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Alveolar Antral Artery Isolation During Sinus Lift Procedure with the Double Window Technique

Identifieur interne : 000553 ( Pmc/Checkpoint ); précédent : 000552; suivant : 000554

Alveolar Antral Artery Isolation During Sinus Lift Procedure with the Double Window Technique

Auteurs : Paolo Maridati [Italie] ; Enrico Stoffella [Italie] ; Stefano Speroni [Italie] ; Marco Cicciu [Italie] ; Carlo Maiorana [Italie]

Source :

RBID : PMC:4062959

Abstract

The sinus lift technique, introduced in 1976 by Tatum and subsequently described by Boyne in 1980, is nowadays considered a safe and reliable procedure for the rehabilitation of the atrophic upper posterior maxilla.

The alveolar antral artery (AAA) is anastomoses between the posterior superior alveolar artery (PSAA) and the infraorbital artery (IOA) and may be present in the sinusal antrostomy. The haemorrhage of this vascular bundle represents the second intra-operatory complication in term of frequency during sinus lift procedure.

Purpose of this study was to illustrate and describe a new technique allowing the AAA isolation during sinus lift procedure in cases in which the artery is clearly present inside the surgical area, detectable through CT scan exam. Presence, course and possible identification of the alveolar antral artery are also discussed, according to the studies present in the literature.


Url:
DOI: 10.2174/1874210601408010095
PubMed: 24949106
PubMed Central: 4062959


Affiliations:


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PMC:4062959

Le document en format XML

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<p>The sinus lift technique, introduced in 1976 by Tatum and subsequently described by Boyne in 1980, is nowadays considered a safe and reliable procedure for the rehabilitation of the atrophic upper posterior maxilla. </p>
<p>The alveolar antral artery (AAA) is anastomoses between the posterior superior alveolar artery (PSAA) and the infraorbital artery (IOA) and may be present in the sinusal antrostomy. The haemorrhage of this vascular bundle represents the second intra-operatory complication in term of frequency during sinus lift procedure. </p>
<p>Purpose of this study was to illustrate and describe a new technique allowing the AAA isolation during sinus lift procedure in cases in which the artery is clearly present inside the surgical area, detectable through CT scan exam. Presence, course and possible identification of the alveolar antral artery are also discussed, according to the studies present in the literature.</p>
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<article-meta>
<article-id pub-id-type="pmid">24949106</article-id>
<article-id pub-id-type="pmc">4062959</article-id>
<article-id pub-id-type="publisher-id">TODENTJ-8-95</article-id>
<article-id pub-id-type="doi">10.2174/1874210601408010095</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Article</subject>
</subj-group>
</article-categories>
<title-group>
<article-title> Alveolar Antral Artery Isolation During Sinus Lift Procedure with the Double Window Technique</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Maridati</surname>
<given-names>Paolo</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Stoffella</surname>
<given-names>Enrico</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Speroni</surname>
<given-names>Stefano</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Cicciu</surname>
<given-names>Marco</given-names>
</name>
<xref ref-type="aff" rid="aff2">2</xref>
<xref ref-type="corresp" rid="cor1">*</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Maiorana</surname>
<given-names>Carlo</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
</contrib-group>
<aff id="aff1">
<label>1</label>
Department of Implant Dentistry, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano, Università degli Studi di Milano, Milan, Italy</aff>
<aff id="aff2">
<label>2</label>
Department of Human Pathology, School of Dentistry, Università degli Studi di Messina, Messina, Italy</aff>
<author-notes>
<corresp id="cor1">
<label>*</label>
Address correspondence to this author at the Department of Human Pathology, Dental School, Messina University,
<italic>Via</italic>
Consolare Valeria 98100, Messina, Italy, Tel: 0039-090 221 6911, E-mail:
<email xlink:href="acromarco@yahoo.it">acromarco@yahoo.it</email>
</corresp>
</author-notes>
<pub-date pub-type="epub">
<day>30 </day>
<month>5</month>
<year>2014</year>
</pub-date>
<pub-date pub-type="collection">
<year>2014</year>
</pub-date>
<volume>8</volume>
<fpage>95</fpage>
<lpage>103</lpage>
<history>
<date date-type="received">
<day>20</day>
<month>2</month>
<year>2014</year>
</date>
<date date-type="rev-recd">
<day>27</day>
<month>3</month>
<year>2014</year>
</date>
<date date-type="accepted">
<day>13</day>
<month>5</month>
<year>2014</year>
</date>
</history>
<permissions>
<copyright-statement> © Maridati
<italic>et al.</italic>
, Licensee
<italic>Bentham Open.</italic>
</copyright-statement>
<copyright-year>2014</copyright-year>
<copyright-holder>Maridati</copyright-holder>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">
<license-p>This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (
<uri xlink:type="simple" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</uri>
) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.</license-p>
</license>
</permissions>
<abstract>
<p>The sinus lift technique, introduced in 1976 by Tatum and subsequently described by Boyne in 1980, is nowadays considered a safe and reliable procedure for the rehabilitation of the atrophic upper posterior maxilla. </p>
<p>The alveolar antral artery (AAA) is anastomoses between the posterior superior alveolar artery (PSAA) and the infraorbital artery (IOA) and may be present in the sinusal antrostomy. The haemorrhage of this vascular bundle represents the second intra-operatory complication in term of frequency during sinus lift procedure. </p>
<p>Purpose of this study was to illustrate and describe a new technique allowing the AAA isolation during sinus lift procedure in cases in which the artery is clearly present inside the surgical area, detectable through CT scan exam. Presence, course and possible identification of the alveolar antral artery are also discussed, according to the studies present in the literature.</p>
</abstract>
<kwd-group>
<title>Keywords</title>
<kwd>Alveolar antral artery</kwd>
<kwd>sinus lift complications.</kwd>
</kwd-group>
</article-meta>
</front>
<floats-group>
<fig id="F1" position="float">
<label>Fig. (1)</label>
<caption>
<p>Bony window as described by Boyne 1. The dimension of the antrostomy are aproximally 10 mm x 20 mm. </p>
</caption>
<graphic xlink:href="TODENTJ-8-95_F1"></graphic>
</fig>
<fig id="F2" position="float">
<label>Fig. (2)</label>
<caption>
<p>AAA identification through CT scan, cross sections. </p>
</caption>
<graphic xlink:href="TODENTJ-8-95_F2"></graphic>
</fig>
<fig id="F3" position="float">
<label>Fig. (3)</label>
<caption>
<p>The AAA course is highlined on the lateral wall of the maxillary sinus using a surgical pencil. </p>
</caption>
<graphic xlink:href="TODENTJ-8-95_F3"></graphic>
</fig>
<fig id="F4" position="float">
<label>Fig. (4)</label>
<caption>
<p>Double window design. AAA course remains covered by a bony wall as a protection from possible damages. </p>
</caption>
<graphic xlink:href="TODENTJ-8-95_F4"></graphic>
</fig>
<fig id="F5" position="float">
<label>Fig. (5)</label>
<caption>
<p>Graft material in place surrounding the AAA course. </p>
</caption>
