Surgical Endoscopic Treatment of Odontogenic Sinusitis.

Introduction: Odontogenic sinusitis is a frequent disease of the maxillary sinus, resulting from a dental inflammatory condition or a foreign body migrated in the sinus cavity. We performed a clinical retrospective study aimed to review the two surgical endoscopic approaches for odontogenic maxillary sinusitis middle and inferior meatotomy, in terms of realistic indications, efficacy, outcomes, and possible complications. Materials and Methods: In our study, we included a number of 400 patients with odontogenic maxillary sinusitis divided into two groups, treated in our hospital over five years, from January 2019 to December 2023. The patients included in this research were over 18 years old, diagnosed with odontogenic maxillary sinusitis, and underwent either middle meatal antrostomy or inferior meatotomy. Results: We examined the medical records of 400 patients. The vast majority of patients had a history of dental interventions, and the most affected tooth was the first maxillary molar. The symptoms at admission were typical for sinusitis: nasal obstruction, anterior or posterior rhinorrhea, hyposmia to anosmia, cacosmia, and pain or facial pressure. 80% of the patients in the study underwent middle meatal antrostomy, while 20% underwent inferior meatotomy. There were no significant differences between these two approaches in terms of efficacy, complication rates, recovery, or relapses. The complications that occurred after the surgical treatment were minor and with a very low frequency. The most reported were middle meatus synechiae and the persistence of the meatotomy ostium, with mucus recirculation (in patients with inferior meatotomy). Conclusions: Endoscopic surgical treatment of odontogenic maxillary sinusitis can be done as middle or inferior meatotomy, each having specific indications. The maxillary antrostomy is preferred in the majority of cases, as it is a procedure in which the natural ostium of the maxillary sinus is enlarged, thereby maintaining the natural drainage pathway of the sinus. However, the inferior meatotomy is preferred in the case of foreign bodies or maxillary sinus retention cysts localized at the level of the sinus floor or in the alveolar or lateral recesses, or as part of a combined approach (inferior and middle meatotomy), when the ablation of a "fungus ball" is required.

[Risk factors of perioperative hypertension in dental implant surgeries with bone augmentation].

OBJECTIVE: To investigate the characteristics and risk factors of perioperative hypertension during dental implant surgeries with bone augmentation. METHODS: A retrospective cohort study was conducted. Seven hundred and twenty-eight cases underwent dental implant placement and bone augmentation in Peking University School and Hospital of Stomatology from September 2021 to August 2022 were recruited in this study according to the inclusion and exclusion criteria. They were divided into different groups according to the exposure factors which were gender, age, surgical time, and surgical approach. The correlation between perioperative hypertension and the exposure factors was analyzed. RESULTS: The average systolic blood pressure variability was 9.93%±6.63% (maximum 50.41%), the average diastolic blood pressure variability was 12.45%±8.79% (maximum 68.75%), and the average mean arterial pressure variability was 10.02%±6.61% (maximum 49.48%). The incidence rate of perioperative hypertension was 26.77%. Male, age ≥ 60 years, and surgical time > 60 minutes were risk factors for perioperative hypertension (P < 0.05), and the relative risks (95%CI) were 1.74 (1.21-2.50), 2.35 (1.54-3.58), and 1.65 (1.15-2.38), respectively. There was no significant difference in the incidence of perioperative hypertension among the guided bone regeneration, sinus floor elevation with transalveolar approach, and sinus floor elevation with lateral window approach (P>0.05). However, the risk factors varied according to bone augmentation approaches. For the patients underwent guided bone rege-neration, the risk factors for perioperative hypertension included male, age ≥ 60 years, and surgical time > 60 minutes (P < 0.05). For the patients underwent maxillary sinus lift with transalveolar approach, the risk factor for perioperative hypertension was age ≥60 years (P < 0.05). For the patients underwent maxillary sinus lift with lateral window approach, male, age ≥60 years, and surgical time >60 minutes were not risk factors for perioperative hypertension (P>0.05). CONCLUSION: There was a certain risk of perioperative hypertension in oral implantation with bone augmentation. The influence of male, age ≥60 years and surgical time > 60 minutes on perioperative hypertension was related to the approach of bone augmentation.

