Which Sinus Lift Technique Should I Consider?

Dr.K What type of bone he has? How much occlusal clearence he has? If you have 7mm residual ridge it seem like you will have very good stability. Only problem is how dense is the bone. If he has Type III bone so it is easy. If you use high torqe/slow speed handpiece you can start osteotomy 6mm at 3.5mm diameter harvest bone fragiment, osteotome to puch sinus up 4mm and place bone you just save and place 4.3X10 just 0.5mm below ridge. Megagen also sells a kit for internal sinus lift. Good Luck.

Not wanting to be negative,but if you have to ask the question perhaps you should think about not doing this case. The procedure that you more than likely would want to employ would be an internal lift. There is a fairly steep learning curve with all sinus procedures this being the least difficult. You need to know that when a sinus procedure goes bad you are up to your neck in a septic tank. Sinus infections can be severe,and chronic to the point of never getting completly better. Before you go there make certain you have the educational background.

Dask is the way forward whether internal or lateral (my preference)although internal with 7mm is fine here.Dask allows for safe osteotomy preparation where the hydrolic pressure deflects and lifts the lining preventing damage to it. You can then use a bacterio-static synthetic graft material to further improve the safety of your procedure. Sinus augmentation has risks (always scan ) but is a vital skill to employ and fortunately these new systems have helped make the procedure much safer and comfortable for the patient. Peter

Dr K The height and width you mention,should be sufficient for a summers procedure,though it is a blind procedure and some membrane tears are not evident intra operatively. The other things to be kept in mind are the patient's bite forces,existing occlusion,and bone types. i personally like the lateral wall approach and wait for sufficient time before starting the restorative process. Good luck

Why do you want to even touch the sinus floor, although nothing wrong in it, but if you have 7mm bone, you could very well use a 6mm Bicon Implant and forget about the sinus, place it subcrestal and you would have a very well Bicortical type of integration, which would be excellent in this scenario.

Direct or Indirect Sinus Lift ? A dilemma almost everyone worth his experience in Implantology has faced from time to time! All past masters at the game from the big boys that led the field... to the present generation of leaders across the globe, agree that the Indirect Sinus Lift is the less radical (not necessarily less aggressive) of the two. However, that must not necessarily be the criteria for the choice of the procedure. Following Prof John Brunski's revelations of the dynamics of Load over implants (Posterior Maxillary implants being, arguably the most susceptible under load), we have learnt to value the need for Occlusal forces 'landing' on the Crown to be optimized for Implant longevity. One of the ways we achieve that is by proposing a favorable Implant:Crown ratio. Although a selection of authors have critiqued the philosophy (those that particularly endorse the philosophy of shorter implants to avoid Sinus related bone compromise in the posterior maxilla), none has conclusively proven long-term superiority over an optimal Implant:Crown ratio. That being the case, it would allude to the choice of a "longer" implant in the posterior maxilla , than a "shorter" implant! The fact that pneumatization of the Sinus and atrophic maxillary residual alveolus take away much of the recipient site,in turn causes the Posterior Maxillary Implant Crown height to be inevitably greater than usual. To support an Implant of around 11 to 15mm(Avg 13mm) length, it would mean you would have to raise the present bony height by a good 8-9mm from the existing 6mm (if you want 1-2mm bone beyond the apex of the implant as well). Only a direct Sinus Lift can get this kind of bone volume increase PREDICTABLY. Membrane perforations notwithstanding, the use of good instrumentation, retractors, optimal regenerative mixture (based on assessment of pt factors such as quality of bone, age of the pt, pre-op CT assessment for existing Sinus pathologies etc) invariably favor the formation of bone that is often ideal for this area. The Indirect sinus Lift may be employed more freely when at least 70 % or more of the proposed length of the implant would be primarily encased in residual alveolar ridge, and only the remaining 25 to 30% is what we are looking at achieving using the Lift. The fallouts of both procedures are of course the different intra-operative and post-operative issues they can each lead to! Cheers and Good luck Dr K

I know you said you are using nobel but if you have 7mm wide and 7mm in height, just place an Endopore 7x5, by summers compresion and that will give you a great support for a single molar. It has external hex, internal hex or morse cone, all of them work great. So you see no real need for a sinus lift. best wishes alex

