Fig. 6. The hydraulic lifter stabilized in the osteotomy before injecting the saline
Fig. 6. The hydraulic lifter stabilized in the osteotomy before injecting the saline
Fig. 5. se conical shape. b The hydraulic lifter
Fig. 5. a The CAS drill has four blades and an inverse conical shape. b The hydraulic lifter
Fig. 4. The inflated balloon while elevating the sinus membrane (The balloon is seen from the medial.)
Fig. 4. The inflated balloon while elevating the sinus membrane (The balloon is seen from the medial.)
Fig. 3.
Fig. 3. a The balloon in a resting position. b The inflated balloon [12]
Fig. 2. The exposed mesial aspect of the sinus
Fig. 2. The exposed mesial aspect of the sinus
Fig. 1. Determination of the remaining bone height (RBH) on the CBCT image
Fig. 1. Determination of the remaining bone height (RBH) on the CBCT image
Methods
BAOFSE
BALLOON
CAS kit
Number of cases
12
12
...
BAOSFE
BALLOON
CAS kit
Total
Stats
p value
Occurrence of perforation
...
Yassin Alsabbagh, A., Alsabbagh, M.M., Darjazini Nahas, B. et al. Comparison of three different methods of internal sinus lifting for elevation heights of 7 mm: an ex vivo study.
Int J Implant Dent 3, 40 (2017). https://doi.org/10.1186/s40729-017-0103-5
Download citation
Received: 13 March 2017
Accepted: 29 August 2017
Published: 04 September 2017
DOI: https://doi.org/10...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Aghiad Yassin Alsabbagh, Mohammed Monzer Alsabbagh, Batol Darjazini Nahas, and Salam Rajih declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Department of Periodontology, Damascus University Dental School, Damascus, Syrian Arab Republic
Aghiad Yassin Alsabbagh & Mohammed Monzer Alsabbagh
Department of Orthodontics, Damascus University Dental School, Damascus, Syrian Arab Republic
Batol Darjazini Nahas
Temple university, Philadelphia, USA
Salam Rajih
You can also search for this author in
PubMed Google ...
Toffler M, Toscano N, Holtzclaw D. Osteotome-mediated sinus floor elevation using only platelet-rich fibrin: an early report on 110 patients. Implant Dent. 2010;19(5):447–56.
Download references
Zitzmann NU, Scharer P. Sinus elevation procedures in the resorbed posterior maxilla. Comparison of the crestal and lateral approaches. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85(1):8–17.
Esposito M, Felice P, Worthington HV. Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus. The Cochrane database of systematic reviews 2014(5):CD008397.
Sc...
Seong WJ, Barczak M, Jung J, Basu S, Olin PS, Conrad HJ. Prevalence of sinus augmentation associated with maxillary posterior implants. The Journal of oral implantology. 2013;39(6):680–8.
Cawood JI, Howell RA. A classification of the edentulous jaws. Int J Oral Maxillofac Surg. 1988;17(4):232–6.
Tan WC, Lang NP, Zwahlen M, Pjetursson BE. A systematic review of the success of sinus floor elev...
An amendment to this paper has been published and can be accessed via the original article.
Within the limitation of this study and that of an ex vivo study, we can accept our hypotheses that the balloon is better than the BAOSFE in elevating the membrane mucosa and the CAS kit is better than the BAOSFE in preparing the osteotomy and breaking the sinus floor for elevation heights of 7 mm. Further, in vivo studies need to be taken to prove these findings.
The BAOSFE technique caused perforations in the membrane in 7 out of 12 cases with a percentage of 58.4. This result is consistent with many previous studies which state that this technique has a high rate of perforations when the RBH is less than 5 mm [2, 7, 26]. Also, all the perforations happened during the elevation process; however, this percentage is different than that reported by Steltzle...
Using a reamer instead of the osteotomes for breaking the sinus floor has the advantage of creating a thin bone shell that prevents direct contact between the drill and the Schneiderian membrane [24]. Moreover, using a reamer has been shown to cause less discomfort and nausea when compared to the osteotome technique as a result of the constant tapping of the osteotomes [25]. As a result, the CAS k...
Although the lateral sinus floor elevation is a proven clinically successful technique [14], the indirect SFE approach is favorable among clinicians because it does not require a second surgery site and hence cause less trauma and discomfort for the patient [14,15,16]. However, this method has its drawbacks, such as a higher risk of membrane perforation, a decreased space for using surgical instru...
For the entire sample, the mean perforation length was (0.711 mm, SD = 1.4) and the mean time required to perform the procedure was (5.65 min, SD = 2.26), and out of the entire sample (N = 36), perforations happened in nine cases for a percentage of 25%.
Chi-square test showed a significant association between method used and the occurrence of perforation (chi-square statistic = 8.585, ...
