Abstract
Bone augmentation of the maxillary sinus is commonly required due to resorption of the alveolar crest before implant treatment for maxillary molar defects. Maxillary sinus floor elevation performed using a lateral window technique sometimes necessitates the creation of a bone window in the anterior wall of the maxillary sinus, although care is required with regard to the blood vessels present in the anterior wall to create the bone window safely.
We developed a method that allows observation of blood vessels that are located within the area where the bony window will be created. In this paper, we summarize a case managed using this method and details of the surgery. We created a diagnostic stent for use during preoperative planning, and used simulation software to plan the implant insertion. When we confirmed the position of the bone window, we observed blood vessels running along the anterior wall and floor of the maxillary sinus. In order to confirm the position of the blood vessels, we created a bone model of the maxilla using a 3D printer, and simulated the creation of the bone window on the model. Maxillary sinus floor elevation was then performed based on the preoperative planning. There were no complications, such as abnormal hemorrhage, during or after surgery, and the clinical course was favorable. We did not observe marked bone resorption around the implant two years after we mounted the final superstructure, and plaque was well controlled.
We encountered a case in which blood vessels ran through the area where the bone window would be located in the anterior wall during maxillary sinus floor elevation using a lateral window technique. By performing a preoperative simulation using a bone model created with a 3D printer as part of preoperative planning and using computed tomography (CT) as a form of diagnostic imaging, we were able to detect the position of the blood vessels in advance. This enabled us to gain a comprehensive understanding of the position of the blood vessels, which enabled us to minimize blood vessel injury intraoperatively.