Clinical outcomes and risk factor analysis of dental implants inserted with lateral maxillary sinus floor augmentation: A 3- to 8-year retrospective study.

AIM: To evaluate the 3- to 8-year outcomes of dental implants placed with lateral sinus floor augmentation (LSFA) and to identify factors affecting implant survival. MATERIALS AND METHODS: This retrospective study was performed by screening all implants placed with LSFA procedures, which were conducted between January 2012 and December 2016. Subantral bone gain (SABG) and apical bone height (ABH) were assessed using panoramic radiographs. The cumulative survival rate of implants was analysed using life-table analysis and Kaplan-Meier survival curves. The influential risk factors affecting survival were assessed using univariate log-rank tests and multivariable mixture cure rate model. Implant complications were recorded. RESULTS: Based on the established criteria, a total of 449 patients (760 implants) were included in this study. In the 3- to 8-year follow-up (mean ± SD, 5.81 ± 1.33 years), 15 implants in 14 patients failed, with a CRS of 96.81% on an implant basis and 95.07% on a patient basis. A history of periodontitis and poor compliance with supportive periodontal treatment was associated with a significantly higher risk of implant failure at both implant and patient levels. Significant decreases in ABH occurred during each yearly interval except for 3 years. A similar trend has been observed for SABG at 1, 2, 6 and 8 years. The total complication rate was 31.84% on implant basis, with peri-implant mucositis (21.58%) being the most frequent biologic complication and porcelain cracking (5.00%) being the most common technical complication. CONCLUSIONS: Implant with LSFA is a reliable treatment option in atrophic maxilla. A history of periodontitis without regular supportive periodontal treatment was identified as a predictor for implant failure. Slight but significant shrinkage of vertically augmented bone can be observed after implant placement.

Comparison of sinusitis rate after sinus lift procedure and zygomatic implant surgery: a meta-analysis.

PURPOSE: To evaluate and compare the reported sinusitis occurrence after the sinus lift procedure and zygomatic implant placement. METHODS: This meta-analysis has been registered at PROSPERO. Studies were searched on six databases. Two authors screened titles and abstracts and fully analyzed the studies against the inclusion and exclusion criteria. The RoB 2.0 and the ROBINS-I tools were used to assess the quality and risk of bias of the included studies. The random-effects model was used for the meta-analysis. The prevalence of sinusitis was calculated based on the total of patients. Subgroup analysis was performed by sinus lift or zygomatic implant surgery technique. RESULTS: The search identified 2419 references. After applying the inclusion criteria, 18 sinus lift and 9 zygomatic implant placement studies were considered eligible. The pooled prevalence of sinusitis after sinus lift procedure was 1.11% (95% CI 0.30-2.28). The prevalence after zygomatic implant placement was 3.76% (95% CI 0.12-10.29). In the subgroup analysis, the lateral window approach showed a prevalence of sinusitis of 1.35% (95% CI 0.34-2.8), the transcrestal technique of 0.00% (95% CI 0.00-3.18), and the SALSA technique of 1.20% (95% CI 0.00-5.10). Regarding the techniques for zygomatic implant placement, the sinus slot technique showed a prevalence of 21.62% (95% CI 9.62-36.52) and the intrasinus technique of 4.36% (95% CI 0.33-11.08), and the prevalence after the extrasinus technique was 0.00% (95% CI 0.00-1.22). CONCLUSION: The sinusitis occurrence rate was higher after zygomatic implant placement than after sinus lift procedure and this occurrence was different depending on the used technique.

How to Prevent and Manage Postoperative Complications in Maxillary Sinus Augmentation Using the Lateral Approach: A Review.

Maxillary sinus augmentation with a lateral approach is known to present more postoperative complications than other atrophic posterior maxilla treatment modalities because it is more invasive. These complications include infections that occur in the form of chronic or acute sinusitis. According to the literature, the frequency of these complications ranges from 3% to 5%. They can result from an inadequate management of intraoperative complications or from a poor evaluation of maxillary sinus particularities and pathology before the surgery. Therefore, the prevention of postoperative complications lies in the selection of cases that will allow for the identification and evaluation of infectious risk. Only a multidisciplinary approach that includes an implantologist, a rhinologist, and the treating physician will allow this. On the other hand, in infectious complication cases, the intervention of the otorhinolaryngologist (ENT) specialist is necessary. Based on the available literature and the author's experience, the methodology described in this article will allow for the prevention and management of postoperative complications related to this surgical technique.