This approach starts like BAOSFE. The osteotomy is enlarged to 5.0 mm before the balloon (Zimmer Sinus Lift Balloon, Zimmer Dental Inc., California, USA) is inserted (Fig. 3). The sinus floor was broken with the 5 mm osteotome after the addition of bone. The sleeve of the balloon was inserted 1 mm beyond the sinus floor. The saline was injected slowly from the syringe into the balloon, so the ...
To achieve our purposes, an experimental ex vivo study was carried. This research project was approved by the University of Damascus Local Research Ethics Committee (UDDS-3045PG.) and was funded by the Damascus University Postgraduate Research Budget (97687027834DEN). The sinus floor elevations were done on 18 bisected heads of lambs aged between 6 and 12 months that were slaughtered in a maximum...
Therefore, the two working hypotheses of our study were “the CAS-Kit is safer than BAOSFE in breaking the sinus floor and the balloon is safer than BAOSFE in elevating the Schneiderian membrane” for elevation heights of 7 mm.
More than half of the implants placed in the posterior maxilla require sinus floor elevation (SFE) [1]. The need for this procedure is explained by continuous ridge resorption in an apical direction after tooth extraction combined with progressive sinus pneumatization in addition to poor bone quality that is frequently seen in the maxilla [2].
Sinus membrane perforation is considered the most com...
Various techniques are available for elevating the sinus membrane. The aim of this study is to evaluate three methods of indirect sinus floor elevation regarding elevation heights of 7 mm on the outcomes of membrane perforation, length of perforation, and time required to perform the procedure.
Three different methods for indirect sinus lifting, bone added osteotome sinus floor elevation (BAOS...
Fig. 6. The hydraulic lifter stabilized in the osteotomy before injecting the saline
Fig. 6. The hydraulic lifter stabilized in the osteotomy before injecting the saline
Fig. 5.
Fig. 5. a The CAS drill has four blades and an inverse conical shape. b The hydraulic lifter
Fig. 4. The inflated balloon while elevating the sinus membrane (The balloon is seen from the medial.)
Fig. 4. The inflated balloon while elevating the sinus membrane (The balloon is seen from the medial.)
Fig. 3. 12]
Fig. 3. a The balloon in a resting position. b The inflated balloon [12]
Fig. 2. The exposed mesial aspect of the sinus
Fig. 2. The exposed mesial aspect of the sinus
Fig. 1. Determination of the remaining bone height (RBH) on the CBCT image
Fig. 1. Determination of the remaining bone height (RBH) on the CBCT image
Methods
BAOFSE
BALLOON
CAS kit
Number of cases
12
12
...
BAOSFE
BALLOON
CAS kit
Total
Stats
p value
Occurrence of perforation
...
Yassin Alsabbagh, A., Alsabbagh, M.M., Darjazini Nahas, B. et al. Comparison of three different methods of internal sinus lifting for elevation heights of 7 mm: an ex vivo study.
Int J Implant Dent 3, 40 (2017). https://doi.org/10.1186/s40729-017-0103-5
Download citation
Received: 13 March 2017
Accepted: 29 August 2017
Published: 04 September 2017
DOI: https://doi.org/10...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Aghiad Yassin Alsabbagh, Mohammed Monzer Alsabbagh, Batol Darjazini Nahas, and Salam Rajih declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Department of Periodontology, Damascus University Dental School, Damascus, Syrian Arab Republic
Aghiad Yassin Alsabbagh & Mohammed Monzer Alsabbagh
Department of Orthodontics, Damascus University Dental School, Damascus, Syrian Arab Republic
Batol Darjazini Nahas
Temple university, Philadelphia, USA
Salam Rajih
You can also search for this author in
PubMed Google ...
Toffler M, Toscano N, Holtzclaw D. Osteotome-mediated sinus floor elevation using only platelet-rich fibrin: an early report on 110 patients. Implant Dent. 2010;19(5):447–56.
Download references
Zitzmann NU, Scharer P. Sinus elevation procedures in the resorbed posterior maxilla. Comparison of the crestal and lateral approaches. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85(1):8–17.
Esposito M, Felice P, Worthington HV. Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus. The Cochrane database of systematic reviews 2014(5):CD008397.
Sc...
Seong WJ, Barczak M, Jung J, Basu S, Olin PS, Conrad HJ. Prevalence of sinus augmentation associated with maxillary posterior implants. The Journal of oral implantology. 2013;39(6):680–8.
Cawood JI, Howell RA. A classification of the edentulous jaws. Int J Oral Maxillofac Surg. 1988;17(4):232–6.
Tan WC, Lang NP, Zwahlen M, Pjetursson BE. A systematic review of the success of sinus floor elev...
An amendment to this paper has been published and can be accessed via the original article.
