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.

Dental Evaluation: Oral Surgery-Related Complications.

The article provides an in-depth review focused on diagnosing oral surgery-related complications that may cause odontogenic sinusitis (ODS). It emphasizes the importance of evaluating patients with prior oral surgical procedures to determine whether the prior procedure is an ongoing infectious source of the ODS. Specifically, diagnostic evaluations will be described for detecting oroantral communications and fistulas, dental implant dislocation or protrusion, and whether implants and graft placed in maxillary sinuses are infected. It highlights the role of different oral examination techniques, optimal imaging modalities, and the importance of otolaryngologic collaboration to evaluate for infectious ODS.

Minimally Invasive Sinus Augmentation: A Systematic Review.

AIM: Technology improvement and a better understanding of sinus anatomy and wound healing in the past decade have allowed the development of minimally invasive surgical techniques. This systematic review focused on identifying and describing these techniques for vertical and lateral sinus augmentation (VSA and LSA). MATERIALS AND METHODS: Electronic and hand search were conducted to screen the literature published from January 2003 to May 2024. The selected studies had to include detailed techniques for minimally invasive SA. Data extraction included the study types, sample size, technique/instrument details, and outcome measurements. RESULTS: A total of 36 articles (27 VSA, 8 LSA with an additional 1 article included both procedures) with 2732 sinus augmentation met the inclusion criteria. Minimally invasive VSA includes the use of modified rotary instruments with stopper, balloon, hydraulic pressure, digital planning, endoscope, and operating microscope. These techniques aim for conservative flap reflection, precise sinus window preparation, and/or controlled sinus membrane elevation. Most of the selected studies (n = 15) did not report the incidence of sinus membrane perforation. CONCLUSION: Within the limitations of this review, minimally invasive VSA and LSA achieved sufficient sinus augmentation and implant success with the potential advantages of reduced surgical complications and morbidity. Comparative studies with defined outcomes are encouraged to further validate these useful minimally invasive techniques for SA.

Maxillary sinus opacification after surgery in asymptomatic patients: Transient swelling of the sinus mucosa or graft dispersion into the maxillary sinus. A radiographic report of three cases after a follow-up period of at least 5 years.

Maxillary sinus grafting is a predictable regenerative technique to facilitate maxillary posterior implant placement when there is insufficient vertical bone height inferior to the maxillary sinuses to allow placement of implants of adequate dimensions. It enables an increase in vertical bone height, which makes implant placement easier. Maxillary sinus mucosal membrane perforation is one of the most common intraoperative complications during maxillary sinus grafting and may result in extrusion of graft material into the sinus. When this occurs, the mucociliary function of the maxillary sinus may expel the extruded graft material through its natural ostium, though graft particles may remain in the sinus or possibly occlude the natural ostium. After grafting, transient maxillary sinus mucosal oedema may occur. A postoperative CBCT scan may reveal varying degrees of sinus opacification, namely partial, subtotal or total. Although it is always possible to identify graft material, which may enter the sinus as a result of membrane perforation that might not even be visible to the implantologist during the surgical procedure, it is challenging to assess whether sinus opacification is due to mucosal thickening or mucus accumulation. The aim of the present case series was to offer a pragmatic approach to managing asymptomatic patients whose CBCT scans demonstrated partial, subtotal or total maxillary sinus opacification with bone graft particles that seemed to have been extruded into the sinus.

Mucosal cyst aspiration in conjunction with maxillary sinus elevation: A clinical cohort study.

INTRODUCTION: Patients with mucosal cysts in the maxillary sinus require special consideration in patients who require implant therapy for the restoration when undergoing implant therapy for the restoration of the posterior maxillary dentition. Treatment strategies for these clinical situations remain controversial in the literature. Thus, this study seeks to describe a safe and effective therapeutic strategy for sinus augmentation in patients with pre-existing maxillary antral cysts. METHODS: A total of 15 patients and 18 sinuses were consecutively enrolled in this cohort study and underwent maxillary antral cyst treatment by needle aspiration and simultaneous maxillary sinus augmentation (MSA). During surgical procedures, threeimplants (Zimmer Biomet, Indiana, USA) were positioned in 11 sinuses and two implants (Zimmer Biomet, Indiana, USA) were positioned in 5 sinuses. RESULTS: Overall implant success and survival rates were 100% and 97.8%, respectively at 1 year and 5-year follow-ups. Crestal bone resorption averaged 0.3 ± 0.2 mm 5-year post-loading, showing bone stability. Implant survival rate at 5-year follow-up expressed predictability of the technique comparable to historical data when MSA was performed alone. Crestal bone resorption averaged 0.3 ± 0.2 mm 5 years post-loading and shows bone stability utilizing mucosal cyst aspiration with concomitant MSA procedures. Quality of life evaluation at 1-week post-op showed similar results to published historical data. In 81% (13 sinuses), the CBCT examination at 5-year follow-up showed no cyst reformation, in 19% (3 sinuses) cyst reformation was visible, but smaller in size when compared to the pre-op CBCT evaluation, and all the patients were asymptomatic. CONCLUSIONS: Maxillary sinus mucosal cyst aspiration with concomitant MSA, may be a viable option to treat maxillary sinus cyst.

