Schneiderian Membrane Detachment Using Transcrestal Hydrodynamic Ultrasonic Cavitational Sinus Lift: A Human Cadaver Head Study and Histologic Analysis

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Schneiderian Membrane Detachment Using Transcrestal Hydrodynamic Ultrasonic Cavitational Sinus Lift: A Human Cadaver Head Study and Histologic Analysis Angelo Troedhan, MD, DMD, PhD, Andreas Kurrek, DMD, PhD, Marcel Wainwright, DMD, PhD, Siegfried Jank, MD, DMD, PhD Journal of Oral and Maxillofacial Surgery Volume 72, Issue 8, Pages 1503.e1-1503.e10 (August 2014) DOI: 10.1016/j.joms.2014.02.021 Copyright © 2014 American Association of Oral and Maxillofacial Surgeons Terms and Conditions

Figure 1 Surgical protocol of the transcrestal hydrodynamic ultrasonic cavitational sinus lift. 1, Opening of the sinus floor; 2, preparation of the receptacle (“ventile seat”); 3, detachment of the schneiderian membrane using hydrodynamic cavitational pressure; 4, widening of the trepanation to 2.6 mm; 5, widening of the trepanation to 2.8 mm; and 6, insertion of the bone graft and/or dental implant. Journal of Oral and Maxillofacial Surgery 2014 72, 1503.e1-1503.e10DOI: (10.1016/j.joms.2014.02.021) Copyright © 2014 American Association of Oral and Maxillofacial Surgeons Terms and Conditions

Figure 2 Resected human sinus after transcrestal hydrodynamic ultrasonic cavitational sinus lift. Journal of Oral and Maxillofacial Surgery 2014 72, 1503.e1-1503.e10DOI: (10.1016/j.joms.2014.02.021) Copyright © 2014 American Association of Oral and Maxillofacial Surgeons Terms and Conditions

Figure 3 Macroscopic verification of full integrity of the detached sinus membrane performed by filling the subantral elevation volume with saline solution at 5 mBar. Journal of Oral and Maxillofacial Surgery 2014 72, 1503.e1-1503.e10DOI: (10.1016/j.joms.2014.02.021) Copyright © 2014 American Association of Oral and Maxillofacial Surgeons Terms and Conditions

Figure 4 Hematoxylin-eosin–stained specimen at 2× magnification with a detached sinus membrane: a indicates respiratory epithelium; b, unity of connective tissue and periosteum; c, bone marrow; d, trabeculae of maxillary bone; e, procedural artifact (“shrinking gap”); f, artery; and g, gland. Journal of Oral and Maxillofacial Surgery 2014 72, 1503.e1-1503.e10DOI: (10.1016/j.joms.2014.02.021) Copyright © 2014 American Association of Oral and Maxillofacial Surgeons Terms and Conditions

Figure 5 Azan-stained specimen at 20× magnification with a detached sinus membrane: a indicates respiratory epithelium; b, connective tissue and unity with periosteum; c, periosteum; d, maxillary bone; and e, cleanly ripped Sharpey fibers. Journal of Oral and Maxillofacial Surgery 2014 72, 1503.e1-1503.e10DOI: (10.1016/j.joms.2014.02.021) Copyright © 2014 American Association of Oral and Maxillofacial Surgeons Terms and Conditions

Figure 6 Azan-stained specimen at 40× magnification: a indicates the respiratory epithelium; b, subepithelial connective tissue; c, periosteum; d, maxillary bone; and e, cleanly ripped Sharpey fibers. Unity of subepithelial connective tissue and periosteum can be seen. Journal of Oral and Maxillofacial Surgery 2014 72, 1503.e1-1503.e10DOI: (10.1016/j.joms.2014.02.021) Copyright © 2014 American Association of Oral and Maxillofacial Surgeons Terms and Conditions

Figure 7 Trichrome-stained specimen at 2× magnification: a indicates trepanation canal to the sinus floor (performed with diamond-coated ultrasonic surgical tool, TKW 2-4); b, sinus cavity; and c, detached unity of periosteum, subepithelial connective tissue, and respiratory epithelium. Journal of Oral and Maxillofacial Surgery 2014 72, 1503.e1-1503.e10DOI: (10.1016/j.joms.2014.02.021) Copyright © 2014 American Association of Oral and Maxillofacial Surgeons Terms and Conditions

Figure 8 Trichrome-stained specimen at 10× magnification: a indicates detached unity of periosteum, subepithelial connective tissue, and respiratory epithelium; and b, maxillary bone. Journal of Oral and Maxillofacial Surgery 2014 72, 1503.e1-1503.e10DOI: (10.1016/j.joms.2014.02.021) Copyright © 2014 American Association of Oral and Maxillofacial Surgeons Terms and Conditions

Figure 9 Schematic force distribution scheme using Summers technique (yellow arrows indicate dangerous shearing forces). Journal of Oral and Maxillofacial Surgery 2014 72, 1503.e1-1503.e10DOI: (10.1016/j.joms.2014.02.021) Copyright © 2014 American Association of Oral and Maxillofacial Surgeons Terms and Conditions

Figure 10 Schematic force distribution scheme using Bass technique (yellow arrows indicate dangerous shearing forces). Journal of Oral and Maxillofacial Surgery 2014 72, 1503.e1-1503.e10DOI: (10.1016/j.joms.2014.02.021) Copyright © 2014 American Association of Oral and Maxillofacial Surgeons Terms and Conditions

Figure 11 Schematic force distribution scheme using transcrestal hydrodynamic ultrasonic cavitational sinus lift, with no shearing forces. Journal of Oral and Maxillofacial Surgery 2014 72, 1503.e1-1503.e10DOI: (10.1016/j.joms.2014.02.021) Copyright © 2014 American Association of Oral and Maxillofacial Surgeons Terms and Conditions