Hi everyone, I wanted to touch base on an important topic that I believe scares some clinicians from performing implants near the sinus area.
Having had the chance to try various kits and techniques over the last 10 years, I want to share my experience with you on what I believe is a relatively safe approach to the sinus.
First we need to begin with classifying what we consider easy, medium and hard difficulty cases.
Easy: In these cases, we have between 7-10mm to the sinus floor. I would suggest to start with a few of these cases first, to practice breaking through the sinus floor in an indirect method (through the osteotomy). The reason being, even if you happen to have a small perforation, you can still go ahead and place your implant as the perforation will not affect the implant placement you are going to be performing. A perforation is typically seen as a black hole in your osteotomy.
Medium: In these cases, we have between 4-6mm of bone remaining to the sinus floor. I commonly use the indirect sinus lift kit from Hiossen (CAS KIT) to perform my sinus elevation using the novabone putty injection technique. Due to the putty consistency of graft material, it allows for displacement of the sinus membrane safely and also seal any micro-perforations. It is important to undersize the osteotomy in these cases to allow stability to be achieved from the crestal portion of ridge. Depending on the torque achieved you can place a healing abutment or cover screw if you wish on these cases.
Hard: In these cases, 2-3mm of bone remains to the sinus floor. Although an indirect approach can be done here, case selection is key and I would only reserve this in an indirect approach for the experienced clinician. You should be comfortable with a lateral window approach here to rescue the case if need be. CBCT is a must in all category cases but especially here as we want as wide of a ridge as possible. Pressure is defined as Force/Area. I always suggest for your approach just directly below the sinus to be done with your largest planned osteotomy burr. This in essence is the area of contact of your osteotomy burr. The largest the area, the less the pressure applied over the area of contact will be. This will decrease your chance of perforation as well. *Hint: A smaller amount of height of bone to the sinus floor is actually easier to detect a perforation in as you can visually see the sinus lining and possible perforations.
Enjoyed this post? stay tuned for part 2: Novabone Indirect sinus lift technique
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