Maksiller Sinüs Anatomisi ve İleri Cerrahi Teknikler
Özet
Maksiller sinüs, posterior maksillanın en önemli anatomik yapılarından biri olup paranazal sinüsler içinde en büyük hacme sahip boşluktur. Bu yapının anatomik sınırları, mukosiliyer klirens sistemi, Schneiderian membranın özellikleri ve ostiomeatal kompleksin açıklığı, özellikle implant cerrahisi ve sinüs augmentasyonu planlamasında belirleyici rol oynar. Posterior maksillada diş kaybını takiben gelişen alveolar kemik rezorpsiyonu ve sinüs pnömatizasyonu, implant yerleştirilmesi için gerekli rezidüel kemik yüksekliğini azaltarak ileri cerrahi gereksinimini artırmaktadır. Maksiller sinüs tabanı elevasyonu, bu gibi durumlarda implant rehabilitasyonuna uygun kemik hacmi oluşturmak amacıyla uygulanan öngörülebilir bir cerrahi yaklaşımdır. Bu bölümde maksiller sinüsün anatomisi, fizyolojisi, drenaj mekanizmaları ve klinik açıdan önemli yapıları ayrıntılı biçimde ele alınmıştır. Ayrıca sinüs lift cerrahisinin biyolojik temelleri, endikasyonları, kontrendikasyonları, lateral pencere ve transalveolar yaklaşımlar gibi temel teknikleri değerlendirilmiştir. Greftli ve greftsiz uygulamalar, kısa implantlar gibi alternatif tedavi seçenekleri, komplikasyonlar ve bunların yönetimi de tartışılmıştır. Sonuç olarak başarılı bir sinüs augmentasyonu için ayrıntılı preoperatif radyolojik değerlendirme, dikkatli vaka seçimi, doğru teknik tercihi ve uygun biyomateryal kullanımı büyük önem taşımaktadır.
The maxillary sinus is one of the most important anatomical structures of the posterior maxilla and the largest cavity among the paranasal sinuses. Its anatomical boundaries, mucociliary clearance system, Schneiderian membrane characteristics, and the patency of the ostiomeatal complex play a decisive role in implant surgery and sinus augmentation planning. Following tooth loss in the posterior maxilla, alveolar bone resorption and sinus pneumatization reduce the residual bone height required for implant placement and increase the need for advanced surgical procedures. Maxillary sinus floor elevation is a predictable surgical approach used to create sufficient bone volume for implant-supported rehabilitation in such cases. This chapter comprehensively reviews the anatomy, physiology, drainage mechanisms, and clinically important structures of the maxillary sinus. In addition, the biological basis, indications, contraindications, and principal surgical techniques of sinus lift procedures, including lateral window and transalveolar approaches, are discussed. Grafted and graft-free applications, alternative treatment options such as short implants, possible complications, and their management are also evaluated. In conclusion, detailed preoperative radiologic assessment, careful case selection, correct surgical technique, and appropriate biomaterial use are critical for successful sinus augmentation and long-term implant outcomes.
Referanslar
von Arx T, Lozanoff S. Maxillary Sinus. In: Clinical Oral Anatomy. Springer International Publishing; 2017:163-201 . doi:10.1007/978-3-319-41993-0_9.
Rosano G, Vacher C, Lazaroo B. Anatomy of the Maxillary Sinus and the Role of CT Scans in Maxillary Sinus Augmentation Surgery. Clin Implant Dent Relat Res. 2025;27(2):e70019. doi:10.1111/cid.70019
Alshamrani A M, Mubarki M, Alsager A S, et al. Maxillary Sinus Lift Procedures: An Overview of Current Techniques, Presurgical Evaluation, and Complications. Cureus .2023;15(11): e49553. DOI 10.7759/cureus.49553
Esposito M, Grusovin MG, Rees J, et al. Effectiveness of sinus lift procedures for dental implant rehabilitation: a Cochrane systematic review. Eur J Oral Implantol. 2010;3(1):7-26.