Within the limitation of this study and that of an ex vivo study, we can accept our hypotheses that the balloon is better than the BAOSFE in elevating the membrane mucosa and the CAS kit is better than the BAOSFE in preparing the osteotomy and breaking the sinus floor for elevation heights of 7 mm. Further, in vivo studies need to be taken to prove these findings.
The BAOSFE technique caused perforations in the membrane in 7 out of 12 cases with a percentage of 58.4. This result is consistent with many previous studies which state that this technique has a high rate of perforations when the RBH is less than 5 mm [2, 7, 26]. Also, all the perforations happened during the elevation process; however, this percentage is different than that reported by Steltzle...
Using a reamer instead of the osteotomes for breaking the sinus floor has the advantage of creating a thin bone shell that prevents direct contact between the drill and the Schneiderian membrane [24]. Moreover, using a reamer has been shown to cause less discomfort and nausea when compared to the osteotome technique as a result of the constant tapping of the osteotomes [25]. As a result, the CAS k...
Although the lateral sinus floor elevation is a proven clinically successful technique [14], the indirect SFE approach is favorable among clinicians because it does not require a second surgery site and hence cause less trauma and discomfort for the patient [14,15,16]. However, this method has its drawbacks, such as a higher risk of membrane perforation, a decreased space for using surgical instru...
For the entire sample, the mean perforation length was (0.711 mm, SD = 1.4) and the mean time required to perform the procedure was (5.65 min, SD = 2.26), and out of the entire sample (N = 36), perforations happened in nine cases for a percentage of 25%.
Chi-square test showed a significant association between method used and the occurrence of perforation (chi-square statistic = 8.585, ...
This approach starts like BAOSFE. The osteotomy is enlarged to 5.0 mm before the balloon (Zimmer Sinus Lift Balloon, Zimmer Dental Inc., California, USA) is inserted (Fig. 3). The sinus floor was broken with the 5 mm osteotome after the addition of bone. The sleeve of the balloon was inserted 1 mm beyond the sinus floor. The saline was injected slowly from the syringe into the balloon, so the ...
To achieve our purposes, an experimental ex vivo study was carried. This research project was approved by the University of Damascus Local Research Ethics Committee (UDDS-3045PG.) and was funded by the Damascus University Postgraduate Research Budget (97687027834DEN). The sinus floor elevations were done on 18 bisected heads of lambs aged between 6 and 12 months that were slaughtered in a maximum...
Therefore, the two working hypotheses of our study were “the CAS-Kit is safer than BAOSFE in breaking the sinus floor and the balloon is safer than BAOSFE in elevating the Schneiderian membrane” for elevation heights of 7 mm.
More than half of the implants placed in the posterior maxilla require sinus floor elevation (SFE) [1]. The need for this procedure is explained by continuous ridge resorption in an apical direction after tooth extraction combined with progressive sinus pneumatization in addition to poor bone quality that is frequently seen in the maxilla [2].
Sinus membrane perforation is considered the most com...
Various techniques are available for elevating the sinus membrane. The aim of this study is to evaluate three methods of indirect sinus floor elevation regarding elevation heights of 7 mm on the outcomes of membrane perforation, length of perforation, and time required to perform the procedure.
Three different methods for indirect sinus lifting, bone added osteotome sinus floor elevation (BAOS...
Fig. 3. Forest plot of random effects meta-analysis of the incidence of Schneiderian membrane perforation using piezoelectric devices. The weighted average for the incidence rate of Schneiderian membrane perforation was 8%
Fig. 3. Forest plot of random effects meta-analysis of the incidence of Schneiderian membrane perforation using piezoelectric devices. The weighted average for the incidenc...
Fig. 2. Forest plot of random effects meta-analysis of the incidence of Schneiderian membrane perforation using conventional rotative instruments. The weighted average for the incidence rate of Schneiderian membrane perforation was 24%
Fig. 2. Forest plot of random effects meta-analysis of the incidence of Schneiderian membrane perforation using conventional rotative instruments. The weighted...
Fig. 1. Result of the search strategy and included and excluded studies
Fig. 1. Result of the search strategy and included and excluded studies
Piezoelectric
Event rate
Lower limit
Upper limit
z value
p value
...
Conventional
Event rate
Lower limit
Upper limit
z value
p value
...
Jordi, C., Mukaddam, K., Lambrecht, J.T. et al. Membrane perforation rate in lateral maxillary sinus floor augmentation using conventional rotating instruments and piezoelectric device—a meta-analysis.
Int J Implant Dent 4, 3 (2018). https://doi.org/10.1186/s40729-017-0114-2
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Received: 28 September 2017
Accepted: 20 December 2017
Published: 29 January 20...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
The authors Jordi Corinne, Mukaddam Khaled, Lambrecht Jörg Thomas and Kühl Sebastian state that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Department of Oral Surgery, Oral Radiology and Oral Medicine, University Center for Dental Medicine, University of Basel, Basel, Switzerland
Corinne Jordi, Khaled Mukaddam, Jörg Thomas Lambrecht & Sebastian Kühl
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We would like to express our gratitude to Ms. Irene Mischak for the statistical support.
