Sinus Savvy: Exploring the Current Techniques of Maxillary Sinus Augmentation

Abstract

Sinus ridge augmentation is a surgical procedure aimed at increasing the volume of bone in the posterior maxilla to permit successful dental implant placement. The current review article presents an overview of various techniques used for sinus ridge augmentation, including the lateral window technique, crestal approach, transalveolar technique, and piezoelectric osteotomy. The article examines the advantages and limitations of each technique, such as invasiveness, surgical difficulty, and the requirement for additional procedures. Additionally, the article discusses the factors that influence the success of the procedure, including patient age, residual bone height, and the kind of bone graft substance used. The review also emphasizes the importance of proper case selection, surgical planning, and postoperative care to ensure optimal outcomes. Overall, the article provides valuable insights into the current techniques used for sinus ridge augmentation, highlighting the need for further research to improve patient outcomes and the success of placing dental implants over the long run.

Keywords: bone morphogenetic protein (bmp); dental implants; maxillary sinus lift; sinus floor augmentation; sinus floor elevation.

Figure 1. Coronal view of the ostiomeatal complex. The uncinate process lies in a sagittal plane. The maxillary sinus ostium drains into the infundibulum.

Source: Stern and Green (2012) [2]; reproduced with permission from Elsevier

Figure 2. A bone graft composite is packed into the sinus site. After approximately six months, implants are placed, followed by a final restoration after another six months.

Source: Stern and Green (2012) [2]; reproduced with permission from Elsevier

Figure 3. Diagram showing the lateral wall of the maxilla rotated medially into the sinus, which is optional. The bone graft material is placed into the sinus, either in particulate material or block form, to support the implant. Ideally, the block grafts should engage the superior surface of the implant.

Source: Stern and Green (2012) [2]; reproduced with permission from Elsevier

Figure 4. Bone harvesting

Source: Stern and Green (2012) [2]; reproduced with permission from Elsevier

Figure 5. The unicortical osteotomies form a rectangular outline in the symphysis

Source: Stern and Green (2012) [2]; reproduced with permission from Elsevier

Figure 6. Incision and mucoperiosteal flap reflection

Source: Stern and Green (2012) [2]; reproduced with permission from Elsevier

Figure 7. Diagram depicting the ideal location of the sinus window preparation of the lateral maxillary wall. The inferior ostectomy should be approximately 1 mm above or level with the floor of the sinus. The posterior ostectomy should be at the corner of the maxillary buttress. The anterior ostectomy should be adjacent to and parallel to the lateral wall of the nose, and the superior ostectomy should be at the height of the intended graft.

Source: Stern and Green (2012) [2]; reproduced with permission from Elsevier

Figure 8. Complete quadrilateral osteotomy

Source: Stern and Green (2012) [2]; reproduced with permission from Elsevier

Figure 9. The membrane is carefully elevated and reflected medially into the sinus.

Source: Stern and Green (2012) [2]; reproduced with permission from Elsevier

Figure 10. The crestal incision is combined with anterior and posterior vertical release incisions to allow for exposure of the lateral wall of the maxilla. The lateral wall of the sinus is rotated medially with membrane reflection. A small perforation is seen.

Source: Stern and Green (2012) [2]; reproduced with permission from Elsevier

Figure 11. Incision and mucoperiosteal flap reflection

Source: Stern and Green (2012) [2]; reproduced with permission from Elsevier

Figure 12. Trephined bone core partially intruded into the sinus cavity

Source: Stern and Green (2012) [2]; reproduced with permission from Elsevier

Figure 13. Graft placed through the implant receptor site into the sinus cavity

Source: Stern and Green (2012) [2]; reproduced with permission from Elsevier

Figure 14. BMP is placed on a collagen sponge, and the sponge is cut into five or six strips.

Source: Stern and Green (2012) [2]; reproduced with permission from Elsevier

Figure 15. A BMP-impregnated collagen membrane is placed into the sinus with no membranes used to cover the sinus graft site.

Source: Stern and Green (2012) [2]; reproduced with permission from Elsevier