Surgical Ciliated Cyst of the Maxilla: A Case-Series of Three Cases

The surgical ciliated cyst is an iatrogenic lesion occurring after surgeries in which the Schneiderian membrane has been exposed, such as in orthognathic surgery or maxillary sinus procedures. This lesion has been infrequently documented in western countries. In this case series, we present three cases of surgical ciliated cysts of the maxilla.

Effects of Platelet-rich Fibrin on Osteogenic Differentiation of Schneiderian Membrane Derived Mesenchymal Stem Cells and Bone Formation in Maxillary Sinus

BackgroundThe existence of mesenchymal stem cells (MSCs) in Schneiderian membrane has not been determined. The aim of this study is to investigate whether there are MSCs in Schneiderian membrane, and the effect of platelet-rich fibrin (PRF) on osteogenic differentiation of these cells and on new bone formation in maxillary sinus after maxillary sinus floor elevation.MethodsSchneiderian membrane derived mesenchymal stem cells (SM-MSCs) were isolate from rabbit maxillary sinus. Cells were identified by flow cytometry and multipotential differentiation. Real-time cell analysis assay, fluorescence staining, transwell assay, and wound healing assay were used to determine the effects of PRF stimulation on cell proliferation and migration. The osteogenic differentiation ability of cells stimulated by PRF or osteoinductive medium (OM) was evaluated by alkaline phosphatase (ALP) staining, alizarin red staining, PCR and Western blot. Equivalent volume Bio-oss and the mixture of Bio-oss and PRF were used as bone graft materials for maxillary sinus floor elevation. Micro-CT, bone double-staining, HE staining, Masson staining, and toluidine blue staining were used to evaluate the osteogenic effect in 8 and 12 weeks after surgery.ResultsThe cell surface markers were positive for expression of CD90, CD105, and negative for expression of CD34, CD45. SM-MSCs had the ability of osteogenic, adipogenic and chondrogenic differentiation. PRF can stimulate proliferation, migration and osteogenic differentiation of SM-MSCs, which is achieved by up-regulating ERK 1/2 signaling pathway. PRF can accelerate the formation of new bone in maxillary sinus and increase the amount of new bone formation. ConclusionsMSCs exist in Schneiderian membrane, and PRF stimulation can promote cell proliferation, migration and osteogenic differentiation. The application of PRF in maxillary sinus floor elevation can accelerate bone healing and increase the quantity and quality of new bone.

Maxillary Implant Placement in a Limited Residual Bone Height

The limitation of residual bone height (RBH) and vital structures such as sinuses in the maxillary often make the implant placement procedure becomes complicated. Clinicians may perform sinus elevation prior to implant placement to accommodate the length of the implant fixture. Sinus elevation is an invasive procedure and complication may occur during the surgery including the most frequent complication is perforation of Schneiderian membrane. Objectives: To discuss a comprehensive management of implant placement and its complication step by step from surgical procedures to crown placement Case Report: 67-year-old female patient with partial edentulism in the right maxillary region, presence of sinus septum, and RBH was 4mm. The patient was planned to do sinus elevation surgery prior to implant placement, perforation of the Schneiderian membrane occurred while surgery performed and pericardium membrane was attached around the perforation site. Sinus re-entry and implant placement were performed after 3 months followed by prosthetics procedures in the next 6 month. Conclusion: Dental implant is a complicated treatment and complication may occur during the placement, thus a comprehensive management is very essential to minimize the risk of complications.

External Approach to Bilaterally Septated Maxillary Sinuses: A Case Report

The careful planning of a sinus lift procedure is the key to avoiding surgical complications. In this clinical case, a female patient, 59 years old and totally edentulous in the maxilla, was referred to Egas Moniz’s Dental Clinic Implantology consultation with indication for bilateral external sinus lift of the maxillary sinuses prior to implant placement. Both orthopantomography and cone-beam computed tomography were used to show the anatomy of the maxillary sinuses, which presented multiple sinus septa. A multiple anterolateral window approach was applied in order to avoid perforation of the Schneiderian membrane while accessing it.

