Clinical, Radiographic and Histologic Evaluation of Tenting the Schneiderian Membrane Using Titanium Mesh for Maxillary Sinus Lift Procedure: A Randomized Controlled Study
Phase: NA
Conditions: Maxillary Sinus Floor Augmentation
Sponsor: Suez Canal University

 
 
 
 
 
 
 
 
       Clinical, Radiographic and Histologic Evaluation of Tenting 
the Schneiderian Membrane Using Titanium Mesh for Maxillary 
Sinus Lift Procedure: A Randomized Controlled Clinical Trial 
A Thesis Protocol  
Submitted for partial fulfillment of the requirements of the  
Master  Degree in dental science  
In 
Oral and Maxillofacial Surgery 
Research code: HE-12 
 
Submitted By 
 
Hedra Sherif Kamel Michael 
B.D.S, Suez Canal University, 2017 
Free lance dentist 
Supervisors: 
Title 
Name 
Job Title 
University 
Signature 
Professor 
Mohamed Ahmed 
Elsholkamy 
Professor of Oral and 
Maxillofacial 
Surgery, Faculty of 
Dentistry 
Suez Canal 
University 
 
Dr. 
Mohamed Nageh 
Gad Elhak 
Lecturer in Oral and 
Maxillofacial 
Surgery, Faculty of 
Dentistry 
Suez Canal 
University 
 
                                             Faculty of Dentistry  
Suez Canal University 
2025 
 
 
 
 

 
Tel:+20 1226182970 
 
Email: 
hedra_sherif@dent.suez.edu.eg 
 
1 
 
 “Thesis Research Protocol” 
Student Name:  Hedra 
Sherif 
Kamel 
Michael 
Student 
ID: 
29302241900211 
 
 
 
 
Submission 
Date: 
 
 
 
Degree: 
☒ 
M.D.Sc. 
☐ D.D.Sc 
☐ 
PH.D.  
 
 
 
 
 
Department: 
Oral and maxillofacial surgery 
 
 
Thesis Title in 
English: 
Clinical, Radiographic and Histologic Evaluation of 
Tenting 
the 
Schneiderian 
Membrane 
Using 
Titanium Mesh for Maxillary Sinus Lift Procedure: 
A 
Randomized 
Controlled 
Clinical 
Trial 
 
 
 
Thesis Title in 
Arabic 
التقييم اإلكلينيكي و ال
شعاعي و الهيستولوجي 
 لتخييم غشاء شنايدر
بإ ستخدام شبكة التيتانيوم
إلج
راء رفع غشاء الجيب األنفي الفكي :
 تجربة.سريرية عشوائية محكمة 
 
 
 
 
 
 
 
 
 

 
Tel:+20 1226182970 
 
Email: 
hedra_sherif@dent.suez.edu.eg 
 
2 
 
1. Abstract: 
 
 
 
 
 
Introduction: Atrophic maxillary ridge following long-standing 
extractions together with maxillary sinus pneumatization   presents a 
challenge when an implant supported prosthesis is intended to be 
done.A variety of techniques and materials have been put forth to 
enhance the atrophic maxillary bone in order to receive an endosseous 
implant. Aim: the aim of this study is to evaluate the use of titanium 
mesh in tenting the Schneiderian membrane both clinically and 
radiographically while augmenting the Maxillary sinus. Methodology: 
Twenty posterior maxillary edentulous sites requiring open sinus 
augmentation for staged dental implant placement will be studied. 
Patients will be randomly allocated into two groups using random group 
generator (random.org): Group I (study group) the Schneiderian 
membrane will be elevated using titanium mesh fixed by bone screws. 
Group II (control group) will have stainless steel screws/pins placed 
bucco-palatally to maintain the elevated membrane and stabilize the 
formed blood clot. Platelet rich fibrin (PRF) will be placed at the site 
of elevated membrane in both groups. Surgeries will be evaluated 
clinically in terms of pain, edema and tissue response during the follow 
up period. Radiographic assessment will be performed during the 
surgical follow-up period and after 6 months, to evaluate the formed 
bone height and density using CBCT. At the time of implant placement 
(6 months post-sinus lift), bone core biopsies will be harvested from the 
grafted sinus area using a trephine bur under sterile conditions. The 
samples will be fixed in 10% buffered formalin, decalcified, embedded 
in paraffin, sectioned, and stained with Hematoxylin and Eosin (H&E) 
stain. 

 
Tel:+20 1226182970 
 
Email: 
hedra_sherif@dent.suez.edu.eg 
 
3 
 
2. Introduction and Background 
The paired maxillary sinuses are air-filled spaces lying within the bilateral 
maxillae, lateral to the nasal cavity, superior to the maxillary teeth, inferior to 
the orbital floors, and anterior to the infratemporal fossa. These sinuses are 
the largest of the paranasal sinuses, measuring an average of 12.5 mL in 
volume.2 The maxillary sinuses are lined with a thin bilaminar mucoperiosteal 
membrane known as the Schneiderian membrane. (Avichai Stern and James 
Green.,2012). 
Within the 4 paranasal sinuses, the maxillary sinuses are the most important 
for dentistry due to its proximity to teeth. As the maxillary bone develops, the 
sinuses cavities are formed and filled by air, a physiological process called 
pneumatization. The pneumatization itself causes the maxillary sinuses to 
expand into the adjacent anatomical structures, being the alveolar process the 
anatomical region with the highest prevalence rate. (Del Fabro M and 
Testori T.,2009). 
It is still a poorly understood process. There are reports in literature of some 
factors that may influence maxillary sinuses pneumatization, such as heredity, 
nasal mucous membrane pneumatization, craniofacial configuration, bone 
density, sinus surgeries, growth hormones, air pressure within the cavity of 
the sinus and an age-related process. (Sánchez-Pérez A et al.,2016). 
Tooth loss promotes local dimensional changes of hard and soft tissues. In 
posterior regions of the upper jaw, maxillary sinus approximation may be 
present and such event, in combination with bone loss, can difficult implant 
installation in these sites. (Misawa M et al.,2016). 
Cone-beam computed tomography (CBCT) is currently a complementary 
diagnostic tool that provide three-dimensional (3D) images. It significantly 
reduces the overlapping of anatomical structures and enable a better 
evaluation of the alveolar bone and the maxillary sinus floor status.  (Hamdy 
RM and Abdel-Wahed N. .,2013) 

