Maxillary Sinus Revisited

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“Clinicians must, obviously, become familiar with implant-related sinus procedures. But, just as important, if not more so, is the preparedness for the treatment of various potential complications that may occur both during and subsequent to initial completion. Clinician beware!” This is the concluding paragraph of Dr. Richard Kraut (Assistant Editor) in his editorial of 2011.1
In that same issue, a book review was written by Dr. Craig Misch on a text by Testori, Del Fabbro, and Weinstein titled “Maxillary Sinus Surgery and Alternatives in Treatment.”2 In the foreword of this text, Dr. Dennis Tarnow wrote “This publication thus manages to combine the goals of a student textbook with a valid tool for the development of professional clinical experts.”
All these analyses, admonitions, and commentaries appeared in “The Sinus Issue”3 of this journal along with 7 basic and clinical research articles and 7 clinical science and techniques articles.
We are well aware of the fact that since 2011 many, many articles regarding the maxillary sinuses have appeared in the literature. Sinuses have been diminished for the placement of maxillary implants. They have not been augmented. The encompassing bone has been augmented. Various transcrestal techniques have been used either laterally or vertically. The omnipresent Schneiderian membrane has been lifted by osteotomies, balloons, hydraulic pressure, or variations thereof. Sinuses have been intruded on by familiar autogenous bone and by not as familiar (but nonetheless successful) exogenous substrates. The multitude of sinus floor elevation materials cover a broad spectrum, including, but not exclusively, anorganic bovine bone, beta-tricalcium phosphate, growth factors. They fall within the categories of allografts, alloplasts, and xenografts. Then, in the real world of sinus procedures, there have been cases of perforations of the membrane and free-floating implants within the hollows of the sinus: enter endoscopy.
Yet, are clinicians all that familiar with this anatomical structure before entering its confines? Naturally, the use of CBCT and the advent of different types of surgical guide systems have facilitated the successful surgeries and have seen a diminishment (so we hope) of surgical complications and of postoperative morbidities. Thus, the recent textbook “Sinonasal Complications of Dental Disease and Treatment: Prevention, Diagnosis, Management” is a must read for all clinicians who are involved with maxillary sinus surgical procedures. Written by Felisati, an otolaryngologist, and Chiapasco, an oral and maxillofacial surgeon, it was reviewed by Dr. Christian Makary in the most recent issue of IMPLANT DENTISTRY.4 Its content enables us to be more aware of the vagaries and nuances of the sinus beyond the Schneiderian membrane. It underscores the need to learn more about the sinus before a scalpel is even lifted, before a technique is even undertaken. So, even if we read an updated systematic review of sinus surgical techniques (which we should),5 the knowledge imparted to us by an otolaryngologist and an oral maxillofacial surgeon lays the groundwork for successful implant procedures.
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