Delilbasi C, Gurler G. Comparison of piezosurgery and conventional rotative instruments in direct sinus lifting. Implant Dent. 2013;22(6):662–5.
Becker ST, Terheyden H, Steinriede A, Behrens E, Springer I, Wiltfang J. Prospective observation of 41 perforations of the Schneiderian membrane during sinus floor elevation. Clin Oral Implants Res. 2008;19(12):1285–9.
Hernandez-Alfaro F, Torradeflo...
Blus C, Szmukler-Moncler S, Salama M, Salama H, Garber D. Sinus bone grafting procedures using ultrasonic bone surgery: 5-year experience. Int J Periodontics Restorative Dent. 2008;28(3):221–9.
Cortes AR, Cortes DN, Arita ES. Effectiveness of piezoelectric surgery in preparing the lateral window for maxillary sinus augmentation in patients with sinus anatomical variations: a case series. Int J ...
Froum SJ, Khouly I, Favero G, Cho SC. Effect of maxillary sinus membrane perforation on vital bone formation and implant survival: a retrospective study. J Periodontol. 2013;84(8):1094–9.
Stricker A, Voss PJ, Gutwald R, Schramm A, Schmelzeisen R. Maxillary sinus floor augmentation with autogenous bone grafts to enable placement of SLA-surfaced implants: preliminary results after 15-40 months. C...
Wannfors K, Johansson B, Hallman M, Strandkvist T. A prospective randomized study of 1- and 2-stage sinus inlay bone grafts: 1-year follow-up. Int J Oral Maxillofac Implants. 2000;15(5):625–32.
Hallman M, Nordin T. Sinus floor augmentation with bovine hydroxyapatite mixed with fibrin glue and later placement of nonsubmerged implants: a retrospective study in 50 patients. Int J Oral Maxillofac I...
Tawil G, Mawla M. Sinus floor elevation using a bovine bone mineral (Bio-Oss) with or without the concomitant use of a bilayered collagen barrier (Bio-Gide): a clinical report of immediate and delayed implant placement. Int J Oral Maxillofac Implants. 2001;16(5):713–21.
Yilmaz HG, Tozum TF. Are gingival phenotype, residual ridge height, and membrane thickness critical for the perforation of max...
Geminiani A, Tsigarida A, Chochlidakis K, Papaspyridakos PV, Feng C, Ercoli C. A meta-analysis of complications during sinus augmentation procedure. Quintessence Int. 2017;48(3):231–40.
Esposito M, Felice P, Worthington HV. Interventions for replacing missing teeth: augmentation procedures of the maxillary sinus. Cochrane Database Syst Rev. 2014;5:CD008397.
Galindo-Moreno P, Avila G, Fernandez...
Tatum H. Maxillary and sinus implant reconstructions. Dent Clin N Am. 1986;30(2):207–29.
Boyne PJ, James RA. Grafting of the maxillary sinus floor with autogenous marrow and bone. J Oral Surg. 1980;38(8):613–6.
Khoury F. Augmentation of the sinus floor with mandibular bone block and simultaneous implantation: a 6-year clinical investigation. Int J Oral Maxillofac Implants. 1999;14(4):557–6...
The aim of the present study was to resume in a review the literature evaluating the incidence of sinus membrane perforation comparing conventional rotating instruments with piezoelectric devices. Since only scarce studies exist comparing both techniques directly, we decided to additionally include any study on MSA in which information on the applied technique, e.g. conventional or piezosurgery, w...
Atieh [11] found no significant difference in perforation risk. In these studies, occurred in the two groups of the RCTs are almost identical perforations. Maybe due to the fact that they included only one RS, while our study included 22, they see no deviation.
The review of Stacchi [12] also described a lower incidence of membrane perforation during piezosurgery (10.9%) than during conventional ...
Though both techniques exist more than 20 years, only single studies could be found in which the incidence of membrane perforation was focused comparing both operative techniques. This was the rationale for our meta-analysis. Principally, there is a controversy in the literature concerning the use of piezosurgical devices for MSA. Torrella et al. showed a reduced risk for perforations of the sinu...
Finally, a significance analysis was performed between both groups in terms of a t test. The significance level was set at p
The database PubMed and the US National Library of Medicine were screened from January 8, 2012, to January 6, 2016, for potential studies reporting on membrane perforations during MSA from 1980 till 2015. The search was conducted independently and in duplicate by two authors (MK and JC). The following search terms were used:
MeSH Terms:
Piezo-surgery
Ultrasound
Ultrasonic Osteotomy
Maxillary ...
