Treatment of maxillary sinusitis of odontogenic origin

Rezumat. Studiul nostru reprezintă unul retrospectiv efectuat pe un lot de 27 pacienţi la care s-a stabilit diagnoza sinuzita maxilară de origine odontogenă. Pacienţii au fost divizaţi în 3 loturi: lotul I — a fost constituit din 21 de pacienţi cu sinuzita maxilară de origine odontogenă, la care ca tratament am efectuat numai extracţia dintelui cauzal. Lotul II — a fost alcătuit din 4 pacienţi la care s-a aplicat tratamentul funcţional endoscopic, înlăturarea dintelui cauzal și tratamentul medicamentos. Lotul III — din 2 pacienţi, la care s-a efectuat cura radicală și înlăturarea dintelui cauzal. Rezultate: Din 21 de pacienţi din lotul I, la 18 pacienţi numai extracţia dintelui cauzal a fost suficientă pentru a rezolva sinuzita (rata de succes 85%.) și nici o intervenţie adaugătoare asupra sinusului nu a fost necesară. Rata de succes în lotul II și III de pacienţi a constituit 100%. Concluzie: Tratamentul sursei odontogene de infecţie în majoritatea cazurilor va fi suficient pentru tratamentul sinuzitei și cura radicală a sinusului maxilar sau tratamentul funcţional endoscopic nu este obligator în managementul sinuzitei odontogene.Summary. A retrospective study was performed, which included 27 patients with the diagnosis of CMSDO. Extraction of the causative tooth was performed in all patients, the result of the treatment being followed up. Functional endoscopic sinus surgery or radical cure was performed in patients with ineffective treatment. Patients were divided into 3 groups: The first group included 21 patients — only extraction of the odontogenic source, the second group (4 patients) was performed the combination of tooth extraction and FESS, in the third group (2 patients) b– extraction and radical cure of the sinus. Results: In the first group the success rate was 85 %, complete treatment of sinusitis being achieved in 18 patients; in the second and third groups the success rate constituted 100%. Conclusion: Treatment of odontogenic source in most cases is sufficient for sinusitis treatment and FESS or radical cure of the sinus are not mandatory

Lateral sinus floor elevation with simultaneous mucosal cysts management

Introduction. Specialists in the field often face uncertainty in deciding whether to perform sinus lifting surgery in the presence of a mucosal cyst during the pre-implantation preparation of patients with maxillary sinus pathology. While some specialists believe that the sinus lifting operation cannot be performed in the presence of sinus pathology and should be resorted to after a long period of healing, others believe that it can be performed in the presence of sinus pathology or simultaneously with sinus sanitation. As a result, there are more controversies about the treatment tactics, stages, and timing required to achieve the rehabilitation of these patients, demonstrating the significance of the problem at hand. Materials and methods. The study included twenty patients who were referred to the Department of OMF Surgery and Oral Implantology “Arsenie Guţan” and the dental clinic “OmniDent” between 20.06.2016 and 01.01.2019 for implant-prosthetic rehabilitation due to partial edentulism in the upper jaw in the lateral area and the presence of a mucosal cyst in the maxillary sinus. The first group comprised of seven patients in whom the mucosal cyst was completely removed while simultaneously undergoing lateral sinus lifting. The second group consisted of five patients, aged between 18 and 67 years (average 45 years), who underwent marsupialization of the mucosal cyst. The third group comprised of six patients in whom the cyst content was only aspirated, without removal or marsupialization of the cyst. Results. All three methods were found to be effective, although total perforations of the sinus mucosa were recorded in the first two groups, preventing the performance of sinus lifting at that stage. The method of aspirating the cystic content, however, is a simple and low-risk procedure that does not carry the risk of perforating the sinus membrane and provides predictable results. Conclusions. The mucosal cyst does not present a contraindication to sinus lifting but requires additional surgical procedures

Effectiveness of causative tooth extraction in maxillary sinusitis of dental origin

