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Jiang Y, Yang Y, Chen L, Zhou W, Man Y, Wang J. Digitally Guided Aspiration Technique for Maxillary Sinus Floor Elevation in the Presence of Cysts: A Case Series. Clin Implant Dent Relat Res 2025; 27:e70009. [PMID: 39994763 DOI: 10.1111/cid.70009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Revised: 01/04/2025] [Accepted: 01/26/2025] [Indexed: 02/26/2025]
Abstract
OBJECTIVES Sinus floor elevation (SFE) is a widely established surgical procedure for dental implant placement in the atrophic posterior maxilla. However, the presence of maxillary sinus cysts (MSCs) can significantly complicate this intervention. This study presents and evaluates the efficacy and safety of the Digitally Guided Aspiration Technique (DGAT), a novel approach for managing MSCs during SFE procedures. MATERIALS AND METHODS Implant survival and success rates were evaluated according to established criteria, and all complications were systematically documented. Three-dimensional measurements, including MSC volume, residual bone height (BH) surrounding the implants, and apical bone coverage, were obtained using cone beam computed tomography (CBCT). Marginal bone loss (MBL) was assessed through standardized periapical radiographs following prosthetic loading. The accuracy of implant positioning was evaluated by measuring the three-dimensional deviations between virtually planned and actually placed implants. Comprehensive cytological and histological analyses were conducted on aspirated cystic fluid and harvested bone specimens, respectively. Patient-reported outcomes were assessed using questionnaires at the 6-month post-restoration follow-up. RESULTS The study comprised seven patients with seven cysts receiving a total of 10 implants. At the 6-month follow-up, the implant survival rate was 100% with no biological or technical complications observed. Volumetric analysis revealed a significant mean reduction in MSC volume of 45.34% ± 33.08% (p = 0.012). Postoperative measurements demonstrated a statistically significant increase in BH compared to baseline values (p < 0.001). This gain remained largely stable throughout the 6-month observation period, with minimal resorption noted in the buccal aspect (p = 0.03) and mean value (p = 0.05). Prior to second-stage surgery, radiographic evaluation confirmed complete bone coverage of all implants, with 60% exhibiting > 2 mm of apical bone coverage. MBL remained within physiological limits. Analysis of implant positioning accuracy showed that coronal global and vertical deviations fell within acceptable clinical parameters, while apical global deviation and angular deviation marginally exceeded recommended thresholds. Cytological analysis of the aspirated cystic fluid revealed no evidence of infection, while histological examination of the regenerated tissue demonstrated mature bone formation with abundant vascularization. Patient-reported outcomes indicated high satisfaction levels. CONCLUSIONS DGAT can reduce the volume of MSCs, achieve favorable bone grafting and dental implant outcomes with a low incidence of complications. The safety and effectiveness of this procedure need to be compared to the traditional aspiration technique in future randomized controlled trials. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR2400083235. This clinical trial was not registered prior to participant recruitment and randomization.
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Affiliation(s)
- Yuhuan Jiang
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yujia Yang
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Liya Chen
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Weikai Zhou
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yi Man
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jing Wang
- State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Guo X, Huang Z, Huang J, Wei J, Li Y, Zheng H, Zhao S. Accuracy of a Cascade Network for Semi-Supervised Maxillary Sinus Detection and Sinus Cyst Classification. Clin Implant Dent Relat Res 2025; 27:e13431. [PMID: 39898709 DOI: 10.1111/cid.13431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 11/11/2024] [Accepted: 12/03/2024] [Indexed: 02/04/2025]
Abstract
OBJECTIVE Maxillary sinus mucosal cysts represent prevalent oral and maxillofacial diseases, and their precise diagnosis is essential for surgical planning in maxillary sinus floor elevation. This study aimed to develop a deep learning-based pipeline for the classification of maxillary sinus lesions in cone beam computed tomography (CBCT) images to provide auxiliary support for clinical diagnosis. METHODS This study utilized 45 136 maxillary sinus images from CBCT scans of 541 patients. A cascade network was designed, comprising a semi-supervised maxillary sinus area object detection module and a maxillary sinus lesions classification module. The object detection module employed a semi-supervised pseudo-labelling training strategy to expand the maxillary sinus annotation dataset. In the classification module, the performance of Convolutional Neural Network and Transformer architectures was compared for maxillary sinus mucosal lesion classification. The object detection and classification modules were evaluated using metrics including Accuracy, Precision, Recall, F1 score, and Average Precision, with the object detection module additionally assessed using Precision-Recall Curve. RESULTS The fully supervised pseudo-label generation model achieved an average accuracy of 0.9433, while the semi-supervised maxillary sinus detection model attained 0.9403. ResNet-50 outperformed in classification, with accuracies of 0.9836 (sagittal) and 0.9797 (coronal). Grad-CAM visualization confirmed accurate focus on clinically relevant lesion features. CONCLUSION The proposed pipeline achieves high-precision detection and classification of maxillary sinus mucosal lesions, reducing manual annotation while maintaining accuracy.
