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Title Bucco-Palatally Narrow Sinus Floors Demonstrate Increased Success for Internal Sinus Augmentation
Clinical Question In patients that need a maxillary internal sinus floor elevation, regarding the buccal-palatal dimension, is an initially narrow sinus floor able to achieve a more successful augmentation, compared to an initially wide sinus floor?
Clinical Bottom Line Attempting to lift the maxillary sinuses is more likely to succeed if the sinus floors are narrow in the buccal and palatal dimensions. A retrospective study and two clinical studies evaluating internal sinus augmentation and maxillary buccal palatal sinus dimensions support this conclusion. As a means of better understanding the outcome of different variables, clinicians should evaluate the maxillary sinus buccal palatal dimension when performing internal sinus surgery.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 35028068Zheng/202263 sites/45 patients Clinical Study
Key resultsThe mean sinus width at the 63 sites evaluated was 14.05 +/- 2.73 mm. This study found that residual bone height ranged between 2.11 mm and 7.64 mm, with a mean value of 4.54 +/- 1.56 mm. The sinus lift height initially was 5.89 +/- 1.49 mm, and 6 months later it was 4.41 +/-1.66 mm. Scatter plots and radiographic imaging revealed a positive correlation between sinus width and graft resorption.
#2) 25720811Zheng/201657 sites/33 patients Clinical Study
Key resultsThe sinus widths at the 57 sites evaluated ranged from 7.88 to 21.63 mm. The mean value measured was 13.68 +/- 2.66 mm from the buccal to palatal dimension. After 6 months, the mean apical graft bone height decreased from 2.85 mm to 1.38 mm. As a result, using an osteotome technique, bone resorption occurred more dramatically in patients with wider sinus floors than in those with narrow sinus floors.
#3) 25196695Spinato/201460 sites/60 patientsRetrospective Cohort Study
Key resultsThe association between the buccal-palatal distance between sinus walls and intra-sinus bone loss was confirmed by both analytics and CBCT. In sinuses with a buccal-palatal width greater than 13.27 mm, intra-sinus bone loss was more prevalent than in sinuses with a width less than 13.27 mm. In terms of graft bone retention, internal sinus lifts of narrower maxillary sinuses with residual bone less than 5 mm were more predictable.
Evidence Search Maxillary sinus lift, (maxillary sinus width) AND (CBCT), (internal sinus lift) AND (maxillary width), Maxillary sinus size, (sinus floor elevation) AND (CBCT).
Comments on
The Evidence
Zheng et al. performed two clinical studies, both well done, but relatively low on the research evidence pyramid. They both had a similar number of sites evaluated and both studies had consistent follow-up periods to obtain accurate imaging data. Using a variation of published quality appraisal tools, most quality check questions were answered positively in both the 2016 and 2022 studies. Quality appraisal tools help guide readers to determine if articles have legitimate information. Questions that were answered favorably from both studies included; "Was the exposure measured accurately to minimize bias?", "Did the study address a clearly focused issue?", "Did the author use an appropriate method to answer their question?", "How precise are the results?" and "Do the results of the study fit with other available evidence?" In addition, Spinato et al. conducted a retrospective study evaluating 60 patients that also performed well on the appraisal tools, and indicated similar results to the two clinical studies. It is also important to acknowledge the questions of the appraisal tool that may be lacking in clarity from the three studies such as; "What confounding factors have the authors accounted for?" This may not be represented due to isolated populations.
Applicability Many reasons may require dental clinicians to increase the bone quantity in the maxillary sinus. The use of an internal sinus augmentation approach has many benefits and can help avoid issues such as patient discomfort and maxillary sinus membrane perforation. In order to optimize procedure outcomes, clinicians should assess the buccal-palatal width of the maxillary sinus.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics)
Keywords Maxillary sinus lift, sinus floor elevation, transcrestal sinus floor elevation, maxillary sinus width, internal sinus lift, crestal sinus augmentation, intra-sinus bone loss, marginal bone loss, maxillary sinus size, radiographic and CBCT evaluation, maxillary sinus angle, residual bone height.
ID# 3510
Date of submission: 11/30/2022spacer
E-mail Simonsen@livemail.uthscsa.edu
Author Jaret Simonsen, DMD. Periodontics
Co-author(s) Cindy Quyen Huynh
Co-author(s) e-mail huynhc1@livemail.uthscsa.edu
Faculty mentor/Co-author Charles Powell DDS, MS
Faculty mentor/Co-author e-mail Powellc2@uthscsa.edu
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