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66]

Review Article

Maxillary sinus augmentation

Shalu Chandna Bathla, Ramesh Ram Fry,1 Komal Majumdar2

Departments of
Periodontology and
Oral Implantology and
1
Oral and Maxillofacial
Surgery Implantology,
M M College of Dental
Sciences and Research,
Ambala, Haryana,
2
Private Practitioner,
Mumbai, Maharashtra,
India
Abstract:
The placement of endosseous implants in posterior edentulous maxilla is normally a challenging task in implant
dentistry due to maxillary sinus pneumatization. Various sinus augmentation techniques have been used with
impressive success rates aimed at developing these sites for implant placement. Knowledge of anatomy of
maxillary sinus guides us not only in proper preoperative treatment planning but also helps us to avoid the
possible complications that may arise during sinus augmentation procedure. This topic attracts a rising number
of publications with most of them reporting results that suggest, the patients with atrophic maxillae requiring
implant treatment can benefit considerably from the use of sinus augmentation. This article explains the basic
techniques, namely, direct and indirect techniques used for maxillary sinus elevation and augmentation.
Key words:
Crestal approach, direct lateral window, maxillary sinus, maxillary sinus augmentation, osteotome

INTRODUCTION Sinus anatomy and dimensions

Maxillary sinus is the biggest pyramidal‑shaped

M axillary sinus augmentation (also known

as sinus floor elevation) procedures have
become increasingly popular procedures before
placement of dental implants in posterior
maxillae that have suffered severe bone loss due
Access this article online
to sinus pneumatization, alveolar bone atrophy,
Website:
or trauma. In 1970s, Hilt Tatum used maxillary
www.jisponline.com
sinus cavity to increase available bone using graft
DOI:
10.4103/jisp.jisp_236_18 material, which allowed greater implant to bone
contact area once the bone graft matured.[1] The
Quick Response Code:
maxillary sinus lift grafting procedure that was
designed and described by Boyne and James,[2]
is not the same procedure that is performed
today. After that, numerous articles have been
published regarding different grafting materials
and modifications of their technique. [3,4] The
purpose of this review article is to enumerate all
the techniques used for maxillary sinus elevation
and augmentation.
paranasal sinus. The average dimensions
of the maxillary sinus are 36–45 mm in
height, 23–25 mm in width, and 38–45 mm
in length (anteroposterior axis). The average
volume of the maxillary sinus is 15 ml.[8] Anterior
wall extends from inferior orbital rim to the
maxillary alveolar process containing infraorbital
neurovascular bundle. Superior wall is the floor
of orbit and is very thin. Posterior wall separates
the maxillary sinus and pterygopalatine fossa
which contains posterior superior alveolar
nerve and blood vessels, the pterygoid plexus
of veins and internal maxillary artery. Medial
wall is the lateral wall of the nasal cavity which
houses primary ostium. This ostium serves as
the main channel for drainage of secretions.
Lateral wall forms the buccal aspect of the sinus
and contributes to the posterior maxillary and
zygomatic process; this wall provides access for
the lateral wall sinus graft procedure.

Anatomical considerations Maxillary sinus septa

Having knowledge of sinus anatomy is a Maxillary sinus septa were first mentioned by
prerequisite for understanding the principles Underwood in 1910.[9] Based on their origin,
involved in making proper incisions and designing septa can be further subdivided into primary
and managing the sinus elevation. Clinicians septa, formed during maxillary development and
should also be familiar with other anatomic
This is an open access journal, and articles are
structures before performing sinus elevation. distributed under the terms of the Creative Commons
Address for
Diagnostic imaging is an essential component Attribution‑NonCommercial‑ShareAlike 4.0 License, which
correspondence:
Dr. Shalu Chandna Bathla, of treatment planning in oral rehabilitation allows others to remix, tweak, and build upon the work
non‑commercially, as long as appropriate credit is given and
H. No 782, Sector 13, in posterior maxillary region. [5] Cone‑beam the new creations are licensed under the identical terms.
