Apsun Dental Hospital, Seoul, Korea.
Int J Oral Maxillofac Implants. 2012 Jan-Feb;27(1):211-7.
There has been considerable controversy about the placement of barrier membranes over osteotomy and graft sites in sinus bone grafts via the lateral window approach. Particularly when the sinus membrane remains intact, clinicians should consider the benefits and costs of a barrier membrane. This article presents clinical and radiologic findings following repositioning of a detached bony window without a barrier membrane in the lateral approach for maxillary sinus bone grafts.
After a complete 360-degree osteotomy on the lateral maxillary wall, a bony window was outfractured and separated from the sinus membrane by gentle elevation. After the sinus membrane was confirmed to be intact, grafting was carried out and the bony window was repositioned over the graft material without rigid fixation or a barrier membrane. Clinical and radiologic examinations were performed 6 months postoperative. The relationships between the patterns of gap bone healing, number of implants, time of implant placement (simultaneous with grafting or staged), and thickness of the lateral sinus wall were analyzed. The Fisher exact test and Spearman nonparametric correlation coefficient were employed for statistical evaluation.
All 23 included patients experienced no complications. Overall external cortical healing and bone regeneration in the gap between the repositioned window and the lateral wall of the sinus were satisfactory. No significant differences in the patterns of gap bone healing were found, with respect to the number of implants placed or time of implant placement. As the lateral sinus wall was thinner, gap bone healing was better. To date, no implants have failed.
A detached bony window that is repositioned on graft material might function as a barrier membrane in the lateral approach for maxillary sinus bone grafts.
经外侧入路行上颌窦骨增量术时，关于在骨切开和植骨部位放置屏障膜存在较大争议。特别是当窦膜完整时，临床医生应权衡屏障膜的利弊。本文报道了经外侧入路行上颌窦骨增量术时，不使用屏障膜重新定位游离骨窗的临床和影像学结果。
在外侧上颌骨壁行 360°完全截骨后，通过轻轻抬起将骨窗骨折并与窦膜分离。确认窦膜完整后，进行植骨，将骨窗重新定位在移植材料上，不进行刚性固定或使用屏障膜。术后 6 个月进行临床和影像学检查。分析了间隙骨愈合模式、种植体数量、种植体植入时间（同期或分期）以及外侧窦壁厚度之间的关系。采用 Fisher 确切检验和 Spearman 非参数相关系数进行统计学评估。
23 例患者均无并发症发生。所有患者的外侧皮质均愈合良好，窦侧壁与重新定位的骨窗之间的骨再生情况良好。在间隙骨愈合模式方面，无论种植体数量或植入时间如何，均无显著差异。外侧窦壁越薄，间隙骨愈合越好。到目前为止，没有种植体失败。
在上颌窦骨增量术的外侧入路中，重新定位在移植材料上的游离骨窗可能起到屏障膜的作用。
