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Table of Contents   
SHORT COMMUNICATION  
Year : 2017  |  Volume : 28  |  Issue : 2  |  Page : 207-208
Surgical pneumatization through maxillary sinus wall and the schneiderian membrane: A new technique to facilitate augmentation of the maxillary sinus


1 Department of Surgical Sciences, Section of Oral and Maxillofacial Surgery, Uppsala University, Uppsala, Sweden; Department of ENT and Oral and Maxillofacial Surgery, Zealand University Hospital, Denmark
2 Department of Oral and Maxillofacial Surgery, Västmanland's Hospital Västerås, Västerås; Department of Surgical Sciences, Section of Orthopaedics, Uppsala University, Uppsala; Centre for Clinical Research, Uppsala University, County Hospital, 721 89, Västerås, Sweden
3 Department of Surgical Sciences, Section of Oral and Maxillofacial Surgery, Uppsala University, Uppsala, Sweden

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Date of Web Publication12-Jun-2017
 

   Abstract 


A minimum subantral bone height in the posterior maxilla may require a bone augmentation where a sinus lift procedure is the most commonly used technique, either preceding or simultaneously with the implant installation. While elevating the Schneiderian membrane ruptures are common, possibly resulting in less bone formation. In this paper, we propose the surgical pneumatization of the Schneiderian membrane as a new technique to minimize the risk of such complications. This can be achieved mainly by creating a hole for the immediate and increased passage of air through the Schneiderian membrane and the maxillary sinus wall above the region of augmentation.

Keywords: Dental implants, maxillary sinus augmentation, maxillary sinus floor elevation, surgery

How to cite this article:
Carlsson AP, Kharazmi M, Thor A. Surgical pneumatization through maxillary sinus wall and the schneiderian membrane: A new technique to facilitate augmentation of the maxillary sinus. Indian J Dent Res 2017;28:207-8

How to cite this URL:
Carlsson AP, Kharazmi M, Thor A. Surgical pneumatization through maxillary sinus wall and the schneiderian membrane: A new technique to facilitate augmentation of the maxillary sinus. Indian J Dent Res [serial online] 2017 [cited 2018 Jun 20];28:207-8. Available from: http://www.ijdr.in/text.asp?2017/28/2/207/207784



   Introduction Top


Lack of bone in the posterior parts in the maxilla, because of the extension of the maxillary sinuses, is often a problem in implant treatment in this region. The sinus lift is the most common choice of treatment with the lateral approach [1] being the most commonly used technique for maxillary sinus augmentation. Simultaneous installation of implants can be performed with the use of bone grafts or bone substitutes.[2] Bone graft or bone substitutes can also be used for augmentation with the insertion of the implants after a period of healing. During the past decade, this approach has also been successfully used when lifting only the Schneiderian membrane to create conditions for bone formation from a blood clot without the use of grafts of any kind.[3] During maxillary sinus augmentation, the Schneiderian membrane is dissected and elevated from the floor of the maxillary sinus. However, as the membrane is very thin, ruptures are common and an undesirable intraoperative complication.[4] Pressure from the air inside the maxillary sinus toward the Schneiderian membrane makes it difficult to elevate the membrane safely. We propose the surgical pneumatization of the Schneiderian membrane(SPSM) as a new technique to minimize the risk of such complications. This can be achieved mainly by creating conditions for the immediate and increased passage of air through the Schneiderian membrane and the maxillary sinus wall above the region of augmentation[Figure1] and [Figure2].
Figure1: Schematic drawings explaining the chronology of events during the use of the surgical pneumatization of the Schneiderian membrane technique. (A) the lateral sinus wall and the Schneiderian membrane are perforated to create immediate ventilation of air (arrows in lateral direction). The procedure will overcome the overpressure of air within the sinus, hence facilitating the elevation of the Schneiderian membrane (B)

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Figure2: The conditions after the use of the surgical pneumatization of the Schneiderian membrane technique combined with a standardized fenestration of the lateral wall of the maxillary sinus. Lines at the inferior part of the sinus illustrate area created after the elevation of the Schneiderian membrane.(A) perforation used for the surgical pneumatization of the Schneiderian membrane technique.(B) Schneiderian membrane. (C) standardized fenestration of the lateral wall of the maxillary sinus

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   Technique Top


The surgery is initiated as a standardized maxillary sinus augmentation. After elevation of the mucoperiosteal flap, the lateral sinus wall and the Schneiderian membrane are perforated with a small (∅= 2.1 mm) round burr[Figure3]. The perforation is located at about the level of the first maxillary molar and 20-25 mm superior to the alveolar crest. After the perforation, a bone window is created in the lateral sinus wall[Figure4], and the procedure is continued as a standard maxillary sinus augmentation[Figure4]. The only difference will be reduced resistance during mobilizing of the Schneiderian membrane due to reduced air pressure in the sinus.
Figure3: The lateral sinus wall and the Schneiderian membrane are perforated (black arrow) with a small(∅= 2.1 mm) round burr. The perforation is located about the level of the first maxillary molar and 20-25 mm superior of the alveolar crest

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Figure4: After perforation of the lateral sinus wall and the Schneiderian membrane(black arrow), a bone window is created in the maxillary sinus wall, and the surgery is continued as a standardized maxillary sinus augmentation; in this case with simultaneous implant installation

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   Discussion Top


A rupture of the membrane reduces the prognosis of implant treatment [5] and is less likely to occur if the SPSM technique is used. Although intended to be used before bone fenestration of the lateral wall, the SPSM can also be used in cases where difficulty in elevation of the Schneiderian membrane is encountered, when surgery has been initiated as standardized maxillary sinus augmentation. The perforation of the lateral sinus wall and the Schneiderian membrane should be placed superior to the vertical height of the implant. Inferior positioning can cause a puncture that mimics a small rupture in the membrane. Hence, manipulation of the membrane before implant placement can broaden the puncture of the membrane and create a larger rupture.


   Discussion Top


The SPSM is a safe and time-saving technique that can be easily incorporated into the standard augmentation of the maxillary sinus floor, whether performed with or without simultaneous graft material. While facilitating augmentation of the maxillary sinus, future investigations will be required to determine the prognosis of the SPSM.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Tatum H Jr. Maxillary and sinus implant reconstructions. Dent Clin North Am 1986;30:207-29.  Back to cited text no. 1
    
2.
EllegaardB, BaelumV, Kølsen-PetersenJ. Non-grafted sinus implants in periodontally compromised patients: A time-to-event analysis. Clin Oral Implants Res 2006;17:156-64.  Back to cited text no. 2
    
3.
RibenC, ThorA. The maxillary sinus membrane elevation procedure: Augmentation of bone around dental implants without grafts–A review of a surgical technique. Int J Dent 2012;2012:105483.  Back to cited text no. 3
    
4.
WallaceSS, MazorZ, FroumSJ, ChoSC, TarnowDP. Schneiderian membrane perforation rate during sinus elevation using piezosurgery: Clinical results of 100 consecutive cases. Int J Periodontics Restorative Dent 2007;27:413-9.  Back to cited text no. 4
    
5.
NolanPJ, FreemanK, KrautRA. Correlation between Schneiderian membrane perforation and sinus lift graft outcome: A retrospective evaluation of 359 augmented sinus. JOral Maxillofac Surg 2014;72:47-52.  Back to cited text no. 5
    

Top
Correspondence Address:
Mohammad Kharazmi
Department of Oral and Maxillofacial Surgery, Vastmanland's Hospital Västerås, SE-721 89 Västerås
Sweden
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdr.IJDR_11_16

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    Figures

  [Figure1], [Figure2], [Figure3], [Figure4]



 

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