Journal of Indian Society of Periodontology
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   Table of Contents    
SHORT COMMUNICATION
Year : 2015  |  Volume : 19  |  Issue : 5  |  Page : 593-594  

Bone suture and lateral sinus lift surgery


1 Oral and Maxillofacial Diseases Research Center, School of Dentistry, Mashhad, Iran
2 Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran

Date of Web Publication13-Oct-2015

Correspondence Address:
Saeedeh Khajehahmadi
Dental Research Center of Mashhad University of Medical Sciences, Vakilabad Blvd, P. O. Box: 91735-984, Mashhad
Iran
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Source of Support: This study was supported by a grant from the Vice Chancellor of Research of Mashhad University of Medical Sciences,, Conflict of Interest: None


DOI: 10.4103/0972-124X.162208

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   Abstract 


Bone suture in lateral sinus lift has four indications. Three of them depend on creating a hole in the lateral maxillary sinus wall above the antrostomy window for securing the elevated medial maxillary sinus membrane to manage perforated Schneiderian membrane. Covering the buccal antrostomy window with the buccal fat pad (BFP) for better nourishment of the inserted graft and as an alternative for bone tags in fixation of collagen membrane has been reported previously. A new indication for firmly anchoring the BFP to the medial maxillary sinus wall as the last resort for the management of perforated Schneiderian membrane is explained in this article.

Keywords: Buccal fat pad, lateral sinus lift, Schneiderian membrane


How to cite this article:
Rahpeyma A, Khajehahmadi S. Bone suture and lateral sinus lift surgery. J Indian Soc Periodontol 2015;19:593-4

How to cite this URL:
Rahpeyma A, Khajehahmadi S. Bone suture and lateral sinus lift surgery. J Indian Soc Periodontol [serial online] 2015 [cited 2020 Jun 6];19:593-4. Available from: http://www.jisponline.com/text.asp?2015/19/5/593/162208




   Introduction Top


Sinus lift surgery is recommended in maxillary edentulous region when the remaining available bone is inadequate as consequence of maxillary sinus pneumatization.[1] It is a preprosthetic surgery that was popularized with the introduction of dental implants.[2] Other uses have been explained for this technique for outpatient posterior maxillary segmental orthognathic surgery and orthodontic purposes.[3],[4]

Bone suture consists of creating a hole in the bone for the purpose of anchoring soft tissues to the bone. Creating bone holes in lateral maxillary sinus wall above the antrostomy window for fixing torn Schneiderian membrane is a known indication for bone suture technique [Figure 1].
Figure 1: Elevating Schneiderian membrane from the medial maxillary sinus wall and securing it to the bone hole above the antrostomy window

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Securing the buccal fat pad (BFP) to the periphery of the antrostomy window for better nourishment of the grafted material in maxillary sinus and as an alternative to bone tags for fixation of collagen membrane are the other applications.[5],[6],[7] A new indication for firmly anchoring the BFP to the medial maxillary sinus wall as the last resort for the management of perforated Schneiderian membrane is explained in this article.


   Surgical Technique and Patient Top


The patient was 62-year-old male who had decided to replace his lost teeth in the jaws with fixed dental implants. During the lateral sinus lift surgery, a large perforation occurred that was not amenable to local application of collagen membrane. The BFP was brought out through a 1-cm incision behind the maxillary buttress and was firmly attached to the medial wall with the aid of the bone suture. The biomaterial (DFDBA: Cenobone, Hamanand Saz Baft, Kish, Iran) was added beneath that, between BFP and maxillary sinus floor. Six months after lateral sinus lift surgery, two dental fixtures (Biohorizons: Birmengam, USA) were inserted. Prosthodontic treatment was uneventful [Figure 2].
Figure 2: (a) Buccal fat pad (*) is fixed to the palate by means of bone suture; (b) schematic representation; (c) cone-beam computed tomography taken 1-month after the operation shows the ability of the flap to retain the biomaterial between the flap and maxillary sinus floor; (d) postoperative photograph 1-year after prosthetic replacement

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   Discussion Top


Using BFP as the last resort for managing perforated Schneiderian membrane is increasing today.[8],[9] Suturing this flap to the remaining Schneiderian membrane is difficult and has the risk of suture release through the delicate thin Schneiderian membrane. Firmly securing the BFP to the medial maxillary sinus wall has the benefit of isolating the graft/biomaterial from maxillary sinus and participating in graft nourishment. We do every effort to complete the procedure in the first sinus lift surgery because stopping the procedure and re-entry to the surgical field in another session is associated with a great failure rate in our hands.

Lateral sinus lift is a modified form of caldwell-luc surgery in which the integrity of maxillary sinus membrane is preserved. When the schneiderian membrane is torn and the surgeon decide to stop the procedure and doing another attempt several month later, then the clinician is confronted with previously operated sinus with established increased risk of complications.[10]


   Conclusion Top


Bone suture in the medial maxillary sinus wall is a useful aid in managing large perforated Schneiderian membrane, with the aid of the BFP. This technique should be considered when other simpler methods are not responsive.


   Acknowledgement Top


This study was supported by a grant from the Vice Chancellor of Research of Mashhad University of Medical Sciences.

 
   References Top

1.
Khajehahmadi S, Rahpeyma A, Hoseini Zarch SH. Association between the lateral wall thickness of the maxillary sinus and the dental status: Cone beam computed tomography evaluation. Iran J Radiol 2014;11:e6675.  Back to cited text no. 1
    
2.
Rahpeyma A, Khajehahmadi S. Alveolar antral artery: Review of surgical techniques involving this anatomic structure. Iran J Otorhinolaryngol 2014;26:73-8.  Back to cited text no. 2
    
3.
Hwang JH, Jung BY, Lim CS, Cha IH, Park W. Posterior maxillary segmental osteotomy concomitant with sinus lift using a piezoelectric device. J Oral Maxillofac Surg 2011;69:2339-44.  Back to cited text no. 3
    
4.
Vitral RW, da Silva Campos MJ, de Andrade Vitral JC, Santiago RC, Fraga MR. Orthodontic distalization with rigid plate fixation for anchorage after bone grafting and maxillary sinus lifting. Am J Orthod Dentofacial Orthop 2009;136:109-14.  Back to cited text no. 4
    
5.
Clementini M, Ottria L, Pandolfi C, Bollero P. A novel technique to close large perforation of sinus membrane. Oral Implantol (Rome) 2013;6:11-4.  Back to cited text no. 5
    
6.
Hassani A, Khojasteh A, Alikhasi M, Vaziri H. Measurement of volume changes of sinus floor augmentation covered with buccal fat pad: A case series study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:369-74.  Back to cited text no. 6
    
7.
DiBona MC. Membrane anchoring: An alternative technique. J Oral Implantol 1997;23:43-4.  Back to cited text no. 7
    
8.
Kim YK, Hwang JW, Yun PY. Closure of large perforation of sinus membrane using pedicled buccal fat pad graft: A case report. Int J Oral Maxillofac Implants 2008;23:1139-42.  Back to cited text no. 8
    
9.
Hassani A, Khojasteh A, Alikhasi M. Repair of the perforated sinus membrane with buccal fat pad during sinus augmentation. J Oral Implantol 2008;34:330-3.  Back to cited text no. 9
    
10.
Cote MT, Segelnick SL, Rastogi A, Schoor R. New York state ear, nose, and throat specialists' views on pre-sinus lift referral. J Periodontol 2011;82:227-33.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2]



 

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    Abstract
   Introduction
    Surgical Techniq...
   Discussion
   Conclusion
   Acknowledgement
    References
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