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The incidence of sinus membrane perforation in crestal sinus lift technique
EAO Online Library. Uçar Boyacigil D. Oct 9, 2018; 232731; P-SU-38
Duygu Uçar Boyacigil
Duygu Uçar Boyacigil
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Background- Both crestal and lateral techniques in sinus elevation and augmentation are surgical procedures to create adequate bone volume in posterior maxilla. Membrane perforation is a common complication during sinus lifting and it causes the loss of total partial bone graft and acute sinusitis in postoperatively. The lateral approach allows direct vision of the elevated membrane, whereas the crestal technique is a blind procedure so membrane perforation can be occured without being noticed.Aim- The aim of this study was to reveal the incidence of sinus membran perforation in crestal sinus lift technique using cone-beam computed tomography (CBCT) scans and determine the morbidity associated with the membrane perforation in follow-up period. Material and Methods- Twenty-five patients with a total of 44 crestal sinus lift procedures were included in this study. Each patient were taken CBCT preoperatively, immediate postoperatively and 3 months later postoperatively. The crestal sinus lifting were performed according to Summers technique and modified Summers technique. Dental implants were placed simultaneously crestal sinus lifting or 4 months later based on residual bone height. The membrane thickness, residual bone height and bone width, any sinus pathology were recorded preoperatively. The membrane perforation was determined using immediate postoperative CBCT scans. If a dome-shaped radiologic appearance around the apex of the dental implant or graft material is not observed and an increased radiopacity in the sinus is observed on CBCT scans, the sinus membrane is accepted as perforated. The clinical and radiographical changes were recorded in patients with a membrane perforation. Results- The mean residual bone height was 5.59 mm. The mean membrane thickness was 1.35 mm. Membrane perforation rate was 18.2% in 44 crestal sinus lifting. The most perforation rate was found in patients with a membrane thickness below 1 mm (23.5%) but the difference among the groups was not statistically significant (p=0.431). In all patients with a sinus membrane perforation, the increased radiopacity was detected compared with the preoperative CBCT. 2 patients were suffered from acute sinusitis in follow-up period. Therefore oral antibiotic regimen was prescribed for 14 days in these patients. In 4 sinus lifting, it was determined that graft materials were spreading in the sinus cavity. 3 months later, the radiopacity was decreased in all patients but one. However, this patient had no complaint about clinical signs and symptoms of chronic sinusitis. In 2 patients, the graft resorption around the apex of dental implants was observed after 3 months. Conclusions- The clinical and radiographical results show that crestal sinus lifting is a safe and predictable surgical procedure. However, the patients with membrane perforation need to be kept in close follow-up to control sinus infection and maintain dental implant survival.
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