 
Tel:+20 1226182970 
 
Email: 
hedra_sherif@dent.suez.edu.eg 
 
4 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
In addition, the CBCT study can also reveal whether there are septa within 
the planned sinus surgical site. Normally, septa with low height (less than 2 
mm) do not require further attention because the membrane can usually be 
elevated without difficulty. However, high septa with partial or complete 
separation of the sinus cavity may involve the preparation of 2 windows 
during sinus lift surgery. Finally, the clinician can observe possible sinus 
mucosal thickening, sinus polyps, and air fluid levels. (Kao DW., 2020). 
A maxillary sinus augmentation is recommended when there is less than 10 
mm of space available from the alveolar crest to the maxillary sinus, and the 
clinician and patient wish not to use small implants to reconstruct the area. 
(Carrao V and DeMatteis I. .,2015). 
Different surgical techniques are used with maxillary sinus augmentation. A 
lateral maxillary window sinus lift is generally performed on patients who 
require more than 3 mm of augmentation. Generally, when a large amount 
of bone is required to place an implant, the lateral window sinus lift is 
recommended2 rather than a trans crestal sinus lift. (Kao DW., 2020). 
A less invasive procedure, often referred to as the trans-crestal osteotome 
sinus floor elevation technique, was first presented by Dr Summers in 1994 
and is a viable alternative in certain clinical settings to the lateral window 
sinus lift procedure. (Summers R. .,1994). 
Osseodensification is a technique that involves plastic deformation of bone 
that is created by rolling and sliding contact using a densifying bur that is 
fluted in such a manner that it densifies and compacts the bone with minimal 
heat elevation. A rather new implant site/osteotomy preparation technique 
was developed in 2013, which densifies the bone as it prepares the implant 
site by means of a non-substractive drilling technique referred to as by its 
innovator Dr Huwais as osseodensification. This is a surgical technique that 
uses specialized designed fluted burs (DENSAHburs) that help densify the 
bone as they prepare the osteotomy site. (Huwais S., 2018). 

 
Tel:+20 1226182970 
 
Email: 
hedra_sherif@dent.suez.edu.eg 
 
5 
 
 
 
 
 
 
 
 
 
 
 
 
There has been a wide variety of materials suggested for augmentation of 
the maxillary sinus cavity in order to gain bone height and overall volume. 
These materials have been subject to several modifications along the 
years to achieve a more predictable outcome within an expected time 
frame. Graft materials have also varied in origin according to the desired 
role as osteoconductive, osteoinductive and osteogenic (Yip et al., 2015). 
 
A recently adopted idea when augmenting the maxillary sinus is using the 
established blood clot created beneath the elevated Shneiderian membrane 
and its later development into bone, as a graftless technique. This reduces 
the overall cost of the procedure eliminating the additional costs needed for 
a graft material.  (Wang et al., 2024).  
 
Stabilization of the membrane at the new elevated level and maintaining the 
void created remains necessary. This may be performed using the implants 
placed when the residual bone height allows primary implant stability 
(Zabalbu et al., 2024).  
 
Or it may require the use of an appliance as a space maintainer during a 
staged approach for augmentation of the sinus prior to implant placement 
(Cricchio et al., 2011) (Johansson et al., 2012) (Kaneko et al., 2012) (Atef 
et al., 2014) (Ghanem et al., 2020). 
       
The principle governing bone formation by simply elevating the sinus 
membrane could also be applied in cases where insufﬁcient bone anchorage 
hinders simultaneous implant placement. Thereafter evolved the idea of 
maxillary sinus membrane lifting without the use of any bone grafts, this 
was first introduced by Lundgren and colleagues. (Lundgren S. et al., 
2004). 
 
Histologic analysis allows clinicians to assess the quality, maturity, and 
composition of newly formed bone in sinus lift sites, often revealing the 
proportion of vital bone, residual graft particles, and connective tissue 
within the regenerated area (Scarano et al., 2008) 
 

 
Tel:+20 1226182970 
 
Email: 
hedra_sherif@dent.suez.edu.eg 
 
6 
 
 
Tissue biopsies obtained during implant placement enable a detailed 
histologic evaluation of bone healing dynamics, providing critical data 
on graft biocompatibility and osteoconductive capacity in maxillary 
sinus augmentation cases (Testori et al., 2002). 
Histologic sections stained with specific dyes, such as hematoxylin and 
eosin or Masson’s trichrome, facilitate the differentiation between 
mineralized bone, marrow spaces, and remaining graft particles, offering 
a comprehensive view of the healing process (Zitzmann et al., 2001). 

 
Tel:+20 1226182970 
 
Email: 
hedra_sherif@dent.suez.edu.eg 
 
7 
 
3. Research Question (RQ): 
In patients with atrophied edentulous posterior maxillary ridges 
indicated for implant placement, what is the difference between using  
titanium mesh versus bone screws in tenting the Schneiderian 
membrane in terms of: 
- Clinical ease of application, reducing the operation cost and duration. 
- Radiographical gained bone height. 
- Histologic structure of the newly formed bone. 
4. Research Hypothesis, Aim, Objectives & Expected Outcomesss 
a. Hypothesis  
Null Hypothesis: There is no significant difference in ease of 
application and the formed bone quantity and quality between both 
tenting techniques. 
 
