The Journal of Craniofacial Surgery
Brief Clinical Studies
23. Bengazi F, Wennstro¨m JL, Lekholm U. Recession of the soft tissue margin at oral implants. A 2-year longitudinal prospective study. Clin Oral Implants Res 1996;7:303Y310
Current Concepts on Complications Associated With Sinus Augmentation Procedures Paolo Boffano, MD, Tymour Forouzanfar, MD, DDS Abstract: The sinus augmentation, or sinus lift procedure, is an internal augmentation of the maxillary sinus, which is intended to increase the vertical bony dimension in the lateral maxilla to make the placement of dental implants possible. Complication rate associated with maxillary sinus augmentation procedures in the literature is quite low. Typically, perforation of the Schneiderian membrane, hemorrhage, infection, and rhinosinusitis are more frequently encountered. Therefore, the aim of this article was to briefly review and resume the more common complications associated with sinus augmentation procedures. Key Words: Complications, maxillary sinus, sinus augmentation, sinus lift
T
he sinus augmentation, or sinus lift procedure, is an internal augmentation of the maxillary sinus, which is intended to increase the vertical bony dimension in the lateral maxilla to make the placement of dental implants possible. During the sinus augmentation via a lateral window approach, a bony window is performed on the lateral sinus wall, and a space is created between the Schneiderian membrane and the sinus walls, where a grafting material was placed. One key advantage of this approach is gaining direct access to the sinus. However, despite the high success rate, complications do occur. Complication rate associated with maxillary sinus augmentation procedures in the literature is quite low. Typically, perforation of the Schneiderian membrane, hemorrhage, infection, and rhinosinusitis are more frequently encountered.1 Therefore, the aim of this article was to briefly review and resume the more common complications associated with sinus augmentation procedures.
PERFORATION OF THE SCHNEIDERIAN MEMBRANE Maxillary sinus membrane perforation is the most common complication arising during sinus augmentation; its prevalence is between 7% and 44%.1Y17 From the Department of Oral and Maxillofacial Surgery/Oral Pathology, Vrije Universiteit University Medical Center/Academic Center for Dentistry Amsterdam, Amsterdam, the Netherlands. Received July 3, 2013. Accepted for publication August 27, 2013. Address correspondence and reprint requests to Paolo Boffano, MD, San Giovanni Battista Hospital, University of Turin, Corso Dogliotti 14, 10126, Torino, Italy; E-mail: [email protected] The authors report no conflicts of interest. Copyright * 2014 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000000438
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& Volume 25, Number 2, March 2014
The integrity of the sinus membrane is essential in maintaining the healthy, normal function of the maxillary sinus. The mucociliary apparatus protects the sinus against infection by removing organisms trapped in mucus through the ostium. The membrane also acts as a biologic barrier, and an increased chance of infection results if the biologic barrier (the membrane) perforates because a greater number of bacteria can invade the graft.18 Possible causes include septa, pathologic conditions, or very thin membranes.10 Perforation of the Schneiderian membrane often results when the lateral wall is being in-fractured, but it can also happen when the membrane is being elevated off the inferior and anterior bony aspect of the sinus and can occur because of irregularities of the sinus floor.1 The Schneiderian membrane consists of pseudociliated stratified respiratory epithelium, and it plays a fundamental role in the protection and constitution of the maxillary sinus. During the surgical intervention of sinus elevation, a small tear in the membrane determines a direct communication between the graft material and the contaminated sinus cavity. Perforation of the membrane always threatens the coverage of the graft materials. This may provoke infection and chronic sinusitis, with an eventual loss of graft volume.19 Fugazzotto and Vlassis20 classified sinus membrane damage based on location of the perforation (Table 1). The authors indicated that membrane perforations are not a reason to abort sinus augmentation procedures but should be addressed by properly repairing it.17,19 Many methods have been advocated for treatment of perforation of the Schneiderian membrane during the sinus floor elevation and augmentation.1 Perforations have most commonly been repaired with the use of collagen membranes between the graft material and the Schneiderian membrane. Repair could include folding the membrane on itself, covering the perforation with collagen tape, resorbable membrane, or freezedried human lamellar bone sheets, and, with larger perforations, careful suturing. As an alternative, use of fibrin adhesive for repair of perforations has been advocated.1Y21 However, there are no guidelines for the treatment of these complications.1,22
