How to avoid intraoperative and postoperative complications in maxillary sinus elevation

Abstract

Maxillary sinus floor elevation, via the lateral approach, is one of the most predictable bone augmentation procedures performed in implant dentistry. but both intra‑ and postoperative complications can occur, and some of them are severe. Our aim is as follows: To review the pertinent literature on the topic, especially assessing the risk factors related to complications. To give clinical recommendations to minimize intra‑ and postoperative complications with the ultimate scope of improving the standard of clinical care and patient safety.

Mucosal cyst aspiration in conjunction with maxillary sinus elevation: A clinical cohort study

“…Prior to any intervention, a meticulous diagnosis, involving radiological evaluation (Panoramic exam and CT scan) and eventually otolaryngological examination when needed. 21 In general, when considering utilization of MSA, the contraindications in the field of otolaryngology pertain to conditions or anatomical variations that either currently or potentially obstruct the natural drainage of the maxillary sinus through its natural opening. Both medical conditions that affect ciliary function (such as rhinosinusitis and cystic fibrosis) and physical obstructions (like polyps and neoplasms) can hinder sinus drainage, increasing the risk of infection after a sinus graft.…”

A Clinical Approach for the Removal of a Large Antral Pseudocyst with Simultaneous Maxillary Sinus Augmentation: A Case Series

“…Schneiderian membrane perforation is the most common accidental intraoperative complication during sinus lift [23,24]. Factors, such as thickness and morphology of the Schneiderian membrane, anatomy of the sinus, limited residual ridge height, and sinus pathology, can increase the risk.…”

“…Factors, such as thickness and morphology of the Schneiderian membrane, anatomy of the sinus, limited residual ridge height, and sinus pathology, can increase the risk. Sinus pathology may be accompanied by poor membrane vascularity and elasticity and reduced membrane resistance to elevation [15,24]. Membrane perforation in the presence of sinus pathoses may also lead to graft contamination and sinus infection with the leakage of cystic fluid or inflammatory exudate unless the lesion is enucleated ahead of MSFA.…”

“…On the other hand, several studies have supported the conflicting opinion that membrane perforation is not associated with postoperative infection or implant failure, probably because of improved access for instruments and materials, and repair techniques [23,26,30]. Proper strategies to manage a perforated membrane are suggested to reduce complications [6,24,31]. Currently, intentional perforation during sinus lift is mostly indicated for the removal of implants displaced into the sinus cavity [32] and for treating sinus mucosal thickening or pathology.…”

Missing the point

“…26 To compensate for the lack of maxillary bone height, several bone augmentation or sinus lift techniques have been proposed. Membrane perforations represent the most common complication among these procedures, 27,28,29 with sinus infection a known risk outcome. The authors were highlighting this as something general dentists should have some awareness of as a cautionary measure.…”