Feasibility of sinus lift in case of thickened sinus membrane?

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This 59 year old male with no significant personal or medical history who presented with bilateral edentulous maxillary posterior segments. I have treatment planned him for implant placements. I have enclosed the CBCT scan. My question is if it is advisable to proceed with bilateral sinus lifts to create a more favorable environment for the implants with bone augmentation. The CBCT scans show deficient bone bilaterally in range of 3-5 mm and thickened sinus membrane (5-6 mm in 1st quadrant and up to 16 mm in 2nd quadrant in first molar region). Clinically no signs of maxillary sinusitis are evident. How do you recommend that I should proceed with this case? Do you advise going ahead with the sinus lifts?



7 Comments on Feasibility of sinus lift in case of thickened sinus membrane?

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Dan
2/27/2018
I would send him first to an ENT to take a close look to the sinuses before taking any decision.
Greg Kammeyer
2/27/2018
Great question. First and foremost you must have a through health history for subantral augmentation and then a CT scan that shows the Osteomeatal Complex (OMC)-you need to see that to know how well it drains. Study this if you are not familiar with it. If you have a limited view CT machine, the patient can be repositioned so you get the maxilla to the orbit and that will show you the OMC, which should be evaluated in all 3 planes. . Then look at how much support you have from the remaining teeth: With so many teeth (roots) missing, several w RCT's, I would plan to over build this case. Specifically I doubt the thickness of the Rt sinus membrane will be problematic. The Left however may present a problem especially if you are doing a Caldwell luc approach( which I strongly recommend in this case) to get in 13mm implants (My preference for grafted sinus'). Use a Medrol dose pack and several days PO of Afrin nasal spray to keep the OMC open. I recommend an ENT referral and consider an OMFS referral if you have doubts. Good luck!!!
Pascal Valentini DDS
2/28/2018
in Order to answer this question it is necessary to have a largest view showing if the OMC is patent or not. There are no direct correlation between the membrane thickness and the potency of the OMC. In this case the local thickening seems to be a mucosal cyst which is not a contra indication. The risk is to displace it toward the OMC while the membrane is elevated and to block it. In order to pprevent this risk the cyst must be drained during the surgery with an insulin syringe.
Pascal Valentini
2/28/2018
For the left sinus it seems that the OMC is completely blocked and it is mandatory to refer the patient to the ENT for a meatotomy. Short implants are prefreable
David Levitt
3/1/2018
This is not a cyst as previously mentioned as it is not domed shaped. This is an extremely thickened membrane (especially the left). These are the result of allergic rhinitis and generally respond well to antihistamines/decongestants times 2 - 6 weeks. Try the medication (Claritin D is good, you can also add Afrin) and see what transpires (take a panorex). Response can take up to 6 weeks. Careful with pseudoephedrine in patients who have HBP (phenylephrine might be better in those cases). Refer for a sinus antrostomy and meatal opening (uncinectomy) if no response (usually both are performed together). BTW - the lower is a good candidate for all-on-4,5,or6.
Dr Prasoon Shukla
3/2/2018
Thanks everyone for the guidance
Kaz
3/11/2018
How did you determine that the OMC is blocked. I do not believe the field of view is sufficient to determine that.