Alternative Hypothesis: There is a significant difference in ease of 
application and the formed bone quantity and quality between both 
tenting techniques. 
 
b. Aim  
The aim of this study is to evaluate using titanium mesh versus bone 
screws in tenting the Schneiderian membrane clinically, radiographically 
and histologically. 
 
c. Objectives: 
Assessment of both tenting techniques considering the ease of application, 
quality and quantity of formed bone in augmentation of the maxillary 
sinus in terms of: 
- Clinical intra-operative ease of application and post-operative pain 
and edema through Visual Analogue Scale (V.A.S.) and edema 
scale. 
- Radiographical evaluation of formed bone through measurements 
on the CBCT. 
 
 
Assessment of both tenting techniques of the Schneiderian membrane in 
terms of: 
- Clinical intra-operative ease of application and post-operative pain 
and edema through Visual Analogue Scale (V.A.S.) and edema 
scale. 
- Radiographical evaluation of formed bone through measurements 
on the CBCT. 
- Histologic structure of the newly formed bone using hematoxylin 
and eosin stains. 

 
Tel:+20 1226182970 
 
Email: 
hedra_sherif@dent.suez.edu.eg 
 
8 
 
d. Expected Outcomes  
 
Using stainless steel screws as a tenting barrier may be easier in 
application than using a titanium mesh while achieving the same clinical 
and radiographic results as a graftless approach for the maxillary sinus. 
 
 
5. Research Design and Methods 
I-Materials: 
The following materials will be used in the study: 
Item 
Composition 
Trade name 
Resorbable suture 
Vicryl 
Egysorb 
Cairo, Cairo governorate, 
Egypt 
Surgical Lancet No.15 
Carbon steel 
Kiato 
Kanpur, India 
 
Local anesthesia  
Articaine with 
epinephrine           
( 1:100,000 ) 
Artpharma 
Cairo, Cairo governorate, 
Egypt 
 
Surgical titanium mesh 
Titanium type V 
Riton 
Guangdong, China 

 
Tel:+20 1226182970 
 
Email: 
hedra_sherif@dent.suez.edu.eg 
 
9 
 
Surgical stainless steel 
screws 1.5 mm. 
Stianless steel 
Haenaem 
Gyeonggi-do, Korea 
Collagen membrane 
Collagen 
Matrix graft 
Friedrich, Germany 
II-Methods: 
a) Study design: Randomized controlled clinical study, randomization  
will be done using random group generator (random.org).  
b) Study setting: The study will be conducted in the outpatient clinic 
of the Oral and Maxillofacial Surgery Department, Faculty of 
Dentistry,Suez Canal University. 
 
c) Study population and samples: Participants enrolled in this study 
will be selected from a group of patients seeking implant supported 
dental restorations in an atrophic posterior maxilla requiring staged 
augmentation. 
d) Patient selection: 20 edentulous sites indicated for an implant 
supported restoration in severely atrophic posterior maxilla. 
Patients could be partially edentulous receiving a single implant 
restoration or fully edentulous receiving an implant supported 
overdenture. 
 
Patient will be selected based on eligibility criteria: 
 
Inclusion criteria: (Testori et al., 2024) 
- Adult male/female patients with age interval 18:60 years old. 
- Patients with one or more teeth requiring implant supported dental 
restoration in atrophic maxilla. 
- Alveolar bone height less than 5 mm at the defective site. 
- Good oral hygiene. 
- Patient’s consensual agreement to be enrolled in the study. 
 
 
 
 

 
Tel:+20 1226182970 
 
Email: 
hedra_sherif@dent.suez.edu.eg 
 
10 
 
Exclusion criteria: (Wimalarathna., 2021). 
- Medically compromised patients with conditions contraindicating 
surgery (eg. uncontrolled diabetics, bisphosphonate intake, radio or 
chemotherapy). 
- Patients with active infection at or related to the site of surgery (eg. 
acute sinusitis). 
- Heavy smokers. 
-Patients not indicated for an implant supported restoration at the time of 
enrollement (eg. active/untreated periodontal disease). 
(Patients developing any medical condition that interferes with the 
outcomes after enrolment in the study will be excluded). 
e) Clinical examination and radiographic evaluation: 
- Thorough clinical examination of the oral cavity, mucosal thickness, 
inter-arch distance as well as dental history taking and whether previous 
complications occurred with local anesthesia and compliance to given 
treatments and instructions. 
- Each patient will have a CBCT for evaluation and measurement of 
bone height at the defected site requiring restoration. This will dictate the 
exact location of the osteotomy and the desired height and width of 
augmentation as well as help in planning for implant placement. CBCTs 
will be done using the following exposure parameters for standardization: 
6x8 cm field of view, 90 KV, 10 mA, an exposure time of 6.1 seconds 
and a voxel size of 0.2 mm. 
f) Random allocation: Patients will be randomly allocated in the two 
groups of the study. 
 
g) Surgical Procedure:  
1) For the study group: Administration of local anesthesia to the surgical 
field will be followed by reflection of a full-thickness trapezoid 
mucoperiosteal flap with a crestal incision and two releasing incisions 
mesially and distally to expose the lateral wall of the sinus at the site to be 
augmented. A round diamond bur will be used to outline the lateral 
antrostomy window predetermined radiographically preserving a trap door 
to support and protect the membrane during procedure. The membrane will 
be elevated across the floor latero-medially with mesial and distal freeing to 