Department of Oral and Maxillofacial Surgery and Oral Implantology Arsenie Gutan, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaIntroduction. Odontogenic maxillary sinusitis (OMS) is an inflammatory disease caused by the spread of dental inflammation into the sinus. The rate of OMS was reported to be 25-40%. A lot of methods of treatment were proposed starting with medicine administration only, till radical sinusotomy. The question is what is the efficacy of the initial treatment, the one that includes the treatment of causal tooth only. Aim of the study. The purpose of this study was to identify the factors of significance that may contribute to the results of the initial treatment of OMS. Materials and methods. Twenty four patients were studied, which were divided in 2 groups, depending on the result of the treatment: effective and non-effective. Efficacy of the treatment was evaluated 3 months after causative tooth treatment with CT scan, which was compared with initial one. First group included 21 patients and the second one 3 persons, that required surgical treatment. Conclusions. 1. Causal tooth treatment of OMS is an effective and miniinvasive method. 2. Maxillary ostium obstruction is an important factor to predict outcome of the treatmen

Minimally invasive surgical method of oroantral communication closure

Rezumat. Comunicarea oro-sinusală reprezintă o soluţie de continuitate între cavitatea bucală şi sinusul maxilar. Cea mai frecventă cauză a comunicarii orosinusale este extracţia dinţilor laterali la maxilarul superior. Metodele de închidere a comunicării oro-sinusale sunt multiple. În studiul actual au fost comparate metodele tradiţionale prin crearea lambourilor mucoperiostale cu o metoda miniinvazivă prin utilizarea materialului sintetic „Kolapol KP 3LM“. În studiul au fost incluşi 34 pacienţi. Pentru analiza comparativă a metodelor în grupurile studiate am analizat 5 criterii: prezenţa edemului ţesuturilor moi, modificarea laţimii gingiei cheratinizate, modificarea inalţimii vestibulului oral, necesitatea operatiilor repetate, prezenţa sau lipsa recidivei postoperatorii, inalţimea osului subantral si posibilitatea implantării la acest nivel dupa perioada de vindecare. Metoda de plastie cu materialul „Kollapol KP3 LM“ a dovedit eficienţa sa si traumatism minimal.Summary. Oroantral communications are communications between oral cavity and maxillary sinus. The most common cause of oroantral communications is upper first molar extraction. There are a lot of methods of oroantral closure. In this study we compared the method of oro-antral communication closure using vestibular flap versus mini-invasive method using grafting of tooth socket using „Collapol KP3“ (collagen with hydroxyapatite). In study were included 34 patients. To compare 2 groups we used 5 criteria: presence or absence of edema of soft tissues, modification of the width of vestibular keratinized gingiva, modification of the length of the vestibulum of the mouth, the necessity of the repeated operations, the recurrence of OA C, the length of the remaining alveolar bone and possibility of implant placement. The method of OA C closure using osteoconductive material „Collapol KP3“ proved to be effective and minimally traumatic

Surgical aspects of implantprosthetic rehabilitation using Knifethread®, nanostructured implants, with surface in-built calc

Rezumat În cadrul studiului retro- şi prospectiv au fost incluşi 165 pacienţi (58 bărbaţi şi 107 femei), cu vârsta cuprinsă între 19 şi 74 ani (vârsta medie - 42,46 ani; ES±0,88 ani; DS 11,42), care s-au adresat în Clinica Stomatologică SRL “Omni Dent” (Chişinău, Republica Moldova), în perioada aprilie 2016 – decembrie 2017, pentru reabilitare implanto-protetică. Au fost inserate 443 implante dentare endoosoase AnyRidge (Megagen, Gyeongsang, Korea), dintre care s-au studiat 235 implante, după perioada de osteointegrare, care a constituit 7,07 luni. S-a evaluat eficacitatea utilizării acestui tip de implante în funcţie de: timpii de reabilitare, varietatea situaţiilor clinice, oferta osoasă calitativă/cantitativă şi rezultatele obţinute în dinamică.Summary In this retro and prospective study were included 165 patients (58 men and 107 women), with ages between 19 and 74 years (average age - 42,46 years; ES±0,88 years; DS 11,42), patients who addressed for treatment in SRL “Omni Dent” Dental Clinic (Chisinau, Republic of Moldova) during April 2016 – December 2017. There were placed 443 AnyRidge (Megagen, Gyeongsang, Korea) implants. From this total number, by the end of the osteointegration period, which had an average of 7,07 months, 235 implants were studied. We studied the efficiency of this implant system according to: treatment stages, the variability of clinical indications, bone disponibility and the clinical results over time

