Article Type : Research Article
Authors : Hakobyan G, Khachatryan G, Khachatryan L, Yessayan L and Mathevosyan D
Keywords : Sinus pathology; Endoscopic endonasal sinus surgery; Sinus lifting; Dental implantation
At present,
dental implants are the best solution for the rehabilitation of patients with
various forms of toothless [1]. However, atrophy of the edentulous ridges makes
difficult for implant placement difficult.
Numerous
procedures and materials are used to repair bone defects. The bone graft
procedures used in oral implantology include autograft reconstruction, GBR,
maxillary sinus floor elevation, and alveolar distraction osteogenesis [2-8].
The decision to choose any option depends on clinical factors and ultimately on
the skill of the clinician.
The sinus
lift procedure is one of the primary surgical options allowing placement of
dental implants in the posterior maxilla. The traditional technique consists in
a modified Caldwell–Luc approach, where access to maxillary sinus is obtained
by drilling above window in lateral sinus wall; then, Schneiderian membrane is
carefully detached and elevated from sinus floor in order to insert grafting
materials, including autogenous bone, allografts, xenografts, or alloplasts.
Implants can be inserted simultaneously, or in a second stage if residual bone
is not sufficient to obtain an adequate primary stability [9-13].
If the
residual bone is 6-7 mm, use the closed sinus lift method with access from the
chewing surface of edentulous ridges using osteomas [14].
Sinus floor
augmentation with auto genus bone grafts or with biomaterials has since long
been the predominant, well-documented procedure in the literature [15-16].
However, the procedure may be complicated in patients with chronic maxillary
sinusitis [17,18]. Sinus membrane pathology can potentially complicate the post
procedural course of sinus lift. In clinical practice, chronic maxillary
sinusitis is often observed due to the hit of filling material from the tooth
canal into the sinus cavity [19]. To remove the filling material from the sinus
cavity, the traditional Caldwell-Luc method was used. Modern tendencies of ?ral
surgery are aimed at minimizing surgical trauma and reducing the time for
rehabilitation of patients. In this connection, new technologies without
perforation violating the vestibular sinus wall which allow to reduce the
volume surgical intervention and shorten the time of treatment. Revision sinus
surgery for inflammatory diseases of maxillary sinus has been revolutionized by
endoscopic techniques used in maxillary sinus surgery [20,21].
Recent
technological advances in the field of endoscopy have resulted in substantial
improvements in endoscope-controlled surgery of paranasal sinuses. Endoscopically
technique involves endonasal approach by endoscope and is a minimally invasive
procedure [22-26].
?he most
important factor in sinus lift surgery is atraumatic detachment of the
periosteum of the maxillary sinus membrane from the bony antrum-floor to the
preparation of a mucoperiosteal flap to provide a reliable osseointegration of
and bone regeneration around the grafting material, which can only take place
with a fully intact periosteum.
Treating
maxillary sinus pathology by endoscopic approaches, prior to implant insertion
and/or sinus augmentation, is crucial for a better outcome of the dental
procedure. In patients with pathologies sinus due to hit of filling material
from the tooth canal into the sinus cavity needing a sinus lift procedure, optimal
solution using endoscopic technology [27].
Optimization
of the sinus-lifting in patients with filling material in maxillary sinus
cavity by a one-stage endonasal endoscopic elimination of the sinus pathology
and carrying out a sinus-lifting.
A total of
14 patients (8 males and 6 females, the age was 31 to 64 years, from 2016 to
2020) with ridge defects in age group were selected for the study. All patients
had a partially or totally edentulous atrophied posterior maxilla. All patients
underwent a thorough clinical examination according to a generally accepted
scheme.
Preoperative
planning includes a careful history and physical exam, in addition to
preoperative radiologic investigation, which include computed tomography scan
to determine the existing osseous structure and to evaluate any pathology of
the sinuses (Figure 1). Treatment initiates with the administration of a single
preoperative dose of systemic antibiotic (Amoxicillin, clindamycin, or Levaquin)
and Chlorhexidine 0.12 percent rinse.
A total of
18 sinus lifting procedures were performed, using a mixture of bovine bone,
autogenous bone and PRP.
Figure 1: Preoperative CT scan of a patient with polyposive sinusitis, showing foreign bodies in the maxillary sinus (filling material).
Figure 2: Treatment of sinusitis associate with filling material of the maxillary sinus by endonasal endoscopic sinus surgery simultaneous sinus-lifting and dental implantation.
Any
intraoperative and postoperative complications, such as bleeding, membrane
perforation, swelling, ecchymosis, pain, nasal bleeding, and infection, were
recorded clinically and radiographically. The following parameters were
assessed: failure of the augmentation procedure, implant failure, and vertical
bone height.
Of the 46
implants placed in these 12 patients, 2 failed to Osseo integrate. The CT
examination showed the presence of dense bone around and above the implants.
The implants appeared to be well integrated with no peri-implant bone loss. At
5 years follow up, excellent integration of grafted tissue, steady levels of
bone around the implants and healthy peri-implant tissues were reported.
Satisfactory facial symmetry, chewing and speech functions of the patients were
restored. Implants placed in the reconstructed areas were demonstrated to
integrate normally, postoperative occlusal function and esthetics have been
favorable.
The method
of simultaneous endonasal sanitation of the maxillary sinus and dental
implantation, allows to reduce the probability of perforation of the membrane,
significantly shortening the rehabilitation time of patients with insufficient
bone tissue in the maxillary sinus.
As
a result of the introduction of these innovative technologies, surgical
technologies for managing patients with sinus pathology have been optimized,
using minimally invasive endoscopic technique, simultaneous endonasal sanction
of the maxillary sinus with endoscopic assisted sinus lifting before dental implantation.
The
method of simultaneous endonasal sanitation of the maxillary sinus,
sinus-lifting, dental implantation, allows to reduce the probability of
perforation of the membrane, significantly shortening the rehabilitation period
of patients with insufficient bone tissue in the maxillary sinus. These methods
led to simpler, more comfortable, lower risks of morbidity, more predictable
compared to more invasive maxillary sinus augmentation.