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Affiliation(s)
- Xueqi Guo
- Department of Oral Implantology, School and Hospital of Stomatology, Guangdong Engineering Research Center of Oral Restoration and Reconstruction & Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zelun Huang
- The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Jieying Huang
- Department of Oral Implantology, School and Hospital of Stomatology, Guangdong Engineering Research Center of Oral Restoration and Reconstruction & Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jialing Wei
- Shenzhen Technology University, Shenzhen, Guangdong Province, China
| | - Yongshan Li
- Department of Oral Implantology, School and Hospital of Stomatology, Guangdong Engineering Research Center of Oral Restoration and Reconstruction & Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Haoran Zheng
- Department of Chemical & Materials Engineering, University of Auckland, Auckland, New Zealand
| | - Shiyong Zhao
- Department of Oral Implantology, School and Hospital of Stomatology, Guangdong Engineering Research Center of Oral Restoration and Reconstruction & Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China
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Lee WU, Han JJ, Kwon IJ. Maxillary Sinus Augmentation and Implant Installation in Patients With Pseudocysts and Mucous Retention Cysts. J Craniofac Surg 2024; 35:e312-e316. [PMID: 38315743 PMCID: PMC11122716 DOI: 10.1097/scs.0000000000009980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/21/2023] [Indexed: 02/07/2024] Open
Abstract
This case study systematically assessed diverse approaches to sinus augmentation in the presence of sinus pathology. Three patients were carefully selected and categorized as pseudocyst (PsC) (type 1), mucous retention cyst (MRC) smaller than 20 mm (type 2), and MRC larger than 20 mm in size (type 3). All patients underwent sinus augmentation procedures, with each case utilizing a unique surgical approach. Spontaneous drainage was performed for the patient with PsC (type 1), followed by uncomplicated sinus augmentation. For the patient with an MRC smaller than 20 mm (type 2), aspiration of the cyst contents preceded sinus augmentation. Conversely, the patient with a larger MRC (type 3) underwent cyst enucleation followed by sinus augmentation after complete recovery of the sinus membrane. No complications were noted in any of the cases, and follow-up revealed stable implant installation at the site of sinus augmentation. Within the constraints of this study, the choice of surgical procedure, whether involving spontaneous drainage, aspiration, or enucleation, should be guided by an anticipated pathologic diagnosis and the size of the sinus cyst. This informed approach empowers clinicians to make well-informed decisions for the best possible outcomes and sustained results. Overall, this study offers valuable insights for clinicians seeking to optimize sinus augmentation procedures in the presence of sinus pathology.