Maxillary sinus pathology treatment in implant-prosthetic rehabilitation: Summary of the Doctoral Thesis in Medical Sciences: 323.01 – Stomatology

Actuality and importance of the studied problem Prosthetic rehabilitation has become a method of choice in treating patients without teeth (edentulous patients). Following tooth extraction, there is a progressive atrophy of the alveolar process, and often, specialists face a deficiency in bone support. In the lateral areas of the upper jaw, besides the atrophy of the alveolar process at the crown, there is also pneumatization of the maxillary sinus with resorption of the alveolar crest at the apical part. The most commonly used method for bone augmentation in the lateral areas of the upper jaw is the sinus lift (SL) procedure, which has proven its high efficiency and predictability over time. However, one of the primary conditions for performing SL is that the maxillary sinus (SM) must be intact. At the same time, there needs to be more data in the specialized literature regarding the criteria and boundaries for assessing the functional state of the maxillary sinus. It is well-established that the primary reason for postoperative complications of SL is the pathological state of the maxillary sinus before the operation [6, 7]. Sinus mucosal thickening is found in 23.7%-28.2% of patients, mucosal cysts in 8.9%-19.4%, and acute sinusitis in 3.6%- 6.5% of patients seeking implant-prosthetic rehabilitation [8, 9]. Beaumont (2005) reported that 40% of patients seeking SL have pathology of the maxillary sinus [5]. Analyzing the functional state of the maxillary sinus, the thickness of the Schneiderian mucosa, and the permeability of the natural ostium play a vital role in determining the indications and contraindications for SL. The issues and questions highlighted above, as well as many others encountered in our routine practice and by other specialists in the field, have motivated us to initiate this study. The purpose of the Study To evaluate the optimal treatment methods for maxillary sinus conditions in pre-implant preparation and to develop recommendations for the insertion of endosseous dental implants involving the operated maxillary sinus. Research Objectives Develop a methodology for clinical and paraclinical examination of patients indicated for the sinus lift procedure. Study the advantages and disadvantages of existing surgical techniques for pre-implant preparation in patients with maxillary sinus conditions. Evaluate the role of the osteomeatal complex in surgical treatment planning. Assess the role of anatomical deviations of the endonasal structures in the treatment of sinusitis and the planning of the sinus lift. Develop a method to clean the maxillary sinus in combination with a sinus lift in a single surgical stage through an intraoral approach. Scientific research methodology A controlled clinical study was conducted with randomized patient selection, comprising a total of 128 participants. The research subjects were divided into two groups. The study group included 65 patients undergoing sinus lifting with the presence of maxillary sinus pathology, where functional endoscopic sinus surgery clearance was performed, followed by implant- prosthetic rehabilitation. The control group consisted of 63 patients who underwent surgical treatment following modified Caldwell-Luc procedure, with subsequent implant-prosthetic rehabilitation. 5 The study groups were compared based on the following outcome criteria: Lund-Kennedy scale assessment; OMU (osteomiatal unit) status assessment; Sinus mucosa thickness assessment; Persistence of postoperative pain (days); Duration of the surgical intervention (minutes); Healing duration (months); Presence/absence of anterior maxillary sinus wall defect. Approval for the thesis topic was obtained during the Scientific Council meeting of the "Nicolae Testemițanu" State University of Medicine and Pharmacy (USMF), number 6, dated November 1, 2016. Positive feedback from the Research Ethics Committee for the study was obtained during the session on June 17, 2016. Scientific Novelty and Originality A step-by-step methodology for diagnostic rhinoscopy of sinus lifting candidates was developed. A step-by-step algorithm for CBCT examination of sinus lifting candidates was created. It was demonstrated for the first time that OMU blockage in maxillary sinusitis is usually secondary and occurs due to increased swelling of the sinus membrane. It was proven that anatomical deviations of endonasal structures are important factors but not determinants in the pathogenesis of sinusitis. The first endooral osteoplastic access to the maxillary sinus was developed. A novel method for treating fungal sinusitis in combination with sinus lifting through endooral access was proposed. Guidelines for the treatment of sinus lifting candidates with maxillary sinus conditions were developed. Implementation of Scientific Results The study results are applied in clinical practice and in the teaching process at the Department of Oro-Maxillofacial Surgery and Oral Implantology "A. Guțan" of USMF "Nicolae Testemițanu". Implementation details are provided in the Annex. Approval of Scientific Results: The results were presented in 27 active participations at national and international scientific forums, including various conferences and congresses. Thesis Publications: The main thesis materials were published in 2 articles with Impact Factor, 4 articles in category B journals, 3 articles in category C journals, 3 abstracts in international scientific conference proceedings, 1 single-author publication, and 2 innovation certificates. Thesis Volume and Structure: The thesis text consists of 136 pages of processed computer-based content, including a list of abbreviations, introduction, 4 chapters, general conclusions, practical recommendations, bibliography with 219 sources, and 2 annexes. The illustrative material includes 16 tables, 50 figures, and 2 formulas

