Management of the Sinus Membrane Along the Vertical Medial Wall of the Sinus: Which Technique?
Dr. M. asks:
I will be doing guided surgery to place dental implants in the maxilla. I will be placing a 5/13mm Nobel Biocare tapered implant in the #14 site [maxillary left first molar; 26]. According to the calculations of my CBVT scan, the implant will make contact with the medial vertical wall of the maxillary sinus and the apical portion of the implant will penetrate into the sinus. About 1/3 [one third] of the diameter of the apical portion of the implant should project into the sinus. What technique would you recommend for the management of the sinus membrane along the vertical medial wall of the sinus? Would you lift it laterally or vertically? What technique would you recommend for accomplishing this?
7 Comments on Management of the Sinus Membrane Along the Vertical Medial Wall of the Sinus: Which Technique?
New comments are currently closed for this post.
dr.keyhan
3/29/2011
no problem.u shoude do conventional sinuse lift procedure.it,s a routin s.lift case.when u do it from open app.keep in mind that u shud lift shniderian memebran completly from the floor.medial wall and anterior wall.the most common cause of most failur in s.lift procedures are seen in cases that membran didn,t lift completly from medial and ant, wall of sinus.degree of lifting depended on multiple factors.i recomended do it from close app(crestal app.trefine technice,baloon tech.,.....).it,s easy and fast.with good results.have good time with your case dear dr.
dr.p
3/29/2011
why u doin a 13 mm???
can u place a 10 mm or a 11.5 mm.
even a 5x 9 mm will suffice in my modest opinion.
thanks
M. Maningky
3/29/2011
Dear dr M,
First of al I agree with dr p march, a 11.5 mm implant should be enough. However you are still likely to perforate the sinus if you use conventional drills.
First drill to 8 or 9 mm until 2.5 or 3 mm diameter.
Continue your preparation with a bone condensing osteotome gently.
This way you will keep the membrane intact there's no need to graft if you do a small lift like this. You can do it if you're not comfortable with just doing the lift but I don't think it's necesarry.
Even if you accidentely perforate the membrane if you place a 11.5 mm implant you should still be fine. With a 13 mm implant it might be tricky.
Good luck
M
Osurg
3/30/2011
Why such a long implant. Crown/root ratio is aa invalid misconception when dealing with implants. Anyone who has had the thrill of trying to extract an ankylosed primary molar will know what I mean. We have all seen 10mm implants with only 3mm of bone which are rock solid. My point is that a 10mm implant or even smaller will keep you out of trouble avoid a sinus lift and work.
sergio
3/30/2011
Osurg,
It's somehow a concept dentists have hard time understanding but I agree with you 110%. When are we going to realize you don't have to duplicate the size of the root with implant replacing it?
Once it integrates, IT DOESN"T MATTER!!.
It gets frustrating to try to explain this to some dentists who don't know what osteointegration really means.
dr mcfatter
3/30/2011
Thanks for all the input. I realize that I may have worded the question a little confusing but your input is helpful. The length is not really the issue as much as the width at the apical 1/3. This area of the implant engages a vertical wall of the sinus and would still engage this wall with an 11.5. Only about 1.0-1.5 mm of the apical width will extend into the sinus according to the pictures. I think I will need to condense the wall 'laterally' from the osteotmy prep. I think that osteotomes in a step sequence may be best route Any imput will be appreciated thanks
ttmillerjr
4/9/2011
Dr. M,
I think you'll find that the CT is great for planning, I own one and use it often, but there is a certain margin of error with any guided surgery. I don't know what guided technique you are using, but in my experience 1mm this way or that is common. When preparing your osteotomies you will feel the thin cortical thickening bordering the sinus in this area. Using an osteotome you can infracture the sinus wall in the apical third of your prep. this will probably keep the membrane intact, but even if it tears, with the implant in place the likelihood of a problem is remote. Not grafting is more predictable in this case. Good luck.