BLEEDING AND HEMORRHAGE The facial antral wall is populated with anastomosing vessels between the posterior superior alveolar artery and the infraorbital artery. The mean height from the alveolar ridge of these vessels is 18.9 to 19.6 mm; thus, they are in close proximity to the lateral window osteotomy. The surgical severance of one of the vessels during sinus augmentation may complicate the procedure because of the more difficult visualization of the Schneiderian membrane.18,19 Three arteries supply the maxillary sinus: the posterior superior alveolar, infraorbital, and posterior lateral nasal arteries. They are all ultimate branches of the maxillary artery. The posterior superior alveolar artery supplies the lining of the antrum, posterior teeth, and superficial branches to supply the maxillary gingivae and mucoperiosteum. The dental branch of this artery courses intraosseously, halfway up the lateral sinus wall, and forms a horizontal anastomosis with the infraorbital artery. The infraorbital artery runs through the infraorbital canal, and before emerging from the infraorbital foramen, it gives off 1 or 2 branches that course caudally along the anterior antral wall.18 Treatment for such complication includes firm pressure, direct ligation, bone wax, burnish with burs, and electrocautery.19 Intraoperative bleeding may happen readily during sinus augmentation because of highly vascular environment supported by the maxillary sinus.19 An abnormal increase in intraoperative bleeding may arise from a hypertensive state of the patient and can be * 2014 Mutaz B. Habal, MD
Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
The Journal of Craniofacial Surgery
& Volume 25, Number 2, March 2014
Brief Clinical Studies
TABLE 1. Classification of Sinus Membrane Perforations According to Fugazzotto and Vlassis20 Class
Description
Class I
Perforation is adjacent to the osteomy site. Class I perforations are often ‘‘sealed off ’’ as a result of the membrane folding upon itself following completion of elevation. A class II perforation is located in the midsuperior aspect of the osteotomy, extending mesiodistally for two thirds of the dimension of total osteotomy site. A class II perforation occurs most frequently when in-fracture design of the osteotomy is used. A class III perforation is located at the inferior border of the osteotomy at its mesial or distal sixth. This is the most common perforation and is almost always the result of inadequacy of osteotomy or improper execution of membrane reflection. A class IV perforation is located in the central two thirds of the inferior border of the osteotomy site. Such a perforation is relatively rare and is almost always caused by lack of care when preparing the osteotomy site and represents a considerable clinical challenge. A class V perforation is a preexisting area of exposure of the sinus membrane, due to a combination of extensive antral pneumatization and severe ridge resorption.
Class II
Class III
Class IV
Class V
controlled with local anesthesia, verbal reassurance, and additional sedation. Profuse bleeding must be contained immediately and hemostasis maintained after completion of surgery.19 Finally, another form of perioperative or postoperative bleeding that can occur is an epistaxis, indicating a membrane perforation.1,18
INFECTION Although the incidence is low, infection after sinus augmentation may occur and may compromise the bone graft. In situations where infection has contaminated the graft, the complete removal of the graft may be necessary to reduce the damage that can occur. Typically, the sinus may be regrafted after eradication of the infection has been secured. A regimen of antibiotics and nasal decongestant has to be started before sinus grafting and continued during healing. In particular, aminopenicillins such as amoxicillin may be the appropriate antibiotic of choice for acute sinus infections to contrast involved bacteria such as Haemophilus influenza, Moraxella catarrhalis, Streptococcus pneumoniae, and methicillin-sensitive Staphylococcus aureus.18
RHINOSINUSITIS The low complication rate (1%Y4%) for postoperative maxillary sinusitis can be surprising, as a transient or persisting effect on the ciliated antral mucosa would be expected after maxillary sinus floor elevation. However, the maxillary sinus mucosa is capable of adapting adequately to the changes induced by elevation procedures, especially in cases of noncompromised sinus clearance.1,18 Preoperative screening of patients with predisposing factors for rhinosinusitis is necessary to reduce the incidence of sinusitis developing after sinus augmentation procedures. In particular, preoperative use of antibiotics, steroids, and decongestants has been advised to reduce the risk of obstruction of the ostium postoperatively. However, confronted with postoperative transient sinusitis, decongestants and antibiotic therapy are recommended with close monitoring of any further symptoms. If the sinusitis does not resolve after 2 weeks, endoscopy may be necessary.1Y18
CONCLUSIONS An appropriate preoperative clinical assessment is fundamental to decrease the risk for such complications. Therefore, preoperative radiographic examination including thin-slice axial and coronal computed tomographic scans is useful to investigate the maxillary
Treatment Treatment should be considered when the perforation is still evident after membrane reflection. Repair and treatment are similar to those for class I.
