Article_5_3_6
ORAL IMPLANTOLOGY
THE EFFICACY OF BONE SCRAPER FOR BONE WINDOW OSTEOTOMY
Original Article
IN THE COURSE OF SINUS AUGMENTATION
Liat Chaushu1a , Hadar Better2b, Samuel Porphirio Xavier3c, Sarit Naishlos4d, Joseph Nissan5,7e, Gabi Chaushu6,7f*
1Department of Periodontology and Implant Dentistry, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv-University, Tel Aviv, Israel
2Private practice
3Department of Oral and Maxillofacial Surgery and Periodontology, Ribeirão Preto Dental School, University of São Paulo, Ribeirão Preto, SP, Brazil
4Department of Pedodontics, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv-University, Tel Aviv, Israel
5Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv-University, Tel Aviv, Israel
6Department of Oral & Maxillofacial Surgery, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv-University, Tel Aviv, Israel
7Rabin Medical Center, Petah Tiqva, Israel
a
DMD, MSc
b
MD, DMD, MSc
c
DMD, PhD, Professor
d
DMD
e
DMD, Associate Professor
f
DMD, MSc, Professor, Head
ABSTRACT DOI: 10.25241/stomaeduj.2018.5(3).art.6
OPEN ACCESS This is an Open Access
article under the CC BY-NC 4.0 license.
Introduction: The aim was to determine the efficacy of the bone scraper in the
Peer-Reviewed Article
course of sinus augmentation.
Methodology: A total of 50 sinus augmentation procedures performed in 35 Citation: Chaushu L, Better H, Xavier SP, Naishlos
S, Nissan J, Chaushu G. The efficacy of bone scraper
patients were included in this study. The outcome parameters included membrane for bone window osteotomy in the course of sinus
perforation and bone volume collected. augmentation. Stoma Edu J. 2018;5(3):179-182.
Results: Twenty-two were female, and 13 males. The age ranged from 55 to 80 Academic Editor: Constantinus Politis, MD, DDS,
years. The average osteotomy site dimensions were (12 ± 2) x (10 ± 2) mm. There MM, MHA, PhD, Professor & Chairperson, University
of Leuven, Leuven, Belgium
were no perforations of the sinus membrane during the creation of the bony
Received: September 01, 2018
window. The average bone volume from the 50 osteotomies was 0.75 ± 0.25 cm3. Revised: September 05, 2018
There were no statistically significant differences between edentulous vs. partially Acccepted: September 11 2018
Published: September 17, 2018
edentulous patients, men vs. women, or time length of edentulism.
Conclusions: The proper use of the bone scraper allows autogenous bone *Corresponding author: Professor Gabi Chaushu,
DMD, MSc, Head, Department of Oral & Maxillofacial
harvesting and prevents sinus membrane perforation during the creation of the Surgery, The Maurice and Gabriela Goldschleger School
bony window and is cost-effective financially. of Dental Medicine, Tel Aviv-University, Tel Aviv, Israel, Tel:
+972-8-6219999, Fax: +972-1533-7164979, e-mail:
Keywords: bone scraper, sinus floor, augmentation, perforation, membrane, gabi.chaushu@gmail.com
bone graft. Copyright: © 2018 the Editorial Council for the
Stomatology Edu Journal.
1. Introduction short convoluted ribbons. While being cut, shavings
Implant dentistry in the posterior atrophic maxilla still combine with blood and flow into the handle's head.
poses a challenge, due to lack of alveolar bone height. This graft material, an osseous coagulum, is then
Sinus augmentation procedures are done to generate delivered with the handle directly to the recipient site,
sufficient bone to place an implant. Bone graft may be or to a bowl.
autogeneous bone and/or xenografts and/or alloplasts The object of this study was to measure the amount
to fill in the volume created. For the autogenous donor of bone that can be harvested from common bony
site, the iliac crest or the mandibular symphyseal area window osteotomy prior to sinus membrane elevation
are often used [1-9]. Autogenous bone graft particles dental implant osteotomies using the bone scraper in
still serve as the gold-standard of bone grafting [8- order to give the surgeon an idea of how much bone
12]. Particulate bone grafts are often used alone or in can be collected. Thus, the surgeon will be able to
combination with xenografts or allografts during sinus predict in advance how much additional graft material
augmentation procedures [13]. Estimating the bone will be needed to fill the sinus.
volume to be harvested prior to surgery for maxillary
sinus floor bone grafting might help in selecting the
donor site, minimizing complications following bone 2. Methodology
harvesting, and reducing expenses [14]. Patients undergoing sinus augmentation at the Tel
The bone scraper (Ebner™ grafter, Maxilon Laboratories, Aviv University or the private practice of the authors
Inc. Hollis, NH, USA) is an instrument comprised of a were included in the study. Inclusion criteria were
reusable stainless-steel handle and a disposable blade. absence of clinically significant health problems, use
The blade shaves bone from cortical surfaces producing of bone scraper, valid documentation regarding sinus
Stomatology Edu Journal 179
THE EFFICACY OF BONE SCRAPER FOR BONE WINDOW OSTEOTOMY
IN THE COURSE OF SINUS AUGMENTATION
membrane perforation and bone volume. The study
Original Article was approved by the ethical committee of the Tel Aviv
University.