Urban Estate, Karnal, computed tomography (CBCT) provides more
Haryana, India. For reprints contact: reprints@medknow.com
precise dimensions of the residual bone height
E‑mail: periodonticsrevisited
and density.[6] It also provides information about
@rediffmail.com How to cite this article: Bathla SC, Fry RR,
maxillary sinus membrane, arterial passages in
Majumdar K. Maxillary sinus augmentation. J Indian
Submission: 09‑04‑2018 the lateral sinus wall, pathologies of maxillary
Soc Periodontol 2018;22:468-73.
Accepted: 01‑06‑2018 sinus, and presence of septa.[7]

468 © 2018 Indian Society of Periodontology | Published by Wolters Kluwer - Medknow

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Bathla, et al.: Maxillary sinus
tooth growth, or secondary septa which is acquired during the
pneumatization of the maxillary sinus after tooth loss.[10] The
majority of septa are located between the second premolar and
first molar area.[11] Sinus augmentation is usually complicated
by the presence of septa. If there is a full partition of the sinus
by a septum, more than one lateral window is created as part
of the sinus opening to circumvent the septa.[12]
Schneiderian membrane
Maxillary sinus is lined by the membrane called as Schneiderian
membrane. This membrane is a pseudostratified columnar
respiratory membrane ciliated epithelium formed by the basal
cells, columnar cells, and goblet cells fixed to the basal membrane.
About 100–150 cilia present on each columnar cell which vibrate
at 1000 beats/min. Thickness of the membrane normally varies
from 0.13 to 0.5 mm (average 0.8 mm thick).[13] The membrane
should be freed totally from the caudal area to enable lifting of
the sinus; however, the distal side of the sinus might extend
considerably.[14] Chances of sinus membrane perforation depend
on the angle between the lateral and the medial wall of the sinus.
Greater than 60º angle has 0% chances of perforation; 30º–60º
angle has 28.6% chances of perforation; and <30º angle has 62.5%
chances of perforation.[15] Thus, narrow angles result in higher
perforations. Overfilling of the maxillary sinus with the bone
graft material may cause necrosis of the membrane as well as
sinusitis and the potential loss of the bone graft into the sinus.
Relation of sinus to dentition – Roots of maxillary premolars
and molars have an intimate relationship with the inferior
aspect of the maxillary sinus. Molars roots are closer to sinus
than premolar roots.[16] Mesiobuccal root apex of the second
molar is closest to the maxillary sinus wall (average distance
of 0.83 mm), whereas lingual root apex of the first premolar is
furthest from the sinus wall.[17]
Vascularization
Blood supply occurs by the branches of maxillary artery,
namely, infraorbital artery, posterior lateral nasal artery, and
posterior superior alveolar artery. Additional blood supply to
the inferior part of the sinus may come from the greater palatine
artery.[18] Infraorbital artery and posterior superior alveolar
artery supplies the lateral wall of the maxillary sinus, while
posterior lateral nasal artery supplies the medial wall of the
sinus. Lateral wall of sinus has both extraosseous (in the buccal
tissues) and intraosseous (within the buccal plate of bone)
anastomosis that occurs between infraorbital and posterior
superior alveolar artery. Extraosseous anastomosis is around
23–26 mm from the ridge. It may cause hemorrhage during flap
preparation. Intraosseous anastomosis is around 16–19 mm
from the ridge. When examining cross‑sections of a CBCT
scan, detection of radiolucency in the buccal plate denotes the
presence of an intraosseous blood vessel. Thus, it may need to
be managed during a lateral window preparation.[19]
Indications:
1. Inadequate residual bone height (<10 mm of vertical bone
height)
2. Atrophic posterior maxillary alveolus.
Contraindications:
1. Acute active sinus infection
2. Recurrent chronic sinusitis
Journal of Indian Society of Periodontology - Volume 22, Issue 6, November-December 2018 469