Completion of membrane refraction rarely results in covering a class III perforation and treatment is needed.
sinus and in particular the osteomeatal unit. Moreover, a transnasal endoscopic evaluation would complete the preoperative assessment. Findings of a noninfectious disease of the sinus should prompt surgical biopsy and cyst or tumor removal. Chronic sinusitis requires the administration of pharmacologic treatment with decongestants, antihistamines, steroids, and possibly antibiotics, as prescribed by an otorhinolaryngologist, to complete resolution to provide the best possible surgical environment. If conservative therapy fails, functional endoscopic sinus surgery should be performed to broaden the natural ostium in the middle meatus and thereby ensure adequate ventilation and drainage of the antral secretions and prevent stagnation of the sinus.8 Findings should be followed for 6 months by clinical and computed tomography reevaluation of the sinus and ostium before maxillary sinus grafting and implant procedures are performed.
REFERENCES 1. Ardekian L, Oved-Peleg E, Mactei EE, et al. The clinical significance of sinus membrane perforation during augmentation of the maxillary sinus. J Oral Maxillofac Surg 2006;64:277Y282 2. Barone A, Santini S, Sbordone L, et al. A clinical study of the outcomes and complications associated with maxillary sinus augmentation. Int J Oral Maxillofac Implants 2006; 21:81Y85 3. Raghoebar GM, Timmenga NM, Reintsema H, et al. Maxillary bone grafting for insertion of endosseous implants: results after 12Y124 months. Clin Oral Implants Res 2001;12:279Y286 4. Garg AK. Augmentation grafting of the maxillary sinus for placement of dental implants: anatomy, physiology, and procedures. Implant Dent 1999;8:36Y46 5. Raghoebar GM, Batenburg RH, Timmenga NM, et al. Morbidity and complications of bone grafting of the floor of the maxillary sinus for the placement of endosseous implants. Mund Kiefer Gesichtschir 1999;3:S65YS69 6. Regev E, Smith RA, Perrott DH, et al. Maxillary sinus complications related to endosseous implants. Int J Oral Maxillofac Implants 1995;10:451Y461 7. Schwartz-Arad D, Herzberg R, Dolev E. The prevalence of surgical complications of the sinus graft procedure and their impact on implant survival. J Periodontol 2004;75:511Y516 8. Anavi Y, Allon DM, Avishai G, et al. Complications of maxillary sinus augmentations in a selective series of patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 106:34Y38 9. Griffa A, Berrone M, Boffano P, et al. Mucociliary function during maxillary sinus floor elevation. J Craniofac Surg 2010; 21:1500Y1502 10. Pikos MA. Maxillary sinus membrane repair: report of a technique for large perforations. Implant Dent 1999;8:29Y34
* 2014 Mutaz B. Habal, MD
Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
e211
Brief Clinical Studies
The Journal of Craniofacial Surgery
11. Jensen J, Sindet-Pedersen S, Oliver A.J. Varying treatment strategies for reconstruction of maxillary atrophy with implants: results in 98 patients. J Oral Maxillofac Surg 1994;52:210Y216 12. 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;14:557Y564 13. van den Bergh JP, ten Bruggenkate CM, Disch FJ, et al. Anatomical aspects of sinus floor elevations. Clin Oral Implants Res 2000;11:256Y265 14. van den Bergh JP, ten Bruggenkate CM, Krekeler G, et al. Maxillary sinus floor elevation and grafting with human demineralized freeze dried bone. Clin Oral Implants Res 2000;11:487Y493 15. Wannfors K, Johansson B, Hallman M, et al. A prospective randomized study of 1- and 2-stage sinus inlay bone grafts: 1-year follow-up. Int J Oral Maxillofac Implants 2000;15:625Y632 16. Kreisler M, Moritz O, Weihe Ch, et al. Die externe Sinusbodenelevation vor dem Hintergrund der evidenzbasierten Medizin. Z Zahna¨rztl Implantol 2007;23:68Y86