Dr. K., as always, when you pose a question to this forum, you will get a variety of intelligent answers by responsible clinicians. One part of your question that has not been addressed by any of the above clinicians who have responded so far, is the maintenance issue of the finished (hopefully) successful crown on #2. With a vertical bone loss of 6mm, regardless of how much bone was generated in the sinus cavity, the finished crown is going to be a plaque and food trap, that will cause periodontal problems if not cleaned out after every single morsel of food is put in the patient's mouth, and flossing and brushing, waterpicking,stimudenting,rubber tipping, etc. at least six times a day. I would serious think of trying to build bone on top of the existing ridge to get rid of the 6mm gap.If you are able to build 8-9 mm (as suggested by Dr. Jeevan Aiyappa above), you probably don't have to touch the sinus. Dr. Gerald Rudick Montreal,Canada

i would try internal first with 7 mm remaining bone, you will get pretty good stability with appropriate under-size osteotomy. Also, there are good internal sinus kits out there. DASK. is one. SCA is one I Have now. HISE with piezo with Prof Sohn tip. another good equipment. but it takes patience. If you have qucik temper, it would be better to open laterally. some people says a lots about sinus creating unreasonable fear. But I think sinus is another anatomy we deal with it. and sinus is one of the most predictable new bone formation place if membrane is not torn.

As a NBC user I would recommend first tissue punching, then after preparation with swing drill to the sinus cortex use a narrow diameter tapered bur to the same length. Proceed with NBC tapered osteotomes to widen for the 5.0/8mm tapered groovy implant. If you can't achieve primary stability (which you should) go 1-2 mm through the sinus cortex again with narrow diameter tapered bur and the groovy will stuck! Good luck!

I would use the technique that works best! You can also use different implant modalities that avoid the sinus, such as angled implants (root form, STR),DISK, UNILATERAL SUBPERIOSTEALS, INTERDENTAL SUBPERIOSTEALS. yOU MAY WANT TO STAY AWAY FROM THE TUBEROSITYS OR PTERYGIOD PLATES AS BONE QUALITY AND ACCESS CAN BE AN ISSUE. iF YOU CAN NOT GET THE INSTRUMENTATION AND HANDS ON THE SITE THEN DO NOT DO IT.

I think, Bicon 4.5 x 6 mm., is very good for you.

Dear sir, it's been shown that by Summer's (osteotome) lifting, the maximum addition to the thickness of your sinus floor, will only be about 3 mms which eventually will lead to a thickness of 9 mms.In that case, you won't even be able to use an 8 mm long implant.I believe that you shouldn't hesitate to choose the open sinus floor lifting alternative.

I always show Heuckmanns great internal footage of a balloon aided internal sinus lift at my talks , it is fun to see how much the lining can be lifted in a view from "the other side". But as said i prefer the lateral approach,another thing both in research and in our cases the grafted bone in the sinus is better than the natural maxillary bone.

Dr. K I just reviewed the sinus augmentation literature for a lecture. Statically this is the way it breaks down in the literature. If you have 6mm or more residual bone any method with any bone graft with any quality of patient bone provides a mid 90% or better success rate. Between 2mm and 5mm of residual bone only the lateral wall technique with delayed placement or a method we developed provided mid 90% or better success rate. 2mm or less residual bone required the traditional lateral wall technique with delayed implant placement (6 months) to reach mid 90% or better success rate. Hope this helps. Greg Steiner

Dr. Jafar: I have been using the Sommers Technique for a long time (shortly after the technique was published), I have had nothing but success with said technique. It is technique and touch sensitive. If you think you perfed the membrane then place a piece of colla tape in first and then place your graft material. Follow with the implant. Be careful when placing the implant. Tap very grently or you will have another procedure on your hands. The Abrahammi method is also a nice one. Even if you perf the membrane, most likely you will get about 4 mm. of bone growing up the implant. I have not had many patients complaine about vertigo. If so it is of a short duration. Let's get real, you can have other surgeries in the body and the outcomes can be bad and with a significant post op morbidity.

The Width you have is adequate. With only 7mm in the post .Maxilla where the bone density is poor, its in your best interest to establish at least another 3mm. 5 would be best. If the patient has parafunction or a strong bite, occluding on an implant below, I would do a lateral full window technique with immediate placement of the implant. If the patients force factors are low, you can probably get away with life the membrane 3 mm with an osteotome technique. Jason Retter, Montreal, Canada

if i were you I will do summers technique without bone graft and insert an 8 mm long, 4-5 mm wide imolant. good luck

Hello,Is it possible to have a direct sinus lift for a patient with just 2 mm bone?or just a lateral sinus lift? Thanks all

Look up ISM. I think you will have an epiphony.