Maxillary Sinus Augmentation Using Bio-Oss and Bio-Gide

Before the surgery, we listened carefully to the patient’s requests and explained to them the risks and possible outcomes of the procedure. The procedures were performed under local anesthesia with articaine. The range of anesthesia is on both sides of the maxillary first molar or maxillary second molar, up to the root of the nasolabial fold. The dosage was adjusted according to intraoperative patient feedback. We performed an internal beveled incision of the gingiva on the buccal side. The incision is usually up to the top of the alveolar crest, on both sides of the maxillary first molar, and to a subperiosteal depth. Precise anatomical extent and target area of filling were individualized. We then flipped the mucoperiosteal flap and exposed the maxilla (Figure 1a). On each side of the filling area, 4–8 bleeding holes were prepared with a dental drill to facilitate subsequent bone regeneration (Figure 1b). According to the preoperative evaluation, we used different amounts of Bio-Oss bone powder for augmentation to suit the specific depression of each patient. Based on the biodegradability of the Bio-Oss bone powder and previous experience, a 10% overfill was performed (Figure 1c). After the Bio-Oss bone powder was laid on the maxilla, we covered the surface with the Bio-Gide collagen membrane and fixed it with titanium screws (Figure 1d). The filling position was confirmed and adjusted by CT before and after placing the drainage strips. The surgical site was washed with normal saline. Finally, we sutured oral mucosa with 4–0 absorbable sutures.
Perioperative management includes continuous antibiotic application (tinidazole + cephalosporins) for 5 days, revisit for 3 consecutive days after the operation, and instructions for patients to avoid compression of the surgical site and large positive and negative pressure in the oral cavity for 1 week following the operation. The drainage strips were removed on postoperative day 3, and the titanium screws were usually removed 6 months after the operation.