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Patients and methods : Crestal endoscopic approach for evaluating sinus membrane elevation technique [2]

Patients and methods : Crestal endoscopic approach for evaluating sinus membrane elevation technique [2]

author: Samy Elian, Khaled Barakat | publisher: drg. Andreas Tjandra, Sp. Perio, FISID

After completing the elevation of the Schneiderian membrane, the endoscope (70° lens) was removed from the lateral wall of the maxillary sinus and re-inserted (with 0°) from the crestal osteotomy site of the implant (Fig. 4) to check the integrity of the Schneiderian membrane, as well as to ensure the absence of any undetected minor perforation (Fig. 5). The implant was finally inserted in the osteotomy site to gradually lift the membrane under total endoscopic guidance from the same lateral sinus trephined hole to ensure again unperforated sinus lining from the lifting procedure during implant insertion. Afterwards, the endoscope was removed from the lateral sinus hole, and the small trephined part of bone was placed back to its original place in the buccal wall and soft tissue closed with interrupted sutures.

The sinus membrane patterns were classified into three types: flat, irregular and polyp. The membrane thickness was measured preoperatively using CBCT. The mean thickness was measured at the proposed implant osteotomy site. Patients were divided into two groups according to membrane thickness (Table 1):

Group A (4 cases): includes membrane thickness less than 2 mm

Group B (8 cases): includes membrane thickness more than 2 mm

Mucosal thickening was classified according to the criteria adopted from Soikkonen and Ainamo as follows [11]:

Flat: shallow thickening without well-defined outlines.

Semi-aspherical: thickening with well-defined outlines rising in angle of > 30° from the floor or the walls of the sinus.

Mucocele-like: complete opacification of the sinus.

Other mucosal thickening types or pathological findings.

Perforation occurrence was clinically monitored and recorded using the endoscopic evaluation through crestal osteotomy site. As it is a new method, we confirmed the evaluation endoscopically through a small trephined hole in the lateral sinus wall. Perforation occurrence was statistically compared to membrane thickness and type using pair-wise test, whereas Mann-Whitney U test was used for comparison between membrane thickness of different morphologies (Figs. 6 and 7). Chi-square was also used to show perforation rate among different groups and different morphologies.

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