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Abstract
Discussion Forum (0)
The following report summarises the first paper presented during the To learn from complications session, at the EAO's 24th annual Scientific Meeting in Stockholm, 2015.
Sinus grafting is a well-documented and frequently used augmentation technique. In a recent retrospective study, 54.2% of maxillary posterior implants were associated with a sinus augmentation (Seong et al. 2013).
Although the procedure is undoubtedly predictable (Valentini & Abensur. 2003), a variable percentage of complications have been reported, some of which are severe. The complications can be intra- or postoperative. Intra-operative complications may lead to postoperative complications, and both are closely linked to infection.
There are two main ways of preventing complications prior to surgery, and both relate to appropriate case selection:
- having precise knowledge of the anatomy of the sinuses in order to foresee and to manage intra-operative complications
- diagnosing the health status of the sinus and the anatomical particularities of the sinus to rule out disturbed drainage in order to prevent postoperative complications
The most common intra-operative complication is the perforation of the membrane lining the sinus (Figure 1). The prevalence of these perforations is reported with great disparity by different authors as ranging from 14 to 56%. The risk factors associated with sinus membrane perforation, listed in order of statistical significance, are (Schwarz et al. 2015):
- septa and complex sinus morphology
- residual bone height less than 3.5mm
- smokers
Membrane perforation is not easy to handle. The lecturer illustrated a closure procedure using one resorbable collagen membrane and titanium pins. In cases of membrane perforation, there was a higher prevalence of sinusitis (31.4%), even after intra-operative closure, due to bacterial graft contamination or graft migration into the sinus cavity.
The second common complication is a vascular damage due to the presence of the alveolar antral artery with an intra bony passage. The best way to prevent intra- or postoperative bleeding is to dissect this vessel using ultrasonic surgery (Figure 2).
Figure 1
Figure 2
The most frequent is an acute sinusitis which can occur 3 to 4 weeks post surgery. According to the literature, sinusitis seems to principally occur in patients who are predisposed to it. This predisposition can be diagnosed with a pre-operative cone beam CT, CT scan or a presurgical endoscopic evaluation. Those examinations will allow us to detect a sinus pathology which can be a relative or an absolute contraindication. It is also possible to detect some anatomical particularities (Figure 3) which could disturb postoperatively the sinus drainage as teeth which can induce a postoperative infection of the sinus graft (Figure 4). In most cases, an ear, nose and throat examination during the presurgical evaluation of the patient is recommended if they have any of the following history:
- sinus inflammation
- polyps
- thickened sinus membrane
- nasal or sinus obstruction
- seasonal allergies
Generally speaking, if the patency of the ostium is insufficient, a functional endoscopic sinus surgery (FESS) procedure is indicated to restore the ventilation of the sinus (Figure 5).
Figure 3
Figure 4
Figure 5
The risk of postoperative infection is also increased by systemic factors. The patient's medical status should be evaluated when planning sinus surgery to identify the following:
- allergic patients (penicillin allergy?)
- osteoporosis treated with bisphosphonates
- immunocompromised patients
- diabetes (Hb1Ac>7%)
- haemostasis problems
- vitamin D deficiency
The following conclusions can be drawn:
1. A preoperative 3D radiographic study of the sinus is mandatory to assess the anatomical risks
2. The patient's medical history must be checked to evaluate for systemic risks
3. Sinus grafting procedures should involve a team approach that includes ear, nose and throat colleagues in case selection and patient preparation, as well as management of possible postoperative complications
Schwarz L, Schiebel V, Hof M, Ulm C, Watzek G, Pommer B. Risk Factors of Membrane Perforation and Postoperative Complications in Sinus Floor Elevation Surgery: Review of 407 Augmentation Procedures. J Oral Maxillofac Surg. 2015 Jul;73(7):1275-82. doi: 10.1016/j.joms.2015.01.039. Epub 2015 Feb 12.
Seong WJ, Barczak M, Jung J, Basu S, Olin PS, Conrad HJ. Prevalence of sinus augmentation associated with maxillary posterior implants. J Oral Implantol. 2013 Dec;39(6):680-8. doi: 10.1563/AAID-JOI-D-10-00122. Epub 2011 Jun 8.
Valentini P, Abensur DJ. Maxillary sinus grafting with anorganic bovine bone: a clinical report of long-term results. Int J Oral Maxillofac Implants. 2003 Jul-Aug;18(4):556-60.
