Efficacy of Endoscopic sinus surgery for associated with filling material of the maxillary sinus, simultaneous sinus-lifting and dental implantation

Abstract

Objectives: Optimization of the sinus-lifting in patients with filling material in maxillary sinus cavity by a one-stage endonasal endoscopic elimination of the sinuspathology and carrying out a sinus-lifting. Materials and methods: A total of 28 patients (12 males and 16 females, the age was 31 to 64 years, from 2016 to 2022) with ridge defects in age group were selected for the study. All patients had a partially or totally edentulous atrophied posterior maxilla. All patients underwent a thorough clinical examination according to a generally accepted scheme.For sinus surgery, used endoscope is 4.0 mm diameter rigid endoscope (Karl Storz). The fungal material, and hypertrophic mucosa within the maxillary sinus were removed and sent for pathological analysis.Sinus lifting procedures were performed using a lateral window approach. A total of 34 sinus lifting procedures were performed, using a mixture of bovine bone, autogenous bone and PRP. According to our surgical procedure we performed in our patients 1 a 2 stage sinus lifting, 98 implants were inserted. Dental prosthetic rehabilitation was undertaken 5 months after implants insertion and submerged healing. Implant success was assessed clinically and radiographically. The height of the graft and bone density was measured 6th and 9th month after surgery using serial CT. The following parameters were assessed: failure of the augmentation procedure, implant failure, and vertical bone height. Results: Any intraoperative and postoperative complications, such asbleeding, membrane perforation, swelling, ecchymosis, pain, nasal bleeding, and infection, were recorded clinically and radiographically. Of the 98 implants placed in these 28 patients, 3 failed to osseointegrate. The CT examination showed the presence of dense bone around and above the implants. The implants appeared to be well integrated with no peri-implant bone loss. At 6 years follow up, excellent integration of grafted tissue, steady levels of bone around the implants and healthy peri-implant tissues were reported. Implants placed in the reconstructed areas were demonstrated to integrate normally, postoperative occlusal function and esthetics have been favorable. Conclusion: The method of simultaneous endonasal sanitation of the maxillary sinus, sinus-lifting, dental implantation, allows to reduce the probability of perforation of the membrane, significantly shortening the rehabilitation period of patients with insufficient bone tissue in the maxillary sinus. These methods led to simpler, more comfortable, lower risks of morbidity, more predictable compared to more invasive maxillary sinus augmentation