Rationale

The biological rationale for this procedure is based on the ability of a graft material to promote bone formation in a compartment, which is surgically created between the Schneiderian membrane and the sinus walls (Esposito et al., 2010).

Products and Devices

Nowadays, only rough surface implants are used in sinus floor elevation procedures.

Specific Instrumentation

Lateral Approach

• Round carbide and diamond burs
• Piezoelectric surgical device (optional)
• Sinus curettes

Transalveolar Approach (Syn. Osteotome Technique, Summers Technique)

Osteotomes

Graft Materials

Bone substitutes are now preferred to autogenous bone because of the lack of donor site morbidity. Allografts, alloplasts, and xenografts can be used alone or in combination with autogenous bone. Xenografts (Bio-Oss®) are now extensively used and well documented. No relevant differences between grafting materials in terms of ISR (96.3% to 99.8%) are found for rough surface dental implants (Chiapasco et al., 2009; Nkenke & Stelzle, 2009).

Barrier Membranes

In the lateral approach, procedures performed with resorbable membrane coverage of the lateral window show a higher ISR than when no membranes are used (Tonetti & Hammerle, 2008).

Technical Procedures

Lateral Approach (Fig. 41.1)

A mid-crestal incision is performed, and a buccal releasing incision is extended into the buccal vestibulum. A mucoperiosteal flap is elevated. The outline of the window is marked onto the lateral sinus wall with a small round carbide bur or with the saw of the piezoelectric device.