Andrea Pizzini1, Hussein S Basma1, Peng Li2, Nicolaas C Geurs1, Ramzi V Abou-Arraj1. 1. Department of Periodontology, School of Dentistry, University of Alabama at Birmingham, Birmingham, Alabama, USA. 2. Department of Acute, Chronic and Continuing Care, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Abstract
OBJECTIVES: This retrospective study aimed to evaluate the influence of anatomical, patient and surgical factors on the occurrence of membrane perforation (MP) during lateral window sinus floor elevation (LWSFE). MATERIAL AND METHODS: A review of LWSFE patient records between 2014 and 2019 accounted for MP occurrence, window surface area (WSA), intravenous sedation use, osteotomy instrument type, and clinician experience. Preoperative cone-beam computed tomography (CBCT) scans were analyzed for lateral wall thickness (LWT), LFM and LAM angles formed between lateral and medial walls at the floor and anterior wall respectively, sinus width at 5-, 10- and 15-mm (LM-5, LM-10 and LM-15) from the floor, residual bone height (RBH), sinus pathologies, septa and arterial anastomoses. The generalized estimating equations (GEE) approach with a sandwich variance-covariance estimator was used to evaluate the associations with MP. RESULTS: MP occurred in 25.74% of 202 LWSFE procedures (166 patients). Mean 1.6mm-LWT, 3.2mm-RBH, 95°-LFM, 75.5°-LAM, 12mm-LM-5, 20.79% septa, 16.83% arterial anastomosis, 37.62% sinus pathology and 29.21% intravenous sedations, 85.24% WSA ≥40mm2 and 57% >10 procedures/clinician were reported. Greater MP rates were encountered as follows: 38.3% (LWT≥1.5mm), 38% (LFM<90°), 59.6% (LAM<70°), 45.4% (LM-5<10mm), and 36.4% (WSA ranged >80mm2 ), with statistically significant associations with all these outcomes (P<.05). The presence of pathologies was also associated with MP (P=.013). Associations between MP and the presence of septa and arterial anastomoses, age/gender, right/left sinus, RBH, clinician's experience, instrument type and intravenous sedation use could not be demonstrated. CONCLUSIONS: MP is significantly associated with thicker lateral walls, narrower sinuses, larger windows and existing sinus pathology. This article is protected by copyright. All rights reserved.
OBJECTIVES: This retrospective study aimed to evaluate the influence of anatomical, patient and surgical factors on the occurrence of membrane perforation (MP) during lateral window sinus floor elevation (LWSFE). MATERIAL AND METHODS: A review of LWSFE patient records between 2014 and 2019 accounted for MP occurrence, window surface area (WSA), intravenous sedation use, osteotomy instrument type, and clinician experience. Preoperative cone-beam computed tomography (CBCT) scans were analyzed for lateral wall thickness (LWT), LFM and LAM angles formed between lateral and medial walls at the floor and anterior wall respectively, sinus width at 5-, 10- and 15-mm (LM-5, LM-10 and LM-15) from the floor, residual bone height (RBH), sinus pathologies, septa and arterial anastomoses. The generalized estimating equations (GEE) approach with a sandwich variance-covariance estimator was used to evaluate the associations with MP. RESULTS:MP occurred in 25.74% of 202 LWSFE procedures (166 patients). Mean 1.6mm-LWT, 3.2mm-RBH, 95°-LFM, 75.5°-LAM, 12mm-LM-5, 20.79% septa, 16.83% arterial anastomosis, 37.62% sinus pathology and 29.21% intravenous sedations, 85.24% WSA ≥40mm2 and 57% >10 procedures/clinician were reported. Greater MP rates were encountered as follows: 38.3% (LWT≥1.5mm), 38% (LFM<90°), 59.6% (LAM<70°), 45.4% (LM-5<10mm), and 36.4% (WSA ranged >80mm2 ), with statistically significant associations with all these outcomes (P<.05). The presence of pathologies was also associated with MP (P=.013). Associations between MP and the presence of septa and arterial anastomoses, age/gender, right/left sinus, RBH, clinician's experience, instrument type and intravenous sedation use could not be demonstrated. CONCLUSIONS:MP is significantly associated with thicker lateral walls, narrower sinuses, larger windows and existing sinus pathology. This article is protected by copyright. All rights reserved.