Atieh et al. [11] examined the intra- and postoperative events associated with the use of piezoelectric devices and conventional rotary instruments for lateral MSA in a systematic review. They included four studies with 178 lateral MSA in 120 participants. The meta-analysis did not show any significant difference between the two surgical techniques. Stacchi et al. [12] analysed the occurrence of i...
Maxillary sinus augmentation (MSA) is a successful and predictable procedure to rehabilitate the atrophic edentulous posterior maxilla after postextractional pneumatisation of the sinus and bone loss with dental implants. Different approaches to elevate the maxillary sinus floor have been described and were originally introduced by Tatum [1, 2]. The lateral approach provides drilling a window in t...
Maxillary sinus augmentation (MSA) is a successful and predictable intervention with low complication rates. Perforations of the Schneiderian membrane may occur impairing the general success. The aim of this study was to compare the incidence of membrane perforations between conventional rotating instruments and piezoelectric devices in a meta-analysis.
An electronic research on MEDLINE and PubMe...
Fig. 5. Bone resorption in the follow-up of the control group and the perforation group
Fig. 5. Bone resorption in the follow-up of the control group and the perforation group
Fig. 4. The initial bone level of the control group and the perforation group
Fig. 4. The initial bone level of the control group and the perforation group
Fig. 3. Reasons for perforations
Fig. 3. Reasons for perforations
Fig. 2. Overview of the perforation treatment in the study group
Fig. 2. Overview of the perforation treatment in the study group
Fig. 1. Bone levels after sinus floor elevation
Fig. 1. Bone levels after sinus floor elevation
Peri-implantitis
No peri-implantitis
Perforation group
12
80
Control group
...
One-stage procedure
Two-stage procedure
Perforation group
11
81
Control group
...
Adjusted p values
multiple comparison
Control group
bone level 4 mm
0.0453
Control group
bone level > ...
Bone level preoperatively
Bone level postoperatively
Bone level follow-up
Bone resorption
Perforation group
...
Origin of bone graft
No bone graft
Linea obliqua
Iliac crest
Scapula flap
Perforation...
Implant position
3
4
5
6
7
8...
Beck-Broichsitter, B.E., Westhoff, D., Behrens, E. et al. Impact of surgical management in cases of intraoperative membrane perforation during a sinus lift procedure: a follow-up on bone graft stability and implant success.
Int J Implant Dent 4, 6 (2018). https://doi.org/10.1186/s40729-018-0116-8
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Received: 03 October 2017
Accepted: 03 January 2018
Publish...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
The authors Benedicta Beck-Broichsitter, Dorothea Westhoff, Eleonore Behrens, Jörg Wiltfang, and Stephan T. Becker declare that there are no existing competing interests concerning this collaborative work.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Correspondence to
Benedicta E. Beck-Broichsitter.
Department of Oral and Maxillofacial Surgery, Charité–University Medical Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
Benedicta E. Beck-Broichsitter
Department of Oral and Maxillofacial Surgery, Schleswig-Holstein University Hospital, Arnold-Heller-Straße 3, Haus 26, 24105, Kiel, Germany
Dorothea Westhoff, Eleonore Behrens, Jörg Wiltfang & Stephan T. Becker
You can al...
This study was not funded.
Shlomi B, Horowitz I, Kahn A, Dobriyan A, Chaushu G. The effect of sinus membrane perforation and repair with Lambone on the outcome of maxillary sinus floor augmentation: a radiographic assessment. Int J Oral Maxillofac Implants. 2004;19(4):559–62.
Moreno Vazquez JC, Gonzalez de Rivera AS, Gil HS, Mifsut RS. Complication rate in 200 consecutive sinus lift procedures: guidelines for prevention ...
Sakkas A, Konstantinidis I, Winter K, Schramm A, Wilde F. Effect of Schneiderian membrane perforation on sinus lift graft outcome using two different donor sites: a retrospective study of 105 maxillary sinus elevation procedures. GMS Interdiscip Plast Reconstr Surg DGPW. 2016;5:Doc11.
Springer IN, Terheyden H, Geiss S, Harle F, Hedderich J, Acil Y. Particulated bone grafts—effectiveness of bone...
Wiltfang J, Schultze-Mosgau S, Nkenke E, Thorwarth M, Neukam FW, Schlegel KA. Onlay augmentation versus sinuslift procedure in the treatment of the severely resorbed maxilla: a 5-year comparative longitudinal study. Int J Oral Maxillofac Surg. 2005;34(8):885–9.
Pikos MA. Maxillary sinus membrane repair: report of a technique for large perforations. Implant Dent. 1999;8(1):29–34.
Cha HS, Kim ...
In conclusion, and within the limits of its retrospective nature, our study implies that in cases of intraoperative perforation of the Schneiderian membrane, a consequent surgical assessment and treatment might avoid complications regarding graft stability and implant survival. Two-stage procedures might be appropriate if primary stability does not seem to be achievable. Augmentation of the sinus ...
