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Implantology > Sinus Augmentation > Flashcards

Sinus Augmentation Flashcards

1
Q

Maxillary Sinus Augmentation: History

A
  • Boyne & James: 1980
    • first published technique
  • Tatum: 1986
    • crestal approach
  • Summers: 1994
    • Osteotome technique
  • Sinus Consensus: 1996
    • predictable & effective
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2
Q

Alternatives to Sinus Augmentation

A
  • RPD
  • Fixed Bridges
  • Cantilevers
  • Implants:
    • Short
    • Zygomatic
    • Tilted
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3
Q

Maxillary Sinus Anatomy:

A
  • Shape:
    • Pyramidal
  • Membrane:
    • Lined by Pseudostratified columnar epithelium
        • periosteum→ Schneiderin Membrane (0.3-0.8m)
  • Size: 12-15 mL
  • Dimensions:
    • Length: 38-45 mm
    • Height: 26-45 mm
    • Width: 25-35 mm
  • Septa:
    • Normally In premolar Area
  • Ostium
    • 40 mm from floor
  • 6 walls:
    • Anterior
    • Posterior
    • Superior
    • Inferior
    • Medial
    • Lateral
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4
Q

What Blood Vessels Innervate the maxillary sinus?

A
  • Posterior Superior Alveolar A.
  • Infraorbital A.
  • Posterior Lateral Nasal A.
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5
Q

What nerves innervate the maxillary sinus

A
  • Superior Alveolar N
  • Infraorbital N.
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6
Q

Maxillary Sinus Function

A
  • Warm Air
  • Lighten Head
  • Voice Resonance
  • Dissipate Heat
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7
Q

Sinus Anatomy Classification

A

Height from alveolar crest

  • SA-1
    • > 12 mm
  • SA-2
    • 10-12 mm
  • SA-3
    • 5-10 mm
  • SA-4
    • <5 mm
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8
Q

Sinus Augmentation: Indications vs Contraindications

A
  • Indications:
    • Posterior Maxilla Lacks vertical dimension
      • alveolar ridge resorption
      • sinus pneumatization
  • Contraindications:
    • Relative:
      • Treatable sinus pathology
      • Smoking
    • Absolute:
      • Treated Sinus pathology that left irreversible dysfxn
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9
Q

Pre-Op Sinus Evaluation

A
  • Medical Contra-indication
  • CBCT Scan
  • ENT Consult
    • sinus problems
    • Destructive sinus surgery
  • Delay Sinus Surgery due to:
    • nasal congestion
    • sinusitis
    • Respiratory Tract Infection
  • Sinus pathology 30%
    • Thickend mucosa (65%)
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10
Q

Pre-Op Sinus Medicines

A
  • Antibiotics:
    • Amoxicillin
    • Clindamycin
    • Can be mixed in graft
      • 1:4 (Antibiotic:Graft)
  • Decongestants
    • maintain patent ostium
    • Oxymetazoline (Afrin)
    • Pseudoephedrine
  • Anti-inflammatory
    • Decreased edema & post-op pain
    • Medrol dose pack
    • Ibuprofen 800 mg
  • Analgesics
    • Hydrocodone w/acetaminophen (Vicoden)
    • Codeine w/Acetaminophen (Tylenol #3)
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11
Q

Amoxicillin

A
  • Pre-op med
  • 1g 1hr before surgery
  • 500 mg qid 5-7 days
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12
Q

Clindamycin

A
  • Pre-op Med
  • 300 mg 1 hr before surgery
  • 150 mg tid 5-7 days
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13
Q

Oxymetazoline

A
  • aka Afrin
  • Decongestant
  • 1 hour before surgery until
    • 2 days after surgery
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14
Q

Pseudoephedrine

A
  • decongestant
  • 1 tablet tid on day of surgery
  • 2 days after surgery if perforation
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15
Q

Ibuprofen

A
  • Anti-inflammatory
  • 800 mg
  • 1 tablet tid 7 days after surgery
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16
Q

Surgical Technique

A
  • Osteotome (transcrestal)
    • SA-2 and SA-3
  • Lateral Approach (Window)
    • SA-3 and SA-4
17
Q

Osteotome Technique

A
  • Aka Transcrestal
  • SA-2 and SA-3
  • Instrument: OSteotomes
    • Curved tip
      • straight or angled
  • Implant Survival Rate:
    • Bone Height:
      • ≥ 5mm = 96%
      • < 4 mm = 86%
  • Advantages:
    • less
      • invasive
      • painful
      • risk of infection
  • Disadvantages:
    • Blind
    • perforation
    • Lack Control
18
Q

Osteotome Technique: Advantages vs Disadvantages

A
  • Advantages:
    • Less
      • Invasive
      • risk of infeciton
      • painful
      • overhead
  • Disadvantages:
    • Lack control
    • Blind
    • Membrane perforation
19
Q

Osteotome Technique: Research studies

A
  • Implant Survival Rate:
    • Bone Height ≥ 5mm → 96%
    • Bone Height < 4 mm → 86%
20
Q

Lateral Approach

A
  • Aka Window
  • S3-S4
  • More invasive
  • direct vision of sinus
  • Instruments:
    • Pizoelectric surgery
    • Sinus Elevators
    • Kerrison Rongeur
21
Q

Osteotome vs Lateral Approach:

Bone Height Gain

Success Rate

A
  • Osteotome:
    • Bone Height Gain: 3.5 mm
    • Success Rate: 95%
  • Lateral Approach:
    • Bone Height Gain: 12.7 mm
    • Success Rate: 100%
22
Q

Pizoelectric Sinus Elevation

A
  • Reduced perforation risk
  • Ultrasonic Vibrations
  • Hydropneumatic pressure
23
Q

Sinus Augmentation: Risks and Complications

During Surgery

Early Post Op

Late Post op

A
  • During Surgery:
    • Sinus mucosa perforation
      • Schneiderin Membrane perforation (most common)
    • Fracture residual alveolar ridge
    • Obstruct Maxillary Ostium
    • Inadequate Fill
    • Bleeding
    • Damage adjacent dentition
  • Early Post-op
    • Wound Dehiscence
    • Acute Sinusitis
    • Exposed barrier membrane
    • Lose implant or graft
  • Late Post-op
    • insufficient quality or quantity of bone forming in sinus graft
    • oro-antral fistula
    • Chronic bone pain
      • remove implant
    • Chronic Sinus Disease
24
Q

Sinus Perforation

A
  • Incidence: 10-30%
    • Pizo reduces to 7%
  • Causes:
    • Tear membrane during prep
    • Fracture window
    • Elevate membrane
    • Septa or pathologic conditions
    • Very thin membrane
  • Increase risk of infection
    • delay implant placement
  • contaminated mucosa in graft
25
Q

What can cause a Sinus perforation

A
  • Tear membrane during prep
  • Fracture window
  • Elevate membrane
  • Septa or pathologic conditions
  • Very thin membrane

Implantology (15 decks)

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