Zusammenfassung
Hintergrund
Der klassischen Sinusbodenelevation und ihren Modifikationen kommt in der Versorgung des atrophen posterioren Oberkiefers eine zentrale Bedeutung zu. Erstmals berichtete Tatum 1977 über eine neue Operationsmethode zur Verbesserung der vertikalen Knochenhöhe im Sinusboden, 1980 veröffentlichten Boyne u. James den lateralen Zugang mittels Antrotomie in Verbindung mit einer Sinusbodenelevation. Zur Kompensation des Volumendefekts im Rahmen der Sinusbodenelevation wurden autologer Knochen, Knochenersatzmaterial und Kombinationen dieser Materialen eingesetzt.
Methoden
Die häufig schwierige anatomische Situation im distalen Oberkiefer wird durch die Pneumatisation des Sinusbodens in Kombination mit einer Alveolarfortsatzatrophie definiert. Die vertikale Problematik kann zudem mit einem horizontalen Knochenverlust vergesellschaftet sein. Diese Kombinationsdefekte verlangen umfassende Kenntnisse in der Planung und Durchführung augmentativer Maßnahmen. Der Erfolg der Gesamtbehandlung wird auch wesentlich durch die prothetische Konzeption bestimmt. Aus den statisch funktionellen und ästhetischen Planungsdaten ergeben sich die optimale Implantatposition und somit die notwendigen augmentativen Maßnahmen („backward planning“). In vielen Fällen sind die Planung und Durchführung einer Sinusbodenaugmentation nur auf der Basis einer digitalen Volumentomographie oder Computertomographie möglich. Exakte Kenntnisse der Anatomie und Physiologie des Mittelgesichtes sowie der absoluten und relativen Kontraindikationen auch auf Hals-Nasen-Ohren-ärztlichem Gebiet sind wichtige Voraussetzungen für eine erfolgreiche Gesamtstrategie.
Abstract
Background
Classical sinus floor elevation and its modifications are of central importance in the treatment of an atrophic posterior maxilla. In 1977 Tatum first reported a new method to improve the vertical height of the sinus floor and in 1980 Boyne and James published the lateral approach by antrostomy in association with sinus floor elevation. To compensate for the volume defect in sinus floor elevation, autologous bone, bone substitute material and combinations of both these materials were used.
Methods
The often difficult anatomical situation of the posterior maxilla is the result of both the pneumatization of the sinus floor and atrophy of the alveolar process. The vertical problem can be associated with a horizontal loss of bone. The combination of these kinds of defects requires an extensive knowledge in planning and implementation of augmentation procedures. The success of the whole treatment essentially depends on a sufficient prosthetic strategy. The backward planning process with integration of aesthetic and static functional aspects determines the correct positioning of the implants and therefore defines the necessary augmentation. The planning and execution of sinus floor elevation augmentation is often only possible based on computed tomography or cone beam computed tomography. Prerequisites for a successful total strategy are excellent knowledge of the physiology and anatomy of the mid-face and also experience in the field of otorhinolaryngology, including absolute and relative contraindications.
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K. Dawirs und S. Haßfeld geben an, dass kein Interessenkonflikt besteht.
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Dawirs, K., Haßfeld, S. Sinusbodenelevation. MKG-Chirurg 9, 12–19 (2016). https://doi.org/10.1007/s12285-015-0043-0
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DOI: https://doi.org/10.1007/s12285-015-0043-0