The surgical management in cases of a membrane perforation might also influence the overall postoperative outcome and complications. Although the sinus lifting procedure has been established for many years now, there are no evidence-based guidelines for perforation closure or indications to interrupt the procedure. To date, most existing studies recommend sealing smaller sizes of perforations with...
One implant was lost in the perforation group due to early-onset peri-implantitis, whereas all implants in the control group were still in place. As we had previously prospectively reported on the first 6 months after dental implantation in this cohort [11], there was no further impact of membrane perforation on implant loss for at least 12 to 24 months in this retrospective evaluation. The appe...
The aim of this retrospective cohort study was to evaluate the impact of intraoperative perforations of the Schneiderian membrane during sinus floor elevation on the stability of the augmented area and its influence on osseointegration after implant insertion. Therefore, we could re-assess a patient cohort of originally 34 patients with 41 perforations and compare their outcome with a control grou...
The initial bone level differed significantly (p = 0.05) between both groups with a median value of 5.69 mm in the study group and 3.87 mm in the control group (Fig. 4). A Mann-Whitney-U-Wilcoxon test revealed no significant difference between bone level postoperatively (p = 0.7851; median value control group 17.40 mm; median value perforation group 16.91 mm), in follow-up (p = 0....
The mean control interval was 2.69 (± 2.03) years. At the time of the follow-up examination, the average age was 59.95 (± 11.82) years.
In the remaining collective of 31 patients (96.97%; 12 males (37.54%) and 19 females (59.43%)), a total of 92 implants were inserted. The overview of perforation treatment in the study group is given in Fig. 2, and Fig. 3 depicts the reasons for perforati...
One independent oral and maxillofacial surgeon performed the clinical follow-up examinations according to a standardized protocol. A peri-implant probing including probing pocket depths and recessions on four sites of each implant was assessed as was bleeding on probing (BOP) to determine the status of oral hygiene objectively. Signs of gingivitis and pus suppuration were also recorded. The criter...
Three different oral and maxillofacial surgeons performed the sinus lift procedure with an external approach according to comparable surgical standards and inserted all implants examined in this study in a submerged protocol with uncovering after 3–4 months due to the manufacturer’s surgical recommendations. Specifically, a total of 35 external sinus floor elevations were performed through a ...
In accordance with the WMA Declaration of Helsinki—Ethical Principles for Medical Research Involving Human Subjects, approval was given by the local ethics committee of the Christian-Albrechts-University in Kiel (AZ 132/10). All patients gave informed written consent to participate.
A total of 201 sinus floor elevation procedures, which were performed from 2005 to 2006 in the Department of Oral...
Sinus floor elevation procedures have become a predictable and successful treatment, performed when the maxillary alveolar ridge is atrophied and the bone height is not sufficient for primary implantation. If the postoperative course remains uneventful, the outcome is highly predictable [1,2,3]. However, complications may have a negative impact on the overall treatment success. As a common complic...
Until now, sinus floor elevation represents the gold standard procedure in the atrophic maxilla in order to facilitate dental implant insertion. Although the procedure remains highly predictive, the perforation of the Schneiderian membrane might compromise the stability of the augmented bone and implant success due to chronic sinus infection. The aim of this retrospective cohort study was to show ...
Fig. 7. Box and Whisker plot representing median and range values of membrane thicknesses with different morphologies
Fig. 7. Box and Whisker plot representing median and range values of membrane thicknesses with different morphologies
Fig. 6. Box plot representing mean values of membrane thicknesses for the investigated groups
Fig. 6. Box plot representing mean values of membrane thicknesses for the investigated groups
Fig. 5. Endoscopic view from the crestal osteotomy site showing perforation of the sinus lining under the power of magnification and illumination of the endoscope
Fig. 5. Endoscopic view from the crestal osteotomy site showing perforation of the sinus lining under the power of magnification and illumination of the endoscope
Fig. 4. Schematic drawing showing entrance of the endoscope from the crestal osteotomy site after sinus membrane elevation to assess the integrity of the membrane
Fig. 4. Schematic drawing showing entrance of the endoscope from the crestal osteotomy site after sinus membrane elevation to assess the integrity of the membrane
Fig. 3. Endoscopic view from the lateral sinus wall showing the dome-shape elevation of sinus lining
Fig. 3. Endoscopic view from the lateral sinus wall showing the dome-shape elevation of sinus lining
Fig. 2. Malleting instruments supplied from InnoBioSurg (IBS) Company, Korea. a magic sinus splitter: used to widen and split the crest. b magic sinus lifter: used to lift the available bone with its attached membrane
Fig. 2. Malleting instruments supplied from InnoBioSurg (IBS) Company, Korea. a magic sinus splitter: used to widen and split the crest. b magic sinus lifter: used to lift the a...
