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 »  Home  »  Dental Implant 3  »  Complications After Maxillary Sinus Augmentation: A Case Report
Complications After Maxillary Sinus Augmentation: A Case Report
Discussion - Conclusions - References.

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DISCUSSION.
The author’s impression is that the current complication is the result of excessive elevation of the schneiderian membrane during the bone grafting procedure. This usually results in a folded membrane superiorly positioned, which cannot be brought inferiorly to a lower position. This increased the dimension of the compartment to receive the bony graft material. As a result, the surgeon was forced to fill the entire area to the more superior level than was anticipated. The patient’s current symptoms are synonymous with the findings. The ideal treatment is to somehow approach the newly formed floor of the sinus and reduce the bone height to allow aeration of the sinus. This proposed procedure has never been attempted before; therefore, it will definitely need an otolaryngologist’s intervention. The current plan is to monitor the area for future surgical intervention. However, the patient decided not to pursue any further implant-related treatment and to have a maxillary partial denture fabricated for replacement of his missing teeth.

CONCLUSIONS.
This complication of excessive augmentation of the maxillary sinus could have been prevented with gentle elevation and meticulous manipulation of the sinus floor membrane as described in the literature.3–7 Measurement of the desired bone height should be done from the CT scan or the panoramic film before the procedure. During the procedure, elevation of the membrane should also be measured using periodontal probe or a ruler to avoid an overfill. Elevation of the membrane is always attempted by separating the membrane from the bony walls of the sinus. The membrane is folded in a superior position; therefore, it cannot be unfolded and brought inferiorly. If this occurs, then the best way to handle this complication is to abort the procedure rather than overfilling the sinus.
Another attempt can be accomplished in several weeks in which the membrane will eventually relapse toward the floor of the sinus. Although the findings in this case are highly unusual and not previously documented, it is proposed that an experimental procedure should be attempted to reduce the height of the excessive bone mass in the maxillary sinus. The approach, the technique, and the necessary armamentarium should be investigated. An otolaryngologist is being called upon to investigate this situation and its solution.

REFERENCES.

Tatum OH. Maxillary and sinus implant construction. Dent   Clin North Am. 1986;30:207-229.
Misch CE. Maxillary sinus augmentation for endosseous implants: Organized   alternative treatment plans. Int J Oral Implant. 1987;4:49-58.
Chanavaz M. Maxillary sinus: Anatomy, physiology, surgery and bone grafting   related to implantology: 11 years of surgical experience. J Oral Implantol.   1990;16:199-209.
Smiler DG, Johnson PW, Lazada JL, et al. Sinus lift grafts and endosseous   implants: Treatment of the atrophic posterior maxilla. Dent Clin North Am.   1992; 36:151-186.
Adell R, Lekholm U, Grondahl K, et al. Reconstruction of severely resorbed   edentulous maxillae using fixtures in immediate autogenous bone grafts. Int J Oral Maxillofac Implants. 1990;3:233- 246.
Fugazzotto PA. Maxillary sinus grafting with and without simultaneous implant   placement: Technical consideration and clinical reports. Int J Periodontics   Restorative Dent. 1994;14:545-551.
Vlassis JM, Hurzeler MB, Quinones CR. Sinus lift augmentation to facilitate   placement of nonsubmerged implants. A clinical and histological report. Pract Periodontics Aesthet Dent. 1993;5:15-23.
Kahnberg KE, Nystrom E, Barholdsson L. Combined use of bone grafts and Branemark   fixtures in the treatment of severely resorbed maxillae. Int J Oral Maxillofac   Implants. 1989;4:297-304.
Kent JN, Boock MS. Simultaneous maxillary sinus floor bone grafting and placement   of hydroxylapatite coated implants. J Oral Maxillofac Surg. 1989;47: 238-242.  
Hurzeler MB, Kirsch A, Ackermann KL, et al. Reconstruction of the severely   resorbed maxilla with dental implants in the augmented maxillary sinus: A five   year clinical examination. Int J Oral Maxillofac Implants. 1996;11:466-475.  
Fugazzotto PA. Report of 302 consecutive ridge augmentation procedures: Technical   considerations and clinical results. Int J Oral Maxillofac Implants. 1998;13:358-368.  
Misch CE. Maxillary sinus lift and elevation with subantral augmentation.   In: Misch CE (ed). Contemporary Implant Dentistry. 2nd ed. St. Louis: Mosby,   1999: 489-493.
Pikos MA. Maxillary Sinus membrane repair: Report of a technique for large   perforations. Implant Dent. 1999;8: 29-34.
Block MS, Kent JN. Maxillary Sinus bone grafting. Atlas Oral Maxillofac   Surg Clin North Am. 1994;2:63.
Smiler DG. The sinus lift graft: Basic technique and variations. Pract   Periodontics Aesthet Dent. 1997;9:885-893.
Lockhart R, Ceccaldi J, Bertrand JC. Postoperative maxillary cyst following   sinus bone graft: report of a case. Int J Oral Maxillofac Implants. 2000;4:583-586.  
Garg AK, Mugnolo GM, Sasken H. Maxillary antral mucocele and its relevance   for maxillary sinus augmentation grafting: A case report. Int J Oral Maxillofac   Implants. 2000;15:287-290.
Vlassis JM, Fugazzotto PA. A classification system for sinus membrane perforations   during augmentation procedures with options for repair. J Periodontol. 1999;70:692-699.