[Osteotome sinus floor elevation with tapered implants: a short-term evaluation].

PURPOSE: The aim of this study was to evaluate the short-term clinical outcome of tapered implants placed in posterior maxilla with osteotome sinus floor elevation (OSFE) technique. METHODS: The study population comprised 40 patients in whom 44 Astra tapered implants were inserted with OSFE technique from March to September in 2019. The surgical indication was that the bone height below the maxillary sinus was considered to be 2mm ~8mm. Astra tapered implants were inserted. Prosthetic restoration was completed 4 months after surgery. The implant success rate and stability, as well as osseointegration of the implant were clinically evaluated, and bone gain around the implants were measured. The data were analyzed using SPSS 19.0 software package. RESULTS: During the study period,the implant survival rate was 100%. The mean variation of implant stability quotient(ISQ) was 12.07±5.86. The mean value of ISQ ranged from 67.55±8.07 to 79.62±5.08. The average marginal bone loss was (0.32±0.29) mm. The endo-sinus bone gain(ESBG) was (1.06±0.4) mm. No mechanical complication was observed. The average probing depth around the implant was (3.2±1.51) mm, the bleeding on probing rate was(11.36±4.28)%, and the modified plaque index was 1.23±0.43. CONCLUSIONS: Astra tapered implants were found to produce predictable results in osteotome sinus floor elevation surgery. Further properly designed clinical trials are required to validate the use of tapered dental implants in sinus floor elevation technique.

The Impact of Sinus Floor Elevation Techniques on Sinus Membrane Perforation: A Systematic Review and Network Meta-analysis.

Purpose: To compare the risk of sinus membrane perforation (SMP) among lateral window sinus floor elevation (LSFE) and transcrestal sinus floor elevation (TSFE) techniques in prospective and retrospective studies for patients who underwent sinus augmentation for dental implant placement. Materials and Methods: A database search was conducted to screen the literature published from January 1960 to August 2021. The associations between SMP and surgical techniques as well as other clinical factors were evaluated via network meta-analysis. The impact of SMP on vertical ridge gain and implant survival was also evaluated. Results: Eighty-five studies with 5,551 SFE procedures were included. In LSFE techniques, using rotary burs showed the highest risk of SMP (surface under the cumulative ranking area [SUCRA] = 0.0745). In TSFE techniques, using reamers had the lowest risk of SMP (SUCRA = 0.9444). Increased SMP prevalence was significantly associated with reduced implant survival rate (odds ratio [OR] = 0.45 per 10% increase of SMP rate [95% credible interval (CreI): 0.21, 0.71], P < .001). Conclusions: With the inherent limitations, this network meta-analysis suggested that some techniques within either the LSFE or TSFE group may reduce SMP risk. Additional randomized controlled trials and better assessment of SMP are required to directly compare the risk of SMP between LSFE and TSFE.

Which factors affect the risk of membrane perforation in lateral window maxillary sinus elevation? A prospective cohort study.

It was the aim of this prospective cohort study to assess the various anatomical and other patient-related factors that increase membrane perforation risk. Patients underwent cone-beam computed tomography (CBCT) before surgery. The presence of septa, presence of mucous retention cyst, lateral wall thickness, membrane thickness, and residual bone height were predictive factors. Age, gender, and smoking were covariates for the study. The presence or absence of membrane perforation was the study outcome. In total, 140 subjects were studied. The hazard ratio (HR) for the presence of septa with membrane perforation was 8.07 (2.93-22.29) (p < 0.001). The HR for perforation with a single edentulous area relating to two or more teeth was 68.09 (9.52-49.16). The risk of membrane perforation in smokers was 25 times more than in non-smokers - HR 25 (7.58-82.51) (p < 0.001). The HR for membrane perforation in subjects with mucous retention cysts compared with subjects without retention cysts was 27.75 (8.73-88.23) (p < 0.001). Within the limitations of the study it seems that anatomical, habitual, and pathological factors may increase the risk of Schneiderian membrane perforation when a lateral window approach is used for sinus floor augmentation.

