03/02/2025
Denal Bytes series
Radiographic images detailing features when undertaking maxillary sinus procedures.
(a) Peri-apical radiograph showing anterior extension and vertical bone height with no septa—this
may be suitable for simultaneous implant placement;
(b) half OPT highlighting the vertical bone
height and presence of septa on the right maxillary sinus—given the position of the septa, two
lateral access holes may need to be undertaken;
(c) re-formatted CT image (coronal view) of max-
illa detailing presence of a horizontal septum;
(d) re-formatted CT image (coronal view) of maxilla
detailing presence of a vertical septum
Augmentation can be undertaken with autologous/autogenous bone, allografts, alloplasts or xenografts and is dependent on clinical indication, personal preference, and patient preference.
Whilst the maxillary sinus may be one continuous structure, septa may often be present, and have been identifed in approximately 30% of the sinuses in the
premolar and molar areas . Therefore, prior to undertaking sinus foor augmentation procedures, a thorough radiographic evaluation of the anatomy
within the sinus should be undertaken in order to anticipate any diffculties that may be faced in terms of root encroachment into the foor of the sinus or position
and number of septa present. When negotiating large or multiple septa during such procedures, more than one lateral access hole may need to be created
as part of the antral opening in order to prevent tearing of the sinus membrane when refecting it.
If a tear in the Schneiderian membrane does occur and it is relatively small, it can be repaired with a small collagen membrane patch. However, when a tear is large and occurs in an area where it is diffcult to manage or re-engage the membrane through lateral access hole enlargement then the procedure may have to be aborted,and the site allowed to heal for a period of time before a second attempt is made.
The thickness of the sinus membrane can vary considerably, and occasionally may be very thin, thereby making sinus foor augmentation extremely difficult.
