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Trans-Sinus Implants

Published on Jan 21, 2022   -  4 min read

Abstract

Read the article to know the indications, inclusion and exclusion criterion, advantages, prophylaxis, and procedure of trans-sinus implants.

Contents

Overview:

Trans-sinus implants may be used when the insertion of conventional tilted implants is not possible before considering the use of pterygoid and zygomatic implants or bone grafting procedures.

What Are Trans-Sinus Implants?

For the rehabilitation of atrophic posterior maxilla, that is, the edentulous and resorbed maxillary (upper jaw region at the level of premolars and molars), an alternative technique is adopted by the implantologist to achieve prosthetic success and prevent biologic failure of the implants, especially in severely resorbed bone morphologies.

Placement of implant via the trans-alveolar maxillary sinus floor lift is a positively tested method that is also minimally invasive in comparison with endosteal implants (most commonly used dental implants). Trans-sinus implants thus can offer maximum benefit via this route or approach mainly for bicortical anchorage (nasal cortical bone can also be used) or stabilization. The outcome measures studied as per conventional implant research show less esthetic and functional complaints from the patients and a reduction in postoperative complications compared to traditional endosteal implantation (is evidential). Success rates of the prosthetic part of the implant and the peri implant-bone marginal levels have also been considerably improved by adopting this minimally invasive technique of the trans-sinus approach.

What Are the Indications for a Trans-Sinus Implant?

Maxillary edentulous patients or patients with a terminal dentition who presented a maxillary sinus pneumatization can be selected to receive an immediately loaded fixed restoration supported with four or six implants.

However, in a few cases, the maxilla may have a particular anterior sinus wall anatomy that does not allow insertion of a tilted implant fully inside the bone in the premolar and molar regions, at least in one side, so the case should be studied thoroughly by the dental implantologist before proceeding with this trans-sinus implant.

The fixed rehabilitation of a totally edentulous maxilla is often associated with anatomical limitations, generally due to a decreased bone volume in the posterior area, especially when an immediate function is implemented. Bone atrophy or resorption evolves rapidly during the first year after tooth extraction and then progresses in an unpredictable manner. The other factors that can affect the quality of available bone are mainly the progressive maxillary sinus pneumatization and the use of removable prostheses.

When bone volumes are not sufficient for implant placement, bone augmentation procedures can be performed. However, alternative treatments should be considered, in particular tilted implants, pterygoid and zygomatic implants. These alternative treatments, such as the trans-sinus implants, could be indicated in patients who cannot undergo bone graft procedures for different financial, psychological, or clinical reasons. Posterior implants are angled forward, passing trans-sinus to fixate in the nasal cortical bone. The trans-sinus implants can be inserted without sinus bone grafting or simultaneously with bone grafting and placed into immediate function achieving good success rates upto three years.

What Are the Inclusion and Exclusion Criteria?

Inclusion Criterion:

Exclusion Criterion:

The following exclusion criteria were used,

What Are the Advantages of Trans-Sinus Implants?

The advantage of placing trans-sinus implants mainly is that they can be placed without a bone graft, reducing the surgery time and decreasing the treatment cost. Trans-sinus implants are indicated in the presence of a residual bone height of a minimum of 4mm and a maximum of 6 mm available under the sinus floor to anchor the implant’s head.

Alternative less invasive treatments should be considered, in particular short implants or crestal sinus elevation procedures. On the other hand, such alternative procedures could reduce the possibility of reaching good primary stability of the implant in most cases. Implants can be tilted through the sinus and can still be immediately loaded provided that the implants are inserted with good primary stability, and a cross-arch-stabilized prosthesis is made. All the implants are inserted with torque superior to 45 N cm to be immediately loaded as previously described for single implants. The primary stability required is easily reached in all the patients because implants can be inserted in three layers of cortical bone. Even the nasal cortical bone is used, if necessary, to increase stability in the case of soft bone. Operators can choose to graft or not the sinus simultaneously to trans-sinus implant placement supporting cross arch immediately loaded fixed prostheses. If these results are confirmed by longer follow-ups, it should be better to avoid any graft in order to reduce the morbidity and the cost of the treatment and to simplify and reduce the time of the procedure.