Effectiveness and complications of transcrestal sinus floor elevation using the cushioned grind-out technique: A retrospective cohort study with up to 7 years of follow-up.

AIM: To evaluate the effectiveness and complications of the cushioned grind-out technique. The primary outcome was endo-sinus bone gain (ESBG), while secondary outcomes included the Schneiderian membrane perforation rate and mid- to long-term implant survival. MATERIALS AND METHODS: In this retrospective study, we compared the cushioned grind-out technique with the classic osteotome technique, establishing statistical models to assess ESBG, membrane perforation rate and implant survival rate. RESULTS: A total of 259 patients and 340 implants were included. The mean ESBG was 5.31 mm for the cushioned grind-out group and 4.64 mm for the osteotome group. Multivariable regression analysis revealed that the cushioned grind-out technique significantly facilitated ESBG (p = .028). Nineteen preparation sites experienced membrane perforation, with rates of 5.5% and 6.4% for the cushioned grind-out and osteotome groups, respectively. However, the difference was not statistically significant (p = .920). Additionally, the cumulative survival rate of the implants for 7 years was 95.2% and 91.4%, respectively, with the surgical technique not significantly influencing the results. CONCLUSIONS: With 6 months to 7 years of post-prosthetic restoration review data, our findings show that the cushioned grind-out technique facilitates a higher ESBG, with no significant difference in membrane perforation or implant failure rate.

How to avoid intraoperative and postoperative complications in maxillary sinus elevation.

Maxillary sinus floor elevation, via the lateral approach, is one of the most predictable bone augmentation procedures performed in implant dentistry. but both intra- and postoperative complications can occur, and some of them are severe. Our aim is as follows: To review the pertinent literature on the topic, especially assessing the risk factors related to complications. To give clinical recommendations to minimize intra- and postoperative complications with the ultimate scope of improving the standard of clinical care and patient safety.

Risk factors and longitudinal regenerative outcomes of sinus membrane perforation during lateral window sinus floor elevation: A retrospective analysis up to 9 years.

BACKGROUND: Lateral-window sinus floor elevation (LSFE) is a reliable procedure to reconstruct the posterior maxilla for implant therapy. This retrospective study aimed to investigate risk factors associated with Schneiderian membrane perforation (SMP) occurrence during LSFE and longitudinal regenerative outcomes following LSFE up to 9 years. METHODS: Patients who had LSFE between 2010 and 2019 were included. All demographic and surgical-related data were retrieved from existing electronic health records. Radiographs were used to evaluate the vertical dimensional changes of ridge and graft materials and the potential anatomic factors of SMP. RESULTS: A total of 122 LSFE procedures in 99 patients were included in the study. Mean ridge height gain and graft shrinkages were 9.5 ± 3.47 and 1.57 ± 2.85 mm. The influence of the healing period on graft shrinkage showed a positive trend; the longer the healing period, the greater the graft shrinkage (p = 0.09). The pathology in the sinus showed a positive correlation with SMP (p = 0.07). However, other anatomical factors did not negatively impact SMP and subsequent ridge height gain (p > 0.05). CONCLUSIONS: With inherent limitation, the findings with up to 9 years of follow-up indicate a consistent ridge remodeling lasting for about 3 years after LSFE procedures. SMP or membrane thickening may not significantly affect the ridge gain following LSFE. The healing period had the most significant influence on graft shrinkage, showing that the longer the healing time between LSFE and implant placement, the greater the graft shrinkage.

Association between smoking and Schneiderian membrane perforation during maxillary sinus floor augmentation: A systematic review and meta-analysis.

