Implant installment in the UL6 site: Thoughts on sinus lift?

please use a bicon short implant! The only implant what works in souch cases, we use it in Germany a lot with excellent results! More than 35 years don't lie, if you follow the protocoll you will not fail!

STRESS=F/A SO I WOULD GO WITH A LATERAL SINUS GRAFT. MAKE YOUR WINDOW AT LEAST 10MMX 1OMM YOU ARE VERY LIKELY TO PERF THE MEMBRANE IF YOU ATTEMPT A CRESTAL APPROACH TO ONLY GAIN A FEW MM IN HEIGHT. JUST NOT WORTH IT. ALSO SUGGEST A STAGED APPROACH.

Not exactly clear from pictures as to actual measurements. The recommended minimum bone for insertion and a Summers Lift would be 4mm If you have more than this and can achieve primary stability then a graft via the osteotomy is viable. Construct your osteotomy to within 1 mm of sinus floor. Break through with osteotomyr and lift sinus membrane. Augment via this route and place implants but only if primary stability is achievable.

If you ask for recommendations from three dentists, you will very likely get three different recommendations. There are guidelines for determining whether a sinus graft should be internal or lateral. Furthermore, placing the implant at the same time as the sinus graft requires enough bone volume and quality of bone to get good initial stability, otherwise you are risking possible implant displacement into the sinus. You don't provide measurements, but it seems that this case is a Misch SA-3 classification or worse, and requires a lateral approach with delayed placement of the implant. I hope the other recommendations you get are similar. Good luck!

Please go to the Quantum Implant site and the Bicon site also. Both have implants that have sinus lift healing abutments that are larger than the implants to prevent the implant from ending up floating about in the sinus. The sinus lift abutment in contact with the crest of the ridge will provide stability even if the implant does not firmly engage the walls of the osteotomy. An implant length of 6mm would work very well. The Bicon site has video of the surgical procedures. Bicon implant and abutment both press fit. The Quantum implant can be both press fit or screwed in (same implant) and abutments available are both press fit or screw in (different abutments).

have a look at the CMC technique, magic sinus kit by IBS implants

THE FIRST OBJECTIVE SHOULD BE TO CORRECT THE SINUS DEFECT FOR THAT GOAL AND THAT GOAL ALONE AND THE MOST PREDICTABLE TECHNIQUE WOULD BE LATERAL I USE CORONAL TECHNIQUE OFTEN BUT IN THIS CASE I WOULD FEEL MORE COMFORTABLE WITH LATERAL. THEN PLACE IMPLANT AT THE BEST ANGELE THE PATIENT WINS WITH THE SINUS DEFECT CORRECTED AND AN IMPLANT PLACED INTHE OPTIMAL POSITION

I would do a crestal lift via hydraulic elevation. It's much safer and has less morbidity than a lateral window. There are a number of kits that use a non agressive tip cutting bur with stops in 1mm length increments. When you go through the floor of the sinus you can feel it in the handpiece. A small blunt sinus elevator is used to confirm the membrane is intact and elevate slightly. A connector is screwed into the ostomy site and saline is pushed into the sinus elevating the membrane about 3mm/cc saline. I use cortical cancellous allograft if larger volume is needed some PRP can be mixed in. If you have 6mm of bone at the crest the implant can go in immediately otherwise wait 6 mos then place implants

I would recommend considering the Bicon system. You may want to use the 5mm length . Many of the lateral surgeries can be avoided. Think about what you would prefer for yourself or a family member.

Hi , I am very much agree with Dr Mano steel and Rob Dum. Definitely, crestal approach with hydrolic lift is the safest. If you have atleast 4 mm bone best option is crestal. In fact, to be frank if you get used to this technique in 95 % of cases you prefer crestal. Regards

Do a Lateral sinus lift to add 12-14mm of bone and wait 6 months end up with about 10 mm added and giving you enough bone for a 10 to 12 mm implant

Dr. Bob You are right both Bicon and Quantum implants can be placed in a situation like this. I routinely place Quantum Short-T implants in cases that have between 1 and 3 mm of bone in the cortical area of the sinus. Quantum has a Thread in Taper lock abutment with a larger diameter than the implant, this prevents the implant from falling into the sinus. Bicon is a great implant, but of course I favor Quantum, since I designed the system. Thanks for mentioning Quantum as an option

Looking closely at this case leaves me with a straight forward answer which is a crestal approach.Patient's morbidity is much less than performing a lateral window which in this situation is not that easy to perform. As for crestal options- they are numerous and depend on operator's skills and experience.My pick today would be Osseodensification! Enjoy

Dr. mazor, This case in question does not have enough bone to do Osseodensification, it has only about 1mm in thickness

I recommend Versah burs oseodensification...crestal sinus lift. This case is an easy OMG crestal lift. It take takes less than 15 min. New technology means perfecting old tried and true dentistry. I would still do FTP (full thickness flap) as I am still old school and doing flapless prevents us from finding other areas of abnormality they may need to be fixed. Looks like you may be planning to do this one flapless. DON'T. You need to see if you have perfed the membrane if you do crestal so flap it. Add metronidazole 150mg to your graft material...use small piece of collagen first if you perf then add your graft/ with implant. (it is a tiny hole) side note... Versah Burs are expensive but you can argue with 70Ncm2 torque on initial placement.

None of you seems to have an issue with that tooth 16 (2nd molar) highly probable Mesial bony defect and Mesial furcation involvment... I think we should be more than screw installers. This needs to be said.

Joe, You are correct, that tooth is a problem and if an implant is placed in that are it will fail. I think that most responses were regarding the different options of placing an implant with either crestal or lateral lifts, and not regarding specifically about this case. But one way or another your comment deserves an A+ Raul

I would consider using the Southern Implant System - Tri-Max to replace #14 I have used the tap drills of this system in progression to condense bone vertically and laterally from a crestal approach. In this case,I would consider sectioning and removal of the 2nd molar , #15, as well, with simultaneous immediate placement of SI - Tri-Max. Now your are done with a single surgery ; restore 14,15 in 6+ mos. Patient experiences little or no pain / swelling, as this is a minimal reflection surgery Your primary support for your implants will come from native crestal bone no matter what volume of grafting materials you pack sub-antral. This approach does work; however, you must feel comfortable with this Implant System regarding immediate placement of implants in molar positions. Good Case !

Lateral approach, delayed implant placement