Management of Schneiderian membrane perforations during maxillary sinus floor augmentation with lateral approach in relation to subsequent implant survival rates: a systematic review and meta-analysis

Background This systematic review aimed to propose a treatment protocol for repairing intraoperative perforation of the Schneiderian membrane during maxillary sinus floor augmentation (MSFA) procedures with lateral window technique. In turn, to assess subsequent implant survival rates placed below repaired membranes compared with intact membranes and therefore determine whether membrane perforation constitutes a risk factor for implant survival. Material and methods This review was conducted according to PRISMA guidelines. Two independent reviewers conducted an electronic search for articles published between 2008 and April 30, 2020, in four databases: (1) The National Library of Medicine (MEDLINE/PubMed) via Ovid; (2) Web of Science (WOS); (3) SCOPUS; and (4) Cochrane Central Register of Controlled Trials (CENTRAL); also, a complementary handsearch was carried out. The Newcastle-Ottawa Quality Assessment Scale was used to assess the quality of evidence in the studies reviewed. Results Seven articles fulfilled the inclusion criteria and were analyzed. A total of 1598 sinus lift surgeries were included, allowing the placement of 3604 implants. A total of 1115 implants were placed under previously perforated and repaired membranes, obtaining a survival rate of 97.68%, while 2495 implants were placed below sinus membranes that were not damaged during surgery, obtaining a survival rate of 98.88%. The rate of Schneiderian membrane perforation shown in the systematic review was 30.6%. In the articles reviewed, the most widely used technique for repairing perforated membranes was collagen membrane repair. Conclusions Schneiderian membrane perforation during MFSA procedures with lateral approach is not a risk factor for dental implant survival (p=0.229; RR 0.977; 95% CI 0.941-1.015). The knowledge of the exact size of the membrane perforation is essential for deciding on the right treatment plan.

A modified transalveolar sinus floor elevation approach with a bilaterally enlarged osteotomy

Sinus floor elevation is the most commonly used method for vertical bone augmentation in the maxillary posterior area. This clinical report describes a modified transalveolar approach to elevate the sinus floor when placing implants on a severely resorbed maxillary posterior ridge with a buccal-palatal distance of more than 8.0 mm. In this approach, the osteotomy prepared on the crestal is bilaterally enlarged to 8.0-10.0 mm. The enlarged osteotomies can provide better access for practitioners, so that instruments can touch directly to the sinus floor and the Schneiderian membrane can be elevated with a reduced risk of perforation.

Microsurgical endodontic treatment of the upper molar teeth and their relationship with the maxillary sinus: a retrospective multicentric clinical study

Purpose To assess the clinical and radiographic success rate of microsurgical endodontic treatment of upper molar teeth in relationship with the maxillary sinus, with 12 months follow-up. Methods Patients treated with microsurgical endodontic treatment of upper molar teeth in the period between 2017 and 2019 were recruited from two dental clinics according to specific selection criteria. The outcomes were determined based on clinical and radiographic results taken three, six and 12 months post-operatively, compared with those taken immediately before and after surgery. Clinical and radiographic outcomes were recorded. The distance between the most apical part of the root and of the lesion to the maxillary sinus was measured on CBCT images before the surgery. Patient-related outcomes were recorded. Results Out of 35 patients evaluated, 21 were selected according with the selection criteria for a total of 27 roots and 29 canals treated. After 12 months, 18 patients showed a complete healing whereas three demonstrated incomplete healing. Consequently, the success rate in this study was 85.7% after one year. In 28.5% (6 patients) there was a perforation of the Schneiderian membrane that didn’t seem to affect the outcome. All patients kept the molar one year later. The pain level decreased significantly over the time during the first week after surgery. Conclusion Microsurgical Endodontic treatment of the upper molar teeth should be considered a valid and predictable treatment option even in case of Schneiderian membrane perforation. Future clinical studies with a larger sample size are needed to compare the results obtained.

Lateral Sinus Membrane Elevation in Case of Lateral Intra-sinus Linear Calcification: Expanding the Indications

Intra-sinus calcifications (ISCs) which are noted only in 2.4 percent of maxillary sinus pathology can be a challenging condition for the implantologists. A few studies describe only a recommendation for the centrally localized calcification spots in the maxillary sinus. Simultaneously, there is no publications focused on lateral sinus lift performance in cases of laterally, peripherally located linear ISCs. The purpose of our report is to present a surgical tactic for lateral approach of Schneiderian membrane elevation in a 58-year-old female with linear and fine punctate calcifications, inta-sinus hyperostosis, and mucosal swelling with height above the middle level of the sinus.