Surgery commenced as a routine lateral approach
sinus augmentation. Following local anesthesia and
flap elevation, the entire head of the bone scraper
was dipped into sterile saline solution before starting
to cut and collect bone from the window osteotomy.
Force was applied perpendicularly to the lateral sinus
wall surface and the instrument was pulled backwards.
The instrument cut with straight-back or side motion.
Repetitive strokes were used to cause bone shavings
and blood to flow through the aperture into the head.
Looking through the view slots monitored progress.
Over-filling was avoided to prevent aperture clog. The
blade was removed with the aid of a curved 12.5 cm Figure 1. Bone harvested form one window.
Halstead Mosquito hemostat. The head was placed
close to a bowl and the graft material was spooned out
with a curette (Figs. 1-3). In order to harvest additional
graft material, the blade was reattached and the
procedures were repeated as required. Membrane
perforations were registered. Mesiodistal and vertical
dimensions of the lateral bony window were measured
using a periodontal probe. The samples were lightly
packed into a 1 mL syringe for volumetric evaluation.
Chi square test was used for statistical analysis.
3. Results
Thirty-five patients were included in the study. Twenty-
Figure 2. Bone scraper after blade removal.
two were females and 13 males. The average age was
62 ± 3 years, with a range of 55 to 80 years. A total of
50 augmented sinuses were included. The average
window osteotomy site dimensions were (12 ± 2) x
(10 ± 2) mm. There were no perforations of the sinus
membrane during the creation of the bony window.
The total number of major (> 5 mm) sinus membrane
perforations reached 5%. The average bone volume
was 0.75 ± 0.25 cm3 per osteotomy window. There
were no statistically significant differences between
males and females, partially edentulism and complete
edentulism. When comparing length of edentulism, < 5
years to > 5 years, no statistically significant differences
were noted.
4. Discussion Figure 3. Bone spooned out with a curette.
When using a bone scraper during window osteotomy
sites, a predicted 0.75 ± 0.25 cm3 of bone can be In the present study, a volumetric measurement
obtained from an osteotomy site of approximately was used because it is more closely associated with
(12 ± 2) x (10 ± 2) mm. Autogenous grafts can often xenografts or alloplastic materials, which are often
be combined with xenografts or alloplastic materials purchased by volume rather than weight.
to provide extra bulk to fill the sinus or peri-implant A recent study [15] described the use of a mini bone
defects when implants are placed simultaneously. scraper for a lateral bone window approach and
Collecting graft material in this way can often spare the simultaneous bone harvesting during sinus floor
patient a separate surgical donor site. Surgical expense elevation. There was no injury of the Schneiderian
and time can also be saved when this technique is membrane, and the mean volume of particulate
used, which is beneficial to both the patient and the bone collected from the anterior wall of the maxilla
surgeon. When combining xenografts or alloplastic using this technique was 0.74 cm3. Supplementary
material with autogenous bone, decreased amounts of allogeneic materials were not required in all cases.
xenografts or alloplastic material will have to be used They concluded that the use of bone scraper is a simple
to increase the bulk of the graft. This also reduces the and safe procedure in lateral bone window approach
expense for xenografts or alloplastic materials. and simultaneous bone harvesting during sinus
floor elevation, because it is performed under better
180 Stoma Edu J. 2018;5(3):179-182 http://www.stomaeduj.com
THE EFFICACY OF BONE SCRAPER FOR BONE WINDOW OSTEOTOMY
IN THE COURSE OF SINUS AUGMENTATION
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Stomatology Edu Journal 181
THE EFFICACY OF BONE SCRAPER FOR BONE WINDOW OSTEOTOMY
IN THE COURSE OF SINUS AUGMENTATION
Original Article Liat CHAUSHU
DMD, MSc
Department of Periodontology and Implant Dentistry
The Maurice and Gabriela Goldschleger School of Dental Medicine
Tel Aviv-University, Tel Aviv, Israel
CV
Liat Chaushu, DMD, graduated magna cum laude at the Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv
University, Tel Aviv, Israel. She completed her MSc Degree at the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
She is a graduate of the Periodontology program and a member of the Department of Periodontology and Implant Dentistry,
the Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel. Graduate of the European
Federation of Periodontology. She is a member of the Israeli Society of Periodondology and Osseointegration, A member
of the European Federation of Periodontology and also a member of the Israeli Dental Association. She lectures nationally
and internationally and has published over 20 manuscripts in peer-reviewed journals. She is the founder of an Israeli start-up
company, Implant B, with a unique patent for the treatment of peri-implant disease.
Questions
1. Sinus membrane perforations in general may reach up to:
qa. 10%;
qb. 22%;
qc. 44%;
qd. 63%.
2. Sinus membrane perforations using bone scraper may reach up to:
qa. 5%;
qb. 10%;
qc. 44%;
qd. 63%.
3. The average bone volume collected from an osteotomy was:
qa. 0.25 cm3;
qb. 0.5 cm3;
qc. 0.75 cm3;
qd. 1 cm3.
4. The average bone volume collected from an osteotomy in males vs. females is:
qa. Higher;
qb. Lower;
qc. Similar;
qd. Not statistically significant different.
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