A paradigm for evaluation and management of the maxillary sinus before dental implantation

Chen, Yiwei; Lee, Fu‒Ying; Huang, Chi‐Che; Fu, Chia‐Hsiang; Cc, Huang; Lee, Ta‐Jen

doi:10.1002/lary.26856

Cited by 39 publications

(49 citation statements)

References 17 publications

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“…Moreover, FESS is used if antibiotics confer no therapeutic benefits and the risk of developing chronic sinusitis after implantation is considered high. Our institute appears more strict with respect to the application of surgical procedures (mean MSMT/MOD ratio: 0.78 ± 0.24), compared to previous reports [ 16 , 17 ]. However, one case with ostium obstruction showed postoperative sinus complications, although the MSMT/MOD ratio was low (0.23).…”

Section: Discussionmentioning

confidence: 57%

“…Ostial obstruction is believed to be one such risk factor, and it is important to both check for maxillary sinus pneumatization and measure the thickness of the mucous membrane. Chen et al suggested that, when the height of polyp, cyst, or mucosal thickening was not less than half of maxillary sinus, treatment of sinusitis and preventive FESS was needed [ 16 ]. Chan et al reported that it is necessary to consult with an otolaryngologist if mucosal thickening of maxillary sinus is more than one-third [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

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An Anatomic Study on the Maxillary Sinus Mucosal Thickness and the Distance between the Maxillary Sinus Ostium and Sinus Floor for the Maxillary Sinus Augmentation

Lee

Kim

et al. 2020

Medicina

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Background and objectives: The average rate of chronic sinusitis after maxillary implantation was approximately 5.1%. However, the evidence of predictive risk factors for sinusitis after implantation is lacking. The aim of this study was to perform an anatomic study on the maxillary sinus mucosal thickness (MSMT), the distance between the maxillary sinus ostium and sinus floor (MOD), and the MSMT/MOD ratio as a preoperative risk indicator for sinusitis after maxillary dental implantation. Materials and Methods: Between October 2008 and October 2019, all patients referred to the otolaryngology department were included in this study. A total of 120 patients were enrolled. The 95 patients who received no treatment prior to implantation were classified into Group A, the 16 patients who used antibiotics before implantation were classified into Group B, and the patients who had implants inserted after functional endoscopic sinus surgery were classified into Group C. The MSMT, MOD, MSMT/MOD ratio, anatomical factors associated with ostial obstruction, and the occurrence of postoperative sinusitis were reviewed. Results: There were significant group differences in MSMT (Group A vs. Group B, p = 0.001; Group B vs. Group C, p = 0.003; Group C vs. Group A, p < 0.0001). The MOD showed no significant difference among the three groups. The MSMT/MOD ratio showed significant differences between Groups A and B (p = 0.001), B and C (p < 0.0001), and C and A (p < 0.0001). Conclusions: It is important to check not only the proportion of the maxillary sinus occupying lesion, but also the status of the maxillary sinus osteomeatal complex when making therapeutic decisions. In addition, collaboration between dentists and otolaryngologists could improve outcomes in patients with maxillary sinus lesions.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

An Anatomic Study on the Maxillary Sinus Mucosal Thickness and the Distance between the Maxillary Sinus Ostium and Sinus Floor for the Maxillary Sinus Augmentation

Lee

Kim

et al. 2020

Medicina

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“…An analysis of 1,000 patients undergoing CT imaging for neurological indications found abnormalities in 23.6% of the maxillary sinuses (Havas, Motbey, & Gullane, ). A recent CT analysis of 84 symptomatic and asymptomatic candidates for SFE found only 46.4% of physiologic sinuses with the remaining 53.6% exhibiting pathologies such as polyps and fluid accumulation (Chen et al, ). The increasing popularity and use of CBCT imaging in dentistry have led to a large amount of data on prevalence and possible causes of sinus membrane thickening also with this imaging technique.…”

Section: Discussionmentioning

confidence: 99%

“…Others recommend referral in the case of specific conditions present on a checklist, such as moderate thickening in combination with history of recent sinusitis, air-fluid levels, or sinus opacifications exceeding 75% or missing sinus walls (Friedland & Metson, 2014). More differentiated guidelines for ENT referral prior to SFE were formulated by an interdisciplinary group of ENTs and dentists (Chen et al, 2018). The authors recommend prior ENT treatment in the following cases of membrane thickening: (a) the size of the opacification exceeds 50% of the antral volume; (b) occurrence of sinusitis-related symptoms; (c) presence TA B L E 2 p-values of the logistic regression analysis with respect to eligibility for SFE and indication for further ENT diagnosis The presented data showed higher agreement when approaching the two extreme scenarios of no finding or clear pathology, respectively.…”

Section: Ta B L E 1 Continuedmentioning

confidence: 99%

Sinus floor elevation or referral for further diagnosis and therapy: A comparison of maxillary sinus assessment by ENT specialists and dentists using cone beam computed tomography

