Maksiller Sinüs Elevasyonu
Özet
Maksiller sinüs, yüz ve kafatası kemikleri içinde yer alan en geniş paranazal sinüs olup ortalama 12,5 ml hacme sahiptir ve dental implant uygulamalarında anatomik komşuluğu nedeniyle büyük önem taşır. Diş kayıpları ve yaşlanma süreciyle birlikte sinüs tabanında pnömatizasyon ve kemik erimesi meydana gelerek dikey kemik hacmi azalır. Bu yetersizliği gidermek amacıyla sinüs tabanı elevasyonu teknikleri uygulanmaktadır. Geleneksel ve doğrudan görüş sağlayan lateral pencere tekniğinde, sinüsün dış duvarından kemik pencere açılarak Schneiderian membranı yükseltilir ve implantın primer stabilitesine göre tek veya iki aşamalı olarak greftleme gerçekleştirilir. Daha az invaziv bir alternatif olan transkrestal (kapalı) osteotom tekniğinde ise implant yuvasından girilerek hidrolik basınç, özel aletler veya balon yardımıyla körlemesine bir elevasyon ve greftleme sağlanır. Operasyon öncesinde bilgisayarlı tomografi ile hastanın sinüs genişliği, septa varlığı, membran kalınlığı ve antral arter anatomisi titizlikle değerlendirilmelidir; zira dar ve konik sinüsler ile bölmeli anatomik yapılar membran perforasyonu ve kanama gibi komplikasyon risklerini belirgin şekilde artırır.
The maxillary sinus is the largest paranasal sinus located within the facial and cranial bones, possessing an average volume of 12.5 ml, and holds significant importance in dental implant applications due to its anatomical proximity. Following tooth loss and the aging process, pneumatization and bone resorption occur at the sinus floor, reducing the vertical bone volume. Sinus floor elevation techniques are utilized to overcome this deficiency. In the traditional lateral window technique, which provides direct visualization, a bony window is created on the lateral wall, the Schneiderian membrane is elevated, and grafting is performed in either a one- or two-stage approach depending on the primary stability of the implant. Alternatively, the less invasive transcrestal (closed) osteotome technique involves accessing the area through the implant socket to achieve blind elevation and grafting via hydraulic pressure, specialized instruments, or balloons. Preoperatively, the patient's sinus width, presence of septa, membrane thickness, and antral artery anatomy must be meticulously evaluated using computed tomography, as narrow, conical sinuses and septated structures markedly increase the risk of complications such as membrane perforation and hemorrhage.
Referanslar
Nunez-Castruita A, Lopez-Serna N, Guzman-Lopez S. Prenatal development of the maxillary sinus: a perspective for paranasal sinus surgery. Otolaryngology and Head and Neck Surgery. 2012;146(6): 997-1003. doi: 10.1177/0194599811435883
Iwanaga J, Wilson C, Lachkar S, et al. Clinical anatomy of the maxillary sinus: application to sinus floor augmentation. Anatomy & Cell Biology. 2019;52(1): 17-24. doi: 10.5115/acb.2019.52.1.17
Chanavaz M. Maxillary sinus: anatomy, physiology, surgery, and bone grafting related to implantology--eleven years of surgical experience (1979-1990). Journal of Oral Implantology. 1990;16(3): 199-209.
Eberhardt JA, Torabinejad M, Christiansen EL. A computed tomographic study of the distances between the maxillary sinus floor and the apices of the maxillary posterior teeth. Oral Surgery, Oral Medicine, Oral Pathology. 1992;73(3): 345-346. doi: 10.1016/0030-4220(92)90133-b
Kilic C, Kamburoglu K, Yuksel SP, et al. An Assessment of the Relationship between the Maxillary Sinus Floor and the Maxillary Posterior Teeth Root Tips Using Dental Cone-beam Computerized Tomography. European Journal of Dentistry. 2010;4(4): 462-467.