3. Severe allergic rhinitis
4. Neoplasm or large cyst of the sinus
5. Previous sinus surgery like the Caldwell–Luc operation
6. History of radiation therapy to maxilla
7. Presence of Underwood’s septa/severe sinus floor
convolutions
8. Uncontrolled diabetes mellitus
9. Alcoholic and heavy smoker
10. Psychosis.
DIFFERENT TECHNIQUES FOR MAXILLARY
SINUS ELEVATION
The type of maxillary sinus elevation and augmentation that
a surgeon chooses to use on a given patient depends on the
surgeon’s preference as well as patient anatomy. Patient
anatomical factors include the residual bone height and amount
of lift desired. There are two main approaches for maxillary
sinus floor elevation: Direct and Indirect approach. Direct –
lateral window technique and indirect – osteotome sinus floor
elevation, bone added sinus floor elevation, minimally invasive
transalveolar sinus approach, and antral membrane balloon
elevation. But in this article, sinus augmentation using lateral
window approach and osteotome sinus floor elevation are only
described in detail.
Direct/lateral window technique
In this technique, sinus membrane is directly visualized and
instrumented through the window created in the lateral wall
of maxillary sinus.
Following are the steps of direct/lateral window technique:[20]
1. Anesthesia – Infraorbital, posterior superior alveolar,
greater palatine nerve block; subperiosteal anesthesia
through slow infiltration (speed 1 ml/min)
2. Incision – Soft‑tissue incisions must provide adequate
room for creation of the lateral window. Anterior vertical
incision should be at least 10–15 mm anterior to the wall of
sinus to ensure soft tissue over the bone. Next, a mid‑crestal
ridge/palatal incision with 15C blade is made connecting
the vertical incision. It is desirable to make the horizontal
incision in keratinized tissue to facilitate suturing.
Full‑thickness flap is reflected to access canine fossa just
below the infraorbital foramen, buttress of the zygomatic
arch, and posterior lateral maxillary wall. While elevating
full‑thickness flap, the elevator must be adherent to the
bone surface, so that the periosteum remains unchanged
3. Lateral window/antrostomy – After flap elevation, a
sterile number 2 pencil is used to demarcate the outline
of the lateral wall window on the buccal plate of bone.
Position of the antrostomy is determined by the size
and location of maxillary sinus. Coronal outline of the
window will depend on the height of the graft, length of
the implant to be placed, and location of posterior superior
alveolar artery. Apical outline of the window should be
approximately 3 mm above the sinus floor. Mesial outline
of the window should be as close to anterior wall and
distal outline will depend on the number of implants to be
placed. Size of the window should be 20 mm mesiodistally
and 15 mm apicocoronally which is sufficient to guarantee
easy surgical access. When the surgeons experience level
increases then he/she can easily elevate the membrane
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Bathla, et al.: Maxillary sinus
with reduced access and a smaller, more conservative
access window can be made. This will retain a large source
of blood supply to the lateral wall and enhance maturation
of graft. High‑speed handpiece with number 8 diamond
bur is used to outline the window until bluish hue is visible
with gentle brushing or paintbrush stroke. The shape of the
window is usually oval and should not have sharp edges
that may cause perforation of the membrane [Figure 1].
Bone tampers are used to in‑fracture the sinus bony access
window. Antrostomy can either be elevated or completely
removed. It is elevated when there is good surgical access
and the thickness of the cortical wall is <2 mm. It is
completely removed when surgical access is difficult, in
the presence of septa and in shallow sinus
4. Sinus membrane elevation – Detach the sinus membrane
with blunt instrument. Elevation should be preceded only
when the membrane detaches.[21] Membrane should be
elevated carefully starting on the sinus floor and then
extending to the anterior and posterior walls with the
help of sinus curettes [Figure 2]. The final elevation is up
to the medial wall to the full height of the expected graft
placement [Figure 3]. Sinus membrane integrity can be
tested by asking the patient to breathe in deeply while
observing the membrane lifting
Figure 1: Oval configuration of the antral lateral window
Figure 3: Increased distance from the crest of the ridge to the elevated sinus floor
470 Journal of Indian Society of Periodontology - Volume 22, Issue 6, November-December 2018
5. Preparation of implant site – If there is minimum of 3–4 mm
of residual crestal bone of good quality, it is possible to
place implants simultaneously or else place the implant
after 4–6 months. Since the maxillary bone is a low‑density
bone, undersize the implant osteotomy site. Protect the
sinus membrane with periosteal elevator to avoid damaging
with drills
6. Graft placement – Sinus membrane should be protected
with collagen membrane. Implants are placed in the
prepared implant sites. Bone grafts are placed in the least
accessible area first. Anterior and posterior recesses are
filled first followed by the area along the medial sinus wall.