 
Tel:+20 1226182970 
 
Email: 
hedra_sherif@dent.suez.edu.eg 
 
11 
 
avoid potential tearing or perforation. The superior border of the lateral 
antrostomy will be prepared with holes/osteotomies to receive stainless steel 
fixation screws to fix the titanium mesh in place. This will be followed by 
resting the trap door supporting the membrane on the titanium mesh to 
maintain the elevated level and stabilize the blood clot formed underneath. 
2) For the control group: Administration of local anesthesia to the surgical 
field will be followed by reflection of a full-thickness trapezoid 
mucoperiosteal flap with a crestal incision and two releasing incisions 
mesially and distally to expose the lateral wall of the sinus at the site to be 
augmented. A round diamond bur will be used to outline the lateral 
antrostomy window predetermined radiographically preserving a trap door 
to support and protect the membrane during procedure. The membrane will 
be elevated across the floor latero-medially with mesial and distal freeing to 
avoid potential tearing or perforation. The superior border of the lateral 
antrostomy will be prepared with holes/osteotomies to receive stainless steel 
screws/pins to be placed buccopalatally. This will be followed by resting the 
trap door supporting the membrane on the stainless steel screws to maintain 
the elevated level and stabilize the blood clot formed underneath. 
3) The lateral antrostomy will be covered with a collagen membrane 
followed by flap re-adaptation and suturing for primary closure. 
4) The titanium mesh and screws will be retrieved through a second 
intervention after the 6-month follow up period. 
h) Post-operative care: Patients will be advised a list of instructions to 
follow firmly and given medication appropriate with the procedure.  
- Sutures will be removed 7-10 days after the surgery (in case of emergency, 
flap dehiscence, severe pain, bleeding or developing sinus related signs or 
symptoms patients will present to the clinic for examination). 
i) Clinical examination and assessment: 
Post operative edema and pain will be assessed during the post-operative 
follow up phase using edema scale and VAS pain scores respectively.  

 
Tel:+20 1226182970 
 
Email: 
hedra_sherif@dent.suez.edu.eg 
 
12 
 
- Signs of inflammation, tissue reaction or local irritation will be assessed 
and recorded. 
j) Radiographic examination and assessment: 
- CBCT will be obtained during the follow-up period for evaluation of the 
elevated membrane at the desired height through the location of the 
mesh/screws.  
- CBCT will be obtained after 6 months to evaluate the formed bone in terms 
of height. 
- CBCT images will be compared for evaluation of the amount of formed 
bone at the surgical site using OnDemand3D ®App software (Cybermed, 
Seoul, Korea). 
k) Histologic Assessment:  
At the time of implant placement (6 months post-sinus lift), bone core 
biopsies will be harvested from the grafted sinus area using a trephine bur 
under sterile conditions. The samples will be fixed in 10% buffered 
formalin, decalcified, embedded in paraffin, sectioned, and stained with 
Hematoxylin and Eosin (H&E) stain. 
The histologic evaluation will include: 
• 
Assessment of new bone formation. 
• 
Inflammatory response or foreign body reaction. 
The goal of the histologic assessment is to determine the quality of the 
newly formed bone and evaluate tissue compatibility. This process will help 
correlate histological findings with the clinical and radiographic outcomes. 
The histologic analysis will be performed following the standard protocols 
approved and commonly used in public universities and research centers in 
Egypt, ensuring reproducibility and consistency. 
 
 

 
Tel:+20 1226182970 
 
Email: 
hedra_sherif@dent.suez.edu.eg 
 
13 
 
6. Statistical plan 
 
a) Sample size calculation: 
To evaluate the difference between the two proposed groups;  
Group I: control group and Group II: study group. A Paired T Test is 
proposed. A minimum total sample size of 14 samples will be sufficient 
to detect the effect size of 1 mm change in bone height and a power (1-
β=0.80) of 80% at a significance probability level of p<0.05 partial eta 
squared of 0.14. (M. Ahmed et al, 2017) 
 
According to sample size calculations, each group would be represented 
by a minimum of 7 samples and a total sample size 14 samples will be 
selected for the study as shown in tables 1 and figure 1. The sample size 
was calculated according to G*Power software version 3.1.9.6. (Cohen, 
1988, Faul et al., 2007, 2013).  
Where; 
f: is the effect size; α= 0.05; β= 0.20; Power= 1- β = 0.80 
 
 
 
 
 
Figure 1. Sample size calculations 
 
 
 

 
Tel:+20 1226182970 
 
Email: 
hedra_sherif@dent.suez.edu.eg 
 
14 
 
Table 1: Variables of the study 
 
Variable 
Symbol 
Donates 
Number of 
samples 
G 
G1 
Group I 
Study group 
10 
G2 
Group II 
Control group 
10 
Total Sample Size 
20 
 
 
b) Statistical analysis 
 
All data will be subjected to statistical analysis. The statistical analysis 
will be performed using SPSS version X software (IBM SPSS Statistics 
version X (IBM Corp., Armonk, NY, USA). Data will be presented as the 
mean ± SD. The one-sample Kolmogorov–Smirnov test will be used to 
examine the normality of data distribution. Repeated measures analysis of 
variance (ANOVA) will be used to compare variables within each study 
group, and a post hoc test will be performed if the ANOVA is significant. 
The paired samples t-test will be used to compare each pair of studied 
variables within each study group. The independent samples t-test will be 
used to compare variables between the two groups studied. For all tests, 
the result will be considered statistically significant if the P-value is equal 
to or less than 0.05. 
 
7.  Ethics consideration:  
The present research will be conducted after the approval of the Research 
Ethics Committee (REC) of the faculty of Dentistry, Suez Canal University. 
It will be conducted on sixteen samples of patients ethical considerations 
regarding patient well-being and confidentiality will be undertaken by the 
researcher and an informed written consent will be signed by the subjects/ 
patients before commencing the study explaining all clinical examinations, 
procedures and follow up. 

 
Tel:+20 1226182970 
 
Email: 
hedra_sherif@dent.suez.edu.eg 
 
15 
 
8. Time Plan 
Include Grant Chart as following example: 
Starting:   After approval of ethical committee and faculty council 
Ending: after 12 months 
 
9.Research Estimated Budget in Egyptian Pound 
 
CBCT 
2250/case 
36,000 
Materials 
3200/membrane 
x16 
500/Screws 
X64 
 
Titanium 
mesh, cost 
determined 
per case 
with 
average 
(2000/case) 
99,200 
Others 
(Miscallenous) 
250 disposables /case 
4,000 
Statistics 
5000 
Publications 
25,000 
Histopathology 
900/case X 16 
Total 
183,600 
Sponsored by the researcher himself. 
 