Roque-Torres GD, Ramirez-Sotelo LR, Vaz SL, et al. Association between maxillary sinus pathologies and healthy teeth. Brazilian Journal of Otorhinolaryngology. 2016;82(1): 33-38. doi: 10.1016/j.bjorl.2015.11.004
Kim MJ, Jung UW, Kim CS, et al. Maxillary sinus septa: prevalence, height, location, and morphology. A reformatted computed tomography scan analysis. Journal of Periodontology. 2006;77(5): 903-908. doi: 10.1902/jop.2006.050247
Krennmair G, Ulm CW, Lugmayr H, et al. The incidence, location, and height of maxillary sinus septa in the edentulous and dentate maxilla. Journal of Oral and Maxillofacial Surgery. 1999;57(6): 667-671; discussion 671-662. doi: 10.1016/s0278-2391(99)90427-5
Lee WJ, Lee SJ, Kim HS. Analysis of location and prevalence of maxillary sinus septa. Journal of Periodontal & Implant Science. 2010;40(2): 56-60. doi: 10.5051/jpis.2010.40.2.56
Maestre-Ferrin L, Carrillo-Garcia C, Galan-Gil S, et al. Prevalence, location, and size of maxillary sinus septa: panoramic radiograph versus computed tomography scan. Journal of Oral and Maxillofacial Surgery. 2011;69(2): 507-511. doi: 10.1016/j.joms.2010.10.033
Kang SJ, Shin SI, Herr Y, et al. Anatomical structures in the maxillary sinus related to lateral sinus elevation: a cone beam computed tomographic analysis. Clinical Oral Implants Research. 2013;24 Suppl A100: 75-81. doi: 10.1111/j.1600-0501.2011.02378.x
Velasquez-Plata D, Hovey LR, Peach CC, et al. Maxillary sinus septa: a 3-dimensional computerized tomographic scan analysis. International Journal of Oral and Maxillofacial Implants. 2002;17(6): 854-860.
Gonzalez-Santana H, Penarrocha-Diago M, Guarinos-Carbo J, et al. A study of the septa in the maxillary sinuses and the subantral alveolar processes in 30 patients. Journal of Oral Implantology. 2007;33(6): 340-343. doi: 10.1563/1548-1336(2007)33[340:ASOTSI]2.0.CO;2
Lundgren S, Andersson S, Gualini F, et al. Bone reformation with sinus membrane elevation: a new surgical technique for maxillary sinus floor augmentation. Clinical Implant Dentistry and Related Research. 2004;6(3): 165-173.
Park YB, Jeon HS, Shim JS, et al. Analysis of the anatomy of the maxillary sinus septum using 3-dimensional computed tomography. Journal of Oral and Maxillofacial Surgery. 2011;69(4): 1070-1078. doi: 10.1016/j.joms.2010.07.020
Bell GW, Joshi BB, Macleod RI. Maxillary sinus disease: diagnosis and treatment. British Dental Journal. 2011;210(3): 113-118. doi: 10.1038/sj.bdj.2011.47
Chen TW, Chang HS, Leung KW, et al. Implant placement immediately after the lateral approach of the trap door window procedure to create a maxillary sinus lift without bone grafting: a 2-year retrospective evaluation of 47 implants in 33 patients. Journal of Oral and Maxillofacial Surgery. 2007;65(11): 2324-2328. doi: 10.1016/j.joms.2007.06.649
Gudis DA, Cohen NA. Cilia dysfunction. Otolaryngologic Clinics of North America. 2010;43(3): 461-472, vii. doi: 10.1016/j.otc.2010.02.007
Kqiku L, Biblekaj R, Weiglein AH, et al. Arterial blood architecture of the maxillary sinus in dentate specimens. Croatian Medical Journal. 2013;54(2): 180-184. doi: 10.3325/cmj.2013.54.180
Flanagan D. Arterial supply of maxillary sinus and potential for bleeding complication during lateral approach sinus elevation. Implant Dentistry. 2005;14(4): 336-338. doi: 10.1097/01.id.0000188437.66363.7c
Dursun E, Keceli HG, Dolgun A, et al. Maxillary Sinus and Surrounding Bone Anatomy With Cone Beam Computed Tomography After Multiple Teeth Loss: A Retrospective Multicenter Clinical Study. Implant Dentistry. 2019;28(3): 226-236. doi: 10.1097/ID.0000000000000862
Lovasova K, Kachlik D, Rozpravkova M, et al. Three-dimensional CAD/CAM imaging of the maxillary sinus in ageing process. Annals of Anatomy. 2018;218: 69-82. doi: 10.1016/j.aanat.2018.01.008
Gosau M, Rink D, Driemel O, et al. Maxillary sinus anatomy: a cadaveric study with clinical implications. The Anatomical Record. 2009;292(3): 352-354. doi: 10.1002/ar.20859
Velasco-Torres M, Padial-Molina M, Avila-Ortiz G, et al. Maxillary Sinus Dimensions Decrease as Age and Tooth Loss Increase. Implant Dentistry. 2017;26(2): 288-295. doi: 10.1097/ID.0000000000000551
Velasco-Torres M, Padial-Molina M, Alarcon JA, et al. Maxillary Sinus Dimensions With Respect to the Posterior Superior Alveolar Artery Decrease With Tooth Loss. Implant Dentistry. 2016;25(4): 464-470. doi: 10.1097/ID.0000000000000445
Jensen O, T. (2006) The sinus bone graft: Quintessence Pub co.
