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Journal ArticleDOI

Hydrodynamic ultrasonic maxillary sinus lift: review of a new technique and presentation of a clinical case.

01 Mar 2012-Medicina Oral Patologia Oral Y Cirugia Bucal (Medicina Oral S.L)-Vol. 17, Iss: 2, pp 27

TL;DR: The main advantage of this new technique, Intralift, is that it does not require a minimum amount of crestal bone and the possibility of damage to the sinus membrane is minimised by using ultrasound based hydrodynamic pressure to lift it, while applying a very non-aggressive crestal approach.

AbstractObjectives: Placing implants in the posterior maxillary area has the drawback of working with scarce, poor quality bone in a significant percentage of cases. Numerous advanced surgical techniques have been developed to overcome the difficulties associated with these limitations. Subsequent to reports on the elevation of the maxillary sinus through the lateral approach, there were reports on the use of the crestal approach, which is less aggressive but requires a minimal amount of bone. Furthermore, it is more sensitive to operator technique, as the integrity of the sinus membrane is checked indirectly. The aim of this paper is to review the technical literature on minimally invasive sinus lift and compare the advantages of different techniques with Intralift™, a new technique. Study Design: The present study is a review of techniques used to perform minimally invasive sinus lift published in Cochrane, Embase and Medline over the past ten years and the description of the crestal sinus lift technique based on minimally invasive piezosurgery, with the example of a case report. Results: Only eight articles were found on minimally invasive techniques for sinus lift. The main advantage of this new technique, Intralift, is that it does not require a minimum amount of crestal bone (indeed, the smaller the width of the crestal bone, the better this technique is performed). The possibility of damage to the sinus membrane is minimised by using ultrasound based hydrodynamic pressure to lift it, while applying a very non-aggressive crestal approach. Conclusions: We believe that this technique is an advance in the search for less traumatic and aggressive techniques, which is the hallmark of current surgery. Key words: Sinus lift, surgical technique, minimally invasive surgery, ultrasound surgery.

Topics: Sinus lift (58%), Maxillary sinus (53%), Sinus (anatomy) (51%)

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Citations
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Journal ArticleDOI
TL;DR: Although both osteotome and lateral window procedures can help clinicians in overcoming the challenges of placing implants in atrophic posterior maxilla, pre-implant residual bone height is crucial in determining the survival of these implants.
Abstract: Background Sinus lift procedures are used to allow residual bone to accommodate functional implants in atrophic posterior maxilla. Numerous anatomical and surgical advancements in sinus lift surgery are still inspiring clinicians. Purpose The purpose of this study was to describe the recent trends in sinus lift surgery focusing on implant survival, bone grafting, anatomical and surgical considerations, and their clinical implications on the practice of implant dentistry in atrophic posterior maxilla. Materials and Methods We performed an extensive search in MEDLINE, Embase, Scopus, Web of Science, Trip, Cochrane Oral Health Group's Trials Register, Cochrane Central Register of Controlled Trials, and ProQuest Dissertations & Theses. Articles were critically reviewed to determine the level of evidence as per the Canadian Task Force on Preventive Health Care. Results Comprehensive assessment of sinus septa, sinus pathology, and bone quality and quantity using three-dimensional cone beam computed tomography radiographs is important before placing implants in posterior maxilla. With a residual bone height of less than 5 mm, the survival rate of implant decreases substantially. Lateral window approach can increase the vertical bone height to greater than 9 mm, while osteotome approach can increase this height from 3 to 9 mm. The perforation of Schneiderian membrane doubles the risk for the incidence of sinusitis or infection. The use of piezoelectric surgery allows adequate sinus lift while protecting soft tissues and minimizing patient discomfort. Conclusions Although both osteotome and lateral window procedures can help clinicians in overcoming the challenges of placing implants in atrophic posterior maxilla, pre-implant residual bone height is crucial in determining the survival of these implants. Future research directions should consider study designs grounded on longitudinal randomized controlled trials of large sample size.