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Affiliation(s)
- Won-Uk Lee
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University
- Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, Korea
| | - Jeong Joon Han
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University
- Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, Korea
| | - Ik-Jae Kwon
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University
- Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, Korea
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Testori T, Scaini R, Deflorian M, Taschieri S, Decker AM, Saleh M, Zuffetti F, Saibene AM, Felisati G, Wallace SS, Francetti L, Wang HL, Del Fabbro M. Mucosal cyst aspiration in conjunction with maxillary sinus elevation: A clinical cohort study. Clin Implant Dent Relat Res 2024; 26:564-570. [PMID: 38462798 DOI: 10.1111/cid.13315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/13/2023] [Accepted: 02/06/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Patients with mucosal cysts in the maxillary sinus require special consideration in patients who require implant therapy for the restoration when undergoing implant therapy for the restoration of the posterior maxillary dentition. Treatment strategies for these clinical situations remain controversial in the literature. Thus, this study seeks to describe a safe and effective therapeutic strategy for sinus augmentation in patients with pre-existing maxillary antral cysts. METHODS A total of 15 patients and 18 sinuses were consecutively enrolled in this cohort study and underwent maxillary antral cyst treatment by needle aspiration and simultaneous maxillary sinus augmentation (MSA). During surgical procedures, threeimplants (Zimmer Biomet, Indiana, USA) were positioned in 11 sinuses and two implants (Zimmer Biomet, Indiana, USA) were positioned in 5 sinuses. RESULTS Overall implant success and survival rates were 100% and 97.8%, respectively at 1 year and 5-year follow-ups. Crestal bone resorption averaged 0.3 ± 0.2 mm 5-year post-loading, showing bone stability. Implant survival rate at 5-year follow-up expressed predictability of the technique comparable to historical data when MSA was performed alone. Crestal bone resorption averaged 0.3 ± 0.2 mm 5 years post-loading and shows bone stability utilizing mucosal cyst aspiration with concomitant MSA procedures. Quality of life evaluation at 1-week post-op showed similar results to published historical data. In 81% (13 sinuses), the CBCT examination at 5-year follow-up showed no cyst reformation, in 19% (3 sinuses) cyst reformation was visible, but smaller in size when compared to the pre-op CBCT evaluation, and all the patients were asymptomatic. CONCLUSIONS Maxillary sinus mucosal cyst aspiration with concomitant MSA, may be a viable option to treat maxillary sinus cyst.
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Affiliation(s)
- Tiziano Testori
- IRCCS Orthopedic Institute Galeazzi, Dental Clinic, Section of Implant Dentistry and Oral Rehabilitation, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Oral Medicine, Infection and Immunity Harvard University, School of Dental Medicine, Boston, Massachusetts, USA
| | - Riccardo Scaini
- IRCCS Orthopedic Institute Galeazzi, Dental Clinic, Section of Implant Dentistry and Oral Rehabilitation, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Matteo Deflorian
- IRCCS Orthopedic Institute Galeazzi, Dental Clinic, Section of Implant Dentistry and Oral Rehabilitation, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Silvio Taschieri
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
- IRCCS Orthopedic Institute Galeazzi, Dental Clinic, Milan, Italy
| | - Ann M Decker
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Muhammad Saleh
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Periodontics, University of Louisville School of Dentistry, Louisville, Kentucky, USA
| | - Francesco Zuffetti
- IRCCS Orthopedic Institute Galeazzi, Dental Clinic, Section of Implant Dentistry and Oral Rehabilitation, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Alberto Maria Saibene
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Felisati
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Stephen S Wallace
- Department of Periodontics, Columbia University College of Dental Medicine, New York, New York, USA
| | - Luca Francetti
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
- IRCCS Orthopedic Institute Galeazzi, Dental Clinic, Milan, Italy
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
- UOC Maxillofacial Surgery and Dentistry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Park WB, Shin J, Shin S, Hong JY. A Clinical Approach for the Removal of a Large Antral Pseudocyst with Simultaneous Maxillary Sinus Augmentation: A Case Series. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:838. [PMID: 38793021 PMCID: PMC11122721 DOI: 10.3390/medicina60050838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/14/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024]
Abstract
For a large benign lesion within the maxillary sinus, such as an antral pseudocyst, maxillary sinus floor augmentation is more commonly performed using a two-stage approach. This involves first removing the lesion, and then, re-entry following several months of healing. In this case series, we described the "one-bony-window" approach, which is a technical surgical modification of the previous one-stage approach, for simultaneous cyst removal and maxillary sinus floor augmentation. Four patients with large maxillary antral pseudocysts were included. The "one-bony-window" approach involves the preparation of a large window opening of approximately 15 mm × 20 mm at the lateral wall. A mesiodistally extended intentional perforation was made in the upper part of the exposed membrane to enhance the access for instrumentation. The antral pseudocyst was removed in its entirety without being deformed to prevent rupture or leakage of the cystic contents. Subsequent detachment and elevation of the Schneiderian membrane at the sinus floor significantly reduced the perforation site, and bone grafting with implant placement was performed simultaneously. This alleviated the need to surgically repair the perforation. The lateral opening was either uncovered or repositioned using bony window lids. Healing abutments were connected after six months, and the final prosthesis was placed after two months. At the 1-year follow-up, the antral pseudocysts had resolved with no specific recurrence, and the stability of the augmented sinus was maintained with excellent implant survival. Within the limitations of our findings, the "one-bony-window" technique can be suggested for the simultaneous removal of large antral pseudocysts and maxillary sinus floor augmentation with favorable clinical outcomes.
