Transnasal endoscopy – Evaluation and treatment method for patients with sinus lift and dental implants indications

BACKGORUND. Sinus floor elevation, also known as sinus lift, is the surgical procedure meant to elevate the maxillary floor in order to increase the height of the alveolar bone. This will allow the oral surgeon specialist to insert the desired implants, the ground of dental reconstruction. As the procedure involves the maxillary sinus and its Schneiderian membrane the main concern is to have a healthy maxillary sinus prior to implantation and to the maxillary augmentation.

OBJECTIVE. The aim of our study was to identify the patients with abnormal CT scan and refer them to an ENT evaluation, in order to identify and treat any sinusal pathology that can lead to a poor outcome of the sinus-lift intervention.

MATERIAL AND METHODS. Our prospective study included 15 patients selected from a group of 79 adults, candidates for dental implantation with sinus augmentation. These patients had abnormal sinus CT scan in terms of mucosal hypertrophy, cysts or fungal material. Transnasal diameatic sinusoscopy was performed for all the patients, assessing the aspect of the sinus cavity and the mucosa. The following abnormal aspects were found in our group: 5 patients with cysts, 2 patients with fungus ball and 4 with mucosal hypertrophy. 4 patients had normal maxillary mucosa despite the CT scan appearance.

RESULTS. All the patients with abnormal aspects at sinusoscopy (11 patients) were operated on before sinus lift procedure - antrostomy, cyst removal, fungus ball removal. 4 patients showed normal aspect of the sinus mucosa despite the CT scan donations, meaning a 26.66% error rate in appreciating the real changes of the maxillary mucosa on the CT scan.

CONCLUSION. Endoscopic assessment of the maxillary sinus is mandatory in patients with changes of the CT scan. This allows a proper examination of the sinus mucosa and can predict the outcomes of the sinus lift procedures. It is mandatory to cure the inflammation or infection of the maxillary sinus prior to implant procedure in order to be able to increase the success rate, as it can lead to failures of the implant procedure.