Maxillary Sinus Augmentation

.
- Complications,
Management and Measures : A Review

REGISTRATION NO - 0445
GOOD Evening
Failure is Simply an opportunity to begin again,
this time more intelligently.

-Henry Ford
 Introduction

Maxillary Sinus Augmentation First performed by Tatum in 1974.

First published literature Boyne and James in 1980.

Possibility of atrophied posterior maxillary to be rehabilitated by dental

implants prosthesis.
this review covers :
Importance of radiographic evaluation.
Schneiderian membrane perforations.
Intra-operative haemorrhage .
Presence of underwood septa.
Benign paroxysmal positional vertigo.
Post-operative swelling.
Inflammation and infection.
Wound dehiscence and Oro-Antral communication.
Loss of pulp vitality of the adjacent teeth.
Loss of Implant fixture into sinus cavity.
 Bone augmentation techniques

Lateral Approach technique (direct lift)

(Boyne & James, 1980)

Crestal Approach technique (indirect lift)

(Summers,1994)
Anatomy of Maxillary Sinus
 Radiographic EVALUATION

Fig: preop radiograph shows

septum between premolar and Fig: CBCT fractured 1st bicuspid
Fig: OPG shows variations in molar. Making lift difficult
bone height

Fig: CBCT shows undulating radio opacity

diagnosed as chronic sinusitis
Fig: CBCT shows antral pseudocyst in Fig: ct shows presence of septa
related to irreversible pulpitis related to 15
the maxillary sinus floor. in right sinus
 Membrane perforation

Occurs in 7-44 % of the procedures performed.

Ref: Suzanne Caudry, ; Michael Landzberg, http://www.jcda.ca/article/d101, Antonio Barone et al 2006

 Impact of instruments for osteotomy

Ref: Claudio Stacchi, 2013, doi.org/10.1111/cid.12136

 Large perforations

Ref: Massimo Robiony September 2012 open journal of stomatology

 Underwoods septa

Fig: preop radiograph shows

septum between premolar and
molar.

35% of the individual have underwood septa present

Fig: Horizontal underwood
(ref: RAMAZAN KOYMEN, NUKET GOCMEN-MAS,2009) Septa, rarely seen
 Benign paroxysmal positional vertigo
Loose canalith crystals called otoconia in the inner ear

Expect

Recognize

Refer
9% of 786 patients with
BPPV underwent dental
procedure in past 1 month
Figure: A clinical view of osteotome
of diagnosis.
sinus floor elevation.

Ref: tzu-chang et al, 2016; Moon-Sun Kim et al 2010 .

 Intra & Post operative Haemorrhage

Fig: Blood vessel in the area of a

lateral wall sinus osteotomy. Fig: Elevation of the
Schneiderian membrane around
a blood vessel in the area of the
lateral wall sinus osteotomy.

Fig: Particulate bone graft may

be packed into sinus to arrest bleeding.

Ref: Caudry et al www.jcda.ca , Patil et al, fugazotto et al

 Post Operative Swelling
Seen in 100% of 132 total site augmented
96% of 132 sites , swelling disappeared spontaneously in
three months.
Fig: Group 1 A: Incomplete coverage of lateral window with collagen membrane, high buccal migration of graft material , graft material height
reduced

Fig: Group 1 B: Complete coverage of lateral window with collagen membrane, buccal migration of graft
present

Fig: Group 2 Complete coverage of lateral window with titanium mesh, no buccal migration of Ref: Journal of Oral Science & Rehabilitation
graft. Volume 1 | Issue 1/2015
 Infection
Minor infections may be treated alone by antibiotics and NSAIDs

Fig: swelling and transudation after surgery.

Seen in 5% patient
Smoking may be co related
to post op infectivity . Fig: The discharge of pus and graft

ref: https://www.hindawi.com/journals/ijd/2012/365809/tab2/
 Wound dehiscence AND
Oro-antral communication

Debridement and irrigation in indicated.

Buccal Pedicle flap may me used for closer
in case of inadequate mucosa.
Patients complains of water leaking from none
while drinking.
Acute sinusitis may occur.
Anti-biotic therapy is recommended

Ref: P Valentini, Annals of Oral & Maxillofacial Surgery 2013 Aug 01;1(3):23, fugazzotto 2015.
 Loss of implant fixture into sinus

Fig: post-op implant site 17 Fig: radiolucency develop Fig: radiolucency in apical region
indicate failure of graft
Failure of bone graft.
Failure to osseointegrate .
May or may not show symptoms of
complication.
Oro-antral communication closure.
Retrieval by trans-nasal endoscopic
surgery or traditional lateral window.
Fig: displaced into sinus while trying to retieve.
Ref: Xiaojun Ding, Qing Wang Int J Clin Exp Med 2015;8(4):4826-4836
Fig: 5 years post operatively
 Loss of Pulp Vitality

Ref: Georgios E. Romanos, J Periodontol January 2014

 Overfill
May lead to membrane perforation
Obliteration of osteum.
Sinusitis
Increased pressure in sinus.

Fugazzotto et al ,2015
 Conclusion
Although it a predictable procedure, an array of complications may arise during and
after the sinus lift procedure.
The clinician must be aware of the possible complications and their management.
An appropriate patient selection , detailed knowledge of the patients anatomy , use
of radiographic imaging such as OPG, CBCT, IOPAR and Use of appropriate
armamentarium.
May Significantly reduce the occurrence of complications following sinus floor
augmentation or help to manage the augmented site better.
Thank You