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Affiliation(s)
- Won-Bae Park
- Private Practice in Periodontics and Implant Dentistry, Seoul 02771, Republic of Korea;
| | - Jina Shin
- Department of Dentistry, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea;
| | - Seungil Shin
- Department of Periodontology, College of Dentistry, Kyung Hee University Dental Hospital, Kyung Hee University, Seoul 02447, Republic of Korea;
| | - Ji-Youn Hong
- Department of Periodontology, College of Dentistry, Kyung Hee University Dental Hospital, Kyung Hee University, Seoul 02447, Republic of Korea;
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Wang YL, Shao WJ, Wang M. Bone block from lateral window - correcting vertical and horizontal bone deficiency in maxilla posterior site: A case report. World J Clin Cases 2024; 12:2109-2115. [PMID: 38680257 PMCID: PMC11045507 DOI: 10.12998/wjcc.v12.i12.2109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/29/2024] [Accepted: 03/19/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Lateral window approach for sinus floor lift is commonly used for vertical bone augmentation in cases when the residual bone height is less than 5 mm. However, managing cases becomes more challenging when a maxillary sinus pseudocyst is present or when there is insufficient bone width. In this case, we utilized the bone window prepared during the lateral window sinus lift as a shell for horizontal bone augmentation. This allowed for simultaneous horizontal and vertical bone augmentation immediately after the removal of the maxillary sinus pseudocyst. CASE SUMMARY A 28-year-old female presented to our clinic with the chief complaint of missing upper left posterior teeth. Intraoral examination showed a horizontal deficiency of the alveolar ridge contour. The height of the alveolar bone was approximately 3.6 mm on cone beam computed tomography (CBCT). And a typical well-defined 'dome-shaped' lesion in maxillary sinus was observed on CBCT imaging. The lateral bony window was prepared using a piezo-ultrasonic device, then the bony window was fixed to the buccal side of the 26 alveolar ridge using a titanium screw with a length of 10 mm and a diameter of 1.5 mm. The space between the bony window and the alveolar ridge was filled with Bio-Oss, covered with a Bio-Gide collagen membrane, and subsequently sutured. Nine months later, the patient's bone width increased from 4.8 to 10.5 mm, and the bone height increased from 3.6 to 15.6 mm. Subsequently, a Straumann® 4.1 mm × 10 mm implant was placed. The final all-ceramic crown restoration was completed four months later, and both clinical and radiographic examinations showed that the implant was successful, and the patient was satisfied with the results. CONCLUSION The bone block harvested from the lateral window sinus lift can be used for simultaneous horizontal bone augmentation acting as a shell for good two-dimensional bone augmentation.
