Mechanical characteristics of the maxillary sinus Schneiderian membrane ex vivo
- 155 Downloads
It has been speculated that certain Schneiderian membrane thickness (SMT) might be more prone to perforation. This investigation was aimed at studying the mechanical characteristics of the Schneiderian membrane under one- and two-dimensional tests and their correlation to the histological SMT in human samples.
Material and methods
Sixteen Schneiderian membranes were collected from 11 cadaver heads treated with Thiel’s embalming method. The samples were processed and analyzed clinically and histologically. One-dimensional maximum elongation until perforation and two-dimensional resistance to ball penetration were performed after the biopsy. Data was analyzed by using the Wilcoxon rank test and the Spearman’s rank correlation.
The histological SMT was 1.36 ± 0.42 mm, whereas the clinical thickness was 0.27 ± 0.21 mm, yielding statistical significance (p = 0.000). The resistance under ball penetration was 0.59 ± 0.43 N and the mean maximum elongation in the one-dimension test 11.19 ± 7.14 mm. Expressed in percentage, the mean stretch was 241.36 ± 227.97% (range 31.5 up to 947%). A weak positive correlation was found between the ball penetration test and the SMT (r = 0.10, p = 0.711), while a weak negative correlation was found between stretching test and the SMT (r = −0.021, p = 0.94).
Mechanical tests seem to indicate that SMT might not significantly predispose to Schneiderian membrane perforation. Hence, other anatomical and operator’s factors should be considered of surpassing importance.
Thinner SM might be more prone to perforation when detaching it from the maxillary sinus antrum; however, a thick membrane is not prevented to tear, as their resistance under elastic forces is not higher than thinner ones.
KeywordsDental implants Grafting Bone Alveolar ridge augmentation Maxillary sinus floor augmentation
This article was fully supported by FEDICOM (Fundación para el Estudio y Desarrollo de la Implantologia, Cirugía Oral y Maxilofacial, Badajoz, Spain). We thank Dr. Domingo Macias (Department of Anatomy and Pathology, University of Extremadura, Badajoz, Spain) for his collaboration, support, and acquisition of the specimens. We thank Dr. Tomás García-Caballero (Professor with Chair, Department of Morphological Sciences, University of Santiago de Compostela, Spain) for processing and assessing the histological samples. Furthermore, we thank Christian Caballé for designing the clamping devices used in the study.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
As the study involved the biopsy of cadaver samples without personal private information, the approval of the ethical committee was not needed, although it was conducted under the permission and supervision of the Department of Anatomy and Pathology of The University of Extremadura, Badajoz, Spain.
The Department of Anatomy and Pathology of The University of Extremadura kept all the consents for research and educational uses of the bodies.
- 1.Bornstein MM, Chappuis V, von Arx T, Buser D (2008) Performance of dental implants after staged sinus floor elevation procedures: 5-year results of a prospective study in partially edentulous patients. Clin Oral Implants Res 19:1034–1043. https://doi.org/10.1111/j.1600-0501.2008.01573.x CrossRefPubMedGoogle Scholar
- 2.Zinser MJ, Randelzhofer P, Kuiper L, Zoller JE, De Lange GL (2013) The predictors of implant failure after maxillary sinus floor augmentation and reconstruction: a retrospective study of 1045 consecutive implants. Oral Surg Oral Med Oral Pathol Oral Radiol 115:571–582. https://doi.org/10.1016/j.oooo.2012.06.015 CrossRefPubMedGoogle Scholar
- 4.Tan WC, Lang NP, Zwahlen M, Pjetursson BE (2008) A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation Part II: transalveolar technique. J Clin Periodontol 35:241–254. https://doi.org/10.1111/j.1600-051X.2008.01273.x CrossRefPubMedGoogle Scholar
- 6.Tonetti MS, Hammerle CH, European Workshop on Periodontology Group C (2008) Advances in bone augmentation to enable dental implant placement: consensus report of the sixth European workshop on periodontology. J Clin Periodontol 35:168–172. https://doi.org/10.1111/j.1600-051X.2008.01268.x CrossRefPubMedGoogle Scholar
- 8.Monje A, Monje-Gil F, Burgueno M, Gonzalez-Garcia R, Galindo-Moreno P and Wang HL (2016) Incidence of and factors associated with sinus membrane perforation during maxillary sinus augmentation using the reamer drilling approach: a double-center case series. The international journal of periodontics & restorative dentistry 36:549-556. https://doi.org/10.11607/Prd.2525
- 11.Garcia-Denche JT, Wu X, Martinez PP, Eimar H, Ikbal DJ, Hernandez G, Lopez-Cabarcos E, Fernandez-Tresguerres I, Tamimi F (2013) Membranes over the lateral window in sinus augmentation procedures: a two-arm and split-mouth randomized clinical trials. J Clin Periodontol 40:1043–1051. https://doi.org/10.1111/jcpe.12153 CrossRefPubMedGoogle Scholar
- 12.Lin YH, Yang YC, Wen SC, Wang HL (2015) The influence of sinus membrane thickness upon membrane perforation during lateral window sinus augmentation. Clin Oral Implants Res. https://doi.org/10.1111/clr.12646
- 14.Insua A, Monje A, Chan HL, Zimmo N, Shaikh L, Wang HL (2016) Accuracy of Schneiderian membrane thickness: a cone-beam computed tomography analysis with histological validation. Clin Oral Implants Res. https://doi.org/10.1111/clr.12856
- 16.Insua A, Monje A, Chan HL, Wang HL (2017) Association of inflammatory status and maxillary sinus Schneiderian membrane thickness. Clin Oral Investig. https://doi.org/10.1007/s00784-017-2105-3
- 19.Lopez-Nino J, Garcia-Caballero L, Gonzalez-Mosquera A, Seoane-Romero J, Varela-Centelles P, Seoane J (2012) Lamb ex vivo model for training in maxillary sinus floor elevation surgery: a comparative study with human standards. J Periodontol 83:354–361. https://doi.org/10.1902/jop.2011.110210 CrossRefPubMedGoogle Scholar
- 20.Insua A, Monje A, Urban I, Kruger L, Garaicoa C, Sugai J, Wang H-L (2017) The Schneiderian membrane-lateral wall complex: histological description and clinical implications for maxillary sinus augmentation. International journal of periodontics and restorative dentistry (ahead of print)Google Scholar
- 21.Monje A, Urban IA, Miron RJ, Caballe-Serrano J, Buser D, Wang HL (2017) Morphologic Patterns of the Atrophic Posterior Maxilla and Clinical Implications for Bone Regenerative Therapy. Int J Periodontics Restorative Dent 37(5):e279Google Scholar
- 22.Wilke HJ, Werner K, Haussler K, Reinehr M, Bockers TM (2011) Thiel-fixation preserves the non-linear load-deformation characteristic of spinal motion segments, but increases their flexibility. J Mech Behav Biomed Mater 4:2133–2137. https://doi.org/10.1016/j.jmbbm.2011.07.013 CrossRefPubMedGoogle Scholar