Do not compact the bone graft too tightly as it prevents
vascularization. But some authors showed that sinus lift can
be performed using the lateral approach with whole blood
as the sole filling material with promising results.[22,23] Thus,
sinus augmentation with simultaneous implant placement
can be done using platelet‑rich fibrin as a sole grafting[24]
7. Membrane placement – Resorbable membrane is placed
over the window (collagen membrane adheres over the
Figure 2: Scrapping sinus membrane off the bone
a b
c
Figure 4: Bone‑added osteotome sinus floor elevation (a) osteotome
instrumentation by malleting (b) fractured sinus floor and added bone graft in
osteotomy (c) sinus elevation with simultaneous implant placement
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Bathla, et al.: Maxillary sinus
bone which does not require fixation screws and does not
require removal)
8. Suturing/incision closure – Nonresorbable monofilament
suture and horizontal mattress sutures are used to suture
the flap (does not require any advancement).
The major drawback associated with lateral antrostomy is that
it requires the raising of a large flap for surgical access. This
approach is more technique sensitive and time‑consuming. The
procedure’s success relies mainly on the amount of residual
bone.
In 2001, Vercellotti et  al. introduced the piezoelectric
technique.[25] The advantage of piezoelectric osteotomy lies in
being able to cut the bony window with great simplicity and
precision while ensuring the membrane’s integrity. This is due
to the termination of the surgical action when the piezosurgery
tips come in contact with nonmineralized tissue.[26,27]
Indirect/osteotome technique/crestal approach/transalveolar
approach
Transalveolar technique was first performed by Tatum.[1]
Summers later described another crestal approach, using tapered
osteotomes with increasing diameters. Indirect osteotome
maxillary sinus floor elevation is generally indicated where
the residual bone height is equal to or >6 mm.[28]
Following are the steps of osteotome technique:[29]
1. Anesthesia
2. Incision – crestal incision should be extended distally in
some cases, to the tuberosity area where autologous bone
needs to be harvested
3. Flap – to expose ridge crest, full‑thickness mucoperiosteal
flap is elevated
4. Drilling – start the osteotomy preparation with pilot drill
of 2 mm diameter keeping it 2 mm short of the sinus floor.
Here, confirmatory radiograph should be taken by inserting
pilot drill. Either the widened drills or set of osteotomes of
varying dimensions can be sequentially used to widened
the osteotomy site to the same level, i.e., 2 mm short of sinus
floor. In low‑density bone  (D3 and D4), osteotomes are
preferred to laterally condensed the bone and to enhance
the density of the bone
5. Grafting – once the largest osteotome has expanded the
implant site, particulated bone substitutes (mixed with
autogenous bone) are added to the osteotomy as the
grafting material. Composite bone graft composed of
25% autogenous and 75% hydroxyapatite graft should be
preferred. Graft is inserted in the osteotome site, before the
in‑fracture of the sinus floor
6. Fracture – an osteotome of lesser diameter than the implant
body is inserted in the prepared osteotomy site and tapped
gently to fracture up the sinus floor. Look out for the change
in sound while in fracturing the sinus floor. When sinus
floor fractures different pitch of sound can be heard
7. Sinus floor elevation– This is done by reinserting the largest
osteotome in the implant site with the graft material in
place. The added bone graft exert pressure onto the sinus
membrane which elevates it further. Bone graft can be
added and tapped to achieve the desired amount of sinus
membrane elevation [Figure 4a‑c]. Do not exceed the
stretching limit of the membrane
Journal of Indian Society of Periodontology - Volume 22, Issue 6, November-December 2018 471
8. Implant placement – Implant fixture to be placed should
be slightly larger in diameter than the osteotomy created
by the final osteotome.
