Sinus Floor Elevation Using the Lateral Approach and Bone Window Repositioning I: Clinical and Radiographic Results in 102 Consecutively Treated Patients Followed from 1 to 5 Years

Purpose: To determine the potential complications and clinical outcomes using the lateral sinus elevation technique with window repositioning. Materials and Methods: One hundred nine sinus elevations were performed on 102 consecutively treated patients. Following lateral window outward fracturing, sinus mucosa was elevated, and the sinus was grafted with anorganic bovine bone. Two hundred five implants were placed: 160 concomitantly with grafting, and 45 six months after grafting. Seventeen implants replaced single missing molars. One hundred eighty-eight implants replaced multiple missing posterior teeth. The bone window was repositioned over the osteotomy site and the flap sutured. Implants were connected at 6 months and followed up from 12 to 60 months (mean: 29.8 months). In 30 cases, biopsy specimens were harvested from the lateral wall of the sinus for histomorphometric analysis. The Fisher exact test and Kruskal-Wallis test followed by the Mann-Whitney test were used for statistical analysis. Results: No clinically significant complications were encountered in using this technique (mucosa tear, intraoperative bleeding, window sequestration). In three cases, the window was separated in two before outfracturing. In 20 cases, it was stabilized with a collagen fleece. Limited sinus mucosa tears occurred in 14 cases during elevation. They were patched with a collagen membrane, and 18 implants were placed in these cases. All of the latter cases osseointegrated at abutment connection with no statistically significant difference in the outcome compared with implants placed with no tear of the membrane (P .05). The reconstruction of the lateral wall was confirmed in all cases. No significant differences in outcomes were found between the immediately and delayed placed implants (P .05). One implant failed in the immediately placed group due to a sinus infection. All other implants were loaded and remained in function during the observation period. Conclusion: Lateral sinus elevation with window repositioning is safe and effective with minimal risks, such as mucosal tear, intraoperative bleeding, or window sequestration. The repositioned window can serve as an alternative for collagen membrane in containing the graft. Graft maturation, percent of vital bone formation, and the potential of the window to serve as a source of osteogenic cells need to be confirmed histomorphometrically. This will be reported in a subsequent article. Keywords: lateral approach, posterior maxilla, sinus floor elevation, window repositioning