Please wait a minute...
J Zhejiang Univ (Med Sci)  2017, Vol. 46 Issue (6): 630-636    DOI: 10.3785/j.issn.1008-9292.2017.12.09
Application of modified lateral window for maxillary sinus floor augmentation
LU Wei1(),LIN Mengna2,ZHAO Shifang2,WANG Huiming2,HE Fuming2,*()
1. Department of Periodontology, Stomatology Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310006, China
2. Department of Implantology, Stomatology Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310006, China
Download: HTML( 0 )   PDF(1049KB)
Export: BibTeX | EndNote (RIS)      


Objective: To evaluate the clinical efficacy of modified lateral window for maxillary sinus floor augmentation (MSFA). Methods: Fifty-five patients who visited the Stomatology Hospital Affiliated to Zhejiang University School of Medicine between June 2012 and October 2014 were enrolled in the study. Patients underwent MSFA with Bio-Oss grafts based on modified access window. During the operation the vertical height of the bony window was reduced from 6-8 mm of conventional oval window to 4-5 mm of slot-shaped window. The sinus membrane was detached completely via the lateral access and large particle Bio-Oss graft was placed in the sub-mucosal space. The implant survival, graft height, graft volume and resorption rates were measured. Intra-op and post-op complications were recorded. Results: There were 86 implants inserted. The 2-4 year cumulative survival rates were 97.67% by implant-based analysis and 96.36% by patient-based analysis. The residual bone height was (4.7±2.6) mm and bone width was (8.4±2.7) mm. The bone height of implantation site immediately after operation was (16.1±2.5) mm and it was (16.2±2.2) mm at restoration. The bone heights at 1 and 2 years after operation were (14.9±2.5) mm and (13.6±2.6) mm, respectively. The graft height was (10.6±2.8) mm and the graft volume was (1569±745) mm3 immediately after operation. The resorption rate of graft height 6 months after operation was 3.79% and that of graft volume was 7.87%. The 1-year accumulative resorption rate of graft height was 6.63% and that of graft volume was 10.89%. The 2-year accumulative resorption rate of graft height was 7.58% and that of graft volume was 15.26%. Small membrane perforation during MSFA was observed in 5 cases and all were successfully repaired by a collagen Bio-Gide membrane. Conclusion: The modified lateral technique obtains high implant survival rate, excellent graft stability and low complication rate at 2-4 year clinical follow-up, indicating that it is a safe, predictable and minimally invasive surgical method for severe atrophic maxillary posterior dentition.

Key wordsMaxillary sinus/surgery      Biofilms      Bone substitutes/therapeutic use      Gelatin sponge, absorbable/therapeutic use      Bone transplantation/methods      Dental implantation      Treatment outcome      Follow-up studies     
Received: 15 June 2017      Published: 25 December 2017
CLC:  R782.05  
Corresponding Authors: HE Fuming     E-mail:;
Cite this article:

LU Wei,LIN Mengna,ZHAO Shifang,WANG Huiming,HE Fuming. Application of modified lateral window for maxillary sinus floor augmentation. J Zhejiang Univ (Med Sci), 2017, 46(6): 630-636.

URL:     OR


目的: 评估改良侧壁开窗式上颌窦底提升术治疗上颌后牙区缺牙伴重度骨萎缩患者的疗效。方法: 选择2012年6月至2014年10月于浙江大学医学院附属口腔医院就诊的上颌后牙区缺牙伴重度骨萎缩患者55例,均接受改良侧壁开窗式上颌窦底提升术。在上颌窦侧壁开窗操作中,将常规的6~8 mm垂直高度的卵圆形骨窗改良为4~5 mm的沟槽状骨窗,并通过改良骨窗建立的操作通道充分剥离上颌窦底黏膜,于黏膜下方置入适量大颗粒Bio-Oss骨粉。统计种植体存活率,测量骨粉垂直高度、体积并计算其吸收率,记录相关并发症。结果: 同期植入86颗种植体,种植体累计存活率为97.67%(基于种植体分析)和96.36%(基于患者分析)。术前剩余骨高度为(4.7±2.6)mm,宽度为(8.4±2.7)mm。术后即刻种植位点骨高度为(16.1±2.5)mm,修复时骨高度为(16.2±2.2)mm,术后1年和2年的骨高度分别为(14.9±2.5)mm和(13.6±2.6)mm。术后即刻骨粉高度为(10.6±2.8)mm,体积为(1569±745)mm3;术后半年内骨粉高度吸收率为3.79%,体积吸收率为7.87%;术后1年时骨粉高度累计吸收率为6.63%,体积累计吸收率为10.89%;术后2年时骨粉高度累计吸收率为7.58%,体积累计吸收率为15.26%。5例患者术中发生窦底黏膜小穿孔,均使用Bio-Gide胶原膜成功修复。结论: 改良侧壁开窗式上颌窦底提升术治疗上颌后牙区缺牙伴重度骨萎缩患者有较高的种植体存活率、良好的骨粉稳定性以及较低的并发症发生率,是一种安全可靠并且创伤较小的种植骨增量手段。

