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Journal of Oral Science & Rehabilitation Issue 01/2015

32 Volume 1 | Issue 1/2015 Journal of Oral Science & Rehabilitation C om plic a tion s a fter s i nu s f lo o r au gme ntati o n symptoms concerningthe postoperative swelling of the sinus membrane, and we had not pre- viously observed this phenomenon. In approximately 80% of the 132 sites, the extent ofthe postoperative swelling constituted more than one-third of the remaining maxillary sinuscavity.AsshowninFigure1,evenifthesize oftheaugmentedareawasalmostthesame,the extent of the swelling was different. These re- sults suggest that the extent of the postopera- tiveswellingdidnotdependontheareaofthede- tachment, and it was difficult to predict the extentofswellingbeforesurgery. A complication of this postoperative swelling of thesinusmembranewasmigrationoftheβ-TCP granules. This migration was brought about by the pressure of swelling and the direction of pressure was difficult to determine. When the pressure was toward the lateral window, the β-TCPgranules migratedtowardthe buccalside of the alveolar bone through the lateral window. This migration of the granules led to the loss of β-TCP granules at the augmented area and re- sulted in unexpected poor bone formation as in Case 1. Therefore, bone substitute materials such as β-TCP granules act as a space makerfor Figs. 6a–h Figs. 6a–h (a) A coronal CBCT slice image taken before surgery. (b) The area to be augmented was filled with β-TCP granules. (c) A titanium mesh plate was placed over the lateral window and fixed with three microscrews. (d) A coronal CBCT slice image taken on the day of surgery. (e) A coronal CBCT slice image taken one week after surgery. Type 3 swelling of the maxillary sinus membrane had occurred and the trap door had become dislocated (yellow arrows). However, the buccal migration of the β-TCP granules did not occur owing to the rigid coverage of the lateral window with the titanium mesh plate and screws. (f) A coronal CBCT slice image taken three months after surgery. The postoperative swelling of the maxillary sinus membrane had disappeared spontaneously and the trap door returned to its original position. (g) One year after surgery, the titanium mesh plate and screws were removed. The remaining β-TCP granules were observed at the lateral window and embedded in the newly formed bone. Four implants were placed successfully. (h) A coronal CBCT slice image taken after placement of the implants. A radiopaque line similar to that of cortical bone was observed at the newly formed floor of the maxillary sinus (blue arrows). a b c d e f g h

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