Activity/Month  
1
2
3
4
5
6
7
8
9
10
11
12
Patient selection/Surgery 
☒ ☒ ☒ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ 
Collecting data and Statistical 
Analysis 
☐ ☐ ☐ ☒ ☒ ☒ ☒ ☒ ☒ ☐ ☐ ☐ 
Writing 
☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☒ ☒ ☒ 

 
Tel:+20 1226182970 
 
Email: 
hedra_sherif@dent.suez.edu.eg 
 
16 
 
10. References: 
Ahmed M, Abu Shama A, Hamdy RM, Ezz M. (2017). Bioresorbable versus titanium 
space-maintaining mesh in maxillary sinus floor elevation: a split-mouth study. Int J Oral 
Maxillofac Surg. Sep;46(9):1178-1187. 
Atef M, Hakam MM, ElFaramawey MI, Abou-ElFetouh A, Ekram M. 
(2014).Nongrafted sinus floor elevation with a space-maintain- ing titanium mesh: case 
series study on four patients. Clin. Implant Dent Relat Res,16:893–903. 
Avichai Stern, James Green (2012). Sinus Lift Procedures: An Overview of Current 
Techniques, Dental Clinics of North America,Volume 56, Issue 1,Pages 219-233,ISSN 
0011-8532. 
Brayam Z, Oswaldo C and Vergara-Buenaventura A.(2024). Graftless maxillary sinus 
lift with simultaneous implant placement: a casereport. Revista Científica Odontológica, 
12(2), pp.e202–e202. 
Carrao V, DeMatteis I.(2015). Maxillary sinus bone augmentation techniques. Oral 
Maxillofacial Surg Clin N Am ;27(2):245–53. 
Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale, New 
Jersey: Lawrence Erlbaum Associates. 
Cricchio G, Palma VC, Faria PE, de Olivera JA, Lundgren S, Sennerby L, Salata LA. 
(2011). Histological outcomes on the development of new space-making devices for 
maxillary sinus floor augmentation. Clin Implant Dent Relat Res;13:224–30. 
Del Fabro M, Testori T.(2009). Maxillary sinus surgery and alternatives in treatment: 
Anatomy of the maxillary sinus. Berlin: Quintessence. 
Ghanem, S., Beheiry, M., El Bialy, R. (2020). Bone Formation After Maxillary Sinus 
Floor Elevation Using Titanium Mesh Versus Titanium Screws Without Any Graft 
Material: A Preliminary Study', Advanced Dental Journal, 2(4), pp. 201-208. 
Hamdy RM, Abdel-Wahed N. (2014). Three-dimensional linear and volumetric analysis 
of maxillary sinus pneumatization. J Adv Res. May;5(3):387-95.  
Huwais S. (2018). Enhancing implant stability with osseodensification– a case report with 
2 year follow-up. Implant Pract ;8(1):34. 
Johansson L.A., Isaksson S, Adolfsson E, Lindh C, Sennerby L. (2012). Bone 
generation using a hollow hydroxyapatite space- maintaining device for maxillary sinus 
floor augmentation–a clinical pilot study. Clin Implant Dent Relat Res; 14:575–84. 

 
Tel:+20 1226182970 
 
Email: 
hedra_sherif@dent.suez.edu.eg 
 
17 
 
Kao DW.(2020). Clinical maxillary sinus elevation surgery. 
Kaneko T, Masuda I, Horie N, Shimoyama T. (2012). New bone formation innongrafted 
sinus lifting with space maintaining management: a novel technique using a titanium bone 
fixation device. J Oral Maxillofac Surg;70:e217–24. 
Lundgren S, Andersson S, Gualini F, Sennerby L.(2004). Bone reformation with sinus 
membrane elevation: a new surgical technique for maxillary sinus floor augmentation. Clin 
Implant Dent Relat Res; 6: 165–173. 
Misawa M, Lindhe J, Araújo MG. (2016) The alveolar process following single-tooth 
extraction: a study of maxillary incisor and premolar sites in man. Clin Oral Implants Res. 
Jul;27(7):884-9. 
Sánchez-Pérez A, Boracchia AC, López-Jornet P, Boix García P.(2016) 
Characterization of the Maxillary Sinus Using Cone Beam Computed Tomography. A 
Retrospective Radiographic Study. Implant Dent. Dec;25(6):762-9.  
Scarano, A., Degidi, M., Iezzi, G., Pecora, G., Piattelli, M. and Piattelli, A., (2008). 
Maxillary sinus augmentation with different biomaterials: a comparative histologic and 
histomorphometric study in man. Implant Dentistry, 17(3), pp. 321-327. 
Summers R. (1994). A new concenpt in maxillary implant surgery: the osteotome 
technique. Compend Contin Educ Dent. ;15:152. 
Testori, T., Wallace, S.S., Del Fabbro, M., Taschieri, S., Trisi, P., Capelli, M. and 
Weinstein, R.L.,(2002). Repair of large sinus membrane perforations using stabilized 
collagen barrier membranes: Surgical techniques with histologic and radiographic 
evidence of success. The International Journal of Periodontics & Restorative Dentistry, 
22(5), pp. 475-483. 
Wang, M., Li, B., Feng, H., Ye, Q., Sun, Y., Duan, X. and He, J. (2024). Assessment of 
the osteogenic effect after maxillary sinus floor elevation and simultaneous implantation 
with or without bone grafts by analyzing trabecular bone parameters: a retrospective study. 
Journal of applied oral science: revista 32, pe20230406. 
Yip, I.; Ma, L.; Mattheos, N.; Dard, M.; Lang, N.P. (2015). Defect healing with various 
bone substitutes. Clin. Oral Implants Res.,26, 606–614. 
Zitzmann, N.U., Schärer, P. and Marinello, C.P.,(2001). Long-term results of implants 
treated with guided bone regeneration: A 5-year prospective study. The International 
Journal of Oral & Maxillofacial Implants, 16(3), pp. 355-366. 
 