Üngör C (2011) Maksiller sinüs augmentasyonunun ses kalitesi üzerine etkisinin akustik analizler ile değerlendirilmesi: Ankara Üniversitesi Sağlık Bilimleri Enstitüsü, Ankara.
Dakhli I, Abdelsalam Z, Salem D et al. Validity of tridimensional CT study of maxillary sinus reconstruction in potential implant site. Cairo Dental Journal. 2009;25(3): 329-336.
Nunes LS, Bornstein MM, Sendi P, et al. Anatomical characteristics and dimensions of edentulous sites in the posterior maxillae of patients referred for implant therapy. International Journal of Periodontics and Restorative Dentistry. 2013;33(3): 337-345. doi: 10.11607/prd.1475
Dobele I, Kise L, Apse P, et al. Radiographic assessment of findings in the maxillary sinus using cone-beam computed tomography. Stomatologija. 2013;15(4): 119-122.
Kara IM, Kucuk D, Polat S. Experience of maxillary sinus floor augmentation in the presence of antral pseudocysts. Journal of Oral and Maxillofacial Surgery. 2010;68(7): 1646-1650. doi: 10.1016/j.joms.2009.09.116
Pommer B, Unger E, Suto D, et al. Mechanical properties of the Schneiderian membrane in vitro. Clinical Oral Implants Research. 2009;20(6): 633-637. doi: 10.1111/j.1600-0501.2008.01686.x
Khajehahmadi S, Rahpeyma A, Hoseini Zarch SH. Association between the lateral wall thickness of the maxillary sinus and the dental status: cone beam computed tomography evaluation. Iranian Journal of Radiology. 2014;11(1): e6675. doi: 10.5812/iranjradiol.6675
van den Bergh JP, ten Bruggenkate CM, Disch FJ, et al. Anatomical aspects of sinus floor elevations. Clinical Oral Implants Research. 2000;11(3): 256-265. doi: 10.1034/j.1600-0501.2000.011003256.x
Greenstein G, Cavallaro J, Tarnow D. Practical application of anatomy for the dental implant surgeon. Journal of Periodontology. 2008;79(10): 1833-1846. doi: 10.1902/jop.2008.080086
Ewers R. Maxilla sinus grafting with marine algae derived bone forming material: a clinical report of long-term results. Journal of Oral and Maxillofacial Surgery. 2005;63(12): 1712-1723. doi: 10.1016/j.joms.2005.08.020
Kaufman E. Maxillary sinus elevation surgery: an overview. Journal of Esthetic and Restorative Dentistry. 2003;15(5): 272-282; discussion 283. doi: 10.1111/j.1708-8240.2003.tb00298.x
Chan HL, Suarez F, Monje A, et al. Evaluation of maxillary sinus width on cone-beam computed tomography for sinus augmentation and new sinus classification based on sinus width. Clinical Oral Implants Research. 2014;25(6): 647-652. doi: 10.1111/clr.12055
Rahpeyma A, Khajehahmadi S. Open Sinus Lift Surgery and the Importance of Preoperative Cone-Beam Computed Tomography Scan: A Review. Journal of International Oral Health. 2015;7(9): 127-133.
Cho SC, Wallace SS, Froum SJ, et al. Influence of anatomy on Schneiderian membrane perforations during sinus elevation surgery: three-dimensional analysis. Practical procedures & aesthetic dentistry. 2001;13(2): 160-163.