Fig. 1. A trephined hole (4 mm bone) in the lateral wall of the maxillary sinus to allow entrance of the endoscope
Fig. 1. A trephined hole (4 mm bone) in the lateral wall of the maxillary sinus to allow entrance of the endoscope
Morphology
No perforation
Perforation
P value
No. (%)
No. (%)
Flat (n = 4)
...
Morphology
Mean ± SD (mm)
Median (range)
P value
Perforation rate (%)
Flat (n = 4)
...
Group
No perforation
Perforation
P value
No. (%)
No. (%)
Group (A)
...
Group
Membrane thickness
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Elian, S., Barakat, K. Crestal endoscopic approach for evaluating sinus membrane elevation technique.
Int J Implant Dent 4, 15 (2018). https://doi.org/10.1186/s40729-018-0126-6
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Received: 08 November 2017
Accepted: 20 March 2018
Published: 17 May 2018
DOI: https://doi.org/10.1186/s40729-018-0126-6
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
Faculty of Dentistry, Minia University ethics committee approved the study. All patients gave the consent to participate in the surgery.
All patients approved for publications.
The authors Samy Elian and Khaled Barakat declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Faculty of Dentistry, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
Samy Elian
Faculty of Dental Surgery, Royal College of Physicians and Surgeons of Glasgow, Glasgow, Scotland
Samy Elian
Dentistry Department, Sohag University Hospital, Sohag, Egypt
Samy Elian
Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Minya University, Minya, Egypt
Khaled Barakat
You c...
We would like to express our gratitude to Ass. Prof. Hamed Gad for his clinical collaboration.
This research was carried out without funding.
The data supporting our findings can be requested for free at any time.
Berengo M, Sivolella S, Majzoub Z, Cordioli G. Endoscopic evaluation of the bone-added osteotome sinus floor elevation procedure. Int J Oral Maxillofac Surg. 2004;33(2):189–94.
Nkenke E, Schlegel A, Schultze-Mosgau S, Neukam FW, Wiltfang J. The endoscopically controlled osteotome sinus floor elevation: a preliminary prospective study. Int J Oral Maxillofac Implants. 2002;17(4):557–66.
Nahlie...
Summers RB. A new concept in maxillary implant surgery: the osteotome technique. Compendium. 1994;15(2):152. 54-6, 58 passim; quiz 62
Zitzmann NU, Scharer P. Sinus elevation procedures in the resorbed posterior maxilla. Comparison of the crestal and lateral approaches. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85(1):8–17.
Ardekian L, Oved-Peleg E, Mactei EE, Peled M. The clinical ...
Crestal sinus lifting technique is a simple less invasive procedure. Nevertheless, it suffers a serious disadvantage of being a blind technique. Thus, perforation can easily occur without being detected which will lead to later implant failure especially when bone graft is added [1, 12,13,14]. We used endoscopic-assisted evaluation as a dependable method to assess the safety of the Schneiderian me...
On the other hand, assessing the effect of membrane morphology pattern on the perforation risk revealed that the polyp type has the lowest risk of perforation, whereas the irregular type represents the most insecure pattern. There was a relation between different membrane morphology and perforation.
All patients tolerated the procedure without major complications. Minor complications included postoperative swelling, edema, and pain that were managed by antibiotic and anti-inflammatory drugs. All implants were successfully osseo-integrated and loaded after about 6 months.
The floor was lifted without perforation in 83.33% of cases. The lifter was able to raise and stretch the sinus membrane ...
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...
Twelve patients (4 males and 8 females) ranging in age from 25 to 60 years were included in the study. All patients have bone height ranging 3–5 mm below the sinus membrane. They all performed closed sinus lifting and simultaneous immediate implant insertion.
Under local anesthesia, the flap was elevated and retracted exposing the crestal and buccal bone. A trephine bur 4 mm diameter on hand...
The evolution of closed sinus lift techniques since 1994 [1] was proposed as a less invasive method for management of atrophic posterior maxillae [2]. However, it is a blind technique that lacks the ability to confirm an intact sinus floor elevation without perforation and thus represented a real shortcoming [3]. Various forms of osteotome lifters were designed to guarantee safe elevation of maxil...
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Fig. 3. Demonstration of the method used to measure the angle designated by the buccal and lingual walls of the sinus angle for each of the three fixed points in a given height
Fig. 3. Demonstration of the method used to measure the angle designated by the buccal and lingual walls of the sinus angle for each of the three fixed points in a given height
Fig. 2. Demonstration of the method used to measure the thickness of the Schneiderian membrane in the cross-sectional images for each of the three fixed points
Fig. 2. Demonstration of the method used to measure the thickness of the Schneiderian membrane in the cross-sectional images for each of the three fixed points
Fig. 1. Demonstration of the method used in the panoramic image to divide the sinus in four equal parts and find three fixed points for the measurements. Also, these fixed points in the horizontal plane with and without sections
Fig. 1. Demonstration of the method used in the panoramic image to divide the sinus in four equal parts and find three fixed points for the measurements. Also, these ...