OBJECTIVE: To estimate the association between smoking and Schneiderian membrane perforation in sinus floor augmentation. MATERIALS AND METHODS: Searches were conducted in PubMed, Web of Science, Embase, and Cochrane Library. Data were extracted by two authors independently. The inclusion criteria were the (1) age of patients >18, (2) the number of participants >10, and (3) smoking and the patients of Schneiderian membrane perforation were accurately recorded. The risk of bias was assessed by the Newcastle-Ottawa scale (NOS). Statistics analyses were conducted using Reman5.4.1 and Stata (15.0). The association of Schneiderian membrane perforation with smoking habits during maxillary sinus floor elevation was expressed as odds ratios (ORs) with a 95% confidence interval (95% CIs). And the I2 statistic was used to estimate statistical heterogeneity. The funnel plot and Egger's tests were used to evaluate the reliability and stability of the results. RESULTS: Of 1463 articles screened, nine studies were included in our systematic review, and eight were synthesized for meta-analysis. Eight were retrospective observational studies and one was a clinical trial, with a total of 1424 patients included. The nine studies were proved as high quality according to the NOS. There was no significant publication bias in the studies (p = 0.827). A random-effects model was used because of differences in the adopted methodologies (p = 0.39, I2  = 5%). During maxillary sinus augmentation, smoking and Schneiderian membrane perforation were associated (odds ratios, 1.58 [95% CI, 1.10-2.25]). CONCLUSION: Smoking increased the risk of membrane perforation in maxillary sinus floor augmentation. Our evaluation was limited by the poor reporting of the number of cigarettes smoked per day (PROSPERO number was CRD42022306570).

Sinus augmentation procedure via the lateral window technique-Reducing invasiveness and preventing complications: A narrative review.

Sinus augmentation has become an integrated surgical phase in posterior maxillary implant prosthesis reconstruction. Since the residual alveolar bony height usually requires additional volume particularly at this anatomical region, sinus floor augmentation is advocated routinely. Over the years, Implant success rate is proved to be comparable to the one in the pristine bone, which is well documented in the literature. Anatomical aspects as well as surgeon skills are at most importance to achieve predictable outcome. In this narrative review, the different osteotomy techniques, the indications toward 1 or 2-stage approaches, the control of the Schneiderian membrane integrity as well as the management of intra- and post-operative complications are thoroughly discussed according the current data. In light of the excellent long-term implant success rate concurrent with the application of contemporary advanced techniques of the sinus augmentation via the lateral wall osteotomy approach, reduce invasiveness and less complication occurrences are well documented. A well-codified patient selection involving the rhinologist as an integral medical team would be significantly beneficial toward early diagnosis. In-depth knowledge of the anatomy, execution of a well standardized surgical technique, and understanding the complication etiology and their management are prerequisites for reducing patient morbidity to minimal discomfort and predictable successful outcome.

Simultaneous placement of short implants (≤ 8 mm) versus standard length implants (≥ 10 mm) after sinus floor elevation in atrophic posterior maxillae: a systematic review and meta-analysis.

PURPOSE: The objective of this meta-analysis was to compare the clinical outcomes of using short implants (≤ 8 mm) inserted with osteotome sinus floor elevation (OSFE) and standard implants (≥ 10 mm) inserted with sinus floor elevation (SFE) in atrophic posterior maxillae with insufficient residual bone height (RBH). METHODS: An electronic search was performed on PubMed, EMBASE, and the Cochrane Library from 1994 to July 2022, in combination with a manual search of references in relevant articles. Randomized controlled trials (RCTs) that compared the clinical results between short and standard implant placement with SFE were included. The primary outcomes were implant survival rate and marginal bone loss (MBL); the secondary outcome was complication rate. RESULTS: Three RCTs were included, totaling 138 short and 156 standard implants. The results of the meta-analysis showed no significant differences between the short and standard implant groups in survival rate (RR = 1.02, 95% CI 0.96-1.08, p = 0.570), MBL (MD = - 0.13, 95% CI - 0.32 to 0.07, p = 0.190) and complication rate (intra-surgical complication: RR = 1.14, 95% CI 0.46-2.83, p = 0.770; post-operative complication: RR = 1.34, 95% CI 0.71-2.55, p = 0.370). CONCLUSIONS: Using short implants (≤ 8 mm) combined with OSFE might be an alternative to standard implants (≥ 10 mm) with SFE when the RBH of the posterior maxilla is insufficient. Based on a short-term clinical observation, short implants with OSFE show good results in terms of survival rate, MBL, and complication incidence.

Low Window Sinus Elevation Technique: Bone Gain and Postsurgical Discomfort. A Retrospective Case Series.