 
Tel:+20 1226182970 
 
Email: 
hedra_sherif@dent.suez.edu.eg 
 
18 
 
11. Appendices 
Informed consent 
                                                                -1-                                                                            
Suez Canal University 
Faculty of Dentistry 
Research Ethics Committee (REC) 
 
Investigator Application Form 
 
1-Name of researcher: Hedra Sherif Kamel Michael  
2-Name of Department: Oral and maxillofacial surgery. 
3-Adress of researcher: Ismailia,Egypt 
a- Email: hedra_sherif@dent.suez.edu.eg 
b- Phone number +20 1226182970 
c- Fax number: none 
 
4- Name (s) of Co-investigator (s):  
5- Grade of protocol: 
*M.D.Sc. (√ ) 
*Ph.D. ( 
) 
*Doctorate degree (D.D.Sc.) ( 
) 
*Other 
(   ) 
*Domestic 
( 
) 
*Multi-Centre within Egypt 
( 
) 
*International(  ) 
 
 
6-Title of the research: 
Clinical, Radiographic and Histologic Evaluation of Tenting the 
Schneiderian Membrane Using Titanium Mesh for Maxillary Sinus Lift 
Procedure: 
A 
Randomized 
Controlled 
Clinical 
Trial 
 
 7-Type of the research: 
*Drug trial   (  ) 
*Surgical technique    (√ ) *Investigative technique (√ ) 
*Devise study   ( 
) *Survey study   (   ) *Blood sampling (    )  
*Review of old records (   ) 

 
Tel:+20 1226182970 
 
Email: 
hedra_sherif@dent.suez.edu.eg 
 
19 
 
8-Subjects of research: 
 
 * Children (˂ 18 years): (  ) *Adults (>18 years)   (√) 
 * Vulnerable groups (no)         
9- Request is being made to waive (give-up) informed consent:Yes: ()No:(√)  
 10- The research is for the good of society:  Yes: (√)            No: ( )        
 
   
 
11-Study design: 
a-Phase type               I: (    )   II: (   ) III: (   )  
b-Randomization:         Yes: (  √  )  
No: (    ) 
c-Placebo:                      Yes: (   )          No: ( √    ) 
d-Genetic sampling:     Yes: (  )     No: ( √ ) 
 e-Other: 
Yes: ( ) 
No: ( √ ) 
12-Facilities for the research are available: 
Yes: (√) 
No: ( ) 
13- List the risks of the study:  pain, edema, wound infection, 
sinusitis, temporary epistaxis. 
14- Are the risks reasonable to the potential benefits to the subjects, 
if any, or to the knowledge to be gained?  Yes: (√) No: ( ) 
15- Privacy and confidentiality of subjects are assured Yes:  (√) 
No: (  ) 
16- The subject of the research could quit at any time without 
penalty or loss of any benefits to which they would otherwise be 
entitled Yes: (√)     No: (  ) 
 
 
Signature of the principal investigator:                         Date: 
 
                -2- 

 
 
 
 
 
 
التقييم اإلكلينيكي و الشعاعي و الهيستولوجي لتخييم غشاء شنايدر بإ ستخدام شبكة التيتانيوم
إلجراء رفع غشاء الجيب األنفي الفكي
: تجربة سريرية عشوائية محكمة 
 
 خطة بحث مقدمة توطئة
لإل تمام الجزئي
للحصول على 
درجة الماجستير فى علوم طب االسنان 
 في
جراحة الفم والوجه والفكين 
HE-12:  كود البحث 
مقدمة من 
هدرا شريف كامل ميخائيل 
بكالوريوس طب وجراح
ة الفم واأل سنان جامعة قناة السويس2017
 
طبيب أسنان حر 
المشرفين 
اللقب االسم الوظيفة الجامعة التوقيع 
 
.أ.د 
 
محمد أحمد الشلقام
ي 
 أستاذ جراحة الفم
والوجه والفكين ،
 كلية
طب األسنا
ن 
 
 
 جامعة قناة
السويس 
 
د. محمد ناجح جاد الحق 
 مدرس جراحة الفم
والوجه والفكين، 
 كلية
طب االسنان 
 جامعة قناة
السويس 
 
 
كلية طب األسنان 
جامعة قناة السويس 
2025
 
 
 
 
 

 
Tel:+20 1226182970 
 
Email: 
hedra_sherif@dent.suez.edu.eg 
 
1 
 
 
 الملخص العربي: 
1
) ا
لمقدمة: 
 
 يمثل الضمور الشديد في الفك العلوي الخلفي
تحديًا عند الحاجة إلى عمل استعا
ضة سنية 
مدعومة بالزرع
ات
. يحدث هذا مع فقدان العظام المتقدم بعد عمليات ال
ق لع طويلة األمد
باإلضافة إلى تهوية واتساع الجيب الفكي العلوي. 
 تم
ابتكار مجموعة متنوعة من التقنيات والمواد لتعزيز عظ
ا م الفك العلوي من أجل
تهيئته لتلقي 
 غرسة
أسنان. 
2 ) الهدف من البحث: 
 
 مقارنة تقنيتين مختلفتين في
رفع 
 و تثبيت غشاء الجيب األنفي الفكي
إكلينيكيا و إ شعاعيا 
 و
 هيستولوجيا
و ذلك لتعزيز.عظام الفك العلوي 
3
 )
 أسئلة البحث: 
في المرضى الذين يعانون من ضمور الفك العلوي الخلفي  ,
 ما هي تقنية الخيام التي ستكون أسهل
 في التطبيق وأفضل لتثبيت غشاء
الجيب األنفي الفكي 
 لتقليل تكلفة العملية ومدتها وكذلك دراسة
نتائج كلتا التقنيتين من حيث استجابة األنسجة الرخوة وحجم العظام وبنيتها؟ 
4
 )خطة البحث ومنهجية الدراسة:  
 
 سيتم دراسة20
 موقعًا خاليًا من األسنان في الفك العلوي الخلفي تتطلب زيادة عظم الجيوب 
 األنفية المفتوحة جانبيا لوضع غرسة أسنان مرحليا. سيتم
إدراج المرضى بشكل عشوائي في 
مجموعتين باستخدام مولد المجموعة العشوائية   
 (
(random.org
 
- 
 المجموعة1
 
)(مجموعة الدراسة 
 سيتم رفع غشاء شنايدر باستخدام شبكة من التيتانيوم مثبتة
بواسطة مسامير عظمية للحفاظ على الغشاء المرتفع وتثبيت جلطة الدم. 
 
