Table 1: Jensen’s classification following the Sinus Consensus Conference (1996) (5)

In order to assess the complexity of the lateral sinus floor elevation technique, Tiziano et al. suggested a difficulty score based on anatomical and patient-related factors (6). Many of these factors were found in our case such as the presence of a medio lateral septum and the presence of adjacent teeth since there was only one tooth missing.

The presence of an osteoma isn’t found in the litterature to be a difficulty-increasing factor. This is probably due to their low frequency in general, and more specifically in sinuses requiring a floor elevation procedure.

In our case, the management of the osteoma consisted in a partial excision of the segment impeding on the lateral window. The remaining part will be monitored with periodic radiographs in order to assess its growth rate. The total excision was not indicated since the benign tumor was completely asymptomatic.

According to the meta-analysis of Jordi et al., the use of rotating burs resulted in a significantly higher risk of membrane perforations during the osteotomy compared to the piezoelectric instruments. The average incidence of perforation during Lateral maxillary sinus augmentation drops from 24% for rotating instruments to 8% for piezosurgery (10).

Medium-sized osteomas might have required a total excision in the same time as the sinus floor elevation in order to avoid futher growth. A two-stage option can be planned in case of large tumors, starting with the removal of the osteoma followed by the sinus augmentation after a healing period. In this case, an endoscopic approach would be recommended (8), since the caldwell-luc technique usually makes the sinus floor elevation highly complex because scar tissue is much more difficult to manipulate than the physiological one (12).