Minimally invasive techniques
Other minimally invasive techniques for sinus augmentation have
been introduced over the years. Modified trephine/osteotome
technique was described in 1999 was modified by the
simultaneous insertion of implants. The implant site is prepared
using a 3 mm exterior diameter trephine bur at a distance of
1–2  mm from the sinus floor. Bone cylinder is then pushed
apically to a depth of 1 mm less than the one made with the
bur, using an osteotome of the same diameter as the trephine
bur. The final preparation of the implant site is carried out using
osteotomes of increasing diameters, always inserting them to
the same depth. The implants are inserted at a speed of 30 rpm,
causing controlled lateral movement of the bone cylinder inside
the space created by the movement of the sinus membrane.[30]
Antral membrane balloon elevation procedure was given by
Soltan et al. in 2012. This technique uses inflatable balloon to
elevate the sinus membrane. The Zimmer sinus lift balloon
was designed to lift the sinus membrane gently and evenly.
This technique has been shown to reduce the chance of sinus
membrane perforation.[31,32] There is a metal shaft with a tip
connected to a latex balloon which has the inflation capacity
of approximately 5 cm.[3] For lateral window approach, angled
design of balloon and for a crestal approach, the straight
design balloon is used. There is popular micro‑mini design
also available which can be used for either of the approaches.
Before the balloon is inserted, the osteotomy is enlarged to
5 mm. Osteotome of 5 mm is used to break the sinus floor after
the addition of bone. The sleeve of the balloon is then inserted
1 mm beyond the sinus floor. The saline is injected slowly from
the syringe into the balloon so that the balloon would inflate
progressively. The desired elevation is determined by deflating
the balloon and the process is again repeated till the desired
sinus elevation. One cubic centimeter of saline is expected to
raise 6 mm of the membrane.[33]
Minimally invasive transalveolar sinus approach (MITSA)
elevation technique was given by Kher et  al. 2014. In this
procedure, calcium phosphosilicate putty is used for hydraulic
sinus membrane elevation.[34] Drilling is done 1 mm short of the
sinus floor and osteotomy completes till the last drill. Concave
3 mm osteotome is used to in‑fracture sinus floor. Novabone gun
cannula fits snugly in prepared osteotomy. The material gently
lifts membrane due to its consistency. Thereafter, implant is
placed. MITSA technique is minimally invasive as this technique
uses osteotome only once so is less traumatic to the patient.
Minimally invasive transcrestal‑guided sinus lift technique
was given by Pozzi and Moy.[35] This is a new procedure with
computer‑guided planning and a guided surgical approach
to elevate the maxillary sinus. The use of computer‑aided
design/computer‑aided manufacturing generated surgical
template in combination with expander‑condensing osteotomes,
make this surgical technique minimally invasive.
Postoperative instructions and care
Following postoperative instructions should be provided to
the patient with both verbal and written form:[36]
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Bathla, et al.: Maxillary sinus
1. On first night after surgery, head should be elevated on 2
or more pillows
2. Liquid diet for 2 days and then soft diet for 2 weeks
3. Some nasal bleeding may occur during first day
4. Medications – Amoxicillin with clavulanate potassium
625 mg BID for 10 days; ibuprofen 600 mg and acetaminophen
500 mg QID for 3 days; oxymetazoline nasal spray for
7 days; 1.2% chlorhexidine mouth 30 cc BID for 14 days
5. Avoid chewing from the surgical site, blowing the nose
for 2 weeks, smoking, balloon blowing, sucking liquid
with straw, flying in pressured aircraft or scuba diving,
carbonated drinks (minimum 3 days), heavy lifting of
weights, and playing musical instrument that require
blowing. Actions that create negative pressure (blowing
of nose or sucking through straw) must be avoided by the
patient during the first week after surgery. If the patient
does sneeze, he or she must keep the mouth open, so that
the pressure is not exerted within the sinus
6. Swelling – some bruising, facial swelling expected
underneath the eye. Apply ice packs over the face; 10 min
on and 10 min off.