This summary was prepared by the EAO Congress Scientific Report rapporteurs.
View the full publication at: www.eao.org
Maxillary sinus grafting complications and how to avoid them
Sinus grafting is a well-documented and frequently used augmentation technique. In a recent retrospective study, 54.2% of maxillary posterior implants were associated with a sinus augmentation (Seong et al. 2013).
Although the procedure is undoubtedly predictable (Valentini & Abensur. 2003), a variable percentage of complications have been reported, some of which are severe. The complications can be intra- or postoperative. Intra-operative complications may lead to postoperative complications, and both are closely linked to infection.
How to prevent these complications?
There are two main ways of preventing complications prior to surgery, and both relate to appropriate case selection:
- having precise knowledge of the anatomy of the sinuses in order to foresee and to manage intra-operative complications
- diagnosing the health status of the sinus and the anatomical particularities of the sinus to rule out disturbed drainage in order to prevent postoperative complications
The most common intra-operative complication is the perforation of the membrane lining the sinus (Figure 1). The prevalence of these perforations is reported with great disparity by different authors as ranging from 14 to 56%. The risk factors associated with sinus membrane perforation, listed in order of statistical significance, are (Schwarz et al. 2015):
- septa and complex sinus morphology
- residual bone height less than 3.5mm
- smokers
Membrane perforation is not easy to handle. The lecturer illustrated a closure procedure using one resorbable collagen membrane and titanium pins. In cases of membrane perforation, there was a higher prevalence of sinusitis (31.4%), even after intra-operative closure, due to bacterial graft contamination or graft migration into the sinus cavity.
The second common complication is a vascular damage due to the presence of the alveolar antral artery with an intra bony passage. The best way to prevent intra- or postoperative bleeding is to dissect this vessel using ultrasonic surgery (Figure 2).
Postoperative complications
The most frequent is an acute sinusitis which can occur 3 to 4 weeks post surgery. According to the literature, sinusitis seems to principally occur in patients who are predisposed to it. This predisposition can be diagnosed with a pre-operative cone beam CT, CT scan or a presurgical endoscopic evaluation. Those examinations will allow us to detect a sinus pathology which can be a relative or an absolute contraindication. It is also possible to detect some anatomical particularities (Figure 3) which could disturb postoperatively the sinus drainage as teeth which can induce a postoperative infection of the sinus graft (Figure 4). In most cases, an ear, nose and throat examination during the presurgical evaluation of the patient is recommended if they have any of the following history:
- sinus inflammation
- polyps
- thickened sinus membrane
- nasal or sinus obstruction
- seasonal allergies
Generally speaking, if the patency of the ostium is insufficient, a functional endoscopic sinus surgery (FESS) procedure is indicated to restore the ventilation of the sinus (Figure 5).
The risk of postoperative infection is also increased by systemic factors. The patient's medical status should be evaluated when planning sinus surgery to identify the following:
- allergic patients (penicillin allergy?)
- osteoporosis treated with bisphosphonates
- immunocompromised patients
- diabetes (Hb1Ac>7%)
- haemostasis problems
- vitamin D deficiency
The following conclusions can be drawn:
1. A preoperative 3D radiographic study of the sinus is mandatory to assess the anatomical risks
2. The patient's medical history must be checked to evaluate for systemic risks
3. Sinus grafting procedures should involve a team approach that includes ear, nose and throat colleagues in case selection and patient preparation, as well as management of possible postoperative complications
References
Schwarz L, Schiebel V, Hof M, Ulm C, Watzek G, Pommer B. Risk Factors of Membrane Perforation and Postoperative Complications in Sinus Floor Elevation Surgery: Review of 407 Augmentation Procedures. J Oral Maxillofac Surg. 2015 Jul;73(7):1275-82. doi: 10.1016/j.joms.2015.01.039. Epub 2015 Feb 12.
Seong WJ, Barczak M, Jung J, Basu S, Olin PS, Conrad HJ. Prevalence of sinus augmentation associated with maxillary posterior implants. J Oral Implantol. 2013 Dec;39(6):680-8. doi: 10.1563/AAID-JOI-D-10-00122. Epub 2011 Jun 8.
Valentini P, Abensur DJ. Maxillary sinus grafting with anorganic bovine bone: a clinical report of long-term results. Int J Oral Maxillofac Implants. 2003 Jul-Aug;18(4):556-60.
This summary was prepared by the EAO Congress Scientific Report rapporteurs.