48 citations


Journal ArticleDOI
TL;DR: The results of this paper prove the key role of the sinus membrane as the main carrier of bone reformation after sinus lift procedures as multiple experimental studies suggested and the importance of minimal invasive and rupture free sinuslift procedures is underlined and does not depend on the type of grafting material used.
Abstract: Introduction. Sinus lift procedures are a commonly accepted method of bone augmentation in the lateral maxilla with clinically good results. Nevertheless the role of the Schneiderian membrane in the bone-reformation process is discussed controversially. Aim of this study was to prove the key role of the sinus membrane in bone reformation in vivo. Material and Methods. 14 patients were treated with the minimal invasive tHUCSL-Intralift, and 2 ccm collagenous sponges were inserted subantrally and the calcification process followed up with CBCT scans 4 and 7 months after surgery. Results. An even and circular centripetal calcification under the sinus membrane and the antral floor was detected 4 months after surgery covering 30% of the entire augmentation width/height/depth at each wall. The calcification process was completed in the entire augmentation volume after 7 months. A loss of approximately 13% of absolute augmentation height was detected between the 4th and 7th month. Discussion. The results of this paper prove the key role of the sinus membrane as the main carrier of bone reformation after sinus lift procedures as multiple experimental studies suggested. Thus the importance of minimal invasive and rupture free sinuslift procedures is underlined and does not depend on the type of grafting material used.

21 citations


Journal ArticleDOI
TL;DR: The results of the present study suggest tHUCSL-INTRALIFT should be used to perform predictable and safe detachment of the periosteum from the bony sinus floor as a prerequisite for undisturbed and successful physiologic subantral bone regeneration.
Abstract: Purpose Recent studies have suggested the osteogenic layer of the periosteum at the base of the sinus membrane to play a key role in bone regeneration after sinus lift procedures. Thus, atraumatic detachment of the sinus membrane with an intact periosteum seems mandatory. The present histologic study of fresh human cadaver heads investigated the detachment behavior and histologic integrity of the detached periosteum after application of the transcrestal hydrodynamic ultrasonic cavitational sinus lift (tHUCSL-INTRALIFT). Materials and Methods A total of 15 sinuses in 8 fresh human cadaver heads were treated using tHUCSL-INTRALIFT. After surgery, they were checked macroscopically for damage to the sinus membrane and then processed for histologic inspection under light microscopy. A total of 150 histologic specimens, randomly selected from the core surgical sites, were investigated using hematoxylin-eosin (HE), Azan, and trichrome staining. Results None of the 150 inspected specimens showed any perforation or dissection of the periosteum from the subepithelial connective tissue and respiratory epithelium and were fully detached from the bony antrum floor. The connecting Sharpey fibers revealed to be cleanly separated from the sinus floor in all specimens. Conclusions The results of the present study suggest tHUCSL-INTRALIFT should be used to perform predictable and safe detachment of the periosteum from the bony sinus floor as a prerequisite for undisturbed and successful physiologic subantral bone regeneration.

13 citations


Journal ArticleDOI
TL;DR: The results suggest the tHUCSL to be a safe minimal-invasive alternative to traditional lateral approach and transcrestal osteotome sinuslift-procedures applicable to all anatomical situations.
Abstract: Introduction: In 2006 an ultrasound-surgery-based method to hydrodynamically detach the sinus-membrane utilizing the ultrasonic cavitation effect—the tHUCSL—was developed and a surgical protocol established. The aim of the study was to determine the indication-range and success-rate of this novelty procedure. Materials & Methods: Between 2007 and 2009, 404 patients were treated by 6 oral surgeons of different experience-levels with the tHUCSL in 446 sinussites. 637 implants were inserted and then prosthodontically treated and observed and documented until December 2011. The subantral space was augmented via the 3 mm transcrestal approach with an augmentation volume of 1.9 ccm (+/− 0.988 ccm) and an augmentation height of 10.7 mm (+/− 2.85 mm). Results: Within the survey-period 15 (2.35%) of the 637 inserted implants were lost, mostly before implant loading due to postsurgical infection and nonosseointegration in the augmentation site. 1 implant was lost after implant loading and prosthetic treatment within 1 year after loading. The overall success rate with functional implants in site is 97.65% evenly distributed among the participating surgeons. 86% of the patients were observed with no postsurgical swelling and 87% no postsurgical pain. Discussion: The results suggest the tHUCSL to be a safe minimal-invasive alternative to traditional lateral approach and transcrestal osteotome sinuslift-procedures applicable to all anatomical situations.