COMPLICATIONS AND ITS MANAGEMENT
Sinus membrane perforation is the most common intraoperative
complication, which occurs in 7%–35% of sinus augmentation
procedures.[37] Factors that affect sinus membrane perforation
during osteotomy include vigorous instrumentation during
elevation and thickness of the sinus membrane. Sinus membrane
perforation increases rates of postoperative sinusitis and graft
failure. Vlassis and Fugazzotto proposed a classification system
for elevation and treatment.[38] If a membrane is perforated
when creating the lateral window outline, the osteotomy is
extended several millimeters beyond the original window to
reestablish contact with the intact membrane.[39,40] If membrane
perforation occurs during the lifting of sinus membrane and
is a small defect of <2 mm it can be left to heal itself but if the
perforation is more than 2 mm, the opening can be patched
with a piece of hydrated resorbable collagen barrier that’s large
enough to cover the tear by several millimetres.
Bleeding can occur while performing an osteotomy. Bleeding
from the sinus membrane can be controlled by placing gauze
soaked with anesthetic solution containing 1:80,000 epinephrine
directly onto the membrane. Bleeding from the bone requires
application of direct pressure with an artery forceps, or it can
be managed with a cautery unit. Another method for containing
an intraosseous arterial bleeder is to displace the membrane and
compress the bone with a mosquito hemostat, thereby crushing
the bone and obstructing the bleeding blood vessel.[41,42]
Dislodgement of implant into sinus can occur several days
postimplantation, at abutment connection surgery, or
years later. This may be due to positioning of implant in an
unnecessary apical position or excessive pressure during
placement or widening of the ridge due to overdrilling.
Thus, careful treatment planning, patient selection, and the
appropriate sinus augmentation technique are essential to
minimize the risk of implant displacement into the maxillary
sinus. Once the displacement is diagnosed and located in
computed tomography scan/orthopantomogram, the implant
must be removed as soon as possible.[43]
472 Journal of Indian Society of Periodontology - Volume 22, Issue 6, November-December 2018
Other complications are related to the presence of preexisting
antral pathologies, such as rhinosinusitis, odontogenic sinus
diseases, pseudocysts, retention cysts, and mucoceles.[43]
CONCLUSION
Pneumatization of the maxillary sinus secondary to posterior
maxillary tooth loss prevents implant placement in this
region. Maxillary sinus elevation and augmentation provides
predictable outcome of regenerating lost osseous structure in
the posterior maxilla. This offers the patient many advantages
for long‑term success at implant sites.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
1. Tatum H Jr. Maxillary and sinus implant reconstructions. Dent
Clin North Am 1986;30:207‑29.
2. Boyne PJ, James RA. Grafting of the maxillary sinus floor with
autogenous marrow and bone. J Oral Surg 1980;38:613‑6.
3. Smiler DG. The sinus lift graft: Basic technique and variations.
Pract Periodontics Aesthet Dent 1997;9:885‑93.
4. Wallace SS, Tarnow DP, Froum SJ, Cho SC, Zadeh HH, Stoupel J,
et  al. Maxillary sinus elevation by lateral window approach:
Evolution of technology and technique. J Evid Based Dent Pract
2012;12:161‑71.
5. Mazor Z, Horowitz RA, Del Corso M, Prasad HS, Rohrer MD,
Dohan Ehrenfest DM, et  al. Sinus floor augmentation with
simultaneous implant placement using Choukroun’s platelet‑rich
fibrin as the sole grafting material: A radiologic and histologic
study at 6 months. J Periodontol 2009;80:2056‑64.
6. Thor A, Sennerby L, Hirsch JM, Rasmusson L. Bone formation at
the maxillary sinus floor following simultaneous elevation of the
mucosal lining and implant installation without graft material:
An evaluation of 20 patients treated with 44 Astra tech implants.
J Oral Maxillofac Surg 2007;65:64‑72.
