication to the continuation of surgery. But, we obtained clinically favorable results in cases that show repair of the perforated sinus membrane with a micro-suture technique by 4X Loupe ($Surgitel^{(R)}$ Loupe, General Scientific Corporation) in large perforation. The objective of this presentation is to report of several cases of repair of the perforated sinus membrane with micro-suture technique using 7.0 or 8.0 suture materials, to make a brief review of the literature about various technique managing perforated sinus membrane.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제30권5호
• /
• pp.428-433
• /
• 2004

Sinus floor augmentation has been proven an effective treatment procedure to increase bone volume in the posterior edentulous maxilla. Autogenous bone considered to be the best material for reconstructive bone surgery and has been successfully used as a graft material to augment posterior maxilla. However, the collection of autogenous bone required extra risks for morbidity and complaints. So, various bone graft materials included ${\beta}$-tricalcium phosphate(${\beta}$-TCP) has been introduced for replacing the autogenous bone. The objective of this clinical study was to determine the predictability of endosseous implant placed in a maxillary sinus with ${\beta}$-TCP grafting. We performed sinus elevation with ${\beta}$-TCP to install the implant in the 10 maxillary cases. The prosthetic procedure was performed 6-9 months after. The implant-prosthetics was checked about 1 year. We checked the implant and measured the maximum bite force to evaluate the function of the implant. There was not observed the specific problem and complication in dental implant and maxillary sinus in the grafted materials. The maximum bite force was 558N in case of natural tooth, 365N in implant without grafting, 318N in implant with ${\beta}$-TCP grafting. There was no significant difference between with and without sinus grafting on maximum bite force(p>0.05). As though the long term check-up is needed, the grafting of ${\beta}$-TCP as a osteoconductive materials can expand the volume and induce dense new bone formation in maxillary sinus. So, this short-term results support that ${\beta}$-TCP can be a suitable material for sinus augmentation.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제40권1호
• /
• pp.17-20
• /
• 2014

Objectives: The aim of this study was to retrospectively evaluate the clinical survival rate of Astra Tech implants in the maxillary molar region performed with sinus lift and bone graft. Materials and Methods: Ninety-nine Astra Tech implants (Osseospeed) placed in the maxillary molar region using sinus lift from September 2009 to February 2012 were selected with a minimum follow-up period of 1 year. The height of alveolar bone, sinus approach technique, bone material and implant survival rate were evaluated. Results: Of the 99 implants, the survival rate was 90.9%; 8 implants failed within 1 year after implant placement, and 1 implant failed 1 year after implant loading. All failed implants were placed with sinus lift simultaneously. The average height of alveolar bone before implant placement was 6.9 mm, while the height of alveolar bone of failed implants was 2.1 mm, on average. Conclusion: Astra Tech implants placed in the maxillary molar region had generally good survival rates, but the relationship between reduced pre-implant alveolar bone height and implant failure requires further attention.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제41권5호
• /
• pp.284-289
• /
• 2015

In cases of severe alveolar bone atrophy in the posterior maxillary area, which has only a thin sinus floor, the autogenous tooth bone graft block (ABTB) was used to wrap the implant to enhance its primary stability and osseointegration in the sinus. These cases with four years of clinical follow-up demonstrate the applicability of the ABTB in maxillary sinus membrane elevation to improve the outcomes of implant placement.

• Journal of Periodontal and Implant Science
• /
• 제49권4호
• /
• pp.237-247
• /
• 2019