关键词: 上颌窦/外科学,  生物膜,  骨代用品/治疗应用,  明胶海绵, 吸收性/治疗应用,  骨移植/方法,  牙种植,  治疗结果,  随访研究 
Fig 1 Modified lateral bone window for sinus access
Fig 2 Liner parameters assessment
Fig 3 Representative cone beam CT series of modified lateral windows with view to the graft alterations and surgical access
[1]   PJETURSSON B E , TAN W C , ZWAHLEN M et al. A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation. Part Ⅰ:Lateral approach[J]. J Clin Periodontol, 2008, 35 (8 Suppl): 216- 240
[2]   GUERRERO J S , AL-JANDAN B A . Lateral wall sinus floor elevation for implant placement:revisiting fundamentals and the surgical technique[J]. J Calif Dent Assoc, 2013, 41 (3): 185- 187, 190-195
[3]   VERCELLOTTI T , DE PAOLI S , NEVINS M . The piezoelectric bony window osteotomy and sinus membrane elevation:introduction of a new technique for simplification of the sinus augmentation procedure[J]. Int J Periodontics Restorative Dent, 2001, 21 (6): 561- 567
[4]   TESTORI T, WALACE S. Surgical procedures-lateral window approach[M]//TESTORI T, DEL FABBRO M, WEINSTEIN R, et al. Maxillary sinus surgery and alternatives in treatment. Chicago: Quintessence Publishing, 2009: 191-215.
[5]   AVILA-ORTIZ G , NEIVA R , GALINDO-MORENO P et al. Analysis of the influence of residual alveolar bone height on sinus augmentation outcomes[J]. Clin Oral Implants Res, 2012, 23 (9): 1082- 1088
doi: 10.1111/clr.2012.23.issue-9
[6]   SIMONPIERI A , CHOUKROUN J , DEL C M et al. Simultaneous sinus-lift and implantation using microthreaded implants and leukocyte-and platelet-rich fibrin as sole grafting material:a six-year experience[J]. Implant Dent, 2011, 20 (1): 2- 12
doi: 10.1097/ID.0b013e3181faa8af
[7]   PARIENTE L , DADA K , DAAS M . Mini-lateral windows for minimally invasive maxillary sinus augmentation:case series of a new technique[J]. Implant Dent, 2014, 23 (4): 371- 377
[8]   HONG J Y , BAEK W S , CHA J K et al. Long-term evaluation of sinus floor elevation using a modified lateral approach in the posterior maxilla[J]. Clin Oral Implants Res, 2017, 28 (8): 946- 953
doi: 10.1111/clr.2017.28.issue-8
[9]   JUNG U W , HONG J Y , LEE J S et al. A hybrid technique for sinus floor elevation in the severely resorbed posterior maxilla[J]. J Periodontal Implant Sci, 2010, 40 (2): 76- 85
doi: 10.5051/jpis.2010.40.2.76
[10]   黄国伟, 陆薇, 程志鹏 et al. 122例外侧壁开窗式上颌窦底提升术相关并发症的研究[J]. 口腔医学, 2014, 34 (6): 427- 431
HUANG Guowei , LU Wei , CHENG Zhipeng et al. A retrospective study of complications associated with 122 consecutive maxillary sinus augmentations via the lateral window approach[J]. Chinese Journal of Stomatology, 2014, 34 (6): 427- 431
[11]   DASMAH A , HALLMAN M , SENNERBY L et al. A clinical and histological case series study on calcium sulfate for maxillary sinus floor augmentation and delayed placement of dental implants[J]. Clin Implant Dent Relat Res, 2012, 14 (2): 259- 265
doi: 10.1111/cid.2012.14.issue-2
[12]   MORDENFELD A , ALBREKTSSON T , HALLMAN M . A 10-year clinical and radiographic study of implants placed after maxillary sinus floor augmentation with an 80:20 mixture of deproteinized bovine bone and autogenous bone[J]. Clin Implant Dent Relat Res, 2014, 16 (3): 435- 446
doi: 10.1111/cid.2014.16.issue-3
[13]   AGHALOO T L , MOY P K . Which hard tissue augmentation techniques are the most successful in furnishing bony support for implant placement?[J]. Int J Oral Maxillofac Implants, 2007, 22 Suppl 49- 70