View the full publication at: www.eao.org
The following report summarises the first paper presented during the To learn from complications session, at the EAO's 24th annual Scientific Meeting in Stockholm, 2015.
Sinus grafting is a well-documented and frequently used augmentation technique. In a recent retrospective study, 54.2% of maxillary posterior implants were associated with a sinus augmentation (Seong et al. 2013).
Although the procedure is undoubtedly predictable (Valentini & Abensur. 2003), a variable percentage of complications have been reported, some of which are severe. The complications can be intra- or postoperative. Intra-operative complications may lead to postoperative complications, and both are closely linked to infection.
There are two main ways of preventing complications prior to surgery, and both relate to appropriate case selection:
- having precise knowledge of the anatomy of the sinuses in order to foresee and to manage intra-operative complications
- diagnosing the health status of the sinus and the anatomical particularities of the sinus to rule out disturbed drainage in order to prevent postoperative complications
The most common intra-operative complication is the perforation of the membrane lining the sinus (Figure 1). The prevalence of these perforations is reported with great disparity by different authors as ranging from 14 to 56%. The risk factors associated with sinus membrane perforation, listed in order of statistical significance, are (Schwarz et al. 2015):
- septa and complex sinus morphology
- residual bone height less than 3.5mm
- smokers
Membrane perforation is not easy to handle. The lecturer illustrated a closure procedure using one resorbable collagen membrane and titanium pins. In cases of membrane perforation, there was a higher prevalence of sinusitis (31.4%), even after intra-operative closure, due to bacterial graft contamination or graft migration into the sinus cavity.
The second common complication is a vascular damage due to the presence of the alveolar antral artery with an intra bony passage. The best way to prevent intra- or postoperative bleeding is to dissect this vessel using ultrasonic surgery (Figure 2).
Figure 1
Figure 2
The most frequent is an acute sinusitis which can occur 3 to 4 weeks post surgery. According to the literature, sinusitis seems to principally occur in patients who are predisposed to it. This predisposition can be diagnosed with a pre-operative cone beam CT, CT scan or a presurgical endoscopic evaluation. Those examinations will allow us to detect a sinus pathology which can be a relative or an absolute contraindication. It is also possible to detect some anatomical particularities (Figure 3) which could disturb postoperatively the sinus drainage as teeth which can induce a postoperative infection of the sinus graft (Figure 4). In most cases, an ear, nose and throat examination during the presurgical evaluation of the patient is recommended if they have any of the following history:
- sinus inflammation
- polyps
- thickened sinus membrane
- nasal or sinus obstruction
- seasonal allergies
Generally speaking, if the patency of the ostium is insufficient, a functional endoscopic sinus surgery (FESS) procedure is indicated to restore the ventilation of the sinus (Figure 5).
Figure 3
Figure 4
Figure 5
The risk of postoperative infection is also increased by systemic factors. The patient's medical status should be evaluated when planning sinus surgery to identify the following:
- allergic patients (penicillin allergy?)
- osteoporosis treated with bisphosphonates
- immunocompromised patients
- diabetes (Hb1Ac>7%)
- haemostasis problems
- vitamin D deficiency
The following conclusions can be drawn:
1. A preoperative 3D radiographic study of the sinus is mandatory to assess the anatomical risks
2. The patient's medical history must be checked to evaluate for systemic risks
3. Sinus grafting procedures should involve a team approach that includes ear, nose and throat colleagues in case selection and patient preparation, as well as management of possible postoperative complications
Schwarz L, Schiebel V, Hof M, Ulm C, Watzek G, Pommer B. Risk Factors of Membrane Perforation and Postoperative Complications in Sinus Floor Elevation Surgery: Review of 407 Augmentation Procedures. J Oral Maxillofac Surg. 2015 Jul;73(7):1275-82. doi: 10.1016/j.joms.2015.01.039. Epub 2015 Feb 12.
Seong WJ, Barczak M, Jung J, Basu S, Olin PS, Conrad HJ. Prevalence of sinus augmentation associated with maxillary posterior implants. J Oral Implantol. 2013 Dec;39(6):680-8. doi: 10.1563/AAID-JOI-D-10-00122. Epub 2011 Jun 8.
Valentini P, Abensur DJ. Maxillary sinus grafting with anorganic bovine bone: a clinical report of long-term results. Int J Oral Maxillofac Implants. 2003 Jul-Aug;18(4):556-60.
This summary was prepared by the EAO Congress Scientific Report rapporteurs.