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Affiliation(s)
- Yu-Lan Wang
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, Hubei Province, China
- Department of Oral Implantology, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, Hubei Province, China
| | - Wen-Jun Shao
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, Hubei Province, China
- Department of Oral Implantology, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, Hubei Province, China
| | - Min Wang
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, Hubei Province, China
- Department of Oral Implantology, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, Hubei Province, China
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Yu H, Tang Y, He D, Qiu L. Immediately or delayed sinus augmentation after pseudocyst removal: A randomized trial. Clin Implant Dent Relat Res 2023; 25:967-973. [PMID: 37218035 DOI: 10.1111/cid.13225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 05/06/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023]
Abstract
PURPOSE To compare clinical and histological outcomes of sinus augmentation performed immediately or 3 months after pseudocyst removal through a prospective randomized controlled study. MATERIALS AND METHODS In total, 33 sinus augmentation procedures were performed in 31 patients. Augmentation was performed either immediately after pseudocyst removal (one-stage intervention) or after 3 months (two-stage intervention). Six months postoperatively, bone specimens were harvested, and histomorphometric analysis was performed as primary outcome. Data were recorded and evaluated for implant survival rates, marginal bone resorption, complication rate, and patient-centered outcomes (visual analogue scale [VAS]). RESULTS There were no baseline differences between groups or dropouts. Twelve biopsies obtained for histomorphometric analysis showed that delayed sinus augmentation, when compared to immediated led to a 1.1% increased mineralized bone ratio (95% confidence interval [CI]: -15.9 to 13.7). Graft leakage and acute sinusitis occurred in one patient in the one-stage group, none in the two-stage group. No pseudocyst recurrence was observed until the end of 1-year follow-up. Median VAS scores for overall acceptance were significantly increase of 1.4 (95% CI: 0.3-2.56) in immediate group. The degree of post-operative discomfort was not significantly different, although an increase of VAS (0.52, 95% CI: -0.32 to 1.37) was observed in delay group. CONCLUSIONS Both procedures of sinus augmentation immediately and 3 months after pseudocyst removal could obtain comparable histological outcomes and had low complication rates. Patients who underwent the one-stage procedure had a short treatment course and high satisfaction rates, but this procedure is technically challenging to perform. This clinical trial was not registered prior to participant recruitment and randomization. The clinical trial registration number is ChiCTR2200063121. The hyperlink is as follows: https://www.chictr.org.cn/showproj.html?proj=172755.
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Affiliation(s)
- Huajie Yu
- 4th Division, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yiman Tang
- 4th Division, Peking University School and Hospital of Stomatology, Beijing, China
| | - Danqing He
- Orthodontic Department, Peking University School and Hospital of Stomatology, Beijing, China
| | - Lixin Qiu
- 4th Division, Peking University School and Hospital of Stomatology, Beijing, China
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Koleilat A, Mansour A, Alkassimi FM, Aguirre A, Almaghrabi B. A Combination of Platelet-Rich Fibrin and Collagen Membranes for Sinus Membrane Repair: A Case Report (Repair of Sinus Membrane Perforation). Dent J (Basel) 2023; 11:dj11030084. [PMID: 36975581 PMCID: PMC10047151 DOI: 10.3390/dj11030084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/11/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
Maxillary sinus lift surgery is applied to compensate for the reduced vertical height in the posterior maxilla to facilitate placing a dental implant of a suitable length. Pathological conditions may be accidentally discovered, which necessitate careful assessment and management to prevent the infection of the maxillofacial complex and eventually bone grafting and dental implant failure. This case report describes an approach for the management of Schneiderian membrane perforation associated with the removal of an antral pseudocyst for successful dental implant therapy. A 70-year-old healthy Caucasian male presented for implant therapy to replace a non-restorable maxillary molar. Initial examination revealed the need for a sinus lift procedure to prepare the site for implant placement. A 3D CBCT evaluation before surgery revealed an incidental finding of a pathological lesion at the surgical site. The histological analysis of a biopsy specimen retrieved during implant site preparation showed findings consistent with antral pseudocyst. The resulting perforation of the sinus membrane was treated, and an adequate period of healing was given. A thickened sinus membrane was detected upon surgical exposure for implant placement. The novel technique illustrated could result in a fibrotic repaired sinus membrane and help shorten the time required for dental implant treatment.