7. Hatano N, Sennerby L, Lundgren S. Maxillary sinus augmentation
using sinus membrane elevation and peripheral venous blood for
implant‑supported rehabilitation of the atrophic posterior maxilla:
Case series. Clin Implant Dent Relat Res 2007;9:150‑5.
8. van den Bergh JP, ten Bruggenkate CM, Disch FJ, Tuinzing DB.
Anatomical aspects of sinus floor elevations. Clin Oral Implants
Res 2000;11:256‑65.
9. Underwood AS. An inquiry into the anatomy and pathology of
the maxillary sinus. J Anat Physiol 1910;44:354‑69.
10. Krennmair G, Ulm CW, Lugmayr H, Solar P. The incidence,
location, and height of maxillary sinus septa in the edentulous
and dentate maxilla. J Oral Maxillofac Surg 1999;57:667‑71.
11. Ulm CW, Solar P, Krennmair G, Matejka M, Watzek G. Incidence
and suggested surgical management of septa in sinus‑lift
procedures. Int J Oral Maxillofac Implants 1995;10:462‑5.
12. Kim MJ, Jung UW, Kim CS, Kim KD, Choi SH, Kim CK,
et  al. Maxillary sinus septa: Prevalence, height, location, and
morphology. A reformatted computed tomography scan analysis.
J Periodontol 2006;77:903‑8.
13. Kaufman E. Maxillary sinus elevation surgery: An overview.
J Esthet Restor Dent 2003;15:272‑82.
14. Woo I, Le BT. Maxillary sinus floor elevation: Review of anatomy
and two techniques. Implant Dent 2004;13:28‑32.
15. Cho SC, Wallace SS, Froum SJ, Tarnow DP. Influence of anatomy
[Downloaded free from http://www.jisponline.com on Wednesday, May 6, 2020, IP: 125.161.176.66]
Bathla, et al.: Maxillary sinus
on Schneiderian membrane perforations during sinus elevation
surgery: Three‑dimensional analysis. Pract Proced Aesthet Dent
2001;13:160‑3.
16. Fry RR, Patidar DC, Goyal S, Malhotra A. Proximity of maxillary
posterior teeth roots to maxillary sinus and adjacent structures
using denta scan®. Indian J Dent 2016;7:126‑30.
17. Eberhardt JA, Torabinejad M, Christiansen EL. A computed
tomographic study of the distances between the maxillary sinus
floor and the apices of the maxillary posterior teeth. Oral Surg
Oral Med Oral Pathol 1992;73:345‑6.
18. Solar P, Geyerhofer U, Traxler H, Windisch A, Ulm C, Watzek G,
et al. Blood supply to the maxillary sinus relevant to sinus floor
elevation procedures. Clin Oral Implants Res 1999;10:34‑44.
19. Elian N, Wallace S, Cho SC, Jalbout ZN, Froum S. Distribution of
the maxillary artery as it relates to sinus floor augmentation. Int
J Oral Maxillofac Implants 2005;20:784‑7.
20. Harris D, Horner K, Gröndahl K, Jacobs R, Helmrot E, Benic GI,
et  al. E.A.O. Guidelines for the use of diagnostic imaging in
implant dentistry 2011. A consensus workshop organized by
the European Association for Osseointegration at the Medical
University of Warsaw. Clin Oral Implants Res 2012;23:1243‑53.
21. Temmerman A, Hertelé S, Teughels W, Dekeyser C, Jacobs R,
Quirynen M, et  al. Are panoramic images reliable in planning
sinus augmentation procedures? Clin Oral Implants Res
2011;22:189‑94.
22. Janner SF, Caversaccio MD, Dubach P, Sendi P, Buser D,
Bornstein MM, et  al. Characteristics and dimensions of the
Schneiderian membrane: A radiographic analysis using cone
beam computed tomography in patients referred for dental
implant surgery in the posterior maxilla. Clin Oral Implants Res
2011;22:1446‑53.
23. Testori T, Wallace SS. Surgical procedures: Lateral window
approach. In: Testori T, Del Fabbro M, Weinstein R, Wallace SS,
editors. Maxillary Sinus Surgery and Alternatives in Treatment.