Purpose: To analyze the maxillary sinus anatomy over edentulous ridges in the bilateral posterior maxillary area in Taiwanese patients using cone-beam computed tomography (CBCT). Methods: In total, 101 anatomical sites from 61 patients, including 32 premolar and 69 molar regions, were analyzed using CBCT. Measurements were made of the width and height of edentulous ridges, the thickness of the lateral wall of the maxillary sinus, and the presence of a sinus septum and the posterior superior alveolar artery (PSAA). A statistical analysis of the measurements was performed, and correlations among the measurements were assessed. Results: The average ridge width was $10.26{\pm}3.16mm$, with a significantly greater ridge width in the second molar region than in the premolar region. The mean residual ridge height was $8.55{\pm}4.09mm$, and ridge height showed an opposite trend from ridge width for the premolar and molar regions. A sinus septum was present at 5.9% of the sites, and the PSAA was observed in 24.5%. The average thickness of the lateral wall of the maxillary sinus was $2.08{\pm}0.94mm$, with no significant difference between the tooth position and lateral wall thickness. Conclusions: This study presents the anatomical features of the maxillary sinus, which should be considered in sinus lift procedures for implant placement, in the Taiwanese population. The use of CBCT is recommended to avoid intraoperative complications.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제35권2호
• /
• pp.88-93
• /
• 2013

Purpose: Maxillary sinus elevation has been widely used to enable insertion of endosseous implants in severely resorbed maxilla. Maxillary sinusitis after this procedure was considered to be the major drawback, therefore, preoperative evaluation of paranasal sinus is considered to be important. In order to evaluate the condition of the sinus, we used Waters' projection. In this study, asymptomatic patients were evaluated by Waters' view, and compared to timing to assess the sinus cavity. Methods: The retrospective study was based on 14 patients who were performed sinus elevation surgery in Seoul National University Dental Hospital. These patients did not show any signs of maxillary sinusitis. These patients were taken Waters' view at preoperative, postoperative 1 day, 3 months, 6 months. In Waters' view, presence of air fluid level, radiopacity of sinus wall, or radiopacity of entire maxillary sinus were evaluated. The density, and sinus dimension changes were assessed using Adobe Photoshop CS5$^{(R)}$ (Adobe Systems Inc., San Jose, CA, USA). Results: Findings of Waters views in patients with clear maxillary sinus at preoperative time were followed by elevated sinus floor with transplanted bone, mucosal swelling, and air fluid level. At postoperative 3 months, and 6 months, the radiographic findings were similar to preoperative state. By contrast, patients with preoperative mucosal swelling, or haziness in sinus cavity showed radiopacity entire sinus in Waters' view. In cases of the patients who were treated with simultaneous treatment to mucosal swelling, good status of sinus cavity were found. Conclusion: Although Waters' projections provide the limited information, and is less sensitive method compared with computed tomography, it is simple, easy, and economical method to assess of maxillary sinus. We suggest using Waters' view as radiographic routine tool for evaluation of sinus condition, especially in the sinus elevation surgery.

• 대한치과의사협회지
• /
• 제45권8호통권459호
• /
• pp.491-499
• /
• 2007

Deproteinized bovine bone mineral has been widely used as graft material in sinus augmentation procedure. The efficacy of OCS-B(r)(Nibec Inc., Seoul, Korea) as a graft material for sinus augmentaion was evaluated in 10 patients. A total of 13 sinus augmentation procedures were performed, and an average of 6.3 months later 27 implants were placed into the augmentation sinuses. The biopsy specimens were examined histologically and hitomorphometrically. Radiographical evaluation was done also. The average distance form grafted sinus to implant apex at the final evaluation period was $5.7\pm3.1$mm. The average percentage of newly formed bone at an average of 6.3 months was $20.0\pm8.4%$. The degree of bone to graft material contact was $18.7\pm6.4%$. It was shown from both radiographic evaluation and histologic results that sinus augmentation can successfully be performed with $\OCS-B^textcircledR$.