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& Volume 25, Number 2, March 2014
17. Becker ST, Terheyden H, Steinriede A, et al. Prospective observation of 41 perforations of the Schneiderian membrane during sinus floor elevation. Clin Oral Implants Res 2008;19:1285Y1289 18. Zijderveld SA, van den Bergh JP, Schulten EA, et al. Anatomical and surgical findings and complications in 100 consecutive maxillary sinus floor elevation procedures . J Oral Maxillofac Surg 2008;66: 1426Y1438 19. Katranji A, Fotek P, Wang HL. Sinus augmentation complications: etiology and treatment. Implant Dent 2008;17:339Y349 20. Fugazzotto PA, Vlassis J. A simplified classification and repair system for sinus membrane perforations. J Periodontol 2003;74: 1534Y1541 21. Herna´ndez-Alfaro F, Torradeflot MM, Marti C. Prevalence and management of Schneiderian membrane perforations during sinus-lift procedures. Clin Oral Implants Res 2008;19:91Y98 22. Chan HL, Wang HL. Sinus pathology and anatomy in relation to complications in lateral window sinus augmentation. Implant Dent 2011;20:406Y412
* 2014 Mutaz B. Habal, MD
Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
Brief Clinical Studies
23. Bengazi F, Wennstro¨m JL, Lekholm U. Recession of the soft tissue margin at oral implants. A 2-year longitudinal prospective study. Clin Oral Implants Res 1996;7:303Y310
Current Concepts on Complications Associated With Sinus Augmentation Procedures Paolo Boffano, MD, Tymour Forouzanfar, MD, DDS Abstract: The sinus augmentation, or sinus lift procedure, is an internal augmentation of the maxillary sinus, which is intended to increase the vertical bony dimension in the lateral maxilla to make the placement of dental implants possible. Complication rate associated with maxillary sinus augmentation procedures in the literature is quite low. Typically, perforation of the Schneiderian membrane, hemorrhage, infection, and rhinosinusitis are more frequently encountered. Therefore, the aim of this article was to briefly review and resume the more common complications associated with sinus augmentation procedures. Key Words: Complications, maxillary sinus, sinus augmentation, sinus lift
T
he sinus augmentation, or sinus lift procedure, is an internal augmentation of the maxillary sinus, which is intended to increase the vertical bony dimension in the lateral maxilla to make the placement of dental implants possible. During the sinus augmentation via a lateral window approach, a bony window is performed on the lateral sinus wall, and a space is created between the Schneiderian membrane and the sinus walls, where a grafting material was placed. One key advantage of this approach is gaining direct access to the sinus. However, despite the high success rate, complications do occur. Complication rate associated with maxillary sinus augmentation procedures in the literature is quite low. Typically, perforation of the Schneiderian membrane, hemorrhage, infection, and rhinosinusitis are more frequently encountered.1 Therefore, the aim of this article was to briefly review and resume the more common complications associated with sinus augmentation procedures.
