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Lateral Sinus Floor Elevation

Dr. Pascal Valentini
Paris, France

  

Clinical challenge

A sinus floor elevation was carried out with a lateral window approach. Two implants were placed 4-6 months later.

Aim / approach

Today’s modern implants possessing a micro-thread and conical form allow primary stability at a bone height of 2-3 mm. Thus simultaneous implantation and bone augmentation can be carried out more often than in the past. The simultaneous procedure should not be chosen if bone quality is particularly bad. This includes absent cortical bone or deep defects on the crest of the ridge. In this case a staged approach should be chosen.

When implantation and augmentation are performed at the same time I generally load implants 6 months after implantation. Ongoing clinical investigations are analyzing whether reduction of this healing process to 4 months is possible.

Conclusions

I am keeping the diameter of the lateral window as small as possible in order to allow the largest contact surface between Geistlich Bio-Oss® and the bone wall. In addition, it provides stability for the bone substitute. The window is therefore a little larger than the diameter of the syringe I use to insert Geistlich Bio-Oss® into the subantral cavity.

In case of a perforated sinus membrane, the sinus membrane should be carefully detached from the bone wall at a reasonable distance from the perforation, thus loosening tension from the membrane and reducing the size of the perforation. A dry Geistlich Bio-Gide® should be subsequently placed over the perforation. Only after the Geistlich Bio-Gide® is positioned a flat instrument can be used to moisten Geistlich Bio-Gide®.”

I entirely dispense with using autogenous bone in sinus floor augmentation. Various clinical studies with histomorphometric analysis have demonstrated that using autogenous bone only, or in combination with bone substitutes, does not lead to an amelioration of the clinical outcome.1 Grafting of the bone, however, extends the operation time, creates a new surgical site and complicates the course of surgery. The successful use of Geistlich Bio-Oss® alone in sinus floor augmentation has been demonstrated in various publications.2-4 Yet, I make sure I keep Geistlich Bio-Oss® in close contact with the bone walls. At these contact sites new bone will grow in. Therefore, I use small granules of Geistlich Bio-Oss® (0.25-1 mm particle size).

References:

  1. Del Fabbro M, et al.: R.; Int J Periodontics Restorative Dent 2004, 24: 565-77.
  2. Valentini P, Abensur D: Int J Oral Maxillofac Implants 2003; 18: 556-60.
  3. Hallmann M, et al.: Int J Oral Maxillofac Implants 2002; 17: 635-43.
  4. Valentini P, et al.: Int J Periodontics Restorative Dent 2000;20(3): 245-53.