Crestal endoscopic approach for evaluating sinus membrane elevation technique

Area of Science:

• Oral and Maxillofacial Surgery
• Dental Implantology
• Surgical Anatomy

Background:

• Closed sinus lifting is a minimally invasive procedure for augmenting posterior maxillary bone.
• Assessing sinus membrane integrity during closed sinus lifts traditionally required invasive endoscopic methods.
• Direct visual assessment of the sinus membrane during crestal elevation has been challenging.

Purpose of the Study:

• To evaluate the clinical efficacy of direct endoscopic visual assessment of sinus membrane integrity through the crestal osteotomy site during closed sinus lifting.
• To compare the diagnostic capability of crestal endoscopic access versus lateral wall trephination for detecting sinus membrane perforations.

Main Methods:

• A prospective study involving twelve patients with atrophic posterior maxillae (3-5 mm bone height) undergoing closed sinus lifting with immediate implant placement.
• Direct endoscopic visualization of the sinus membrane integrity through the crestal osteotomy site.
• Dynamic monitoring of the sinus membrane via a trephined opening in the lateral sinus wall for confirmation of undetected perforations.

Main Results:

• Sinus floor elevation without perforation was achieved in 83.33% of cases.
• Minor perforations occurred in 16.67% of cases, detected via crestal endoscopic view.
• Crestal endoscopic access provided superior visualization of the sinus membrane compared to the lateral approach.

Conclusions:

• Crestal endoscopic access through the osteotomy site is a simpler, less invasive method for assessing sinus membrane integrity during closed sinus lifts.
• The technique offers better direct vision than lateral wall access, utilizing the existing surgical site.
• Perforation risk is influenced by sinus lining thickness and elasticity; intact sinus floor elevation cannot be guaranteed, especially with thin or irregular membranes.