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Affiliation(s)
| | - Alaa Mansour
- Periodontology Unit, College of Dentistry, Sharjah University, Sharjah P.O. Box 27272, United Arab Emirates
- Correspondence: ; Tel.: +971-566775619
| | - Fatma M. Alkassimi
- Department of Basic & Clinical Oral Sciences, College of Dental Medicine, Umm Al Qura University, Makkah, KSA P.O. Box 715, Saudi Arabia
| | - Alfredo Aguirre
- Department of Oral and Maxillofacial Pathology, UB SUNY School of Dental Medicine, Buffalo, NY 14214, USA
| | - Bandar Almaghrabi
- Department of Restorative Dentistry, UB SUNY School of Dental Medicine, Buffalo, NY 14214, USA
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Wang P, Huang N, Ren J, Gong P, Long J, Huang B. Maxillary Antral Pseudocyst Drift after Osteotome Sinus Floor Elevation with Simultaneous Implant Placement: A Case Report and Literature Review. J Clin Med 2023; 12:jcm12030920. [PMID: 36769568 PMCID: PMC9917374 DOI: 10.3390/jcm12030920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/14/2023] [Accepted: 01/14/2023] [Indexed: 01/26/2023] Open
Abstract
This report describes maxillary antral pseudocyst drift after maxillary sinus floor augmentation through osteotome sinus floor elevation with simultaneous implant placement. 3D Slicer was used to measure the pseudocyst and maxilla for the placement of the implants; follow-up visits were scheduled at 6, 12, and 22 months. No adverse effects were observed during or after surgery, and all implants exhibited osseointegration without mobility. At 6 months after surgery, the pseudocyst had moved posterolaterally from the preoperative position near the anterior medial maxillary sinus, then returned to its original position at 12 months. However, it had remigrated to the posterolateral position at 22 months. The preoperative volume of the pseudocyst was 3.795 mm3; it was 2.370, 3.439, and 2.930 mm3 at 6, 12, and 22 months after surgery, respectively. The changes in pseudocyst drift and volume did not have a substantial negative influence on the implants, presumably because of cystic attachment and the recurrence of multiple pseudocysts at different locations. The risks associated with changes in a pseudocyst can be avoided, if an appropriate treatment plan is selected.
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Affiliation(s)
- Peihan Wang
- West China School of Stomatology, Sichuan University, Chengdu 610041, China
- State Key Laboratory of Oral Diseases, National Center of Stomatology and General Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Nan Huang
- West China School of Stomatology, Sichuan University, Chengdu 610041, China
- State Key Laboratory of Oral Diseases, National Center of Stomatology and General Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Jiayin Ren
- West China School of Stomatology, Sichuan University, Chengdu 610041, China
- State Key Laboratory of Oral Diseases, National Center of Stomatology and General Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Ping Gong
- West China School of Stomatology, Sichuan University, Chengdu 610041, China
- State Key Laboratory of Oral Diseases, National Center of Stomatology and General Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Jie Long
- West China School of Stomatology, Sichuan University, Chengdu 610041, China
- State Key Laboratory of Oral Diseases, National Center of Stomatology and General Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Correspondence: (J.L.); (B.H.); Tel.: +86-28-85503406 (J.L.); +86-02885501427 (B.H.); Fax: +86-28-85501456 (J.L.)
| | - Bo Huang
- West China School of Stomatology, Sichuan University, Chengdu 610041, China
- State Key Laboratory of Oral Diseases, National Center of Stomatology and General Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Correspondence: (J.L.); (B.H.); Tel.: +86-28-85503406 (J.L.); +86-02885501427 (B.H.); Fax: +86-28-85501456 (J.L.)
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Fu M, Jiang Z, Ren L, He J, Zhu D, Yang G. Maxillary sinus floor augmentation comparing removing versus retaining antral pseudocyst: A retrospective cohort study. Clin Oral Implants Res 2022; 33:1098-1113. [PMID: 36062937 DOI: 10.1111/clr.13993] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To retrospectively compare multilevel volumetric changes in both hard and soft tissues between antral pseudocyst (AP) removal and retainment before maxillary sinus floor augmentation (MSFA) and immediate implant placement. MATERIAL AND METHODS Twenty-six patients with thirty-eight implants placed from 2016 to 2021 were included and divided according to a cohort design as follows: 13 removing the cyst (RC group) and 13 "leaving alone" the cyst (LC group). 3D radiographic parameters (primary outcome), 2D parameters and clinical records (secondary outcome) involving both hard and soft tissues were evaluated for 4 periods (T1: immediate postoperative, T2: 6-month, T3: 12-month, and T4: 2- to 5- year follow-up). Possible confounding factors, including sinus anatomical features and implant distribution, were also analyzed to eliminate their disturbance. RESULTS The 3D volumetric change rate of bone grafts in the RC group (-9.32 ± 10.01%) from T2 to T3 was significantly lower than that in the LC group (-19.8 ± 10.59%) (p < .05). The change rate of apical bone height (ABH), endo-sinus bone gain (ESBG) and other 2D parameters were not significantly different between the two groups. 5.3% implants in RC group and 9.1% implants failed during follow-ups. 0% postoperative complications were observed in RC group. The Schneiderian membrane of RC group was significantly thinner than that of LC group at two measuring points in sinus. CONCLUSION The present study demonstrated that compared to AP retainment, AP removal before MSFA and immediate implant placement can obtain higher bone graft volumetric stability and favorable prognosis. The study protocol was approved by the Medical Ethics Committee of the Affiliated Hospital of Stomatology, School of medicine, Zhejiang University, China (Acceptance number: 2021-117(R)).
