Surgical Techniques for Jaw Reconstruction

For a successful dental implant, the first step for some patients is reconstructive surgery of the jaw. A bone graft to augment the upper jaw can now be achieved by several methods. To assess these methods, their risk of sinus perforation, and the best evaluation technology, researchers put these procedures to the test on 20 human cadaver specimens.
An article entitled, “The Incidence of Maxillary Sinus Membrane Perforation During Endoscopically Assessed Crestal Sinus Floor Elevation: A Pilot Study,” by Antoanela Garbacea, DDS, et al, was published in the Journal of Oral Implantology. It presented a pilot study comparing transcrestal techniques for maxillary sinus floor elevation. This is a surgical procedure that increases bone volume and prepares the upper jaw for dental implants. The study sought to determine if any of the techniques carried a greater risk of surgical complications.
Perforation of the sinus membrane is the most common surgical complication associated with maxillary sinus floor elevation. Perforations have been linked to acute or chronic sinus infection, edema, bleeding, loss of bone graft material, and failure of the implant. The conventional method for this procedure is the lateral approach, which gains surgical access through the zygomatic bone bordering the maxillary sinus cavity. While this is an invasive technique, there is a low incidence of complications. A less invasive procedure uses a crestal approach through the osteotomy prepared for dental implant placement. However, this is a sensitive technique that restricts the surgeon’s direct visual examination. The current study used 20 human cadaver specimens with 40 intact sinuses, as test subjects for 3 transcrestal surgical techniques. One experimental group used the DASK (Dentium Advanced Sinus Kit) Sinus Lift and Elevation Kit (Dentium) which features specially designed surgical drills to apply mechanical and hydraulic pressure. Another experimental group received a surgical protocol that permitted entry into the sinus through crestal bone that had been eliminated during site preparation. A control group was treated with the osteotome/crestal sinus membrane elevation technique. Postoperative assessment of the specimens determined whether membrane perforation had occurred. Direct visual endoscopy, cone beam computed tomography, and periapical radiographs were used. While the study found endoscopy to be the preferred form of detecting membrane perforations, no significant differences were found in the rate of perforations among the surgical techniques used.
(Source: Journal of Oral Implantology. August 2012, Volume 38, Issue 4)
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