- 
 المجموعة2 
)(المجموعة الضابطة 
 سيتم رفع غشاء شنايدر باستخدام براغي/دبابيس من الفوالذ
المقاوم للصدأ موضوعة على نحو شدغي حنكي للحفاظ على الغشاء المرتفع وتثبيت جلطة الدم. 
 
سيتم تقييم العمليات الجراحية سريريًا من حيث األلم 
 (VAS) 
 التورم واستجابة
األنسجة 
 خالل فترة المتابعة. سيتم إجراء التقييم اإلشعاعي خالل فترة المتابعة الجراحية
 وبعد
ستة 
،أشهر لتقييم ارتفاع وكثافة العظام المتكونة باستخدام 
CBCT
.
 
 
و ستتم 
 دراسة الهيستولوجي بإستخدام صبغة الهيماتوكسين و االيوسين لتحديد جودة العظم
.المتكون حديثا و تقييم استجابة الفك لوجود مادة غريبة 
 
 
 سيتم شرح كل الخطوات الخاصة بالبحث لكل المرضى المشتركين بالبحث وسيتم الحصول
 على موافقة  مكتوبة على كافة خطوات البحث. 

 
Tel:+20 1226182970 
 
Email: 
hedra_sherif@dent.suez.edu.eg 
 
2 
 
 
 
 
 
 
 اإلجراء
ال
جراحي : 
 
 
ا
لمجموعة الدراسة:
 
 
-
 تلقي التخدير الموضعي 
-
 سيتم رفع غشاء شنايدر باستخدام شبكة من التيتانيوم مثبتة بواسطة مسامير عظمية 
للحفاظ على الغشاء المرتفع وتثبيت جلطة الدم. 
 
ا
لمجموعة الضابطة:
 
 
-
 تلقي التخدير الموضعي 
-
 
 سيتم رفع غشاء شنايدر باستخدام
براغي/دبابيس من الفوالذ المقاوم 
 للصدأ موضوعة
على نحو شدغي حنكي للحفاظ على الغشاء المرتفع وتثبيت جلطة الدم. 
 
 
5
) الخطة اإلحصائية: 
 
 تم حساب حجم العينة وفقا إلصدار برنامجG * power 3.1.9.6. 
 لمعرفة العدد األمثل إلجراء
 التجربة وعند إجراء التجربة سيتم جمع البيانات وجدولتها طبقا للجدول الزمني المحدد وبعد
اإلنتهاء من إجراء التجربة وجمع البيانات 
 كاملة سيتم
إ
ختيار التحليل اإل حصائي المناسب لتحديد
الفروق المعنو
ية 
 بين المجموعات المختلفة تحت الدراسة
س بإ تخدام
أ
حد البرامج ا
إل حصائية مثل
(SPSS (V. 26 عند مستو
ى 
 معنويهP-value ≤ 0.05 or 0.01
 
- 
 سيتم عرض البيانات كمتوسطات± اإل
نحراف المعياري في صورة جداول. 
- عرض البيانات في صورة رسوم بيانية. 
-  إ ستخدام
إ
ختبا
رات للمقارنة بين مجموعتي الدراسة. 
-
 
 سيتم
عرض 
 البيانات
الفئوية 
 على شكل تكرارات(ن) 
 ونسب مئوية (
٪ إ
ن وجدت .
 
-
 إ ستخدام
إ
ختبارمربع كاي إل
ختبار أهمية االرتباط بين المتغيرات الفئوية. 
 
6
) الجدول الزمني:
 
 رقم
المعيار وصف المرحلة 
 التاريخ المتوقع
لالنتهاء من العمل مالحظات 
1
 
 اإلعداد شهر 
 
2
 شراء الخامات المساعدة للبحث شهران 
 

 
Tel:+20 1226182970 
 
Email: 
hedra_sherif@dent.suez.edu.eg 
 
3 
 
تحضير الكيماويات 
3
 الجزء العملي خمسة اشهر 
 
4
 
 تجميع البيانات شهران 
 
5
 التحليل اإلحصائي اسبوع 
 
6
 
 تغيير النتائج اسبوع 
 
7
 
 كتابة المراجعة األدبية اسبوع 
 
8
 
 كتابة طرق البحث اسبوع 
 
9
 
 كتابة المناقشة اسبوعين 
 
10
 تجميع الرسالة كاملة اسبوع 
 
 
 
7
 )مرفقات: 
  
اإلستماره المستنيرة 
 
 
جامعة قناة السويس 
 
 كلية طب
اال سنان 
                       لجنة أ خالقيات
البحث العلمي نموذج الموافقه المستنيرة                          
 
 إلجر
اء بحث طبي علي مشارك متطوع  
 
                                
 
 
سم إ المشارك المريض 
.......................
 النوع:...................................
 
السن:.......................................  تاريخ الميالد:.......................................
 