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Affiliation(s)
- Mengdie Fu
- The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Zhiwei Jiang
- The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Lingfei Ren
- The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Jin He
- The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Danji Zhu
- The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Guoli Yang
- The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, Zhejiang, China
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Anitua E, Alkhraisat MH, Torre A, Eguia A. Are mucous retention cysts and pseudocysts in the maxillary sinus a risk factor for dental implants? A systematic review. Med Oral Patol Oral Cir Bucal 2021; 26:e276-e283. [PMID: 33247569 PMCID: PMC8141309 DOI: 10.4317/medoral.24155] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/18/2020] [Indexed: 12/13/2022] Open
Abstract
Background Mucous retention cysts and pseudocysts of the maxillary sinus are benign lesions present in up to 13% of adult patients. Different surgical approaches for sinus lift and dental implant placement in the presence of these lesions have been proposed.
Material and Methods A systematic review was performed following the PRISMA statement recommendations to answer the PICO question: Does the aspiration or removal of mucous retention cysts/pseudocysts before or during sinus lifting and dental implant placing, affect the survival of the implants? The study was pre-registered in PROSPERO (CRD42020185528). Included articles quality was assessed using the “NIH quality assessment tool” and “The Newcastle-Ottawa scale”.
Results Previous literature in this field is scarce and with a low level of evidence. There are no randomized prospective studies. Only 19 studies were identified, being composed of 2 cohort studies and 17 case series/reports. These studies involved 182 patients with a previous history of mucous retention cyst or pseudocyst in 195 maxillary sinuses where 233 implants were placed. The mean age of the patients was 45.5 (range: 12-80 years); 122 (67%) were male patients and 60 (33%) were female patients. The mean follow-up of the patients was 17.6 (range: 4-90 months). Only two fail was reported. No differences were identified in relation to the surgical approach or in relation to the removal/aspiration of the sinus lesion (prior to or simultaneous to sinus grafting) or not.
Conclusions The level of evidence was grade 4 according to the CEBM and further studies are needed to confirm this observations, but with the available data, dental implants placement after sinus lift procedure in patients with mucous retention cysts and pseudocysts seems to be safe and present high survival regardless on the removal of the lesion or not. Key words:Dental implants, maxillary sinus, sinus lift, mucous retention cyst, pseudocyst.
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Affiliation(s)
- E Anitua
- Jose Maria Cagigal Kalea, 19 01007, Gasteiz, Araba, Spain
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12
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Hung K, Hui L, Yeung AWK, Wu Y, Hsung RTC, Bornstein MM. Volumetric analysis of mucous retention cysts in the maxillary sinus: A retrospective study using cone-beam computed tomography. Imaging Sci Dent 2021; 51:117-127. [PMID: 34235057 PMCID: PMC8219453 DOI: 10.5624/isd.20200267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/29/2020] [Accepted: 12/04/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose The aim of this study was to evaluate the volumetric characteristics of mucous retention cysts (MRCs) in the maxillary sinus and to analyze potential associations of MRCs with dentoalveolar pathologies. Materials and Methods Cone-beam computed tomography (CBCT) scans exhibiting bilateral maxillary sinuses that were acquired from January 2016 to February 2019 were initially screened. A total of 227 scans (454 sinuses) that fulfilled the inclusion criteria were included. The presence, location, and volumetric characteristics of the diagnosed MRCs were evaluated on CBCT images using the 3D-Slicer software platform. The presence of MRCs was correlated with potential influencing factors including age, sex, and dentoalveolar pathology. For MRCs located on the sinus floor, factors with a potential impact on the volume, surface, and diameter were analyzed. Results An MRC was present in 130 (28.6%) of the 454 sinuses. Most MRCs were located on the sinus walls and floor. The mean MRC volume, surface, and diameter were 551.21±1368.04 mm3, 228.09±437.56 mm2, and 9.63±5.40 mm, respectively. Significantly more sinuses with associated endodontically treated teeth/periapical lesions were diagnosed with an MRC located on the sinus floor. For MRCs located on the sinus floor, endodontic status exhibited a significant association with increased volume, surface, and diameter. Conclusion Periapical lesions might be a contributing factor associated with the presence and volume of MRCs located on the sinus floor. The 3D-Slicer software platform was found to be a useful tool for clinicians to analyze the size of MRCs before surgical interventions such as sinus floor elevation procedures.
