Indications Flashcards
What are the 2 types of sinus augmentation
Deciding factor
- Lateral window/ external sinus lift
Transcrestal/transalveolar/ internal sinus lift. - Dependent on the subantral ridge height
What are the local contra indications of sinus augmentation
The presence or history of sinus pathology, which includes
- acute sinusitis
- allergic rhinitis
- chronic recurrent sinusitis
- scarred and hypofunctional mucosal
- local aggressive benign tumors
- malignant tumors
Importance of cbct
- the anatomy of the maxillary sinus and adjacent vital structures -bone septa
- size and pathology of the sinus
- sinus compartments
- bone height between the sinus floor and
- the crest of the ridge
- to identify the location of the posterior superior alveolar branch of the maxillary artery, which may anastomose with the infraorbital artery in the lateral bony wall
- the thickness of the Schneiderian membrane
- the anatomy of the lateral and anterior wall
- the presence and location of septa
- ostium entrance
- the location of the infraorbital nerve
Bone graft material
-Autogenous : gold standard, osteogenic and osteoconductive
Success rate of autogenous with demin. Bovine matrix
The survival rate of rough-surface implants with this grafting protocol is approximately 96.8–99.8
Particulate or Block graft for augmentation?
better outcome with particulate grafts than block grafts. Wallace and Froum reported an 80.40% success rate of rough-surface implants placed in block grafts compared with 94.83% for particulate bone grafts
Indications for simultaneous bone graft
If the amount of residual bone height and bone quality provides an adequate primary stability for the dental implant, simultaneous implant placement is possible with sinus augmentation
Survival rate of implant in augmented sinus
the 3-year implant survival rate can range from 90% to 98%, based on implant level [ 13 , 18 ].
- Tan et al JcClinPerio 2008
- The residual bone height also seems to play a role: implant success rate with less than 5 mm residual bone height is approximately 85.7%, but when theresidual bone height is more than 5 mm the rateis 96%.
Antibiotic prophylaxis
Cochranesystematic review indicated the use of antibiotics for this particular procedure – 2 g amoxicillin 1 h prior to the surgery or 1 g 1 h prior and qid for 2 days afterwards
Transcrestal steps/ blind technique
- A crestal incision must be made (for optimum blood supply to fl aps), and full-thickness fl ap elevation must be done.
- Perform osteotomy greater than 3.5 mm in diameter. In the authors’ clinical opinion, a larger size of osteotome is less likely to perforate the membrane.
- Stop osteotomy 1 mm short of the sinus fl oor (Figure 6 ). Multiple radiographs may be taken to ensure that osteotomy is 1 mm short of the sinus fl oor.
- Have the osteotome to infracture the sinus fl oor (Figure 7 ). This force should be gentle, because we may cause benign positional vertigo. If the patient has anterior teeth, an assistant or operator should hold the maxillary incisor to distribute forces away from the ear canal.
- Pack bone graft into the osteotome using the osteotime. Typically it requires 1 cm 3 of allograft to elevate 4–5 mm of sinus.
Factors to consider in trans crystal
Another important factor when performing implant surgery is to leave a suffi cient amount of attached gingival around the dental implant [ 1–3 ]. A minimum of 2 mm is recommended [ 8 ]. We recommend use of the healing abutment (one-stage approach) to aid in gaining keratinized tissue. However, if we do not gain a good initial stability (<20 N cm), we recommend twostage surgery to prevent the movement of the dental implant during the healing phase (4–6 months). At the same time, too much torque on a dental implant is not recommended. Too much torque can lead to pressure necrosis, because it may limit blood supply to the cortical bone.
If we apply too much torque on our dental implant, what may happen?
Pressure necrosis
What is the measurement of the osteotomy in the osteotome technique?
3.5mm
How much bone graft material is recommend to elevate the sinus membrane (4–5 mm) in the osteotome technique?
1cm cube
What are the advantages of performing the crestal approach with the “specialized sinus drills” (sinus express burs)?
This eliminates complications such as benign vertigo and decreases intraoperative dental fear [ 14 ]. In addition, the “sinus express bur” is proven to be safe on sinus membrane in numerous clinical cases [ 1 ]. This bur has a flat-ended tip, which grinds the bone while not tearing the Schneiderian membrane.