1st ed. London: Quintessence; 2009. p. 191‑215.
24. Gupta KK, Bathla S. Advanced implant surgery. In: Bathla S,
editor. Textbook of Periodontics. 1st ed. New Delhi: Jaypee
Brothers Medical Publishers; 2017. p. 636-46.
25. 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. Int J Periodontics Restorative Dent 2001;21:561‑7.
26. Torrella F, Pitarch J, Cabanes G, Anitua E. Ultrasonic ostectomy
for the surgical approach of the maxillary sinus: A technical note.
Int J Oral Maxillofac Implants 1998;13:697‑700.
27. Wallace SS, Mazor Z, Froum SJ, Cho SC, Tarnow DP. Schneiderian
membrane perforation rate during sinus elevation using
piezosurgery: Clinical results of 100 consecutive cases. Int J
Periodontics Restorative Dent 2007;27:413‑9.
Journal of Indian Society of Periodontology - Volume 22, Issue 6, November-December 2018 473
28. Emmerich  D, Att  W, Stappert  C. Sinus floor elevation using
osteotomes: A systematic review and meta‑analysis. J Periodontol
2005;76:1237‑51.
29. Summers RB. Sinus floor elevation with osteotomes. J Esthet Dent
1998;10:164‑71.
30. Fugazzotto PA, De Paoli S. Sinus floor augmentation on at the
time of maxillary molar extraction: Success and failure rates of 137
implants in function for up to 3 years. J Periodontol 2002;73:39‑44.
31. Soltan M, Smiler D, Ghostine M, Prasad HS, Rohrer MD. Antral
membrane elevation using a post graft: A crestal approach. Gen
Dent 2012;60:e86‑94.
32. Soltan M, Smiler DG. Antral membrane balloon elevation. J Oral
Implantol 2005;31:85‑90.
33. Hu X, Lin Y, Metzmacher AR, Zhang Y. Sinus membrane lift using
a water balloon followed by bone grafting and implant placement:
A 28‑case report. Int J Prosthodont 2009;22:243‑7.
34. Kher U, Ioannou AL, Kumar T, Siormpas K, Mitsias ME, Mazor Z,
et al. A clinical and radiographic case series of implants placed
with the simplified minimally invasive antral membrane elevation
technique in the posterior maxilla. J Craniomaxillofac Surg
2014;42:1942‑7.
35. Pozzi A, Moy PK. Minimally invasive transcrestal guided sinus
lift (TGSL): A clinical prospective proof‑of‑concept cohort study
up to 52 months. Clin Implant Dent Relat Res 2014;16:582‑93.
36. Stern A, Green J. Sinus lift procedures: An overview of current
techniques. Dent Clin North Am 2012;56:219‑33.
37. Barone A, Santini S, Sbordone L, Crespi R, Covani U. A clinical
study of the outcomes and complications associated with
maxillary sinus augmentation. Int J Oral Maxillofac Implants
2006;21:81‑5.
38. Vlassis  JM, Fugazzotto  PA. A  classification system for sinus
membrane perforations during augmentation procedures with
options for repair. J Periodontol 1999;70:692‑9.
39. Pikos MA. Maxillary sinus membrane repair: Update on technique
for large and complete perforations. Implant Dent 2008;17:24‑31.
40. Proussaefs P, Lozada J. The “Loma Linda pouch”: A technique
for repairing the perforated sinus membrane. Int J Periodontics
Restorative Dent 2003;23:593‑7.
41. Regev E, Smith RA, Perrott DH, Pogrel MA. Maxillary sinus
complications related to endosseous implants. Int J Oral
Maxillofac Implants 1995;10:451‑61.
42. Ziccardi VB, Betts NJ. Complications of maxillary sinus
augmentation. In: Jensen TO, editor. The Sinus Bone Graft.
Chicago: Quintessence Publication Co.; 1999. p. 201‑8.
43. Chan HL, Wang HL. Sinus pathology and anatomy in relation
to complications in lateral window sinus augmentation. Implant
Dent 2011;20:406‑12.