Kalyvas, D., Kapsalas, A., Paikou, S. et al. Thickness of the Schneiderian membrane and its correlation with anatomical structures and demographic parameters using CBCT tomography: a retrospective study.
Int J Implant Dent 4, 32 (2018). https://doi.org/10.1186/s40729-018-0143-5
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Received: 29 January 2018
Accepted: 27 August 2018
Published: 19 October 2018
...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
Patient recruitment and data collection for this study took place at National and Kapodistrian University of Athens, School of Dentistry, Greece. The research was approved by the Ethics Committee of the National and Kapodistrian University of Athens, Greece, and all activities were conducted in full accordance with ethical principles, including the World Medical Association Declaration of Helsinki...
Department of Oral and Maxillofacial Surgery, School of Dentistry, National and Kapodistrian University of Athens, Greece, Thivon 2 str, 11527, Athens, Greece
Demos Kalyvas, Andreas Kapsalas & Sofia Paikou
Oral Diagnosis & Radiology Clinic, School of Dentistry, National and Kapodistrian University of Athens, Greece, Thivon 2 str, 11527, Athens, Greece
Konstantinos Tsiklakis
You can also sea...
The data will not be shared, but are available upon request.
Wen S-C, Lin Y-H, Yang Y-C, Wang H-L. The influence of sinus membrane thickness upon membrane perforation during transcrestal sinus lift procedure. Clin. Oral Impl. Res. 2015;26:1158–64.
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Bergh van den JPA, Bruggenkate ten CM, Disch FJM, Tuinzing DB. Anatomical aspects of...
In conclusion, the present study demonstrated that male patients tend to have a thicker membrane than female patients. The angles of the sinus seemed to increase in width from mesial to distal, and they have no significant correlation with any of our parameters. Thickness of the mucosa and width of the maxillary sinus did not seem to correlate. Future studies including larger groups of participant...
In the present study, it was also concluded that the width of the sinus increases from mesial to distal. Male sinuses had higher prevalence of high angle values compared to female sinuses, but the majority of angle values and widths was characterized as moderate.
In an attempt to correlate the membrane biotype regarding thickness with the sinus width, it was proven that there is no correlation be...
Comparing the thickness of the membrane between the two genders, males seem to have thicker membranes than females. Vallo et al. 2010, Janner et al. 2011, Ji-Young Yoo et al. 2011, Cakur et al. 2013, and Jildirim et al. 2017 [9, 11, 12, 16, 17] also come to this conclusion. Our study assumed that this difference is of the order of 40%. On the contrary, Pazera et al. 2010 concluded that there is no...
It is very important to pre-operatively evaluate the thickness of the Schneiderian membrane to plan the surgical procedure in the region that involves the membrane, such as a sinus lift augmentation, which increases the possibility of membrane perforation or other complications.
The present study assumed that the average thickness of the Schneiderian membrane is 1.60 ± 1.20 mm.
There are m...
The mean value of the overall average thickness is 1.60 ± 1.20 mm (males 1.95 ± 1.28 mm and females 1.24 ± 1.02 mm) (Table 1).
The average thickness of the membrane also showed no tendency for differentiation by age group (p = 0.878) (Table 2).
The statistical analysis also shows a clear tendency towards lower values when checking from point AR to point CR and from point ...
These three cross-sectional images, in which the thickness of the Schneiderian membrane was previously measured, were also used for the measurement of the angle of the maxillary sinus. A segment DG (point D is the deepest point of the floor of the maxillary sinus) is created, vertical to the horizontal plane with stable length equal to 9.9 mm. The mean of 9.9 mm was chosen, because of a limitati...
The study sample included 76 patients, of which 39 were females and 37 were males. In total, 120 sinuses (44 both left- and right-sided, 21 right-sided, and 11 left-sided) were evaluated as suitable for the present study and were measured. The total sample was classified in four age groups (below 45 years, 45–54 years, 54–64 years, and over 65 years of age). The mean age value of the sampl...
The maxillary sinus is the largest of the paranasal air-filled spaces, and it develops firstly in utero [1, 2]. Anatomically, the maxillary sinus is a pyramid-shaped cavity located in the facial skull with a mean volume of 12.5 mL (min 5 mL and max 22 mL) [2,3,4,5,6]. The size, the shape, and the wall thickness of every maxillary sinus not only vary among the population, but also between the tw...
The aims of the present study were to determine the thickness of the Schneiderian membrane and identify the width of the maxillary sinus, which is indicated by the buccal and lingual walls of the sinus angle between. Furthermore, to investigate the possibility of a correlation between the aforementioned structures and also other anatomical and demographic parameters using CBCTs for dental implant ...