(9) A Study in Fresh Human Cadaver Heads Examining the Incidence of Maxillary Sinus Membrane Perforation During Crestal Sinus Elevation Comparing Osteotomes to Osseodensification Drills.

Introduction: Crestal sinus membrane elevation technique is a surgical procedure that helps gain Vertical bone volume when there is a pneumatization of the maxillary sinus cavity. Due to some visual limitations inherent to the procedure, the potential for maxillary sinus membrane perforations and subsequent complications exists. A crestal sinus lift technique using osseodensification burs has been used lately but the literature is very scarce on incidence of sinus perforation during Osseodensification crestal sinus lift technique.
The primary aim of this study is to evaluate the incidence of sinus membrane perforation during crestal sinus lift of 5 mm height comparing BAOSFE procedure to osseodensification technique and the secondary aim is to evaluate the timing of the perforation occurs, during elevation, bone graft placement or implant placement.

Methods: A total of 20 sinuses of 10 fresh human cadaver heads were used in a split mouth design One side received bone added osteotome crestal sinus lift and the other side received Osseodensification lift. All the cadaver heads were scanned using a CBCT unit (Newtom Evo KV 110 ) prior to the surgical experimentation and evaluated for any pathology and the anatomical integrity of the sinus cavity. For a direct visual assessment of the incidence of membrane perforations, a metal automatic saw was used to remove skull of the cadaver heads and all the content until exposing the maxillary sinuses. (Figure 1).Video Camera Recording: A high-definition (4K quality) video camera was set with the direct view of the maxillary sinus to record the sinus membrane during procedures to detect any perforation. Membrane perforation assessment:The sinus membrane elevation was recorded during surgical procedures with the video camera.The surgeon was not informed about the incidence of the perforation during recording. Then the examiner reviewed the recorded videos to confirm the perforations. Statistical Analysis: The statistical analysis was done using the McNemar’s test to compare the incidence of the sinus perforation and the alpha level was set at 0.05.

Results: A total of 10 cadaver heads and 20 sinuses were used for the study, 10 sinuses for the BAOSFE and 10 for the osseodensofication technique. The cadavers were previously frozen and thawed before the experiment. The video recordings were reviewed and perforations recorded by the examiner.It was found that the rate of sinus membrane perforation in the Osteotome group (control group) was 40% and the rate for osseodensification group (test group) was 50%. There was no statistical difference between both groups with P value of (0.564). When evaluating the timing of the perforation, most of the perforations happened at the time of implant placement, 20% in the control group and 40% in the test groups with a P value of (0.480) . Meanwhile, 10 % of the sinuses perforated at the time of drilling in the test site compared to 20% in the control group with no significant difference (P value 0.317). No perforations happened at the time of bone graft placement.

Conclusions: No significant difference was found between both groups in the incidence of membrane perforation, we still noticed higher incidence of perforation at the time of implant placement.

Lead Author’s Contributions to the Research Project: The Lead Author was responsible for data collection, camera recording and the composition of the abstract as this was done for partial fulfillment of the requirements for the master of science(MS) degree at Loma Linda University.