Velloso GR, Vidigal GM, Jr., de Freitas MM, et al. Tridimensional analysis of maxillary sinus anatomy related to sinus lift procedure. Implant Dentistry. 2006;15(2): 192-196. doi: 10.1097/01.id.0000223233.29454.77
Niu L, Wang J, Yu H, et al. New classification of maxillary sinus contours and its relation to sinus floor elevation surgery. Clinical Implant Dentistry and Related Research. 2018;20(4): 493-500. doi: 10.1111/cid.12606
Wagner F, Dvorak G, Nemec S, et al. Morphometric analysis of sinus depth in the posterior maxilla and proposal of a novel classification. Scientific Reports. 2017;7: 45397. doi: 10.1038/srep45397
Teng M, Cheng Q, Liao J, et al. Sinus Width Analysis and New Classification with Clinical Implications for Augmentation. Clinical Implant Dentistry and Related Research. 2016;18(1): 89-96. doi: 10.1111/cid.12247
Jang HY, Kim HC, Lee SC, et al. Choice of graft material in relation to maxillary sinus width in internal sinus floor augmentation. Journal of Oral and Maxillofacial Surgery. 2010;68(8): 1859-1868. doi: 10.1016/j.joms.2009.09.093
Avila G, Wang HL, Galindo-Moreno P, et al. The influence of the bucco-palatal distance on sinus augmentation outcomes. Journal of Periodontology. 2010;81(7): 1041-1050. doi: 10.1902/jop.2010.090686
Lombardi T, Stacchi C, Berton F, et al. Influence of Maxillary Sinus Width on New Bone Formation After Transcrestal Sinus Floor Elevation: A Proof-of-Concept Prospective Cohort Study. Implant Dentistry. 2017;26(2): 209-216. doi: 10.1097/ID.0000000000000554
Zheng X, Teng M, Zhou F, et al. Influence of Maxillary Sinus Width on Transcrestal Sinus Augmentation Outcomes: Radiographic Evaluation Based on Cone Beam CT. Clinical Implant Dentistry and Related Research. 2016;18(2): 292-300. doi: 10.1111/cid.12298
Sammartino G, Mariniello M, Scaravilli MS. Benign paroxysmal positional vertigo following closed sinus floor elevation procedure: mallet osteotomes vs. screwable osteotomes. A triple blind randomized controlled trial. Clinical Oral Implants Research. 2011;22(6): 669-672. doi: 10.1111/j.1600-0501.2010.01998.x
Tetsch J, Tetsch P, Lysek DA. Long-term results after lateral and osteotome technique sinus floor elevation: a retrospective analysis of 2190 implants over a time period of 15 years. Clinical Oral Implants Research. 2010;21(5): 497-503. doi: 10.1111/j.1600-0501.2008.01661.x
Chiapasco M, Zaniboni M, Rimondini L. Dental implants placed in grafted maxillary sinuses: a retrospective analysis of clinical outcome according to the initial clinical situation and a proposal of defect classification. Clinical Oral Implants Research. 2008;19(4): 416-428. doi: 10.1111/j.1600-0501.2007.01489.x
Naitoh M, Suenaga Y, Kondo S, et al. Assessment of maxillary sinus septa using cone-beam computed tomography: etiological consideration. Clinical Implant Dentistry and Related Research. 2009;11 Suppl 1: e52-58. doi: 10.1111/j.1708-8208.2009.00194.x
Shen EC, Fu E, Chiu TJ, et al. Prevalence and location of maxillary sinus septa in the Taiwanese population and relationship to the absence of molars. Clinical Oral Implants Research. 2012;23(6): 741-745. doi: 10.1111/j.1600-0501.2011.02195.x
Guncu GN, Yildirim YD, Wang HL, et al. Location of posterior superior alveolar artery and evaluation of maxillary sinus anatomy with computerized tomography: a clinical study. Clinical Oral Implants Research. 2011;22(10): 1164-1167. doi: 10.1111/j.1600-0501.2010.02071.x
Rosano G, Taschieri S, Gaudy JF, et al. Maxillary sinus vascular anatomy and its relation to sinus lift surgery. Clinical Oral Implants Research. 2011;22(7): 711-715. doi: 10.1111/j.1600-0501.2010.02045.x
Boyne PJ, James RA. Grafting of the maxillary sinus floor with autogenous marrow and bone. Journal of Oral Surgery. 1980;38(8): 613-616.
Tatum H, Jr. Maxillary and sinus implant reconstructions. Dental Clinics of North America. 1986;30(2): 207-229.
Hallman M, Thor A. Bone substitutes and growth factors as an alternative/complement to autogenous bone for grafting in implant dentistry. Periodontology 2000. 2008;47: 172-192. doi: 10.1111/j.1600-0757.2008.00251.x
Triplett RG, Nevins M, Marx RE, et al. Pivotal, randomized, parallel evaluation of recombinant human bone morphogenetic protein-2/absorbable collagen sponge and autogenous bone graft for maxillary sinus floor augmentation. Journal of Oral and Maxillofacial Surgery. 2009;67(9): 1947-1960. doi: 10.1016/j.joms.2009.04.085
Voss P, Sauerbier S, Wiedmann-Al-Ahmad M, et al. Bone regeneration in sinus lifts: comparing tissue-engineered bone and iliac bone. British Journal of Oral and Maxillofacial Surgery. 2010;48(2): 121-126. doi: 10.1016/j.bjoms.2009.04.032
Gandhi Y. Sinus Grafts: Science and Techniques-Then and Now. Journal of Maxillofacial and Oral Surgery. 2017;16(2): 135-144. doi: 10.1007/s12663-017-1007-x
Summers RB. A new concept in maxillary implant surgery: the osteotome technique. Compendium. 1994 Feb;15(2):152, 154-6, 158 passim; quiz 162. PMID: 8055503.
