J Korean Assoc Oral Maxillofac Surg.  2011 Apr;37(2):122-126. 10.5125/jkaoms.2011.37.2.122.

Evaluation of the feasibility of bony window repositioning without using a barrier membrane in sinus lateral approach

• Jeon SH
• Cho YS
• Lee BH
• Im TY
• Hwang KG
• Park CJ

• KMID: 2137001
• DOI: http://doi.org/10.5125/jkaoms.2011.37.2.122

Abstract

INTRODUCTION
In the lateral window approach for a maxillary sinus bone graft, there has been considerable controversy regarding the placement of a barrier membrane over the osteotomy site. In particular, when there is no damage to the Schneiderian membrane, clinicians should decide whether to use a barrier membrane or not, considering the benefits and costs. This study presents the clinical cases to demonstrate that only repositioning the detached window can lead to satisfactory bony healing of the grafted material without using a barrier membrane in the lateral approach for a maxillary sinus bone graft.
MATERIALS AND METHODS
Five consecutive patients were treated with the same surgical procedures. After performing the antrostomy on the lateral maxillary wall using a round carbide bur and diamond bur, the bony window was detached by a gentle levering action. After confirming no perforation of the Schneiderian membrane, the grafting procedure was carried out the detached window of the lateral maxillary wall was repositioned over the grafted material without using a barrier membrane. A gross examination was carried out at the postoperative 6 month re-entry, and the the preoperative and postoperative dental computed tomography (CT) at re-entry were compared.
RESULTS
All the procedures in the 5 patients went on to uneventful healing with no complications associated with the bone graft. Satisfactory bone regeneration without the interference of fibrous tissue on the gap between the repositioned window and lateral wall of the maxillary sinus was observed in the postoperative 6 month re-entry. The CT findings at re-entry revealed the, reconstruction of the external cortical plate including repositioned bony window. In addition, the loss of the discontinuity of the lateral maxillary wall was confirmed.
CONCLUSION
This preliminary report showed that the detached window, which was just repositioned on the grafted material, could function as a barrier membrane in the lateral approach for a maxillary sinus bone graft. Therefore additional morphometric and histologic studies will be needed.

Keyword

Bone graft; Dental implants; Membrane

MeSH Terms

Bone Regeneration
Cost-Benefit Analysis
Dental Implants
Diamond
Humans
Maxillary Sinus
Membranes
Nasal Mucosa
Osteotomy
Transplants
Dental Implants
Diamond

Figure

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  Fig. 1. A: Intraoperative view of a bony window repositioned over the graft material. B: Postoperatively 6 month view of bone regeneration around the bony window in Case 3. Reconstruction of the external cortical plate and gap bone regeneration was clinically acceptable. C: Immediately postoperative serial coronal views of CT. D: Postoperatively 6 month serial coronal views of CT. Reconstruction of the external cortical plate including repositioned bony window was shown. Also, loss of the discontinuity of lateral maxillary wall was confirmed. (CT: computed tomography)

Reference

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