Sinus Augmentation With Crestal Approach In Atrophic Posterior Maxilla-case Reports

Objective:Clinically, the maxillary sinus augmentation procedure was designed to increase bone volume for implant therapy. The osteotome technique using osteotome allows the surgeon to elevate the sinus floor, fill the antral space with grafts and place the implants at the same time. In this presentation, we report cases by using combination of drill and osteotome to insert dental implants in maxillary posterior region. The advantages and disadvantages of this method were described.Methods: 10 sites in 6 patients were treated. Of these patients, 3 were women and 3 were men. Patient age ranged from 26 to 72 years.1. Round bur for locating where to start the preparation.2. With a cylindrical pilot drill, 2.0㎜ in diameter, a depth up 1㎜ from the sinus floor is reached(working length).3. The osteotomes are introduced sequentially in the prepared site and with a gentle percussion of the surgical mallet the correct working length is reached.4. With a carrier the chosen biomaterial is placed in the prepared site.5. The last osteotome is inserted again and with a gentle percussion is taken to the working length. This will cause the elevation of Schneiderian membrane in the areas surrounding the osteotomy site.6. Sequential biomaterial adding is completed and the implant can be inserted.7. Gore-Tex sutures were utilized to attain flap closure. Medications prescribed included 0.12% chlorhexidine rinses twice a day, amoxicillin 500 mg 4 times daily, pain medication as needed for pain. 8. All implants had abutments placed at 6 months postoperatively and final restorations were accomplished.Results:1. Ten (4 3i and 6 ANKYLOS dental implants)implants were placed in generated bone following the above technique.2. All implants were restored and in function for up to 2-5years. No implants have been lost or are failing in function.Conclusions:The maxillary bone quality generally reveals type III or IV bone and the prognosis of this region for insertion of implant is less successful compared to mandible. Meanwhile, there are quite often not to have enough bone height for placement of implants due to maxillary sinus. This anatomic limitation leads to challenges that may impede the successful osseointegration and the fabrication of a functional implant-supported prosthesis. Many surgical techniques dealing with the sinus grafting procedure have been developed. The osteotome technique employing the crestal approach is less invasive than that with lateral approach. This technique reduces time, cost, and morbidity. When all surgical steps are carefully observed, successful predictability can be anticipated.