[14]   DEL F M , TESTORI T , FRANCETTI L et al. Systematic review of survival rates for implants placed in the grafted maxillary sinus[J]. Int J Periodontics Restorative Dent, 2004, 24 (6): 565- 577
[15]   ?ZKAN Y , AKO?LU B , KULAK-?ZKAN Y . Maxillary sinus floor augmentation using bovine bone grafts with simultaneous implant placement:a 5-year prospective follow-up study[J]. Implant Dent, 2011, 20 (6): 455- 459
[16]   FERREIRA C E , NOVAES A B , HARASZTHY V I et al. A clinical study of 406 sinus augmentations with 100% anorganic bovine bone[J]. J Periodontol, 2009, 80 (12): 1920- 1927
doi: 10.1902/jop.2009.090263
[17]   CORDARO L , BOSSHARDT D D , PALATTELLA P et al. Maxillary sinus grafting with bio-oss or straumann bone ceramic:histomorphometric results from a randomized controlled multicenter clinical trial[J]. Clin Oral Implants Res, 2008, 19 (8): 796- 803
doi: 10.1111/clr.2008.19.issue-8
[18]   VALENTINI P , ABENSUR D , WENZ B et al. Sinus grafting with porous bone mineral (Bio-Oss) for implant placement:a 5-year study on 15 patients[J]. Int J Periodontics Restorative Dent, 2000, 20 (3): 245- 253
[19]   UMANJEC-KORAC S , WU G , HASSAN B et al. A retrospective analysis of the resorption rate of deproteinized bovine bone as maxillary sinus graft material on cone beam computed tomography[J]. Clin Oral Implants Res, 2014, 25 (7): 781- 785
doi: 10.1111/clr.2014.25.issue-7
[20]   URIBARRI A , BILBAO E , MARICHALAR-MENDIA X et al. Bone remodeling around implants placed in augmented sinuses in patients with and without history of periodontitis[J]. Clin Implant Dent Relat Res, 2017, 19 (2): 268- 279
doi: 10.1111/cid.2017.19.issue-2
[21]   SCHWARTZ-ARAD D , HERZBERG R , DOLEV E . The prevalence of surgical complications of the sinus graft procedure and their impact on implant survival[J]. J Periodontol, 2004, 75 (4): 511- 516
doi: 10.1902/jop.2004.75.4.511
[22]   SHLOMI B , HOROWITZ I , KAHN A et al. The effect of sinus membrane perforation and repair with Lambone on the outcome of maxillary sinus floor augmentation:a radiographic assessment[J]. Int J Oral Maxillofac Implants, 2004, 19 (4): 559- 562
[23]   DANESH-SANI S A , LOOMER P M , WALLACE S S . A comprehensive clinical review of maxillary sinus floor elevation:anatomy, techniques, biomaterials and complications[J]. Br J Oral Maxillofac Surg, 2016, 54 (7): 724- 730
doi: 10.1016/j.bjoms.2016.05.008
[24]   FAVERO V , LANG N P , CANULLO L et al. Sinus floor elevation outcomes following perforation of the Schneiderian membrane. An experimental study in sheep[J]. Clin Oral Implants Res, 2016, 27 (2): 233- 240
doi: 10.1111/clr.2016.27.issue-2
[25]   SCALA A , BOTTICELLI D , RANGEL I G et al. Early healing after elevation of the maxillary sinus floor applying a lateral access:a histological study in monkeys[J]. Clin Oral Implants Res, 2010, 21 (12): 1320- 1326
doi: 10.1111/clr.2010.21.issue-12
[26]   CHANAVAZ M . Sinus grafting related to implantology. Statistical analysis of 15 years of surgical experience (1979-1994)[J]. J Oral Implantol, 1996, 22 (2): 119- 130
[27]   AVILA-ORTIZ G , WANG H L , GALINDO-MORENO P et al. Influence of lateral window dimensions on vital bone formation following maxillary sinus augmentation[J]. Int J Oral Maxillofac Implants, 2012, 27 (5): 1230- 1238
[1] DING Yuan,SUN Zhongquan,ZHANG Wenyan,ZHANG Xiangying,JIANG Yuancong,YAN Sheng,WANG Weilin. Application of enhanced recovery program in laparoscopic distal pancreatectomy[J]. J Zhejiang Univ (Med Sci), 2017, 46(6): 625-629.
[2] ZHU Ziyi,LI Zhijun,HE Zhengfu,WANG Yunzhen. Endoscopic trans-fistula drainage for gastroesophageal anastomotic fistula with para-fistula abscess after esophagectomy[J]. J Zhejiang Univ (Med Sci), 2017, 46(6): 637-642.