Tratamentul afecțiunilor sinusului maxilar în pregătirea preimplantară: Rezumatul tezei de doctor în științe medicale: 323.01 – Stomatologie

INTRODUCERE. Reabilitarea implanto-protetică a devenit o metodă de elecție în reabilitarea pacienților edentați. După extracția dinților are loc atrofia progresivă a procesului alveolar și, deseori, specialiștii în domeniu se confruntă cu deficitul suportului osos. În zonele laterale ale maxilarului superior, în afară de atrofia procesului alveolar în partea coronară, paralel are loc și pneumatizarea sinusului maxilar cu resorbția crestei alveolare în partea apicală. Metoda cel mai des utilizată de augmentare osoasă în zonele laterale ale maxilarului superior este intervenția de sinuslifting (SL), care și-a dovedit eficiența sa înaltă și predictibilitatea în timp. Dar una din condițiile principale ale efectuării SL este că sinusul maxilar (SM) trebuie să fie intact. În același timp, sunt foarte puține date în literatura de specialitate referitor la limitele și criteriile de apreciere a stării funcționale a sinusului maxilar. Este bine știut faptul că motivul principal al complicațiilor postoperatorii a SL este starea patologică a sinusului maxilar preoperator [6, 7]. Îngroșarea mucoasei sinuzale se apreciază în 23,7%-28,2%, chist mucozal – în 8,9-19,4% și sinuzita acută- în 3,6-6,5% din pacienții adresați pentru reabilitarea implanto-protetică [8, 9]. Beaumont (2005) a raportat că 40% dintre pacienții care se adresează pentru SL au patologia sinusului maxilar [5]. Analiza stării funcționale a sinusului maxilar, grosimii mucoasei Schneideriene și permeabilității ostiumului natural are un rol crucial în stabilirea indicațiilor și contraindicațiilor către SL. Problemele și întrebările menționate anterior și multe altele, întâlnite în practica noastră de rutină și ale altor specialiști în domeniu, ne-au determinat la demararea prezentului studiu. Scopul lucrării: Evaluarea metodelor optime de tratament a afecțiunilor sinusului maxilar în pregătirea preimplantară și elaborarea recomandărilor către inserarea implantelor dentare endoosoase cu interesarea sinusului maxilar operat. Obiectivele cercetării 1. Elaborarea metodologiei de examinare clinică și paraclinică a pacientului cu indicații către operația de sinuslifting. 2. Studiul avantajelor și dezavantajelor tehnicilor chirurgicale existente pentru pregatirea preimplantară a pacienților cu afecțiuni ale sinusului maxilar. 3. Aprecierea rolului complexului ostiomeatal în planificarea tratamentului chirurgical la pacienți cu patologia sinusului maxilar. 4. Aprecierea rolului devierilor anatomice a structurilor endonazale în tratamentul sinuzitelor și în planificarea sinusliftingului la pacienți cu patologia sinusului maxilar. 5. Elaborarea metodei de asanare a sinusului maxilar în combinație cu sinuslifting într-o etapă chirurgicală prin acces endobucal