What Is the Trans-Sinus Implant Procedure?

  1. All patients undergo at least one session of oral hygiene instructions and professionally-delivered debridement when required prior to the intervention.

  2. Antimicrobial prophylaxis is obtained with 1 gram of Amoxicillin + Clavulanic acid (or Clarithromycin 500 mg if allergic to Penicillin) starting the night before the intervention, twice a day, for seven days.

  3. On the day of surgery, patients are treated under local anesthesia using Articaine with Adrenaline 1:100,000.

  4. Tooth extractions, when needed, are performed as atraumatic as possible, attempting to preserve the buccal alveolar bone.

  5. Extraction sockets are then carefully cleaned to remove any granulation tissue.

  6. The incision is made along the crest with vertical releasing incisions to obtain access to the mesial wall of the sinus.

  7. Once a full-thickness flap is elevated, the operator is informed whether the trans-sinus implant must be placed without simultaneous bone grafting or sinus elevation procedures.

Conclusion:

Trans-sinus implants are a good alternative approach to conventional endosteal implants in case of bone atrophy in maxillary posterior regions. A detailed assessment by the dental implantologist and bone grafting as required will prevent prosthetic failures.

Frequently Asked Questions


1.

Will the Sinus Implant Placement Procedure Be Painful?

The sinus implant placement may cause only minimal discomfort if done under anesthesia. Once the effect of sedation subsides, the patient may experience swelling and pain. It usually goes away in a day or two.

2.

What Happens When the Implant Is Displaced to the Sinus Cavity?

If the implant is displaced into the sinus, it may affect the anatomy of the sinus. It can cause mucosal thickening leading to maxillary sinusitis and congestion. The displaced implant, once diagnosed, should be removed immediately.

3.

What Are the Indications for a Trans Sinus Implant?

The trans sinus implant is mainly indicated in the cases where bone grafts procedures cannot be done. It has an excellent success rate. These implants can be inserted with or without bone grafting.

4.

In Which Cases Trans Sinus Implants Are Contraindicated?

The trans sinus implants are contraindicated in the cases of uncontrollable systemic diseases, diagnosis of sinusitis preoperatively, undergoing maxillary radiation therapy, substance abusers, and in patients undergoing chemotherapy.

5.

What Are the Advantages of a Trans Sinus Implant?

Trans sinus implants are mainly used when tilted implants cannot be used. The main advantage of a trans sinus implant is that it can be placed without a bone graft, is cost-effective, and reduces surgery time.

6.

Will a Trans Sinus Implant Affect Breathing?

No, a trans sinus implant will not affect breathing. However, in the cases where there is the intrusion of the implant to the sinus, it may cause complications associated with breathing.

7.

What Should Be the Height of Residual Bone for the Placement of Trans Sinus Implant?

The residual bone height available under the sinus floor should be a minimum of 4 mm and a maximum of 6 mm for the implant head to anchor.

8.

Is It Advisable to Do the Sinus Lift and Implant Placement Simultaneously?

Depending upon the size of the bone graft that has to be placed during sinus lift and the individual’s condition, the time gap between the two procedures will vary. In mild to moderate cases, it can be done simultaneously. However, if there is some infection or the scans reveal that there will be no stability if implants are placed immediately, then the two procedures cannot be combined.

9.

Can We Sneeze After a Sinus Lift Surgery?

Sneezing through the nose is not advisable after a sinus lift surgery. It can increase the pressure in the sinus cavity leading to the failure of the procedure; if unavoidable, try to sneeze through the mouth.

10.

Will the Sinus Lift Affect the Appearance of the Face?

The sinus lift is a procedure done if there is no sufficient bone to support the implants. It mainly includes uplifting the sinus membrane. There are chances that this procedure can change the appearance of the face.

Last reviewed at:
21 Jan 2022  -  4 min read

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