Revista nº 793

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152 REVISIÓN
Actualidad
Médica
A C T U A L I D A D
M É D I C A
©2014.Actual.Med.Todoslosderechosreservados
Treatment Options for the Atrophic Posterior
Maxilla
Abstract
Maxillary sinus augmentation has been shown to be a predictable surgical procedure used to enhance bone volume
for the placement of dental implants in the atrophic posterior maxilla. Therefore, various techniques have been
proposed in order to achieve the necessary bone dimension for the insertion of implants in previously compromised
sites. Careful case and material selection corresponding to different indications can be beneficial to achieving
predictable and consistent treatment outcomes in the posterior atrophic maxilla.
The purpose of this review was to discuss the indications, contraindications, limitations, and case selection criteria
used to determine treatment options for the different techniques. It is necessary to define case selection criteria
according to the remaining crestal bone and the anatomy of the sinus cavity.
Enviado: 02-06-2014
Revisado: 01-12-2014
Aceptado: 23-12-2014
Keywords: Maxillary sinus
augmentation; dental implant;
osteotome; lateral wall; bone
graft
INTRODUCTION
Implant therapy for rehabilitation of edentulous posterior
maxillary regions often presents a challenge due to inadequate
alveolar ridge and poor quality of bone. Resorbed alveolar
processes result from a combination of pneumatization of
the maxillary sinus, the effects of periodontal disease, and
physiological bone resorption. Therefore, various techniques
have been proposed in order to achieve the necessary bone
volume for the insertion of implants in the atrophic posterior
maxillar. (1-4) During the past few decades, maxillary sinus
augmentation has been shown to be the most predictable of the
preprosthetic surgical techniques used to enhance bone volume
for the placement of dental implants in previously compromised
sites.5-8
Although there have been some modifications, the most
common approach is the Lateral Wall Sinus Floor Elevation
(LWSFE), whereby an osteotomy “window” in the lateral wall
of the sinus is made for access, sinus membrane elevation and
packing the floor of the sinus with a graft material.1-5 Implants
can be placed simultaneously with the grafting procedure or
after a healing and graft consolidation period of 4 to 9 months.
Elevation of the sinus membrane can also be accomplished with
the transcrestal approach to the maxillary sinus, known as the
Bone Added Osteotome Sinus Floor elevation (BAOSFE) that
has been advocated as “minimally invasive”. (3,4,9) However,
some limitations related to these techniques have been
reported. (7,10,11) In order to reduce these complications, other
approaches have been proposed, including, but not limited to, the
use of short implants and Osteotome-Assited Sinus Augmentation
(OASA) technique. (12-20)
It is necessary to define case selection criteria according
to the remaining crestal bone and the anatomy of the sinus
cavity. The purpose of this review was to discuss the indications,
contraindications, limitations, and case selection criteria used to
determinethe most predictable treatment options of the different
techniques.
MATERIALS AND METHODS
A search of the literature was performed focusing on
techniques related to the sinus augmentation procedure. Clinical
data in this study was obtained from the anonymous Implant
Database (ID) at the Ashman Department of Periodontology
and Implant Dentistry at the New York University College of
Dentistry (NYUCD) Kriser Dental Center. This Data was extracted
as deidentified information from the routine treatment of
patients. The ID was certified by the Health Insurance Portability
and Accountability act (HIPAA) and approved by the University
Committee on the Activities involving Human Subjects (UCASHS).
A computer search of electronic databases from MEDLINE and
PUBMED at the Waldman Library at the NYUCD Kriser Dental
Center was performed. Keywords such as “maxillary sinus,” “sinus
lift,” “sinus augmentation,” “sinus elevation,” “sinus graft,” “bone
grafting,” “dental implants,” and “endosseous implants” were
used, alone and in combination, to search the databases. Non–
Ismael Khouly, DDS, MS, PhD1; Diego Gallego Rivero, DDS2; Alejandro Perez, DDS2; Said
Khouly, DDS, MS3; Sang-Choon Cho, DDS2; Stuart J. Froum, DDS2
1Department of Oral & Maxillofacial Surgery, New York University College of Dentistry, New York, USA; Bluestone
Center for Clinical Research, New York University College of Dentistry, New York, USA
2Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, USA
3 Private Practice, San Sebastian, Spain
Actual. Med.
2014; 99: (793): 152-156
Ismael Khouly, DDS, MS, PhD
Phone: 212-998-9453 – Fax: 212-995-4843
Email:
421 First Avenue – BCCR 2W
New York, NY 10010