Tratamentul afecțiunilor sinusului maxilar în pregătirea preimplantară: Teză de doctor în științe medicale: 323.01 – Stomatologie

INTRODUCERE Reabilitarea implanto-protetică a devenit o metodă de elecție în reabilitarea pacienților edentați. După extracția dinților are loc atrofia progresivă a procesului alveolar și, deseori, specialiștii în domeniu se confruntă cu deficitul suportului osos. În zonele laterale ale maxilarului superior, în afară de atrofia procesului alveolar în partea coronară, paralel are loc și pneumatizarea sinusului maxilar cu resorbția crestei alveolare în partea apicală. Metoda cel mai des utilizată de augmentare osoasă în zonele laterale ale maxilarului superior este intervenția de sinuslifting (SL), care și-a dovedit eficiența sa înaltă și predictibilitatea în timp. Dar una din condițiile principale ale efectuării SL este că sinusul maxilar (SM) trebuie să fie intact. În același timp, sunt foarte puține date în literatura de specialitate referitor la limitele și criteriile de apreciere a stării funcționale a sinusului maxilar. Este bine știut faptul că motivul principal al complicațiilor postoperatorii a SL este starea patologică a sinusului maxilar preoperator [6, 7]. Îngroșarea mucoasei sinuzale se apreciază în 23,7%-28,2%, chist mucozal – în 8,9-19,4% și sinuzita acută- în 3,6-6,5% din pacienții adresați pentru reabilitarea implanto-protetică [8, 9]. Beaumont (2005) a raportat că 40% dintre pacienții care se adresează pentru SL au patologia sinusului maxilar [5]. Analiza stării funcționale a sinusului maxilar, grosimii mucoasei Schneideriene și permeabilității ostiumului natural are un rol crucial în stabilirea indicațiilor și contraindicațiilor către SL. Problemele și întrebările menționate anterior și multe altele, întâlnite în practica noastră de rutină și ale altor specialiști în domeniu, ne-au determinat la demararea prezentului studiu. Scopul lucrării: Evaluarea metodelor optime de tratament a afecțiunilor sinusului maxilar în pregătirea preimplantară și elaborarea recomandărilor către inserarea implantelor dentare endoosoase cu interesarea sinusului maxilar operat. Obiectivele cercetării 1. Elaborarea metodologiei de examinare clinică și paraclinică a pacientului cu indicații către operația de sinuslifting. 2. Studiul avantajelor și dezavantajelor tehnicilor chirurgicale existente pentru pregatirea preimplantară a pacienților cu afecțiuni ale sinusului maxilar. 3. Aprecierea rolului complexului ostiomeatal în planificarea tratamentului chirurgical la pacienți cu patologia sinusului maxilar. 4. Aprecierea rolului devierilor anatomice a structurilor endonazale în tratamentul sinuzitelor și în planificarea sinusliftingului la pacienți cu patologia sinusului maxilar. 5. Elaborarea metodei de asanare a sinusului maxilar în combinație cu sinuslifting într-o etapă chirurgicală prin acces endobucal.Actuality and importance of the studied problem Prosthetic rehabilitation has become a method of choice in treating patients without teeth (edentulous patients). Following tooth extraction, there is a progressive atrophy of the alveolar process, and often, specialists face a deficiency in bone support. In the lateral areas of the upper jaw, besides the atrophy of the alveolar process at the crown, there is also pneumatization of the maxillary sinus with resorption of the alveolar crest at the apical part. The most commonly used method for bone augmentation in the lateral areas of the upper jaw is the sinus lift (SL) procedure, which has proven its high efficiency and predictability over time. However, one of the primary conditions for performing SL is that the maxillary sinus (SM) must be intact. At the same time, there needs to be more data in the specialized literature regarding the criteria and boundaries for assessing the functional state of the maxillary sinus. It is well-established that the primary reason for postoperative complications of SL is the pathological state of the maxillary sinus before the operation [6, 7]. Sinus mucosal thickening is found in 23.7%-28.2% of patients, mucosal cysts in 8.9%-19.4%, and acute sinusitis in 3.6%- 6.5% of patients seeking implant-prosthetic rehabilitation [8, 9]. Beaumont (2005) reported that 40% of patients seeking SL have pathology of the maxillary sinus [5]. Analyzing the functional state of the maxillary sinus, the thickness