GP4b - What Patient, Surgical and Management Factors Influence Postoperative Inflammatory Complications in Sinus Lifts?

Abstract: Insufficient maxillary bone height represents a significant challenge to the placement of dental implants in the posterior maxilla. Accordingly, sinus augmentation procedures (SAPs) have become an indispensable tool in the arsenal of any oral and maxillofacial surgeon looking to combat a low Schneiderian membrane and insufficient bone in this area. [Raghoebar, Onclin et al. 2019] However, the factors affecting sinus augmentation procedures, particularly those which influence the development of postsurgical inflammatory complications, have been poorly studied. [Hong, Kim et al. 2010, Testori, Drago et al. 2012]. Therefore, the aim of this study was to investigate what factors influence the development of postoperative inflammatory complications in SAPs.The medical and dental records of all of the patients who underwent maxillary SAPs at the Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center (CMCVAMC) in Philadelphia, Pennsylvania, between January 1, 2012, and July 28, 2023, were reviewed. A total of 109 patients with an associated 169 SAPs were identified and included in this study. Patient records were audited to document confounding variables (age, diabetic status, social history) and antibiotic use history. Data was extracted into Excel and analyzed for statistical significance. Postoperative inflammatory complications (PICs) were identified via screening follow-up notes for indications of sinusitis, erythema, and/or purulent discharge. Patient factors (gender, diabetic status, smoking history, sinus disease history, and sinus lift history), surgical factors (surgical setting, surgical flap technique, surgical access technique, and Schneiderian membrane perforation), and management factors (chlorhexidine prescription, Augmentin prescription, and postoperative antibiotic course) were studied for their influence on PICs. There was no statistically significant difference in the development of PICs following SAPs in patients without and without diabetes (P = .59), those with and without a current of smoking (P = .25), or those with or without a history of sinus disease (P = .39). Women were more likely than men to develop PICs (P = .01), and patients who had previous SAPs were more likely to experience a PIC than those with a history of SAPs (P = < .01). There was no statistical difference in the development of PICs for those who underwent their procedure in the operating room or the dental clinic (P = .06) or those who underwent a flap or flapless approach to the surgery (P = .26). Patients undergoing an SAP via the lateral window approach were more likely to develop a PIC than those who underwent the transalveolar approach (P = < .01). Perforation of the sinus membrane resulted in an increased risk for PICs compared to no perforation (P = < .01). There was no statistical difference in the development of PICs following SAP for those given a chlorhexidine prescription versus those who were not given one (P = .60), those who were prescribed Augmentin versus those who were not prescribed Augmentin (P = .97), or those who were prescribed antibiotics for a course of ≤5 days versus those who were prescribed a course of antibiotics for >5 days (P = .81). Women as well as those with a history of SAPs were more likely to develop PICs. Patients undergoing a lateral window SAP versus those undergoing a transalveolar SAP as well as those who experienced a perforation to the sinus membrane were more likely to develop PICs. Thus, extra considerations should be given to these patients both during and after surgery. The fact that there was no statistically significant difference in PICs for individuals who were given antibiotics for ≤5 days versus those who were given them for >5 days means that after 5 days, antibiotics have no effect on the development of a postsurgical inflammatory complication. Antibiotic prescriptions should therefore be limited to ≤5 days following sinus lifts. Ethics approval: Approved by the Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center (CMCVAMC) IRB Exempt Studies Committee.

Table 1 Patient-specific factors affecting post-operative inflammatory complications following sinus augmentation procedures.
Table 2 Surgical factors affecting post-operative inflammatory complications following sinus augmentation procedures. Table 3 Management factors affecting post-operative inflammatory complications following sinus augmentation procedures.