Editorial Type:
Article Category: Research Article
 | 
Online Publication Date: 01 Oct 2009

Minimally Invasive Antral Membrane Balloon Elevation in the Presence of Antral Septa: A Report of 26 Procedures

DMD,
DMD,
DMD,
DMD,
DMD,
DMD, and
MD
Page Range: 257 – 267
DOI: 10.1563/AAID-JOI-D-09-00024.1
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Abstract

Antral septa of the maxillary sinus occurs in approximately one third of patients undergoing posterior maxillary bone augmentation and is considered a relative contraindication for lateral maxillary window (“hinge osteotomy”). We present the results of 26 consecutive cases of patients with septated maxillary sinus who underwent minimally invasive antral membrane balloon elevation (MIAMBE) followed by bone augmentation and implant fixation. After undergoing preprocedural assessment and signing an informed consent, 57 consecutive patients were referred for posterior maxillary bone augmentation. Alveolar crest exposure (via 3-mm osteotomies), MIAMBE, and bone augmentation were followed by implant placement and primary closure (executed at the same sitting). Implant loading was done 6–9 months later. Twenty-six out of 57 (45.6%) patients had significant septa (detected on computed tomography) in the designated augmentation region. Twenty-four (92%) concluded the initial procedure successfully. Two patients had membrane tear requiring procedure abortion. Mean procedure time was 48 ± 23 minutes. Incremental bone height consistently exceeded 10 mm, and implant survival of 95.2% was observed at 6–9 months. MIAMBE can be applied to patients in need of posterior maxilla bone augmentation in the presence of septated maxillary sinus with high procedural success, low complication rate, and satisfactory bone augmentation and implant survival. MIAMBE should be an alternative to the currently employed methods of maxillary bone augmentation, especially in the presence of septated maxilla.

Copyright: American College of Veterinary Internal Medicine
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Figure 1. Balloon harboring device: when balloon (b) is deflated and concealed (a), during balloon inflation (b), with dedicated Teflon (T) stoppers (c). Figure 2. Horizontal (a) and vertical (b) incisions, and power drilling to obtain initial osteotomy (c and d).


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Figure 3. Widening osteotomy (a) with dedicated osteotome (b). Final osteotomy size (c). Figure 4. Screw tap (a) tapped into osteotomy (b).


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F igures 5–6

Figure 5. Balloon harboring device in osteotomy (a) and at low pressure inflation (b), and bone graft injector (c). Figure 6. Implant placement (a) and primary closure (b).


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Case 1. (a) Pre-extraction radiograph area 26–27, bone height is approximately 1 mm with a developed septum (S). (b) Post extraction in area 27—there is no floor in—only the sinus membrane. (c) Anterior (A) and posterior (P) compartments. (d) MIAMBE first balloon inflation. (e) Bone grafting (G) in the anterior compartment.


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7. Case 1 continued
F igure 7. Case 1 continued

(f) MIAMBE second balloon inflation. (g) Implant placement in the first compartment. (h) Drilling 9 months later. (i) Second implant placement. (j) Implant rehabilitation 20 months later.


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Case 2. (a) Preprocedural periapical radiograph: septum (S) noted. (b) Osteotome (O) fracturing the sinus floor. (c) First balloon inflation (MIAMBE of the anterior compartment). (d) After bone grafting of the anterior compartment and implant placement, osteotomy is enlarged toward the posterior compartment. (e) After MIAMBE and bone grafting of the posterior compartment implant placement.


Contributor Notes

Efraim Kfir, DMD, is at a dental clinic in Petah-Tikvah, Israel.

Moshe Goldstein, DMD, is at the Department of Periodontology, Faculty of Dental Medicine, The Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

Ronen Rafaelov, DMD, is at a dental clinic in Sprintzak St, Tel-Aviv, Israel.

Israel Yerushalmi, DMD, is at a dental clinic in Ramat Gan, Israel.

Vered Kfir, DMD, is at a dental clinic in Kupat Holim Clalit (Remez), Rehovot, Israel.

Ziv Mazor, DMD, is at a periodontal clinic, Raánana, Israel.

Edo Kaluski, MD, is at the Department of Cardiology, University Hospital, University of Medicine and Dentistry, Newark, New Jersey. Address correspondence to Dr Kaluski, Director of Invasive Cardiology and Cardiac Catheterization Laboratories University Hospital, University of Medicine and Dentistry of New Jersey, 185 South Orange Ave, MSB I-538, Newark, NJ 07103. (e-mail: kalusked@umdnj.edu)

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