PERFORATION OF THE SCHNEIDERIAN MEMBRANE Maxillary sinus membrane perforation is the most common complication arising during sinus augmentation; its prevalence is between 7% and 44%.1Y17 From the Department of Oral and Maxillofacial Surgery/Oral Pathology, Vrije Universiteit University Medical Center/Academic Center for Dentistry Amsterdam, Amsterdam, the Netherlands. Received July 3, 2013. Accepted for publication August 27, 2013. Address correspondence and reprint requests to Paolo Boffano, MD, San Giovanni Battista Hospital, University of Turin, Corso Dogliotti 14, 10126, Torino, Italy; E-mail: [email protected] The authors report no conflicts of interest. Copyright * 2014 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000000438
e210
& Volume 25, Number 2, March 2014
The integrity of the sinus membrane is essential in maintaining the healthy, normal function of the maxillary sinus. The mucociliary apparatus protects the sinus against infection by removing organisms trapped in mucus through the ostium. The membrane also acts as a biologic barrier, and an increased chance of infection results if the biologic barrier (the membrane) perforates because a greater number of bacteria can invade the graft.18 Possible causes include septa, pathologic conditions, or very thin membranes.10 Perforation of the Schneiderian membrane often results when the lateral wall is being in-fractured, but it can also happen when the membrane is being elevated off the inferior and anterior bony aspect of the sinus and can occur because of irregularities of the sinus floor.1 The Schneiderian membrane consists of pseudociliated stratified respiratory epithelium, and it plays a fundamental role in the protection and constitution of the maxillary sinus. During the surgical intervention of sinus elevation, a small tear in the membrane determines a direct communication between the graft material and the contaminated sinus cavity. Perforation of the membrane always threatens the coverage of the graft materials. This may provoke infection and chronic sinusitis, with an eventual loss of graft volume.19 Fugazzotto and Vlassis20 classified sinus membrane damage based on location of the perforation (Table 1). The authors indicated that membrane perforations are not a reason to abort sinus augmentation procedures but should be addressed by properly repairing it.17,19 Many methods have been advocated for treatment of perforation of the Schneiderian membrane during the sinus floor elevation and augmentation.1 Perforations have most commonly been repaired with the use of collagen membranes between the graft material and the Schneiderian membrane. Repair could include folding the membrane on itself, covering the perforation with collagen tape, resorbable membrane, or freezedried human lamellar bone sheets, and, with larger perforations, careful suturing. As an alternative, use of fibrin adhesive for repair of perforations has been advocated.1Y21 However, there are no guidelines for the treatment of these complications.1,22
BLEEDING AND HEMORRHAGE The facial antral wall is populated with anastomosing vessels between the posterior superior alveolar artery and the infraorbital artery. The mean height from the alveolar ridge of these vessels is 18.9 to 19.6 mm; thus, they are in close proximity to the lateral window osteotomy. The surgical severance of one of the vessels during sinus augmentation may complicate the procedure because of the more difficult visualization of the Schneiderian membrane.18,19 Three arteries supply the maxillary sinus: the posterior superior alveolar, infraorbital, and posterior lateral nasal arteries. They are all ultimate branches of the maxillary artery. The posterior superior alveolar artery supplies the lining of the antrum, posterior teeth, and superficial branches to supply the maxillary gingivae and mucoperiosteum. The dental branch of this artery courses intraosseously, halfway up the lateral sinus wall, and forms a horizontal anastomosis with the infraorbital artery. The infraorbital artery runs through the infraorbital canal, and before emerging from the infraorbital foramen, it gives off 1 or 2 branches that course caudally along the anterior antral wall.18 Treatment for such complication includes firm pressure, direct ligation, bone wax, burnish with burs, and electrocautery.19 Intraoperative bleeding may happen readily during sinus augmentation because of highly vascular environment supported by the maxillary sinus.19 An abnormal increase in intraoperative bleeding may arise from a hypertensive state of the patient and can be * 2014 Mutaz B. Habal, MD
Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
The Journal of Craniofacial Surgery
& Volume 25, Number 2, March 2014
Brief Clinical Studies
TABLE 1. Classification of Sinus Membrane Perforations According to Fugazzotto and Vlassis20 Class
Description
Class I
Perforation is adjacent to the osteomy site. Class I perforations are often ‘‘sealed off ’’ as a result of the membrane folding upon itself following completion of elevation. A class II perforation is located in the midsuperior aspect of the osteotomy, extending mesiodistally for two thirds of the dimension of total osteotomy site. A class II perforation occurs most frequently when in-fracture design of the osteotomy is used. A class III perforation is located at the inferior border of the osteotomy at its mesial or distal sixth. This is the most common perforation and is almost always the result of inadequacy of osteotomy or improper execution of membrane reflection. A class IV perforation is located in the central two thirds of the inferior border of the osteotomy site. Such a perforation is relatively rare and is almost always caused by lack of care when preparing the osteotomy site and represents a considerable clinical challenge. A class V perforation is a preexisting area of exposure of the sinus membrane, due to a combination of extensive antral pneumatization and severe ridge resorption.
