Feasibility of Shape-Memory Ni/Ti Alloy Wire Containing Tube Elevators for Transcrestal Detaching Maxillary Sinus Mucosa: Ex Vivo Study

Abstract

Background: Osteotome sinus floor elevation is a less invasive approach to augment an insufficient alveolar bone at the posterior maxilla for dental implantation. However, this approach has some limitations due to the lack of sinus lift tools available for clinical use and the small transcrestal access to the maxillary sinus floor. We recently invented shape-memory Ni/Ti alloy wire containing tube elevators for transcrestal detaching maxillary sinus mucosa, and developed goat ex vivo models for direct visualizing the effectiveness of detaching sinus mucosa in real time during transcrestal maxillary sinus floor elevation. Methods: We evaluated our invented elevators, namely elevator 012 and elevator 014, for their effectiveness for transcrestal detaching maxillary sinus mucosa using the goat ex vivo models. We measured the length of sinus mucosa detached in mesial and distal directions or buccal and palatal directions, and the space volume created by detaching maxillary sinus mucosa in mesial, distal, buccal and palatal directions using the invented elevators. Results: Elevator 012 had a shape-memory Ni/Ti alloy wire with a diameter of 0.012 inch, while elevator 014 had its shape-memory Ni/Ti alloy wire with a diameter of 0.014 inch. Elevator 012 could detach the goat maxillary sinus mucosa in the mesial or distal direction for 12.1±4.3 mm, while in the buccal or palatal direction for 12.5±6.7 mm. The elevator 014 could detach the goat maxillary sinus mucosa for 23.0±4.9 mm in the mesial or distal direction, and for 19.0±8.1 mm in the buccal or palatal direction. An average space volume of 1.7936±0.2079 ml was created after detaching the goat maxillay sinus mucosa in both mesial/distal direction and buccal/palatal direction using elevator 012; while the average space volume created using elevator 014 was 1.8764±0.2366 ml. Conclusion: Both two newly invented tube elevators could effectively detach the maxillary sinus mucosa on the goat ex vivo sinus models. Moreover, elevator 014 has advantages over the elevator 012 for the capability to detach sinus mucosa.

New Perspectives about Maxillary Sinus Lifting: a Literature Review

“…It is performed by experienced surgeons, favoring the lowest probability of complications. We realize that there is a development in the techniques that promotes the reduction of operative time, perforations and consequently a better postoperative for the patient, reducing the unpleasant perception of the surgery 8,12,15,28,29,43,47,48 .…”

“…The authors were able to elevate the membrane in the mesial to distal direction by 19 ± 8.1 mm and buccal to palatal direction by 23 ± 4.9 milimeters. The elevator demonstrated to reduce the incidence of perforation, being considered a promising tool for MSL 48 .…”

Comparison of biological and mechanical properties of different paranasal sinus mucosa in goat

“…The maxillary sinuses are the largest of all paranasal sinuses and are located bilaterally within the maxilla bone, assuming a pyramidal shape [ 9 ]. However, although significant efforts have been made to improve the techniques and design novel tools for crestal maxillary sinus elevation [ 10 ], mmaxillary sinus membrane perforation is the most common complication for maxillary sinus floor elevation [ 11 ]. Therefore, the mechanical properties are crucial for MSA.The anatomical structure of the maxillary sinus of goats, including location, size, shape, and bone structure, is very similar to that of humans.…”

Goat Model for Direct Visualizing the Effectiveness of Detaching Sinus Mucosa in Real Time During Crestal Maxillary Sinus Floor Elevation

“…8,13,14 Recently, we have been designing novel tools for better detaching the maxillary sinus mucosa. 15,16 Ex vivo animal models with the capability of real-time direct visualization have great advantages in the evaluation of the effectiveness of improved or newly designed tools. 17,18 Selection of the proper animal model is crucial to evaluating novel technologies and new materials designed for clinical applications.…”