Raja SV. Management of the posterior maxilla with sinus lift: review of techniques. J Oral Maxillofac Surg. 2009;67(8):1730-1734. doi:10.1016/j.joms.2009.03.042
Barros, Mariana & Amaral, Regiane & Pedron et al. New Perspectives about Maxillary Sinus Lifting: a Literature Review. ARCHIVES OF HEALTH INVESTIGATION.2023; 12. 26-32. 10.21270/archi.v12i1.5930.
Bagis, Nilsun & Yıldız, Hasan & Barbaros, Rahme. Maxillary Sinus Lifting. International Journal of Experimental Dental Science.2018; 7. 91-97. 10.5005/jp-journals-10029-1181
Alsharekh MS, Almutairi AA, Jahlan AS, et al. Evolving Techniques and Trends in Maxillary Sinus Lift Procedures in Implant Dentistry: A Review of Contemporary Advances. Cureus. 2024;16(10):e71424. Published 2024 Oct 14. doi:10.7759/cureus.71424
Silva LD, de Lima VN, Faverani LP, de Mendonça MR, Okamoto R, Pellizzer EP. Maxillary sinus lift surgery-with or without graft material? A systematic review. Int J Oral Maxillofac Surg. 2016;45(12):1570-1576. doi:10.1016/j.ijom.2016.09.023
Thoma DS, Zeltner A, Hilbe M, Hämmerle CHF, Jung RE. Long-term outcomes of standard implants in combination with maxillary sinus floor elevation: a systematic review and meta-analysis. J Clin Periodontol. 2015;42(suppl 16):S176-S197 . doi:10.1111/jcpe.12359.
Juzikis E, Gaubys A, Rusilas H. Uses of maxillary sinus lateral wall bony window in an open window sinus lift procedure: literature review. Stomatologija. 2018;20(1):14-21.
Schiavon L, Perini A, Brunello G, et al. The bone lid technique in lateral sinus lift: a systematic review and meta-analysis. Int J Implant Dent. 2022;8(1):33. Published 2022 Aug 29. doi:10.1186/s40729-022-00433-3
Parra M, Atala-Acevedo C, Fariña R et al. Graftless Maxillary Sinus Lift Using Lateral Window Approach: A Systematic Review. Implant Dent. 2018;27(1):111-118. doi:10.1097/ID.0000000000000695
Pérez-Martínez S, Martorell-Calatayud L, Peñarrocha-Oltra D et al. Indirect sinus lift without bone graft material: Systematic review and meta-analysis. J Clin Exp Dent. 2015;7(2):e316-e319. Published 2015 Apr 1. doi:10.4317/jced.51716
Mokcheh A, Jegham H, Turki S. Short implants as an alternative to sinus lift for the rehabilitation of posterior maxillary atrophies: Systematic review and meta-analysis. J Stomatol Oral Maxillofac Surg. 2019;120(1):28-37. doi:10.1016/j.jormas.2018.11.006
Molina A, Sanz-Sánchez I, Sanz-Martín I, Ortiz-Vigón A, Sanz M. Complications in sinüs lift procedures: Classification and management. Periodontol 2000. 2022;88(1):103-115. doi:10.1111/prd.12414
Browaeys, H., Bouvry, P., & De Bruyn, H. (2007). A literature review on biomaterials in sinus augmentation procedures. Clinical implant dentistry and related research, 9(3), 166-177.
Referanslar
von Arx T, Lozanoff S. Maxillary Sinus. In: Clinical Oral Anatomy. Springer International Publishing; 2017:163-201 . doi:10.1007/978-3-319-41993-0_9.
