Bone augmentation: sinus floor elevation
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.
- Round carbide and diamond burs
- Piezoelectric surgical device (optional)
- Sinus curettes
Transalveolar Approach (Syn. Osteotome Technique, Summers Technique)
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).
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).
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.