[3] ZHANG Siying, CHEN Feng. Research progress of CT/MRI parametric response map in precision evaluation of therapeutic response of cancer patients[J]. J Zhejiang Univ (Med Sci), 2017, 46(5): 468-472.
[4] PAN Jingying, HE Mengye, KE Wei, HU Menglin, WANG Meifang, SHEN Peng. Advances on correlation of PET-CT findings with breast cancer molecular subtypes, treatment response and prognosis[J]. J Zhejiang Univ (Med Sci), 2017, 46(5): 473-480.
[5] ZOU Lixia, LU Meiping, GUO Li, TENG Liping, XU Yiping, ZHENG Qi. Efficacy and safety of humanized interleukin-6 receptor antibody in treatment of systemic juvenile idiopathic arthritis[J]. J Zhejiang Univ (Med Sci), 2017, 46(4): 421-426.
[6] ZHANG Meixia, ZHOU Ying, ZHANG Ruiting, ZHANG Sheng, LOU Min. Maximal infarct volume to benefit from intravenous thrombolysis and its relation with onset to treatment time[J]. J Zhejiang Univ (Med Sci), 2017, 46(4): 384-389.
[7] ZHENG Jing, ZHANG Yu, HONG Fang, YANG Jianbin, TONG Fan, MAO Huaqing, HUANG Xiaolei, ZHOU Xuelian, YANG Rulai, ZHAO Zhengyan, HUANG Xinwen. Screening for fatty acid oxidation disorders of newborns in Zhejiang province:prevalence, outcome and follow-up[J]. J Zhejiang Univ (Med Sci), 2017, 46(3): 248-255.
[8] HONG Fang, HUANG Xinwen, ZHANG Yu, YANG Jianbin, TONG Fan, MAO Huaqing, HUANG Xiaolei, ZHOU Xuelian, YANG Rulai, ZHAO Zhengyan. Screening for newborn organic aciduria in Zhejiang province:prevalence, outcome and follow-up[J]. J Zhejiang Univ (Med Sci), 2017, 46(3): 240-247.
[9] HUANG Xinwen, ZHANG Yu, HONG Fang, ZHENG Jing, YANG Jianbin, TONG Fan, MAO Huaqing, HUANG Xiaolei, ZHOU Xuelian, YANG Rulai, ZHAO Zhengyan. Screening for amino acid metabolic disorders of newborns in Zhejiang province:prevalence, outcome and follow-up[J]. J Zhejiang Univ (Med Sci), 2017, 46(3): 233-239.
[10] WENG Luxi,SONG Xiaojia,LI Juan,LIU Pengruofeng,LIN Jun. Midpalatal cortex osteotomy assisted rapid maxillary expansion for correction of maxillary transverse deficiency in young adults[J]. J Zhejiang Univ (Med Sci), 2017, 46(2): 198-205.
[11] CHEN Gang,ZHANG Ding,YING Yacao,WANG Zhifeng,TAO Wei,ZHU Hao,ZHANG Jingfeng,PENG Zhiyi. Clinical investigation on transarterial chemoembolization with indigenous drug-eluting beads in treatment of unresectable hepatocellular carcinoma[J]. J Zhejiang Univ (Med Sci), 2017, 46(1): 44-51.
[12] GAO Qiuming, XUE Yun, DENG Yinshuan, ZHOU Shungang, LI Meng, SHI Peisheng. One-stage bone grafting combined with non-contact plate technique for treatment of post-traumatic femoral osteomyelitis and bone defects[J]. J Zhejiang Univ (Med Sci), 2016, 45(6): 631-635.
[13] XIA Guangfa, ZHU Juanying, YUAN Jun, CAO Bo, TANG Jie, CHEN Yiding. Efficacy of adjuvant endocrine therapy in breast cancer patients with a positive-to-negative switch of hormone receptor status after neoadjuvant chemotherapy[J]. J Zhejiang Univ (Med Sci), 2016, 45(6): 614-619.
[14] LI Wenbo, DING Gaoheng, LIU Jun, SHI Jie, ZHANG Chao, GAO Qiuming. Operative versus non-operative treatment for three- or four-part proximal humeral fractures in elderly patients: a meta-analysis of randomized controlled trials[J]. J Zhejiang Univ (Med Sci), 2016, 45(6): 641-647.
[15] HE Bin, CHAI Yanlan, WANG Tao, ZHOU Zhenxing, LIU Zi. Progress on clinical application of bevacizumab for the treatment of refractory cervical cancer[J]. J Zhejiang Univ (Med Sci), 2016, 45(4): 395-402.