Soft tissue-related complications around anterior implants: commentary and clinical checklist.

Implant-based rehabilitation is a clinical challenge, especially in the esthetic area. Numerous factors influence the outcome of the rehabilitation; however, the two main factors are the bone and soft-tissue deficiencies at the intended implant site. Peri-implant soft tissue complications can arise from a combination of factors that can be summarized as two categories: diagnostic errors and surgical planning management errors. Most of the complications can be corrected after each step of the treatment and even after the delivery of the prosthetic restoration with adequate soft tissue management in order to give the patient an esthetically pleasing outcome. The aims of this article were: to present the current literature, to propose a clinical checklist to guide clinicians in evaluating the prognosis of the treatment utilizing soft tissue grafting, and to illustrate a case series partially employing the proposed clinical checklist. The proposed checklist could be helpful in evaluating the prognosis of the treatment utilizing only soft tissue grafting. In clinical cases in which the prognosis is classified as good, soft tissue management could be a viable treatment option before attempting more radical procedures like implant removal.

Long-Term Results of Intraforaminal Immediately Loaded Implants and Posterior Mandibular Regrowth Evaluation in Severely Atrophic Mandibles.

PURPOSE: The aim of this clinical study was to verify the predictability of the rehabilitation of extremely atrophic jaws with immediately loaded short implants and evaluate posterior mandibular regrowth. MATERIALS AND METHODS: A cohort of consecutive fully edentulous patients wearing complete dentures in both arches was enrolled. Periodically, implant survival and prosthetic success were assessed. After informed consent, a subsample of 10 patients who had preoperative CBCT underwent a postoperative CBCT 1 year after immediate implant loading, and 3D superimpositions of pre- and postoperative images were performed. Linear measurements of bone height were performed at two sites in each hemimandible and, on the same sections, bone density according to the qualitative gray values (GVs) was analyzed in an area of 3 mm2 including the cortical mandibular bone. RESULTS: Fifty-nine fully edentulous patients (31 females, 28 males) with Class VI atrophic mandibles according to Cawood and Howell were rehabilitated with the insertion of four to five short implants (4-mm diameter, 7- or 8.5-mm long). Overall, 251 implants were immediately loaded with a fixed hybrid prosthesis. Four patients did not show up for recall visits, bringing the final number down to 55 patients (31 females, 24 males) and 231 implants. In up to 14 years of follow-up, a total of 4 implant failures were recorded (cumulative survival rate, 98.4%). The biologic complications included 9 mucositis (3.9%) and 3 peri-implantitis (1.3%) at implant-level analysis. Mechanical complications involved 9 chippings of the prosthetic restorations (17.0%). In the 10-patient subsample, the analysis showed bone growth (average of 1.2 ± 0.7 mm) in the posterior areas of the mandible. In addition, bone density was found to increase 17% to 27% with reference to the preoperative CBCT. CONCLUSION: The immediate loading of short implants may represent a feasible therapeutic option for the treatment of fully edentulous patients with severely atrophic mandibles. Bone regrowth in the posterior areas and an increase in bone density of the mandible may occur.

The Buccally Displaced Palatal (BDP) Flap to Increase Quantity and Thickness of Peri-implant Soft Tissue.

Common challenges encountered for atrophic maxilla rehabilitation are the inadequate width and height of attached keratinized mucosa (AKM) and shallow vestibular depth. This study presents a buccally displaced palatal (BDP) flap technique to increase the tissue thickness and AKM width at the second-stage surgery and reestablish the correct fornix depth. The peri-implant pocket depths, modified Plaque Index score, modified sulcus Bleeding Index score, and soft tissue recession were evaluated 6 and 12 months after prostheses loading. A total of 52 implants were placed and analyzed, and no implant failures were found. No significant changes in peri-implant parameters were observed between 6 and 12 months, and mean recession was less than 0.2 mm after 12 months. Though this change was statistically significant, it was clinically irrelevant. The results demonstrate that adequately healthy peri-implant soft tissues and substantial dimensional stability of vestibular soft tissues at the 1-year follow-up were achieved with the BDP flap technique. The BDP flap could represent a viable option for increasing the width and the height of AKM and establishing the correct maxillary fornix depth.

