PREDICTION OF INTRAAND POSTOPERATIVE COMPLICATION RISKS OF LATERAL SINUS FLOOR AUGMENTATION BASED ON MULTIFACTORIAL MODELS OF LOGISTIC REGRESSION: A PROSPECTIVE ANALYSIS OF 310 OPERATIONS
DOI:
https://doi.org/10.35220/2078-8916-2024-51-1.25Keywords:
Lateral sinus floor augmentation, perforation, sinusitis, complications, risk factors, dental implantation, patient-specific implants.Abstract
Objective of the study. Determine the frequency of perforations (P) of the mucoperiosteum of the maxillary sinus (MS), acute and chronic sinusitis (S), as well as the loss of bone-replacement material in patients undergoing lateral sinus floor augmentation (LSFA) for tooth row defects in the lateral sections of the upper jaw (UJ), and also identify the risk factors for these complications. Materials and methods of the study. The study involved 240 patients with a deficiency in the bone proposition of the alveolar process of the upper jaw (≤4 mm.) in the distal section, who required LSFA procedures for further restoration of masticatory efficiency with prosthetic constructions on dental osseointegrating implants. Statistical analysis involved identifying factors associated with an increased risk of complications in the early and late postoperative periods. The analysis of the complication risk in patients after LSFA was based on the univariate logistic regression models, for each factor, as well as a multifactorial analysis with the ROC curves, calculated using the EZR program (v.1.54). Study results: 240 patients (54 % women – 130 patients) underwent 310 LSFA procedures. The average age was 50.7±7.39. Seventy-seven patients (32 %) were smokers. Unilateral LSFA was performed on 170 patients (71 %). Left-sided LSFA was performed on 165 patients (53 %). The reason for tooth loss: 214 cases (69 %) were due to caries, periodontal diseases in 68 cases (21 %), and trauma in 28 cases (10 %). Xenogenic bonereplacement materials were used in 278 cases (89.7 %), while autologous bone blocks were used in the other 32 cases (10.3 %).Complications in the form of acute and/ or chronic sinusitis developed in 17 patients (7 %) in 21 operated sinuses. However, in 9 cases (3 %), the adverse course of inflammatory processes led to complete loss of the bone graft and failure of the pre-implantation preparation. Conclusions. The frequency of intra- and postoperative complications in patients undergoing LSFA as part of the pre-implantation preparation in this series was as follows: perforation of the mucoperiosteum of the maxillary sinus – 32%, acute and chronic maxillary sinusitis – 7 %, complete loss of the graft due to an infectious purulent-inflammatory process – 3 %. The increased risk of mucoperiosteum perforation was associated with the category of septa, the position of the vascular anastomosis, the presence of bleeding, and the thickness of the anterior bone wall of the maxillary sinus (p<0.05). The four-factor model we proposed for predicting perforation is characterized by a very strong association with an AUC = 0.83 (95 % CI 0.78 – 0.88), and the five-factor model for predicting the risk of maxillary sinusitis at an AUC = 0.91 (95 % CI 0.86 – 0.96) can be used in planning treatment measures in patients with tooth row defects in the distal sections of the maxillary sinus.
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