View the full publication at: www.eao.org
Maxillary sinus grafting complications and how to avoid them
Sinus grafting is a well-documented and frequently used augmentation technique. In a recent retrospective study, 54.2% of maxillary posterior implants were associated with a sinus augmentation (Seong et al. 2013).
Although the procedure is undoubtedly predictable (Valentini & Abensur. 2003), a variable percentage of complications have been reported, some of which are severe. The complications can be intra- or postoperative. Intra-operative complications may lead to postoperative complications, and both are closely linked to infection.
How to prevent these complications?
There are two main ways of preventing complications prior to surgery, and both relate to appropriate case selection:
- having precise knowledge of the anatomy of the sinuses in order to foresee and to manage intra-operative complications
- diagnosing the health status of the sinus and the anatomical particularities of the sinus to rule out disturbed drainage in order to prevent postoperative complications
The most common intra-operative complication is the perforation of the membrane lining the sinus (Figure 1). The prevalence of these perforations is reported with great disparity by different authors as ranging from 14 to 56%. The risk factors associated with sinus membrane perforation, listed in order of statistical significance, are (Schwarz et al. 2015):
- septa and complex sinus morphology
- residual bone height less than 3.5mm
- smokers
Membrane perforation is not easy to handle. The lecturer illustrated a closure procedure using one resorbable collagen membrane and titanium pins. In cases of membrane perforation, there was a higher prevalence of sinusitis (31.4%), even after intra-operative closure, due to bacterial graft contamination or graft migration into the sinus cavity.
The second common complication is a vascular damage due to the presence of the alveolar antral artery with an intra bony passage. The best way to prevent intra- or postoperative bleeding is to dissect this vessel using ultrasonic surgery (Figure 2).
Postoperative complications
The most frequent is an acute sinusitis which can occur 3 to 4 weeks post surgery. According to the literature, sinusitis seems to principally occur in patients who are predisposed to it. This predisposition can be diagnosed with a pre-operative cone beam CT, CT scan or a presurgical endoscopic evaluation. Those examinations will allow us to detect a sinus pathology which can be a relative or an absolute contraindication. It is also possible to detect some anatomical particularities (Figure 3) which could disturb postoperatively the sinus drainage as teeth which can induce a postoperative infection of the sinus graft (Figure 4). In most cases, an ear, nose and throat examination during the presurgical evaluation of the patient is recommended if they have any of the following history:
- sinus inflammation
- polyps
- thickened sinus membrane
- nasal or sinus obstruction
- seasonal allergies
Generally speaking, if the patency of the ostium is insufficient, a functional endoscopic sinus surgery (FESS) procedure is indicated to restore the ventilation of the sinus (Figure 5).
The risk of postoperative infection is also increased by systemic factors. The patient's medical status should be evaluated when planning sinus surgery to identify the following:
- allergic patients (penicillin allergy?)
- osteoporosis treated with bisphosphonates
- immunocompromised patients
- diabetes (Hb1Ac>7%)
- haemostasis problems
- vitamin D deficiency
The following conclusions can be drawn:
1. A preoperative 3D radiographic study of the sinus is mandatory to assess the anatomical risks
2. The patient's medical history must be checked to evaluate for systemic risks
3. Sinus grafting procedures should involve a team approach that includes ear, nose and throat colleagues in case selection and patient preparation, as well as management of possible postoperative complications
References
Schwarz L, Schiebel V, Hof M, Ulm C, Watzek G, Pommer B. Risk Factors of Membrane Perforation and Postoperative Complications in Sinus Floor Elevation Surgery: Review of 407 Augmentation Procedures. J Oral Maxillofac Surg. 2015 Jul;73(7):1275-82. doi: 10.1016/j.joms.2015.01.039. Epub 2015 Feb 12.
Seong WJ, Barczak M, Jung J, Basu S, Olin PS, Conrad HJ. Prevalence of sinus augmentation associated with maxillary posterior implants. J Oral Implantol. 2013 Dec;39(6):680-8. doi: 10.1563/AAID-JOI-D-10-00122. Epub 2011 Jun 8.
Valentini P, Abensur DJ. Maxillary sinus grafting with anorganic bovine bone: a clinical report of long-term results. Int J Oral Maxillofac Implants. 2003 Jul-Aug;18(4):556-60.
This summary was prepared by the EAO Congress Scientific Report rapporteurs.
