2.15.23 Jon_Sinus Augmentation

Question 1

What contraindications exist for crestal (vertical) sinus lift?

Answer 1

• < 4-5 mm residual bone height
• Oblique sinus floos > 45 degrees
• Sinus pathology (membrane > 4 mm thick, allergic rhinits, chronic sinusitis)
• • Non-patent osteum
• Prior radiation therapy (during or w/in 6mo)
• Incomplete craniofacial growth
• Positional vertigo
• Inner ear complications
• Un-resolved radicular/periapical cysts
• Surgical contraindications

Question 2

What are the classifications for residual bone height?

Answer 2

Misch 1987
Residual bone height
* SA1: 12mm - no aug needed
* SA2: 10-12mm - osteotome
* SA3: 5-10mm - Lateral w/
implant in 2-4mo
* SA4: < 5mm - Lateral w/
implant in 6-10mo

Wang & Katranji
Class A - Abundant RBH: >10mm
Class B - Barely sufficient RBH: 6-9mm (5-8 now) - transcrestal indicated
* Horizontal Deficiency = Ridge Width < 5mm
* Crestal Bone Loss CEJ > 3mm
* Combined (Horizontal and Crestal Loss)
Class C - Compromised RBH: < 5mm (< 4mm now)
* Horizontal Deficiency = Ridge Width < 5mm
* Crestal Bone Loss CEJ > 3mm
* Combined (Horizontal and Crestal Loss)

Question 3

How did Chan classify sinus width?

Answer 3

Narrow
Lower boundary: < 8mm
Upper boundary: < 14mm

Average
Lower boundary: 8-10mm
Upper boundary: 14-17mm

Wide
Lower boundary: >10mm
Upper boundary: >17mm

Question 4

What is the average thickness of the Schneiderian membrane?

how is the thickness assoc. with perforation?

Answer 4

Insua 2016
0.79 mm - via CBCT
0.36mm - via histological

Wen 2014
< 1mm = 18% perforations
1-2mm = 14%
> 2 mm = 21%

Question 5

How common are the sinus septae

Answer 5

Pommer ‘12
8923 Sinuses
Prevalence: 28.4%
Premolar: 24.4%
Molar: 54.6%
Retromolar: 21%

Question 6

What type of sinus floor shape has the most predictable sinus augmentation?

Answer 6

Chen
Concave vs. angle vs flat

Most predictable in concave

Question 7

How does residual bone height affect survival rate of implants?

Answer 7

Rosen
174 implants

Residual height ≥ 5 mm
Survival rate = 96%

Residual height ≤ 4 mm
Survival rate = 86%

Question 8

How common is vertigo in osteotome sinus lift?

Answer 8

Sammartino ‘11
Vertigo = 3% prevalence with vertical sinus lift (using osteotomes)

Question 9

What is the Summer’s Osteotome technique?

Answer 9

Summer’s Osteotome Technique (similar to using a Densa bur to condense / densify the bone)
Mid-crestal incision + releasing incisions
* Full thickness flap elevated using guide,
* Implant position marked (round bur)
* Osteotomies 1-1.5mm smaller than implant diameter
* Depth 2mm from sinus floor
* Osteotome 1: pushed 1 mm closer and with light maletting, greenstick
fracture (compact bone)
* Osteotome 2: Larger osteotome diameter is used to increase the fracture
(tapered)
* Osteotome 3: the last osteotome must have a form and diameter suitable
for the implant (e.g.Cylindrical implant = straight)
* Check with a depth gauge
* **To avoid lacking primary stability - do not insert the final osteotome more than once - especially in poor quality bone (D3/D4)

Question 10

How do you use the SCA Sinus Kit?

Answer 10

SCA Sinus Kit (can check their website for video tutorials)
Drill to 1 mm shorter from sinus floor
* S-reamer + stopper 1 mm longer than the
* initial drill and perf. the sinus floor
* Measure residual bone height with a depth gauge
* Bone carrier + condenser
* Bone spreader (or osteotome)

Question 11

Which study compared the Osteotome vs SCA Kit?

Answer 11

Gargallo-Albiol
* SCA: 33% perf (RBH 4.65mm)
* Osteotome: 66.7% (RBH 6.7mm)

Question 12

How much graft should you use in the vertical lift?

Answer 12

Sonoda ‘17
Height:Width < 0.8
Graft volume : vertical elevation is
0.1cc : 3.5 mm high
0.2 cc : 5mm high
0.3 cc: 6mm high

Zill What if you osteotome & don’t add graft?
Implant length: >10mm
* Residual bone height: 5.9 +
1.7mm
* Bone gain: 4.5 + 1.4mm
* Correlated with residual
bone height
* Initial ridge height:
Negative correlation with
survival (OR: 1.6)
* 5yr survival: 93.8%

Santoro & Pippi ‘18
If need 1-2mm: Go graftless
If need ≥3mm: Graft

Question 13

How do you use a Densa bur?

Answer 13

Kumar
Proceed ~ 3mm beyond the sinus floor
Place allografts, then use the burs to condense the bone (advancing 3mm into the sinus floor)

Huwais
Restrospective study with up-to 5 year followup
222 pts
261 implants
Mean 35mo follow up
Avg baslinje ridge
height: 5.4mm
Sig 7mm increase
in bone height
NO SINUS
PERFORATIONS
Survival: 97%

El-Kholey
The different bur techniques work for preparing low-density bone for implants: Undersized final drill, osteotomes, piezosurgery, and osseodensification drills