Rosano G, Vacher C, Lazaroo B. Anatomy of the Maxillary Sinus and the Role of CT Scans in Maxillary Sinus Augmentation Surgery. Clin Implant Dent Relat Res. 2025;27(2):e70019. doi:10.1111/cid.70019
Alshamrani A M, Mubarki M, Alsager A S, et al. Maxillary Sinus Lift Procedures: An Overview of Current Techniques, Presurgical Evaluation, and Complications. Cureus .2023;15(11): e49553. DOI 10.7759/cureus.49553
Esposito M, Grusovin MG, Rees J, et al. Effectiveness of sinus lift procedures for dental implant rehabilitation: a Cochrane systematic review. Eur J Oral Implantol. 2010;3(1):7-26.
Raja SV. Management of the posterior maxilla with sinus lift: review of techniques. J Oral Maxillofac Surg. 2009;67(8):1730-1734. doi:10.1016/j.joms.2009.03.042
Barros, Mariana & Amaral, Regiane & Pedron et al. New Perspectives about Maxillary Sinus Lifting: a Literature Review. ARCHIVES OF HEALTH INVESTIGATION.2023; 12. 26-32. 10.21270/archi.v12i1.5930.
Bagis, Nilsun & Yıldız, Hasan & Barbaros, Rahme. Maxillary Sinus Lifting. International Journal of Experimental Dental Science.2018; 7. 91-97. 10.5005/jp-journals-10029-1181
Alsharekh MS, Almutairi AA, Jahlan AS, et al. Evolving Techniques and Trends in Maxillary Sinus Lift Procedures in Implant Dentistry: A Review of Contemporary Advances. Cureus. 2024;16(10):e71424. Published 2024 Oct 14. doi:10.7759/cureus.71424
Silva LD, de Lima VN, Faverani LP, de Mendonça MR, Okamoto R, Pellizzer EP. Maxillary sinus lift surgery-with or without graft material? A systematic review. Int J Oral Maxillofac Surg. 2016;45(12):1570-1576. doi:10.1016/j.ijom.2016.09.023
Thoma DS, Zeltner A, Hilbe M, Hämmerle CHF, Jung RE. Long-term outcomes of standard implants in combination with maxillary sinus floor elevation: a systematic review and meta-analysis. J Clin Periodontol. 2015;42(suppl 16):S176-S197 . doi:10.1111/jcpe.12359.
Juzikis E, Gaubys A, Rusilas H. Uses of maxillary sinus lateral wall bony window in an open window sinus lift procedure: literature review. Stomatologija. 2018;20(1):14-21.
Schiavon L, Perini A, Brunello G, et al. The bone lid technique in lateral sinus lift: a systematic review and meta-analysis. Int J Implant Dent. 2022;8(1):33. Published 2022 Aug 29. doi:10.1186/s40729-022-00433-3
Parra M, Atala-Acevedo C, Fariña R et al. Graftless Maxillary Sinus Lift Using Lateral Window Approach: A Systematic Review. Implant Dent. 2018;27(1):111-118. doi:10.1097/ID.0000000000000695
Pérez-Martínez S, Martorell-Calatayud L, Peñarrocha-Oltra D et al. Indirect sinus lift without bone graft material: Systematic review and meta-analysis. J Clin Exp Dent. 2015;7(2):e316-e319. Published 2015 Apr 1. doi:10.4317/jced.51716
Mokcheh A, Jegham H, Turki S. Short implants as an alternative to sinus lift for the rehabilitation of posterior maxillary atrophies: Systematic review and meta-analysis. J Stomatol Oral Maxillofac Surg. 2019;120(1):28-37. doi:10.1016/j.jormas.2018.11.006
Molina A, Sanz-Sánchez I, Sanz-Martín I, Ortiz-Vigón A, Sanz M. Complications in sinüs lift procedures: Classification and management. Periodontol 2000. 2022;88(1):103-115. doi:10.1111/prd.12414
Browaeys, H., Bouvry, P., & De Bruyn, H. (2007). A literature review on biomaterials in sinus augmentation procedures. Clinical implant dentistry and related research, 9(3), 166-177.