View the full publication at: www.eao.org
Maxillary sinus grafting complications and how to avoid them
pascal valentini
Abstract
Discussion Forum (0)
The following report summarises the first paper presented during the To learn from complications session, at the EAO's 24th annual Scientific Meeting in Stockholm, 2015.
Sinus grafting is a well-documented and frequently used augmentation technique. In a recent retrospective study, 54.2% of maxillary posterior implants were associated with a sinus augmentation (Seong et al. 2013).
Although the procedure is undoubtedly predictable (Valentini & Abensur. 2003), a variable percentage of complications have been reported, some of which are severe. The complications can be intra- or postoperative. Intra-operative complications may lead to postoperative complications, and both are closely linked to infection.
There are two main ways of preventing complications prior to surgery, and both relate to appropriate case selection:
- having precise knowledge of the anatomy of the sinuses in order to foresee and to manage intra-operative complications
- diagnosing the health status of the sinus and the anatomical particularities of the sinus to rule out disturbed drainage in order to prevent postoperative complications
The most common intra-operative complication is the perforation of the membrane lining the sinus (Figure 1). The prevalence of these perforations is reported with great disparity by different authors as ranging from 14 to 56%. The risk factors associated with sinus membrane perforation, listed in order of statistical significance, are (Schwarz et al. 2015):
- septa and complex sinus morphology
- residual bone height less than 3.5mm
- smokers
Membrane perforation is not easy to handle. The lecturer illustrated a closure procedure using one resorbable collagen membrane and titanium pins. In cases of membrane perforation, there was a higher prevalence of sinusitis (31.4%), even after intra-operative closure, due to bacterial graft contamination or graft migration into the sinus cavity.
The second common complication is a vascular damage due to the presence of the alveolar antral artery with an intra bony passage. The best way to prevent intra- or postoperative bleeding is to dissect this vessel using ultrasonic surgery (Figure 2).
Figure 1
Figure 2
The most frequent is an acute sinusitis which can occur 3 to 4 weeks post surgery. According to the literature, sinusitis seems to principally occur in patients who are predisposed to it. This predisposition can be diagnosed with a pre-operative cone beam CT, CT scan or a presurgical endoscopic evaluation. Those examinations will allow us to detect a sinus pathology which can be a relative or an absolute contraindication. It is also possible to detect some anatomical particularities (Figure 3) which could disturb postoperatively the sinus drainage as teeth which can induce a postoperative infection of the sinus graft (Figure 4). In most cases, an ear, nose and throat examination during the presurgical evaluation of the patient is recommended if they have any of the following history:
- sinus inflammation
- polyps
- thickened sinus membrane
- nasal or sinus obstruction
- seasonal allergies
Generally speaking, if the patency of the ostium is insufficient, a functional endoscopic sinus surgery (FESS) procedure is indicated to restore the ventilation of the sinus (Figure 5).
Figure 3
Figure 4
Figure 5
The risk of postoperative infection is also increased by systemic factors. The patient's medical status should be evaluated when planning sinus surgery to identify the following:
- allergic patients (penicillin allergy?)
- osteoporosis treated with bisphosphonates
- immunocompromised patients
- diabetes (Hb1Ac>7%)
- haemostasis problems
- vitamin D deficiency
The following conclusions can be drawn:
1. A preoperative 3D radiographic study of the sinus is mandatory to assess the anatomical risks
2. The patient's medical history must be checked to evaluate for systemic risks
3. Sinus grafting procedures should involve a team approach that includes ear, nose and throat colleagues in case selection and patient preparation, as well as management of possible postoperative complications
Schwarz L, Schiebel V, Hof M, Ulm C, Watzek G, Pommer B. Risk Factors of Membrane Perforation and Postoperative Complications in Sinus Floor Elevation Surgery: Review of 407 Augmentation Procedures. J Oral Maxillofac Surg. 2015 Jul;73(7):1275-82. doi: 10.1016/j.joms.2015.01.039. Epub 2015 Feb 12.
Seong WJ, Barczak M, Jung J, Basu S, Olin PS, Conrad HJ. Prevalence of sinus augmentation associated with maxillary posterior implants. J Oral Implantol. 2013 Dec;39(6):680-8. doi: 10.1563/AAID-JOI-D-10-00122. Epub 2011 Jun 8.
Valentini P, Abensur DJ. Maxillary sinus grafting with anorganic bovine bone: a clinical report of long-term results. Int J Oral Maxillofac Implants. 2003 Jul-Aug;18(4):556-60.
