Comparison of three different methods of internal sinus lifting for elevation heights of 7 mm: an ex vivo study

Abstract

BackgroundVarious techniques are available for elevating the sinus membrane. The aim of this study is to evaluate three methods of indirect sinus floor elevation regarding elevation heights of 7 mm on the outcomes of membrane perforation, length of perforation, and time required to perform the procedure. MethodsThree different methods for indirect sinus lifting, bone added osteotome sinus floor elevation (BAOSFE), sinus floor elevation with an inflatable balloon, and crestal approach system (CAS kit) from OSSTEM, were assessed for their ability to lift the sinus without causing laceration of the Schneiderian membrane. The study was performed on 18 freshly slaughtered sheep heads (36 sinus lifts were done, 12 for each method). CBCT images of the heads were taken to assess the best location for the sinus lift. Then, the heads were bisected and the membrane was exposed from the medial aspect. After that, each method was performed. The intended elevation height was 7 mm. If the 7 mm were not reached, the maximum height of elevation was measured.ResultsThe method used was significantly associated with the occurrence of perforation (p value = 0.014) where BAOSFE was associated with the largest number of perforations (58.4%, n = 7) compared to 8.3% and 8.3% for the balloon and CAS kit methods, respectively. The odds ratio for perforation occurrence from BAOSFE compared to the CAS kit was significant (OR = 0.091, p = .022). No significant odds ratio was found for the balloon method compared to CAS kit. Additionally, the method used was significantly associated with time of operation and with the length of perforation (p value < 0.001) where CAS kit required the longest time and BAOSFE caused the biggest perforations.ConclusionsThe study shows that both the balloon and the CAS kit were superior to the BAOSFE in terms of safety in elevating the sinus membrane. Further, in vivo studies have to prove these findings.

Schneiderian membrane perforation via transcrestal sinus floor elevation: A randomized ex vivo study with endoscopic validation

“…This could be explained by the greater VEH permitted by the SCA versus osteotome approach. The positive results attributed to this kit demonstrated in this study are in concordance with the results observed in the ex vivo study of Yassin Alsabbagh et al, , where the SCA drill kit was shown to be superior to the osteotome technique in osteotomy preparation and breaking the sinus floor. These results were later corroborated in a clinical study by Kim et al, , who did not report any membrane perforations using the SCA drill kit, but reported an incident of acute maxillary sinusitis 5 months after surgery.…”

“…The percentage of perforations found in the present study was 50%, higher than the data reported by Garbacea et al () and Nolan et al (), who reported a mean IoP rate of 40% and 41%, respectively. These rates were considerably less than the 58.4% reported by Yassin Alsabbagh et al (), or the 62.5% reported by Cho, Wallace, Froum, and Tarnow (). However, perforation during transcrestal sinus membrane elevation is not always detected, indirectly impacting postoperative complications and surgical outcome.…”

“…If this occurs, a number of consequences may entail: the presence of bone graft within the sinus antrum, acute or chronic sinus infection, the invasion of bacteria into the site or disrupted maxillary sinus physiologic function (Katranji et al, ; Li & Wang, ). With all the proposed methods of crestal SFE (Chan et al, ; Kim et al, ; Yassin Alsabbagh et al, ), MT (Wen, Lin, Yang, & Wang, ) RRH (Schwarz et al, ), the amount of bone graft inserted and VEH (Sonoda, Harada, Yamamichi, Monje, & Wang, ) are factors that influence the probability of membrane perforation. In this study sample, MT was not statistically significant between the two study groups, enabling a fair comparison of all other factors between test and control.…”

“…The original procedure consists of inwardly fracturing the sinus floor by preparing the implant bed with osteotomes of increasing diameters. Other techniques were later proposed, such as the balloon technique (Chan et al, ; Yassin Alsabbagh, Alsabbagh, Darjazini Nahas, & Rajih, ) and the piezotome technique, a procedure of standardized sequence of designed drills, trephine and osteotomes (Kim, Lee, Park, Kim, & Oh, ; Trombelli, Franceschetti, Trisi, & Farina, ).…”

Microscope and micro‐camera assessment of Schneiderian membrane perforation via transcrestal sinus floor elevation: A randomized ex vivo study

“…These perforations are generally undetectable by the operator during the surgical procedure, thus eventually leading to further post‐surgical complications (Nolan, Freeman, & Kraut, ). Recently, other improved TSFE has been proposed; these include but are not limited to the balloon technique (Chan et al, ; Yassin Alsabbagh et al, ), the hydraulic elevation technique (Bensaha, ; Better et al, ; Tallarico, Better, De Riu, & Meloni, ), the piezotome technique and the reamer system (Yassin Alsabbagh et al, ). Among the TSFE techniques proposed, the reamer system (e.g., SCA‐Neobiotech, Seoul, South Korea) exhibits less trauma compared with other TSFE techniques (Gargallo‐Albiol, Tattan, Sinjab, Chan, & Wang, ; Kim, Lee, Park, Kim, & Oh, ; Yassin Alsabbagh et al, ).…”