9mm Non-Osteotome Closed Sinus Lift
9mm Non-Osteotome Closed Sinus Lift
Dan Holtzclaw, DDS, MS
Traditional closed sinus lift techniques typically involve use of an osteotome that is tapped with a surgical mallet to upfracture the floor of the maxillary sinus. A number of reports in dental literature document vertigo associated with such procedures. The risk of this complication may be reduced or avoided with use of a non-osteotome technique. The following case demonstrates use of a rotary instrument for a maxillary sinus lift of approximately 9mm.
Preoperative radiograph of site #3. Only 4.6mm of residual native bone remains at the thinnest point of the edentulous site.
2mm twist drill used to create an initial osteotomy to the maxillary sinus floor.
Elevation of Schneiderian membrane with bone compression drill and FDBA graft. Graft is placed into osteotomy and compression drill is used to lift sinus membrane. This is repeated multiple times. The drill never actually touches any membrane (Only the bone graft touches membrane)
4 x 11.5mm Implant placement. Note height of bone graft in relation to the 11.5mm implant. Apical portion of implant is 11.5mm from alveolar crest. 2mm of bone graft is apical to implant apex. This translates into approximately 9mm of lift with the bone compression kit (13.5mm - 4.6mm = 8.9mm)
vs.
Healing at 4 months. Note the bone fill in comparison to the preoperative radiograph (especially at the mesial aspect of the molar) and formation of a well defined lamina dura apical to the implant.
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Comments
Excellent case......Some sinus questions need help?
What a nice case. A couple of questions:
What do you do if a patient has chronic sinus issue prior? How can you manage pre-op and post-op?
MIS kit A Question for Dr. Holtzclaw.
Dr. Holtzclaw, I bought the same kit, and tried on 3 patients with 5-6 mm of bone height. I was not able to infracture the sinus, even if my pilot drill is at the base of sinus floor. The supplied instruction was not very details in term of what torque and rpm should be set at. I set my W&H motor from zimmer to 35 Ncm, and even use the ratchet wrench with lots of pressure, but sinus floor would not elevate. After you use the pilot drill, do you follow it with the series of CONVEX compression screws, or do you prepare the osteotomy close to you implant size, then use the CONCAVE sinus screw(s)?.
MIS Kit Question - Answer
Hdinh,
I know exactly what you are talking about as I have had this happen a few times.
The kit recommends to use the bone compression drills followed by the concave tips (using the supplied ratchet). I have used the implant motor with the RPM's dialed down to 100. In most cases, the concave tips upfracture the sinus floor, but I have had instances where the sinus floor did not want to fracture. In such instances, I have done one of 2 things: 1) use an osteotome to upfracture the sinus floor; 2) use a piezoelectric surgery tip to weaken the sinus floor which will allow easier upfracturing. I like option 2 because the piezo tip will not cut the Schneiderian membrane. After doing this, the strong floors should upfracture with no problem.
sinus lift close tech. with Mis bone graft kit
Dr.Holtzclaw:
very nice case resulted.
i have the same case with 3.5mm height of ridge, the lowest point of the sinus floor. Do i drill my pilot drill at the base of the sinus floor or leave 1mm off the sinus floor?
if i am at the base of the sinus floor, do i use the MIS bone sinus compression drill to condense the floor with or without the grafts particles?
should i place the implant at the same time if i can get primary stability.
thanks
About the MIS Sinus Lift Question
About your question...I cannot specifically give you advice regarding your particular situation. However, I can tell you what I would do (this does not mean that I am endorsing any particular type of treatment in your particular case).
With only 3.5mm of height, I would probably do an open sinus lift. However, if one were to do the closed technique, I would still stop 1mm short of the floor with the pilot drill. I upfracture the sinus floor without bone graft particles. Finally, I never place an implant if I cannot get primary stability. Most of my implant failures have developed when primary stability >20 Ncm was not achieved at placement.
CT
Do YOU use CT for close sinus lift,or PA x-rays it enough?
Sinus Lift Kit
What kit was used in the procedure??
MIS Bone Compression Kit Used for Case
The kit used for the non-ostetome closed sinus lift case was an MIS Bone Compression Kit. Very nice kit. Easy to use. Check out the MIS booth at the AO meeting if you are here. They can give you a quick demonstration.
NonOsteotome Sinus Lift
What sinus lift kit was used in the procedure?? I noticed the same question but no answer.
Dr. Tom Wright
Sinus Lift Reply
Assafm,
The kit used in this case was an MIS bone expansion kit. The kit essentially contains 2 sets of "threaded osteotomes". 1 set is for bone compression and one set is for closed sinus lifts.
The kit is relatively inexpensive and produces good results.
Non Osteotome Close lift: What kit was used?
Dr. Holtzclaw that was an impressive case.
A couple of questions:
What company manufactured the kit that you used?
About how many times and at what rpm did you use the compression drill to get your desired results?
Are there depth gauges on the drill and what are the markings?
Thanks in advance
Sinus lift
Dr Holtzclaw
The instrument you used looks like an ordinary bone tab which is normally supplied in every implant kit.
If it is different, please let us know. Thanks