Class II
Class III
Class IV
Class V
controlled with local anesthesia, verbal reassurance, and additional sedation. Profuse bleeding must be contained immediately and hemostasis maintained after completion of surgery.19 Finally, another form of perioperative or postoperative bleeding that can occur is an epistaxis, indicating a membrane perforation.1,18
INFECTION Although the incidence is low, infection after sinus augmentation may occur and may compromise the bone graft. In situations where infection has contaminated the graft, the complete removal of the graft may be necessary to reduce the damage that can occur. Typically, the sinus may be regrafted after eradication of the infection has been secured. A regimen of antibiotics and nasal decongestant has to be started before sinus grafting and continued during healing. In particular, aminopenicillins such as amoxicillin may be the appropriate antibiotic of choice for acute sinus infections to contrast involved bacteria such as Haemophilus influenza, Moraxella catarrhalis, Streptococcus pneumoniae, and methicillin-sensitive Staphylococcus aureus.18
RHINOSINUSITIS The low complication rate (1%Y4%) for postoperative maxillary sinusitis can be surprising, as a transient or persisting effect on the ciliated antral mucosa would be expected after maxillary sinus floor elevation. However, the maxillary sinus mucosa is capable of adapting adequately to the changes induced by elevation procedures, especially in cases of noncompromised sinus clearance.1,18 Preoperative screening of patients with predisposing factors for rhinosinusitis is necessary to reduce the incidence of sinusitis developing after sinus augmentation procedures. In particular, preoperative use of antibiotics, steroids, and decongestants has been advised to reduce the risk of obstruction of the ostium postoperatively. However, confronted with postoperative transient sinusitis, decongestants and antibiotic therapy are recommended with close monitoring of any further symptoms. If the sinusitis does not resolve after 2 weeks, endoscopy may be necessary.1Y18
CONCLUSIONS An appropriate preoperative clinical assessment is fundamental to decrease the risk for such complications. Therefore, preoperative radiographic examination including thin-slice axial and coronal computed tomographic scans is useful to investigate the maxillary
Treatment Treatment should be considered when the perforation is still evident after membrane reflection. Repair and treatment are similar to those for class I.
Completion of membrane refraction rarely results in covering a class III perforation and treatment is needed.
sinus and in particular the osteomeatal unit. Moreover, a transnasal endoscopic evaluation would complete the preoperative assessment. Findings of a noninfectious disease of the sinus should prompt surgical biopsy and cyst or tumor removal. Chronic sinusitis requires the administration of pharmacologic treatment with decongestants, antihistamines, steroids, and possibly antibiotics, as prescribed by an otorhinolaryngologist, to complete resolution to provide the best possible surgical environment. If conservative therapy fails, functional endoscopic sinus surgery should be performed to broaden the natural ostium in the middle meatus and thereby ensure adequate ventilation and drainage of the antral secretions and prevent stagnation of the sinus.8 Findings should be followed for 6 months by clinical and computed tomography reevaluation of the sinus and ostium before maxillary sinus grafting and implant procedures are performed.
