Crestal lift on pneumatized sinus?

This really depends on your skill level and the techniques you are using , generally not too much of an issue . BUT like golf it depends on the fool swinging the club ....... Peter

My concern is the septa and the protrusions of the roots bit trickier not to perf. I would use a seven iron!

Hi Mark I meant I am an average Golfer and hence opt for safety... No I meant whatever you are most comfortable with , I always prefer the lateral approach but crestal would work well if your are comfortable as about 5 mm of residual bone ....lateral safer as reduced chance or very little chance of tear if using DASK All the best Peter

It is possibly one of the best Implant related inventions in the last 15 years . Since started using 4 and a half years ago I have not torn a single lining when doing a lateral window . Even with thick bone you can open the window and lift in literally seconds safely every time . Sadly made sinus augmentation boring but good for the patients ... Google it , there is an internal drill as well. Try it once and you will see. Hence the issue about equipment and then grafts , I have only used synthetics and have never had an infection in 15 years or so .. Sure I only do 1 a week on average so not many but seems to work very well. Regards Peter

Peter, I just wanted to get back to the question: do you think this anatomical arrangement, where sinus is so pneumatized leads to increased risk of perforation during the crestal lift as compared to the floor that is flat?

Hi Mark no just no need to go too long say 8-10 mm implants and should be good , or maybe a hybrid rescue club.....!!

Peter, I will make another attempt:)))) basically all I wanted to know is whether pneumatization like this leads to increased risk of perforation or NOT.

Question ...Are you removing the 2nd premolar or just placing an implant in the edentulous space? I would use a short implant 5-6mm. I would plan to do a small internal sinus lift with autogenous and allograft material...maybe PRF. I think that would be fine. Thanks for sharing.

Don, I am just adding implant, I am not removing second premolar. I have not done CT yet, but strongly believe I could get away with just a sinus bump if I were to place may be 3.7X6mm or 4.2X6mm.I have not done too many 6mm impls. What is your experience?

I assume that you are placing an implant in the first bicuspid position. If so, the architecture is ideal for an osteotome assisted crestal approach. The reason for this is that the membrane will be in compression up to the point where you are adjacent to the apex of the second bicuspid. Membranes RARELY tear while in compression. They tend to perforation in tension. This will occur if you attempt to raise the floor beyond the apex of the adjacent tooth. RJM

Dr. Miller, thank you for your so valuable input! Based on all the input I got here and my own experience I plan the following: Small bone expanders mediated ( I do not use osteotomes ) lift. Short implant ( 8 or possibly even 6mm. ). Very light occlusion on restoration. I will share with you guys the CT when I get it. Thank you everyone again!

Have started to use the Dask kit more and more as long as have 2-3mm thickness of bone over the sinus - instead of using the membrane lifters I got a hold of the hydrostatic lifters from the HiOssen CAS kit and its producing awesome results, the stops with the DASK kit (or CAS kti) really do work well and no perforations so far, plus using saline to lift the membrane means if there is a perforation (which I have not run into) you will know immediatley. From memory the advice with the crestal approach is to be very careful around bony septa as more likely to perforate during hydrostatic lifting. - Its called the Osstem Cas Kit in Europe

I'm pretty certain that the tensile strength of the sinus membrane has nothing to do with the anatomy of the antrum. I have torn membranes in all scenarios. I have had greater luck and I emphasize luck, when I pretreat my patients with corticosteroids. B Vinci

Tensile or deutility may not be the appropriate descriptive . I guess friability describes the situation better. I was attempting to suggest that the membrane health probably has little to do with the sinus size. I have always had trouble with the term "pneumatized". Most sinuses that are shaped like this are found in the edentulous maxilla, where teeth have super-erupted. Just a thought . B Vinci

Thank you