The Potential Influence of Medial Sinus wall Exposure During Lateral Sinus Floor Elevation Procedure on the Blood Supply to the Grafted Material: A Cohort Study

Abstract

Introduction: Different anatomical parameters may influence the success of lateral sinus floor elevation (LSFE), vascularization of the grafted sinus being a key factor for successful bone remodeling. Since the blood supply from the sinus floor and lateral wall may be compromised other sources such as the medial wall are of utmost importance.Objective: This retrospective cohort study analyzed radiographically the influences of the surgical technique and sinus anatomy on the amount of medial wall exposure during LSFE.Materials and methods: CBCT scans from 51 LSFE procedures were included. Measurements of the sinus mediolateral width augmented mediolateral width, augmented apico-coronal height from the top of the alveolar bone crest and from the sinus floor, the angle between the medial and the most lateral and medial drops of the filled bone substitute. Results:The mean sinus maximal width was 18.18±2.81 mm, and the mean augmentation filling height was 13.89±2.23 mm. The mean medial and lateral filling drops were 4.51±2.11 mm and 2.06±1.35 mm, respectively, representing 42% and 19.2% of the maximum filling height. The average sinus angle was 51.99±13.38°. A significant positive correlation was found between the medial drop and the sinus width (P<0.05). Conclusion:After intended exposure of the medial wall during LSFE procedure, a significant medial and lateral drop in the level of the grafted bone substitute may be expected, thus reducing blood supply to the grafted material; This finding is more accentuated in wide sinuses. Therefore, selective compression of the graft material against the medial wall is advised during this procedure.