 
 
١- عنوان البحث باللغ
ة العر
بية: 
التقييم اإلكلينيكي و الشعاعي و الهيستولوجي 
 لتخييم غشاء شنايدر بإستخدام شبكة التيتانيوم
إلجراء رفع غشاء الجيب األنفي الفكي: تجربة سريرية عشوائية محكمة 
 ٢- 
 
 الخلفية العلمية( الموضوع البحث )
 
 والهدف من
إ
جراء البحث: 
 مقارنة تقنيتين مختلفتين في
رفع 
 و تثبيت غشاء الجيب األنفي الفكي
و
إكلينيكيا و إ شعاعيا
و ذلك 
.لتعزيزعظام الفك العلوي 

 
Tel:+20 1226182970 
 
Email: 
hedra_sherif@dent.suez.edu.eg 
 
4 
 
 
 
 
 
٣- 
 
 ما سوف يتم
إ
جراؤه بالتفصيل: 
 يقتصر هذا البحث على األفراد الذين يسعون إلى الحصول على استعاضات سنية مثبتة بواسطة
غرسات في 
 المنطقة الخلفية من الفك العلوي(منطقة الضروس/ الضواحك) 
 بشرط أال يكون
ارتفاع العظم كافي لوضع الزرع
ات. 
 
 
 يعتمد البحث طريقتين
لتخييم غشاء شنايدر ل زيادة عظم الفك العلوي
من خالل الجيب األنفي 
الفكي كمرحلة تمهيدية الستقبال زرع
ات 
.مستقبلية 
 
 يجب أن تتوافر بعض الشروط في المشاركين في البحث بحيث أال تتعارض حالتهم الصحية/ 
المرضية بشكل عام او موضعي مع اإلجراء الجراح
ي المجرى أثناء فترة البحث. 
 
مكان البحث: عيادات قسم جراحة الفم و الوجه و الفكين، كلية طب األسنان بجامعة قناة 
 ،السويس
اإلسماعيلية. 
 
 :مدة البحث
ستة أشهر. 
  
 :عدد الحاالت المشاركة
عشرون حالة (موضع عظمي ضامر بسبب اتساع و تمدد الجيب  
األنف
ي الفكي). 
 
 تفاصيل خطوات
البحث  
عند التطوع للمشاركة و بعد التأكد من توافر الشروط الالزمة لإلدراج في البحث سيتم 
توزيعك بشكل عشوائي في إحدي مجموعتين: 
 :المجموعة األولى سيتم رفع غشاء شنايدر باستخدام شبكة من التيتانيوم مثبتة بواسطة مسامير
عظمية للحفاظ على الغشاء المرتفع وتثبيت جلطة الد.م 
 :المجموعة الثانية سيتم رفع غشاء شنايدر باستخدام براغي/دبابيس من الفوالذ المقاوم للصدأ
.موضوعة على نحو شدغي حنكي للحفاظ على الغشاء المرتفع وتثبيت جلطة الدم 
 
 
سيخضع كل مشارك لتصوير أشعة مقطعية على الموضع المعني بالبحث قبل إدراجه وبعد 
 الجراحة األولى
و في نهاية.مدة البحث 
 
4
)الفوائد المتوقعه من البحث: 
زيادة عظم الفك العلوي الخلفي بما يسمح باستعاضات سنية مثبتة بواسطة زرعات. و يمكن ايضا 

 
Tel:+20 1226182970 
 
Email: 
hedra_sherif@dent.suez.edu.eg 
 
5 
 
 االستفادة منها على المدى البعيد في تثبيت استعاضات سنية ثابته او متحركة بزرعات سنية
لتعويض خلعات أكثر بالفك العلوي. 
 
-5 ال
مخاطر المحتمل حدوثها من اجراء البحث: 
 تتمثل المخاطر في المضاعفات المصاحبة ألي إجراء جراحي مثل اإلحساس باأللم و التورم و تلك
الوارد حدوثها مثل التهاب الجرح أو التهاب بالجيب األنفي أو النزيف المؤقت من األنف. 
-6 التعويضات في حالة حدوث مخاطر :
 
في حالة عدم تكوين 
 عظم كافي للزرعة عند انتهاء المدة سيتم التعامل مع الموقف في الجراحة
الثانية أثناء وضع الزرعة بواسطة اضافة عظم جديد أو تغيير أجراء تثبيت الزرعة. 
7
- البدائل المتاحة ف ي حالة رفضك
اإلشتراك في 
 هذا البحث: ال
تركيبات الثابتة أو المتحركة .
 
 
8
- سرية معلوماتك: 
 
 سوف
تعامل معلوماتك بسريه كامله ولن يطلع عليها سوي الباحث الرئيسي. 
 بعد انتهاء الدراسه
 سيتم
ابالغك بالنتائج وأي نتائج خاصه تتعلق بحالتك الصحية. 
 
9
- حقك في ا
لإ
نسحا:ب من حقك ا
إل نسحاب من البحث في أي وقت دون
إ بداء أسباب ودون أي
عواقب سلبيه عليك. 
 
 
10
- في حالة أخذ أي عينه: 
 فسوف
ال تستخدم في أي بحث آخر.  
 
 
11
- 
 عند وجود أي
إ ستفسار لديك يمكنك االتصال. 
ب الباحث الرئيسي
: هدرا شريف كامل 
                    تليفون+201226182970 
 
 من ينوب عنه
تليفون:يا 
مقرر 
 لجنة األخالقيات......................................: 
تليفون...........................................
 
 
   أقر أنن 
 اطلعت وفهمت ال جراءات الن   ستتم من
خالل هذا البحث ووافقت عليها.
 
. 
 ي البحث
المشارك ف :                               
 الباحث الرئيسي 
 االسم:..............................................
 
  
 التوقيع:................................................. 
 
البصمه.................................................
 
 التاري  خ ......................................................:
 

 
Tel:+20 1226182970 
 
Email: 
hedra_sherif@dent.suez.edu.eg 
 
6 
 
**ملحوظه:  من حق المتطوع الحصول عل
ى 
 صورة من
اإلقرار. 
 
هذا البحث: 
 
 توطئ
ة 
 لرسالة ماجستير (√)
 
 توطئ
ة لرسالة دكتوراه (   ) 
 
 بحث غير ممول  (√) 
 
 تمت الموافقه علي هذا البحث من قبل لجنة
اخالقيات 
 البحث العلمي
بتاريخ............................................: 
 
هذه الموافقه سارية 
 حتى.......................................................: 
 
 
 رئيس  اللجنة:                                                                              خاتم اللجن
ة: