Applying Crestal Approach in the Case of Lateral Approach of Sinus Lift

March, 2002

By Dr. N. Mitsumori D.D.S., Dr. T.Ishiyama D.D.Sc., Dr. H.Kobayashi

Ishiyama Dental Clinic
IT Osseointegrated Implant Institute
IT Socket Lift Institute

Japanese
Introduction:
 The sinus lift procedure now recognized as a predictable procedure for placement of dental implants in the severely atrophic posterior maxilla. Depending on the residual alveor bone height, sinus lift and implant placement are performed as lateral approach (sinus lift) or crestal approach (socket lift). The actual recommendations for lateral approach is required a minimum of 4-7mm residual alveoral bone height. The purpose of this study is to describe crestal approach (socket lift) procedure in severely atrophic case(2-3mm residual bone height) without compromising the implant stability, location, inclination and parallelism. We call it 『Apply Bone Plug to Socket Lift』.
Objective:
 Panoramic findings revealed loosing teeth of #14,#15,#16,#17,#24,#25,#26 & #27.
The patient had a maxillar removal partial denture. Right and left alveoral bone are extremely atrophy.
It's needs bone augmentation of sinuses for implant insertion. I think the treatment is lateral approach (sinus lift) in this case. However, very few patients will submit to this procedure and the post-operative sequelae can be trouble some. We performed crestal approach procedure(socket lift) in this case.

Assessment:

Left and right Posterior maxillary alveolar bone atrophy
Methods:
 A total of four acid etching fixtures (Nobel Bio Care,TiUnite Ⅲ) were inserted in patient with initial crestal bone height of 2-3mm between the floor of the sinus and alvelar ridge in left and right posterior bones. (#16,#17,#26,#27)
Crestal approach procedure (socket lift) with a small crestal hole (using trephine bar of daimeter 3.5mm) was performed to accsess the sinus membrane. Bone graft was a composit of hydroxyapatite and Osteogen and inserted toward sinus from socket hole after lifting membrane with bone plug (autogenous bone). After that implants were placed into the sinus with careful to preserve the parallelism of the implants. The implants were covered with cover screws.
Forming Bone Plug by Trephine Bar
Lifiting Membrane by Socket Lifter

Bone Plug in Sinus

Results:

 Initial stabillization of the four implants was obtained in all cases. There are no clinical evidence of sinus related complications at the present. At a second stage surgery, all implants were clinically osseointegration (non-mobile, dull to percussion, asymtomatic and without marginal bone loss)
　
Conclusion:
 The following surgical modefication are important in the clinical situations encompassed by the study:(1) a small crestal window opening with few external injuies. (2) shorter time of the procedure with simultenious implant. (3) meticulous lifting of membrane and (4) meticulous insertion of graft materials.

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