• Journal of Periodontal and Implant Science
• /
• 제40권6호
• /
• pp.271-275
• /
• 2010

Purpose: Many techniques have been described for achieving vertical augmentation of the maxillary sinus. The aim of this study is to evaluate the effect of low-intensity pulsed ultrasound (LIPUS) to enhance bone regeneration after sinus floor elevation. Methods: The sinus lifting technique was performed through a lateral approach on 8 different sites of 5 patients (3 males and 2 females) and their mean age was 45.7 years old. The sites were randomly assigned to the control or test groups. The control group had 4 sites that received lateral sinus lifting procedure only, while the test group had 4 sites that received LIPUS application after the lateral sinus lifting procedure. 24-32 weeks (an average of 29 weeks) postoperatively, new bone formation in the augmented sinus sites was evaluated through histologic and histomorphometric analyses of the biopsy specimens obtained during implant placement. Results: In the test group, the mean percentage of newly formed bone was $19.0{\pm}2.8$%. In the control group, the mean percentage of newly formed bone was $15.2{\pm}3.1$%. The percentage of newly formed bone was approximately 4% higher in those cases where the sinus was treated by LIPUS than the percentage in those cases where it was not used. The difference was statistically significant. Conclusions: Within the scope of this study, low-intensity pulsed ultrasound application after sinus lifting appeared to have a significant effect on the development of new bone formation.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제39권6호
• /
• pp.274-282
• /
• 2013

Objectives: The posterior maxillary region often provides a limited bone volume for dental implants. Maxillary sinus elevation via inserting a bone graft through a window opened in the lateral sinus wall has become the most common surgical procedure for increasing the alveolar bone height in place of dental implants in the posterior maxillary region. The purpose of this article is to assess the change of bone volume and the clinical effects of dental implant placement in sites with maxillary sinus floor elevation and autogenous bone graft through the lateral window approach. Materials and Methods: In this article, the analysis data were collected from 64 dental implants that were placed in 24 patients with 29 lacks of the bone volume posterior maxillary region from June 2004 to April 2011, at the Department of Oral and Maxillofacial Surgery, Inha University Hospital. Panoramic views were taken before the surgery, after the surgery, 6 months after the surgery, and at the time of the final follow-up. The influence of the factors on the grafted bone material resorption rate was evaluated according to the patient characteristics (age and gender), graft material, implant installation stage, implant size, implant placement region, local infection, surgical complication, and residual alveolar bone height. Results: The bone graft resorption rate of male patients at the final follow-up was significantly higher than the rate of female patients. The single autogenous bone-grafted site was significantly more resorbed than the autogenous bone combined with the Bio-Oss grafted site. The implant installation stage and residual alveolar height showed a significant correlation with the resorption rate of maxillary sinus bone graft material. The success rate and survival rate of the implant were 92.2% and 100%, respectively. Conclusion: Maxillary sinus elevation procedure with autogenous bone graft or autogenous bone in combination with Bio-Oss is a predictable treatment method for implant rehabilitation.

• 대한치과의사협회지
• /
• 제56권3호
• /
• pp.142-150
• /
• 2018

In the posterior maxillary area, due to resorption of the ridge after extraction and pneumatization of the maxillary sinus, the height of the alveolar ridge may not be sufficient for placement of implants. To solve this problem, sinus augmentation using both crestal and lateral approaches have been widely used. Jung et al. (2010) introduced the modified lateral approach technique, which is a simplified technique that combines the advantages of crestal and lateral approaches. The purpose of this case report is to report two cases in the posterior maxilla in which simultaneous implant placement with maxillary sinus augmentation has been performed using the modified lateral approach technique. In two female patients, 67 and 74 years old, respectively, simultaneous implant placement was performed using the modified lateral approach technique on the left maxillary second premolar and the first molar. In both patients, the residual bone height on the distal side of the maxillary second premolar was measured to be approximately 5 mm, and the residual bone height of the first molar was measured to be 2-3 mm. After flap elevation, osteotomy of the lateral window was performed in the form of a mesiodistally extended slot above the sinus floor and the Schneiderian membrane was elevated. Sequenced drilling was performed while protecting the membrane with a periosteal elevator. Bone graft and implant placement was performed after preparation of the implant site. Sufficient primary stability was achieved for each implant and sinus membrane was not perforated. After four and five months respectively, implant second surgery was performed. Clinically, the implants were observed to be stable. Implants and surrounding peri-implant mucosa were well maintained after prosthodontic treatment. In conclusion, the modified lateral approach could be a predictable and efficient technique for implant placement in the atrophied posterior maxilla.