Palatal window osteotomy technique improves maxillary sinus augmentation in previously insufficient augmentation case

International Journal of Implant Dentistry, Jul 2015

Introduction Perforation of the Schneiderian membrane is the most common complication in sinus floor augmentation (SFA). When volume of grafting is qualified to prevent enlargement of the membrane perforation, lack of bone volume may occur in optimal site. Case presentation SFA was performed in sites #24 to 26 in a 63-year-old male. However, a 10-mm size perforation of the Schneiderian membrane occurred in site #26. Although the sinus cavity was grafted with deproteinized bovine bone mineral (DBBM) after repair of membrane perforation, insufficient bone formation was observed on palatal and distal aspects of site #26 at 5 months after SFA. Although additional SFA was required for implant placement, it seemed to be difficult to elevate the membrane by a conventional lateral approach in the palatal aspect of the sinus floor (site #26). Considering the configuration of new bone formation, it was decided to perform the palatal antrostomy approach. The Schneiderian membrane was elevated without perforation, and the sinus cavity was grafted with DBBM mixed with venous blood. Two 12-mm long, 4.1-mm diameter implants were placed in sites #14 and 16. Four months after implant placement, abutment-connection surgery was successfully performed. The radiographic image indicated improved radiopacity, without obvious bone resorption in site #26. Conclusion The palatal window osteotomy technique could be considered as an alternative method for augmentation of maxillary sinus in cases where difficulty is encountered to elevate a membrane by a conventional approach (e.g., in cases in which buccal bone height is long).

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Palatal window osteotomy technique improves maxillary sinus augmentation in previously insufficient augmentation case

Ueno et al. International Journal of Implant Dentistry Palatal window osteotomy technique improves maxillary sinus augmentation in previously insufficient augmentation case Daisuke Ueno 0 3 Takashi Kurokawa 2 3 Katsuichiro Maruo 1 3 Tsuneaki Watanabe 2 3 Jayanetti Asiri Jayawardena 3 4 0 Department of Implantology and Periodontology, Kanagawa Dental University, Graduate School of Dentistry , 3-31-6 Tsuruya-cho, Kanagawa-ku, Yokohama , Japan 1 Department of Removal Prosthodontics, Kanagawa Dental University, Graduate School of Dentistry , Yokosuka , Japan 2 Unit of Oral and Maxillofacial Implantology, Tsurumi University Dental Hospital , Yokohama , Japan 3 Authors' information DU is a senior assistant professor of the Department of Implantology and Periodontology, Kanagawa Dental University, Graduate School of Dentistry , Yokohama , Japan. TK and TW are clinical research associates of the Unit of Oral and Maxillofacial Implantology, Tsurumi University Dental Hospital , Yokohama , Japan. K.M. is an assistant professor of the Department of Removable Prosthodontics, Kanagawa Dental University, Graduate School of Dentistry , Yokosuka , Japan. JAJ is an assistant professor of the Department of General Education, Tsurumi University, School of Dental Medicine 4 Department of General Education, Tsurumi University, School of Dental Medicine , Yokohama , Japan Introduction: Perforation of the Schneiderian membrane is the most common complication in sinus floor augmentation (SFA). When volume of grafting is qualified to prevent enlargement of the membrane perforation, lack of bone volume may occur in optimal site. Case presentation: SFA was performed in sites #24 to 26 in a 63-year-old male. However, a 10-mm size perforation of the Schneiderian membrane occurred in site #26. Although the sinus cavity was grafted with deproteinized bovine bone mineral (DBBM) after repair of membrane perforation, insufficient bone formation was observed on palatal and distal aspects of site #26 at 5 months after SFA. Although additional SFA was required for implant placement, it seemed to be difficult to elevate the membrane by a conventional lateral approach in the palatal aspect of the sinus floor (site #26). Considering the configuration of new bone formation, it was decided to perform the palatal antrostomy approach. The Schneiderian membrane was elevated without perforation, and the sinus cavity was grafted with DBBM mixed with venous blood. Two 12-mm long, 4.1-mm diameter implants were placed in sites #14 and 16. Four months after implant placement, abutment-connection surgery was successfully performed. The radiographic image indicated improved radiopacity, without obvious bone resorption in site #26. Conclusion: The palatal window osteotomy technique could be considered as an alternative method for augmentation of maxillary sinus in cases where difficulty is encountered to elevate a membrane by a conventional approach (e.g., in cases in which buccal bone height is long). Sinus floor augmentation; Dental implants; Surgical technique; Palatal osteotomy Introduction Sinus floor augmentation (SFA) is the most common technique to obtain bone height for implant placement in posterior maxilla. The most common method is the classical lateral antrostomy approach; After raising a full-thickness flap on the buccal side of the alveolar ridge, a trap door is created by a round bur [ 1 ]. The sinus membrane is dissected, and the trap door is rotated medially to push the Schneiderian membrane apically. Then the graft material is placed on the sinus floor. Although a conventional lateral window technique is known to be very predictable with good long-term success, only few reports have been introduced to evaluate the palatal antrostomy approach [ 2, 3 ]. The authors reported slight usability such as postoperative comfort compared to conventional buccal antrostomy approach [3]. This case demonstrates significant bone augmentation using a palatal antrostomy technique in the palatal aspect of the sinus floor which makes it difficult to elevate the Schneiderian membrane by a conventional approach. Clinical report A 63-year-old male patient was introduced to the Unit of Oral and Maxillofacial Implantology, Tsurumi University Dental Hospital for implant treatment in April 2013 (Fig. 1). Since vertical bone heights in sites # 24 (4 mm) and 26 (less than 1 mm) were not enough for implant placement, SFA was performed prior to implant placement. However, a 10-mm size perforation of the Schneiderian membrane occurred in site #26 during sinus floor elevation. The membrane perforation was covered with a sheet-like collagen sponge1. Then, the sinus cavity was grafted with deproteinized bovine bone mineral (DBBM)2 mixed with venous blood [ 4 ]. Use of DBBM was approved by the ethical committee of Tsurumi University. Nevertheless, volume of grafting in the posterior area was qualified to prevent enlargement of the membrane perforation. Site #24 wa (...truncated)


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Daisuke Ueno, Takashi Kurokawa, Katsuichiro Maruo, Tsuneaki Watanabe, Jayanetti Asiri Jayawardena. Palatal window osteotomy technique improves maxillary sinus augmentation in previously insufficient augmentation case, International Journal of Implant Dentistry, 2015, pp. 19, Volume 1, Issue 1, DOI: 10.1186/s40729-015-0018-y