<graphic xlink:href="TODENTJ-8-95_F5"></graphic>
</fig>
<fig id="F6" position="float">
<label>Fig. (6)</label>
<caption>
<p>Implant insertion after 6 months. No complications were reported. </p>
</caption>
<graphic xlink:href="TODENTJ-8-95_F6"></graphic>
</fig>
<fig id="F7" position="float">
<label>Fig. (7)</label>
<caption>
<p>Perforation of the sinusal membrane is the intra-operative complication with the higher frequency. </p>
</caption>
<graphic xlink:href="TODENTJ-8-95_F7"></graphic>
</fig>
<fig id="F8" position="float">
<graphic xlink:href="TODENTJ-8-95_F8"></graphic>
</fig>
<fig id="F9" position="float">
<label>Fig. (9)</label>
<caption>
<p>(8 and 9). AAA course in two cases in which the double window technique hasn’t been used. As well seen, the artery is exposed and damages can easily occur. </p>
</caption>
<graphic xlink:href="TODENTJ-8-95_F9"></graphic>
</fig>
<table-wrap id="T1" position="float">
<label>Table 1.</label>
<caption>
<p>Intra- and post-operative complications in terms of frequency during Sinus Lift procedure.</p>
</caption>
<table frame="border" rules="all" width="100%">
<thead>
<tr>
<th style="background-color: silver" rowspan="2" valign="middle" align="center" colspan="1"> </th>
<th style="background-color: silver" rowspan="2" colspan="1">Intra-operative </th>
<th style="background-color: silver" colspan="2" rowspan="1">Post-operative </th>
</tr>
<tr>
<th style="background-color: silver" align="center" rowspan="1" colspan="1">Specific </th>
<th style="background-color: silver" align="center" rowspan="1" colspan="1">Non-specific </th>
</tr>
</thead>
<tbody>
<tr>
<td style="background-color: silver" align="center" rowspan="1" colspan="1">I </td>
<td align="center" rowspan="1" colspan="1">Sinusal membrane perforation </td>
<td align="center" rowspan="1" colspan="1">Sinus congestion </td>
<td align="center" rowspan="1" colspan="1">Swelling and Hematoma </td>
</tr>
<tr>
<td style="background-color: silver" align="center" rowspan="1" colspan="1">II </td>
<td align="center" rowspan="1" colspan="1">AAA Hemmorage </td>
<td align="center" rowspan="1" colspan="1">Graft mobility </td>
<td align="center" rowspan="1" colspan="1">Wound dehiscence </td>
</tr>
<tr>
<td style="background-color: silver" align="center" rowspan="1" colspan="1">III </td>
<td align="center" rowspan="1" colspan="1">Antral meatal ostium complex obstruction </td>
<td align="center" rowspan="1" colspan="1">Acute sinusitis induced by the graft </td>
<td align="center" rowspan="1" colspan="1">Hyposensitivity of adjacent teeth </td>
</tr>
<tr>
<td style="background-color: silver" align="center" rowspan="1" colspan="1">IV </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1">Cyst formation and over-filling necrosis </td>
<td align="center" rowspan="1" colspan="1">Increase in temperature </td>
</tr>
</tbody>
</table>
</table-wrap>
<table-wrap id="T2" position="float">
<label>Table 2.</label>
<caption>
<p>AAA detection through CT scan according to its caliper and course.</p>
</caption>
<table frame="border" rules="all" width="100%">
<thead>
<tr>
<th style="background-color: silver" align="center" rowspan="1" colspan="1"> </th>
<th style="background-color: silver" align="center" rowspan="1" colspan="1">Extraosseous </th>
<th style="background-color: silver" align="center" rowspan="1" colspan="1">Extra/intraosseous </th>
<th style="background-color: silver" align="center" rowspan="1" colspan="1">Intraosseous </th>
</tr>
</thead>
<tbody>
<tr>
<td style="background-color: silver" align="center" rowspan="1" colspan="1">Caliber < 2 mm </td>
<td align="center" rowspan="1" colspan="1">5 </td>
<td align="center" rowspan="1" colspan="1">5 </td>
<td align="center" rowspan="1" colspan="1">5 - ✓ </td>
</tr>
<tr>
<td style="background-color: silver" align="center" rowspan="1" colspan="1">Caliber > 2 mm </td>
<td align="center" rowspan="1" colspan="1">5 </td>
<td align="center" rowspan="1" colspan="1">5 - ✓ </td>
<td align="center" rowspan="1" colspan="1"></td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="T2F1">
<p>✓: detectable; ✗: non detectable; ✗ - ✓: possible detection</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="T3" position="float">
<label>Table 3.</label>
<caption>
<p>List of possible causes of surgical procedure and graft healing failure following AAA hemmorage.</p>
</caption>
<table frame="border" rules="all" width="100%">
<thead>
<tr>
<th style="background-color: silver" colspan="2" rowspan="1">Interruption Causes of Sinusal Graft Failure and Surgical Procedure Following AAA Hemmorage </th>
</tr>
</thead>
<tbody>
<tr>
<td align="center" rowspan="1" colspan="1">Lengthening of operatory time </td>
<td align="center" rowspan="1" colspan="1">Excess in bleeding </td>
</tr>
<tr>
<td align="center" rowspan="1" colspan="1">Inability to proper display in the operative field </td>
<td align="center" rowspan="1" colspan="1">Perforation of sinusal membrane </td>
</tr>
<tr>
<td align="center" rowspan="1" colspan="1">Lowest bloody supply to the graft </td>
<td align="center" rowspan="1" colspan="1">Graft mobility due to bleeding </td>
</tr>
</tbody>
</table>
</table-wrap>
</floats-group>
</pmc>
<affiliations>
<list>
<country>
<li>Italie</li>
</country>
<region>
<li>Lombardie</li>
</region>
<settlement>
<li>Milan</li>
</settlement>
</list>
<tree>
<country name="Italie">
<region name="Lombardie">
<name sortKey="Maridati, Paolo" sort="Maridati, Paolo" uniqKey="Maridati P" first="Paolo" last="Maridati">Paolo Maridati</name>
</region>
<name sortKey="Cicciu, Marco" sort="Cicciu, Marco" uniqKey="Cicciu M" first="Marco" last="Cicciu">Marco Cicciu</name>
<name sortKey="Maiorana, Carlo" sort="Maiorana, Carlo" uniqKey="Maiorana C" first="Carlo" last="Maiorana">Carlo Maiorana</name>
<name sortKey="Speroni, Stefano" sort="Speroni, Stefano" uniqKey="Speroni S" first="Stefano" last="Speroni">Stefano Speroni</name>
<name sortKey="Stoffella, Enrico" sort="Stoffella, Enrico" uniqKey="Stoffella E" first="Enrico" last="Stoffella">Enrico Stoffella</name>
</country>
</tree>
</affiliations>
</record>

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