Janner

Dubach

Suter

et al. 2020

Clinical Oral Implants Res

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Objectives:To compare ear, nose, and throat (ENT) specialists and dentists assessing health or pathology of maxillary sinuses using cone beam computed tomography (CBCT). Material and methods:Two ENT specialists and two oral surgeons assessed 100 CBCT datasets of healthy patients referred for dental implant placement in the posterior maxilla and decided on the possibility of sinus floor elevation or the necessity for further diagnostic examinations based solely on radiographic findings. Inter-rater agreements within the same specialty were calculated with Cohen's kappa and overall agreements with Fleiss kappa, and factors influencing the decisions taken were evaluated using regression analyses. Results:The correlation between all four raters was generally fair to moderate. The intra-specialty comparison showed a lower correlation between dentists than between ENT specialists. Absence of membrane thickening and total or subtotal sinus opacification showed the highest predictive value for a consensus in favor of sinus floor elevation and ENT referral, respectively. Flat membrane thickening with an irregular surface morphology was associated with disagreement between the examiners. Dome-shaped membrane thickenings were often considered as to be referred by dentists but not by ENTs. Conclusion:The assessment of maxillary sinuses using CBCT imaging exhibited unsatisfactory agreement between ENT specialists and oral surgeons. Referral guidelines based on accidental CBCT findings that aim to diagnose relevant sinus pathologies early and avoid unnecessary diagnostics and/or therapies are needed, and an initial proposal for such recommendations is provided. Further research on correct interpretation of sinus findings and a validation of the present recommendations are required. K E Y W O R D Scone beam computed tomography, dental implants, ear, nose, and throat, maxillary sinus, sinus floor elevation

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“…Without membrane perforation, post-operative complications following TSFE procedures should be minimal to none (Danesh-Sani, Loomer, & Wallace, 2016;Franceschetti et al, 2017;Moreno Vazquez, Gonzalez de Rivera, Gil, & Mifsut, 2014). A small Schneiderian membrane perforation during TSFE may push the bone graft material into the sinus cavity, leading to mucosal thickening, maxillary sinusitis, infection and other complications (Chen et al, 2018). According to Chirila et al,4.3% patients developed maxillary sinusitis after TSFE procedures related to sinus membrane perforations (Chirila, Rotaru, Filipov, & Sandulescu, 2016).…”

Section: Discussionmentioning

confidence: 99%

Microscope and micro‐camera assessment of Schneiderian membrane perforation via transcrestal sinus floor elevation: A randomized ex vivo study

Gargallo‐Albiol

Sinjab

Barootchi

et al. 2019

Clinical Oral Implants Res

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Objective We sought to assess the effectiveness of using a microscope and non‐invasive camera for assessing sinus membrane perforations during transcrestal sinus floor elevation (TSFE). Materials and methods Five fresh human cadaver heads corresponding to eight maxillary sinuses (six bilateral and two unilateral) underwent 4 TSFEs per sinus (a total of 32 single site elevations). Each elevation was randomly assigned to receive a three or six mm membrane elevation height (MEH). A microscope and micro‐camera were used to assess the sinus membrane perforation. Afterwards, radiological and clinical membrane perforation assessments were performed. The statistical analysis results are expressed using the means, standard deviations, range values of the residual ridge height (RRH), residual ridge width (RRW), sinus membrane thickness (SMT) and incidence of perforation (IoP). Generalized linear methods were used to test for the correlation of RRH and MEH to the microscope and micro‐camera perforation assessments and the correlation of microscope and micro‐camera assessments with the post‐operative CBCT and crestal liquid evaluation. Results The cumulative percentage of IoP was 40.62%, (23.07% with 3 mm MEH, and 76.92% with 6 mm MEH, p < 0.05). The perforation assessed using either the microscope or micro‐camera coincided with the post‐operative CBCT and crestal liquid assessment in 87.55% sites. No significant correlation was found between the microscope or micro‐camera assessments with RRH or MEH. Conclusion Application of a microscope and micro‐camera during transcrestal sinus floor elevation may allow the detection of the integrity of the Schneiderian membrane with greater than 85% accuracy in this ex vivo model.

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A paradigm for evaluation and management of the maxillary sinus before dental implantation

Abstract: 4. Laryngoscope, 128:1261-1267, 2018.

Cited by 39 publications

References 17 publications

An Anatomic Study on the Maxillary Sinus Mucosal Thickness and the Distance between the Maxillary Sinus Ostium and Sinus Floor for the Maxillary Sinus Augmentation

An Anatomic Study on the Maxillary Sinus Mucosal Thickness and the Distance between the Maxillary Sinus Ostium and Sinus Floor for the Maxillary Sinus Augmentation

Sinus floor elevation or referral for further diagnosis and therapy: A comparison of maxillary sinus assessment by ENT specialists and dentists using cone beam computed tomography

Microscope and micro‐camera assessment of Schneiderian membrane perforation via transcrestal sinus floor elevation: A randomized ex vivo study

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