REFERENCES 1. Ardekian L, Oved-Peleg E, Mactei EE, et al. The clinical significance of sinus membrane perforation during augmentation of the maxillary sinus. J Oral Maxillofac Surg 2006;64:277Y282 2. Barone A, Santini S, Sbordone L, et al. A clinical study of the outcomes and complications associated with maxillary sinus augmentation. Int J Oral Maxillofac Implants 2006; 21:81Y85 3. Raghoebar GM, Timmenga NM, Reintsema H, et al. Maxillary bone grafting for insertion of endosseous implants: results after 12Y124 months. Clin Oral Implants Res 2001;12:279Y286 4. Garg AK. Augmentation grafting of the maxillary sinus for placement of dental implants: anatomy, physiology, and procedures. Implant Dent 1999;8:36Y46 5. Raghoebar GM, Batenburg RH, Timmenga NM, et al. Morbidity and complications of bone grafting of the floor of the maxillary sinus for the placement of endosseous implants. Mund Kiefer Gesichtschir 1999;3:S65YS69 6. Regev E, Smith RA, Perrott DH, et al. Maxillary sinus complications related to endosseous implants. Int J Oral Maxillofac Implants 1995;10:451Y461 7. Schwartz-Arad D, Herzberg R, Dolev E. The prevalence of surgical complications of the sinus graft procedure and their impact on implant survival. J Periodontol 2004;75:511Y516 8. Anavi Y, Allon DM, Avishai G, et al. Complications of maxillary sinus augmentations in a selective series of patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 106:34Y38 9. Griffa A, Berrone M, Boffano P, et al. Mucociliary function during maxillary sinus floor elevation. J Craniofac Surg 2010; 21:1500Y1502 10. Pikos MA. Maxillary sinus membrane repair: report of a technique for large perforations. Implant Dent 1999;8:29Y34
* 2014 Mutaz B. Habal, MD
Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
e211
Brief Clinical Studies
The Journal of Craniofacial Surgery
11. Jensen J, Sindet-Pedersen S, Oliver A.J. Varying treatment strategies for reconstruction of maxillary atrophy with implants: results in 98 patients. J Oral Maxillofac Surg 1994;52:210Y216 12. 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;14:557Y564 13. van den Bergh JP, ten Bruggenkate CM, Disch FJ, et al. Anatomical aspects of sinus floor elevations. Clin Oral Implants Res 2000;11:256Y265 14. van den Bergh JP, ten Bruggenkate CM, Krekeler G, et al. Maxillary sinus floor elevation and grafting with human demineralized freeze dried bone. Clin Oral Implants Res 2000;11:487Y493 15. Wannfors K, Johansson B, Hallman M, et al. A prospective randomized study of 1- and 2-stage sinus inlay bone grafts: 1-year follow-up. Int J Oral Maxillofac Implants 2000;15:625Y632 16. Kreisler M, Moritz O, Weihe Ch, et al. Die externe Sinusbodenelevation vor dem Hintergrund der evidenzbasierten Medizin. Z Zahna¨rztl Implantol 2007;23:68Y86
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& Volume 25, Number 2, March 2014
17. Becker ST, Terheyden H, Steinriede A, et al. Prospective observation of 41 perforations of the Schneiderian membrane during sinus floor elevation. Clin Oral Implants Res 2008;19:1285Y1289 18. Zijderveld SA, van den Bergh JP, Schulten EA, et al. Anatomical and surgical findings and complications in 100 consecutive maxillary sinus floor elevation procedures . J Oral Maxillofac Surg 2008;66: 1426Y1438 19. Katranji A, Fotek P, Wang HL. Sinus augmentation complications: etiology and treatment. Implant Dent 2008;17:339Y349 20. Fugazzotto PA, Vlassis J. A simplified classification and repair system for sinus membrane perforations. J Periodontol 2003;74: 1534Y1541 21. Herna´ndez-Alfaro F, Torradeflot MM, Marti C. Prevalence and management of Schneiderian membrane perforations during sinus-lift procedures. Clin Oral Implants Res 2008;19:91Y98 22. Chan HL, Wang HL. Sinus pathology and anatomy in relation to complications in lateral window sinus augmentation. Implant Dent 2011;20:406Y412
* 2014 Mutaz B. Habal, MD
Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
