"A healthy mouth, makes a pleasant and functional
social message positive and reassuring."

dc. Maurizio Serafini

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II° International Congress Loni India

A NEW APPROACH FOR CRESTAL SINUS LIFT A NEW APPROACH FOR CRESTAL SINUS LIFT A NEW APPROACH FOR CRESTAL SINUS LIFT A NEW APPROACH FOR CRESTAL SINUS LIFT

A NEW APPROACH FOR CRESTAL SINUS LIFT

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Abstract:

State of art:
There are currently two techniques widely used for maxillary sinus augmentation:

•Great maxillary sinus lift
Indicated when less than 8 mm of alveolar bone is present (Misch Classification).
The access to the sinus is achieved through a lateral opening on the maxilla (vestibularly). The surgical technique consists in a crestal incision and vertical releasing incisions to allow adequate exposure of the sinus. A full-thickness mucoperiosteal flap is then elevated, exposing the lateral wall of the maxilla. At this point 4 linear osteotomies are performed with round burs or using piezoelectric technology, to form a bony window to access the sinus cavity. With specially designed instruments the Schneiderian membrane is then elevated by starting at the edges and gradually increasing the amount of membrane elevation. If the elevation is too excessive or too much pressure is applied, perforation of the membrane may occur. Once the membrane is elevated, the bone graft material is placed under the membrane in an anterior and inferior direction. Several types of bone graft can be used, including autogenous bone, allograft, xenograft and alloplastic materials. Many different sites can be used to obtain autogenous bone, including the anterior iliac crest, calvarium, proximal tibia and maxillofacial regions but the patient in this case needs to be hospitalized, with the possibility of complications and morbidity. These are some of the reasons why other types of bone graft are preferred. Bone grafting will induce osteogenesis with both volume and volume increase height of the bone.

•Crestal access
The sinus intrusion osteotomy is indicated when at least 5 to 6 mm of alveolar bone is present (Misch Classification).
This technique was developed in 1994 by Summers, and consists in a crestal incision, an invitation to the sinus cortical bone using a drill and preparation of the bone compacting it apically and laterally using osteotomes with progressively increasing diameter and variable lengths, called "Summers Osteotomes” and a surgical mallet.
This technique requires meticulous surgical skills and complications may occur such as tearing of the Schneiderian membrane while performing osteotomy. This could cause failure of the surgery with bone loss and waste of time because the healing of the membrane requires between 3 and 6 months. In addition, the hammering action produces bumps widespread throughout the skull with a sense of discomfort and frustration that persists for several days.
The sinus membrane rupture, which may result, would result in oroantral communication with the possibility of acute and chronic infections such as sinusitis, abscess, empyema with severe heat increases and osteomyelitis

The method which I created and use in my daily routine, it’s a Soft-Surgery approach. The access can be made through an operculum or a mucoperiosteal flap, followed by an invitation to the alveolar crestal bone with a drill using different size burs and to avoid the breaking of the floor of the sinus and tearing of the Schneiderian membrane, is important to stop a few millimeters from it. Follows the placement of the implant, All in One.
The insertion of the implant will produce a progressive fracture of the sinus floor by lifting it together with the membrane, preventing the breakage of the membrane, with a noninvasive procedure, and avoiding the risks described above.