MIAMBE (Minimally Invasive Antral Membrane Balloon Elevation): Discussion

Having know Dr Hueckeman for many years and seen his work with Balloons ( Meisinger ) and well as used them I think this is a great way to reduced the tear rate when entering the sinus crestally . I use Dask to enter the sinus , but if there is significant resistance to lifting then resort to the use of a balloon as you will tear the lining. Overall I still prefer the lateral window as you can really see what you are doing and with practice you can work through smaller windows . Peter

I love using the antral balloon for membrane elevation in either approach. Usually, the lateral approach will give the greatest visibility, except if you encounter a septum upon elevation. Always obtain a CBCT before treatment planning this surgery.

The advantage of Summer's Lift or transcrestal approach is that the implant can be restored after 8 weeks. This is because the prerequisite of this approach is the present of a minimum of 5 mm of residual alveolar ridge to enable the simultaneous implant placement. Healing in transcrestal approach is therefore faster. Both are technique-sensitve and should not be attempted without further training, CBCT imaging and careful planning are necessary as mentioned above. Transcrestal approach is best suited to Flat sinus floor to avoid iatrogenic complication. BPPV (vertigo) has been reported as one of the complications and should be mentioned in your consent. I still prefer the lateral window approach as I can SEE what I am doing and technically it is no more complicated than the Summer's technique. The use of piezoelectric surgery has made light work of the lateral window osteotomy. Sinus membrane may fail to lift easily as a result of previous infection. This is not a problem when using the lateral window approach. MIAMBE, Dask, CWM, CAS-kit, LAS-kit are just some of the clones of these two basic techniques mentioned above. They are supposed to make the job easier and more predictable. Like all the surgical techniques, is is a white-knuckle ride with a steep learning curve. I know someone is going to say something about short implants here !

I have reduced orbital floor fxs via this technique, but the balloon came out at 4-6 weeks. This technique is rather antiquated. My concern with this method( I have never done it ), is that you abort two principles, vision and access. The most technique sensetive part of the sinus augmentation is lifting the membrane from the floor and medial wall. As most know the membrane is integrated with feeder vessels that keep " it " secured to the bone. I'm afraid that relying on blind expansion could'nt reliably lift the intact schniderian membrane. Again, it's just a matter of preference, I'll spend the twenty minutes using the lateral window method and knowing exactly what I have, at the end of the procedure. Bv

Why use a balloon when you can use the graft material to raise the sinus membrane? Because the graft material is a paste it lifts the membrane hydraulically without tearing- the more graft material you inject the higher the membrane is lifted. The lateral wall or the implant osteotomy can be used. I prefer the lateral wall because you can visualize the membrane and the osteotomy is only the size of the syringe tip. Place the implants at the same appointment. Greg Steiner Steiner Laboratories