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Affiliation(s)
- Kuofeng Hung
- Oral and Maxillofacial Radiology, Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Liuling Hui
- Oral and Maxillofacial Radiology, Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Andy Wai Kan Yeung
- Oral and Maxillofacial Radiology, Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Yiqun Wu
- Second Dental Clinic, Department of Oral Implantology, Ninth People's Hospital, School of Medicine, Shanghai Key Laboratory of Stomatology, National Clinical Research Center of Stomatology, Shanghai Jiao Tong University, Shanghai, China
| | - Richard Tai-Chiu Hsung
- School of Information Engineering, Guangdong University of Technology, Guangzhou, China.,Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Michael M Bornstein
- Oral and Maxillofacial Radiology, Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.,Department of Oral Health & Medicine, University Center for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
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13
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Fang Y, Bi Y, Mashrah M, Su Y, Ge L, Dong Y, Qin L, Wang L. Does sinus floor elevation in the presence of Schneiderian membrane pathology increase therisk of membrane perforation and implant failure rate? J ORAL IMPLANTOL 2020; 48:147-157. [PMID: 33270880 DOI: 10.1563/aaid-joi-d-20-00145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Schneiderian membrane (SM) thickness >2mm is regarded to be a pathological mucosal change. The aim of the current study is to answer the question" Does presence of pathological changes in the SM increase the risk of sinus perforation during surgical sinus floor elevation (SFE)?" An electronic database (PubMed, Embase, Cochrane Library, and Chinese database) were systemically searched for the studies published until February 2020. Randomized and non-randomized studies that reported the incidence of SM perforation in patients with SM pathology (antral pseudocyst or mucosal thickening) during SFE. The outcome measures were the incidence of SM perforation and implant survival rate. The pooled odds ratio (OR) with 95% confidence intervals and the Fixed-effects model were calculated. P-value ≤ 0.05 was considered to be statistically significant. Eighteen studies with a total of 1542 patients and 1797 SFE were included. Statistically insignificant difference in the incidence of SM perforation was observed between the normal-appearing sinus and thickened sinus mucosa (Fixed; OR, 0.896; 95%CI, 0.504 - 1.59; P =0.707, I 2 =32%). The rate of SM perforation in the normal sinus, mucosal thickening, and antral pseudocysts was 14%, 6%, and 6% respectively. The Implant survival rate was 98% in the normal sinus, and 100% in antral pseudocyst and mucosal thickening. SM thickening or antral pseudocyst did not increase the risk of membrane perforation and implant failure rates. Future RCTs are needed to evaluate the risk of the presence of pathological changes in the SM on the failure of the bone augmentation and dental implant.
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Affiliation(s)
- Ying Fang
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, China
| | - Ye Bi
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, China
| | - Mubarak Mashrah
- Guangzhou Medical University Dental implantology HuangSha street CHINA Guangzhou Guangdong 500332 008613172053275 Guangzhou Medical University
| | - Yucheng Su
- Department of Dental Implantology of Peking Union Medical College Hospital, Beijing, China
| | - Linhu Ge
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, China
| | - Yu Dong
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, China
| | - Lei Qin
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, China
| | - Liping Wang
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou 510140, China. Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Affiliated Stomatology Hos
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