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Sinus Elevation: Indirect Approach part 2

Updated: Jan 8, 2023

Hi everyone and happy Halloween.

I wanted to share a nice followup of a peri-implantitis case I dealt with 3 months ago and a surprising result using the novabone approach in an indirect method.

So let's first begin with what we started with, you can see that there is severe bone loss around these pre-existing implants needing removal. Forcep extractions especially with the severity of bone loss that has occurred works well in this situation. We then proceeded to graft the area with a non resorbable membrane to hold the ridge shape for the next 4-6 months using a combination of cancellous 50/50 bone. You can add a xenograft mixture as well to this if you wish.

Severe bone loss around implants which are removed followed by grafting and primary closure
Severe bone loss and proximity to sinus behind

Given that we did not have adequate bone for a typical all on X procedure without resorting to zygomatic and/or pterygoid implants, we elected to engineer the case for several months from now with a sinus augmentation.

Traditionally with extreme atrophy cases (1-2mm of vertical height remaining) a lateral window approach would be chosen, however we wanted to test if we can elevate the membrane safely using 2 access points and perform an indirect approach in this case as it is minimally invasive in healing.

Using the Hiossen CAS (Crestal Approach to Sinus) Kit we were able to elevate the sinus using the novabone putty technique. The nice thing about this product is that the putty consistency forces the membrane ahead of it to elevate nicely as you will see next.

Novabone putty in cartridge form that is injectable
Sinus elevation and ridge grafting

Here is the 4 month followup CBCT of sinus augmentation, I was very happy to see the volume using an indirect approach and I would recommend for clinicians to learn how to approach the sinus in both an indirect and direct approach with the appropriate training.

Sinus CBCT followup, with excellent bone gain

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