This summary was prepared by the EAO Congress Scientific Report rapporteurs.
View the full publication at: www.eao.org
Maxillary sinus grafting complications and how to avoid them
Sinus grafting is a well-documented and frequently used augmentation technique. In a recent retrospective study, 54.2% of maxillary posterior implants were associated with a sinus augmentation (Seong et al. 2013).
Although the procedure is undoubtedly predictable (Valentini & Abensur. 2003), a variable percentage of complications have been reported, some of which are severe. The complications can be intra- or postoperative. Intra-operative complications may lead to postoperative complications, and both are closely linked to infection.
How to prevent these complications?
There are two main ways of preventing complications prior to surgery, and both relate to appropriate case selection:
- having precise knowledge of the anatomy of the sinuses in order to foresee and to manage intra-operative complications
- diagnosing the health status of the sinus and the anatomical particularities of the sinus to rule out disturbed drainage in order to prevent postoperative complications
The most common intra-operative complication is the perforation of the membrane lining the sinus (Figure 1). The prevalence of these perforations is reported with great disparity by different authors as ranging from 14 to 56%. The risk factors associated with sinus membrane perforation, listed in order of statistical significance, are (Schwarz et al. 2015):
- septa and complex sinus morphology
- residual bone height less than 3.5mm
- smokers
Membrane perforation is not easy to handle. The lecturer illustrated a closure procedure using one resorbable collagen membrane and titanium pins. In cases of membrane perforation, there was a higher prevalence of sinusitis (31.4%), even after intra-operative closure, due to bacterial graft contamination or graft migration into the sinus cavity.
The second common complication is a vascular damage due to the presence of the alveolar antral artery with an intra bony passage. The best way to prevent intra- or postoperative bleeding is to dissect this vessel using ultrasonic surgery (Figure 2).
Postoperative complications
The most frequent is an acute sinusitis which can occur 3 to 4 weeks post surgery. According to the literature, sinusitis seems to principally occur in patients who are predisposed to it. This predisposition can be diagnosed with a pre-operative cone beam CT, CT scan or a presurgical endoscopic evaluation. Those examinations will allow us to detect a sinus pathology which can be a relative or an absolute contraindication. It is also possible to detect some anatomical particularities (Figure 3) which could disturb postoperatively the sinus drainage as teeth which can induce a postoperative infection of the sinus graft (Figure 4). In most cases, an ear, nose and throat examination during the presurgical evaluation of the patient is recommended if they have any of the following history:
- sinus inflammation
- polyps
- thickened sinus membrane
- nasal or sinus obstruction
- seasonal allergies
Generally speaking, if the patency of the ostium is insufficient, a functional endoscopic sinus surgery (FESS) procedure is indicated to restore the ventilation of the sinus (Figure 5).
The risk of postoperative infection is also increased by systemic factors. The patient's medical status should be evaluated when planning sinus surgery to identify the following:
- allergic patients (penicillin allergy?)
- osteoporosis treated with bisphosphonates
- immunocompromised patients
- diabetes (Hb1Ac>7%)
- haemostasis problems
- vitamin D deficiency
The following conclusions can be drawn:
1. A preoperative 3D radiographic study of the sinus is mandatory to assess the anatomical risks
2. The patient's medical history must be checked to evaluate for systemic risks
3. Sinus grafting procedures should involve a team approach that includes ear, nose and throat colleagues in case selection and patient preparation, as well as management of possible postoperative complications
References
Schwarz L, Schiebel V, Hof M, Ulm C, Watzek G, Pommer B. Risk Factors of Membrane Perforation and Postoperative Complications in Sinus Floor Elevation Surgery: Review of 407 Augmentation Procedures. J Oral Maxillofac Surg. 2015 Jul;73(7):1275-82. doi: 10.1016/j.joms.2015.01.039. Epub 2015 Feb 12.
Seong WJ, Barczak M, Jung J, Basu S, Olin PS, Conrad HJ. Prevalence of sinus augmentation associated with maxillary posterior implants. J Oral Implantol. 2013 Dec;39(6):680-8. doi: 10.1563/AAID-JOI-D-10-00122. Epub 2011 Jun 8.
Valentini P, Abensur DJ. Maxillary sinus grafting with anorganic bovine bone: a clinical report of long-term results. Int J Oral Maxillofac Implants. 2003 Jul-Aug;18(4):556-60.
This summary was prepared by the EAO Congress Scientific Report rapporteurs.