Split-Thickness Flap for the Management of a Maxillary Sinus Wall Bony Fenestration During Lateral Window Sinus Augmentation: Case Reports and Technical Surgical Notes.

Maxillary sinus wall fenestration at the lateral wall or floor of the sinus can result from many potential factors, such as the repair of oro-antral communication, Caldwell-Luc antrostomy, tooth extraction after an endodontic or periodontal infection that eroded the sinus wall, and the combination of sinus pneumatization and alveolar ridge resorption after teeth removal. When sinus wall fenestration is observed on radiographs, it usually indicates adhesion between the sinus membrane and buccal flap, which makes the reentry surgery for subsequent sinus augmentation challenging. To minimize surgical complications in these challenging scenarios, this paper presents a split-flap surgical technique for the management of soft tissue adhesion between the sinus membrane and alveolar mucosa when attempting a lateral window sinus augmentation.

Total Face Approach (TFA) 3D Cephalometry and Superimposition in Orthognathic Surgery: Evaluation of the Vertical Dimensions in a Consecutive Series.

BACKGROUND: Cephalometry is fundamental in diagnosis, analysis, and planning of orthodontic-surgical treatment as it reveals skeletal relationship between the upper and lower jaw as well as facial aesthetic parameters. Nevertheless, 3D cephalometry has still not become the exam of choice in orthognathic treatment even though today CBCT (Cone Beam Computed Tomography) is routinely used in other branches of dentistry. METHODS: In a sample of 13 patients undergoing bimaxillary orthognathic surgery a chin-vertex CBCT exam was prescribed prior to orthodontic treatment (OT) and 12 months after surgery (T1). The DICOM files uploaded to MaterialiseSimplant Ortho software pro 2.1 (Materialise Co., Leuven, Belgium) were analyzed following the multiplane 3D Total Face cephalometry protocol (TFA). RESULTS: Results comparing pre-op and post-op TFA 3D cephalometry, were then evaluated considering reference values reported in literature. The CBCT, carried out pre- and post-surgery, were subsequently analyzed employing the superimposition method using cranial base as reference. The aim of this study is to evaluate the advantages and disadvantages of the two methods in orthognathic surgery. CONCLUSIONS: Multiplane 3D TFA allows the clinician to locate where major or minor skeletal discrepancies are found with respect to ideal parameters and is also useful in classifying skeletal intermaxillary relation. The superimposition method is highly intuitive but does not provide information on the quantity and location of osteotomic movement.

Simplified Digital Protocol for Fully Edentulous Immediate Implant Placement and Loading: A Report of 10 Consecutive Cases.

The aim of this article is to propose a simplified digital protocol for the treatment of the fully edentulous patient, using an immediate implant and immediate loading protocol to deliver a polymethyl methacrylate metal-reinforced hybrid prosthesis. Ten consecutive patients were treated with this approach. At the end of 1 year, there was an implant survival rate of 97.8% and a prosthetic success rate of 100%. Based on the responses to the quality of life questionnaire, patients had a high acceptance rate for this treatment protocol. Within the limits of this case series, the proposed simplified digital protocol could be utilized for reconstruction in the fully edentulous patient and for delivering an implant-supported prosthesis immediately after implant placement.

Maxillary Sinus Elevation Difficulty Score with Lateral Wall Technique.

Maxillary sinus augmentation is a procedure commonly performed in patients in need of posterior maxillary implants with limited vertical ridge height and sinus pneumatization. However, minimal information has been presented to evaluate the complexity of the sinus elevation procedure via a lateral window approach based on patient examination, including extraoral findings, anatomical factors, and the possible influence from the surgeon's experience. Therefore, this article presents a new scheme of maxillary sinus floor elevation difficulty score based on comprehensive patient- and surgical-related factors. The proposed scoring tool aims to aid surgeons in performing a comprehensive presurgical evaluation prior to the lateral wall sinus augmentation surgery and also enhance communication between clinicians and patients regarding the complexity of the case.

Autogenous transplant of two impacted mandibular canines: a case report with 2-year follow-up.

PURPOSE: To present a case report of autogenous transplant of two impacted mandibular canines. MATERIALS AND METHODS: A 12-year-old girl, with vestibular impaction of mandibular left and right canines had them extracted and transplanted in the anatomically corrected sites, after an unsuccessful orthodontic treatment including surgical exposure. RESULTS: After 2 years the teeth are stable and their vitality is maintained. CONCLUSIONS: In this case the transplantation of the mandibular canines was successful and maintained the vitality of the transplanted teeth for at least 2 years. By preserving the periodontal ligament is it possible to re-establish a functional tooth unit, which allows a physiologic growth of the jaws.