of the Schneiderian mucosa, and the permeability of the natural ostium play a vital role in determining the indications and contraindications for SL. The issues and questions highlighted above, as well as many others encountered in our routine practice and by other specialists in the field, have motivated us to initiate this study. The purpose of the Study To evaluate the optimal treatment methods for maxillary sinus conditions in pre-implant preparation and to develop recommendations for the insertion of endosseous dental implants involving the operated maxillary sinus. Research Objectives Develop a methodology for clinical and paraclinical examination of patients indicated for the sinus lift procedure. Study the advantages and disadvantages of existing surgical techniques for pre-implant preparation in patients with maxillary sinus conditions. Evaluate the role of the osteomeatal complex in surgical treatment planning. Assess the role of anatomical deviations of the endonasal structures in the treatment of sinusitis and the planning of the sinus lift. Develop a method to clean the maxillary sinus in combination with a sinus lift in a single surgical stage through an intraoral approach. Scientific research methodology A controlled clinical study was conducted with randomized patient selection, comprising a total of 128 participants. The research subjects were divided into two groups. The study group included 65 patients undergoing sinus lifting with the presence of maxillary sinus pathology, where functional endoscopic sinus surgery clearance was performed, followed by implant- prosthetic rehabilitation. The control group consisted of 63 patients who underwent surgical treatment following modified Caldwell-Luc procedure, with subsequent implant-prosthetic rehabilitation. 5 The study groups were compared based on the following outcome criteria: Lund-Kennedy scale assessment; OMU (osteomiatal unit) status assessment; Sinus mucosa thickness assessment; Persistence of postoperative pain (days); Duration of the surgical intervention (minutes); Healing duration (months); Presence/absence of anterior maxillary sinus wall defect. Approval for the thesis topic was obtained during the Scientific Council meeting of the "Nicolae Testemițanu" State University of Medicine and Pharmacy (USMF), number 6, dated November 1, 2016. Positive feedback from the Research Ethics Committee for the study was obtained during the session on June 17, 2016. Scientific Novelty and Originality A step-by-step methodology for diagnostic rhinoscopy of sinus lifting candidates was developed. A step-by-step algorithm for CBCT examination of sinus lifting candidates was created. It was demonstrated for the first time that OMU blockage in maxillary sinusitis is usually secondary and occurs due to increased swelling of the sinus membrane. It was proven that anatomical deviations of endonasal structures are important factors but not determinants in the pathogenesis of sinusitis. The first endooral osteoplastic access to the maxillary sinus was developed. A novel method for treating fungal sinusitis in combination with sinus lifting through endooral access was proposed. Guidelines for the treatment of sinus lifting candidates with maxillary sinus conditions were developed. Implementation of Scientific Results The study results are applied in clinical practice and in the teaching process at the Department of Oro-Maxillofacial Surgery and Oral Implantology "A. Guțan" of USMF "Nicolae Testemițanu". Implementation details are provided in the Annex. Approval of Scientific Results: The results were presented in 27 active participations at national and international scientific forums, including various conferences and congresses. Thesis Publications: The main thesis materials were published in 2 articles with Impact Factor, 4 articles in category B journals, 3 articles in category C journals, 3 abstracts in international scientific conference proceedings, 1 single-author publication, and 2 innovation certificates. Thesis Volume and Structure: The thesis text consists of 136 pages of processed computer-based content, including a list of abbreviations, introduction, 4 chapters, general conclusions, practical recommendations, bibliography with 219 sources, and 2 annexes. The illustrative material includes 16 tables, 50 figures, and 2 formulas