RESUMEN
BACKGROUND: During implant treatment in the maxillary molar area, maxillary sinus floor augmentation is often performed to ameliorate the reduced alveolar bone height attributable to bone remodeling and pneumatization-induced expansion of the maxillary sinus. However, this augmentation may cause complications such as misplaced implants, artery damage, and maxillary sinus mucosal perforation; infections like maxillary sinusitis; and postsurgical complications such as bone graft leakage and postoperative nasal hemorrhaging. To reduce the complications during maxillary sinus floor augmentation and postoperative infections, we performed retrospective investigations of various systemic and local factors that influence pre-operative sinus mucosal thickness (SMT) by using cone-beam computed tomography (CBCT). Subjects included patients who underwent maxillary sinus floor augmentation in an edentulous maxillary molar area with a lateral approach. Pre-operative SMT, existing bone mass, and nasal septum deviation were measured using CBCT images. Relationships between SMT and the following influencing factors were investigated: (1) age, (2) sex, (3) systemic disease, (4) smoking, (5) period after tooth extraction, (6) reason for tooth extraction, (7) residual alveolar bone height (RBH), (8) sinus septa, and (9) nasal septum deviation. Correlations were also investigated for age and RBH (p < 0.05). RESULTS: We assessed 35 patients (40 sinuses; 11 male, 24 female). The average patient age was 58.90 ± 9.0 years (males, 57.9 ± 7.7 years; females, 59.9 ± 9.4 years; age range, 41-79 years). The average SMT was 1.09 ± 1.30 mm, incidence of SMT > 2 mm was 25.0%, incidence of SMT < 0.8 mm was 50.0%, and the average RBH was 2.14 ± 1.02 mm. The factors that influenced SMT included sex (p = 0.0078), period after tooth extraction (p = 0.0075), reason for tooth extraction (p = 0.020), sinus septa (p = 0.0076), and nasal septum deviation (p = 0.038). CONCLUSIONS: Factors associated with higher SMT included male sex, interval following tooth extraction < 6 months, periapical lesions, sinus septa, and nasal septum deviation. Factors associated with SMT > 2 mm were sex and reason for tooth extraction, while factors associated with SMT < 0.8 mm were time following tooth extraction and nasal septum deviation. Despite the limitations of this study, these preoperative evaluations may be of utmost importance for safely conducting maxillary sinus floor augmentation.
Asunto(s)
Boca Edéntula , Elevación del Piso del Seno Maxilar , Adulto , Anciano , Tomografía Computarizada de Haz Cónico , Femenino , Humanos , Masculino , Seno Maxilar/diagnóstico por imagen , Persona de Mediana Edad , Estudios Retrospectivos , Elevación del Piso del Seno Maxilar/efectos adversosRESUMEN
Rehabilitation of oral function using dental implants is clinically effective and highly predictable. Both bone quantity and quality at the implant site affect the success of the procedure. However, the effect of bisphosphonate (BP) use on mandibular bone quality has not been well documented. The purpose of this retrospective cohort study was to evaluate the bone mineral density (BMD) and cortical thickness of the mandible, as well as the influence of BP use on early implant failure. Twenty-five female patients (≥60 years of age) were selected from among 93 candidates with partially edentulous posterior mandibles. Eleven patients had received BP therapy using alendronate (BP group), and 14 patients had received alternate therapy (non-BP group). Cortical and trabecular BMD was measured using quantitative computed tomography. Cortical thickness was measured using computed tomography. The BMDs and cortical thicknesses of the two groups were compared. The results were as follows: (1) Cortical BMD was significantly higher in the BP group, (2) trabecular BMD was not affected by BP use, and (3) Cortical thickness was affected by the duration of BP use. These results indicate that BP use affects the quality and quantity of the cortical bone in the partially edentulous posterior mandible of patients with osteoporosis, which should be considered prior to treatment with dental implants in patients taking BPs.