PMC5005788_01
a Computed tomography (CT) was requested to plan the procedure. b Lyophilized particulate human bone administered into the right maxillary sinus. c Mineralized granular bovine bone was administered into the left maxillary sinus. d Two blocks of mineralized bone inserted in the anterior region of the maxilla
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Fig1
The analysis of the digital examination revealed that both the left and right maxillary sinuses were pneumatized and that the anterior region had an extremely thin flange making implant surgery impossible owing to reduced bone thickness (Fig. 1a). Mineralized granular bovine bone was administered on the left side (OrthoGen, Baumer, Mogi-Mirim, Sao Paulo, Brazil), which was also mixed with physiological saline and compressed (Fig. 1b, c), and postoperative care were passed to the patient.
a Communication between the left maxillary sinus and the oral cavity (oroantral communication). b Epithelization of the area with the insertion of a fibrin sponge impregnated with colloidal silver. c The sponge was glued to the edges of the flap. d The bloody tissue was sutured
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Fig2
Three months after surgery, a reassessment was performed, and clinical examination revealed a communication between the left maxillary sinus and the oral cavity (oroantral communication) (Fig. 2a). An epithelization of the area was conducted together with the insertion of a fibrin sponge impregnated with colloidal silver (Gelatamp, Roeko, Langenau, Germany) (Fig. 2b). The sponge was glued (Glubran 2, GEM S. r. l, Viareggio [LU], Italy) to the edges of the flap (Fig. 2c), and the bloody tissue was sutured with nylon (5-0, Shalon, Sao Luiz de Montes Belos, Goias, Brazil) (Fig. 2d).
a CT with a circular image suggesting potential cyst formation. b Open-access window without any secretion at the site. c The site was irrigated using saline with added antibiotics. d The pneumatization site of the bone graft was re-filled with granular bovine bone biomaterial
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Fig3
A circular image within the graft of the left maxillary sinus was observed, suggesting potential cyst formation (Fig. 3a). There was no presence of odor or secretion at the void site, which made it impossible to carry out the biopsy (Fig. 3b). The site was irrigated using saline with added antibiotics (a supernatant of 500 mg of tetracycline dissolved in 10 mL of saline) after confirming that there was no communication with the rest of the maxillary sinus (Fig. 3c). After irrigation, the pneumatization site of the bone graft was re-filled with granular bovine bone biomaterial (Fig. 3d).
a CT slices (oroantral communication). b Panoramic radiograph (follow-up)
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Fig4
Simple suturing was performed for cooptation of the flap edges, followed by a continuous suture, again as an attempt to close the oroantral communication, which can be observed in detail in the CT slices (Fig. 4a).