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Crestal endoscopic approach for evaluating sinus membrane elevation technique.

Samy Elian1,2,3, Khaled Barakat4

  • 1Faculty of Dentistry, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland. drsamiyazied@gmail.com.

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|May 18, 2018
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Summary

Closed sinus lifting is a less invasive technique. Direct endoscopic assessment through the crestal osteotomy site offers better visualization of the sinus membrane integrity compared to lateral approaches, though perforation risk remains.

Keywords:
Atrophic posterior maxillaCrestal sinus lifterEndoscopic implantsMaxillary sinus endoscopySchneiderian membrane perforationSinus implants

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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.