View the full publication at: www.eao.org
The following report summarises the first paper presented during the To learn from complications session, at the EAO's 24th annual Scientific Meeting in Stockholm, 2015.
Sinus grafting is a well-documented and frequently used augmentation technique. In a recent retrospective study, 54.2% of maxillary posterior implants were associated with a sinus augmentation (Seong et al. 2013).
Although the procedure is undoubtedly predictable (Valentini & Abensur. 2003), a variable percentage of complications have been reported, some of which are severe. The complications can be intra- or postoperative. Intra-operative complications may lead to postoperative complications, and both are closely linked to infection.
There are two main ways of preventing complications prior to surgery, and both relate to appropriate case selection:
- having precise knowledge of the anatomy of the sinuses in order to foresee and to manage intra-operative complications
- diagnosing the health status of the sinus and the anatomical particularities of the sinus to rule out disturbed drainage in order to prevent postoperative complications
The most common intra-operative complication is the perforation of the membrane lining the sinus (Figure 1). The prevalence of these perforations is reported with great disparity by different authors as ranging from 14 to 56%. The risk factors associated with sinus membrane perforation, listed in order of statistical significance, are (Schwarz et al. 2015):
- septa and complex sinus morphology
- residual bone height less than 3.5mm
- smokers
Membrane perforation is not easy to handle. The lecturer illustrated a closure procedure using one resorbable collagen membrane and titanium pins. In cases of membrane perforation, there was a higher prevalence of sinusitis (31.4%), even after intra-operative closure, due to bacterial graft contamination or graft migration into the sinus cavity.
The second common complication is a vascular damage due to the presence of the alveolar antral artery with an intra bony passage. The best way to prevent intra- or postoperative bleeding is to dissect this vessel using ultrasonic surgery (Figure 2).
Figure 1
Figure 2
The most frequent is an acute sinusitis which can occur 3 to 4 weeks post surgery. According to the literature, sinusitis seems to principally occur in patients who are predisposed to it. This predisposition can be diagnosed with a pre-operative cone beam CT, CT scan or a presurgical endoscopic evaluation. Those examinations will allow us to detect a sinus pathology which can be a relative or an absolute contraindication. It is also possible to detect some anatomical particularities (Figure 3) which could disturb postoperatively the sinus drainage as teeth which can induce a postoperative infection of the sinus graft (Figure 4). In most cases, an ear, nose and throat examination during the presurgical evaluation of the patient is recommended if they have any of the following history:
- sinus inflammation
- polyps
- thickened sinus membrane
- nasal or sinus obstruction
- seasonal allergies
Generally speaking, if the patency of the ostium is insufficient, a functional endoscopic sinus surgery (FESS) procedure is indicated to restore the ventilation of the sinus (Figure 5).
Figure 3
Figure 4
Figure 5
The risk of postoperative infection is also increased by systemic factors. The patient's medical status should be evaluated when planning sinus surgery to identify the following:
- allergic patients (penicillin allergy?)
- osteoporosis treated with bisphosphonates
- immunocompromised patients
- diabetes (Hb1Ac>7%)
- haemostasis problems
- vitamin D deficiency
The following conclusions can be drawn:
1. A preoperative 3D radiographic study of the sinus is mandatory to assess the anatomical risks
2. The patient's medical history must be checked to evaluate for systemic risks
3. Sinus grafting procedures should involve a team approach that includes ear, nose and throat colleagues in case selection and patient preparation, as well as management of possible postoperative complications
Schwarz L, Schiebel V, Hof M, Ulm C, Watzek G, Pommer B. Risk Factors of Membrane Perforation and Postoperative Complications in Sinus Floor Elevation Surgery: Review of 407 Augmentation Procedures. J Oral Maxillofac Surg. 2015 Jul;73(7):1275-82. doi: 10.1016/j.joms.2015.01.039. Epub 2015 Feb 12.
Seong WJ, Barczak M, Jung J, Basu S, Olin PS, Conrad HJ. Prevalence of sinus augmentation associated with maxillary posterior implants. J Oral Implantol. 2013 Dec;39(6):680-8. doi: 10.1563/AAID-JOI-D-10-00122. Epub 2011 Jun 8.
Valentini P, Abensur DJ. Maxillary sinus grafting with anorganic bovine bone: a clinical report of long-term results. Int J Oral Maxillofac Implants. 2003 Jul-Aug;18(4):556-60.
