MAXILLARY SINUS AUGMENTATION

PRESENTED BY, PAAVANA FINAL YEAR BDS

CONTENTS• INTRODUCTION

• ANATOMY OF MAXILLARY SINUS

• ETIOLOGY OF DECREASED BONE HEIGHT

• INDICATIONS AND CONTRAINDICATIONS

• BENEFITS OF SINUS LIFT

• AUGMENTATION TECHNIQUES

• COMPLICATIONS

• CONCLUSION

INTRODUCTIONSYNONYMS- SINUS LIFT, SINUS

GRAFT,SINUS AUGMENTATION AND SINUS LIFT PROCEDURE.

It is a ridge augmentation procedure which helps in increasing the amount of bone in the posterior maxilla/upper jaw bone in the area of premolar and molar by lifting the Schneiderian membrane/sinus membrane and placing a bone graft.

DR OSCAR.H.TATUM Jr

ANATOMY OF MAXILLARY SINUS•Maxillary sinus is the largest sinus in the head and neck region.•SHAPE-Pyramidal with base towards the lateral wall of nose and apex toward zygomatic process of maxilla.•BOUNDRIES -Anterior wall-facial surface of maxillaPosterior wall- infratemporal surface of maxilla. Roof- Floor of orbitFloor – Alveolar process of maxilla.•Opens into middle meatus via semilunar hiatus.

ETIOLOGY OF DECREASED BONE HEIGHT IN POSTERIOR MAXILLA

The maxillary sinus grows by a bone remodelling process named PNEUMATIZATION as age advances. This physiological process accompanied with increased tooth resorption due to tooth loss leads to decrease in bone height in the posterior maxilla.

INDICATIONS

• Loss of more than one tooth in posterior maxilla with inadequate bone height.

• Presence of missing teeth with inadequate bone height due to genetics or birth.

CONTRAINDICATIONS

• Infections• Pathological

growth.• Allergies• Radiation therapy.• Excessive tobacco

use.

INDICATIONS AND CONTRAINDICATIONS

BENEFITS• Reconstruct highly atrophic

posterior maxilla for implant placement.

AUGMENTATION TECHNIQUES

• INDIRECT SINUS LIFT

• DIRECT SINUS LIFT

INDIRECT SINUS LIFT• A preferred method in which at least

5mm of residual bone is present.

• An approximate amount of 3-5mm of height is gained with simultaneous implant placement option.

• A trans alveolar approach is followed by placing incision palatal to the alveolar bone and two vertical incisions are made anterior and posterior of initial incision and reflection of buccal flap is done.

• A series of external bone burs compatible with the implant system is used to create osseous receptors 1-2mm below the sinus membrane. The sinus membrane is usually lifted to prevent perforation.

Parallel pins are placed to ascertain the proper position of implant in relation to another.

Graft material mixed with hematopoietic material is placed in the space

BONE GRAFTS• Autograft

• Allograft

• Xenograft

• Alloplastic

Simultaneous implant is placed and primary interrupted sutures are given to the gingiva . The healing is expected to occur in 4-6months.

DIRECT SINUS LIFT• It is recommended when residual bone

is less than 5mm

• An increased bone height greater than 5mm can be obtained with implant placement immediately after bone grafting or 6months after healing.

A crestal incision is made on the palatal aspect followed by two vertical incisions made one on cuspid eminence and another on maxillary tuberosity which are connected by buccal incision extending inro vestibule using no 15 scalpel blade

Dimensions of bone is evaluated

Using a bone pencil alveolar bone, sinus floor anterior wall and position of antral window on lateral aspect of maxilla is outlined. A no 6 round bur is used to create oval osteotomy.This is done till the sinus membrane is visible.

The sinus membrane is lifted using sinus elevators

SINUS ELEVATORS OR CURETTE

Bone graft is placed. Implants are only placed if primary stabilization of former is possible other wise it should be placed after 6 months of sinus lift.

Final contoured bone with implants

COMPLICATIONS• Perforation of sinus membrane.

• Dehiscence with loss of graft material.

• Infections

• Potential loss of implant.

CONCLUSION

Thus with the advent of maxillary sinus augmentation, oral rehabilitation along with esthetic and functional efficiency of oral and perioral structures is being made possible

REFERENCES• Dental implants-the art and

science-3RD Edition-CHARLES A BABBUSH

• Controlled technique for indirect sinus grafting with simultaneous implant placement- Dr Mark Hsiang En Lin