Clinical Application Of Modified Minimally Invasive Type Sinus Floor Elevation Technique

Objective: The aim of this report was to introduce the method of modified minimally invasive type sinus floor elevation technique and to discuss the effect of the clinical application.Methods: First, determine the sites of maxillary sinus and implant surgery with x-ray radiograph and panoramic radiography or 3D CT, after done flapping operation at where implant is to be made, then create a window approximately 7-8mm long and 4-5mm wide at 1-2mm above buccal bone on the edge of maxillary sinus floor, grind the edges to brake completely or incompletely, then use curette to scoop out bone pieces at the window just made and grind to tidy up the edges. Then use a piece of gauze wetted with saline to push sinus membrane with vertical pressure in order to create an open space, push again down inward, with repetition to loosen and enlarge it outwardly (in up and down, lift and right directions) in order to create an ample space, then do osteotomy from gingival ridge in preparation of implant site. After placement of implant and having done artificial or autograft of bone , sew up the wound.Result: 15 patients(12 male and 3 female) using the modified minimally invasive type sinus floor elevation technique and simultaneously placed 22 implants and done bone grafts. Among the patients, except 3 patients had broken membrane during the operation and needed isolation with regenerative membrane, all others experienced no membrane damage, nor post-operative infection. X-ray examination afterward found the bone grafting tightly fused well with patients'own, and on average gained 6.5mm(2.8-15mm)in height.After 6-8 months the patients had two-stage operation for removing healing abutment and finished fabrication of crown. Clinical observation finds no bone absorbent. Return clinic visit one year later has found that all is well.Conclusion: The modified minimally invasive type sinus floor elevation technique using gauze to expand membrane has merits of (1) minimized window size and wound, deduction in incident of artery damage, hemorrhaging, and avoid occurrence of post-operative swelling.(2)the operation has bone pieces scooped out, and so even when met with maxillary sinus septum, it is breakable , and having no bone piece is pushed inward to cause membrane break.(3)due to smaller size of the window, it is hard to instrumentally peel the membrane, but using gauze technique is inexpensive and simple.(4)when an window be opened from gingival ridge, it is possible to employ gauze technique in creation of necessary space.(5)If one side of maxillary needs multiple implants, or in the instance of a large maxillary sinus opening , 2 or 3 windows can be created for ease of operation and lessen post-operative swelling. The method should be able to offer much better solution for the doctors when they met with cases of interior maxillary bone deficiency to the profit of their patients.