Assessment of correlation between schneiderian membrane thickness, gingival phenotype and residual ridge height in partially edentulous subjects: A clinical study.
6. BRIEF RESUME OF THE INTENDED WORK
6.1 NEED FOR THE STUDY
Knowledge of the mean thickness and the anatomic characteristics of the schneiderian membrane to the gingival phenotype and residual ridge height are very limited.
There are no guidelines to assess and classify schneiderian membrane’s mucosal findings in the maxillary sinus.
Hence the purpose of this study is to analyse the thickness, anatomic characteristics of the schneiderian membrane and its correlation to the gingival phenotype and residual ridge height using limited field view CBCT in patients referred for dental implant placement in the posterior maxilla.
6.2 REVIEW OF LITERATURE: -Ardekian, et al. reported small residual ridge height as a risk factor for sinus membrane perforation.1 -Aimette, et al. reported that healthy sinus membranes are thicker in subjects with a thick gingival biotype than in those with a thin gingival biotype.2
-Pommer, et al. investigated the mechanical properties of the sinus membrane in vitro and showed that thicker membranes have significantly higher load limits.5
-Fu, et al. reported a positive correlation between thickness of the gingival phenotype and its underlying bone.11
-Fu, et al. reported that cone beam computed tomography measurements of both bone and labial soft tissue thickness are accurate.11
6.3 OBJECTIVES OF THE STUDY:
To assess the gingival phenotype and the residual alveolar ridge height to the schneiderian membrane thickness in dentulous and edentulous region.
To compare the gingival phenotype and the residual alveolar ridge height to the schneiderian membrane thickness in dentulous and edentulous region.
To correlate the gingival phenotype and the residual alveolar ridge height to the schneiderian membrane thickness in dentulous and edentulous region.
7 MATERIALS AND METHOD:
7.1 SOURCE OF DATA:
80 CBCT images of subjects referred for dental implant placement in posterior maxilla.
The study will include 80 consecutive patients without clinical or radiologic signs of maxillary sinus pathologies. A total of 80 CBCT images will be taken using limited field view reformatted coronal and sagittal images with 1mm slice thickness will be analysed with regard to the thickness and characteristics of the schneiderian membrane.Residual ridge height (RRH) will be determined by drawing a reference line on the CBCT image from the lowest point of the sinus floor to the highest point of the alveolar ridge.Membrane thickness(SM) will be measured at the centre of the interteeth distance (proposed implant site) for each sinus, the highest values of sinus membrane will be recorded.The soft tissue thickness will be measured at 2mm apically from the alveolar bone crest and perpendicular to the external cortical plate of the tooth socket by using an endodontic file no 20 and graduated scale at the midline of the selected teeth.Gingival phenotype will be designated as either thin (<1.5mm) or thick (>2mm) the measurement for residual ridge height, sinus membrane and gingival phenotype will be repeated on the dentulous side. Then the measurements of the dentulous area will be compared with the edentulous area in gender (male and female), age groups separately. Data will be subjected to statistical analysis using student ‘t’test.
7.3 Does the study require any investigation or intervention to be conducted on patients or other humans or animals? If so, please describe briefly.
Yes.Patients will be subjected to limited field view CBCT and the thickness of gingiva will be assessed clinically using endodontic file no 20.
Has ethical clearance been obtained from your institution in case of above?
Yes,ethical clearance has been obtained.
8. LIST OF REFERENCES
1. Ardekian L, Oved-Peleg E, Mactei EE, Peled M. The clinical significance of sinus membrane perforation during augmentation of the maxillary sinus. J Oral Maxillofac Surg. 2006 Feb;64(2):277-82.
2.Aimetti M, Massei G, Morra M, Cardesi E, Romano F. Correlation between gingival phenotype and Schneiderian membrane thickness. Int J Oral Maxillofac Implants. 2008 Nov-Dec;23(6):1128-32.
3.Becker S T, Terheyden H, Steinriede A, Behrens E, Springer I, Wiltfang J. Prospective observation of 41 perforations of the schneiderian membrane during sinus floor elevation. Clin Oral Implants Res 2008 DEC;19(12):1285-9.
4.De Rouck T, Eghbali R, Collys K, De Bruyn H, Cosyn J. The gingival biotype revisited: transparency of the periodontal probe through the gingival margin as a method to discriminate thin from thick gingiva. J Clin Periodontol. 2009 May;36(5):428-33.
5. Pommer B, Unger E, Sütö D, Hack N, Watzek G. Mechanical properties of the schneiderian membrane in vitro. Clin Oral Implants Res. 2009 Jun;20(6):633-7.
6. Fu JH, Yeh CY, Chan HL, Tatarakis N, Leong DJ, Wang HL. Tissue Biotype and Its Relation to the Underlying Bone Morphology. J Periodontol. 2010 Apr;81(4):569-74.
7.Kan JY,Morimoto T, Rungcharassaeng K, Roe P, Smith DH. Gingival phenotype assessment in the esthetic zone: visual versus direct measurement. Int J Periodontics Restorative Dent. 2010 Jun;30(3):237-43.
8.Cakur B, Sumbullu M A, Durna D. Relationship among schneiderian membrane, underwood’s septa, and the maxillary sinus inferior border. Clin Implant Dent Relat Res. 2011 Apr 19.
9. Kumar V, Faizuddin M. Effect of smoking on gingival microvasculature: A histological study. J Indian Soc Periodontol. 2011 Oct;15(4):344-8.
10. Janner SF, Caversaccio MD, Dubach P, Sendi P, Buser D, Bornstein MM. Characteristics and dimensions of the schneiderian membrane: a radiographic analysis -using cone beam computed tomography in patients referred for dental implant surgery in the posterior maxilla. Clin Oral Implants Res. 2011 Dec;22(12):1446-53.
11. Yilmaz HG, Tozum TF. Are gingival phenotype, residual ridge height and membrane thickness critical for the perforation of maxillary sinus. J Periodontol. 2012 Apr;83(4):420-5.
I ……………………………………. son/daughter/wife of ……………………………………… aged…………….. resident of …………………………………………………………………. do hereby give consent to use my CBCT data and measure my gingival thickness for research purpose. The procedure has been explained to me in my own language. I agree that no responsibility will be attached to the surgeon or the hospital authorities.