COMPLICATIONS OF MAXILLARY SINUS AUGMENTATION
Abstract:
Introduction: Maxillary sinus augmentation for implant reconstruction of the posterior maxilla is a predictable procedure which needs to fulfil certain criteria in order to get optimum results. A preoperative evaluation methodology, including a careful selection of patients is very important for the success rate of this type of surgery. The factors that should be taken into account include osteomeatal complex permeability and functional paranasal sinuses. A good surgical technique is essential, including the management of complications. Implant failure, especially after several years, usually indicates an inadequate or poor dispensary treatment plan. The objective of this study is to demonstrate that immediate complications depend heavily on the intraoperative manipulation technique of the implantologist, the instruments used, and when they occur, the treatment is successful if an appropriate surgical and medical treatment is considered. Well treated complications will ensure a high rate of success and a very good long term result. Materials and methods: The resulting data were gathered through statistical analysis of 110 sinus augmentation interventions performed on 79 patients (mean age 49 years old (25-65)), with 342 implants in function for a minimum of 3 years. Preoperatively and postoperatively, OPT examination was mandatory for all patients, while the most difficult cases were examined by computed tomography (CT). Long-term success rates are of 90-97%. By using the autogenous bone or allografts combinations, alloplaste, xenografts and autogenous bone all led to similar results. The survival rate of implants assessed at inclusion and after a successful load was compared between: different augmentation materials; smokers / nonsmokers; presence or absence of intraoperative complications; immediate / delayed insertion of implants. Results: Smoking was considered a relative contraindication in this study, although smoking is considered by some surgeons an absolute contraindication. We encountered perforations of membranes especially due to a partial septum and after trimming the sinus membrane, but the holes were not large, being able to continue the intervention with good results both, immediately and after the prosthetic work. We had an infection in 2 (of 45) patients who were smokers, after receiving a sinus graft, consisting of granular bone and resorbable membrane. We achieved higher success rates in non-smoking patients (82.7%) than in smokers (65.3%). Thus, we concluded that smoking affects the success rate of osseointegration of implants for sinus augmentation, regardless of the number of cigarettes smoked per day. Maxillary sinus grafting has become a common technique for site development and implant reconstruction. We achieved excellent success rates for sinus grafting and implant insertion in both protocols with a single step, and those in two stages. Although the predictability and success rates are very good, there were some cases in which complications occurred.
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