8 citations


Cites methods from "Hydrodynamic ultrasonic maxillary s..."

  • ...To combine the advantages of a lateral approach sinuslift (scalable augmentation area and volume) with the atraumaticity of the transcrestal approach and to avoid the need of the surgeon to touch the sinus membrane with instruments or balloons in the detachment-process (and therewith eliminate one of the major risks of intrasurgical membrane perforation) and to utilize the well documented advantages of hydrodynamic pressure sinusmembrane-detachment [36,37] and atraumaticity of ultrasonic surgery, the transcrestal hydrodynamic ultrasonic cavitational sinuslift (tHUCSL-INTRALIFT) was developed in 2006 [38-40]....

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Book ChapterDOI
17 Oct 2015
TL;DR: The combination of postextraction ridge resorption and pneumatization of the maxillary sinus often limits the bone available for implant placement in the posterior maxilla, and the lateral and transcrestal approaches to sinus floor elevation (SFE) and augmentation can reproduce adequate subantral bone volumes for implant-supported rehabilitation in this region.
Abstract: The combination of postextraction ridge resorption [1] and pneumatization of the maxillary sinus [2, 3] often limits the bone available for implant placement in the posterior maxilla. Fortunately, the lateral and transcrestal approaches to sinus floor elevation (SFE) and augmentation can reproduce adequate subantral bone volumes for implant-supported rehabilitation in this region. The lateral window osteotomy (LWO) is the most frequently invoked method, providing ready access to the sinus, significant elevation of the floor, and creation of sufficient bone volume to provide long-term support for implants in the posterior maxilla [4–11]. However, this technique can be quite aggressive and often patients would prefer an option that stresses a less invasive (LI) approach. The LI transcrestal approach for SFE was first suggested by Tatum [12] and later developed as an osteotome technique by Summers [13, 14]. Summers’ boneadded osteotome sinus floor elevation (BAOSFE) procedure uses tapered concave-tipped osteotomes to reposition existing crestal bone under the sinus along with graft materials, elevating the sinus floor and increasing osseous support for the simultaneously placed implant [14] (Figs. 20.1 and 20.2). BAOSFE was recommended for patients with at least 5.0–6.0 mm of residual subantral bone height (RSBH). A number of case series reports [15–21] attest to the success of this procedure, furthering its popularity amongst clinicians. It was originally suggested that grafting material be used in combination with osteotome-mediated sinus floor elevation (OMSFE) to facilitate the postulated

6 citations


References
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Journal Article
TL;DR: The root and sinus series of the Omnii system have been used extensively and their design attempts to maximize the use of the available bone, and placement techniques allow the manipulation of bone to form sockets in otherwise deficient areas of bone.
Abstract: The root and sinus series of the Omnii system have been used extensively since 1981. They are very versatile in their ability to be used within edentulous areas of the maxilla. Their design attempts to maximize the use of the available bone, and placement techniques allow the manipulation of bone to form sockets in otherwise deficient areas of bone. The root implants can be used as free-standing implants or as multiple abutments. The sinus implant is always used as an abutment. It may be used in conjunction with other implants or with natural abutments. Maxillary implants are not loaded until a 6-month healing time has elapsed following placement. An understanding of the different qualities of bone found in the maxilla is important to achieving the successful loading of these implants. Different times are required to allow physiologic loading in different qualities of maxillary bone. Restorative treatment is normally done with fixed bridge work, and the use of any type of stress breaker attachments is not recommended.

1,238 citations


Journal Article
Summers Rb1
TL;DR: The author concludes that the osteotome technique is superior to drilling for many applications in soft maxillary bone and allows more implants to be inserted in a greater variety of sites during a routine office procedure.
Abstract: This article reviews the limitations of drilling into soft bone to place endosseous implants. Differences among bone types and the anatomy of the maxilla are described. The osteotome technique, which is a new method of placing implants into maxillary bone without drilling, and the rationale for two other procedures, the osteotome sinus floor elevation and the ridge expansion osteotomy, are detailed. How osteotomes conserve osseous tissue and may improve bone density around the implant is also discussed. A pilot study that shows excellent results with several types of press-fit implants using the osteotome technique is provided. The author concludes that the osteotome technique is superior to drilling for many applications in soft maxillary bone. Furthermore, the osteotome technique allows more implants to be inserted in a greater variety of sites during a routine office procedure.

