Maxillary Sinus Surgery and Alternatives in Treatment.
Testori T, Del Fabbro M, Weinstein R, et al, ed. 378 pp., illustrated. Quintessence Publishing; 2009. ISBN: 9781850971702.
This text is authored by a prestigious group of clinicians and researchers on the topic of maxillary reconstruction for dental implant treatment. The 378 pages include numerous photographs, drawings, and radiographs. In addition to the 4 primary authors, there are 26 contributing authors, mostly European. The surgical procedures are presented in detail with research from clinical studies to support their use.
Chapter 1 is an introduction to the topic and provides a history of managing the posterior maxilla with endosteal implants. Chapter 2 discusses the anatomy of the maxillary sinus including the membrane, dimensions, and changes with tooth loss and bone resorption, bony septa, and neurovascular supply. There are cadaver specimens, clinical photographs, and radiographs that nicely depict the anatomical review. Chapter 3 focuses on otorhinolaryngologic contraindications to sinus grafting. Dr. Mantovani discusses the applied anatomy in a very clinically relevant perspective. It emphasizes the need for collaboration with specialists including oral maxillofacial surgeons, otolaryngologists, pulmonologists, and internists. Chapter 4 provides a unique review of sinus endoscopy use in sinus augmentation and endoscopic surgery for treating sinus pathology. The use of endoscopic procedures to manage sinus disease is a significant advancement over open surgical techniques used in the past.
In Chapter 5, Drs. Trisi and Massei review the biology of bone graft healing specific to the sinus floor as well as the developing bone-implant interface. The biomechanical response to loading implants in grafted bone is also covered. There are several figures of histologic specimens that document the events of bone graft healing. Chapter 6 is a short summary of using imaging techniques such as computed tomography (CT) and magnetic resonance for diagnosis and planning. Considering the common use of cone beam CT scans and treatment planning software, it is surprising that these topics were not discussed in more detail. Chapter 7 proposes a new classification for maxillary atrophy and addresses reconstructive surgical options. The classification system divides the maxilla into anterior and posterior regions. The posterior category for sinus hyperpneumatization does not designate the amount of vertical bone below the sinus floor. The residual ridge categories are basic as well (horizontal deficiency, vertical deficiency, and combined). The classification allows the authors to present plans for management of the various conditions but is not useful for broader applications such as research. Sinus augmentation with autogenous bone is presented as the ideal treatment for sinus pneumatization. Autogenous block bone grafting is the predominant technique proposed for treating ridge deficiencies.
Chapter 8 discussed the use of midazolam for conscious sedation. This chapter could have been eliminated without detracting from the text. In Chapter 9, Dr. Wallace describes the clinical indications for different types of graft materials. He uses evidence-based reviews to analyze the data on graft materials including autogenous bone, allografts, and xenografts. The efficacy of xenografts for sinus bone grafting is described in detail. Platelet concentrate, recombinant platelet-derived growth factor, and rhBMP-2 are also discussed. Chapters 10 and 11 review sinus grafting with bone substitutes. Chapter 12 covers the lateral window approach to sinus grafting. It nicely describes the steps of the technique and is well documented with clinical photographs. Complications, including sinus membrane perforation, are also discussed. Chapter 13 presents alternatives to sinus grafting including short implants, tilted implants, and cantilevers.
Dr. Vercellotti describes the use of piezoelectric surgery for sinus bone grafting in Chapter 14. Chapter 15 discusses maxillary sinus augmentation through the ridge crest. The various techniques are described and the literature on this approach is reviewed. Chapters 16 and 17 review techniques for the harvest of autogenous bone from intraoral and extraoral sites. A discussion of platelet-rich plasma (PRP) in sinus bone grafting is covered in Chapter 18. The authors present research on PRP and thoroughly review the literature on this topic. They conclude there is no significant improvement in routine sinus graft healing with PRP, but it may provide benefits in compromised sites.
Chapter 19 discusses intraoperative, postoperative, and late complications of sinus bone grafting. Chapter 20 provides a systematic review of the literature on maxillary sinus augmentation. This scientific approach to researching bone graft materials and techniques provides clinicians with well-documented conclusions. Chapter 21 discusses future developments and the need for research to improve outcomes. Chapter 22 covers the use of 3-dimensional imaging and virtual planning. The appendix has data collection forms. The informed consent form lacks detail and is not recommended for private practice use.
The clinical photography is excellent and illustrates the techniques very well. The figures and corresponding legends are somewhat difficult to follow, although there is a diagram to explain the layout on each page. Rather than having been placed under each figure, the legends are grouped together in all capital text with white lettering on a dark blue background.
Whenever there are many authors, there are bound to be inconsistencies or conflicting views in a text. In Chapters 5 and 7, the authors refer to autogenous bone as “the gold standard” for bone grafting. However, Chapters 8 and 20 imply that some bone substitutes, such as xenografts, may provide just as positive, if not better, results.
Dr. Dennis Tarnow wrote the foreword stating, “This publication thus manages to combine the goals of a student textbook with a valid tool for the development of professional clinical experts.” I agree that Maxillary Sinus Surgery and Alternatives in Treatment would be a welcomed addition to the library of both graduate students and seasoned clinicians who perform dental implant therapy.
Craig M. Misch, DDS, MDS
Council/Section Editor, Implant Dentistry