Riben C, Thor A. The Maxillary Sinus Membrane Elevation Procedure: Augmentation of Bone around Dental Implants without Grafts-A Review of a Surgical Technique. International Journal of Dentistry. 2012;2012: 105483. doi: 10.1155/2012/105483
Boyne PJ. Analysis of performance of root-form endosseous implants placed in the maxillary sinus. Journal of Long-Term Effects of Medical Implants. 1993;3(2): 143-159.
Ellegaard B, Kolsen-Petersen J, Baelum V. Implant therapy involving maxillary sinus lift in periodontally compromised patients. Clinical Oral Implants Research. 1997;8(4): 305-315. doi: 10.1034/j.1600-0501.1997.080409.x
Lundgren S, Andersson S, Sennerby L. Spontaneous bone formation in the maxillary sinus after removal of a cyst: coincidence or consequence? Clinical Implant Dentistry and Related Research. 2003;5(2): 78-81. doi: 10.1111/j.1708-8208.2003.tb00187.x
Ellegaard B, Baelum V, Kolsen-Petersen J. Non-grafted sinus implants in periodontally compromised patients: a time-to-event analysis. Clinical Oral Implants Research. 2006;17(2): 156-164. doi: 10.1111/j.1600-0501.2005.01220.x
Thor A, Sennerby L, Hirsch JM, et al. Bone formation at the maxillary sinus floor following simultaneous elevation of the mucosal lining and implant installation without graft material: an evaluation of 20 patients treated with 44 Astra Tech implants. Journal of Oral and Maxillofacial Surgery. 2007;65(7 Suppl 1): 64-72. doi: 10.1016/j.joms.2006.10.047
Jensen SS, Terheyden H. Bone augmentation procedures in localized defects in the alveolar ridge: clinical results with different bone grafts and bone-substitute materials. International Journal of Oral and Maxillofacial Implants. 2009;24 Suppl: 218-236.
Del Fabbro M, Testori T, Francetti L, et al. Systematic review of survival rates for implants placed in the grafted maxillary sinus. International Journal of Periodontics and Restorative Dentistry. 2004;24(6): 565-577.
Felice P, Pistilli R, Piattelli M, et al. 1-stage versus 2-stage lateral sinus lift procedures: 1-year post-loading results of a multicentre randomised controlled trial. European Journal of Oral Implantology. 2014;7(1): 65-75.
Fugazzotto PA. Immediate implant placement following a modified trephine/osteotome approach: success rates of 116 implants to 4 years in function. International Journal of Oral and Maxillofacial Implants. 2002;17(1): 113-120.
Cosci F, Luccioli M. A new sinus lift technique in conjunction with placement of 265 implants: a 6-year retrospective study. Implant Dentistry. 2000;9(4): 363-368. doi: 10.1097/00008505-200009040-00014
Sotirakis EG, Gonshor A. Elevation of the maxillary sinus floor with hydraulic pressure. Journal of Oral Implantology. 2005;31(4): 197-204. doi: 10.1563/1548-1336(2005)31[197:EOTMSF]2.0.CO;2
Soltan M, Smiler DG. Antral membrane balloon elevation. Journal of Oral Implantology. 2005;31(2): 85-90. doi: 10.1563/0-773.1
Jesch P, Bruckmoser E, Bayerle A, et al. A pilot-study of a minimally invasive technique to elevate the sinus floor membrane and place graft for augmentation using high hydraulic pressure: 18-month follow-up of 20 cases. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2013;116(3): 293-300. doi: 10.1016/j.oooo.2013.05.014
Mijiritsky E, Barbu H, Lorean A, et al. Use of Implant-Derived Minimally Invasive Sinus Floor Elevation: A Multicenter Clinical Observational Study With 12- to 65-Month Follow-Up. Journal of Oral Implantology. 2016;42(4): 343-348. doi: 10.1563/aaid-joi-D-15-00157
