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ePaper created 2015-11-17, 15:11:47 | version 1.38.0
Volume 1 | Issue 1/2015 33Journal of Oral Science & Rehabilitation C om pli cati o ns af te r si nu s f lo o r au gme ntati o n bone augmentation in sinus floor elevation. Ahn et al. reported that little to no new bone forma- tion was observed at the augmented area six months after sinus floor augmentation using blood-soaked collagen sponges as a space maker.6 Scala et al. concluded that the void ini- tially occupied by the coagulum after sinus membrane elevation shrank substantially during the observation period.4, 5 Furthermore, Schweikert et al. reported the function of a tita- nium device as a space maintainer in sinus floor augmentationinmonkeys.7 Theyconcludedthat shrinkage of the newly formed tissue was ob- served and the space-maintaining function of the device was in doubt. The current study found that the postoperative swelling of the sinus membrane occurred in 100% sites and the pressure of swelling was strong enough to migrate the β-TCP granules toward the buccal side. Therefore, blood-soaked collagen sponges or clots would have collapsed under the pres- sure of postoperative swelling of the sinus membrane. The migration of bone substitute materials posed the risk of wound dehiscence and infec- tion. In Case 2, the buccal migration of the β-TCP granules occurred even though the lat- eral window had been covered with two colla- gen membranes. When the postoperative swelling was Type 2 or 3, the pressure of the swelling was sufficiently strong to push the membranes out of the lateral window. There- fore,we nowcoverthe lateralwindowwith ati- tanium mesh plate and screws, as was done in Case 3. In the lateral window technique, it is recommended that the lateral window be cov- ered tightlyto avoid the migration of bone sub- stitute materials through the lateralwindow. Conclusion One week after sinus floor augmentation, post- operative swelling of the maxillary sinus mem- brane occurred in all 132 sites. The swelling brought about the migration of the bone substi- tutematerials.Furthermore,themigrationofthe β-TCP granules caused loss of volume at the augmentedareaandwounddehiscence.Inorder toavoidthemigrationofbonesubstitutemateri- als, the lateralwindow should be covered tightly withatitaniummeshplateandscrewsforsafety in the lateral window technique for sinus floor augmentation. Competinginterests The authors declare that they have no compet- ing interests. Acknowledgments Some photographs of Cases 1–3 were ex- cerpted from Nosaka Y. Sinus floor elevation: avoiding pitfalls using cone-beam CT. Quintes- sence Publishing; 2010. Yasuhiro Nosaka,* Hitomi Nosaka* & Yoshinori Arai† * Nosaka Oral Surgery Clinic, Ashiya, Japan † School of Dentistry, Nihon University, Tokyo, Japan Corresponding author: Yasuhiro Nosaka Nosaka Oral Surgery Clinic 2F Chambre-Ashiya 11-17, Nishiyama-cho Ashiya, Hyōgo 659-0083 Japan T +81 797 25 0545 F +81 797 25 0546 nosasen@aol.com 1. Okano T, Harata Y, Sugihara Y, Sakaino R, Tsuchida R, Iwai K, Seki K, Araki K. Absorbed and effective doses from cone beam volumetric imaging for implant planning. → Dentomaxillofac Radiol. 2009 Feb;38(2):79–85. 2. Li G. Patient radiation dose and protection from cone-beam computed tomography. → Imaging Sci Dent. 2013 Jun;43(2):63–69. 3. Lofthag-Hansen S, Thilander-Klang A, Ekestubbe A, Helmrot E, Gröndahl K. Calculating effective dose on a cone beam computed tomography device: 3D Accuitomo and 3D Accuitomo FPD. → Dentomaxillofac Radiol. 2008 Feb;37(2):72–9. 4. Scala A, Botticelli D, Rangel IG Jr, De Oliveira JA, Okamoto R, Lang NP. Early healing after elevation of the maxillary sinus floor applying a lateral access: a histological study in monkeys. → Clin Oral Implants Res. 2010 Dec;21(12):1320–6. 5. Scala A, Botticelli D, Faeda RS, Rangel IG Jr, De Oliveira JA, Lang NP. Lack of influence of the Schneiderian membrane in forming new bone apical to implants simultaneously installed with sinus floor elevation: an experimental study in monkeys. → Clin Oral Implants Res. 2012 Feb;23(2):175–81. 6. Ahn JJ, Cho SA, Byrne G, Kim JH, Shin HI. New bone formation following sinus membrane elevation without bone grafting: histologic findings in humans. → Int J Oral Maxillofac Implants. 2011 Jan-Feb;26(1):83–90. 7. Schweikert M, Botticelli D, De Oliveira JA, Scala A, Salata LA, Lang NP. Use of a titanium device in lateral sinus floor elevation: an experimental study in monkeys. → Clin Oral Implants Res. 2012 Jan;23(1):100–5. References T +81797250545 F +81797250546