Recently, the Low Window technique was proposed to facilitate sinus augmentation and reduce postsurgical patient discomfort. It was shown to be both safe and effective. This case series evaluates the postsurgical discomfort of patients undergoing Low Window sinus augmentation, the bone gain achieved, and whether these factors correlate with the osteotomy area. Records of patients (n = 26) who underwent a sinus elevation using the Low Window approach (n = 34 interventions), followed by implant placement and prosthetic rehabilitation (n = 97 implants), were assessed retrospectively. The analyzed outcomes were the medial, middle, and lateral bone gain ≥ 9 months after augmentation; pain at 5 to 6 hours postsurgery, evaluated on a visual analog scale (VAS; 0 to 100); pain, swelling, and hematoma formation every day up to 7 days postsurgery, evaluated by VAS; implant and prosthetic success and survival rates; and rate of complications. The average follow-up time was 62.1 ± 14.9 months. No intraoperative sinus membrane perforations or other complications occurred. Medial, middle, and lateral bone gains were 10.1 ± 1.7 mm, 11.6 ± 0.8 mm, and 10.7 ± 0.9 mm, respectively. At the last follow-up, the implant success rate was 99%. Postsurgical VAS pain 5 to 6 hours postsurgery was 12.3 ± 8.0 and decreased significantly thereafter. Swelling prevalence was 29.4% at 1 day postsurgery, 20.6% at 2 days, and 2.9% the following day. No swelling was observed from day 4 onward. Prevalence of hematoma was 8.8% for 2 days postsurgery, 2.9% the day after, and no hematoma was observed thereafter. Only the osteotomy area correlated with immediate postsurgical pain, but not with other discomfort outcomes or with bone gain. Low Window sinus elevation might allow bone gain and medium-term implant and prosthetic success rates similar to that of other access window designs. Prospective, comparative studies are needed to investigate whether the technique is more advantageous than traditional approaches.

Incidence of Sinus Membrane Perforation Using Two Types of Implant Drills: An Ex Vivo Animal Study.

This ex vivo study evaluates the incidence of sinus membrane perforation during implant site osteotomy with two different types of drills and drilling techniques. Fifty goat heads with 50 sinus pairs (100 sinus sides) were assigned to two groups (osseodensification bur [OB] group and inverse conical shape bur [ICSB] group) to simulate transcrestal sinus elevation (50 sinus sides per group). An osteotomy was performed to pass through the lateral sinus wall no more than 3 mm. The integrity of the sinus membranes was examined and confirmed under a microscope. Of the 50 sinuses per group, the OB group presented with 14 (28%) perforated sinuses, while the ICSB group presented with 2 (4%) perforated sinuses. Of the 14 perforations from the OB group, 6 (42.9%) showed a pinpoint perforation pattern, 4 (28.5%) of which were not visible until direct air pressure was applied. Overall, the ICSB drill group demonstrated a lower sinus perforation rate than the OB group.

Complications of sinus floor elevation procedure and management strategies: A systematic review.

AIM: This systematic review aimed to investigates the types and incidences of complications following sinus floor elevations (SFE) along with their prevention and management strategies. MATERIALS AND METHODS: Electronic database and hand search were conducted to screen the literature published from January 1960 to June 2021. The selected studies had to report well-described SFE techniques, complications during, and post-SFE. Data extraction included types of SFE techniques, complications, and their treatment strategies. RESULTS: A total of 74 studies with 4411 SFE procedures met the inclusion criteria. Different SFE techniques demonstrated varying patterns for both complications and complication rates. Postoperative pain, swelling, and edema were widely reported. The most common complications that required intervention following Lateral SFE (LSFE) were sinus membrane perforation (SMP), wound dehiscence, graft exposure and failure, and sinusitis. LSFE had more SMPs and sinusitis cases compared with a transcrestal SFE (TSFE). The presence of benign paroxysmal positional vertigo following TSFE was significant in certain selected studies. CONCLUSION: Given the inherent limitations, this systematic review showed distinct features of complications in SFE using varying techniques. Treatment planning for these procedures should incorporate strategies to avoid complication occurrence.

Intraoperative complications and early implant failure after transcrestal sinus floor elevation with residual bone height ≤5 mm: A retrospective multicenter study.

