Antral Augmentation, Osseointegration, and Sinusitis: The Otolaryngologist's Perspective

Abstract

Osseointegrated dental implants are a widely used method of replacing lost or missing teeth. Resorption of the alveolar ridge of the edentulous posterior maxilla may necessitate augmentation before osseointegration to provide adequate bone for implant fixation. This can be accomplished through an intraoral approach to the maxillary sinus, with elevation of the mucosa of the sinus floor creating a pocket for graft placement. Disruption of the intact sinus mucosa may result in sinusitis, graft infection, or extrusion with secondary formation of an oroantral communication. To treat these patients effectively, the otolaryngologist must be aware of the techniques of sinus augmentation and osseointegration as well as the etiology of associated complications. We will discuss the management of four patients with significant sinus complications, and evaluate the otolaryngologist's role in the preoperative and postoperative care of these patients.

Sinus Bone Graft - Where and Where Not to be? - A Review

“…Any factor interfering with one of these functions will compromise maxillary sinus health. A grafting procedure generally does not interfere with sinus function when performed on a healthy sinus [23][24][25][26][27][28]; however, when performed on an unhealthy sinus, the same procedure will contribute to fluid stagnation and bacterial overgrowth, leading to an exacerbated sinusitis. Moreover, the presence of space-occupying masses such as polyps, tumors, and hyperplastic mucosa represent obstacles to the elevation of the sinus mucosa.…”

Multidisciplinary Management of Candidates for Maxillary Sinus Augmentation by a Surgeon and ENT Specialist

“…Small perforation of the sinus membrane is usually not considered a risk factor for maxillary sinusitis after sinus augmentation, specifically in patients without prior clinical symptoms; however, larger perforation puts the patient in higher risk of complications due to greater exposure of grafting material that might penetrate into the sinus cavity. 12 In conclusion, multidisciplinary management of patients prior to sinus augmentation could aid in diagnosis of a preexisting sinus disease and prevention of further complications after surgical procedure. Patients with the radiographic signs of sinus disease or conditions with compromised nasal/sinus drainage or impaired epithelial function require a referral to ENT specialist for further assessment.…”

“…12 Common anatomic alterations, such as the existence of paradoxical middle turbinates or small concha bullosae or mild deviation of the septum do not need any surgical correction by ENT specialists prior to sinus augmentation. 8 However, the patient should be closely monitored for the presence of any discharge or dysventilation and symptoms of sinus disease.…”

“…It may also lead to perforation of the membrane that can alter mucus composition due to bacterial infections. Osteomeatal complex patency might be affected in different ways 7,12 :…”

Endoscopic Surgery of Maxillary Sinuses in Oral Surgery and Implantology

“…This treatment varies from simple fistula closure by local flap to endoscopically assisted surgery of the maxillary sinus. Besides oroantral fistulae, other common causes of OMS are chronic periapical or periodontal odontogenic infections, odontogenic cysts of the maxilla and iatrogenic factors, including placement of dental implants, sinus augmentations and intra-antral foreign bodies www.intechopen.com (Brook, 2006;Zimbler et al, 1998) (Figure 2). What is common for all these conditions is that disruption of the sinus membrane results in creation of a pathway through which oral microorganisms invade the antrum, resulting in sinus inflammation.…”