668 citations


Reference EntryDOI
TL;DR: To test the null hypothesis of no difference in the success, function, morbidity and patient satisfaction between different bone augmentation techniques for dental implant treatment, 17 randomised controlled trials of different techniques and materials for augmenting bone for implant treatment were conducted.
Abstract: BACKGROUND: Dental implants require sufficient bone to be adequately stabilised. For some patients implant treatment would not be an option without bone augmentation. A variety of materials and surgical techniques are available for bone augmentation. OBJECTIVES: General objectives: To test the null hypothesis of no difference in the success, function, morbidity and patient satisfaction between different bone augmentation techniques for dental implant treatment. Specific objectives: (A) to test whether and when augmentation procedures are necessary; (B) to test which is the most effective augmentation technique for specific clinical indications. Trials were divided into three broad categories according to different indications for the bone augmentation techniques: (1) major vertical or horizontal bone augmentation or both; (2) implants placed in extraction sockets; (3) fenestrated implants. SEARCH STRATEGY: The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched. Several dental journals were handsearched. The bibliographies of review articles were checked, and personal references were searched. More than 55 implant manufacturing companies were also contacted. Last electronic search was conducted on 1 October 2005. SELECTION CRITERIA: Randomised controlled trials (RCTs) of different techniques and materials for augmenting bone for implant treatment reporting the outcome of implant therapy at least to abutment connection. DATA COLLECTION AND ANALYSIS: Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted independently and in duplicate. Authors were contacted for any missing information. Results were expressed as random-effects models using weighted mean differences for continuous outcomes and odd ratios for dichotomous outcomes with 95% confidence intervals. The statistical unit of the analysis was the patient. MAIN RESULTS: Thirteen RCTs out of 29 potentially eligible trials reporting the outcome of 330 patients were suitable for inclusion. Since different techniques were evaluated in different trials, no meta-analysis could be performed.Six trials evaluated different techniques for vertical or horizontal bone augmentation or both. Four trials evaluated different techniques of bone grafting for implants placed in extraction sockets and three trials evaluated different techniques to treat bone dehiscence or fenestrations around implants. AUTHORS' CONCLUSIONS: Major bone grafting procedures of extremely resorbed mandibles may not be justified. Bone substitutes (Bio-Oss or Cerasorb) may replace autogenous bone for sinus lift procedures of extremely atrophic sinuses. Both guided bone regeneration (GBR) procedures and distraction osteogenesis can augment bone vertically, but it is unclear which is the most efficient technique. It is unclear whether augmentation procedures at immediate single implants placed in fresh extraction sockets are needed, and which is the most effective augmentation procedure, however, sites treated with barrier + Bio-Oss showed a higher position of the gingival margin, when compared to sites treated with barriers alone. Non-resorbable barriers at fenestrated implants regenerated more bone than no barriers, however it remains unclear whether such bone is of benefit to the patient. It is unclear which is the most effective technique for augmenting bone around fenestrated implants. No bone promoting molecule has been shown to be effective or necessary in conjunction with dental implant treatment. The use of particulated autogenous bone from intraoral locations, also taken with dedicated aspirators, might be associated with an increased risk of infective complications. These findings are based on few trials including few patients, having sometimes short follow up, and being often judged to be at high risk of bias.

166 citations


Journal ArticleDOI
Arun Garg1
TL;DR: In patients with an inadequate amount of bone for implant placement, sinus lift surgery can be performed to restore a sufficient amount of alveolar bone to allow for successful implant placement and subsequent prosthetic reconstruction.
Abstract: In patients with an inadequate amount of bone for implant placement, sinus lift surgery can be performed to restore a sufficient amount of alveolar bone to allow for successful implant placement and subsequent prosthetic reconstruction. In this article, the anatomy and physiology of the maxillary sinus, the mechanisms of bonegrafting, bone grafting material, preoperative evaluation, surgical technique, and the grafting procedure, as well as intraoperative bleeding and postoperative complications, are discussed. (Implant Dent 1999;8:36–46)

112 citations