OBJECTIVE: Clinical indications for maxillary sinus floor elevation with transcrestal techniques have increased in recent years even in sites with minimal residual bone height (RBH). Nevertheless, limited information is currently available on incidence of intraoperative complications and early implant failure in these cases. MATERIAL AND METHODS: This retrospective multicenter study was performed on anonymized clinical and radiographic records of patients who underwent transcrestal sinus floor elevation in seven clinical centers. Influence of different factors related to patient, and sinus anatomy and surgical technique on the incidence of intraoperative complications and early implant failure rate after transcrestal sinus lift were investigated. RESULTS: A total of 430 patients treated with transcrestal sinus floor elevation for single-implant insertion in sites with RBH ≤5 mm were included in the final analysis. After 1 year of loading, 418 implants of 430 were satisfactorily in function. Early implant failure was recorded in 12 cases (2.8%); results were significantly associated with the presence of large sinus cavities and with the occurrence of membrane perforation. The following adverse events were recorded: membrane perforation (7.2%), acute sinusitis (0.9%), implant displacement into the sinus cavity (0.7%), oro-antral fistula (0.2%), and benign paroxysmal positional vertigo (0.5% of osteotome cases). A strong direct correlation between sinus membrane perforation and bucco-palatal sinus width (p = .000) was demonstrated. CONCLUSIONS: Early implant failure after transcrestal sinus elevation showed significant direct correlation with bucco-palatal maxillary sinus width and the presence of membrane perforation. Sinus membrane perforation was strongly associated with bucco-palatal sinus width (extremely low perforation rate in narrow and much higher incidence in wide sinuses).

Postoperative Bleeding in Patients Under Direct Oral Anticoagulation After Maxillary Sinus Floor Augmentation: A Case-Control Study.

PURPOSE: The aim of this case-control study was to investigate the occurrence of bleeding events related to maxillary sinus elevation with a lateral window in patients under direct oral anticogulant therapy. MATERIALS AND METHODS: Seventyseven consecutive patients were scheduled for unilateral maxillary sinus floor elevation using a lateral window approach. Participants were divided into two groups: group A, formed by 37 patients who were under novel oral anticoagulation therapy (rivaroxaban/apixaban), and a control group, composed of 40 healthy subjects. Within group A, assumption of direct oral anticoagulants was not suspended nor modified before surgical procedures. Time (early/delayed) and site (intraoral/extraoral) of bleeding episodes were recorded in both groups of patients, in addition to bleeding severity (mild, moderate, or severe). RESULTS: Maxillary sinus floor elevation was performed in all patients. One dropout happened due to intraoperative membrane perforation. Overall bleeding episodes were comparable in both groups, chi-square (1) = .68, P = .41. Early intraoral bleeding events were more common in absolute terms, but also occurred with approximately the same frequency in both group A and the control group (Fisher exact tests: P = 1.00 and P = .375, respectively). No severe bleeding was observed in any of the attended patients. CONCLUSION: Within the limitations of this case-control study, maxillary sinus floor augmentation with a lateral window approach can be safely administered to patients who are under direct oral anticoagulation therapy when specific recommendations are instituted.

Complications in sinus lifting procedures: Classification and management.

Open and closed sinus lifting procedures are predictable methods to augment the bone needed for appropriate implant placement in the posterior maxilla in cases where available bone is limited. However, these techniques may give rise to complications and associated comorbidities. In the case of open sinus lifting, perforation of the Schneiderian membrane during osteotomy is the most common complication, with an incidence rate of around 20%-25%. Apart from those complications associated with oral surgery in general (such as swelling or hematoma), there are specific complications of open sinus lifting procedures that may arise less frequently (chronic rhinosinusitis, hemorrhage, or ostium blockage by overfilling) but which may nevertheless compromise the viability of the graft and/or the implants and cause substantial discomfort to the patient. Closed sinus lifting is a less invasive approach that allows transcrestal placement of the implants in cases where there is sufficient residual bone height. However, it may also be associated with specific complications, including membrane perforation, benign paroxysmal positional vertigo, and implant displacement to the sinus cavity. New technologies have been proposed to reduce these complications and comorbidities associated with conventional sinus lifting procedures, such as the use of piezoelectric devices and hydraulic sinus lift or reamer burs. The evidence supporting their effectiveness and safety, however, is still lacking. A detailed medical history together with a thorough radiographic and clinical examination are essential prior to any kind of bone regenerative augmentation involving the maxillary sinus. Moreover, it is recommended to employ the most appropriate surgical technique for the specific characteristics of the case and, at the same time, accommodating the experience and skills of the surgeon.