This summary was prepared by the EAO Congress Scientific Report rapporteurs.
View the full publication at: www.eao.org
Maxillary sinus grafting complications and how to avoid them
Sinus grafting is a well-documented and frequently used augmentation technique. In a recent retrospective study, 54.2% of maxillary posterior implants were associated with a sinus augmentation (Seong et al. 2013).
Although the procedure is undoubtedly predictable (Valentini & Abensur. 2003), a variable percentage of complications have been reported, some of which are severe. The complications can be intra- or postoperative. Intra-operative complications may lead to postoperative complications, and both are closely linked to infection.
How to prevent these complications?
There are two main ways of preventing complications prior to surgery, and both relate to appropriate case selection:
- having precise knowledge of the anatomy of the sinuses in order to foresee and to manage intra-operative complications
- diagnosing the health status of the sinus and the anatomical particularities of the sinus to rule out disturbed drainage in order to prevent postoperative complications
The most common intra-operative complication is the perforation of the membrane lining the sinus (Figure 1). The prevalence of these perforations is reported with great disparity by different authors as ranging from 14 to 56%. The risk factors associated with sinus membrane perforation, listed in order of statistical significance, are (Schwarz et al. 2015):
- septa and complex sinus morphology
- residual bone height less than 3.5mm
- smokers
Membrane perforation is not easy to handle. The lecturer illustrated a closure procedure using one resorbable collagen membrane and titanium pins. In cases of membrane perforation, there was a higher prevalence of sinusitis (31.4%), even after intra-operative closure, due to bacterial graft contamination or graft migration into the sinus cavity.
The second common complication is a vascular damage due to the presence of the alveolar antral artery with an intra bony passage. The best way to prevent intra- or postoperative bleeding is to dissect this vessel using ultrasonic surgery (Figure 2).
Postoperative complications
The most frequent is an acute sinusitis which can occur 3 to 4 weeks post surgery. According to the literature, sinusitis seems to principally occur in patients who are predisposed to it. This predisposition can be diagnosed with a pre-operative cone beam CT, CT scan or a presurgical endoscopic evaluation. Those examinations will allow us to detect a sinus pathology which can be a relative or an absolute contraindication. It is also possible to detect some anatomical particularities (Figure 3) which could disturb postoperatively the sinus drainage as teeth which can induce a postoperative infection of the sinus graft (Figure 4). In most cases, an ear, nose and throat examination during the presurgical evaluation of the patient is recommended if they have any of the following history:
- sinus inflammation
- polyps
- thickened sinus membrane
- nasal or sinus obstruction
- seasonal allergies
Generally speaking, if the patency of the ostium is insufficient, a functional endoscopic sinus surgery (FESS) procedure is indicated to restore the ventilation of the sinus (Figure 5).
The risk of postoperative infection is also increased by systemic factors. The patient's medical status should be evaluated when planning sinus surgery to identify the following:
- allergic patients (penicillin allergy?)
- osteoporosis treated with bisphosphonates
- immunocompromised patients
- diabetes (Hb1Ac>7%)
- haemostasis problems
- vitamin D deficiency
The following conclusions can be drawn:
1. A preoperative 3D radiographic study of the sinus is mandatory to assess the anatomical risks
2. The patient's medical history must be checked to evaluate for systemic risks
3. Sinus grafting procedures should involve a team approach that includes ear, nose and throat colleagues in case selection and patient preparation, as well as management of possible postoperative complications
References
Schwarz L, Schiebel V, Hof M, Ulm C, Watzek G, Pommer B. Risk Factors of Membrane Perforation and Postoperative Complications in Sinus Floor Elevation Surgery: Review of 407 Augmentation Procedures. J Oral Maxillofac Surg. 2015 Jul;73(7):1275-82. doi: 10.1016/j.joms.2015.01.039. Epub 2015 Feb 12.
Seong WJ, Barczak M, Jung J, Basu S, Olin PS, Conrad HJ. Prevalence of sinus augmentation associated with maxillary posterior implants. J Oral Implantol. 2013 Dec;39(6):680-8. doi: 10.1563/AAID-JOI-D-10-00122. Epub 2011 Jun 8.
Valentini P, Abensur DJ. Maxillary sinus grafting with anorganic bovine bone: a clinical report of long-term results. Int J Oral Maxillofac Implants. 2003 Jul-Aug;18(4):556-60.
This summary was prepared by the EAO Congress Scientific Report rapporteurs.
View the full publication at: www.eao.org
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