Choice of graft material in relation to maxillary sinus width in internal sinus floor augmentation

When grafts with solely osteoinductive or osteoconductive effects are used in the maxillary sinus, the medial wall of the sinus membrane should be reflected to receive the vascular supply and the osteoconductive effect. Because the internal sinus floor augmentation is a blind technique, it is impossible to directly verify whether the medial sinus wall is reflected in the operation. The purpose of this study is to describe the modality of choice among the grafting materials and techniques in relation to the width of the maxillary sinus through preoperative planning and measuring in computed tomography (CT) images.

In a total of 57 patients, 100 implants were placed by 3 different sinus floor augmentation techniques. Postoperative cone-beam CT (CBCT) scans were performed and the arrival distance of grafts from lateral wall to medial wall at the apical end level of the implant in the maxillary sinus was measured.

Buccolingual arrival distances of grafts were measured to be a mean of 12.1 mm +/- 2.0 in postoperative CT images. In 23 of 77 cases (29.9%) in which distances were greater than 12.1 mm, the grafts made contact with the medial wall. However, in 22 of 23 cases (95.7%) in which distances were less than 12.1 mm, the grafts made complete contact with the medial wall.

The buccolingual width of the maxillary sinus should be measured at the apical end level of the implant that will be placed in preoperative CT. In the internal sinus floor augmentation, grafting materials with solely osteoconductive potential are to be used for narrow sinuses. For large sinuses, autogenous bone with osteogenic potential should be used; alternatively, the reflection of the medial wall by the lateral window technique is recommended.